Browsing by Subject "Quality"
Now showing items 1-18 of 18
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(2023)BACKGROUND: Seriously injured patients may benefit from prehospital interventions provided by a critical care physician. The relationship between case volume and outcome has been established in trauma teams in hospitals, as well as in prehospital advanced airway management. In this study, we aimed to assess if a volume-outcome relationship exists in prehospital advanced trauma care.METHODS: We performed a retrospective cohort study using the national helicopter emergency medical services database, including trauma patients escorted from scene to hospital by a helicopter emergency medical services physician during January 1, 2013, to August 31, 2019. In addition, similar cases during 2012 were used to determine case volumes. We performed a multivariate logistic regression analysis, with 30-day mortality as the outcome. Age, sex, Glasgow Coma Scale, shock index, mechanism of injury, time interval from alarm to the patient and duration of transport, level of receiving hospital, and physician's trauma case volume were used as covariates. On-scene times, interventions performed, and status at hospital arrival were assessed in patients who were grouped according to physician's case volume.RESULTS: In total, 4,032 escorted trauma patients were included in the study. The median age was 40.2 (22.9-59.3) years, and 3,032 (75.2%) were male. Within 30 days, 498 (13.2%) of these patients had died. In the highest case volume group, advanced interventions were performed more often, and patients were less often hypotensive at handover. Data for multivariate analysis were available for 3,167 (78.5%) of the patients. Higher case volume was independently associated with lower mortality (odds ratio, 0.59; 95% confidence interval, 0.38-0.89).CONCLUSION: When a prehospital physician's case volume is higher in high-risk prehospital trauma, this seems to be associated with more active practice patterns and significantly lower 30-day mortality. The quality of prehospital critical care could be increased by ensuring sufficient case volume for the providers of such care. (J Trauma Acute Care Surg. 2023;94: 425-432. Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc.) LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.
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(2013)A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia. Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes. 316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. similar to 6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. similar to 20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg. Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery. This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed.
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(2022)Quality factors are the subject of increasing interest in the research and practice of early childhood education and care (ECEC). The purpose of the article is to emphasize the importance of the children's voice in relation to the quality of ECEC. This article focuses on children's negative experiences of ECEC as they can be used to improve services and increase children's wellbeing. The data was collected by means of a questionnaire from 2500 children aged 2-6 years (girls 50.4%) in Finland. The data was analysed using qualitative and quantitative content analysis. According to the results, children mentioned both structural and process factors. Peer interaction among children was mentioned the most when referring to negative experiences in ECEC. We conclude that children's negative experiences provide an opportunity for ECEC professionals to support children's resilience and a sense of belonging, which are important elements in the process quality of ECEC.
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(2023)This paper develops, tests and validates a Multi-sensory Public Participation GIS (MSPPGIS) method combining the qualities of soundscapes and landscape values mapping. The development of the method involved: a) Public Participation GIS survey design; b) three-phase evaluation of survey addressing analytical, applicability and usability criteria; c) survey refinement; d) sampling and data collection, and; e) spatial data analysis. The analysis consisted of hotspot mapping involving Kernel Density Estimation, spatial overlap assessment using Jaccard coefficients and value compatibility analysis showing the level of spatial compatibility between positive landscape values and positive and negative soundscapes. Results indicated very low to low spatial overlap between the different landscape values and pleasant/unpleasant sound hotspots, suggesting that landscape values do not necessarily reflect sonic perception of urban green and blue spaces. Pleasant and unpleasant sounds were located closer to home than landscape values (except for urban life values), indicating that respondents' soundscape 'cognitive map' is smaller in spatial range. The MSPPGIS method enables the elicitation of a more dynamic and diverse set of sounds compared to previous soundscape mapping which tend to focus on 'noise' instead of multiple experiences of different sounds. Also, the combination of landscape values and soundscapes in MSPPGIS provides for a more integrated assessment of 'where' and 'how' to design urban green infrastructure.
