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Rehab H Ashour,1,2 Eman A Abdelkader,3 Omar Hamdy,4 Mohamed Elmetwally,4 Wafaa Laimon,5 Mohamed A Abd-Elaziz1 1Clinical Pharmacology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 2Pharmacology & Toxicology Department, Faculty of Medicine at Al-Qunfudah, Umm Al-Qura University, Al-Qunfudah, Kingdom of Saudi Arabia; 3Internal Medicine Department, Faculty of Medicine, Mansoura University, Specialized Medical Hospital, Mansoura, Egypt; 4Surgical Oncology Department, Faculty of Medicine, Oncology Center Mansoura University “OCMU”, Mansoura, Egypt; 5Pediatric Endocrinology and Diabetes Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura University Children’s Hospital, Mansoura, EgyptCorrespondence: Rehab H Ashour, Clinical Pharmacology Department, Faculty of Medicine, Mansoura University, 60 El-Gomhoria Street, Mansoura, Al-Dakahlia, 35516, Egypt, Tel +2 01005409956, Fax +20 50 2248203, Email drrehab40@mans.edu.eg; rhashour@uqu.edu.saBackground: The misuse of antimicrobials has major consequences, particularly antimicrobial resistance (AMR) and antimicrobials’ related adverse effects. So, the WHO proposed antimicrobial surveillance to improve antimicrobials use. This point prevalence survey (PPS) was conducted to illustrate the prevalence of antimicrobial use at Mansoura University hospitals (MUH), Egypt.Methods: The survey process used was adapted from the European survey of antimicrobial resistance with modifications. The survey was conducted from 8 AM to 8 PM daily within 2 weeks.Results: A total of 300 patients received antimicrobials and the prevalence rate of antimicrobial prescription was 79.15%. The major indications of antimicrobials were surgical prophylaxis followed by the treatment of community-acquired infection. The most commonly prescribed initial antimicrobial group was Aminopenicillin ± β-lactamase inhibitors. Although the purpose for antimicrobial administration was recorded in all cases, the stop/review history was recorded only in 19.6% and local guidelines were not available for 77.6% of antimicrobial prescriptions. The use of combined antimicrobials was common (46.6%), particularly in orthopedic and cardiothoracic surgery.Conclusion: The prevalence of antimicrobial prescription at MUH was high which requires serious actions including reviewing the antimicrobial indication, implementing local prescription guidelines, initiating an antimicrobial stewardship program (ASP), and optimizing infection control measures.Keywords: antimicrobial prescription pattern, Egypt, Mansoura, point prevalence survey, quality indicators

In view of obtaining high-grade and competitive products, food industry manufacturers, as well as others, place the client, the consumer, at the top of the quality pyramid. The application of the Customer Orientation principle is essential. For the product “gingerbread”, the subject of this work, textural analysis is used as a survey method, to improve the quality of the product. Gingerbread manufacturers, aiming to satisfy the clients’ requirements, study the behaviour of the products developed by using various ingredients, in different proportions, with various maturation times and with water activities originating from different moisture levels of the product. Such values are intended to particularize the product and to assign it better quality and preservability during the validity term. Thus, in this survey, wheat flour was replaced with rye flour in different percentages, and the dough obtained was left to mature for 30, and respectively 150 minutes. The textural properties of the finished product were analysed, having an impact on the consumer, namely hardness, strength, and resilience. These parameters subject to analysis can be considered quality indicators for gingerbread. It was determined that the replacement of wheat flour with rye flour to a certain percentage leads to minimum toughness of the product. Corelations were made with maturation times, as well as with the moisture of the product. Maturation processes are complex, and the effects of the various factors considered are contradictory. [ABSTRACT FROM AUTHOR]

Research Question (RQ):Which are the most commonly monitored and gaged quality indicators in primary healthcare? Purpose:The purpose of this research is to study and research the grounds for quality indicators and measuring thereof in primary healthcare. Method:For this research we used the method of existing knowledge on quality indicators in healthcare and on monitored quality indicators in primary healthcare by systematical review of existing literature. We used triangulation to ensure better understanding of the problem, check and confirm data, and thus ensure the integrity of the research Results:Research showed the origin of quality indicators in primary healthcare and quality indicators which are measured by organizations in primary healthcare. Organization:Primary healthcare organizations will get an overview over most commonly monitored quality indicators in primary healthcare and thus the possibility to compare success and efficiency. Society:Data on measured quality indicators should be public. Users of primary healthcare services can choose the most successful healthcare organization based only on these data. Originality:A systematical review of the most commonly monitored and measured quality indicators in primary healthcare. Limitations/Future Research: The research is limited due to a smaller number of existing sources used and due to a smaller sample of interviewees. In the future it would be meaningful to research which quality indicators are measure by the majority of healthcare centers in Slovenia and establish a new model of monitored or obligatory quality indicators in primary healthcare based on the findings of this research.

