PENGARUH FORMULASI TEPUNG BERAS MERAH (Oryza nivara L) DAN TEPUNG BUAH PARE (Momordica charantia L) TERHADAP NILAI ORGANOLEPTIK DAN NILAI GIZI COOKIES SEBAGAI MAKANAN SELINGAN PADA PENDERITA DIABETES

ABSTRACTThe aim of this study was to determine the effect of the formulation of brown rice (Oryza nivaraL) flour and bitter gourd (Momordica charantia L) flour on the organoleptic and nutritional values of cookies as a snack for diabetics. This study was arranged based on a completely randomized design (CRD). This study used five treatments, namely brown rice flour: bitter gourd flour A0 (100%: 0%), A1 (97%: 3%), A2 (94%: 6%), A3 (91%: 9%), and A4 (88% : 12%). The data were analyzed using analysis of variances (ANOVA) and if it had a significant effect on the observed variables, then Duncan's Multiple Range Test (DMRT) was conducted at a 95% confidence level (α=0.05). The results showed that the most preferred product was found in A2 treatment with organoleptic scores of color, texture, taste, and aroma reached 3.61 (like), 3.70 (like), 3.29 (like), and 3.57 (like), respectively. The nutritional value of cookies produced in A2 treatment shows that it has 3.30% water, 0.81% ash, 32.54% fat, 7.76% protein, and 18.20% glucose. The brown rice and bitter gourd cookies products met the national quality standards for water, ash, and protein contents.Keywords: brown rice, bitter gourd, cookies, snack, proximate value.ABSTRAKPenelitian ini bertujuan penelitian ini adalah untuk pengaruh formulasi tepung beras merah (Oryza nivaraL) dan tepung buah pare (Momordica charantia L) terhadap nilai organoleptik dan nilai gizi cookies sebagai makanan selingan pada penderita diabetes. Penelitian ini disusun berdasarkan rancangan acak lengkap (RAL). Penelitian ini menggunakan lima perlakuan yang yaitu Tepung beras merah : Tepung Buah Pare A0 (Tepung 100 % : 0%), A1 (97% : 3 %), A2 (94%: 6%), A3 (91%: 9%), A4 (88% : 12%). Data dianalisis menggunakan analysis of variances (ANOVA) dan apabila berpengaruh nyata terhadap variabel pengamatan, maka dilakukan uji duncan’s multiple range Test (DMRT) pada taraf kepercayaan 95% (α=0,05). Hasil penelitian menunjukkan bahwa penilaian organoleptik terhadap cookies dengan penambahan beras merah (Oryza nivara L) dan buah pare (Momordica charantia L) yang disukai panelis terdapat pada perlakuan A2 dengan skor organoleptik warna 3,61 (suka), organoleptik tekstur 3,70 (suka), organoleptik rasa 3,29 (suka), organoleptik aroma 3,57(suka). Nilai gizi cookies yang dihasilkan pada perlakuan A2 mengandung kadar air sebesar 3.30%, kadar abu sebesar 0,81%, kadar lemak sebesar 32,54 %, kadar protein 7,76%, kadar glukosa sebesar 18,20%. Berdasarkan standar mutu SNI cookies bahwa produk cookies beras merah dan buah pare sudah memenuhi standar mutu SNI untuk kadar air, kadar abu, dan kadar protein.Kata kunci : beras merah, buah pare, cookies, makanan selingan, nilai proksimat.

Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation

Background The ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor. Objective To assess the effect of quality improvement collaborative participation on ABCDEF bundle performance. Methods This interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation. Results Complete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility. Conclusions Quality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.

Longitudinal study of patients’ health-related quality of life using EQ-5D-3L in 11 Swedish National Quality Registers

ObjectiveTo compare problems reported in the five EQ-5D-3L dimensions and EQ VAS scores at baseline and at 1-year follow-up among different patient groups and specific diagnoses in 11 National Quality Registers (NQRs) and to compare these with the general population.DesignLongitudinal, descriptive study.Participants2 66 241 patients from 11 NQRs and 49 169 participants from the general population were included in the study.Primary and secondary outcome measuresProportions of problems reported in the five EQ-5D-3L dimensions, EQ VAS scores of participants’ own health and proportions of participants and mean/median EQ VAS score in the Paretian Classification of Health Change (PCHC) categories.ResultsIn most of the included registers, and the general population, problems with pain/discomfort were the most frequently reported at baseline and at 1-year follow-up. Mean EQ VAS score (SD) ranged from 45.2 (22.4) among disc hernia patients to 88.1 (15.3) in wrist and hand fracture patients at baseline. They ranged from 48.9 (20.9) in pulmonary fibrosis patients to 83.3 (17.4) in wrist and hand fracture patients at follow-up. The improved category of PCHC, improvement in at least one dimension without deterioration in any other, accounted for the highest proportion in several diagnoses, corresponding with highest improvement in mean EQ VAS score.ConclusionsThe study documented self-reported health of several different patient groups using the EQ-5D-3L in comparing with the general population. This demonstrated the important role of patient-reported outcomes in routine clinical care, to assess and follow-up health status and progress within different groups of patients. The EQ-5D-3L descriptive system and EQ VAS have an important role in providing a ‘common denominator’, allowing comparisons across NQRs and specific diagnoses.Trial registration numberClinicalTrials.gov (NCT04359628).

