Search results for: clinical quality

Authors: Laura Mion

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The implementation of quality management systems in higher education in different countries is determined by national regulatory choices and supranational indications (such as the European Standard Guidelines for Quality Assurance). The effective functioning and transformative capacity of these quality management systems largely depend on the organizational context in which they are applied and, more specifically, on the culture of quality developed in single universities or in single countries. The University's concept of quality culture integrates the structural dimension of QA (quality management manuals, process definitions, tools) with the value dimension of an organization (principles, skills, and attitudes). Within the EHEA (European Higher Education Area), countries such as Portugal, the Netherlands, the UK, and Norway demonstrate a greater integration of QA principles in the various organizational levels and areas of competence of university institutions or have greater experience in implementation or scientific and political debate on the matter. Therefore, the study, through an integrative literature review, of the quality management systems of these countries is aimed at determining a framework of the culture of quality, helpful in defining the elements which, both in structural-organizational terms and in terms of values and skills and attitudes, have proved to be factors of success in the effective implementation of quality assurance systems in universities and in the countries considered in the research. In order for a QA system to effectively aim for continuous improvement in a complex and dynamic context such as the university one, it must embrace a holistic vision of quality from an integrative perspective, focusing on the objective of transforming the reality being evaluated.

Keywords: higher education, quality assurance, quality culture, Portugal, Norway, Netherlands, United Kingdom

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Authors: Sadaf Ilyas, Saba Riaz

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The extensive use of antibiotics has led to increases emergence of antibiotic-resistant organisms. Pseudomonas is a notorious opportunistic pathogen involoved in nosocomial infections and exhibit innate resistance to many antibiotics. The present study was conducted to assess the prevalence, levels of antimicrobial susceptibility and resistance mechanisms of Pseudomonas. A total of thirty clinical strains of Pseudomonas were isolated from different clinical sites of infection. All clinical specimens were collected from Chughtais Lahore Lab. Jail road, during 8-07-2010 to 11-01-2011. Biochemical characterization was done using routine biochemical tests. Antimicrobial susceptibility was determined by Kirby-Baeur method. The plasmids were isolated from all the strains and digested with restriction enzyme PstI and EcoRI. Transfer of Multi-resistance plasmid was checked via transformation and conjugation to confirm the plasmid mediated resistance to antibiotics. The prevalence of Pseudomonas in clinical specimens was found out to be 14% of all bacterial infections. IPM has shown to be the most effective drug against Pseudomonas followed by CES, PTB and meropenem, wheareas most of the Pseudomonas strains have developed significant resistance against Penicillins and some Cephalasporins. Antibiotic resistance determinants were carried by plasmids, as they conferred resistance to transformed K1 strains. The isolates readily undergo conjugation, transferring the resistant genes to other strains, illustrating the high rates of cross infection and nosocomial infection in the immunocompromised patients.

Keywords: pseudomonas, antibiotics, drug resistance, horizontal gene transfer

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: A. Ikhlef

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Image noise in computed tomography, is mainly caused by the statistical noise, system noise reconstruction algorithm filters. Since last few years, low dose x-ray imaging became more and more desired and looked as a technical differentiating technology among CT manufacturers. In order to achieve this goal, several technologies and techniques are being investigated, including both hardware (integrated electronics and photon counting) and software (artificial intelligence and machine learning) based solutions. From a hardware point of view, electronic noise could indeed be a potential driver for low and ultra-low dose imaging. We demonstrated that the reduction or elimination of this term could lead to a reduction of dose without affecting image quality. Also, in this study, we will show that we can achieve this goal using conventional electronics (low cost and affordable technology), designed carefully and optimized for maximum detective quantum efficiency. We have conducted the tests using large imaging objects such as 30 cm water and 43 cm polyethylene phantoms. We compared the image quality with conventional imaging protocols with radiation as low as 10 mAs (<< 1 mGy). Clinical validation of such results has been performed as well.

Keywords: computed tomography, electronic noise, scintillation detector, x-ray detector

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Authors: Hamna Hamid, Kashmala Zaman

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The aim of this study was to evaluate the relationship between self-efficacy, resilience and social support among clinical psychologists, counselors and teachers of special schools. The study also assesses the gender differences on self-efficacy, resilience, social support and vicarious trauma and also vicarious trauma differences among three professions i.e. clinical psychologists, counselors and teachers of special schools. A sample of 150 women and 97 men were handed out a set questionnaire to complete: General Self-Efficacy Scale, Brief Resilience Scale, Multidimensional Scale of Perceived Social Support and Vicarious Trauma Scale. Results showed that there is significant negative correlation between self-efficacy, resilience and vicarious trauma. Women experiences higher levels of vicarious trauma as compared to men. While clinical psychologists and counselors experience higher levels of vicarious trauma as compared to teachers of special schools. Moderation effect of social support is not significant towards resilience and vicarious trauma.