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(2018)Official food control inspections (official inspections) of food establishments and third party audits of food safety management systems (FSMSs) based on international standards both focus on food safety, which has raised discussions on whether FSMSs and their audits could reduce official inspections in food establishments. The aim of this study was to investigate whether the findings of official inspections and third party audits in food establishments are in alignment and to survey the inspectors' and food business operators' (FBOs) perceptions of official inspections and audits. The results can be used in planning the use of audit results as part of official food control. The results show that both inspectors and auditors recognized non-compliances/non-conformities, but significant discrepancies between the findings of official inspections and audits existed, making the utilization of audit results challenging. However, most of the FBOs and inspectors agreed that official inspections and audits overlap, and the majority also agreed that audits of a certified FSMS could under certain circumstances reduce official inspections. (C) 2017 Elsevier Ltd. All rights reserved.
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(2018)Background ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Melanoma: essential requirements for quality care: Melanoma, the most-deadly skin cancer, is rising in incidence among fair-skinned people in Europe. Increasing complexity of care for advanced disease in clinical areas such as staging and new therapies requires attention to a number of challenges and inequalities in a diverse patient group. Care for advanced melanoma must only be carried out in, or in collaboration with, specialist melanoma centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis to treatment and follow-up, to improve survival and quality of life for patients. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma.
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(2018)Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Oesophageal and gastric: essential requirements for quality care: Oesophageal and gastric (OG) cancers are a challenging tumour group with a poor prognosis and wide variation in outcomes among European countries. Increasing numbers of older people are contracting the diseases, and treatments and care pathways are becoming more complex in both curative and palliative settings. High-quality care can only be a carried out in specialised OG cancer units or centres which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Such units or centres are far from universal in all European countries. It is essential that, to meet European aspirations for comprehensive cancer control, healthcare organisations implement the essential requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer.
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(2020)Background ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. Prostate cancer Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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(2017)Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Sarcoma: essential requirements for quality care Sarcomas - which can be classified into soft tissue and bone sarcomas - are rare, but all rare cancers make up more than 20% of cancers in Europe, and there are substantial inequalities in access to high-quality care. Sarcomas, of which there are many subtypes, comprise a particularly complex and demanding challenge for healthcare systems and providers. This paper presents essential requirements for quality cancer care of soft tissue sarcomas in adults and bone sarcomas. High-quality care must only be carried out in specialised sarcoma centres (including paediatric cancer centres) which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis and follow-up, to treatment, to improve survival and quality of life for patients. Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for soft tissue sarcomas in adults and bone sarcomas. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams is guaranteed to all patients with sarcoma. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.
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(2023)Background: Total occlusion of the iliac-femoral tract can cause a variety of life-limiting symp-toms ranging from mild claudication to chronic limb-threatening ischemia. Efforts should be made to revascularize the symptomatic ischemic limb. Currently there are different options in the vascular surgeon's armamentarium to achieve this. The aim of the study was to verify the feasibility and outcomes of inflow hybrid revascularizations combining femoral endarterectomy and recanalization of iliac atherosclerotic occlusion. Methods: A retrospective review was conducted of all hybrid revascularizations involving femoral endarterectomy and endovascular treatment of iliac occlusion. The operations were per-formed in Helsinki University Hospital between January 2013 and December 2018. First, infor-mation about patients' baseline characteristics, indications and details of surgery and technical/ hemodynamic success, and complications and mortality were obtained from the vascular regis-try and patients records. Secondarily, a prospective assessment of mid-term patency was per-formed through follow-up in November 2019. Immediate technical success, 30-day mortality, complications, and patency were considered major outcomes. Hemodynamic improvement, amputation rate, and overall mortality were also assessed.Results: One hundred sixty three iliofemoral occlusions were performed on 147 patients during the period studied. Six patients (3.6%) had infrarenal aortic occlusion, 86 (52.7%) had common iliac, and 128 (78.5%) had external iliac artery occlusion. Technical success rate was 88.3% (n = 144 occlusions recanalized). Primary technical success was somewhat lower in lesions > 90 mm (87.1%) compared to lesions shorter than 90 mm (95.7%; c2 P = 0.06). Iliac stent was deployed in 141 (94.6%) cases, 51 (34.3%) of which were covered stents. Significant resid-ual stenosis remained in 1.2% of cases. Median operative time was 4 hr 34 min (interquartile range 2 hr 43 min) and median estimated blood loss was 743 mL (interquartile range 500 mL). Five patients (3.0%) developed a deep groin infection and 12 (8.1%) suffered any ma-jor cardiovascular event or stroke perioperatively. Primary patency at 30 day, 6 months, 1 year, and 2 years was 98.7%, 98.1%, 96.6%, and 93.7%, respectively. Hemodynamic success was documented in 107 patients (73%). By the end of the follow-up, 7 iliofemoral tracts (11.1%) reoc-cluded, 2 limbs (1.2%) required amputation, and 50 patients (3.0%) died. Conclusions: Good immediate success rate and mid-term patency can be achieved by hybrid revascularization of iliofemoral occlusions. Careful patient selection is mandatory because this pop-ulation often suffers from universal atherosclerosis. The involvement of the aorta represents a sig-nificant determinant of worse long-term patency, although it did not preclude technical success.
