Using lot quality assurance sampling to improve immunization coverage in Bangladesh.

OBJECTIVE: To determine areas of low vaccination coverage in five cities in Bangladesh (Chittagong, Dhaka, Khulna, Rajshahi, and Syedpur). METHODS: Six studies using lot quality assurance sampling were conducted between 1995 and 1997 by Basic Support for Institutionalizing Child Survival and the Bangladesh National Expanded Programme on Immunization. FINDINGS: BCG vaccination coverage was acceptable in all lots studied; however, the proportion of lots rejected because coverage of measles vaccination was low ranged from 0% of lots in Syedpur to 12% in Chittagong and 20% in Dhaka's zones 7 and 8. The proportion of lots rejected because an inadequate number of children in the sample had been fully vaccinated varied from 11% in Syedpur to 30% in Dhaka. Additionally, analysis of aggregated, weighted immunization coverage showed that there was a high BCG vaccination coverage (the first administered vaccine) and a low measles vaccination coverage (the last administered vaccine) indicating a high drop-out rate, ranging from 14% in Syedpur to 36% in Dhaka's zone 8. CONCLUSION: In Bangladesh, where resources are limited, results from surveys using lot quality assurance sampling enabled managers of the National Expanded Programme on Immunization to identify areas with poor vaccination coverage. Those areas were targeted to receive focused interventions to improve coverage. Since this sampling method requires only a small sample size and was easy for staff to use, it is feasible for routine monitoring of vaccination coverage.     

Does formal approval of educational courses guarantee quality?

OBJECTIVES: To assess whether organizers of continuing medical education for general practitioners used principles of adult learning when designing their meetings. DESIGN: A questionnaire study of organizers of approved educational meetings for general medical practitioners (GPs). SETTING: South East Scotland. SUBJECTS: Organizers of educational meetings. RESULTS: Organizers often failed to use principles of adult learning in the construction of their meetings. Organizers with prior training in medical education were, however, significantly more likely to adopt these principles. CONCLUSIONS: Given concern about the quality of educational meetings as assessed by their educational impact, formal approval is not an indicator of quality. Postgraduate bodies should use explicit criteria both in the development and approval of continuing educational meetings.     

Measuring energy response for RTQA Radiochromic film to improve quality assurance procedures

RTQA Gafchromic, radiochromic film is assessed for its radiation energy dependence in photon beams ranging from superficial to megavoltage energies. RTQA radiochromic film has uses in radiation quality assurance procedures due to its auto development and visualisation properties. These properties allow for immediate comparison of x-ray alignment and coincidence not available with radiographic films. Results show that the RTQA film produces an energy dependant darkening to x-rays which results in x-ray energies of 69 keV photon equivalent (150 kVp) to produce 2.14 times the optical density to dose ratio of a 6MV x-ray beam. The following dose ratio's (normalized to 1 at 150 kVp) provide the same net optical density change for RTQA film. 1.47-50 kVp : 1.21-75 kVp : 1.09-100 kVp : 1.01-125 kVp: 1.00-150 kVp : 1.03-200 kVp : 1.07-250 kVp : 2.14-6 MVp : 2.14 10 MVp. Although the film is not designed to be used as a quantitative measure of radiation it is still useful to know its energy response at differing x-ray energies to expose the film to the appropriate dose to provide optimal darkening characteristics for a given QA test at the appropriate energy. Our results have shown that a 0.3 optical density change with RTQA film provides a colour change level useable for accurate alignment procedures     

军队药品仪器检验所药检业务质量管理系统的研究开发

根据药品仪器检验所药检业务工作的质量管理要求,从软件工程角度介绍药检业务质量管理系统的实现方法。应用结果表明,本方法能很好地适用于药检常规工作,有效控制全部质检过程的质量,实现检验数据的科学性和正确性。     

An evaluation of lot quality assurance sampling to monitor and improve immunization coverage

Quality assurance sampling techniques with small samples offer a method of monitoring performance of health services in small health areas, and of identifying areas with poor performance in which remedial actions need to be targetted. Lot Quality Assurance Sampling methods were used to assess the coverage resulting from three immunization campaigns in rural and urban areas in the mountains of Peru. Application of these methods in 12 health areas with populations of 538 to 15 780 by Ministry of Health personnel proved feasible and could be used to identify areas with poorer vaccination coverage. Further discussion about possible reasons for poor coverage led to corrective actions in these health areas and an improvement in overall coverage from 78% to 88% in a three-month period. These quality assurance methods are a useful supervisory tool to improve health programme performance.     