Keywords: self-efficacy, resilience, vicarious trauma, social-support

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Authors: Ilham Akbar Rahman, Aflah Dhea Bariz Yasta, Iin Fadhilah Utami Tamasse, Devina Juanita

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Meningioma is adult brain tumors originating from the meninges covering the brain and spinal cord. The females have approximately twice higher 2:1 than male in the incidence of meningioma. This study aimed to analyze the histopathological grading and clinical aspect in predicting the prognosis of meningioma patients. An observational study with cross sectional design was used on 53 meningioma patients treated at Dr. Wahidin Sudirohusodo hospital in 2016. The data then were analyzed using SPSS 20.0. Of 53 patients, mostly 41 (77,4%) were female and 12 (22,6%) were male. The distribution of histopathology patients showed the meningothelial meningioma of 18 (43,9%) as the most type found. Fibroplastic meningioma were 8 (19,5%), while atypical meningioma and psammomatous meningioma were 6 (14,6%) each. The rest were malignant meningioma and angiomatous meningioma which found in respectively 2 (4,9%) and 1 (2,4%). Our result found significant finding that mostly male were fibroblastic meningioma (50%), however meningothelial meningioma were found in the majority of female (54,8%) and also seizure comprised only in higher grade meningioma. On the outcome of meningioma patient treated operatively, histopathological grade remained insignificant (p > 0,05). This study can be used as prognostic value of meningioma patients based on gender, histopathological grade, and clinical manifestation. Overall, the outcome of the meningioma’s patients is good and promising as long as it is well managed.

Keywords: meningioma, prognostic value, histopathological grading, clinical manifestation

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Authors: Nurten Tasdemir, Busra Baloglu, Zeynep Cingoz, Can Demirel, Zeki Gezer, Barıs Efe

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Student nurses are increasingly exposed to technology in the workplace after graduation with the growing numbers of electric health records (EHRs), handheld computers, barcode scanner medication dispensing systems, and automatic capture of patient data such as vital signs. Internationally, electronic health records (EHRs) systems are being implemented and evaluated. Students will inevitably encounter EHRs in the clinical learning environment and their professional practice. Nursing students must develop competency in the use of EHR. Aim: The study aimed to examine nursing students’ experiences of learning to use electronic health records (EHR) in clinical placements. Method: This study adopted a descriptive approach. The study population consisted of second and third-year nursing students at the Zonguldak School of Health in the West Black Sea Region of Turkey; the study was conducted during the 2015–2016 academic year. The sample consisted of 315 (74.1% of 425 students) nursing students who volunteered to participate. The students, who were involved in clinical practice, were invited to participate in the study Data were collected by a questionnaire designed by the researchers based on the relevant literature. Data were analyzed descriptively using the Statistical Package for Social Sciences (SPSS) for Windows version 16.0. The data are presented as means, standard deviations, and percentages. Approval for the study was obtained from the Ethical Committee of the University (Reg. Number: 29/03/2016/112) and the director of Nursing Department. Findings: A total of 315 students enrolled in this study, for a response rate of 74.1%. The mean age of the sample was 22.24 ± 1.37 (min: 19, max: 32) years, and most participants (79.7%) were female. Most of the nursing students (82.3%) stated that they use information technologies in clinical practice. Nearly half of the students (42.5%) reported that they have not accessed to EHR system. In addition, 61.6% of the students reported that insufficient computers available in clinical placement. Of the students, 84.7% reported that they prefer to have patient information from EHR system, and 63.8% of them found more effective to preparation for the clinical reporting. Conclusion: This survey indicated that nursing students experience to learn about EHR systems in clinical placements. For more effective learning environment nursing education should prepare nursing students for EHR systems in their educational life.