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(2023)We have studied the changes in the aromatic nature of two cyclobutadiene (C4H4) molecules on decreasing the intermolecular distance and approaching the cubane structure in a face-to-face fashion. The analysis based on the calculations of the magnetically induced current density and the induced magnetic field shows that the aromaticity of the two C4H4 rings changes from a strongly antiaromatic character at long distances to an aromatic transition state of stacked C4H4 rings at intermediate internuclear distances when approaching the antiaromatic state of cubane.
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(2021)Background: No data are available on the quality of targeted temperature management (TTM) provided to out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. Methods: Post hoc analysis of the TTH48 study (NCT01689077), which compared the effects of prolonged TTM at 33 degrees C for 48 h to standard 24-h TTM on neurologic outcome. Admission temperature, speed of cooling, rewarming rates, precision (i.e. temperature variability), overcooling and overshooting as post-cooling fever (i.e. >38.0 degrees C) were collected. A specific score, ranging from 1 to 9, was computed to define the "quality of TTM". Results: On a total of 352 patients, most had a moderate quality of TTM (n = 217; 62% - score 4-6), while 80 (23%) patients had a low quality of TTM (score 1-3) and only 52 (16%) a high quality of TTM (score 7-9). The proportion of patients with unfavorable neurological outcome (UO; Cerebral Performance Category of 3-5 at 6 months) was similar between the different quality of TTM groups (p = 0.90). Although a shorter time from arrest to target temperature and a lower proportion of time outside the target ranges in the TTM 48-h than in the TTM 24-h group, quality of TTM was similar between groups. Also, the proportion of patients with UO was similar between the different quality of TTM groups when TTM 48-h and TTM 24-h were compared. Conclusions: In this study, high quality of TTM was provided to a small proportion of patients. However, quality of TTM was not associated with patients' outcome.
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(2019)In this article, sustainability is considered as a subset of quality and as a challenging target area to innovations for the quality of society. Quality and innovation are conceptually age-old issues and significant business factors today. They represent two distinct professional disciplines, which have a lot of meaningful connections. However, their formal definitions have not been commonly established and neither have their relationships been clearly recognized. Hence in this article, their practical definitions and interactivity are discussed and highlighted regarding individuals, organizations and society. Also, the relatively new concept of sustainability is not understood unambiguously nor practiced consistently. The purpose of the article is to clarify the concepts and to present a comprehensive approach to the theory of sustainability through interactive quality and innovation management for enhancing the quality of society. Organizations play an important role in striving for sustainable development. Quality and innovation management should be considered in an integrated way in the organizations, and they should cover the area of sustainability. In the whole society, sustainability is realized through diffusion. National and regional initiatives have been launched to promote quality, innovation and sustainability measures. Ultimately, quality and innovation are based on human creativity, activity, and perception. In this article, discipline-dedicated research and development of quality and innovation, interdisciplinary collaboration and multidisciplinary integrative realization of the specific organizational solutions are highlighted and conceptualized. The ideas presented are based on the long-term practical experience of the authors and our studies from different perspectives and critical inference. When considering practical events, objects and problems, we have combined sound and justified conceptual thinking in creating objective knowledge as the foundation for the efficient doing and effective methodological means. (C) 2018 Elsevier Ltd. All rights reserved.
