Implementation of a continuous quality improvement program in transfusion medicine]

The transfusion safety is one of the themes of National Quality Assurance Programme 1995/1996 (National Agency for the Promotion of Medical Evaluation-ANDEM/Direction des H?pitaux (National Hospital Authority)). The Quality Assurance Programme (QAP) in transfusion medicine of our University Hospital has been selected. The QAP is a prospective and normative programme, in which all the actors of the transfusion process are involved. The goals are: i) to assure the quality and the safety of the blood products delivered all along the chain leading to blood or blood components transfusion; ii) the guarantee of the exhaustiveness and the quality of information about the transfusion process that are used to mark out blood products; iii) the standardization of the different steps and the creation of "tools" in order to control the application of written procedures.     

Barriers to implementing a quality improvement program

Critical barriers can prevent the implementation of an effective quality improvement (QI) program in the health care setting, including organizational culture, restructuring, quality assurance/quality control functions, QI teams and costs. Common pitfalls encountered that cause QI programs to falter--or worse, to fail--are discussed.     

Program specification: a precursor to program monitoring and quality improvement. A case study from Boysville of Michigan

The reaction of synthetic DOPA melanin (DM) with lactoperoxidase (LPO), hydrogen peroxide, and nitrite (NO2-) has been investigated using EPR. We observed that in the presence of nitrite LPO/H2O2 generated large amount of melanin radicals, as evidenced by a strong, up to 11-fold, increase in the intensity of the melanin EPR signal. In contrast, when nitrite was omitted the increase was much less, ca. 30%, which, nevertheless, indicates that DM can be metabolized directly by LPO/H2O2. When the nitrite was present, the concentration of melanin radicals was linearly dependent on [NO2-] (for [NO2-] <5 mM), and increased when [LPO] and [H2O2] increased (at constant [NO2-]). We propose that the mechanism for the generation of melanin radicals by the LPO/H2O2/nitrite system involves oxidation of NO2- by LPO/H2O2 to a reactive metabolite, most likely the nitrogen dioxide radical (.NO2), which subsequently reacts with melanin 5,6-dihydroxyindole subunits producing the respective semiquinone radicals. Because melanin and .NO2 generating systems (nitrite, peroxidase enzymes, hydrogen peroxide) may coexist in cells in vivo, our results suggest that melanin could function as a natural scavenger of this highly reactive nitrogen species. This property may be relevant to the physiological functions of the melanin pigments in vivo.     

Implementing a unit based quality improvement program: one hospital's experience

The continuous enhancement of the quality of patient care is the prime directive of a Nursing Quality Improvement Program. A decentralized approach, using a Unit Based Quality Improvement model, was used in one hospital. In this paper, the author examines the process from conceptualization to implementation and evaluation of the decentralized approach.     

Developing a conscious sedation program: from policy development through quality improvement

Conscious sedation (CS) has rapidly become a popular method of anesthesia, administered to decrease the pain and anxiety associated with operative or invasive procedures while avoiding the potential complications of general anesthesia. Intravenous conscious sedation (IVCS) is most frequently administered, but the patient can also receive CS by oral, intramuscular, or rectal routes. Although the level of sedation using CS is not as deep as general anesthesia, the patient is potentially at risk for respiratory depression. CS provides many benefits. It also places an increased burden on healthcare providers to ensure safe and competent care when this form of anesthesia is used.     

An anesthesia quality improvement program utilizing a computer database to effect change

We investigated the clinical characteristics of acute myocardial infarction (AMI) not preceded by angina in 256 patients with first AMIs. Complications, including sustained ventricular tachycardia or ventricular fibrillation, pump failure and cardiac rupture, were more frequent in patients with AMI not preceded by angina (group 1, n = 92) than those preceded by angina (group 2, n = 164). The in-hospital mortality rate was higher in group 1 than in group 2. Poor preexisting collateral channels or lack of ischemic preconditioning may be responsible for the poorer outcome in group 1 patients.     

A framework for integrated quality improvement

The importance of maintaining and improving quality is well understood in most health care organizations. This work becomes more challenging as internal and external conditions rapidly change. A quality improvement framework was developed to help clinicians and administrators organize intergrated, multifaceted quality programs that have the flexibility necessary for success in today's fast-paced health care environment.     

