Sample survey methods as a quality assurance tool in a general practice immunisation audit

AIMS: In a multidoctor family practice there are often just too many sets of patients records to make it practical to repeat an audit by census of even an age band of the practice on a regular basis. This paper attempts to demonstrate how sample survey methodology can be incorporated into the quality assurance cycle. METHODS: A simple random sample (with replacement) of 120 from 580 children with permanent records who were aged between 6 weeks and 2 years old from an Auckland general practice was performed, with sample size selected to give a predetermined precision. The survey was then repeated after 4 weeks. RESULTS: Both surveys were able to be completed within the course of a normal working day. An unexpectedly low level of under 2 years olds that were recorded as not overdue for any immunisations was found (22.5%) with only a modest improvement after a standard telephone/letter catch up campaign. Seventy-two percent of the sample held a group one community services card. CONCLUSIONS: The advantages of properly conducted sample surveys in producing useful estimates of known precision without disrupting office routines excessively were demonstrated. Through some attention to methodology, the trauma of a practice census can be avoided.     

Importance of in vivo dosimetry as part of a quality assurance program in tangential breast treatments

PURPOSE: The investigation of the accuracy and reproducibility in the daily dose delivered in tangential breast treatments with in vivo dose measurements. METHODS AND MATERIALS: In vivo dose measurements performed on the tangential treatment fields of 35 breast cancer patients are analysed for three units: a 6 MV linear accelerator, an old Cobalt unit and a new Cobalt unit. The results are plotted in frequency distributions. Deviations on the mean are often the expression of a systematic error in one of the core procedures of a department. A large spread of the results around the mean indicates a high burden of random set-up errors and/or systematic errors in individual patients. The reproducibility in dose delivery is studied by comparing repetitive checks to their respective mean for investigation of random day-to-day variation. RESULTS: A small systematic error on the entrance dose (+ 1.4%) is detected on the old Cobalt unit due to a discrepancy between measured and published percentage depth dose values. An unexpected systematic overdosage (+ 6%) is detected after implementation of a new software for dose calculation, proving that treatment quality is a process needing continuous monitoring. The transmission measurements demonstrate a systematic error in dose delivery of 1.5 to 3% due to the assumption that the breast is water equivalent when calculating the dose. The large spread of the transmission measurements (sa = 7.7%) shows that the weakest point in the treatment preparation chain is inaccurate acquisition of external body contours, leading to systematic errors in dose delivery for specific patients. The standard deviation for the reproducibility is 3.1% for the old Cobalt unit, vs. 1.6% on the other units, demonstrating the influence of staffing and mechanical characteristics of the units on daily precision in dose delivery. CONCLUSION: In vivo dosimetry is an important tool in a departmental quality assurance program to detect systematic errors in dose delivery, to identify inadequate treatment situations, to investigate weak points in the chain of treatment preparation and to ensure accurate dose delivery for individual patients. The predictive value of a single check for the accuracy in dose delivery during the whole treatment series is high for reproducible treatment methodologies.     

The quality assurance process as a management method for psychology training programs.

Describes a psychology training program in a community-based psychological service center managed by a system of quality assurance. Professional psychology doctoral candidates practice in the center and participate in the quality assurance management process as part of their training. Trainees participate in the practice and serve on peer review panels. It is concluded that the peer review system appears well received, functional, useful, and worth continuing. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The programme of quality assurance of the EORTC radiotherapy group. A historical overview

Decreased activity of cholesterol 7 alpha-hydroxylase, the rate-limiting enzyme in the catabolism of cholesterol to bile acids, is known to result in increased biliary cholesterol concentration and supersaturation of bile. Supersaturation of bile by cholesterol is a necessary condition for cholesterol gallstone formation. In guinea pigs, the hepatic concentration of ascorbic acid affects the catabolism of cholesterol: hypovitaminosis C reduces cholesterol 7 alpha-hydroxylase activity. Cholesterol gallstones are frequently found in ascorbic acid-deficient guinea pigs. Risk factors for cholesterol gallstones in humans include obesity, aging, estrogen treatment, pregnancy and diabetes. Plasma ascorbic acid levels are reduced in these groups. Vegetarian diets, which typically have high ascorbic acid contents, protect against gallstones. Since ascorbic acid effects the rate-limiting step in the catabolism of cholesterol in the guinea pig and many human risk groups for cholesterol gallstones are associated with reduced ascorbic acid levels, ascorbic acid may play a contributory role in human gallbladder disease.     

