Development and deployment of the Computer Assisted Neighborhood Visual Assessment System (CANVAS) to measure health-related neighborhood conditions

Public health research has shown that neighborhood conditions are associated with health behaviors and outcomes. Systematic neighborhood audits have helped researchers measure neighborhood conditions that they deem theoretically relevant but not available in existing administrative data. Systematic audits, however, are expensive to conduct and rarely comparable across geographic regions. We describe the development of an online application, the Computer Assisted Neighborhood Visual Assessment System (CANVAS), that uses Google Street View to conduct virtual audits of neighborhood environments. We use this system to assess the inter-rater reliability of 187 items related to walkability and physical disorder on a national sample of 150 street segments in the United States. We find that many items are reliably measured across auditors using CANVAS and that agreement between auditors appears to be uncorrelated with neighborhood demographic characteristics. Based on our results we conclude that Google Street View and CANVAS offer opportunities to develop greater comparability across neighborhood audit studies.     

A method of audit for ward clinical waste

We describe the conduct of an annual audit concerning the handling of clinical waste at ward level. The annual audit resulted in an improvement in the supply of colour coded bags and holders, and improved the efficiency of waste disposal in the hospital. The annual report of the audit enabled the hospital administrators to pinpoint defects and was partly responsible for the appointment of an "administrative officer responsible for waste".     

Nasogastric tube audit: standard setting and review of specifications

This paper describes the procedure and outcome of an audit exercise designed to identify the equipment of choice from among the nasogastric (NG) tubes available on the UK market. In order to assess some of these in a systematic way, a working party of dietitians and nurses was established. Standards expected from a NG tube were set and agreed. These were then used to evaluate seven tubes to see which reached the agreed standard. This was not an exhaustive survey of all available tubes on the market, but a selection of those commonly available.
Among the seven tubes investigated, the Corslo®Merck tube was found to be the NG tube of choice in Oxfordshire. Future reassessments will be required as new NG tubes become available.     

Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

PURPOSE: To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery. METHOD: Instrument content was based on qualitative data ascertained from focus groups of patients and input from an expert panel of clinicians and psychometricians. A draft questionnaire was then piloted and revised, leading to the 27-item Convalescence and Recovery Evaluation (CARE). CARE consists of four individually scored domains, which were identified using factor analysis. Test-retest reliability, internal consistency, and convergent validity were assessed. RESULTS: Test-retest reliability was high, ranging from 0.78 for the activity domain to >0.88 for all others. Internal consistency varied over time postoperatively but was moderate to high for all domains throughout. Correlations between the four domains of CARE were low (each r相似文献   

An audit of nutritional supplement distribution and consumption on a care of the elderly ward

Background: Malnutrition in hospital is often an unrecognized problem which can affect recovery from illness or injury and highlights the need for comprehensive training on clinical nutrition. One group at high risk of malnutrition are the elderly and several studies have described how dietary supplementation with oral sip feeds can improve the outcome in this group of patients. Aim: The aim of this audit was to establish how much of the prescribed volume of oral sip feed was offered to and consumed by the patients on an acute 35-bed care of the elderly ward over a 12-day period including one weekend. Methods: A standard pro-forma was used to record what supplements had been prescribed, what had been offered to the patient and what volume had been consumed. Results: Not all patients received the supplements prescribed and 39% of patients who did receive a supplement consumed none or hardly any of it. Forty-three per cent consumed nearly all of the supplement provided, similar to the results from other studies. Conclusions: The study highlighted the need for training of ward staff about the preparation and distribution of supplements.     

Validation of an automated method for the analysis of fat content of dulce de leche

This work aimed to validate an automated method for acid hydrolysis and extraction of fat content of dulce de leche, a typical Latin American dairy product. Validation parameters were analyzed according to Commission Decision 657/2002/EC. The measurement uncertainty and the limits of detection (LoD) and quantification (LoQ) were also determined. Precision, recovery and decision limit were evaluated in two regulatory levels (6.0 and 9.0 g/100 g), with recoveries of 89% and 95%. The method was linear in the concentration range of 0.53–12.00 g/100 g and the LoD and the LoQ were set to 0.16 and 0.53 g/100 g, respectively. The validated method was compared to a Röse-Gottlieb reference method, presenting better precision in terms of repeatability and better recovery. Then, commercial samples, processed by inspected establishments in Argentina (n = 3), Uruguay (n = 2) and Brazil (n = 17) were analyzed and fat contents were among 1.10 and 10.12 g/100 g. Thus, this method is suitable for accurate routine analysis of the fat content of dulce de leche.     

临床、医技科室ISO9001内审检查表的编制与应用

在ISO9001内部审核过程中,结合临床、医技科室的工作内涵,融合ISO9001标准和卫生行业要求,编制检查表,把检查表作为内部审核的引擎,在全面审核基础上,重点精化审核内容,把握审核重点,突出审核专业性,使内部审核与卫生行业检查相融合、与日常管理工作相结合,成为评价医疗服务质量的一种有效方式。     

Professional Practice Development Groups—a method of reviewing clinical practice

A new tool, the Professional Practice Development Group, is proposed for the evaluation of clinical aspects of a dietetic service. This tool relies on giving individuals specific roles in order to break down the task. This paper outlines the nature and purpose of the group. A professional practice development group could form part of a clinical audit programme and also act as a method of self-development for staff.     