Keywords: electronic health record, clinical placement, nursing student, nursing education

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Authors: R. Bužgová, R. Kozáková, M. Škutová, M. Bar, P. Ressner, P. Bártová

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Introduction: Currently, there has been an increasing concern about the provision of palliative care in non-oncological patients in both professional literature and clinical practice. However, there is not much scientific information on how to provide neurological and palliative care together. The main objective of the project is to create and to verify a concept of neuro-palliative and rehabilitative care for patients with selected neurological diseases in an advanced stage of the disease and also to evaluate bio-psychosocial and spiritual needs of these patients and their caregivers related to the quality of life using created standardized tools. Methodology: Triangulation of research methods (qualitative and quantitative) will be used. A concept of care and assessment tools will be developed by analyzing interviews and focus groups. Qualitative data will be analyzed using grounded theory. The concept of care will be tested in the context of the intervention study. Using quantitative analysis, we will assess the effect of an intervention provided on the saturation of needs, quality of life, and quality of care. A research sample will be made up of the patients with selected neurological diseases (Parkinson´s syndrome, motor neuron disease, multiple sclerosis, Huntington’s disease), together with patients´ family members. Based on the results, educational materials and a certified course for health care professionals will be created. Findings: Based on qualitative data analysis, we will propose the concept of integrated care model combining neurological, rehabilitative and specialist palliative care for patients with selected neurological diseases in different settings of care and services. Patients´ needs related to quality of life will be described by newly created and validated measuring tools before the start of intervention (application of neuro-palliative and palliative approach) and then in the time interval. Conclusion: Based on the results, educational materials and a certified course for doctors and health care professionals will be created.

Keywords: multidisciplinary approach, neuropalliative care, research, quality of life

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Authors: Shuji Fujimoto, Fumiko Kojima, Mika Shigematsu

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Biorisk management (Biosafety/Biosecurity) is required for anyone working in a clinical laboratory (including medical/clinical research laboratories) where infectious agents and potentially hazardous biological materials are examined/stored. Proper education and training based on international standards of biorisk management should be provided not only as a part of laboratory safety program in work place but also as a part of introductory training at educational institutions for continuity and to elevate overall baseline of the biorisk management. We reported results of the pilot study of biorisk management education for graduate students majored in laboratory diagnostics previously. However, postgraduate education is still late in their profession and the participants’ interview also revealed importance and demands of earlier biorisk management education for undergraduates. The aim of this study is to identify the need for biosafety/biosecurity education and training program which is designed for undergraduate students who are entering the profession in clinical microbiology. We modified the previous program to include more basic topics and explanations (risk management, principles of safe clinical lab practices, personal protective equipment, disinfection, disposal of biological substances) and provided incorporating in the routine educational system for faculty of medical sciences in Kyushu University. The results of the pre and post examinations showed that the knowledge of the students on biorisk control had developed effectively as a proof of effectiveness of the program even in the undergraduate students. Our study indicates that administrating the basic biorisk management program in the earlier stage of learning will add positive impact to the understanding of biosafety to the health professional education.

Keywords: biorisk management, biosafety, biosecurity, clinical microbiology, education for undergraduates

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Authors: Luca Zarrilli, Miguel Brito, Marianna Cappucci

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Tourists recently awarded Lisbon as the best city break destination in Europe. This article analyses the various types of tourist experiences in the city of Lisbon. The research method is the questionnaire, aimed at investigating the choices of tourists in the area of mobility, their perception of the quality of life and their level of appreciation of neighbourhoods, landmarks and infrastructures. There is an obvious link between the quality of life and the quality of the tourist experience, but it is difficult to measure it. Through this questionnaire, we hope to have made a small contribution to the understanding of the perceptive sphere of the individual and his choices in terms of behaviour, which is an essential element of any strategy for tourism marketing.

Keywords: Lisbon, mobility, quality of life, perception, tourism, hospitality

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Authors: Irene Doosuur Mngutyo

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The preliminary stages in the development of human communities are the formation of a correct understanding of people’s needs. However, perception of human needs is highly subjective and difficult to aggregate. Quality of life measurements are an appropriate means for achieving an understanding of Human needs. Hence this study endeavors to measure quality of life in Makurdi using subjective indices to measure three aspects of subjective wellbeing. A sample of 400 respondents achieved by applying the Taro Yamane formula to Makurdi’s projected population. Questionnaires were randomly distributed to residents of nine wards in Makurdi. Findings from a pilot study( N=100) demonstrated that among the 2 aspects of overall quality of life investigated,22% had a mean low overall assessment of quality of life now being3on the scale and an even poorer assessment for projected quality in the next five years by 17%(3)although an equal percentage are hopeful for a better life(10)in the next five years.60% of the respondents record very rare positive feelings while only 10% have positive feelings always on the eudaimonic scale69%strongly agree that they have a purposeful and meaningful life. Findings indicate good social ties as a strong indicator for perceived good feelings and even though quality of life is perceived as low there is optimism for the future.

