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BackgroundThere are significant racial disparities in head and neck cancer (HNC) outcomes. Racial differences in survival may be explained by differential access to high-quality care. The goal of this study was to evaluate the association of race and ethnicity with the quality of the treating hospital, and receipt of guideline-compliant care among HNC patients.MethodsRetrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Outcome measures included the quality of treating hospital, and NCCN guideline-compliant care.ResultsBlack (OR 0.76, 95 % CI 0.67 to 0.85) and Hispanic (OR 0.68, 95 % CI 0.63 to 0.74) patients were less likely to be treated in top-quality hospitals compared with non-Hispanic White patients, after adjusting for demographic, and clinical factors. This association disappeared for Black patients, but persisted for Hispanic patients, after additionally adjusting for socioeconomic status and insurance status. Black patients with advanced-stage disease were less likely to be treated with dual-modality therapy (OR 0.82, 95 % CI 0.70 to 0.96), however, this association disappeared after adjusting for demographic, and clinical factors, and hospital quality.ConclusionThere are significant racial and ethnic disparities in quality of care for patients with HNC. Our findings suggest that differential access to high-quality care may account for some of the racial disparities in HNC survival, and highlight the need for continued investigation into the drivers of racial disparities in HNC outcomes.

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.

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.

OBJECTIVES: Contraception is crucial for safely timing pregnancies in patients with SLE. This study investigated predictors of contraception documentation in patients with SLE, and the alignment of contraception practices with the 2020 American College of Rheumatology (ACR) guidelines, within the Rheumatology Informatics System for Effectiveness (RISE) registry. MATERIALS AND METHODS: Female patients (aged 18-44 years) with SLE were identified via International Classification of Diseases (ICD)-9/ICD-10 coding within the RISE registry, which includes data from rheumatology clinics across the USA. Eligible patients were required to have ≥1 clinical visit in 2019 (prepandemic) or between 1 April 2020 and 30 March 2021 (mid-pandemic). Adjusted multilevel logistic modelling assessed patient, provider and practice characteristics for associations with contraception documentation. Contraception patterns were identified and compared with the 2020 ACR guidelines. RESULTS: Contraception documentation rates were similar in the prepandemic and mid-pandemic groups (8.1% and 8.5%, respectively). Higher documentation rates were found in women who were younger, White, and had more visits, as well as those seen within a health system, by a female provider, and within specific regions and electronic health record (EHR) systems. Prescription of a teratogenic medication did not influence contraception documentation or type. Oestrogen-containing contraceptives were prescribed less often to women at high risk for thrombosis (26.2% with thrombotic risk vs 60.6% without, p

BACKGROUND: Despite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care. METHODS: We used facility-based cross-sectional survey data from women (n = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons (n = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes. RESULTS: Compared to low integration, high integration (≥four woman-reported PC-ISP experiences vs.

This scoping review focuses on the evolution of pre-analytical errors (PAEs) in medical laboratories, a critical area with significant implications for patient care, healthcare costs, hospital length of stay, and operational efficiency. The Covidence Review tool was used to formulate the keywords, and then a comprehensive literature search was performed using several databases, importing the search results directly into Covidence (n=379). Title, abstract screening, duplicate removal, and full-text screening were done. The retrieved studies (n=232) were scanned for eligibility (n=228) and included in the review (n=83), and the results were summarised in a PRISMA flow chart. The review highlights the role of healthcare professionals in preventing PAEs in specimen collection and processing, as well as analyses. The review also discusses the use and advancements of artificial intelligence (AI) and machine learning in reducing PAEs and identifies inadequacies in standard definitions, measurement units, and education strategies. It demonstrates the need for further research to ensure model validation, address the regulatory validation of Risk Probability Indexation (RPI) models and consider regulatory, safety, and privacy concerns. The review suggests that comprehensive studies on the effectiveness of AI and software platforms in real-world settings and their implementation in healthcare are lacking, presenting opportunities for further research to advance patient care and improve the management of PAEs. [ABSTRACT FROM AUTHOR]