Fadi Abu Baker,1 Amir Mari,1 Kamal Aamarney,2 Abu Ras Hakeem,3 Barouch Ovadia,1 Yael Kopelman,11Gastroenterology and Hepatology Department, Hillel Yaffe Medical Center, affiliated to the Ruth and Rappaport Faculty of Medicine, Haifa, Israel; 2Pharmacy Services Department, Hillel Yaffe Medical Center, affiliated to the Ruth and Rappaport Faculty of Medicine, Haifa, Israel; 3Anesthesiology Department, Hillel Yaffe Medical Center, affiliated to the Ruth and Rappaport Faculty of Medicine, Haifa, Israel Background: Propofol-mediated sedation is safe and clearly associated with increased patient satisfaction. However, whether it results in a favorable effect on colonoscopy outcomes and performance compared to standard sedation with benzodiazepines/opiates remains unclear.Objectives: To determine the effect of propofol-mediated sedation on colonoscopy-quality measures compared to traditional sedation.Methods: A large cohort of 44,794 patients who had undergone sedated colonoscopies were included. Colonoscopy-quality indicators were examined in benzodiazepine/opiate-sedated patients and compared with a propofol-mediated sedation group. Adjustment for potential confounders, such as age, sex, quality of bowel preparation, procedural setting, and indication was performed.Results: Patients who received propofol-mediated sedation were more likely, and in a dose-dependent manner, to have an enhanced polyp-detection rate (22.8% vs 20.9%, P

Peter Holmberg Jørgensen,1 Gunnar Schwarz Lausten,2 Alma B Pedersen3 1Tumor Section, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, 2Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Aim: The aim of the database is to gather information about sarcomas treated in Denmark in order to continuously monitor and improve the quality of sarcoma treatment in a local, a national, and an international perspective. Study population: Patients in Denmark diagnosed with a sarcoma, both skeletal and ekstraskeletal, are to be registered since 2009. Main variables: The database contains information about appearance of symptoms; date of receiving referral to a sarcoma center; date of first visit; whether surgery has been performed elsewhere before referral, diagnosis, and treatment; tumor characteristics such as location, size, malignancy grade, and growth pattern; details on treatment (kind of surgery, amount of radiation therapy, type and duration of chemotherapy); complications of treatment; local recurrence and metastases; and comorbidity. In addition, several quality indicators are registered in order to measure the quality of care provided by the hospitals and make comparisons between hospitals and with international standards. Descriptive data: Demographic patient-specific data such as age, sex, region of living, comorbidity, World Health Organization's International Classification of Diseases – tenth edition codes and TNM Classification of Malignant Tumours, and date of death (after yearly coupling to the Danish Civil Registration System). Data quality and completeness are currently secured. Conclusion: The Danish Sarcoma Database is population based and includes sarcomas occurring in Denmark since 2009. It is a valuable tool for monitoring sarcoma incidence and quality of treatment and its improvement, postoperative complications, and recurrence within 5 years follow-up. The database is also a valuable research tool to study the impact of technical and medical interventions on prognosis of sarcoma patients. Keywords: sarcoma, skeletal and ekstraskeletal, population-based database, online database, quality indicators

The institutional funding is a major source of funding for the public universities in Romania, reason why its allocating mechanism is particularly significant. Romanian higher education funding has always been a sore spot and a highly controversial topic of debate for both members of the political class and of the civil society. For a long time they have been searching for the best solutions regarding the university funding, as a key lever for shaping and supporting a high quality academic education system. In this context, through this paper we propose to highlight the current mechanism for allocating the institutional funding to public universities in our country. Structurally, the paper begins with exposing the competences for the budgetary funding and the structure of the institutional funding for universities presentation, after which it focuses on the current model of allocating basic and additional financing. The end is intended to the conclusions, through which we aim to capture the impact of the state decisions regarding the funding methodology on academic education.

Purpose. Primary care is the cornerstone of the health care system and increasingly countries are developing indicators for assessing quality in primary care practices. The ‘Quality Tool’, developed in Ontario, Canada, provides a framework for assessing practices and consists of indicators and criteria. The purpose of this study was to validate the indicators and simplify the Quality Tool. Methods. This study involved a systematic comparison of indicators in the Quality Tool with those in other local and international tools to determine common indicators to include as valid in the Quality Tool. A Delphi process was used to help reach consensus for inclusion of any indicators that were not included in the comparison exercise. Setting. Primary care in Ontario, Canada. Subjects. Key informants were those with known expertise and experience in quality assessment in primary care. Main outcome. Validated set of indicators for inclusion in an updated Quality Tool. Results. Twenty-three stakeholders participated in the Delphi panel. Forty-four indicators were included as valid after the systematic comparison of similar indicators in other assessment tools. Of the 63 indicators brought to the Delphi panel, 37 were included as valid, 15 were excluded and 11 became criteria for other included indicators. Conclusions. The study resulted in a set of 81 validated primary care indicators. The validation of the indicators provided a strong foundation for the next version of the Quality Tool and may be used for quality assessment in primary care. [ABSTRACT FROM PUBLISHER]

