scholarly journals 688 Cancellation Rate of Prostate Template Biopsy: Are There Any Merits to Implementing Pre-Operative Bowel Preparations?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Lim ◽  
A Damola ◽  
I Apakama
Keyword(s):  
George Eliot ◽  
Poor Quality ◽  
Routine Practice ◽  
Improvement Project ◽  
Transperineal Prostate Biopsy ◽  
Cancellation Rate ◽  
Potential Benefits ◽  
Bowel Prep ◽  
Bowel Preparations

Abstract Introduction The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged. Method Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software. Results There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons. Conclusions The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.

scholarly journals Evidence-Based Chinese Medicine for Hypertension

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Jie Wang ◽  
Xingjiang Xiong
Keyword(s):  
Chinese Medicine ◽  
Tai Chi ◽  
Clinical Evidence ◽  
Poor Quality ◽  
Evidence Based ◽  
Hypertensive Patients ◽  
Primary Endpoints ◽  
Potential Benefits ◽  
Public Health Challenge

Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go.

69 Continuous and Regular Live Feedback is Required to Maintain An Improvement in the Quality of Discharge Summaries. Shop 75 +

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Cross ◽  
J Evans ◽  
A Pederson ◽  
D Yidana ◽  
D Carey ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Feedback System ◽  
Poor Quality ◽  
Significant Deterioration ◽  
Improvement Project ◽  
Continuous Quality ◽  
Feedback Interventions ◽  
Discharge Summaries

Abstract Background This quality improvement project aims to improve communication between secondary and primary care at the time of hospital discharge of older patients. Introduction Discharge summaries (DS) are a key component of communication between secondary and primary care. Poor quality DS are associated with poorer outcomes in terms of adverse events [1], readmissions [2] and medication errors [3]. There is NICE and AMRC guidance on what constitutes a good DS [4, 5]. Method Prospective review of DS from a range of wards was completed in August 2017 against a detailed data tool. A random selection of DS from the same wards was audited monthly from November 2017 onwards. A novel live-feedback system was introduced to the same wards in February 2018 so that the teams completing DS received feedback on how well their summaries complied with the recommendations and what areas needed improvement. A change in staffing lead to a break in the delivery of monthly feedback to the ward teams from April to September 2019 when it was re-commenced. Results In the majority of areas there has been an increase in the quality of the DS from the beginning of the project until March 2019 when the regular feedback interventions were suspended. There was a decrease in the quality of summaries in July and August 2019, followed by an increase as regular feedback interventions recommenced in September 2019. The aggregate results of the four main components of DS (follow-up actions, medicines, clinical summary, and functional assessment), scored “good” in 13% of DS at baseline, 40% in March 2019, 20% in July 2019 and 31% in October 2019. Conclusions The suspension of regular direct interventions resulted in a significant deterioration in the quality of discharge summaries, and this improved quickly after reintroduction of PDSA cycles in key areas. Continuous quality improvement requires uninterrupted focus on regular live feedback. References 1. Clegg et al. Lancet 2013; 381: 752–62. 2. Samra et al. Age Ageing 2017; 46: 911–9. 3. Romero-Ortuno et al. Age Ageing 2012; 41: 684–9.

scholarly journals Education and training as key drivers for improving the quality of fluid balance charts: findings from a quality improvement project

2021 ◽  
Vol 10 (3) ◽  
pp. e001137
Author(s):  
Alpha Madu ◽  
Harshini Asogan ◽  
Ajmal Raoof
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Fluid Balance ◽  
Poor Quality ◽  
Quality Improvement Project ◽  
Hydration Status ◽  
Improvement Project ◽  
Cost Efficient ◽  
Competency Assessments

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan–do–study–act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.

50 Using A Targeted Teaching Intervention to Drive up the Quality of Discharge Summaries. Shop 75+

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
R C Robey ◽  
A Danson ◽  
J Evans ◽  
J Froggatt ◽  
A Pederson ◽  
...  
Keyword(s):  
Patient Information ◽  
Poor Quality ◽  
Teaching Intervention ◽  
Intended Audience ◽  
Improvement Project ◽  
Group Settings ◽  
Questionnaire Surveys ◽  
Discharge Summaries