Background: Patients need to be supported in combining treatment with daily life. However, measurement of supportive care indicators related to treatment-related side effects is under-reported. This review aimed to identify a list of quality indicators for managing cancer treatment-induced toxicities for adult patients with cancer. Methods: A review was conducted on PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and Embase from September 26, 2013 to December 26, 2023. Published English articles that developed or analyzed quality indicators of managing cancer treatment-induced toxicities for adult patients with cancer were selected. The identified indicators were classified according to Donabedian's model for quality of care in healthcare. Results: Forty-two indicators (4 structural, 27 process, and 11 outcome indicators) in 18 articles were identified. Eight articles (44.4%) were from North America, four (22.2%) from Europe, two (11.1%) from Oceania, two (11.1%) from Asia, and one (5.6%) from Africa; 64.3% of the indicators were process indicators based on guidelines. The prevalence of patient symptoms determined using a patient-reported outcome measure was proposed as an outcome indicator. In seven studies (38.9%), these indicators were selected by multidisciplinary experts. None of the studies involved patients or family members in the indicator selection process. Conclusion: The quality of supportive care should be improved by measuring these indicators, considering the patient's needs for supportive care at each hospital such that patients can continue their lives while undergoing treatment. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic entailed a global health crisis, significantly affecting medical service delivery in Germany as well as elsewhere. While intensive care capacities were overloaded by COVID cases, not only elective cases but also non-COVID cases requiring urgent treatment unexpectedly decreased, potentially leading to a deterioration in health outcomes. However, these developments were only uncovered retrospectively. Especially university hospitals, which were meant to take on a central coordinating role, did not have detailed information on expected healthcare utilization, available resources and capacities, and the quality of medical care. The experience of compromised healthcare and a lack of monitoring during the COVID-19 pandemic made it clear that healthcare systems should be better prepared. Therefore, the aim of this work was to develop a set of indicators suited to detect undesirable developments concerning the provision of inpatient healthcare. Material & methods: The study employed a literature review, online surveys, expert interviews, and a multistep evaluation process to develop a core set of quality indicators (QIs) suitable for assessing the resilience of university hospitals during pandemics. This initial set of indicators was refined through consultations with a) quality and risk management officials from German university hospitals via an online survey and b) a diverse panel of experts. Results: The comprehensive evaluation identified two primary strands: organizational/management indicators (Strand A, 60 indicators) and disease-specific clinical quality and patient safety indicators (Strand B, 20 indicators for critical conditions like stroke, myocardial infarction, and cancer.) Three additional indicators were added after a final expert panel meeting, resulting in a final set of 83 indicators. Discussion and conclusion: The developed QIs mark a significant advancement in the operational preparedness of university hospitals for pandemics. The study contributes to quality management in healthcare during pandemics by creating the basis for a structured approach to pandemic preparedness and response. This unique set of QIs within the German context presents an opportunity for establishing quality improvement, underscoring the importance of a robust, adaptable quality management framework as a basis for safeguarding against future health crises. [ABSTRACT FROM AUTHOR]

Objective: To assess the methodological quality of radiomics-based models in endometrial cancer using the radiomics quality score (RQS) and METhodological radiomICs score (METRICS). Methods: We systematically reviewed studies published by October 30th, 2023. Inclusion criteria were original radiomics studies on endometrial cancer using CT, MRI, PET, or ultrasound. Articles underwent a quality assessment by novice and expert radiologists using RQS and METRICS. The inter-rater reliability for RQS and METRICS among radiologists with varying expertise was determined. Subgroup analyses were performed to assess whether scores varied according to study topic, imaging technique, publication year, and journal quartile. Results: Sixty-eight studies were analysed, with a median RQS of 11 (IQR, 9–14) and METRICS score of 67.6% (IQR, 58.8–76.0); two different articles reached maximum RQS of 19 and METRICS of 90.7%, respectively. Most studies utilised MRI (82.3%) and machine learning methods (88.2%). Characterisation and recurrence risk stratification were the most explored outcomes, featured in 35.3% and 19.1% of articles, respectively. High inter-rater reliability was observed for both RQS (ICC: 0.897; 95% CI: 0.821, 0.946) and METRICS (ICC: 0.959; 95% CI: 0.928, 0.979). Methodological limitations such as lack of external validation suggest areas for improvement. At subgroup analyses, no statistically significant difference was noted. Conclusions: Whilst using RQS, the quality of endometrial cancer radiomics research was apparently unsatisfactory, METRICS depicts a good overall quality. Our study highlights the need for strict compliance with quality metrics. Adhering to these quality measures can increase the consistency of radiomics towards clinical application in the pre-operative management of endometrial cancer. Clinical relevance statement: Both the RQS and METRICS can function as instrumental tools for identifying different methodological deficiencies in endometrial cancer radiomics research. However, METRICS also reflected a focus on the practical applicability and clarity of documentation. Key Points: The topic of radiomics currently lacks standardisation, limiting clinical implementation. METRICS scores were generally higher than the RQS, reflecting differences in the development process and methodological content. A positive trend in METRICS score may suggest growing attention to methodological aspects in radiomics research. [ABSTRACT FROM AUTHOR]

