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The study evaluated the effects of conventional pasteurization and ohmic heating (OH) at different electric fields (12, 16, 20, or 24 V/cm -1 ) on probiotic chocolate dairy desserts' physicochemical, microbiological, sensory properties and volatile profiles. Both treatments were analyzed for parameters such as pH, syneresis, cream stability index, rheology, bioactive compounds (total phenolics and antioxidant capacity), and probiotic viability (Lactobacillus acidophilus LA-05) over a 28-day storage period. Ohmic heating at higher electric fields (20 and 24 V/cm -1 ) showed comparable results to pasteurization for most parameters, with non-significant differences or even higher values for some. Sensory analysis revealed that pasteurized samples were more associated with "creamy" and "firm" textures. In contrast, OH-treated samples were linked to lumps and fluidity, particularly in OH24 and OH16, respectively. Volatile compounds such as propanal and ethyl propanoate were detected across treatments, with ethyl acetate unique to OH24. The results suggest that OH, especially at higher electric fields, is a promising technology for processing probiotic dairy desserts, offering similar or enhanced qualities compared to conventional pasteurization. These findings provide insights into the potential for OH to be routinely applied in functional dairy product production., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Addressing the evidence-to-practice gap in midwifery is vital for improving maternal and newborn health outcomes. Despite the potential of involving midwives in quality improvement interventions to address this gap, such interventions are understudied. In a Ugandan urban hospital, midwifery practices with a significant evidence-to-practice gap have been identified as areas for clinical improvement., Objectives: The primary objective of the Quality Improvement was to increase the uptake of identified and essential midwifery practices through a quality improvement approach led by midwives., Participants: We enrolled 703 women aged 18 years and older with uncomplicated full-term pregnancies (between 37+0 and 42+0 weeks) who gave birth at the facility., Intervention: The intervention focused on evidence-based practices with an identified evidence-to-practice gap: dynamic birth position, including women's involvement in birth position decision-making, perineal protection and intrapartum support. A team of midwives led a seven-month co-created quality improvement intervention. The intervention used Plan-Do-Study-Act (PDSA) cycles, following the Model for Improvement and included a train-the-trainer approach and weekly online support meetings., Data Collection: In this single-case prospective observational study, we compared pre-, during and post-intervention uptake of evidence-based practices. Trained research assistants collected data through interviews and observations., Results: We observed improvements in the uptake of all clinical improvement areas. Dynamic birth positions increased from 0 % to 79 %, decision-making of birth positions from 0 % to 75 %, perineal protection measures from 62 % to 92 % and intrapartum support from 7 % to 67 %., Conclusion: A multifactorial midwife-led Quality Improvement resulted in significant and sustained improvements in the uptake of evidence-based practices in maternal and newborn healthcare. If given the mandate and time, midwives can successfully lead Quality Improvements, which enhance the quality of care and close the evidence-to-practice gaps in maternal and newborn health. The study's results underscore the significance of developing effective strategies to enhance care quality and promote the adoption of evidence-based midwifery practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Benchmarking in CD34 + cell apheresis is crucial for optimizing resources, ensuring consistent collection performance, and ultimately, decision-making algorithms to improve donor safety. Key performance indicators such as the "performance ratio" (PR) are applied routinely in some apheresis centers, whereas this report identifies the "cell throughput" (CT) as another quality indicator in apheresis., Material and Methods: This single-center study includes retrospective data from 117 aphereses. CT and PR were calculated based on the mononuclear cell collection (MNC) or continuous mononuclear cell collection (cMNC) protocols of the Spectra Optia® apheresis system, types of venous access, transplant settings, and mobilization regimens., Results: CTs (× 10 6 CD34 + cells/min) were found to be greater in cMNC compared to MNC protocols (1.4 vs. 1.0, p = 0.0037), in allogeneic versus autologous (1.3 vs. 1.1, p = 0.0274), and in the mobilization regimen of G-CSF alone versus the G-CSF combined (1.3 vs. 1.0, p = 0.0249). In contrast, PR (%) was only statistically significant in favor of the cMNC protocol (213.0 vs. 186.8 for MNC)., Conclusions: CT and PR are feasible quality indicators on CD34 + cell apheresis, are easy to calculate and implement, and have clinical and administrative implications. Analyzing CT and PR may strengthen the institutional criteria for selecting cMNC or MNC protocols; they may also be used to evaluate the performance of new personnel or cell separator devices or, eventually, trigger investigations for those aphereses under-collected by specific thresholds., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To explore the feasibility of using a disposable platelet storage bag containing a leukocyte filter to prepare leukocyte-depleted pooled platelet concentrates with the buffy coat method., Methods: 150 bags of whole blood samples (400 mL/bag) were stored overnight at 22 ± 2°C, and buffy coats were separated on Day 2, then 5 units of ABO homotypic buffy coat and 1 unit of plasma were pooled into a disposable platelet storage bag containing a leukocyte filter to prepare leukocyte-depleted pooled platelet concentrates and stored in a Platelet Agitator. On Day 2, 4, 5 and 7 after the collection of whole blood, platelet content, pH value, pO 2 , pCO 2 , glucose (GLU), ATP, and other quality indicators were measured., Results: The quality indicators of leukocyte-depleted pooled platelet concentrates met the requirements for leukocyte-depleted aphaeresis platelets in the Chinese national standard Quality Requirements for Whole Blood and Blood Components (GB18469-2012). With the prolongation of storage time, MPV and PDW of platelets gradually increased, pH value, bicarbonate, and GLU gradually decreased, LA, LDH, and ATP gradually increased, pO 2 slightly increased, pCO 2 decreased, and HSR had no significant change. ESC decreased significantly on Day 7, CD62p decreased first and then increased, sP-selectin and GP V increased first and then decreased, but the results on Day 7 were higher than those on Day 2., Conclusion: The quality of leukocyte-depleted pooled platelet concentrates prepared by the buffy coat method using disposable platelet storage bags containing a leukocyte filter was comparable to that of leukocyte-depleted apheresis platelets, and could be used clinically.

Background: Since human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) infection have been identified, significant improvements have been made concerning its diagnosis and treatment. Few contributions have been made in the area of quality indicators in the Democratic Republic of Congo (DRC). To address this gap, a recent study conducted in the said area in 2023 resulted in the development of a comprehensive list of 88 indicators for assessing the quality of clinical care for HIV and AIDS. Out of these, 66 were identified as a core set of quality indicators for the assessment of HIV and AIDS clinical care. The aim of this study was to evaluate compliance with these quality indicators and determine those that are associated with mortality among people living with HIV and AIDS (PLWHA) in the DRC., Methods: A retrospective cohort study was conducted at Panzi Hospital in Bukavu, South Kivu province of the DRC. The study population included PLWHA adult patients who were followed for a period of five years at the antiretroviral (ARV) clinic from January 2017 to December 2021. Descriptive analysis was performed to evaluate essential characteristics, and inferential statistics were performed including a multivariable logistic regression analysis performed to assess the association between selected clinical care indicators and PLWHA mortality, to estimate the odds ratios of mortality based on various factors, and to control for confounding variables., Results: A total of 884 PLWHA were included. The level of compliance with the quality indicators was 78.79%. In the multivariate analysis, the quality-of-care indicators associated with mortality in the follow-up PLWHA on treatment were items 12 (Late diagnosis of HIV infection in specialized care), 24 (Assessment of resistance in cases of virologic failure), and 38 (Evaluation of Cardiac risk). Other factors associated with mortality were male sex, lower CD4 (< 500mm 3 ) and high viral load (> 50 copies/ml)., Conclusion: The level of compliance with the indicators was moderate. Some quality indicators were associated with mortality. These indicators are associated with delayed diagnosis of HIV infection, assessment of resistances in case of virologic failure, and evaluation of cardiac risk. Addressing gaps in adherence to these quality of care indicators (clinical care standards) could potentially reduce mortality rates and enhance the overall management of HIV and AIDS, particularly at Panzi Hospital in Bukavu, South Kivu Province, and in general in the DRC., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent to participate in the study was not required from the participants in the study because the data collection involved retrospective analysis of PLWHA records, and no direct contact with the PLWHA was required. According to national regulations and ethical guidelines, this type of research, which poses minimal risk to participants and involves pre-existing data, does not require individual consent. The study utilized anonymized data from PLWHA ' files, ensuring that personal identifiers were not disclosed. However, the study has received Ethical Approval (Approval number: BREC/00004657/2022) from the Biomedical Research Ethics Committee (BREC) at the University of KwaZulu-Natal Ethics Approval Board Institutional Review Board according to national regulations. In addition, a gatekeeper letter to conduct the study was obtained from the Healthcare facility as well. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024. The Author(s).)