Percentages of cervical cytologic diagnoses as a quality assurance method

OBJECTIVE: To demonstrate empirically that the efficiency of rescreening to discover false negative cytologic diagnoses is greatly enhanced by prospectively stratifying accessions according to risk level. STUDY DESIGN: We stratified accessions from 11 clinical sources and established the rate of diagnoses according to three categories: (1) "within normal limits"/"benign cellular changes" (WNL/BCC), (2) "atypical squamous/glandular cells of undetermined significance" (ASCUS/AGCUS) and (3) "squamous intraepithelial lesion/invasive carcinoma" (SIL/CA). We then prospectively rescreened all negative smears from sources with rates of positive diagnoses (ASCUS/AGCUS and SIL/CA) in excess of 20% and 5% of negative smears from sources with rates of positive diagnoses < 20%. We compared the detection rates of false negatives on rescreening target groups with random rescreening of 10% of all negative smears. RESULTS: The rates of SIL/CA, ASCUS/AGCUS and WNL/BCC varied from 0 to 43%, 4% to 14% and 46% to 94%, respectively. Rescreening 10% of all negative smears revealed a false negative fraction of 3%; rescreening target groups revealed a false negative fraction of 5.9%. CONCLUSION: The yield of prospectively detected false negative diagnoses was significantly increased by targeting high-risk accession groups. When cytology laboratories serve diverse populations, stratifying accessions by risk to permit increased sampling from the proportionately higher risk categories is a simple and effective device to maximize the yield and benefit from rescreening.     

Quality assurance in inpatient treatment of depression. Aspects of quality monitoring and external quality assurance exemplified by a pilot project of inpatient treatment of depression]

An apparent species-specific relatedness of SIVagm suggests a coevolution with their natural hosts. However, the exact species or subspecies classification of African green monkeys, AGM, is uncertain because current classification schemes rely on phenotype markers, while more definitive genetic data are lacking. In this study, the CD4 protein involved in tissue type recognition was genetically cloned and sequenced from PBMC RNA from all AGM species, including Barbados green monkeys (BGM). Phylogenetic trees were constructed that also included genomic CD4 nucleotide sequences from patas, sooty mangabeys, rhesus and pig-tail macaques, chimpanzees, and humans. Chimpanzees and humans consistently clustered together. Monkeys within the Cercopithecus genus formed a separate cluster which included pata monkeys, supporting its grouping as a member of Cercopithecus. Surprisingly, sooty mangabeys were genetically more closely related to Asian macaques than to other African species, which might explain why macaques are more susceptible to infection by the SIVsm group than to infection by SIVagm or HIV-1 and why patas, on the other hand, are highly susceptible to SIVagm infection. Based on CD4 genetic data, tantalus, vervets, grivets, and sabaeus formed separate subgroups with BGM grouping closely with vervets. The branching order of the AGM species was related to that of their respective SIVagm env sequences. The study suggests a strong correlation between CD4 phylogeny and the susceptibility of the host species to infection by a specific lentivirus and supports the assumption of a coevolution of SIVagm and AGM. CD4 sequencing is suggested as a relevant method for genetic determination of primate species.     