Keywords: quality of life, subjective indicators, development, urban planning

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Authors: Pachawo Bisani, Goodall Nyirenda

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The Malawi National Antiretroviral Therapy (NART) Electronic Medical Record (EMR) system was designed and developed with guidance from the Ministry of Health through the Department of HIV and AIDS (DHA) with the aim of supporting the management of HIV patient data and reporting in high prevalence ART clinics. As of 2021, the system has been scaled up to over 206 facilities across the country. The system is integrated with the clinical decision support system (CDSS) to assist healthcare providers in making a decision about an individual patient at a particular point in time. Despite NART EMR undergoing several evaluations and assessments, little has been done to evaluate the clinical decision support system in the NART EMR system. Hence, the study aimed to evaluate the use of CDSS in the NART EMR system in Malawi. The study adopted a mixed-method approach, and data was collected through interviews, observations, and questionnaires. The study has revealed that the CDSS tools were integrated into the ART clinic workflow, making it easy for the user to use it. The study has also revealed challenges in system reliability and information accuracy. Despite the challenges, the study further revealed that the system is effective and efficient, and overall, users are satisfied with the system. The study recommends that the implementers focus more on the logic behind the clinical decision-support intervention in order to address some of the concerns and enhance the accuracy of the information supplied. The study further suggests consulting the system's actual users throughout implementation.

Keywords: clinical decision support system, electronic medical record system, usability, antiretroviral therapy

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Authors: Tarik Bazgour, Cedric Heuchenne, Danielle Sougne

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We examine time variation in the market beta of portfolios sorted on quality, liquidity level and liquidity beta characteristics across stock market phases. Using US stock market data for the period 1970-2010, we find, first, the US stock market was driven by four regimes. Second, during the crisis regime, low (high) quality, high (low) liquidity beta and illiquid (liquid) stocks exhibit an increase (a decrease) in their market betas. This finding is consistent with the flight-to-quality and liquidity phenomena. Third, we document the same pattern across stocks when the market volatility is low. We argue that, during low volatility times, investors shift their portfolios towards low quality and illiquid stocks to seek portfolio gains. The pattern observed in the tranquil regime can be, therefore, explained by a flight-to-low-quality and to illiquidity. Finally, our results reveal that liquidity level is more important than liquidity beta during the crisis regime.

Keywords: financial crises, quality, liquidity, liquidity risk, regime-switching models

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Authors: Zhenzhong Yang

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Herbal medicines are important supplements to chemical drugs and usually consist of a complex mixture of constituents. The current quality control strategy of herbal medicines is mainly based on chemical markers, which largely failed to owe to the markers, not reflecting the herbal medicines’ multiple mechanisms of action. Herein, a bioactive chemical markers based strategy was proposed and applied to the quality assessment and control of herbal medicines. This strategy mainly includes the comprehensive chemical characterization of herbal medicines, bioactive chemical markers identification, and related quantitative analysis methods development. As a proof-of-concept, this strategy was applied to a Panax notoginseng derived herbal medicine. The bioactive chemical markers based strategy offers a rational approach for quality assessment and control of herbal medicines.

Keywords: bioactive chemical markers, herbal medicines, quality assessment, quality control

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Authors: Tadesse Melaku Abegaz

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Background: there was paucity of data on the self-reported adverse drug reactions (ADRs), level of adherence and clinical outcomes with antidepressants among major depressive disorder (MDD) patients in Ethiopia. Hence, the present study sought to determine the level of adherence for and clinical outcome with antidepressants and the magnitude of ADRs. Methods: A prospective cross-sectional study was employed on MDD patients from September 2016 to January 2017 at Gondar university hospital psychiatry clinic. All patients who were available during the study period were included under the study population. The Naranjo adverse drug reaction probability scale was employed to assess the adverse drug reaction. The rate of medication adherence was determined using morisky medication adherence measurement scale eight. Clinical Outcome of patients was measured by using patient health questionnaire. Multivariable logistic carried out to determine factors for adherence and patient outcome. Results: two hundred seventy patients were participated in the study. More than half of the respondents were males 122(56.2%). The mean age of the participants was 30.94 ± 8.853. More than one-half of the subjects had low adherence to their medications 124(57.1%). About 186(85.7%) of patients encountered ADR. The most common ADR was weight gain 29(13.2). Around 198(92.2%) ADRs were probable and 19(8.8%) were possible. Patients with long standing MDD had high risk of non-adherence COR: 2.458[4.413-4.227], AOR: 2.424[1.185-4.961]. More than one-half 125(57.6) of respondents showed improved outcome. Optimal level of medication adherence was found to be associated with reduced risk of progression of the diseases COR: 0.37[0.110-5.379] and AOR: 0.432[0.201-0.909]. Conclusion: Patient reported adverse drug reactions were more prevalent in major depressive disorder patients. Adherence to medications was very poor in the setup. However, the clinical outcome was relatively higher. Long standing depression was associated with non-adherence. In addition, clinical outcome of patients were affected by non-adherence. Therefore, adherence enhancing interventions should be provided to improve medication adherence and patient outcome.