Midclavicular catheters in the antepartum population. A continuous quality improvement review

The obese gene (OB) product, leptin, has been shown to exert control on metabolic processes such as food intake and body weight homeostasis, possibly through a neuropeptide Y (NPY) neurotransmission. More recently, leptin has been shown to control several neuroendocrine axes, modulating pituitary hormone secretions in function of metabolic conditions. Since in the rat growth hormone (GH) secretion is dependent upon prevailing metabolic conditions, and NPY has been shown to be implicated in the feedback mechanisms of this hormone, we reasoned that leptin could also exert control over GH secretion and we examined this hypothesis in male rats submitted to a 3-day fast. Circulating leptin concentrations measured by RIA abruptly fell to low values after 24 h of fasting and remained low thereafter. Upon refeeding, leptin secretion regularly increased. As shown by others, pulsatile GH secretion had disappeared after 3 days of fasting. Centrally administered leptin (10 microg/day, i.c.v. infusion initiated at the beginning of the fasting period) totally prevented the disappearance of pulsatile GH secretion. No leak of centrally administered leptin to the general circulation was observed. Infusing the same amount of leptin intracerebroventricularly to rats receiving ad libitum feeding produced a severe reduction in food intake but maintained a normal GH secretory pattern. In contrast, pair-fed rats, submitted to the same food restriction, exhibited a marked reduction in GH secretion. Hypothalamic NPY gene expression, estimated by Northern blot analysis, was significantly increased in fasting rats, and decreased in leptin-treated, fasting rats. In rats receiving ad libitum feeding, leptin treatment reduced NPY gene expression, consistent with the observed reduction in food intake, whereas pair-fed animals logically exhibited increased NPY gene expression. In both situations with reduced feeding, normal GH secretion was seen in leptin-treated animals exhibiting low NPY gene expression, whereas decreased or abolished GH secretion was seen in animals not receiving leptin and exhibiting increased NPY mRNA levels. Interestingly, despite maintenance of normal GH secretion in leptin-treated, fasting rats, plasma IGF-I levels were low, as in vehicle-treated rats. Indeed, hepatic gene expression for both GH receptor and IGF-I was markedly reduced by fasting, and no correction was seen with leptin treatment. In summary, the regulation of GH secretion, at least the changes linked with malnutrition, appears to be dependent upon a leptin signal, perceived centrally, possibly related to circulating levels of this new hormone. The present data suggest that leptin can rescue normal pulsatile GH secretion by preventing the documented inhibitory action of NPY on GH secretion.     

Criteria for the evaluation of quality improvement programs and the use of quality improvement data.

This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient data gathered by such QIPs. Although developed for psychologists, these criteria may be useful across health service areas and professions. Psychologists support continuous quality improvement and professional development to ensure that their patients receive the best possible care. Careful evaluation of quality improvement strategies helps ensure improved quality of care while avoiding unintended negative consequences to the patient and/or the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of patient improvement in a token economy treatment program.

Investigated various indices of improvement in 20 female chronic mental patients (mean age = 36 yrs) who were randomly assigned to a token economy treatment ward as compared with 20 control patients who received typical custodial treatment. All Ss were given standardized interviews consisting of 5 experimental tasks. Segments of the interviews were video-recorded and rated by naive raters on a 20-item questionnaire. Results indicate that the token-economy Ss were better oriented, had more skill in making business purchases and discriminations, and were better able to follow commands. Token economy Ss were rated as being more cooperative and communicative, more socially desirable, more appropriate in mood, and as exhibiting less psychotic behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigating Hospital Administrators' Experience of Workplace Mistreatment.