Training of new coworkers in the intensive care unit as a means for quality assurance

Among patients with bone marrow failure, differentiating acquired aplastic anemia (AA) from hypocellular refractory anemia (hypo RA) can be a difficult and challenging task. Morphological, cytochemical, immunocytochemical, and cytogenetic studies may provide tools for discriminating between both entities. In addition, differences in the pattern of proliferation and apoptosis of bone marrow cells in AA and in the myelodysplastic syndrome have been reported. Because of the correlation between p53 and apoptosis, we examined the overexpression of p53 on bone marrow biopsies in RA and AA. Our study included 14 patients with hypo RA, 14 patients with hypercellular (hyper) RA, ten patients with classic acquired AA, and 37 hematologically normal individuals. p53 was overexpressed in eight (57%) hypo RA patients and 11 (79%) hyper RA patients. All normal individuals and patients with AA showed no overexpression of p53 in their marrow. These results were statistically significant:p < 0.01 (AA vs hypo RA), p<0.001 (AA vs hyper RA), while the difference between hypo RA and hyper RA was not statistically significant. We conclude that p53 overexpression in bone marrow biopsies is a valuable tool for studying bone marrow failure and may provide additional information to help differentiate hypo RA from acquired AA.     

The role of APA in the development of quality assurance in psychological practice.

Discusses the American Psychological Association's (APA) involvement in quality assurance for psychological services. The APA's role includes providing development of accreditation standards for practitioner training programs; standards and model guidelines for psychology licensure; and a sponsor-approval system for continuing professional education, ethical principles, and peer review screening criteria. Although many elements of a comprehensive quality assurance system for psychology exist, many problems still must be resolved, including the need to educate the public and the profession as to the value of quality assurance efforts, limited enforcement and capability, lack of integration of separate activities, and an insufficient data base on which to evaluate the effectiveness of these activities. It is concluded that a conflict exists between increasing professional self-regulation and consumer and governmental skepticism toward the profession in general. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-oriented quality assurance. Information and cooperation of the health services as a condition for integrated care

The increasing care needs of the elderly and chronically ill have a growing impact on health care services. With complex needs to meet, the patient's quality of life depends on multiple factors, of which the continuity of care plays an important role. Information on the past and present health state and on self care resources are prerequisites for adequate rehabilitation efforts that are patient-oriented and of high quality. Institutionally induced "cascade episodes of incompetence" (Ulmer & Saller, 1994) have to be avoided. To make sure that interventions promote or stabilize the quality of life, the participation of the client is crucial in all stages of the process of care planning and coordination. Integrated care requires the exchange of information and close coordination on the concept of care between all participants in the care process. Yet, collaborative care is often seriously jeopardized by lack of knowledge about the concepts, scope of action and requests of the involved health professionals and services. At the Agnes Karll Institute of Nursing Research an action research project aiming at cooperative quality assurance was carried out. It became obvious that there is a large amount of intersectoral knowledge necessarily needed by all professionals and services to ensure seamless professional care. But often they have no access to the information needed. Therefore a client's accompanying booklet was developed to pass on basic information. It is kept by the client and shall be used and filled out by them, their relatives and the different health professionals and health care services involved.     

医院客户机服务器前台程序开发

介绍了客户服务器前台程序的开发     

Internal quality assurance activities of a surgical pathology department in an Australian teaching hospital

Parotid and mandibular saliva was obtained from red kangaroos by concurrent acetylcholine isoprenaline stimulation. Salivary proteins were separated by horizontal electrophoresis on either cellulose acetate or starch gels and assessed by specific staining techniques for 23 enzymes commonly found in mammalian tissues and body fluids. Parotid saliva was positive for acid phosphatase, alpha-amylase, carbonic anhydrase, glucose-6-phosphate dehydrogenase, sorbitol dehydrogenase and superoxide dismutase activities. Mandibular saliva was positive for alcohol dehydrogenase in addition to the above six enzymes. The kangaroo salivas lacked activity for alkaline phosphatase, beta-galactosidase and non-specific esterase which occur in saliva from some mammalian species.     

Is prostate specific antigen density an important prognostic indicator for patients with prostate cancer treated with external beam therapy?

