Using National Quality Forum Breast Cancer Indicators to Measure Quality of Care for Patients in an AVON Comprehensive Breast Center

Abstract: In April 2007, the National Quality Forum (NQF) endorsed the first nationally recognized hospital‐based performance measures for quality of care for breast cancer. The aim of this study was to measure quality of care at our AVON Center for Breast Care (AVONCBC) using these indicators. We retrospectively reviewed tumor registry and medical records of females under age 70 diagnosed with breast cancer in years 2005–2006. For patients diagnosed with hormone receptor negative breast cancer, 22 of 29 (75.9%) and 28 of 32 (87.5%) were considered for or received chemotherapy in 2005 and 2006, respectively. Of those patients, 21 of 29 (72.4%) and 24 of 32 (75.0%) were considered for or received chemotherapy within the NQF 4‐month period. For patients undergoing breast conserving surgery (BCS), 20 of 23 (86.9%) in 2005 and 37 of 39 (94.9%) in 2006 were referred for adjuvant radiation therapy. The proportion of patients who received radiation therapy within 1 year of diagnosis was 18 of 23 (78.2%) and 29 of 39 (74.4%) for diagnosis years 2005 and 2006, respectively. The vast majority of patients in our AVONCBC are referred to medical and/or radiation oncology for adjunctive therapy and about three‐fourths receive treatment compliant with the NQF QI. To increase our compliance rate, we are developing methods to improve access to the multiple disciplines in our AVONCBC. Using the NQF indicators serves to assess hospital performance at a systems‐level and as a useful method for tracking cancer quality of care.     

以点带面全面推行医院护理品管圈活动

目的 探索在医院护理工作中全面推行品管圈活动的方法,进一步促进护理质量持续改进.方法 在全院通过以点带面的方法,先对少数护理骨干进行培训,在试点科室率先开展后再逐步向全院铺开,品管圈推行委员会适时进行监督指导,全面推行“品管圈”活动.结果 全院开展的品管圈由21圈增至80圈;患者对护理工作的满意度由2008年的86.53％升至2012年的95.76％.结论 以点带面的方法能有效地在全院范围内全面推行品管圈活动,整体提升护理管理和护理服务质量.     

Semen Characteristics of 49 Fertile Males

We examined the semen characteristics of 49 men whose partners had conceived within the last 16 weeks. There was considerable variation in the semen results. The % of morphologically ideal forms and the absence of sperm bound antibodies appeared to be the two most important semen characteristics when assessing the fertilising potential of the samples. A large proportion of samples (70%) when compared to the WHO standards of normality, were classed abnormal, however, only 25% of the samples had greater than 2 abnormal characteristics. It is diagnostically more relevant to determine the number of abnormalities within a sample rather than categorising the sample as "normal" or "abnormal".     

Sperm Characteristics of Infertile and Fertile Zairian Men at the University Clinic of Mont Amba (Kinshasa)

The best interpretation of different sperm characteristics of zairian men consulting for infertility results from comparative studies with the sperm characteristics of fecund men. In this study four sperm variables permitted us to distinguish infecund from fecund men: sperm count, total sperm count, morphology and motility at the 24th-26th hour. No differences have been observed about aspect, odor, pH and volume of ejaculate.     

护理文书质量评价标准细则的制定及应用实践

目的探讨护理文书质量评价标准细则的制定方法和实施效果。方法回顾和分析既往护理文书记录缺陷,以护理文书书写规范及其相关的法律法规为指南,结合医院实际情况,针对性地制定护理文书质量检查评价标准细则(包括25条单项否决项目和40条评分细则);用定性定量评价法综合判断护理文书质量。结果 2005～2009年护理病历评分从88.20±7.18提高至97.80±2.15,重点病历护理文书合格率从95.83%提高至100%;优良率从55.56%提高至94.22%;单项否决病历从1.66%降至0。结论护理文书质量检查评价标准细则的制定和应用,可有效提高护理文书的质量。     

Public policy and quality of healthcare

Anaesthesiologists have long been interested in improving the quality of clinical care. However, clinical care is but one contributor to healthcare quality, which is influenced by a wide range of factors including health policy, health system funding, and organization. It is the interaction between these drivers and a nation's social and economic conditions (such as education and personal income) that determines the population's health. Whereas public debate has focused on healthcare funding, health systems face similar problems in achieving the best outcomes most affordably. The ability to measure outcome is limited in most jurisdictions, mainly by the lack of information systems. Nevertheless, public reporting of quality indicators has increased. Affordability is threatened by new technologies, population growth and ageing. This threat is creating renewed interest in prevention and population health, particularly through the use of leading indicators. With this interest in population health, the role and education of physicians may need to change.     