Background: The quality of the doctor-patient relationship plays a crucial role in patients' experiences with healthcare services, positively influencing clinical outcomes and satisfaction with care. The Patient-Doctor Relationship Questionnaire (PDRQ-9) is widely used to assess this relationship. However, there are no quality categories that can be derived from the instrument's score to facilitate understanding and decision-making., Objectives: This study aims to establish categories of the quality of the relationship based on the PDRQ-9 score., Methods: A latent class analysis (LCA) was conducted using interviews with 6160 users of primary health care units throughout Brazil to define different homogeneous response profiles. The Youden index was used to determine the cut point between classes., Results: LCA identified the presence of two response profiles, one associated with a high evaluation of the quality of the doctor-patient relationship and another associated with a moderate evaluation. The cut point between classes, established through the Youden index, was 3.5 (on a possible score range of 1-5) or 31 (on a possible score range of 9-45). The cut point demonstrated high accuracy (0.94), sensitivity (0.96), and specificity (0.98)., Conclusions: The categorization proposed in this study enhances the interpretability of PDRQ-9 results, providing a practical framework for assessing the quality of the doctor-patient relationship. By establishing actionable quality categories, this tool could support targeted interventions, such as performance feedback and training, aimed at fostering empathy, communication, and trust in healthcare settings., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The acquisition of health information via the internet has emerged as a prevalent approach within the general population and is likely to exert an influence on health decision-making processes. This study aims to evaluate the comprehensive quality of online information about anxiety treatment and management comparing websites in English, which is widely used for international scientific communication, and Italian, a popular local language. It was used a multidimensional methodology that assesses scientific quality of information; readability of the website; the technological quality of the website and the website's popularity ranking., Methods: We conducted a systematic search on four widely used online search engines. Duplicated, unrelated websites, and scientific papers were excluded. The assessment included the use of several criteria and tools: the DISCERN scale, the JAMA benchmark criteria, adherence to the Health on the Net Code; the Nibbler tool; PageRank; and the Flesch Reading Ease test/the Gulpease readability index., Results: 78 websites in Italian and 60 in English were evaluated. Quality of information of the English websites was higher than that of the Italian ones, but only a small percentage of them reported high level information about all treatment types and shared decision-making process. Technological quality was higher in English websites. In general, all websites were difficult to read, requiring reading skills at the high school level or higher., Conclusions: These results can promote future guidelines to improve online health information. Users should be able to find information about all treatment types (pharmacological and psychosocial) in line with the current guidelines for the treatment and the management of anxiety disorders. This would help internet users to achieve a higher level of quality information., Competing Interests: Declaration of competing interest All the authors Paola Melis, Alessandra Perra, Antonio Egidio Nardi, Thurayya Zreik, Antonio Preti, Mauro Giovanni Carta declare: - There are no any relevant conflict of interest at any time and during the 36 months prior to publication; - There are no any patents, wether palenned, pending or issued, broadly, relevant to the work; - There are no other relationships/conditions/circumstances that present a potential conflict of interest; - In general the authors have nothing to disclose., (Copyright © 2024. Published by Elsevier Ltd.)

Aim: This study evaluates the impact of monitoring a primary quality indicator and the effect of training on improving the care and maintenance of vascular access devices., Design: A prospective, quasi-experimental, multicentre study with 10 periodical cross-sections from 2017 and 2020., Participants: Adult patients hospitalised over 24 h, with or without vascular access device, excluding those in emergency, psychiatry, outpatients or minor surgery units., Methods: The study included 10 cross-sections between 2017 and 2020 in all participating hospitals, using the INCATIV ® (Quality Indicators in Intravenous Therapy and Vascular Access) questionnaire. Training sessions for nursing staff were conducted between cross-sections, involving face-to-face sessions in open classrooms and clinical sessions in the units, based on the study Care bundle., Results: 53,991 vascular accesses were analysed, with an average INCATIV Index score of 8.95 (SD: 1.32), showing improvement from 8.09 in the first cross-section to 9.21 in the last. Significant variability was observed between hospitals, with secondary hospitals scoring lower on the INCATIV ® Index. Training interventions 1 and 2 showed significant improvement across all hospital categories, whereas intervention 5 did not show significant effects. Compliance with main recommendations was studied, with a notable decrease in phlebitis rates from 4.45% in the first cross-section to 1.23% in the tenth., Conclusion: The study developed a single indicator to assess and quantify vascular access care quality. It demonstrated that implementing a care bundle through serial training interventions and continuous assessment by nursing staff, supported by process indicators and data availability on the study platform, significantly reduces complications and enhances the quality and safety of vascular access care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Structured data are the capital of empirical health research. The value of these data relates to their quality and to their fit for use. A German guideline for the management of data quality in registries and cohort studies lists 51 quality indicators organized into the categories organization, integrity, and trueness. An update of the guideline will take into account the current view on dimensions of data, the appropriate structure for the definition of an indicator, and the collection of quality indicators itself. In the next version, the collection will explicitly address measures of metadata quality. The first step of a literature review revealed a high number of potential sources of evidence. These will be categorized into the topics dimensions, structure, and indicators respectively. Special attention will be paid to new challenges of data quality control arising from big data and artificial intelligence.

Objectives: Low-value care refers to medical services whose benefits do not outweigh the costs and potential harm. This study estimates the prevalence, distribution, and associated costs of 24 low-value care services within the German public healthcare system., Methods: Large-scale retrospective observational study using statutory health insurance data provided by the Techniker Krankenkasse (TK) spanning from 2018 to 2021 covering approximately 11.1 million insured individuals annually. The prevalence of 24 low-value service indicators, which were identified through a systematic review and expert consultations was calculated. To address uncertainties in distinguishing between appropriate and low-value care, both broad (potential overestimation) and narrow definitions (potential underestimation) were applied to all suitable indicators, providing a range within which the true extent of low-value care is expected to lie., Results: Between 2019 and 2021, 1.6 million patients were identified as having received at least one low-value service, using the 24 indicators. Of all 10.6 million delivered services (cases) examined, on average per year, 1.1 million cases (broad definition) and 0.43 million cases (narrow definition) were classified as low-value, corresponding to 10.4% and 4.0%, respectively. Costs incurred by the identified services were approximately 15.5 million euros (broad definition) and 9.9 million euros (narrow definition) annually., Conclusions: Despite the limitations of German statutory health insurance data, considerable low-value care was found within several of the 24 low-value-indicators. The findings highlight the necessity for targeted interventions to mitigate low-value care in Germany, guiding healthcare policy and practice to enhance quality and safety effectively., (Copyright © 2024. Published by Elsevier Inc.)