Keywords: adverse drug reactions, clinical outcomes, Ethiopia, prospective study, medication adherence

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Authors: Atefeh Heydari, Mohammadali Tavakoli, Zuriati Ismail, Naomie Salim

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Seeking and sharing knowledge on online forums have made them popular in recent years. Although online forums are valuable sources of information, due to variety of sources of messages, retrieving reliable threads with high quality content is an issue. Majority of the existing information retrieval systems ignore the quality of retrieved documents, particularly, in the field of thread retrieval. In this research, we present an approach that employs various quality features in order to investigate the quality of retrieved threads. Different aspects of content quality, including completeness, comprehensiveness, and politeness, are assessed using these features, which lead to finding not only textual, but also conceptual relevant threads for a user query within a forum. To analyse the influence of the features, we used an adopted version of voting model thread search as a retrieval system. We equipped it with each feature solely and also various combinations of features in turn during multiple runs. The results show that incorporating the quality features enhances the effectiveness of the utilised retrieval system significantly.

Keywords: content quality, forum search, thread retrieval, voting techniques

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Authors: Mochammad Indra Permana, Andhiani Sharfina Arnellya, Dika Pramita Destiani, Budhi Prihartanto

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Cardiovascular disease is the cause of the highest mortality rates in the world. The number of cardiovascular disease patients is increasing every year. Data obtained from World Health Organization (WHO) that 17,5 million people died from this disease. The condition of cardiovascular diseases such as atrial fibrillation, myocardial infarction, venous thromboembolism, and several other conditions need anticoagulant therapy. Results of the anticoagulant therapy are measured not only by the effectiveness of International Normalized Ratio (INR) value but also by the quality of life of the patients. The purpose of this study was to determine the quality of life of patients on oral anticoagulant therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This is a cross-sectional study with collecting data from the quality of life questionnaire and medical record of the patients. The results of this study showed that 28 patients (46,7%) had a good quality of life, 30 patients (50%) had a moderate quality of life, and 2 patients (3,3%) had a poor quality of life with no significant differences in quality of life based on age, gender, diagnosis, and duration of drug use.

Keywords: anticoagulant, cardiovascular diseases, INR, quality of life

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Authors: Salma Ainine, Colin Ritchie, Tracey McFee

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Background: The societal impact of antibiotic resistance is a major public health concern. The increase in the incidence of resistant bacteria can ultimately be fatal. Objective: To analyse the appropriateness of antibiotic prescribing in Dundee Dental Hospital, ultimately improving the safety and quality of patient care. Methods: Two examiners independently cross-checked approximately fifty consecutive prescriptions, and corresponding patient case notes, for three data collection cycles between August 2014–September 2015. The Scottish Dental Clinical Effectiveness Program (SDCEP) Drug Prescribing for Dentistry guidelines was the standard utilised. The criteria: clinical justification, regime justification, and review arrangements was measured, and compared to the standard. Results: Cycle one revealed 42% of antibiotic prescriptions were appropriate. Interventions included: multiple staff meetings, an introduction of a checklist attached to the prescription pack, and production of patient leaflets explaining indications for antibiotics. Cycle two and three revealed 44%, and 30% compliance, respectively. Conclusion: The results of the audit have yet to meet target standards set out in prescribing guidelines. However, steps are being taken and change has occurred on a cultural level.

Keywords: antibiotic resistance, antibiotic stewardship, dental infection, hygiene standards

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Authors: Mohammad Matin

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Nowadays, one of the basic problems of higher education is a significant decline in the quality of education and reduction in efficiency of training. These research and studies are aiming to assess affecting factors of the erosion of academic quality, including educational environmental and content, social and economic factors, elements of the training, elements of education, family factors, from the perspective of students. The result of such improper competition, totally, has led to the decline of education quality in higher education centers, and in many aspects. The results showed a significant difference between male and female students' perspective for two areas of social and economic factors.

