Quality Standards Of Care Research Articles

Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology

ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients...

Breast cancer surgery during the Covid-19 pandemic: a monocentre experience from the Regina Elena National Cancer Institute of Rome

The Covid-19 pandemic has challenged hard the national health systems worldwide. According to the national policy issued in March 2020 in response to the evolving Covid-19 pandemic, several hospitals were re-configured as Covid-19 centers and elective surgery procedures were rescheduled according to the most recent recommendations. In addition, Covid-19 protected cancer hubs were established, including the Regina Elena National Cancer Institute of Rome, Central Italy. At our Institute, the Breast Surgery Department continued working under the sign of a multidisciplinary approach. The number of professional figures involved in case evaluation was reduced to a minimum and interactions took place in the full respect of the required safety measures. Treatments for benign disease, pure prophylactic surgery and elective reconstructive procedures were all postponed and priority was assigned to the histologically-proven malignant breast tumors and highly suspicious lesions. From March 15th though April 30th 2020, we treated a total of 79 patients. This number is fully consistent with the average quantitative standards reached by our Department under ordinary circumstances. Patients were mostly discharged the day after surgery and none was readmitted due to surgery-related late complications. More generally, post-operative complications rates were unexpectedly low, particularly in light of the relatively high number of reconstructive procedures performed in this emergency situation. A strict follow up was performed based on the close contact with the surgical staff by telephone, messaging apps and telemedicine.Patients ascertainment for their Covid-19 status prior to hospital admission and hospital discharge allowed to maintain the “no-Covid-19” status at our Institution. In addition, during the aforementioned time window, none of the care providers developed SARS-CoV-2 infection or disease, as shown by the results of anti-SARS-CoV-2 immunoglobulin M and G profiling. In conclusions, elective breast cancer surgery procedures were successfully performed in a lockdown situation due to a novel viral pandemic. The well-coordinated regional and hospital efforts in terms of medical resource re-allocation and definition of clinical priorities allowed to maintain high quality standards of breast cancer care while ensuring safety to the cancer patients and care providers involved.

Telecritical Care Clinical and Operational Strategies in Response to COVID-19

Background: The cororavirus disease 19 (COVID-19) pandemic has strained intensive care unit (ICU) material and human resources to global crisis levels. The risks of staffing challenges and clinician exposure are of significant concern. One resource, telecritical care (TCC), has the potential to optimize efficiency, maximize safety, and improve quality of care provided amid large-scale disruptions, but its role in pandemic situations is only loosely defined. Planning and Preparation Phase: We propose strategic initiatives by which TCC may act as a force multiplier for pandemic preparedness in response to COVID-19, utilizing a tiered approach for increasing surge capacity needs. The goals involved usage of TCC to augment ICU capacity, optimize safety, minimize personal protective equipment (PPE) use, improve efficiencies, and enhance knowledge of managing pandemic response. Implementation Phase: A phased approach utilizing TCC would involve implementing remote capabilities across the enterprise to accomplish the goals outlined. The hardware and software needed for initial expansion to cover 275 beds included $956,670 for mobile carts and $173,106 for home workstations. Team role deployment and bedside clinical care centering around TCC as critical care capacity expand beyond 275 beds. Surge capacity was not reached during early phases of the pandemic in the region, allowing refinement of TCC during subsequent pandemic phases. Conclusions: Leveraging TCC facilitated pandemic surge planning but required redefinition of typical ICU staffing models. The design was meant to workforce efficiencies, reduce PPE use, and minimize health care worker exposure risk, all while maintaining quality care standards through an intensivist-led model. As health care operations resumed and states reopened, TCC is being used to support shifts in volume and critical care personnel during the pandemic evolution. The lessons applied may help health care systems through variable phases of the pandemic.

Comparison of quality standards of public care in the emergency, infectious and non-infectious wards of Imam Reza Hospital in Mashhad: Before and after Covid 19 pandemic onset

Comparison of quality standards of public care in the emergency, infectious and non-infectious wards of Imam Reza Hospital in Mashhad: Before and after Covid 19 pandemic onset