Background: The quality of treatment is especially critical in the context of complex and chronic diseases such as multiple sclerosis (MS). The Brain Health Initiative, an independent international consortium of neurologists, reached a consensus on time-based quality standards prioritizing brain health-focused care for people with MS., Objectives: To gain deeper insights into the transferability of these quality standards to a specific area, we conducted a survey among MS experts across various MS centers in Germany., Methods: Participants were asked about time frames considered high standards and those currently being implemented in daily routine based on their experience., Results: The results reveal a large gap between ideal conceptions and their adaptation in the real world, mostly due to a lack of resources., Conclusions: Nevertheless, these guidelines and recommendations can be aspired to as ideals. Consensual and inclusive clinical pathways complemented by measurable quality indicators are needed to improve care and approach these ideals. Neither exists in the current management of MS., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests IV declares that she has no competing interests.KA received personal compensation from Roche, Sanofi, Novartis, Merck, Teva, and BMS for consulting or speaker service.HI received speaker honoraria from Roche and financial support for research activities from Teva, Biogen and Alexion.JH declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.HT has no personal pecuniary interests to discluse, other than being the Secretary General of the German Multiple Sclerosis Society, Federal Association (DMSG), which recently received funding from a range of public and corporate sponsors, including G-BA, The German MS Trust, Biogen, Bristol Myers Squibb, Hexal, Merck, Novartis, Ottobock, Roche, Sanofi and Viatris.SGM declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.GG reports: In the last two years, GG has received compensation for serving as a consultant or speaker for or has received research support from Aurinia Pharmaceuticals, Biogen, BMS-Celgene, GlaxoSmithKline, Janssens/J&J, Japanese Tobacco, Merck KGaA/EMD Serono, Moderna, Novartis, Sandoz, Sanofi and Roche/Genentech.TZ reports the following: a scientific advisory board and/or consulting for Biogen, Roche, Novartis, Celgene, and Merck; compensation for serving on speakers bureaus for Roche, Novartis, Merck, Sanofi, Celgene, and Biogen; and research support from Biogen, Novartis, Merck, and Sanofi., (© 2024. The Author(s).)

Objectives: To identify different approaches (unique domains) and indicators to evaluate quality in assisted living communities in the United States., Design: Scoping review supplemented with key informant and technical panel guidance., Setting and Participants: Assisted living settings and residents., Methods: We obtained feedback on our review protocol and search strategy from key informants with expertise in AL quality, including feedback on a supplementary gray literature search for relevant non-peer-reviewed literature (such as nonempirical policy briefs). We scanned MEDLINE and CINAHL databases for peer-reviewed literature published from 2009 through 2019 assessing quality in assisted living in the United States. We synthesized evidence using the Donabedian framework and presented our analyses in 2 expert panel discussions for additional insights., Results: We screened 833 abstracts, of which 49 studies met our selection criteria. Gray literature search yielded an additional 45 non-peer-reviewed sources. Nine unique domains were assessed: (1) resident quality of life, (2) resident and family satisfaction, (3) staffing and staff-related outcomes, (4) resident safety, (5) resident health outcomes, (6) care planning and integration, (7) physical and social environment, (8) service availability, and (9) core values and philosophy. Resident quality of life and satisfaction were the most prioritized domains in published literature, key informant interviews, and expert panel discussions. Domains such as staffing, safety, resident health outcomes, care planning, and integration were identified as vitally important for the increasing clinical and sociodemographic heterogeneity in the resident population. Expert panels emphasized the importance of including residents' voice in the quality measures development process., Conclusions and Implications: Lack of standardized measurement of quality impedes provision of person-centered, value-based care in US-based assisted living settings. Our comprehensive list of domains and indicators should inform future concerted efforts to develop and incorporate standardized quality measurement as part of routine practice in assisted living communities in the United States., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Background/Objectives: This study aims to develop and validate a Midwifery Interventions Classification (MIC), which is an evidence-based, standardized taxonomy and classification of core midwifery interventions based on a salutogenic perspective for maternity care. Methods: This study described the consensus process up to the results regarding the validation of the MIC through a two-round Delphi survey involving three panels of stakeholders: Midwives, Healthcare Researchers, and Maternity Service Users. Results: The resulting MIC comprises 135 core midwifery interventions classified into Direct Midwifery care (n = 80 interventions), Indirect Midwifery Care (n = 43 interventions), and Community Midwifery Care (n = 12 interventions), reaching an overall consensus rate among experts equal to 87%. These interventions were, therefore, adapted specifically for the Italian midwifery care context, with potential for international transferability, implementation, and scalability. Conclusions: The MIC is pivotal to boosting quality improvement, education, and comparable data collection for research, sustaining midwives' role in promoting optimal health for women, newborns, and families at large.

Introduction: Dashboards are used to track and visualize quality indicators within health systems to improve clinical performance. Structured serious illness conversation (SIC) documentation templates within electronic health records (EHR) have enabled the development of SIC dashboards for quality improvement. Little is known about the successes and challenges of SIC dashboards., Methods: This implementation case series describes findings from semi-structured interviews and surveys with nine palliative care leaders in eight health systems that implemented SIC dashboards. Interviews and case information were analyzed to identify themes., Results: Five themes were identified. First, dashboards focus on process metrics. By creating transparent and efficient access to data on EHR-documented SICs, dashboards facilitated monitoring of the results of clinician training and quality improvement efforts. Second, palliative care leaders used dashboard data on documented SICs to implement clinician practice change strategies (e.g. data feedback; quality incentives), but clinicians had mixed reactions to data. Third, dashboards facilitated leadership investment in SIC efforts and required financial and technical resources to build and maintain. Fourth, while dashboards streamlined data collection for implementation teams, participants noted challenges with data reliability, including inadequate clinician use of structured SIC documentation templates (which most dashboards rely on for measurement). Fifth, needs and tensions arose with integrating patient-centered outcome measures as part of dashboards., Conclusion: Dashboards can be powerful tools for identifying gaps in SIC and driving interventions for clinician practice change. However, challenges related to clinician adoption of structured templates for SIC documentation and mixed clinician receptivity to data feedback may limit their reliability and use., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Dr Bradley discloses serving as a Senior Medical Advisor, Measurement, for the American College of Cardiology. Dr Das discloses serving as an assistant editor for Circulation and as the President of the Dallas Regional Board of the American Heart Association.

BackgroundNon-university hospitals are the major provider of inpatient care in Germany, serving 89% of acute care hospital beds. Although surveillance data on antimicrobial use in hospitals are widely available, data on prescription quality are rare.AimWe aimed to provide an in-depth analysis of antimicrobial prescribing patterns and quality in southwest German non-university hospitals.MethodsDuring 2021, we performed three point prevalence surveys (PPS) in 10 non-university hospitals, representing ca 10% of hospital beds in the federal state of Baden-Württemberg (11 million inhabitants). Demographic and clinical information were collected. We assessed the overall performance of 14 validated process quality indicators (QI) covering infection diagnostics, antimicrobial therapy and documentation.ResultsOf 8,560 patients analysed, 2,861 (33%) received at least one antimicrobial. Most (2,789, 80%) antimicrobial prescriptions were for therapeutic indications. Most frequently prescribed agents were beta-lactam/beta-lactamase inhibitors (1,120, 40%) in therapeutic and cefuroxime (269, 37%) in prophylactic indications. According to the World Health Organization's Access, Watch, Reserve classification, the Access-to-Watch ratio was 0.73. Overall adherence to QIs was low and varied substantially (27-93%), with documentation, possible streamlining and switching to oral therapy exhibiting the lowest fulfilment rates (< 50%).ConclusionThe results indicate a need to improve antimicrobial prescribing quality in non-university hospitals. The high prevalence of antimicrobial use in our setting underlines the demand for sustainable antimicrobial stewardship programmes in this sector. Our QI-based PPS approach can be used to identify key targets for future antimicrobial stewardship interventions. The results indicate a need for further legislation on antimicrobial stewardship.