Keywords: higher education, decline, the quality of education, student

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Authors: Diom Loreen Ndum, Omarine Njimanted

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With increasing automation in clinical laboratories, the requirements for quality control materials have greatly increased in order to monitor daily performance. The constant use of commercial control material is not economically feasible for many developing countries because of non-availability or the high-cost of the materials. Therefore, preparation and use of in-house quality control serum will be a very cost-effective measure with respect to laboratory needs.The objective of this study was to determine the efficacy of in-house prepared pooled sera with respect to commercially acquired control sample for routine internal quality control at the Nkwen District Hospital Laboratory. This was an analytical study, serum was taken from leftover serum samples of 5 healthy adult blood donors at the blood bank of Nkwen District Hospital, which had been screened negative for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and Hepatitis B antigens (HBsAg), and were pooled together in a sterile container. From the pooled sera, sixty aliquots of 150µL each were prepared. Forty aliquots of 150µL each of commercially acquired samples were prepared after reconstitution and stored in a deep freezer at − 20°C until it was required for analysis. This study started from the 9th June to 12th August 2022. Every day, alongside with commercial control sample, one aliquot of pooled sera was removed from the deep freezer and allowed to thaw before analyzed for the following parameters: blood urea, serum creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), potassium and sodium. After getting the first 20 values for each parameter of pooled sera, the mean, standard deviation and coefficient of variation were calculated, and a Levey-Jennings (L-J) chart established. The mean and standard deviation for commercially acquired control sample was provided by the manufacturer. The following results were observed; pooled sera had lesser standard deviation for creatinine, urea and AST than commercially acquired control samples. There was statistically significant difference (p<0.05) between the mean values of creatinine, urea and AST for in-house quality control when compared with commercial control. The coefficient of variation for the parameters for both commercial control and in-house control samples were less than 30%, which is an acceptable difference. The L-J charts revealed shifts and trends (warning signs), so troubleshooting and corrective measures were taken. In conclusion, in-house quality control sample prepared from pooled serum can be a good control sample for routine internal quality control.

Keywords: internal quality control, levey-jennings chart, pooled sera, shifts, trends, westgard rules

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Authors: Arvind Dhingra, Ashwani Kumar Sharma

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Power quality is an important parameter for today’s consumers. Various custom power devices are in use to give a proper supply of power quality. Dynamic Voltage Restorer is one such custom power device. DVR is a static VAR device which is used for series compensation. It is a power electronic device that is used to inject a voltage in series and in synchronism to compensate for the sag in voltage. Inductive Loads are a major source of power quality distortion. The induction furnace is one such typical load. A typical induction furnace is used for melting the scrap or iron. At the time of starting the melting process, the power quality is distorted to a large extent especially with the induction of harmonics. DVR is one such approach to mitigate these harmonics. This paper is an attempt to overview the various control strategies being followed for control of power quality by using DVR. An overview of control of harmonics using DVR is also presented.

Keywords: DVR, power quality, harmonics, harmonic mitigation

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Authors: Pei-Ru Yang, Yu-Chen Lin, Jia-Min Wu

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Background: A 58-year-old man with a history of osteoporosis and diabetes presented with chronic pain in his left knee due to severe knee joint degeneration. The knee replacement surgery was recommended by the doctor. But the patient suffered from low pain tolerance and wondered if virtual reality could relieve acute postoperative wound pain. Methods: We used the PICO (patient, intervention, comparison, and outcome) approach to generate indexed keywords and searched systematic review articles from 2017 to 2021 on the Cochran Library, PubMed, and Clinical Key databases. Results: The initial literature results included 38 articles, including 12 Cochrane library articles and 26 PubMed articles. One article was selected for further analysis after removing duplicates and off-topic articles. The eight trials included in this article were published between 2013 and 2019 and recruited a total of 723 participants. The studies, conducted in India, Lebanon, Iran, South Korea, Spain, and China, included adults who underwent hemorrhoidectomy, dental surgery, craniotomy or spine surgery, episiotomy repair, and knee surgery, with a mean age (24.1 ± 4.1 to 73.3 ± 6.5). Virtual reality is an emerging non-drug postoperative analgesia method. The findings showed that pain control was reduced by a mean of 1.48 points (95% CI: -2.02 to -0.95, p-value < 0.0001) in minor surgery and 0.32 points in major surgery (95% CI: -0.53 to -0.11, p-value < 0.03), and the overall postoperative satisfaction has improved. Discussion: Postoperative pain is a common clinical problem in surgical patients. Research has confirmed that virtual reality can create an immersive interactive environment, communicate with patients, and effectively relieve postoperative pain. However, virtual reality requires the purchase of hardware and software and other related computer equipment, and its high cost is a disadvantage. We selected the best literature based on clinical questions to answer the patient's question and used share decision making (SDM) to help the patient make decisions based on the clinical situation after knee replacement surgery to improve the quality of patient-centered care.