100 European core quality standards for cancer care and research centres

100 European core quality standards for cancer care and research centres

Global Quality Standard for Identification and Management of Severe Asthma

IntroductionSevere asthma is a debilitating, life-threatening disease associated with substantial global morbidity, mortality, and health care resource utilization. Patients may not receive guideline-directed medical care for severe asthma. Moreover, viable precision-based assessment tools and newer preventive therapies that can reduce the frequency of exacerbations and associated functional impact are underused. As a result, high rates of poorly controlled severe asthma persist, and patient health-related quality of life suffers.MethodsIn 2019, the Improve Access to Better Care Task Force of the PRECISION Steering Committee set out to develop a global template on quality standards for severe asthma care to support improved access to and delivery of quality care. This Quality Standard is grounded in the vast body of published evidence available for severe asthma care, published clinical guidelines (i.e., from the Global Initiative for Asthma in 2019 and the European Respiratory Society/American Thoracic Society in 2014), and the 2018 PRECISION-supported Charter to Improve Patient Care in Severe Asthma.ResultsThe Quality Standard developed emphasizes four key elements aimed at optimizing clinical care and outcomes in severe asthma: (1) organization of services, (2) timely identification and referral for suspected severe asthma, (3) specialized assessment and management of severe asthma to optimize outcomes, and (4) patient-centric care and shared decision-making that is reflective of the patient’s expectations, priorities, and values. Four key Quality Statements are provided, along with quality metrics and strategies for local adaptation to optimize implementation.ConclusionThis Global Quality Standard is intended to mobilize policymakers, health care providers, and patient advocacy groups to build consensus on the definition and expectations of quality care in severe asthma, to promote patient-centric care, to identify gaps in care and areas for improvement, and systematically implement improvement measures and outcomes and to reduce the burden of illness for patients with severe asthma.

Day Care Centers for Children in Karachi City A Mapping Study

Many parents send their pre-school aged children to daycare services. Generally, children spend their time in daycare from the age of 3 months to 5 years. Various daycare centers are operating in Karachi. This researcher is exploratory and was focused on gathering information about the care quality standards of daycare centers. Different factors, which include institution type, operational timings, building structure and capacity, financial sources, workforce competency, service delivery mechanism (use of equipment), the behavior of staff, amenities available, hygiene management, and perception of daycare service providers have been analyzed in this research.

Pharmacoepidemiology of medications omitted in New Zealand Residential Aged Care Homes.

To investigate the dispensing, administration and omission of medications in residential aged care (RAC) homes in New Zealand (NZ). Secondary data from a medication management database were analysed, to identify the most frequently omitted regular medications and commonly reported reasons for omissions in a sample of 11015 residents across 374 RAC homes. Overall, 3.59 medication doses were omitted per 100 (±7.4) prescribed doses per resident (SD 7.43). Common regular medications omitted ranged from analgesics to psychotropic medications. Recording of justifications for medication omissions was inconsistent-only 48% of omissions had a recorded reason. A wide range of medications are regularly prescribed and administered to RAC home residents in NZ. Omitted doses are frequently recorded without a justification. Inconsistent recording of omissions can increase potential for error, particularly in relation to psychotropic medications. More consistent recording may help staff to maintain a high standard of quality care.

Patterns of care for inflammatory bowel disease in China during the COVID-19 pandemic

Patterns of care for inflammatory bowel disease in China during the COVID-19 pandemic

Maintaining the Quality Standards of Care for Inflammatory Bowel Disease Patients During the COVID-19 Pandemic

Since February 20, 2020, the SARS-COV2 infection has spread in Lombardy, and in the rest of the Italian regions, forcing our government to impose a national lockdown.1 Hospitals have been forced to adapt and to restructure their units to cope with this urgent new critical situation.2 Alternative solutions have been found to manage patients with inflammatory bowel disease (IBD), including remote monitoring, drug home delivery, limitations for infusion units, and patient education on measures to prevent infection,3 to maintain high-quality care.4.

Modern view of intra- and post-operative blood loss prevention during hysteroresectoscopy in patients with submucous uterine leiomyoma