Background: People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities., Objective: To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved., Design: A mixed-methods study with six interlinked work packages., Setting: Predominantly the North of England., Methods: Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups., Findings: Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment., Limitations: Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ., Conclusions: Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change., Study Registration: This study is registered at researchregistry.com (Ref: 5098)., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

Background and Objectives: To develop key performance indicators (KPI) for use in quality assessment of our institutional goal-directed massive transfusion (GDMT)., Materials and Methods: A team comprising our transfusion and emergency medicine departments carried out a cross-sectional data analysis of GDMT in adult patients from January 2021 to December 2022. The study was rooted in the Define, Measure, Analyse, Improve, Control (DMAIC) approach. Features of KPIs were (a) importance, (b) scientific soundness and (c) feasibility. Study parameters were defined and analysed using measures of central tendencies and benchmark comparison., Results: Ninety-two massive transfusion events occurred and 1405 blood components were used. Trauma was the leading cause, followed by postpartum haemorrhage and upper gastrointestinal bleeding. Appropriate GDMT activation was observed only in 43.47% of events. The turnaround time (TAT) was within the benchmark in 85.8% of events with an average of 16 ± 10 min. The average utilization of blood components was 20.5 (interquartile range [IQR] = 11.3) in the appropriate group and 5.5 (IQR = 4.25) in the inappropriate group with a wastage rate of 3.5%. Duration of activation was 6.19 ± 4.59 h, and the adherence to thromboelastography was 66.3%. Overall mortality was 45.65%, and the average duration of hospital stay was 6.1 ± 5.9 days., Conclusion: The KPIs developed were easy to capture, and the analysis provided a comprehensive approach to the quality improvement of the GDMT protocol., (© 2024 The Author(s). Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Aims: The aim of the study was to develop a set of nursing-sensitive quality indicators for acute poisoning in emergency departments., Design: A two-round e-Delphi study was conducted from July to November 2023., Methods: Subject-matter experts from 19 tertiary hospitals across four provinces of China participated in the survey. Potential indicators identified through a literature review were rated on a 5-point Likert scale and comments solicited. Descriptive statistics were used to demonstrate convergence of expert opinion, and consensus was reached in two rounds. Weights of each indicator were determined by analytic hierarchy process. There were 20 expert responses in Round 1 and 18 in Round 2., Results: After two rounds, experts reached a consensus on definitions, calculation formulas, and data collection methods for these indicators. Three primary and 11 secondary indicators were included in the final nursing-sensitive quality indicators for acute poisoning in the emergency department., Conclusion: A set of indicators about acute poisoning care, applicable to the Chinese context, was developed in collaboration with emergency nurse specialists., Implications for the Profession and Patient Care: The lack of supervision of the nursing quality for acute poisoning leads to great variability in clinical practice in different medical institutions. The results can help in their standardization in China and in other countries lacking regulation. Our study also offers nursing managers a concrete and operable evaluation tool for quality supervision. Normative nursing behaviours are conducive to increase safety and enhance patients' experience of medical treatment., Impact: The indicators identified in this study closely approach clinical practice and exhibit the characteristics of sensitivity and practicality. Although developed in the Chinese healthcare system, there is potential for adoption or adaption in other healthcare settings., Reporting Method: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies., Patient or Public Contribution: No patient or public contribution in this study., Contribution to the Wider Global Clinical Community: The nursing quality of acute poisoning in emergency departments remains a growing attention, but the relevant assessment tools are lack. This study provides a set of nursing-sensitive quality indicators for acute poisoning to guide the quality monitoring of nursing managers. Study recommendations have broad applicability to all healthcare professionals who are engaged in emergency nursing., (© 2024 John Wiley & Sons Ltd.)

Background and Objective: Hospitalization significantly interferes with the individual's well-being and it occurs both during and after the hospitalization period. Different approaches to minimize morbidity related to hospitalization and the post-discharge period have been proposed, especially to those aimed at reducing readmission rates. The aim of this study is to evaluate the effect of multicomponent intervention (MI) on operational indicators and continuity of care outcomes., Materials and Methods: A quasi-experimental study conducted in a Brazilian university hospital in order to compare the impact of the intervention with usual care. The MI was the implementation of multidisciplinary rounds, the inclusion of the role of the navigator nurse, and care transition actions with half of the Internal Medicine teams in a clinical unit of a general hospital. Adult patients hospitalized were included in 2 periods and divided in 3 groups - Group A: before the intervention; Group B: after and with MI; Group C after and without MI., Results: A total of 2333 hospitalizations were evaluated. There was a reduction in the rate of intensive care transfers to intensive care unit (ICU) and in the length of stay (LOS). LOS, discharge before noon, and transfers to ICU improved when comparing before and after the intervention, but were not different in post-intervention groups with and without MI., Conclusion: These results reflect the improvement of care provided by MI, an effect that could be due to cross contamination also to teams without the intervention., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: This article outlines a research study that ranked health information quality criteria on social media from experts' perspectives., Methodology: A mixed-method approach (qualitative-quantitative) used in current research. In the qualitative phase a literature review explored existing dimensions for evaluating social media content quality, focusing on identifying common dimensions and attributes. Furthermore, a quantitative method involving experts was utilized to rank the health information quality criteria for social media., Results: The findings indicated various dimensions of health information quality in the literature. Out of 17 criteria, accuracy, credibility, and reliability had the highest ranks, while originality, value-added, and amount of data had the lowest ranks, respectively, according to experts., Conclusion: The endeavor to bolster the dissemination of reliable health information on social media demands a sustained commitment to enhancing accountability, transparency, and accuracy, ensuring that users have access to information that is not only informative but also trustworthy., (© 2024. The Author(s).)

In recent decades, there has been increasing interest in measuring the quality of care across all medical fields, including neurosurgery. This interest aims not only to optimize care but also to reduce healthcare costs. For this purpose, different quality indicators (QIs) have been developed. We performed a systematic review according to the PRISMA guidelines aiming at identifying studies that critically evaluate QIs applied in cranial neurosurgery. A total of 34 studies, suggesting 22 indicators, were identified. The most discussed indicator was the 30-day readmission rate, followed by the 30-day reoperation rate. The majority of QIs are influenced by baseline and underlying patient characteristics, reflecting the severity of the patient`s underlying disease, rather than adherence to best available evidence of treatment. Therefore, it is crucial to implement adequate risk adjustment strategies when applying QIs to compensate for differences in patient complexity and to ensure that departments that are treating high-risk patients do not have worse results. The review revealed several limitations of the currently used quality indicators. Most suggested indicators are attractive from a payer point of view, easy to measure and therefore convenient for reimbursement purposes. However, from a clinician's point of view, most indicators were considered poor performance markers as they do not correlate with meaningful outcome and do not reflect treatment quality. In addition, there is a lack of disease- and neurosurgery specific indicators. This highlights the need for clinicians to actively participate in developing more clinically relevant QIs tailored to neurosurgical practice., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Healthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals., Methods: World Health Organization's Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process., Results: Four priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts., Conclusions: This work presents a significant stride in improving Romanian public hospitals' quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere., (© 2024. World Health Organisation, and Dragos Garofil, Alexandru Rogobete, Niek Klazinga.)

Objectives: A quality indicator (QI) for the treatment of systemic lupus erythematosus (SLE) during pregnancy and childbirth that is useful for sharing standard treatment policies has not yet been developed. This study aimed to develop a QI for SLE associated with pregnancy and childbirth., Methods: To identify candidate QIs, we conducted a systematic literature review on the development of QIs for SLE related to pregnancy and childbirth and on clinical practice guidelines. Candidate QI items were extracted from the final selected articles, and a first evaluation, panel meeting, and second evaluation were conducted to determine whether the candidate items were appropriate as QIs. Items for which all panel members reached a consensus were designated pregnancy and childbirth-related SLE QIs., Results: Four articles on SLE QI development and 28 practice guidelines were listed through abstract/text screening. Based on these studies, 52 candidate QIs were extracted that were limited to items related to pregnancy and childbirth and 41 items were selected on which all panel members agreed., Conclusion: We developed pregnancy-related SLE QIs using the RAND/UCLA method and selected 41 items, which could be used clinically., (© Japan College of Rheumatology 2024. Published by Oxford University Press.)