Implementation of a quality assurance instrument (Preffi 1.0) to improve the effectiveness of health promotion in The Netherlands

This paper describes the design and outcomes of implementing Preffi 1.0, a quality assurance instrument for health promotion (HP) interventions, among Dutch HP professionals. The Preffi instrument promotes a systematic way of working that is driven by evidence, which is expected to lead to high-quality projects and better outcomes. Implementation interventions included nationwide activities aimed at awareness of and positive attitudes toward the instrument, and an intensive 5-day programme for a self-selected sample aimed to enhance self-efficacy and use. Effects of the nationwide activities were measured in two independent representative samples of Dutch HP professionals (N = 120 and 316, respectively), while a cohort design was used to measure the effects of the training programme. The Theory of Planned Behavior was used to guide both the interventions and the study. While the nationwide implementation activities raised awareness of Preffi and contributed to a more positive attitude towards the instrument, a significant increase in its use required a more intensive training programme. Attitude was especially influenced by the perceived value and necessity of a systematic approach, and the usefulness of the instrument. Health managers in The Netherlands failed to stimulate a systematic implementation of Preffi, even though the embeddedness of Preffi in the quality system of a HP team was found to be a major predictor of its implementation. The study showed that determinants of the implementation stages vary by stage.     

The contribution of quality assurance to national veterinary organizations in developing countries: the case of Africa

Food safety has, within a few years, become an essential concern for producers and consumers, especially in Western countries, but also in Africa. African countries are increasingly aware of the issues involved, and of the need to react and to implement appropriate strategies in order to avoid public health risks and obstacles to their export markets. Most countries recognise that the overall sanitary quality of foodstuffs produced and distributed in the region must be improved. The OIE (World organisation for animal health) recommends that Veterinary Services attempt to improve the safety of animal products by establishing a framework of risk management, throughout the food chain, which will reduce risks by eliminating or controlling hazards during the first stages of processing. The activities of Veterinary Services, from the organisational, technical, financial and human resource points of view, must be guided by quality assurance considerations, pursuant to the standards laid down in the Terrestrial Animal Health Code of the OIE. The quality of Veterinary Services depends therefore on a range of factors, including fundamental ethical, organisational and technical principles. It goes without saying that ethical principles cannot be effective unless the Veterinary Services have the resources necessary to reinforce them. The implementation of quality assurance by the Veterinary Services in developing countries, and particularly in Africa, will promote better organisation, effective use of limited resources, and professionalism in decision-making. It will also allow for better access to international markets thanks to certification recognised by the OIE and the international community.     

Quality improvement: a new approach to quality assurance

The use of programs to help administrators and staff of health care facilities assess and monitor the quality of services provided is not new. For years, quality assurance (QA) programs have provided generalized sets of standards against which hospitals and other agencies measure their performance. Recently, there has been a trend towards quality improvement (QI) programs which advocate a more proactive response to quality concerns and emphasize a decentralized use of assessment and evaluation findings to continuously improve the care provided. QI is recognized as holding great opportunities for the enhancement of professional nursing practice and the improvement of patient care. In this paper, the process and design of QI was described and the advantages of this approach were recognized.     

Impact on diarrhoeal illness of a community educational intervention to improve drinking water quality in rural communities in Puerto Rico

Background  

Waterborne disease is a major risk for small water supplies in rural settings. This study was done to assess the impact of an educational intervention designed to improve water quality and estimate the contribution of water to the incidence of diarrhoeal disease in poor rural communities in Puerto Rico a two-part study was undertaken.     

Using problem-based learning to improve educational outcomes

As the health care industry and the occupational therapy profession experience rapid change and growth, our professional preparation and continuing education must prepare graduates and therapists for an evolving practice environment. By exploring and evaluating alternative teaching methods and their impact on educational outcomes, occupational therapy educators demonstrate their commitment to improving the quality of student education. This article proposes that the traditional educational paradigm prepared clinicians for the old health care environment, and that problem-based learning (PBL) is an educational strategy that could prepare occupational therapists for success in a new practice environment that values cost, quality, and customer satisfaction. The PBL approaches used by various international occupational therapy educators are reviewed to highlight the strategies that have been implemented to achieve educational objectives that parallel the requirements of this new practice environment. Copyright © 1996 Whurr Publishers Ltd.     

Development of indicators for quality assurance in public health medicine.

OBJECTIVES--To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN--Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING--Five Scottish health boards. SUBJECTS--Public health physicians in the five health boards. MAIN MEASURES--Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS--Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION--Measurable indicators of quality for public health medicine can be developed.     

Using decision analysis to assess the quality of quality assurance

Quality assurance is rapidly encroaching on the fields of epidemiology and infection control. If we are to lead this most recent revolution in medical care, we must ensure that our approach is structured, that we reassess our goals and methods regularly and that we achieve the maximal benefit from the resources we consume. According to Colloton, "Unless refined or replaced, the unsophisticated methodologies now emerging on several fronts will be used, with or without our endorsement, to assess the quality of care rendered within all of medical practice."