This study examines the nature and impact of workplace mistreatment, excluding sexual harassment and physical contact, experienced by administrators of a hospital. Factor analyses show that mistreatment behaviours are reflected by three dimensions: verbal abuse, work obstruction, and emotional neglect. Verbal abuse is regarded as an interpersonal form of mistreatment whereas obstruction and neglect are considered as organizational forms. Administrators reported having experienced organizational mistreatment more frequently than interpersonal mistreatment. We then examined relationships among mistreatment, context support, employee psychological well-being, organizational commitment, work satisfaction, and intent to leave. As predicted, supportive work environments mediate between workplace mistreatment and well-being, commitment and work satisfaction but, surprisingly, not the intention to leave the organization. Implications for healthier and more productive workplaces for hospital administrators are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A crisis intervention program. Staff go the extra mile for client improvement

Anopheles sacharovi, An. atropatvus, An. pulcherrimus, An. superpictus. An. stephensi, Culex pipiens females to prefer fresh water for their oviposition. The differences between them are that the An.stephensi and Culex pipiens avoid high salinity values more frequently than other species. The eggs of a all the species studied do not survive at 2% salinity. The An. sacharovi eggs are more resistant to salinity while the An. pulcherrimus ones are less resistant. Nevertheless, the females of all the species oviposited a quantity into the significant salinity water obviously unsuited to the development of preimaginal stages.     

Results of an intervention for the improvement of operating room quality and safety. Note 1: anesthetic gases

The proliferation of human melanoma cell line A375-6 is inhibited by several cytokines, including interleukin-1 (IL-1) and interleukin-6 (IL-6). However, during a long period of culture, the cells progressively acquire resistance to IL-1 irrespective of functional IL-1 receptor expression. These cells constitutively produce IL-1alpha and IL-6, and also acquire resistance to IL-6. In order to investigate the mechanism of the acquired resistance to these cytokines, we performed somatic cell hybridization experiments. Parental cells for the construction of hybrid cells were rendered G418- or hygromycin B-resistant by transfection with expression vectors containing drug-resistant genes. Hybridization was conducted using IL-1-resistant subclones A375-R8 and R19 and an IL-1 highly sensitive clone C2-1, which was originally resistant but became sensitive to IL-1 upon transfection with a human type I IL-1 receptor (IL-1R) expression plasmid. Cells produced by hybridization of resistant cells and C2-1 cells appeared to be sensitive to IL-1 and IL-6. In contrast, production of IL-1 was augmented in the hybrid cells. These results suggest that resistance to IL-1 and IL-6 is a recessive phenotype, while production of IL-1 is dominant in melanoma cells.     

Psychology in action: A PhD program aimed at survival.

Discusses the current involvement of psychology in social problems in terms of the citizen-scholar, and the social clinician. It is argued that these roles are inadequate to solve current social problems, since they either have no community experimentation, or have a naive conception of the social change process. A new PhD training program is described in which innovative social subsystems are set up experimentally in the community, evaluated longitudinally, and, if successful, implemented on a wide scale. The focus of such training is described as problem-oriented, experimental, and with a strong interdisciplinary flavor. Details of such a program at a state university are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experience with ambulatory preoperative bowel preparation at the Johns Hopkins Hospital

Ultrasound is in widespread use in the study of gastrointestinal pathologies. In Crohn disease it is helpful in diagnosing complications such as thickening of the bowel loop walls, abscesses, lymph node enlargement and vesical-enteric fistulas. This report presents two cases in which vesical-enteric fistulas were visualized by US; confirming a diagnosis of Crohn's disease in one case, and diagnosing the fistula during the follow-up in the second patient in whom Crohn's disease had previously been diagnosed.     

Promoting safety belt use at industrial sites: An effective program for blue collar employees.

Evaluated an incentive program applicable for large-scale motivation of safety belt wearing at 2 industries (with 300–500 employees each) where it was possible to compare the safety belt use of blue collar (BC) vs white collar (WC) employees. At one plant, incentives were preceded by a 20-min awareness session for BC Ss, which involved group discussions of assets and liabilities of safety belts. The baseline rate of seat belt usage was similar at each plant but was significantly lower for BC (6%) than for WC (18%) Ss. At the plant not receiving group awareness sessions, safety belt use doubled during the 5-mo incentive period (with mean usage of 13% for BC Ss and 32% for WC Ss). The awareness session tripled the BC safety belt use (to 21% mean belt use over a 1-mo period). During the subsequent 5-wk incentive period, mean safety belt use was 41.7% for BC Ss and 35.9% for WC Ss. Safety belt wearing decreased substantially after the incentive program was withdrawn but only returned to the initial baseline level for the BC Ss who had not received the awareness sessions. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)