Change in Quality of Tuberculosis (TB) Care since National Quality Assessment Program of TB Healthcare Service

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1^st to 3^rd national quality assessment (QA) program for TB healthcare service in Korea was conducted.Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy).Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%.Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

Comparative Study of Business Excellence Frameworks and Awards in Southeast Asian Countries

Many countries have initialized and adopted the business excellence framework to encourage high-quality achievements and be recognised internationally, including in Southeast Asian Nations (ASEAN). ASEAN as an economic and political organization of 11 countries located in Southeast Asia, established a business excellence framework to promote international organizational excellence and serve as national quality awards, which most of them adopted the Baldrige Excellence Framework (BEF). This study utilizes the accumulation and analysis of qualitative information using several sources and evidence from the business excellence frameworks and awards in ASEAN countries. This paper presents analytical comparisons of various aspects of the framework, such as their goals, award and recognition, categories, and score points (scores). It also discusses the similarities and differences among them.

A national framework for promoting business excellence (NFPBE)

PurposeThe purpose of this paper is to propose a national framework for promoting business excellence (NFPBE) using a quality management assessment framework (QMAF) with information knowledge communication (IKC) as an enabler.Design/methodology/approachThe NFPBE using the plan–do–check–act (PDCA) cycle is developed, re-enforcing key quality management aspects/areas including national quality awards, QMAF summary and national innovation programmes using a meta-analysis.FindingsThe operationalising of the NFPBE is enabled and supported by an auditing tool to assess the degree of mentoring provided by universities/research institutions/consulting firms to participating firms whose progress will be assessed by the QMAF. It was emphasised that the success of the framework requires the buy-in of national governments to support the programme through stimulus incentives such as government assistance with the costs of research and development, and cooperative research ventures between universities and companies.Research limitations/implicationsThe framework is conceptualised into a process flowchart, which is a blueprint to advancing business excellence in organisations at a national scale. The study is limited to only the conceptualisation of the framework. Therefore, an extended study of the framework implementation/application is required for revealing implementation guidelines.Practical implicationsThe national framework has a propensity to enhancing the business excellence of organisations at a national level. Therefore, quality managers and policy makers could use the framework to understand the quality management shortfalls and consider strategies to achieving business excellence.Originality/valueThis research study proposed a blueprint to advancing quality excellence in organisations at a national level, guided by several quality frameworks.

Physiotherapists’ experiences of osteoarthritis guidelines in primary health care – an interview study

Background Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists’ experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. Methods Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. Results The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management’s support and that guidelines should be easy to follow. Conclusion The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Determinants of falls after stroke based on data on 5065 patients from the Swedish Väststroke and Riksstroke Registers

We aimed to identify determinants in acute stroke that are associated with falls during the stroke unit stay. In order to enable individualized preventive actions, this knowledge is fundamental. Based on local and national quality register data on an unselected sample of 5065 stroke patients admitted to a stroke unit at a Swedish university hospital, univariable and multivariable logistic regression analyses were performed. The dependent variable was any fall during stroke unit stay. The independent variables related to function, activity, personal factors, time to assessment, comorbidities and treatments. Determinants of falls were: being male (odds ratio (OR) 2.25, 95% confidence interval (95% CI) 1.79–2.84), haemorrhagic stroke (OR 1.39, 95% CI 1.05–1.86), moderate stroke symptoms according to the National Institutes of Health Stroke Scale (NIHSS score 2–5 vs. NIHSS score 0–1) (OR 1.43, 95% CI 1.08–1.90), smoking (OR 1.70, 95% CI 1.29–2.25), impaired postural control in walking (OR 4.61, 95% CI 3.29–6.46), impaired postural control in standing (OR 1.60, 95% CI 1.25–2.05), stroke-related arm- and hand problems, OR 1.45, 95% CI 1.11–1.91), impaired cognition (OR 1.43, 95% CI 1.04–1.95), and urinary tract infection (OR 1.91, 95% CI 1.43–2.56). The findings from this study are useful in clinical practice and might help to improve patient safety after stroke.

Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register

Purpose To evaluate the predictive precision of the Dialogue Support, a tool for additional help in shared decision-making before surgery of the degenerative spine. Methods Data in Swespine (Swedish national quality registry) of patients operated between 2007 and 2019 found the development of prediction algorithms based on logistic regression analyses, where socio-demographic and baseline variables were included. The algorithms were tested in four diagnostic groups: lumbar disc herniation, lumbar spinal stenosis, degenerative disc disease and cervical radiculopathy. By random selection, 80% of the study population was used for the prediction of outcome and then tested against the actual outcome of the remaining 20%. Outcome measures were global assessment of pain (GA), and satisfaction with outcome. Results Calibration plots demonstrated a high degree of concordance on a group level. On an individual level, ROC curves showed moderate predictive capacity with AUC (area under the curve) values 0.67–0.68 for global assessment and 0.6–0.67 for satisfaction. Conclusion The Dialogue Support can serve as an aid to both patient and surgeon when discussing and deciding on surgical treatment of degenerative conditions in the lumbar and cervical spine. Level of evidence I.