Objective: To describe the prescribing patterns and their quality in relation to the prescriber’s medical speciality in a defined population.Methods: The study was done on a random sample of all primary care medical prescriptions made through the social security system during 1 year in Andorra, a small European country. Number and type of prescribed medicines, prescribers’ medical speciality and patients’ age and gender were recorded. Medical specialities considered were General Practice, Paediatrics, Cardiology, Pneumology, Gynaecology, Ophthalmology and Other. A set of various quality indicators [World Health Organisation (WHO)/International Network for Rational Use of Drugs (INRUD) indicators and others] was used.Results: The number of medicines prescribed per encounter varied depending on the prescriber’s medical speciality and patient’s age. Cardiologists and pneumologists tended to prescribe more medicines than other medical specialities. Patients older than 65 years received more prescriptions than younger adults, mostly at the expense of cardiovascular drugs. The contribution of the various groups and subgroups of medicines and the scores of various prescribing indicators showed wide variability across the medical specialities.Conclusion: Prescribing patterns and indicators of prescription quality show wide variability depending on the prescriber’s medical speciality. This has important implications for priority setting in information, continuous education and research. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether undertriage affects the outcome for patients requiring direct admission to the intensive care unit (ICU) from the emergency department due to a medical condition. To identify factors associated with undertriage., Material and Methods: Retrospective review of patients treated in 2018 for medical emergencies requiring direct admission to the ICU from the emergency department. The cases were classified in 2 groups according to the assigned triage level. Underestimation was defined as a triage level of III or more. Independent variables were demographic and epidemiologic data and indicators of severity recorded in the emergency department. The main outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, prolonged ICU stay, and prolonged hospital stay., Results: We included 470 patients with a median age of 68 years (first-third quartile range, 57-78 years); 61.1% were men, and 151 (32.1%) were undertriaged. Factors directly related to undertriage according to odds ratios (ORs) were age (OR = 1.017; 95% CI, 1.003-1.032), Quick Sequential Organ Failure Assessment score of 0 or 1 (OR = 1.761; 95% CI, 1.038-2.988), ratio of oxygen saturation to fraction of inspired oxygen greater than 300 (OR = 2.447; 95% CI, 1.418-4.223), a diagnosis of infection (OR = 5.003, 95% CI 2.727-9.188) whether respiratory (OR = 3.993, 95% CI 1.919-8.310) or other (OR = 1.980, 95% CI, 1.036-3.785) versus a diagnosis of cardiovascular disease. Factors inversely related to undertriage were admission during the afternoon (OR = 0.512, 95% CI, 0.306-0.856) and ambulance transfer (OR = 0.373; 95% CI, 0.232-0.600). Ninety patients (19.1%) died within 30 days. Undertriage was not related to 30-day mortality or the other outcomes analyzed., Conclusion: Undertriage was not associated with a worse outcome in patients requiring direct admission to the ICU for a medical emergency. The factors we found to be associated with undertriage, such as patient age and time of day admitted, merit special attention given that these factors should not be affecting the triage process.

Background: There are limited data on human immunodeficiency virus (HIV) quality indicators according to model of HIV care delivery. Comparing HIV quality indicators by HIV care model could help inform best practices because patients achieving higher levels of quality indicators may have a mortality benefit., Methods: Using the Partners HIV Cohort, we categorized 1565 patients into 3 HIV care models: infectious disease provider only (ID), generalist only (generalist), or infectious disease provider and generalist (ID plus generalist). We examined 12 HIV quality indicators used by 5 major medical and quality associations and grouped them into 4 domains: process, screening, immunization, and HIV management. We used generalized estimating equations to account for most common provider and multivariable analyses adjusted for prespecified covariates to compare composite rates of HIV quality indicator completion., Results: We found significant differences between HIV care models, with the ID plus generalists group achieving significantly higher quality measures than the ID group in HIV management (94.4% vs 91.7%, P = .03) and higher quality measures than generalists in immunization (87.8% vs 80.6%, P = .03) in multivariable adjusted analyses. All models achieved rates that equaled or surpassed previously reported quality indicator rates. The absolute differences between groups were small and ranged from 2% to 7%., Conclusions: Our results suggest that multiple HIV care models are effective with respect to HIV quality metrics. Factors to consider when determining HIV care model include healthcare setting, feasibility, and physician and patient preference., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: The purpose of the study was to measure clinical quality by doing an audit of clinical records and to compare the performance based on clinical quality indicators (CQI) for hypertension and type 2 diabetes across seven European countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain., Methods: Two common chronic conditions in primary care (PC), hypertension and type 2 diabetes, were selected for audit. The assessment of CQI started with a literature review of different databases: Organization for Economic Co-operation and Development, World Health Organization, European Commission European Community Health Indicators, US National Library of Medicine. Data were collected from clinical records., Results: Although it was agreed to obtain the clinical indicators in a similar way from each country, the specific data collection process in every country varied greatly, due to different traditions in collecting and keeping the patients' data, as well as differences in regulation regarding access to clinical information. Also, there was a huge variability across countries in the level of compliance with the indicators., Conclusions: Measurement of clinical performance in PC by audit is methodologically challenging: different databases provide different information, indicators of quality of care have insufficient scientific proof and there are country-specific regulations. There are large differences not only in quality of health care across Europe but also in how it is measured., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)