Background: Quality indicators in healthcare are essential to raising awareness about the appropriateness of nursing care. However, identifying the key indicators continues to pose a challenge, above all if one wants to include users and professionals., Aim: Identify which aspects of nursing care should be measured to assess the results of nursing care and how to do so., Methodology: Interpretive qualitative exploratory study. The participants were users and professionals of an autonomous regional health service in Spain. The information was collected by means of two focus groups and eight semi-structured interviews conducted between November 2022 and March 2024. The data were analysed thematically using the Braun and Clarke process., Results: The users and professionals agreed on the need to measure emotional skills and attitudes such as empathy, respect, and warmth when dealing with patients. The professionals highlighted workload and inefficiency of the current record system as barriers to adequately reflecting their work. They proposed improvements in the recording tool and the need for more human resources, as well as leadership that is more focused on quality., Conclusions: It is crucial to develop indicators that reflect both the emotional and technical aspects of nursing care. The participation by patients and professionals alike in this design and selection will make it possible to improve the quality of care and advances in the nursing profession. This study was not registered.

Background: In recent years, health systems worldwide have been confronted with several crises such as natural disasters or the COVID-19 pandemic, that affected lives and health of many people. In light of waves of infections and heat, climate change is considered to be the biggest health threat of the 21st century. Strengthening individual and organizational crisis resilience in healthcare settings thus becomes a crucial factor in maintaining care quality and protecting vulnerable patients during such crises. The RESILARE project therefore aimed to develop and evaluate quality indicators that support primary care practices in preparing for and adapting to crisis-related challenges., Methods: In a three-phased process, indicator development was based on systematic literature research and qualitative data, a two-stage expert panel process, and pilot testing in a maximum of n = 35 ambulatory practices during an outreach visit. Practice-individual indicator-related status and benchmarking information were provided via feedback reports to complete the audit and feedback program. A mixed-methods process evaluation used semistructured interviews with participating General practitioners and nonphysician health professionals to explore support and challenges for the implementation of the derived set of quality indicators. Two online surveys were conducted to evaluate all indicators and the two-part feedback report. Qualitative data were analyzed inductively using a thematic analysis approach. Survey data were analyzed descriptively., Results: A total of n = 32 indicators covered four domains: (1) individual resilience, (2) crisis prevention, (3) organizational resilience, and (4) climate resilience. N = 34 practices participated in the piloting and the process evaluation. Participants generally attributed a high relevance to the domains, and considered the indicator set suitable for implementation into existing quality management systems. Planning and implementation of measures that strengthen crisis resilience in practices were triggered or intensified by piloting the indicators and by the two-part feedback report. The identified challenges involved the volume of indicators and practice-individual implementation of renewable energy sources on rented premises. Participants expressed their desire for peer exchange regarding proven concepts for crisis resilience., (© 2024. The Author(s).)

Objectives: To identify, appraise, and synthesize common themes from quality indicator (QI) sets designed for the assessment, management, and rehabilitation of musculoskeletal (MSK) conditions in primary and community care contexts., Data Sources: A systematic search was performed on six databases (MEDLINE, EMBASE, AMED, Web of Sciences Core Collection, The Cochrane Library, and The Health Management Information Consortium), public repositories, and the websites of organizations involved in the reporting of MSK QIs., Study Selection: Potential QI sources were screened for relevance using an a priori criteria. After the screening of 1493 titles, abstracts, 71 articles were reviewed independently by two authors, of which 25 met our criteria and were therefore included within the review., Data Extraction: The development of the QI sets was appraised using the AIRE instrument. Key characteristics of QI sets were extracted and tabulated. Nine out of 25 QI sets had "high" developmental methodology quality. A total of 410 QIs were identified from 25 QI sets., Data Synthesis: A narrative synthesis was undertaken to identify common themes among QIs. Themes were mapped against improvement drivers mentioned in recent British primary/community MSK care policy directives. Finally, "Draft Indicators" were synthesized from common themes identified. Eleven overarching themes were synthesized: policy and governance; optimizing access and provision of care; staffing and spending; optimizing assessment and diagnosis; optimizing patient education and self-management; pharmacology and injection guideline adherence; optimizing personalized care; optimizing imaging, investigations, and referral; public health management relevant to MSK conditions; optimizing patient experience; and optimizing patient outcomes., Conclusions: This review has identified common themes among QIs that focus on optimizing assessment, investigations, and treatment decisions for the primary/community care of MSK conditions. This work represents a valuable resource to commissioners, service managers, and clinicians internationally who resource, monitor, manage, assess, and rehabilitate individuals with MSK conditions., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the reliability of speech data and speech-related quality indicators in the Swedish quality registry for cleft lip and palate (CLP) at 10 years of age., Design: Retrospective study., Setting: University hospitals., Participants: One hundred twenty-one 10-year-olds with unilateral or bilateral CLP., Main Outcome Measures: Six independent raters reassessed audio recordings for comparison with registry data. For calculation of agreement, the single measures intraclass correlation coefficient (ICC) was used for percentage of consonants correct (PCC) and non-oral speech errors, quadratic weighted kappa for velopharyngeal competence (VPC), and percentage agreement and kappa for quality indicators. The results of the three to four raters with the highest intra-rater and inter-rater reliability were used for comparison with registry data., Results: There was excellent agreement between registry data and reassessments for PCC (ICC, 0.93) and percentage of non-oral errors (ICC, 0.80). For VPC, one rater and registry data had good agreement (k, 0.704); the remaining cases had fair agreement (k, 0.476-0.554). The percentage agreement between registry data and reassessments for quality indicators ranged from fair to excellent. When calculated with kappa, agreement was good to excellent (mean of all k values, 0.67-0.70)., Conclusions: The CLP registry variables PCC and percentage of non-oral errors and the quality indicators without non-oral speech errors and competent/marginally incompetent velopharyngeal function are reliable for use in clinical audits and research of 10-year-olds. The three-tier ratings of VPC have weaker reliability but can still be useful in more detailed analyses if interpreted with caution., Competing Interests: Data AvailabilityThe datasets generated and/or analyzed during the current study are not publicly available because of ethical restrictions but are available from the corresponding author on reasonable request. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The care of critically ill patients involves communication and shared decision-making with families and determination of goals of care. Analyzing these aspects through electronic health records (EHRs) can support research in ICUs, associating them with outcomes. This review aims to explore studies that examine these topics., Methods: A scoping review was conducted through a systematic literature search of articles in PubMed, Web of Science, and Embase databases using MESH terms up to 2024, conducted in ICU settings, focusing on communication with families, shared decision-making, goals, and end-of-life care., Results: A total of 10 articles were included, divided into themes: Records and family, and records in quality improvement projects. Variables based on records with common characteristics were identified. Outcome analysis was performed through questionnaires to family members, healthcare professionals or by analyzing care processes. The studies revealed associations between family members' perceptions and mental health symptoms and documented elements such as communication, therapeutic limitations, social and spiritual support. Studies evaluating quality communication improvement projects did not show significant impact on documented care, except for those that assessed improvements based on palliative care., Conclusion: The analysis of documented care for critically ill patients can be conducted from various perspectives. Processes amenable to improvement, such as communication with family members, definition of goals of care, limitations, shared decision-making, evaluated through EHRs, are associated with mental health symptoms and perceptions of families of critically ill patients. Documentation-based studies can contribute to improvements in patient- and family-centered care in the ICU., How to Cite This Article: de Aquino VW, da Silveira GF, Boniatti MM, Terres MS. Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review. Indian J Crit Care Med 2024;28(10):977-987., Competing Interests: Source of support: Nil Conflict of interest: NoneConflict of interest: None, (Copyright © 2024; The Author(s).)