丙泊酚和七氟醚对术后睡眠质量的影响

目的观察丙泊酚或七氟醚对全麻术后睡眠质量及褪黑素分泌的影响。方法选择行妇科腹腔镜手术的患者120例,年龄18～49岁,BMI 18.5～25 kg/m~2,ASAⅠ或Ⅱ级,采取随机数字表法分为两组(n=60):丙泊酚组(P组)和七氟醚组(S组)。两组采用相同药物麻醉诱导; P组麻醉维持采用丙泊酚靶控输入4~12 mg·kg~(-1)·h~(-1),间断静注舒芬太尼0.2μg/kg、顺阿曲库铵0.1 mg/kg,维持BIS 40～60;S组麻醉维持采用七氟醚吸入MAC 1.0～1.3,间断静注舒芬太尼0.2μg/kg、顺阿曲库铵0.1 mg/kg,维持BIS 40~60。观察术前1 d及术后1、3、7、30 d患者的匹兹堡睡眠质量指数(PSQI)及晨尿硫酸褪黑素浓度。结果与术前比较,术后1、3 d P组PSQI明显升高,术后1 d S组PSQI明显升高(P0.05)。术后3 d S组的PSQI明显低于P组(P0.05)。与术前比较,术后1、3 d P组褪黑素浓度明显降低(P0.05);术后1 d S组褪黑素浓度明显降低(P0.05)。术后3 d S组褪黑素浓度明显高于P组(P0.05)。结论丙泊酚和七氟醚对全麻术后睡眠质量都有明显影响,但七氟醚对睡眠质量的影响较丙泊酚短暂。     

消毒供应中心设置总质检班对物品清洗消毒灭菌质量的影响

目的探讨消毒供应中心设立总质检班次对提高各种污染物品清洗和灭菌质量的作用。方法 2009年10月始重新调整班次职责,设置专职总质检班,依据卫生部对消毒供应中心清洗消毒灭菌质量的规定,建立"日常监测记录表"对污染器械、物品清洗质量进行监测并记录,以确保清洗、消毒、灭菌各环节的工作质量,为全院提供合格的无菌产品。结果 2009年10月至2012年3月设立总质检班后污染器械清洗不合格数下降;无菌物品采样细菌培养均为无菌生长,100%合格。结论总质检班护士每日实行常态化检查督促,及时发现并纠正清洗环节的问题,协助护士长做好难点、弱点、重点的质量管理,能在第一时间纠正偏差,使消毒供应中心器械清洗工作质量得以及时有效的持续改进。     

Quality registry improves the data of chronic ulcers: Validation of Tampere Wound Registry

Quality registries are potential tools for improving health care documentation, but the quality and completeness of each registry should be ensured. This study aimed to evaluate the completion rate (completeness) and accuracy of data, first contact-to-registration time (timeliness), and case coverage of the Tampere Wound Registry (TWR) to assess whether it can be reliably used in clinical practice and for research purposes. Data from all 923 patients registered in the TWR between 5 June 2018 and 31 December 2020 were included in the analysis of data completeness, while data accuracy, timeliness and case coverage were analysed in those registered during the year 2020. In all analyses values over 80% were considered good and values over 90% excellent. The study showed that the overall completeness of the TWR was 81% and overall accuracy was 93%. Timeliness achieved 86% within the first 24 h, and case coverage was found to be 91%. When completion of seven selected variables was compared between TWR and patient medical records, the TWR was found to be more complete in five out of seven variables. In conclusion, the TWR proved to be a reliable tool for health care documentation and an even more reliable data source than patient medical records.     

“优质护理服务示范工程”活动在三甲医院的实践与成效

目的探讨创建、推进及进一步深化优质护理服务的举措对提高护理质量、保障患者安全,提高患者和护士满意度的作用。方法完善支持系统,合理定编设岗,规范岗位管理,建立长效激励机制,强化护士培训,改革功能制护理为＂人文关怀护理＂为主题的责任制整体护理,开展延续护理服务,改进护理质量管理模式以保障患者安全,引入第三方评价机制客观评价患者满意度。结果2010~2013年医院护理三级质控结果、第三方电话调查出院患者满意度、护士工作满意度均稳步提高;护理差错发生率逐年下降;护理工作获得社会和各级政府的肯定和赞誉。结论 ＂优质护理服务示范工程＂活动对提高护理质量、保障患者安全,提高患者满意度和护士工作满意度,提升医院美誉度起到积极的推动作用。     

Quality measurement affecting surgical practice: Utility versus utopia

The Triple Aim: improving healthcare quality, cost and patient experience has resulted in massive healthcare “quality” measurement. For many surgeons the origins, intent and strengths of this measurement barrage seems nebulous-though their shortcomings are noticeable.This article reviews the major organizations and programs (namely the Centers for Medicare and Medicaid Services) driving the somewhat burdensome healthcare quality climate. The success of this top-down approach is mixed, and far from convincing. We contend that the current programs disproportionately reflect the definitions of quality from (and the interests of) the national payer perspective; rather than a more balanced representation of all stakeholders interests-most importantly, patients' beneficence. The result is an environment more like performance management than one of valid quality assessment. Suggestions for a more meaningful construction of surgical quality measurement are offered, as well as a strategy to describe surgical quality from all of the stakeholders' perspectives. Our hope is to entice surgeons to engage in institution level quality improvement initiatives that promise utility and are less utopian than what is currently present.     

Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the Republic of Korea

Pressure ulcers result in financial losses, including the cost of unnecessary medical expenses because of extended hospital stays, treatment, and examination. This was a retrospective, observational, methodological study to develop quality indicators related to pressure ulcer development and validate risk adjustment factors for pressure ulcer development. We performed a literature review to develop risk adjustment factors, and an expert group performed a content validity test. To validate risk adjustment factors for pressure ulcer development using electronic medical records, 127 patients admitted to a long-term care hospital in South Korea from June to September 2015 were enrolled in the study. Pressure ulcer risk factors were peripheral vascular disease, end-stage disease, past pressure ulcer history, high risk group for pressure ulcer development, fever, haemoglobin, and albumin (all P < 0.05); only albumin (odds ratio: 0.210, P < 0.001) was significantly associated with pressure ulcer development as an independent risk factor. Further research with a large sample size is needed for the validation of risk adjustment factors. Risk-adjusted quality indicators for pressure ulcer development can be used to evaluate the quality of nursing care and compare outcomes after preventive pressure ulcer care activities or between long-term care hospitals.     

绝经后女性骨密度和生活质量、睡眠质量及疲劳之间相关性研究

目的 本研究旨在探讨绝经后妇女的生活质量(quality of life,QOL)、睡眠质量和疲劳水平与骨密度(bone mineral density,BMD)之间的关系。方法 本研究纳入113例无骨折的绝经后骨质疏松症(postmenopausal osteoporosis,PMO）患者,172例骨量减少患者和102例BMD正常的患者。疼痛、生活质量、睡眠质量和疲劳的严重程度使用视觉模拟量表(VAS)、欧洲骨质疏松症基金会QOL问卷(QUALEFFO-41)、匹兹堡睡眠质量指数(PSQI)和个人力量(CIS)问卷检查表评估。结果 在VAS和QUALEFFO-41总分方面,三组间差异无统计学意义 (P＞0.05)。另一方面,与BMD正常组相比,PMQ和骨量减少组的PSQI和CIS总分比较差异具有统计学意义(分别为P = 0.015和0.007)。结论 QOL、睡眠质量和疲劳对PMO或骨量减少的女性影响显著。     

眼科病房护理质量评价指标的构建

目的构建眼科病房护理质量评价指标。方法结合文献初步构建眼科病房护理质量评价指标框架,形成专家咨询问卷,应用德尔菲专家咨询法对23名眼科医疗和护理专家进行2轮咨询,确定眼科病房护理质量评价指标,最后利用层次分析法设置各项指标权重。结果构建的眼科病房护理质量评价指标包括3个一级指标、11个二级指标、48个三级指标。两轮专家咨询的积极系数均为100%,权威系数分别为0.859和0.879;协调系数分别为0.256和0.224,各级指标的层次单排序及总排序一致性比率均0.1,具有满意的一致性检验结果,说明咨询结果和权重设置比较可靠。结论构建的指标符合眼科病房专科特色、各指标间层次分明、临床操作性强,可作为眼科病房护理质量的评价工具。     

Annual Scientific Meeting of The College of Surgeons of Hong Kong: A 5‐year audit

Objective : To examine the quality of surgical research in Hong Kong by auditing the results of abstracts submitted for annual scientific meetings held by The College of Surgeons of Hong Kong. Materials and Methods : From 1993 to 1998, all abstracts submitted for the meetings were evaluated and classified according to the hierarchy of evidence. The institutions of the presenting authors were recorded. Ovid MEDLINE search was then conducted to determine whether the abstracts were subsequently published in an indexed medical journal. Results : In total, 165 abstracts were submitted for the meeting in a 5‐year period. Randomized controlled trials constituted 12% of this research. Participation from community surgeons showed an encouraging trend from 17% in 1993 to 63% in 1998. In the first 4 years, 38% of abstracts were of publishable quality. More than half of the prospective randomized controlled trials were selected for presentation and subsequently published. Those abstracts selected for presentation have a higher chance of being published subsequently (P < 0.03). Conclusions : The randomized controlled trial remains a powerful research tool but is scarce in Hong Kong surgical research.