The purpose of this study was to determine if prostate specific antigen density (PSAD) is a predictor of outcome following external beam radiotherapy for prostate cancer, and to compare it with other prognostic factors. Between January 1990 and December 1993, 205 patients with T1-T3 adenocarcinoma of the prostate received a radical course of external beam irradiation, with no prior or adjuvant hormonal therapy. All patients had pre- and post-treatment serum prostate specific antigen (PSA) evaluation. They were followed up for at least 24 months. PSAD was defined as the ratio of pre-treatment serum PSA to the prostate volume, as determined from CT treatment planning scans. Prostate volumes were calculated using the prostate ellipse formula. Median PSA density was 0.37, with a range 0.01-6.7. Biochemical failure was defined as three consecutive rises in serum PSA, regardless of the magnitude of elevation. 4-year biochemical disease-free survival (BDFS) for patients with PSAD < or = 0.3 was 60%, compared with 22% for patients with PSAD > 0.3 (p = < 0.001). In a multivariate analysis, pre-treatment PSA (p = < 0.001), Gleason score (p = 0.002), and stage (p = 0.03) were independent predictors of BDFS, while PSAD was not an important prognosticator (p = 0.62). Pre-treatment serum PSA is the most important prognosticator of BDFS, following external beam radiotherapy, for patients with prostate cancer. PSA density did not predict treatment outcome.     

The development of a programme of research in cardiac rehabilitation

This paper describes the experiences of initiating and developing a coherent programme of research and development in cardiac rehabilitation. It charts the evolution of the research programme from its origins in a few small scale studies and sets the context in which this research was carried out. The paper goes on to describe the valuable lessons learned in undertaking clinical research, such as serving an apprenticeship, receiving supervision and working as a member of a team. Finally, the paper, in acknowledging the importance of research training, shows how this has culminated in the author leading and managing a programme of research, bringing together a research team, disseminating and implementing research and collaborating with colleagues from other disciplines.     

Rheumoorthopedics as an integral part of complex therapy of rheumatic diseases with joint involvement

The paper gives the results of conservative and surgical rehabilitation of patients over 38 years after the foundation of an orthopedic service at the Institute of Rheumatology. Conservative treatments for rheumatic diseases (RD) such as position treatment, formation of a correct stereotype, treatment of the cervical portion of the spine in rheumatic arthritis (RA) and osteoarthrosis derformans (OAD) are evaluated. The author's own experience involving over 5000 operations on the locomotor apparatus in RD, which permits assessment of the most common and successful operations, such as sinovectomy, arthroplasty, arthrodesis, endoprosthesis. Rheumoorthopedics is a part of complex rehabilitative treatment for RD as it enables one to infer actively at different stages of RD and to achieve high results in patients, including those who unresponsive to medical treatment.     

Couple therapy as a treatment for depression: II. The effects of relationship quality and therapy on depressive relapse.

Investigated the effects of behavioral couple therapy, cognitive–behavioral therapy, and their combination on female depression 6 and 12 mo after therapy ended. It was predicted that couples receiving a behavioral couple treatment would be less likely to relapse than those receiving a cognitive–behavioral treatment for the depressed spouse alone. Relapse rates, however, did not discriminate between treatments at any follow-up point. Reductions in husband and wife dysphoria and increases in wife facilitative behavior during therapy predicted recovery. Moreover, high rates of husbands' facilitative behavior at posttest were associated with wife recovery and predicted low levels of depression at the 1-yr follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of an advanced filial therapy model.

This article presents an advanced filial therapy model. This model was developed and implemented by the author in an effort to provide parents with ongoing support and skill development after the completion of a standardized filial model called Child–Parent Relationship Therapy. The advanced filial therapy model is described, including an exploration of how it was developed and how it compares with basic filial therapy models. Examples from the author's clinical experience are provided to illustrate various components of this approach. Finally, implications for research and practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)