Keywords: knee replacement surgery, postoperative pain, share decision making, virtual reality

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Authors: Wabinyai Fidel Raja, Gideon Lubisa

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Air pollution is becoming a growing concern in Africa due to rapid industrialization and urbanization, leading to implications for public health and the environment. Establishing a comprehensive air quality monitoring network is crucial to combat this issue. However, conventional methods of monitoring are insufficient in African cities due to the high cost of setup and maintenance. To address this, low-cost sensors (LCS) can be deployed in various urban areas through the use of participatory air quality network siting (PAQNS). PAQNS involves stakeholders from the community, local government, and private sector working together to determine the most appropriate locations for air quality monitoring stations. This approach improves the accuracy and representativeness of air quality monitoring data, engages and empowers community members, and reflects the actual exposure of the population. Implementing PAQNS in African cities can build trust, promote accountability, and increase transparency in the air quality management process. However, challenges to implementing this approach must be addressed. Nonetheless, improving air quality is essential for protecting public health and promoting a sustainable environment. Implementing participatory and data-informed air quality monitoring can take a significant step toward achieving these important goals in African cities and beyond.

Keywords: low-cost sensors, participatory air quality network siting, air pollution, air quality management

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Authors: Wongsim Manirath

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In order to implement AIS adoption successfully, it is important to consider the quality of information management and understand Information Quality (IQ) factors influencing AIS adoption. This research aims to explore ways of managing AIS adoption to investigate the adoption of accounting information systems within organisations. The study has led to the development of a framework for understanding the AIS adoption process in an organisation. This research used qualitative, interpretive evidence. This framework was developed from case studies and by collecting qualitative data (interviews). This research has conducted 10 case studies to study how IQ is managed through the accounting information system adoption process. A special focus is placed on determining how organisation size influences the information quality practices. The finding is especially useful to SMEs as many SMEs have the desire to grow bigger. By better dealing with IQ issues, there could be a successful future.

Keywords: data quality, information quality, accounting information system, information management

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Authors: Pongchan Na-Lampang

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The objective of this study was to compare the results of transport of slaughter pigs to slaughterhouse by 2 methods, i.e. individual confined and group confined on the truck on meat quality. The pigs were transported for 1 h on a distance of 70 km. The stocking densities were 0.35 m2/pig and 0.48 m2 for group and individual crate treatment, respectively. It was found that meat quality of pigs transported by 2 different methods as measured in terms of pH level (at 45 min and 48 hr post mortem), color (brightness, redness and yellowness) and water holding capacity was not significantly different.

Keywords: market pig, transportation, meat quality, confinement

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

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In its simplest form, data quality can be defined as 'fitness for use' and it is a concept with multi-dimensions. Emergency Departments(ED) require information to treat patients and on the other hand it is the primary source of information regarding accidents, injuries, emergencies etc. Also, it is the starting point of various patient registries, databases and surveillance systems. This interventional study was carried out to improve data quality at the ED of the National Hospital of Sri Lanka (NHSL) by introducing an e health solution to improve data quality. The NHSL is the premier trauma care centre in Sri Lanka. The study consisted of three components. A research study was conducted to assess the quality of data in relation to selected five dimensions of data quality namely accuracy, completeness, timeliness, legibility and reliability. The intervention was to develop and deploy an electronic emergency department information system (eEDIS). Post assessment of the intervention confirmed that all five dimensions of data quality had improved. The most significant improvements are noticed in accuracy and timeliness dimensions.

Keywords: electronic health records, electronic emergency department information system, emergency department, data quality

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Authors: Flevy Lasrado

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Purpose: The purpose of this paper is to show the relationship between the service quality dimensions and model them to propose quality improvements using interpretive structural modelling (ISM). Methodology: This paper used an interpretive structural modelling (ISM). The data was collected from the expert opinions that included a questionnaire. The detailed method of using ISM is discussed in the paper. Findings: The present research work provides an ISM based model to understand the relationships among the service quality dimensions. Practical implications or Original Value: An ISM based model has been developed for healthcare facility for improving customer satisfaction and increasing market share. Although there is lot of research on SERVQUAL model adapted to healthcare sector, no study has been done to understand the interactions among these dimensions. So the major contribution of this research work is the development of contextual relationships among identified variables through a systematic framework. The present research work provides an ISM based model to understand the relationships among the service quality dimensions.