Abstract Background Quality improvement project examining discharge communication, and a targeted teaching intervention. Introduction Poor quality, incomplete or missing discharge summaries (DSs) are associated with avoidable/ameliorable adverse events after discharge [1]; preventable readmission [2,3]; failure to implement discharge plans [4]; and medication continuity errors [4,5]. Methods To review the quality of DSs produced, each month forty representative DSs are randomly selected from four clinical areas and qualitatively assessed (total > 1,000, August 2017—to date). Alongside this, in August 2018, incoming foundation doctors were surveyed on perceptions of the purpose/importance of DSs, and training provided on writing them. They were resurveyed after teaching delivery in November 2018 and April 2019. Interventions Data from QI review and survey were used to generate a teaching intervention, in the form of an interactive slide set for delivery in small group settings. This was delivered in weekly mandatory teaching sessions. PDSA cycles were completed for teaching sessions, and the slide set was developed accordingly. Results After the teaching sessions, we noted improvement in satisfaction with training provided on writing DSs (from 24% to 40%), as well as confidence in writing high-quality DSs (from 28% to 100%). We demonstrated increases in responses including the patient as an intended audience for the DS (from 51% to 84%), and rating “patient information in lay terms” of “high importance” (from 41% to 72%). These changes in perceptions were accompanied by improvement in the quality of DSs produced, particularly with respect to the quality of follow-up actions detailed and the quality of patient information provided in lay terminology. The average monthly proportion of DSs achieving a “great score” in these areas increased from 20% and 28% respectively (August 2017—June 2018), to 44% and 71% (August 2018—March 2019). Conclusions These data provide proof-of-principle that targeted teaching, constructed around prior questionnaire surveys, improves awareness of the purpose of DCs and leads to improvement in the quality of DSs produced and enhanced patient safety.

An experience of performing spirometry by trained general practitioners

2020 ◽  
pp. 34-36
Author(s):  
M. A. Pokhaznikova ◽  
E. A. Andreeva ◽  
O. Yu. Kuznetsova
Keyword(s):  
General Practitioners ◽  
Quality Criteria ◽  
Poor Quality ◽  
Male Gender ◽  
Study Research ◽  
The Poor ◽  
Quality Of Research ◽  
Forced Expiratory Maneuver ◽  
Maximal Effort

The article discusses the experience of teaching and conducting spirometry of general practitioners as part of the RESPECT study (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related aetiology). A total of 33 trained in spirometry general practitioners performed a study of 3119 patients. Quality criteria met 84.1% of spirometric studies. The analysis of the most common mistakes made by doctors during the forced expiratory maneuver is included. The most frequent errors were expiration exhalation of less than 6s (54%), non-maximal effort throughout the test and lack of reproducibility (11.3%). Independent predictors of poor spirogram quality were male gender, obstruction (FEV1 /FVC<0.7), and the center where the study was performed. The number of good-quality spirograms ranged from 96.1% (95% CI 83.2–110.4) to 59.8% (95% CI 49.6–71.4) depending on the center. Subsequently, an analysis of the reasons behind the poor quality of research in individual centers was conducted and the identified shortcomings were eliminated. The poor quality of the spirograms was associated either with the errors of the doctors who undertook the study or with the technical malfunctions of the spirometer.

KUALITAS HIDUP PASIEN STROKE DI POLIKLINIK RAWAT JALAN RUMAH SAKIT SWASTA YOGYAKARTA

2019 ◽  
Vol 7 (3) ◽  
pp. 232-237
Author(s):  
Hana Larasati ◽  
Theresia Titin Marlina
Keyword(s):  
Quality Of Life ◽  
Social Relations ◽  
Hemorrhagic Stroke ◽  
Poor Quality ◽  
Social Dimension ◽  
Stroke Patients ◽  
Sampling System ◽  
Post Stroke ◽  
Psychological Dimension

Background: stroke is a disorder of nervous system function that occurs suddenly and is caused by brain bleeding disorders that can affect the quality of life physical dimensions, social dimensions, psychological dimensions, environmental dimensions. Based on the result of Lumbu study (2015) the number of samples were 71 people collected data using the (WHOQOL-BREF). There were 56 people (78,9%) had the poor quality of life of post stroke. The mean of post-stroke quality of life domain was physical domain (45,27%), psychological domain (49,87%), social relations domain (48,15%) and environmental domain (50.01%). Objective: the purpose of the study was know the quality of life of the stroke patients in Outpatient Polyclinic of Private Hospital in Yogyakarta. Methods: used descriptive quantitative by using questionnaire test of purposive sampling system based on patients who have been affected of ischemic or hemorrhagic stroke before, number 30 respondents. Result: quality of life of stroke patient of medium physical dimension (67%), psychological dimension (71%), social dimension (67%), dimension good environment (63%). Conclusion: the quality of life of stroke patients of physical dimension, psychological dimension, and moderate social dimension, while the quality of life of stroke patients were good environmental dimension.   Keywords: Hemorrhagic stroke, ischemic stroke, quality of life

YEAR 2020: ON THE REMAINING REPRODUCTIVE THREATS AND THEIR NEUTRALIZATION ON THE WAYS TO IMPROVE STRATEGIC PLANNING AND INDUSTRIAL POLICY, THE DEPLOYMENT OF THE NATIONAL INNOVATION SYSTEM AND ITS SECTORAL AND REGIONAL SUBSYSTEMS

