Effectiveness of internal quality assurance programmes in improving clinical practice and reducing costs

Rationale, aims and objectives  To assess the effectiveness of internal initiatives to improve quality as compared with external feedback, and as compared with a control group.
Method  Ten primary health centres were randomly selected from the centres in the Murcia's Region and were randomly assigned into three groups: G1 committed themselves to the improvement; G2 composed by two subgroups: with and without quality improvement (QI) activities – received external feedback; G3 received no intervention. Quality of common cold management was measured in a random sample of 50 patients per centre before and after interventions. Effect was assessed comparing criteria compliance and the cost of treatments for common cold in the three groups.
Results  G1 and G2 subgroup with internal QI improved significantly in all criteria, and in G1 average treatment cost decreased by 60% ( P  < 0.01). G3 improved only in one criterion. Estimated yearly savings in treatment costs for common cold, for a centre with internal QI, were €12 193.83 and it would be €1 817 004.65 for the 30 centres in the Region.
Conclusions  Internally assumed QI activities were significantly more effective than external feedback. Besides, the high cost of deficient quality provides a wide margin to invest with benefits in the promotion of internal QI programmes.     

Common data elements in radiologic imaging of traumatic brain injury

Traumatic brain injury (TBI) has a poorly understood pathology. Patients suffer from a variety of physical and cognitive effects that worsen as the type of trauma worsens. Some noninvasive insights into the pathophysiology of TBI are possible using magnetic resonance imaging (MRI), computed tomography (CT), and many other forms of imaging as well. A recent workshop was convened to evaluate the common data elements (CDEs) that cut across the imaging field and given the charge to review the contributions of the various imaging modalities to TBI and to prepare an overview of the various clinical manifestations of TBI and their interpretation. Technical details regarding state‐of‐the‐art protocols for both MRI and CT are also presented with the hope of guiding current and future research efforts as to what is possible in the field. Stress was also placed on the potential to create a database of CDEs as a means to best record information from a given patient from the reading of the images. J. Magn. Reson. Imaging 2010;32:516–543. © 2010 Wiley‐Liss, Inc.     

Coincidence of Congenital Agenesis of Left Lung and Common Atrium: A Very Rare Case

Pulmonary agenesis is characterized by undeveloped pulmonary vessels, bronchi as well as lung parenchyma and is a rare congenital anomaly with unknown etiology. It is usually diagnosed during childhood. Nearly, one third of these patients have concomitant congenital heart diseases. While more than 50% of these patients die before the age of 5 years, some other patients may be asymptomatic throughout their life. On the other hand, common atrium, another rare congenital anomaly, is characterized by complete absence of the atrial septum and is usually accompanied by atrioventricular valve malformations. An 18‐year‐old male presented with concomitant pulmonary agenesis and common atrium and had not undergone surgery due to high risk for mortality.     

The Training Effects of Solution-Focused Brief Counseling on Telephone-Counseling Volunteers in Taiwan

This study investigates the effects of a solution-focused brief counseling training program on telephone-counseling volunteers in Taiwan, with an emphasis on promoting their counseling self-efficacy. There were 14 hotline volunteers recruited from Taipei Lifeline, they received 24 hours of solution-focused brief counseling training over 3 days. All participants were required to fill in an open-ended course feedback form after the solution-focused brief counseling training program and 1 month later. We used open coding to analyze the verbal data from the course-feedback forms. There were 6 features contributing to the effect of this solution-focused brief counseling training program that were found: helpful solution-focused brief counseling skills, the usefulness of solution-focused brief counseling’s stages, the establishment of basic knowledge of solution-focused brief counseling, enhancing the confidence and stability of telephone-counseling volunteers, the positive influence on volunteers’ personal life, and effective ways to learn and master solution-focused brief counseling. Using the research results, this study discusses solution-focused brief counseling training as it relates to telephone-counseling volunteers and suggests further research directions in relevant fields.     

Variation in Female Reproductive Tract Morphology of the Common Bottlenose Dolphin (Tursiops truncatus)

Cetaceans exhibit vaginal folds, unusual protrusions of the vaginal wall into the vaginal lumen. Inconsistent terminology and a lack of anatomical landmarks in the literature have hindered comparative studies of the form and function of vaginal folds. Our objectives are to: (1) develop a standardized measurement protocol for the reproductive tracts of female cetaceans, (2) assess variation in morphometrics within the common bottlenose dolphin (Tursiops truncatus), and (3) determine if vaginal muscle is skeletal, and therefore of somatic origin in this species. We selected 15 measurements to characterize female reproductive tracts and evaluated variability using fresh or frozen‐thawed specimens from southeastern USA representing a range of sexual maturity states and reproductive states (n = 18 specimens). Presence of skeletal muscle and variation in the density of muscle banding were assessed using 90 histological samples (n = 5 specimens). Analyses of the gross morphological data revealed that the dolphins generally had one large vaginal fold that bisected the vaginal lumen. Vaginal morphology was similar for sexually mature and immature specimens and across reproductive states. The histological data revealed that the vaginal musculature consisted of smooth muscle, consistent with other mammals, leading us to conclude that vaginal contractions are likely under autonomic rather than somatic control. No differences were found in the density of smooth muscle banding among vaginal regions or sexual maturity states. Our systematic protocol lays the foundation for evaluating the function (e.g., sexual selection, natural selection) and evolution of vaginal folds. Anat Rec, 299:520–537, 2016. © 2016 Wiley Periodicals, Inc.     

REGENERATION BURNING WITH SEED TREES IN TWO BLACKBUTT (EUCALYPTUS PILULARIS Sm) FORESTS

Experimentation with regeneration burning on two contrasted blackbutt forests is described. The blackbutt forests on Fraser Island are developed on deep sands with little organic matter accumulation, and have a typically sclerophyllous understorey. Burning consistently resulted in excellent seedling establishment and survival. For optimum results timing may be varied within the period February to April depending on the maturity status of the available seed crop and on weather conditions.

Within the experimental area on Cooloolabin Forest, blackbutt occurs on a moderately heavy yellow podsolic soil with a much higher organic matter content, and away from the immediate environs of ridge crests a strong representation of rainfores: element species may be present. In a series of experimental burns, blackbutt seedling establishment largely failed on burnt sites but was recorded where soil had been heavily disturbed during site preparation.

The contrasted results on the two forests are discussed in terms of some recent concepts of the plant-soil relationship on eucalypt forest soils.