Following a systematic review of quality indicators employed in the evaluation of clinical care for individuals with HIV and AIDS, we performed "an exploratory study" that aims to assess the clinical significance and practical applicability of these indicators from the perspective of health care professionals (HCPs) specialising in HIV and AIDS care. Twenty-five HCPs filled out two questionnaires. From the initial list of 88 quality indicators, 50 were identified as the most relevant and useful in HIV and AIDS clinical care. Analysis was conducted on the individual indicators, and the outcomes were categorised into seven domains for clinical relevance and practical usefulness. Health care professionals deemed the functional organisational structure and the therapy domain to have the most pertinent and useful indicators among the seven different clinical domains, followed by the prevention domain.

In Spain, lung cancer (LC) is the fourth most common cancer. Managing LC involves different professionals, and cooperative and coordinated work is crucial. Therefore, important decisions are better made by Multidisciplinary Thoracic Tumour Boards (MTTBs). On the other hand, certification systems have proven to improve the structure of care, ultimately having a positive impact on patient survival. Herein, a multidisciplinary working group of 11 experts (a Radiologist, a Thoracic Surgeon, a Pulmonologist, a Radiotherapy Oncologist, four Medical Oncologists, a Hospital Managing Director, a Cytologist, and a Molecular Biologist specialist) proposed a standard to certify and evaluate MTTBs. The following components were suggested for the standard: minimum requirements for the MTTB, a mixed model developed in two stages (preparation and audit), a structure comprising three groups of indicators (Strategic and Management, Support, and Operational), three certification levels, and an audit process. In our opinion, certifying MTTBs is critical to improve the standard of care for LC patients., (© 2024. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).)

Objective: To develop a set of quality indicators (QIs) tailored to improve the care provided to children with juvenile idiopathic arthritis (JIA) in countries across the Asia-Pacific region., Methods: An adaptation of the Research and Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) was used. An initial set of 32 QIs was developed after a systematic search of the literature. These were presented to members of a Delphi panel composed of pediatric rheumatologists and other relevant stakeholders from the Asia Pacific League of Associations for Rheumatology Pediatric Special Interest Group (APLAR-Pediatric SIG). After each round, the mean scores for validity and reliability, level of disagreement, and median absolute deviation from the mean were calculated., Results: The panelists were presented with 32 QIs in two rounds of voting, resulting in the formulation of a final set of 22 QIs for JIA. These QIs are categorized within six domains of care, including access to care, clinical assessment, medications and medication monitoring, screening for comorbidities, counseling, and self-efficacy and satisfaction with care., Conclusion: These QIs have been developed to evaluate and improve the quality of care provided to children with JIA, aiming to enhance health outcomes and ensure that healthcare services are tailored to the unique needs of this patient population., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean College of Rheumatology. All rights reserved.)

Purpose: Cervical cancer is the fourth most common cancer in women worldwide. A successful screening concept for cervical cancer reduces the incidence and mortality of cervical cancer. Quality indicators (QIs) derived from the screening guidelines for cervical cancer and used by the certified dysplasia units and dysplasia consultancies are evaluated in this paper. The aim of this paper is to present the current data from the annual reports of these units and consultancies., Methods: The results of the basic data and indicators for the audit year 2022 in the gynaecological dysplasia consultancies and units are presented. In 2022, 84 dysplasia consultancies and 42 units were audited. 40 units and 84 consultancies are included in the annual report. QI outcomes for patients treated in certified dysplasia units and dysplasia consultancies are analysed. Median, overall proportion, and standard deviation were calculated for each QI., Results: The indicator year 2021 was analysed, which was audited in 2022 and evaluated in 2023. A total of nine QIs were analysed. Most target goals were met by the 84 certified dysplasia consultancies and by the 40 dysplasia units. The QIs evaluated are implemented to a very high degree. The targets for the three QIs were achieved by both the dysplasia consultancies and the units in at least 95% of the certified centres (QI 1: 100%, QI 2: 95%, QI 3: 100%; QI 1: 100%, QI 2: 97%, QI 3: 100%, respectively). The presentation of patients to the tumour board by the consultancies/units is working; the units are attending the tumour board more regularly than in previous years. Where the target was not met, the auditors issued deviations or reduced the duration of the certificate. The cases are discussed intensively in the sense of an individual case analysis and with the determination of measures on-site., Conclusions: The targets for the various indicators were largely met by the dysplasia consultancies and units in the 2022 audit year. The certification of gynaecological dysplasia consultancies/units which have to cooperate with certified gynaecological cancer centres, has for the first time ensured the continuity of healthcare from prevention and early diagnosis to treatment of gynaecological cancers., (© 2024. The Author(s).)

Aims: This national study investigated hospital quality and patient factors associated with treatment location for systemic anticancer treatment (SACT) in patients with metastatic cancers., Materials and Methods: Using linked administrative datasets from the English NHS, we identified all patients diagnosed with metastatic breast and bowel cancer between 1 January 2016 and 31 December 2018, who subsequently received SACT within 4 months from diagnosis. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regression models were used to estimate the impact of travel time, hospital quality and patient characteristics on where patients underwent SACT., Results: 541 of 2,364 women (22.9%) diagnosed with metastatic breast cancer, and 2,809 of 10,050 (28.0%) patients diagnosed with metastatic bowel cancer bypassed their nearest hospital providing SACT. There was a strong preference for receiving treatment at hospitals near where patients lived (p < 0.001). However, patients who were younger (p = 0.043 for breast cancer; p < 0.001 for bowel cancer) or from rural areas (p = 0.001 for breast cancer; p < 0.001 for bowel cancer) were more likely to travel to more distant hospitals. Patients diagnosed with rectal cancer were more likely to travel further for SACT than patients with colon cancer (p = 0.002). Patients were more likely to travel to comprehensive cancer centres (p = 0.019 for bowel cancer) and designated Experimental Cancer Medicine Centres (ECMCs) although the latter association was not significant. Patients were less likely to receive SACT in hospitals with the highest readmission rates (p = 0.046 for bowel cancer)., Conclusion: Patients with metastatic cancer receiving primary SACT are prepared to travel to alternative more distant hospitals for treatment with a preference for larger comprehensive centres providing multimodal care or hospitals which offer early phase cancer clinical trials., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In this study, chemometrics were employed to explore the relationship between sensory evaluation and physicochemical indicators of sea bass (Lateolabrax japonicus). Through principal component analysis, cluster analysis, and Pearson correlation analysis, three pivotal indicators were identified: protein content, b* value, and condition factor. Leveraging the grey relational analysis, weights were assigned to these three core quality indicators, resulting in a comprehensive sea bass quality evaluation model: Y = 0.911 × protein (g/100 g) + 0.742 × b* + 0.747 × condition factor. Moreover, near-infrared spectroscopy combined with chemometrics were employed to evaluate the quality of sea bass. The different origins of sea bass were accurately distinguished using orthogonal partial least squares discriminant analysis. The partial least squares regression model was constructed for predicting the critical quality indicator, protein content, with R 2 P of 0.926. This study offers new insights for developing rapid, economical, and reliable methods for assessing aquatic product quality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Differences in patient populations and outcomes by hospital type are becoming increasingly relevant as health care systems shift to value-based care models. There is a paucity of literature on patient-level and hospital-level differences for patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to examine differences in patient characteristics, surgical margins, and adjuvant therapy patterns for surgically treated HNSCC across different hospital types., Methods: A statewide retrospective cohort study was conducted to examine differences in surgically treated patients with HNSCC by hospital type., Results: A total of 579 surgically treated HNSCC patients with a mean age of 58.5 [standard deviation (SD) 10.7] years were included. There were 152 patients (26%) treated at academic hospitals, 205 (35%) at community cancer centers, and 222 (38%) at community hospitals. Patients at academic hospitals were more likely to travel farther for surgery (mean distance 43.6 miles for academic centers vs. 12.7 miles for community cancer centers vs. 12.6 miles for community hospitals; P<0.001) and have advanced T stage (T3-T4) at diagnosis (38% academic, 26% community cancer center, 26% community hospital; P=0.003). There was no significant difference in the positive surgical margin rate by hospital type (32.0% for academic hospitals, 32.1% for community cancer centers, and 35.0% for community hospitals; P=0.79). However, patients at academic hospitals were more likely to receive adjuvant chemoradiation even after adjusting for tumor stage and site [odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2-5.0]., Conclusions: There are important patient-level and hospital-level differences for head and neck cancer management in academic versus community hospitals., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-23-2047/coif). J.T. serves as an unpaid editorial board member of Translational Cancer Research from May 2023 to April 2025. J.P.Z. is the founder, board member, and inventor on the majority of IP owned or licensed to Droplet Biosciences, which is not directly relevant to the work included in this manuscript. A.F.O. reports grants from University Cancer Research Fund (General support through the UNC Lineberger Comprehensive Cancer Center). A.M.Z. reports consulting fees from Johnson and Johnson, R and D consulting, payment to his consulting company, unrelated to this work or manuscript. W.G.Y. reports grant funding from NIH for research and payment for expert witness in legal cases. The other authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: Surgical complications are preventable in up to 50% of cases, actually are various tools to avoid them, one of these are morbidity and mortality conferences. However, there are no guides that define their structure for them to be effective. Objective; Analyze the impact of a new modality of surgical conferences in a sector of benign biliary pathology, called quality evaluation conferences. Methodology: Descriptive observational study where the overall improvement of the sector, the decrease in complications and the quality of patient care are compared. For 6 months, a weekly quality evaluation conference was carried out. It had 5 stages; 1. Analysis of all discharged patients. 2. Review of adverse events. 3. Review of the list and order of patients in the surgical plan. 4. Reproduction of recorded surgeries and review of scientific articles. 5. Review of own scientific works in development., Results: after implementing the conferences, there was a decrease in the number and severity of complications, as well as an improvement in the correct and timely surgical indication. Conclusion; Quality evaluation workshops as an evolution of morbidity and mortality workshops are a novel tool that, when well implemented, can help improve quality standards and in turn be used as a learning option in training centers., (Universidad Nacional de Córdoba)