Intrauterine pathology is a complex of diseases, different in etiology and pathogenesis, which are associated with changes in the mucous or muscle membranes of the uterine cavity. In its structure, submucous uterine leiomyoma ranks third with a purity of 6.5%. The introduction of the hysteroresectoscopy method in gynecological practice allowed us to abandon the uterus extirpation in favor of organ-preserving surgery. Since hysteroresectoscopy is an operative intervention, as with any operation, there is a risk of complications. The world statisctics show that the frequency of complications of hysteroscopy varies between 0.4-6%. The objective: to reduce the frequency of intraoperative and postoperative blood loss in patients with submucous uterine leiomyoma during hysteroresectoscopy. Materials and methods. 183 women with submucous uterine leiomyoma was performed. Depending on the chosen treatment strategy, the women were divided into two groups: the main group included 76 patients who received the developed advanced diagnostic and treatment complex. The control group included 107 women, whose inpatient management was carried out in accordance with the current quality standards of medical care. In order to determine the amount of menstrual blood loss during the preoperative period and after 3 months in the operative one, all women were given a clinical interview with filling in the pictogram. Results. The average age of studied women was 31.2±0.34 years. The duration of menstrual discharge was in the range of 7 to 10 days and averaged 9.2±0.2 days. More than half of women - 97 (53.0%) used sanitary tampons along with daily pads. The “super-heavy” volume of menstrual blood loss was typical for 10 women (5.3%). The sizes of individual leiomyoma nodes varied between 1,0 and 3,0 cm in diameter (according to the inclusion criteria) and averaged 1,82±0,29 cm, in women with leiomyoma we noted that myomatous nodes were mapped primarily in blue (dense type according to the classification). Against the background of the developed complex, the average size of leiomatous nodes in patients of the main group significantly differed from the average size of nodes in patients of the control group by an average of 66.4% (the main group – 1.62±0.29; the control group-2.44±0.21; p<0.05). Analysis of hysteroresectoscopic intervention shows that in the main group, increased blood loss that required postoperative administration of uterotonic drugs was registered in 6 (7.9%) cases (the control group – 32 (29.9%) (p<0.05). Postoperative administration of uterotonic drugs in the main group was performed in 14 (18.4%) cases, while in the control group this value was 4.2 times higher and amounted to 82 (76.6%) cases. The “light” volume of blood loss was noted by 36 (33.7%) women in the control group and 50 (65.8%) women in the main group (p<0.05). Conclusions. The use of a two – step approach to intraoperative and postoperative bleeding preventing by applying triptorelin acetate 3.75 mg 28 days before hysteroresectoscopy and terlipresin acetate 0.2 mg 15 minutes before hysteroresectoscopy can significantly reduce the volume of intraoperative (main group – 4 cases (5.3%), control group – 25 cases (23.4%); (p<0.05) and postoperative blood loss (main group – 6 cases (7.9%), control group - 31 cases (28.9%); (p<0.05), reduce the time of endoscopic manipulation; it also reduces the material costs associated with its implementation and also helps prevent postoperative complications. Key words: bleeding, hysteroresectoscopy, intrauterine pathology, intra- and post-operative complications, submucous uterine leiomyoma.

Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method.

Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care.

Restructuring activities have been necessary during the lockdown phase of the coronavirus disease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-care procedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. We aimed to investigate how IBD management was restructured during the lockdown phase, the impact of the restructuring on standards of care and how Italian IBD units have managed post-lockdown activities. A web-based online survey was conducted in two phases (April and June 2020) among the Italian Group for IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuing scheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdown phase. Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visits and 7% of follow-up visits were regularly done, while >70% of follow-up scheduled visits and 5% of first visits were done virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% of biological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modified management of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biological therapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtual clinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future. Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to be maintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, such as virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 era.

Clinicians' Initial Experiences of Transition to Online Interdisciplinary Pain Rehabilitation During the Covid-19 Pandemic.

ObjectivePublic health legislation during the CO-VID-19 pandemic has resulted in forced transitioning to the use of remote care in order to continue the provision of pain rehabilitation worldwide. The objective of this study was to gain insight into clinicians’ initial experiences with the provision of interdisciplinary pain rehabilitation via videoconferencing.DesignObservational, cross-sectional design.ParticipantsTwelve team members (specialists in rehabilitation medicine -MD-, psychologists, physiotherapists and occupational therapists) from a tertiary expertise centre in pain rehabilitation.MethodsQuantitative and qualitative data were collected via a digital survey. Theme-based content analysis was performed for qualitative data.ResultsThe themes that emerged were: the compulsory context; prerequisites for proper use of videoconferencing methods, which are strongly associated with the clinicians’ experiences; changes experienced in specific components of pain rehabilitation; and overarching changes experienced, including opportunities and limitations (sub-themes: therapeutic relationship, system involvement, efficiency, hands-on possibilities, interdisciplinary teamwork, and formalities). Overall, clinicians expressed moderate agreement with the statements that the quality of the pain rehabilitation programme can be maintained using videoconferencing, and that the COVID-19 pandemic offers opportunities for growth and innovation in telehealth.ConclusionIt is feasible to provide valid and satisfactory pain rehabilitation via videoconferencing. This study identified facilitators and barriers to the use of videoconferencing, and great potential for integrating aspects of telehealth into standard care after the pandemic.LAY ABSTRACTLegislation during the COVID-19 pandemic forced transitioning to remote care to continue pain rehabilitation treatment. In this study, first experiences with interdisciplinary pain rehabilitation by videoconferencing were gathered. Both qualitative and quantitative data were collected from team members of a pain rehabilitation team via a digital survey. Overall, clinicians reported that videoconferencing is a valid way to continue care in times when legalisation does not allow for standard face-to-face care. Furthermore, clinicians see opportunities to integrate aspects of telehealth into standard care after the COVID-19 pandemic. However, several limitations and restrictions have been experienced, such as the lack of a physical examination and questions about long-term effectiveness of the treatment. In addition, further investigation is needed to investigate whether pain rehabilitation provided by videoconferencing reaches quality standards of regular care.