Risk of malnutrition in a sample of acute and long-stay NHS Fife in-patients: an audit.

BACKGROUND: Hospital malnutrition (undernutrition) continues to attract concern. The implementation of standards for food and fluids in Scotland provided the stimulus for an audit of current practices in NHS Fife hospitals in order to provide baseline data with which to evaluate progress. METHODS: One hundred and fifty in-patients were recruited from wards likely to yield those with a high risk of malnutrition. Using patient records and anthropometry, data were collected on weight, weight change, body mass index (BMI), mid-upper-arm circumference (MUAC), dietetic referral, therapeutic diets and patients' perceptions of nutritional status. Malnutrition was estimated by comparing BMI, weight change and MUAC with the Malnutrition Universal Screening Tool (MUST) and standards published by the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: Depending upon the standard used, the minimum risk of malnutrition varied from 14 to 25%. The prevalence was lower than that reported previously, although methods were not directly comparable. Obesity was also evident with 42% of patients having a BMI > 25. Mean weight change from admission to audit was +0.4 kg, with a wide range (-11 kg to +13 kg). Most patients identified as malnourished were referred to the dietitian or given nutritional support. CONCLUSIONS: Fewer patients were at risk of malnutrition than expected. However, improving the provision of food and fluids remains a priority in Fife as malnutrition and eating problems can occur across the entire BMI spectrum.     

Trams,trains, planes and automobiles: logistics of conducting a statewide audit of medical records

Objective: This paper reports on the logistics of conducting a validation study of a routinely collected dataset against medical records at hospitals to inform planning of similar studies. Method: A stratified random sample of 15 hospitals and two homebirth practitioners was included. Site visits were arranged following consent. In addition to the validation of perinatal data, information was collected regarding logistics. Results: Records at 14 metropolitan and rural hospitals up to 500 km from the research centre, and two homebirth practitioners, were audited. Obtaining consent to participate took between 5 days and 10 months. Auditors visited sites on 101 days, auditing 737 medical record pairs at 16 sites. Median audit time per record was 51.3 minutes; electronic records each took 36 minutes longer than paper. Travel time accounted for nearly one‐quarter of audit time. Conclusions: Delays obtaining consents, long travel times and electronic records prolonged audit duration and expense. Employment of experts maximised use of available audit time. Conducting a validation study is a time‐consuming and expensive exercise; however, confidence in the accuracy of public health data is vital. Implications: Validation studies are unquestionably important. Three alternative strategies have been proposed to make future studies viable.     

Gastroparesis Cardinal Symptom Index (GCSI): Development and validation of a patient reported assessment of severity of gastroparesis symptoms

BACKGROUND: Patient-rated symptom assessments are needed for evaluating the effectiveness of medical treatments and for monitoring outcomes in gastroparesis. OBJECTIVE: This paper summarizes the development and psychometric evaluation of a new instrument, the Gastroparesis Cardinal Symptom Index (GCSI), for assessing severity of symptoms associated with gastroparesis. METHODS: The GCSI was based on reviews of the medical literature, patient focus groups, and interviews with clinicians. A sample of 169 patients with a documented diagnosis of gastroparesis participated in the psychometric evaluation study. Patients completed the GCSI, the SF-36 Health Survey, and disability days questions at baseline and after 8 weeks. A randomly selected sub-sample of 30 subjects returned at 2 weeks to assess test retest reliability. Clinicians rated severity of symptoms, and both clinicians and patients rated change in gastroparesis-related symptoms over the 8 week study. RESULTS: The GCSI is based on three subscales: post-prandial fullness/early satiety (4 items); nausea/vomiting (3 items), and bloating (2 items). Internal consistency reliability was 0.84 for the GCSI total score and ranged from 0.83 to 0.85 for the subscale scores. Two week test retest reliability was 0.76 for the total score and ranged from 0.68 to 0.81 for subscale scores. Construct validity was supported, given that we observed significant relationships between clinician assessed symptom severity and GCSI total score, significant differences between gastroparesis and dyspepsia patients (n = 760) on GCSI total (p < 0.0001) and subscale scores (p < 0.03 to p < 0.0001), moderate and significant relationships between GCSI total and SF-36 scores, and significant associations between GCSI total score and reports of restricted activity and bed disability days. Patients with greater symptom severity, as rated by clinicians, reported more symptom severity on GCSI total score. GSCI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians (p < 0.0001) and patients (p = 0.0004). CONCLUSION: The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring symptom severity in patients with gastroparesis.     