Objective: Establishing benchmarks for length of stay (LOS) may inform strategies to improve resource efficiency, decrease costs, and advance care quality. In this study, the authors characterize postoperative LOS in endoscopic skull base surgery (ESBS) and elucidate prolonging factors., Methods: A retrospective chart review was conducted at a tertiary academic center including consecutive adult patients who underwent intradural ESBS with intraoperative CSF leak during primary repair between July 2018 and March 2024. LOS, calculated as the time between the end of anesthesia until discharge from the hospital, comprised the primary outcome. Categorical and continuous independent study variables were assessed for univariate LOS association via the Mann-Whitney U-test and Kendall's tau-b correlation, respectively, and those with significant associations were included as multiple linear regression inputs., Results: One hundred sixty-three patients were included, with a median LOS of 4.0 (interquartile range [IQR] 2.8-5.8) days. LOS was significantly prolonged in high-flow (n = 82) compared with low-flow (n = 81) CSF leak cohorts (median 4.5 [IQR 3.9-6.5] vs 2.9 [IQR 2.1-4.7] days, p = 0.002). Defects involving the anterior cranial fossa (n = 16, median 4.6 [IQR 3.3-7.5)] days), suprasellar region (n = 94, median 4.4 [IQR 3.2-6.4] days), sella (n = 138, median 3.9 [IQR 2.8-5.8] days), or posterior cranial fossa (n = 17, median 4.5 [IQR 3.9-6.5] days) had variable LOSs. On multiple linear regression, after controlling for numerous patient, surgical, and postoperative factors, lesion diameter (B = 0.16, 95% CI 0.048-0.26), bone defect area (B = 0.008, 95% CI 0.001-0.014), anesthesia time (B = 0.015, 95% CI 0.004-0.026), bed rest length (B = 2.34, 95% CI 1.12-3.56), postoperative CSF leak (B = 11.06, 95% CI 4.11-18.01), postoperative meningitis (B = 11.79, 95% CI 4.83-18.74), postoperative stroke/hemorrhage (B = 25.25, 95% CI 18.43-32.06), and postoperative pneumonia (B = 5.59, 95% CI 0.79-10.38) independently predicted overall prolonged LOS., Conclusions: With healthcare utilization receiving increased attention, mitigating factors that extend LOS are important. Extent of surgery and certain postoperative complications may constitute key factors prolonging LOS following intradural ESBS with intraoperative CSF leak.

Aim: The aim of this study was to develop quantitative outcome indicators for psychiatric training programs integrated into the General Medicine In-Training Examination (GM-ITE) and to investigate which characteristics correlate with high scores in psychiatry., Methods: A nationwide cross-sectional study was conducted over 3 fiscal years (2021-2023). An anonymous online questionnaire was distributed to postgraduate year 1 and 2 residents who completed the GM-ITE. The primary outcome was GM-ITE score, with a particular focus on psychiatry. Multiple-choice questions for the psychiatry field were created by board-certified psychiatrists with various subspecialties, then reviewed and piloted. Multiple regression analysis examined correlations between GM-ITE score and various resident and facility characteristics., Results: A total of 18,226 residents participated over the 3 years, of whom 5%-6% aspired to specialize in psychiatry. Quantitative scores were effective in the psychiatry field across all 3 years. Psychiatry aspirants had lower scores in internal medicine, emergency, and total scores but higher scores in psychiatry. Residents from university hospitals had lower psychiatry scores, while the number of psychiatry beds and supervising psychiatrists did not correlate with higher psychiatry scores. These findings indicate the need for psychiatric training programs distinct from general internal medicine and emergency training., Conclusion: Based on these quantitative psychiatry scores, this study highlights the necessity of improving physical assessment skills during residency for psychiatry aspirants, who score higher in psychiatry. Future research should identify effective training programs and facility practices that lead to higher psychiatry scores among residents, and thereby better integrate psychiatry into basic clinical skills., Competing Interests: H.T., T.Ko., M.Sa., and D.S. have received an honorarium from JAMEP as exam preparers of the GM‐ITE. Y.N. has received an honorarium from JAMEP as GM‐ITE project manager. Y.T. is the director of JAMEP and has received an honorarium from JAMEP as a speaker at the JAMEP lecture. T.Ka. reports grants from Sumitomo‐Pharma outside the submitted work. T.Ka. is an Editorial Board member of Psychiatry and Clinical Neurosciences Reports and a co‐author of this article. To minimize the bias, he was excluded from all editorial decision‐making. The remaining authors declare no conflict of interest., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires abundant clinical experience and endoscopic skills, and can lead to various complications, some of which may progress to life-threatening conditions. With expanding indications and technological advancements, ERCP is widely utilized, enhancing procedural accessibility. However, without proper quality management, the procedure can pose significant risks. Quality management in ERCP is essential to ensure safe and successful procedures and meet societal demands for improved healthcare competitiveness. To address these concerns, the Korean Society of Pancreatobiliary Endoscopy has developed a Korean-specific ERCP quality indicator reflecting domestic medical environments and realities. Initially, based on a review of foreign ERCP quality indicators and related literatures, key questions were formulated for five pre-procedural items, three intra-procedural items, and four post-procedural items. Descriptions and recommendations for each item were selected through peer evaluation. The developed Korean-specific ERCP quality indicator was reviewed by external experts based on the latest evidence and consensus in this fields. This Korean-specific indicator is expected to significantly contribute to improving ERCP quality in Korea, as it is tailored to local needs.