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(2023)An extensive examination of the external and internal morphological characters of the genus Nychiodes shows that “Nychiodes” tyttha Prout, 1915 is incorrectly placed in this genus. The systematic position of this species was investigated by using a multigene analysis, including one mitochondrial and up to nine protein-coding nuclear gene regions, and morphological characters. These results support a re-classification of this species as Aphilopota tyttha, comb. nov. A re-description supported by illustrations of morphological characters for A. tyttha is provided.
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(BioMed Central, 2019)Abstract Background The use of guidelines has shown to improve clinical practice process and structure of health care, but health care providers don’t always use and keep up-to-date with the new clinical practice guidelines. Nurses’ attitudes towards guidelines have shown to be the most frequently identified factor affecting their actual use of clinical practice guidelines, but no instruments for measuring it are available in China. There are scales validated in the western countries, but there is no information about their validity in Chinese health care. The purpose of this study is to test the validity and reliability of Chinese Attitudes towards guidelines - scale for nurses. Methods The study was conducted from April to July 2017. The Attitudes towards guidelines scale was translated into Chinese with forward-backward translation method and a questionnaire survey was conducted. Eight hundred randomly selected nurses (final N = 768) from Geriatrics, Internal medical and Rehabilitation departments of 16 hospitals were drawn in Sichuan province, China. Construct validity was evaluated by exploratory and confirmatory factor analysis, and reliability was assessed by test-retest reliability (represented by intra class correlation) and internal consistency (expressed by Cronbach’s coefficients). The test-retest reliability was examined with a sample of 32 clinical nurses who filled out the questionnaire 14 days after the first survey. Results Exploratory factor analysis supported a four-factor model for the Chinese version of the scale. Confirmatory factor analysis indicated that the hypothetical four-factor model fitted the data relatively well. The intra class correlation coefficient was 0.85 (95%CI, 0.68–0.93) and the Cronbach’s alpha values for the four subscales ranged from 0.645 to 0.912. Conclusions The results support the acceptable level of validity and reliability of the Chinese version of Attitudes towards guidelines scale, which can be used to assess nurses’ attitudes towards guidelines in China. Future testing for the Chinese version of Attitudes towards guidelines scale needs to be carried out to see whether these results are generalizable to other professionals and occupational groups and to be used to revise attitudes towards specific guidelines in China.
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(Helsingin yliopisto, 2023)Strawberry is one of the most rapidly deteriorating fresh produce and thus prone to significant losses during the whole supply chain. Temperature management is a key factor to retain the quality and to prolong the shelf-life. Cooling facilities may not be available in all farms, exposing strawberries to delayed cooling and subsequent early spoilage. Thus, the main aim was to find out how different temperature profiles and cooling methods affect the quality and shelf-life of four Finnish strawberry cultivars and what kind of differences there are between the cultivars against delayed cooling. Samples of four strawberry cultivars (Honeoye, Rumba, Lumotar and Polka) were acquired from local farms and stored in three different temperature profiles and monitored and tested daily for 10 days for marketability, calyx freshness, firmness, total soluble solids (Brix), weight loss and smell. The results indicated that rapidly started cooling was beneficial for all studied cultivars and delayed the spoilage especially effectively for Polka and Honeoye. The effect was only minor for Rumba and moderate for Lumotar. The Brix values varied greatly by cultivar as Polka and Lumotar had higher values compared to Honeoye and Rumba, but the temperature profiles did not influence them. Tunnel cooling helped to prevent early spoilage only slightly compared to room cooling. Among these cultivars, Rumba appears to be best suited for supply chains where temperature management can’t begin immediately after picking, whereas Polka can only be recommended if rapidly started cooling is possible at the farm.