Medical imaging of textile iatrogenic foreign bodies in abdomen and pelvis

Aim. To systematize modern literature data on medical imaging of textile iatrogenic foreign bodies.Materials and methods. We analyzed the articles about the identification of textile iatrogenic foreign bodies, published until 2019.Discussion. Foreign body detection should be included in the differential diagnostic algorithm for patients who have a history of surgical interventions and unexplained symptoms. In all cases of suspected iatrogenic foreign body, it is desirable to use at least two available techiques of medical imaging: ultrasound, X-ray, MDCT, MRI.Conclusions. Left foreign body entails medical and legal consequences that adversely affect both the reputation of the surgeon and the reputation of the medical institution, as they are considered a classic example of iatrogenic damage and indicate a violation of the quality standards of medical care. The article presents data on the features of medical imaging of textile iatrogenic foreign bodies left in the patient’s body as a result of planned and emergency surgical interventions, and determining the optimal tactics for examination and treatment of this category of patients.

Effect of Staff Development Program on Nurses' Performance Regarding Quality Standards of Neonatal Care

Background: The quality standards of neonatal care provide a basis for what is expected and required, support the monitoring and measurement of performance against measures of best practice in order to identify priorities for improvement and provide information on how best practice can be used to support high quality neonatal care. The aim of this study was to assess the effect of staff development program on nurses' performance regarding quality standards of neonatal care. Design: A quasi-experimental design was used in carrying out the study. Setting: The study was conducted at the Neonatal Care Units at Mansoura University Children's Hospital, Mansoura General Hospital and Mansoura Hospital for Health Insurance. Subjects: A convenient sample of 103 nurses working in neonatal intermediate care units in the previously mentioned study settings. Tools: Data were collected using the following tools; self- administered questionnaire sheet to assess nurses' knowledge about neonatal care standards and standardized practical observational checklist to assess the nurses' application of neonatal care standards in the intermediate care units (Level II). Results: The study results revealed that there was statistical significant difference in relation to nurses' knowledge and practices regarding standards of neonatal care in the intermediate care units pre, immediate post and at follow up of staff development program implementation. It was found that more than four fifth of nurses had poor knowledge before program implementation, while, immediately after the program and at follow up, 98% and 94.2% of them had good knowledge respectively. All of nurses achieved incompetent practice before the program implementation, while 36% and 16.5% of them achieved competent practice immediate post program and at follow up respectively. Conclusion: There was a significant positive effect of staff development program on nurses’ knowledge, while, there was a limited positive effect on their practices and on the achievement of quality standards of neonatal care. Recommendations: Emphasize on the importance of conducting periodical continuing staff development programs for neonatal nurses to improve their performance, and to achieve the quality standards of neonatal care.

Quality of maternal and newborn healthcare services in two public hospitals of Bangladesh: identifying gaps and provisions for improvement

BackgroundHealthcare service delivery systems need to ensure standard quality of care (QoC) for achieving expected health outcomes. Although Bangladesh has a good healthcare service delivery system, there are major concerns about the quality of maternal and newborn health (MNH) care services, which is imperative for achievements in health. The study aimed to measure the QoC for different MNH services in two selected public health facilities of Bangladesh. This study also documented the specific areas of each care which needs intervention.MethodsThe study was conducted in two district-level public health facilities—a district hospital (DH) and a mother and child welfare centre (MCWC). A total of 228 cases of MNH services were observed by using contextualized checklist ‘Standards-based Management and Recognition (S-BMR)’ for 8 selected MNH care services. For scoring, performed activities were calculated as percentages of the total recommended activities and categorized as high (> 80%), moderate (50 to 80%), and low (< 50%).ResultsOverall QoC scores were moderate for each DH (54.8%), and MCWC (56.1%). In DH, the QoC score was high for blood transfusion (80.3%); moderate for maternal complications management (77.0%), caesarean section (CS) (65.6%), infection prevention (64.3%), sick newborn care (54.1%), and normal vaginal delivery (NVD) (52.6%); and low for antenatal care (ANC) (25.6%) and postnatal care (PNC) (19.0%). In MCWC, the QoC scores were high for infection prevention (83.0%); moderate for CS (76.5%) and NVD (59.8%); and low for ANC (36.9%) and PNC (24.5%).ConclusionsIn the study facilities, the QoC for MNH services is found to be unsatisfactory, particularly for ANC and PNC. Urgent initiative needs to be taken by introducing contextualized quality monitoring tools at health facilities, along with training of the care providers and introducing a quality monitoring system.