Objective: We aimed to assess performance parameters in a Hawassa Tuberculosis Culture Laboratory, in the Sidama Regional Public Health Institute., Methods: A cross-sectional survey was conducted between 27 October 2020 and 31 May 2021, on 439 clinical specimens. The specimens were processed using standard procedures, and the final suspension was inoculated into a Microbial Growth Indicator Tube and Lowenstein-Jensen media slant. Ziehl-Neelsen staining and the Bioline test kit were used to identify and confirm Mycobacterium tuberculosis. The data were analyzed using the IBM Statistical Package for Social Sciences (SPSS, version 26)., Results: Out of a total of 439 specimens that were processed, the recovery rates for smear-positive specimens were 61% (25 out of 41) and 58.5% (24 out of 41) for the Mycobacterial Growth Indicator Tube, and the Lowenstein-Jensen methods, respectively. For smear-negative samples, the recovery rates were 4.5% (18 out of 398) for both methods. Only 4 (0.9%) specimens were rejected. The mean turnaround times to detect mycobacteria from smear-positive samples were 14 and 32 days for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods, respectively. The standard deviations were ±6.3 days and ±9.7 days, respectively. For smear-negative samples, the mean turnaround times were 17.7 and 31 days for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods, respectively. The standard deviations were ±9.2 days and ±9.6 days, respectively. The contamination rates for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods were 9.8% (43 out of 439) and 9.6% (42 out of 439), respectively. The detection rate of nontuberculosis mycobacteria was 1.4% (6 out of 439)., Conclusion: It demands attention to improve the low recovery rate among smear-negative cultures and culture contamination rates., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction and Objectives: By 2022, 9 centers had been accredited by the Spanish Society of Cardiology for the atrial fibrillation (AF) process. Our objective was to evaluate the performance of these centers based on the quality indicators (QIs) proposed by the European Society of Cardiology (ESC) in 2020., Methods: Adults with AF who were attended in the cardiology departments of participating centers during the second week of May 2019 were included in a retrospective registry (n=797, age 72±11 years, 60% male). Key ESC QIs were assessed., Results: CHA 2 DS 2 -VASc, HAS-BLED scores, and serum creatinine levels were documented in 24.9%, 6.1%, and 96.2% of patients, respectively. Anticoagulation was appropriately prescribed in 90.6% of high-risk patients according to the CHA 2 DS 2 -VASc score, but was inappropriately prescribed in 57.8% of low-risk patients. Among all patients, 84.1% received high-quality anticoagulation. Inappropriate antiarrhythmic drugs were prescribed in 7.2% of patients with permanent AF, 2.9% of those with structural heart disease, and 0.0% of those with end-stage kidney disease. Catheter ablation was offered to 70% of patients with symptomatic paroxysmal or persistent AF after the failure or intolerance of 1 antiarrhythmic drug. All modifiable risk factors were documented in 59.3% of patients. Rates of all-cause mortality, ischemic stroke or transient ischemic attack, and major bleeding were 8.1, 0.8, and 2.56 per 100 patients/y, respectively. QIs for anticoagulation and outcomes were similar between general cardiology and tertiary referral centers., Conclusions: Although accredited centers in Spain demonstrated good performance in many of the ESC QIs for AF, there remains room for improvement. These data could serve as a starting point for enhancing the quality of care in this population., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual's belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs., Objective: To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation., Methods: Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level., Results: Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R 2  = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup ( n  = 12; R 2  = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort ( n  = 30) model., Discussion: Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual's care.

Background: Patients with advanced cancer experience many symptoms and needs requiring a Palliative Care Intervention (PCI). Identifying gaps between needs for PCIs and experienced delivery may improve health care, furthermore the association of gaps with quality indicators (QI). The multicentre Romanian (RO)-Swiss (CH) reality map study implemented a novel protocol based on needs concepts and culturally adapted quality indicators (QI)., Methods: An interactive mapping guide measuring unmet needs for PCIs monthly over six months, patient characteristics (cognition, EAPC basic data set, Cofactors) and QI (Inappropriate Anticancer Treatment, High Symptom Burden [IPOS, EQ5D], Repeated ER Admissions, Aggressive End-of-Life Care, and Quality of Death-and-Dying) were developed, applying swiss standards for quality assurance. A composite endpoint (QI, cofactors) was planned. Finally, local solutions responding to gaps were piloted., Results: From 308 patients (RO: 262, CH: 46, age 62j [mean], 74 % ECOG PS 1&2, 81 % current anticancer treatment) baseline and first follow-up data revealed main gaps (symptom management, spiritual needs, family support), country differences (e.g. illness understanding, spiritual needs) and a significant association of the number of gaps with depression. Later data become less, and data quality on QI variable, revealing gaps in research conduct competences, resources, and applicability of over-sophisticated quality assurance tools. Nevertheless, the unmet needs data promoted local initiatives, 81 patients participated in feasibility studies. Finally, the joint experience stimulated academic developments and national integration of palliative care into oncology., Conclusions: Pairing motivation and enthusiasm with more modest aims, feasibility testing of all outcomes and investment in research competences may disperse gaps., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis., (Copyright © 2024 American College of Cardiology Foundation and the American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives Overordering of blood products, particularly packed red blood cells (PRBC), leads to inefficiencies and financial burdens within healthcare systems. The objective of this audit was to assess PRBC utilization practices against established quality indicators to enhance efficiency and reduce wastage in a newly established tertiary care hospital in Northern India. Materials and methods A retrospective audit was conducted in the department of transfusion medicine. Data were collected from departmental records and analyzed using various quality indicators, such as crossmatch to transfusion ratio (CTR), transfusion probability (%T), transfusion index (TI), and utilization rate (UR). Microsoft Excel was utilized for statistical calculations including range, percentage, ratio, and quality indicators. Results A total of 1,488 PRBC requisitions were received, 997 (67%) originated from various surgical specialties. The overall CTR was 1.88, with medical and surgical specialties having CTRs of 1.3 and 2.6, respectively. Overall %T was 53.8%, which in medical departments was 85% and in surgical departments was 38.5%. TI was 0.68 overall, which varied among medical (1.1) and surgical (0.48) specialties. The overall UR was 53.14%. Peri-operative blood loss (48%) and anemia (46%) were the primary indications for transfusions. Cardiothoracic and vascular surgery (CTVS), General surgery, and orthopaedics exhibited appropriate blood utilization practices, whereas ear nose and throat (ENT), pediatric surgery, urology, neurosurgery, and obstetrics and gynecology (OBGY) showed tendencies toward overordering and underutilization. Conclusion This audit highlights significant issues related to blood utilization practices, particularly overordering and underutilization in certain surgical specialties within the studied institution. While these findings underscore the potential benefits of implementing audit-driven policies to enhance efficiency and reduce wastage, the results are specific to this institution and may not be universally applicable. Further studies across multiple institutions are recommended to validate these findings and develop broader guidelines for optimizing blood utilization in healthcare systems., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institute Ethics Committee, Bioethics Cell, AIIMS Raebareli issued approval 2024-1-IMP-EXP-6. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kaur et al.)

Some preterm and sick neonates have altered biochemical profiles and follow-up newborn screening (NBS) collections are recommended. The Victorian NBS program historically recommended repeat collections for babies with birth weight < 1500 g (managed by the maternity service provider) and 3 weeks post-transfusion (managed by the laboratory). We aimed to determine adherence to current guidelines and review the guidelines to improve NBS performance. To do this, we audited data from 348,584 babies between January 2018 and June 2022. Babies with a recorded birth weight of <1500 g were filtered for inclusion. For the overall review and visualization of the protocol, we sourced information from the literature, our professional society and tertiary hospital services. A total of 2647 babies had a birth weight recorded between 200 and 1499 g. Of these, 2036 (77%) had a second sample collected, indicating that >1 in 5 babies were not receiving a follow-up collection. Our timing of repeat collections for transfused babies, requiring a 3-week follow-up collection, was longer than in other Australasian jurisdictions. A new combined "sick-prem protocol" was launched to support repeat collections and after a 1-year review achieved 95% compliance. We recommend NBS laboratories audit preterm and sick neonate repeat collections to ensure appropriate follow-up. This should be supported with a visual process map to aid education and compliance.