中文版简式网络社交媒体障碍量表的修订及信效度检验

目的 在中国大学生群体中修订中文版简式网络社交媒体障碍量表。方法 采用中文版简式网络社交媒体障碍量表（C–SMD）、短式抑郁–焦虑–压力量表（DASS–21）、中文版低头行为量表（C–GSP）及手机成瘾倾向量表（MPATS）共对1 185名大学生进行测验。结果 （1） C–SMD的二因素模型拟合较好;（2） C–SMD得分与C–GSP得分、MPATS得分及DASS–21得分均正相关（r = 0.35～0.66, P＜0.01）,其组合信度在0.71～0.84间,平均方差抽取量在0.32～0.44间;（3） C–SMD的Cronbach α系数在0.73～0.82间;分半信度在0.64～0.72间;重测信度在0.72～0.81（P＜0.01）间。结论 中文版简式网络社交媒体障碍量表具有较高的信效度,可以作为未来测评我国大学生网络社交媒体障碍的有效工具。     

An audit of laxative use and fibre/fluid intakes in a care of the elderly rehabilitation ward

Background: Constipation is a common problem in elderly patients, resulting in considerable discomfort and expenditure on prescribed laxatives. Aims and objectives: This study aimed to audit the use of laxatives on a ward for the rehabilitation of elderly people; to assess the fibre and fluid provided to patients on the basis of hospital menus and to assess the individual, daily intakes of fluid and fibre of three patients. Methods: Pharmacy records were used to audit laxative use on the ward over a 3-month period. Provision of fluid and fibre were assessed by analysis of the regular and soft menus for 3 days, using food composition tables. A weighed intake assessment of three patients for one day was undertaken. Results: Ispaghula husk (Fybogel, Regulan) were the most commonly used laxatives. Although the regular menu appeared to provide adequate amounts of fluid and fibre, results for the soft menu were less satisfactory. All three patients had intakes well below the recommended level of dietary fibre. Conclusion: Despite the limitations of this small study, the findings suggest that improvements in catering and food service could be implemented to increase the intake of dietary fibre by patients in this ward. These should be implemented and the use of laxatives re-audited.     

Development and validation of a rapid analytical method to quantify naled residue.

A rapid gas chromatographic method for detecting residues of the thio-organophosphate naled was developed and subsequently validated in laboratory and field studies. More than 90% of naled was recovered by a gas chromatograph when equipped with a DB-5 capillary column and a thermionic specific detector. The limit of detection was 0.01 microg/ml with direct injection. Stabilization of naled under a variety of storage conditions also was examined. Analysis of field data showed that naled broke down rapidly in the environment but was stable when stored in hexane solvent at 4 degrees C and 23 degrees C for at least 7 days. Range of percentage matrix spike recovery was 31-49% for filter paper samples exposed under field conditions for 14 h. A field study was also initiated that collected naled droplets trapped on 6.7-m acrylic mohair-look yarn strands in addition to residue on filter paper after aerial ultra-low-volume mosquito adulticide application. Spike recovery was 79% for filter paper samples and 93% for yarn samples. Average naled residue concentrations with these methods were 373 microg/m2 and 11.28-73.77 microg/yarn, respectively.     

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in the Netherlands and England, 1970–1999

Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing Act of 1984. In England it was the government who promoted medical audit as a compulsory activity for medical specialists, in particular since 1989. In this article the development and introduction of medical audit in the two health care systems is described and its impact on the clinical autonomy of medical specialists gauged. It is concluded that in both countries external pressures seem to have been crucial in the ‘compulsory’ introduction of medical audit. Although there are differences in the organisation and culture of the medical profession in the two countries, in both countries medical audit turned out to be an instrument ‘controlled’ by the profession itself. The question whether medical audit is instrumental in preserving clinical autonomy has also been addressed. Our conclusion is that in its present form medical audit in the two countries has not been a threat to the clinical autonomy of the medical profession. At the same time it is clear that the study of one quality instrument is insufficient to draw conclusions about the development of clinical autonomy, let alone autonomy in general. Moreover, it remains to be seen how medical audit can survive alongside quality improvement mechanisms such as accreditation, certification, performance indicators and formal quality systems (ISO, EFQM) where hospital management executes more control. The history of medical audit in the Netherlands and England over the past 30 years does illustrate, however, the capability of the profession to maintain autonomy through re-negotiated mechanisms for self-control.     

An audit of the organisation of neonatal screening for phenylketonuria and congenital hypothyroidism in the Northern Region

Background

The objectives of the study were to identify whether all districts in the Northern Region had a system in place to ensure that all resident babies were being screened for phenylketonuria and congenital hypothyroidism and to identify potential delays which could influence whether a result was available on all residents before 28 days of age.

Methods

Lead professionals involved in the screening programmes were interviewed in 1993 in all 16 districts.Recommendations for improving the service were made to each district. Six months later a follow up telephone interview with the doctor involved in the screening programmes was undertaken to identify the changes that had been made in the service.

Results

In 1993 three districts made no attempt to match neonatal screening results to birth notifications. Of the 13 districts that undertook matching, two districts did no further checks to identify babies without a result and five districts undertook a check on a monthly basis only. Only six districts were, therefore, found to have a timely fail-safe system for checking that results were available for resident babies. In 1994, following recommendations to improve the timeliness and completeness of the screening programmes, all districts except-two had improved their fail-safe systems.

Conclusion

This multi-disciplinary regional audit resulted in organisational improvements to the neonatalmetabolic screening programmes in the Northern Region.