Nurse managers' perceptions of the competence of newly graduated nurses: A scoping review.

To summarize nurse managers' perceptions of newly graduated nurses' (NGNs) competence and connected factors. Nurse managers recruiting staff are responsible for employing competent nurses to ensure quality care and professional standards. Knowledge of managers' perceptions about the competence of NGNs is needed to understand the expectations of the health care system towards future professionals. A scoping review was conducted. A total of 12 research publications met the inclusion criteria and were analysed using inductive content analysis. Managers' perceptions can be divided into three perspectives: NGNs' competence descriptions, assessment of competences and connected factors. The NGNs' level of competence was assessed to be at least satisfactory, and dependent on prior exposure to the work setting, change in the degree of responsibility and lack of confidence. Existing knowledge about nurse managers' perceptions of NGNs' competence is limited and rather fragmented. There is a clear need for rigorous empirical studies with comprehensive views of managers, emphasizing the key role of managers in the evaluation of nurse competence. Nurse managers can use the results of this review in recruitment, performance reviews and the development of job orientation programmes aimed at enhancing NGNs' transition to the nurse workforce.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ СТОМАТОЛОГИЧЕСКОГО ОРТОПЕДИЧЕСКОГО ЛЕЧЕНИЯ В АСПЕКТЕ ИЗМЕНЕНИЯ

Background. The annual growth of patients ' claims to dentists dictates the need to develop new methods of evaluation and quality standards of care. Often, patients are not happy with the timing of the use of dentures, which is associated with unjustified expectations that have not been adjusted by the attending physician. &#x0D; Relevance. Study of changes in quality of life parameters in a certain group of patients. &#x0D; Objectives. The standard clinical and paraclinical methods and psychodiagnostic analysis in the form of a questionnaire of quality of life were used as research methods. The data of sixty patients who needed repeated prosthetics for various reasons are presented as the material of the study. &#x0D; Results. The correlation of certain parameters of quality of life from the type of prosthesis is determined. So it is proved that patients with removable prostheses physical and emotional state suffers more than patients with fixed prostheses. The presence of depressive States and anxiety experiences is more pronounced in patients with removable dentures. It was determined that in the case of removable prostheses, the period of wearing is directly correlated with changes in the quality of life. At the same time, the quality of life of patients with fixed prostheses, on the contrary, changes minimally until the "critical" moment, when there is an urgent need to remove the denture. The average terms of prosthesis use in months are calculated. &#x0D; Conclusion. The obtained data can be used in research on dentistry and psychology; at the clinical reception by dentists – orthopedists at the initial consultation of the patient about prosthetics of teeth and dentition. The published material is part of the work on the prospective development of a method for predicting the term and long-term results of dental orthopedic treatment.

Complications While Waiting for IBD Surgery-Short Report.

Background and AimsWhile striving to meet the quality standards for oncological care, hospitals frequently prioritize oncological procedures, resulting in longer waiting times to surgery for benign diseases like inflammatory bowel disease [IBD]. The aim of this Short Report is to highlight the potential consequences of a longer interval to surgery for IBD patients.MethodsThe mean waiting times to elective surgery for IBD patients with active and inactive disease [e.g. pouch surgery after subtotal colectomy] at the Amsterdam UMC, location AMC, between 2013 and 2015 were compared with those for colorectal cancer surgery. Correlations between IBD waiting times and disease complications [e.g. >5% weight loss, abscess formation] and additional health-care consumption [e.g. telephone/outpatient clinic appointment, hospital admission] during these waiting times were assessed.ResultsThe mean waiting was 10 weeks [SD 8] for patients with active disease [n = 173] and 15 weeks [SD 16] for those with inactive disease [n = 97], remarkably higher than that for colorectal cancer patients [5 weeks]. While awaiting surgery, 1 out of 8 patients had to undergo surgery in an acute or semi-acute setting. Additionally, 19% of patients with active disease had disease complications, and 44% needed additional health care. The rates were comparable for patients with inactive disease.ConclusionsThe current waiting time to surgery is not medically justified and creates a burden for health-care resources. This issue should be brought to the attention of policy makers, as it requires a structural solution. It is time to also set a maximally acceptable waiting time to surgery for IBD patients.