Keywords: SERQUAL, healthcare, quality, service quality

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Authors: Zahra Alqahtani

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The use of e-learning technologies is gaining momentum in all educational institutions of the world, including Saudi universities. In the e-learning context, there is a growing need and concern among Saudi universities to improve and enhance quality assurance for e-learning systems. Practicing quality assurance activities and applying quality standards in e-learning in Saudi universities is thought to reduce the negative viewpoints of some stakeholders and ensure stakeholders’ satisfaction and needs. As a contribution to improving the quality of e-learning method in Saudi universities, the main purpose of this study is to explore and investigate strategies for the development of quality assurance in e-learning in one university in Saudi Arabia, which is considered a good reference university using the best and ongoing practices in e-learning systems among Saudi universities. In order to ensure the quality of its e-learning methods, Saudi university has adopted Quality Matters Standards as a controlling guide for the quality of its blended and full e-course electronic courses. Furthermore, quality assurance can be further improved if a variety of perspectives are taken into consideration from the comprehensive viewpoints of faculty members, administrative staff, and students.This qualitative research involved the use of different types of interviews, as well as documents that contain data related to e-learning methods in the Saudi university environment. This exploratory case study was undertaken, from the perspectives of various participants, to understand the phenomenon of quality assurance using an inductive technique.The results revealed six main supportive factors that assist in ensuring the quality of e-learning in the Saudi university environment. Essentially, these factors are institutional support, faculty member support, evaluation of faculty, quality of e-course design, technology support, and student support, which together have a remarkable positive effect on quality, forming intrinsic columns connected by bricks leading to quality e-learning. Quality Matters standards are considered to have a strong impact on improving faculty members' skills and on the development of high-quality blended and full e-courses.

Keywords: E-learning, quality assurance, quality matters standards, KKU-supportive factors

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Authors: Mariam Bibi, Rubab Mehboob, Mehreen Sirshar

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Satisfying the customer requirements is the ultimate goal of producing or developing any product. The quality of the product is decided on the bases of the level of customer satisfaction. There are different techniques which have been reported during the survey which enhance the quality of the product through software defect prediction and by locating the missing software requirements. Some mining techniques were proposed to assess the individual performance indicators in collaborative environment to reduce errors at individual level. The basic intention is to produce a product with zero or few defects thereby producing a best product quality wise. In the analysis of survey the techniques like Genetic algorithm, artificial neural network, classification and clustering techniques and decision tree are studied. After analysis it has been discovered that these techniques contributed much to the improvement and enhancement of the quality of the product.

Keywords: data mining, defect prediction, missing requirements, software quality

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Authors: Nisa Mohan

Abstract:

Clinical coding is a feasible method for estimating the national prevalence of adverse drug event (ADE) admissions. However, under-coding of ADE admissions is a limitation of this method. Whilst the under-coding will impact the accurate estimation of the actual burden of ADEs, the feasibility of the coded data in estimating the adverse drug event admissions goes much further compared to the other methods. Therefore, it is necessary to know the reasons for the under-coding in order to improve the clinical coding of ADE admissions. The ability to identify the reasons for the under-coding of ADE admissions rests on understanding the decision-making process of coding ADE admissions. Hence, the current study aimed to explore the decision-making process of clinical coders when coding cases of ADE admissions. Clinical coders from different levels of coding job such as trainee, intermediate and advanced level coders were purposefully selected for the interviews. Thirteen clinical coders were recruited from two Auckland region District Health Board hospitals for the interview study. Semi-structured, one-on-one, face-to-face interviews using open-ended questions were conducted with the selected clinical coders. Interviews were about 20 to 30 minutes long and were audio-recorded with the approval of the participants. The interview data were analysed using a general inductive approach. The interviews with the clinical coders revealed that the coders have targets to meet, and they sometimes hesitate to adhere to the coding standards. Coders deviate from the standard coding processes to make a decision. Coders avoid contacting the doctors for clarifying small doubts such as ADEs and the name of the medications because of the delay in getting a reply from the doctors. They prefer to do some research themselves or take help from their seniors and colleagues for making a decision because they can avoid a long wait to get a reply from the doctors. Coders think of ADE as a small thing. Lack of time for searching for information to confirm an ADE admission, inadequate communication with clinicians, along with coders’ belief that an ADE is a small thing may contribute to the under-coding of the ADE admissions. These findings suggest that further work is needed on interventions to improve the clinical coding of ADE admissions. Providing education to coders about the importance of ADEs, educating clinicians about the importance of clear and confirmed medical records entries, availing pharmacists’ services to improve the detection and clear documentation of ADE admissions, and including a mandatory field in the discharge summary about external causes of diseases may be useful for improving the clinical coding of ADE admissions. The findings of the research will help the policymakers to make informed decisions about the improvements. This study urges the coding policymakers, auditors, and trainers to engage with the unconscious cognitive biases and short-cuts of the clinical coders. This country-specific research conducted in New Zealand may also benefit other countries by providing insight into the clinical coding of ADE admissions and will offer guidance about where to focus changes and improvement initiatives.

Keywords: adverse drug events, clinical coders, decision making, hospital admissions

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