2020 ◽  
pp. 3-53
Author(s):  
Yu.B. Vinslav
Keyword(s):  
Strategic Planning ◽  
Industrial Policy ◽  
Innovation System ◽  
Poor Quality ◽  
National Innovation System ◽  
State Regulation ◽  
Industrial Complex ◽  
The Past ◽  
Technological Modernization

The article analyzes the main indicators of the evolution of the domestic economy and its industrial complex in the past year (in January — November 2019). It Identifies trends in this evolution, including negative trends that determine the preservation of reproductive threats in 2020: sluggishness, instability and low quality of economic growth. The main reasons for the fact that the objective resource capabilities of the macro level were clearly not used enough to effectively solve the urgent problems of technological modernization of the economy and increase people’s welfare are established. The main reason is the poor quality of public administration, including imperfect strategic planning and industrial policy; there is still no modern national innovation system in the country. Accordingly, recommendations for improving the quality of state regulation in its specified components are justified. The recommended measures, according to the author, will help the economy to move to a trajectory of rapid, sustainable and high-quality growth.

Gender and Regional Differences in the Life Expectancy in Russia

2020 ◽  
Vol 27 (1) ◽  
pp. 106-120 ◽  
Author(s):  
L. A. Rodionova ◽  
E. D. Kopnova
Keyword(s):  
Drinking Water ◽  
Alcohol Consumption ◽  
Life Expectancy ◽  
Gender Gap ◽  
Poor Quality ◽  
Living Conditions ◽  
Regional Differentiation ◽  
Russian Regions ◽  
Poor Nutrition

The relevance of the chosen topic is closely related to the development of a system for monitoring the implementation of the May Presidential Decree (2018) to increase life expectancy and improve the quality of life of the population. It has been stated that despite the positive dynamics of life expectancy over the past decade, Russia still has a huge regional differentiation (16,6 years for women, 18,2 years for men in 2016) and an average gender gap - 10,6 years. The choice of factors affecting the gender gap in life expectancy in Russian regions is supported by a conclusion most common in foreign studies that climatic conditions, living conditions, the quality of food and drinking water, alcohol consumption are essential components of public health and life expectancy.The article provides an overview of studies on assessment factors of life expectancy, presents the authors’ approach to identifying gender gaps in life expectancy, living conditions, and lifestyle affecting the indicator of life expectancy. The paper presents the results of a comparative analysis of gender gap in life expectancy in Russia and foreign countries. The paper studies the correlation between living conditions and lifestyle, and life expectancy.Classification of the regions by the life expectancy at birth for men and women is an important component of this study. The authors used Rosstat data for 2016 and the k-means method to select three clusters of Russian regions taking into account gender, living conditions and lifestyle. The paper identifies similar health problems of the regions that are associated with alcohol consumption, poor nutrition and poor quality of drinking water, poor housing and living conditions. The lowest life expectancy rates for men and women are recorded in regions of the 1st cluster (Jewish Autonomous Region, Republic of Tuva, Chukotka Autonomous Area). High mortality rates are a result of external causes. There is a poor quality of drinking water and poor nutrition, excessive alcohol consumption, and inadequate housing conditions.Based on the obtained results were determined possible reserves for reducing the gender and regional differentiation of life expectancy.

UNSUR MANAJEMEN DALAM PENGELOLAAN LEMBAGA PENDIDIKAN ISLAM DI INDONESIA

2018 ◽  
Vol 6 (1) ◽  
pp. 675-695
Author(s):  
FAJRI DWIYAMA
Keyword(s):  
Staff Development ◽  
Management Education ◽  
Poor Quality ◽  
Islamic Education ◽  
Educational Institutions ◽  
Education Management ◽  
Classic Problem ◽  
The World ◽  
Education Personnel

Abstract: Islamic education institutions in Indonesia face two challenges, namely; internal and external. Internally, Islamic education is faced with the classic problem of the low quality of human resources in education management. The causes include poor quality and education staff development and selectivity of education personnel. Furthermore externally, Islamic education institutions faced three major issues; globalization, democratization, and liberalization. The issue of globalization that is identical with market orientation and mechanism also affects the world of education. That way in education also includes awareness about how to attract and convince the community of the type and model of education. From here, the education world is ready or not ready to be involved in competition to gain public trust. To face these challenges Islamic Education institutions must maximally manage and empower all elements of management in the management of educational institutions. A good understanding of the elements of management can have an impact on the readiness of educational institutions to manage their institutions well in any condition to be the best and foremost. Keywords: Elements of Management, Management, Education, Islam

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