Background and Objectives: Early in the global COVID-19 pandemic, a concern was raised that potentially high volumes of COVID-19 inpatients in general hospitals might compromise the hospitals' capabilities to maintain high-quality care for routine patients and, thereby, to comply with indicators specifying quality of care. The objective of this study is to evaluate the impact of the surges of COVID-19 inpatients into general hospitals in Israel on the compliance rates for selected quality indicators reported by these hospitals within the Israeli National Program for Quality Indicators (NPQI). Methods: Compliance rate data were collected from the quality indicators reports made to the NPQI by participating hospitals. COVID-19 inpatient volume data were obtained from the Ministry of Health Digital Technologies and Data Division. Both datasets were analyzed on a week-by-week basis and plotted one alongside the other on a time scale. Association of each quality indicator's compliance rate with the number of COVID-19 inpatients was tested by Pearson's correlation analysis. The study included data from July 1, 2019 through June 30, 2022, spanning the duration of the COVID-19 pandemic in Israel. Five quality indicators included in the study were: Surgical repair of femoral neck fracture within 48 h of admission; Assessment of cerebral ischemic event risk for patients with atrial fibrillation; Duplex carotid ultrasound within 72 h of emergency department admission for patients with suspected transient ischemic attack; Antibiotic prophylaxis for caesarean sections ; and Percutaneous coronary intervention within 90 min for patients presenting with ST-elevation myocardial infarction. Results: Compliance rates for five quality indicators, representing different aspects of routine health care, remained steady – even at times with high volumes of COVID-19 inpatients in general hospitals. This lack of effect was prominent throughout the analyzed period, i.e., general hospitals maintained similar compliance rates for all quality indicators both during the surges of COVID-19 patients and between these periods. Statistical analysis showed no correlation between the quality indicators' compliance rates and the number of COVID-19 inpatients. Conclusions: Our findings indicate that high volumes of COVID-19 inpatients in general hospitals did not affect the hospitals' capability to comply with routine health care quality indicators. The results of our study imply that general hospitals in Israel were able to withstand the challenges associated with the care of COVID-19 inpatients while preserving high quality of care for routine patients. [ABSTRACT FROM AUTHOR]

This study investigates the application of 15 Quality Indicators (QIs) in clinical laboratories in Fujian Province, China, from 2018 to 2023. It identifies the main causes of laboratory errors and explores issues in the application of QIs, providing a reference for establishing provincial state-of-the-art and operational quality specifications (QSs). All clinical laboratories in Fujian Province were organized to submit general information and original QIs data through the online External Quality Assessment (EQA) system of the National Clinical Laboratory Center (NCCL) for a survey of 15 QIs. Data from 2018 to 2023 were downloaded for statistical analysis, and the current QSs for the 15 QIs in Fujian Province were compared and analyzed with those published by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Laboratory Errors and Patient Safety (WG-LEPS). QIs data from 542 clinical laboratories were collected. The survey on data sources showed that the number of laboratories recording QIs data using Laboratory Information Systems (LIS) increased annually, but the growth was modest and the proportion was less than 50 %. Among the laboratories using LIS to record QIs data, 133 continuously participated in this survey for six years, reporting different QIs. Over the six years, all reported QIs showed significant improvement or at least remained stable. The best median Sigma (σ) metrics were for the percentage of critical values notification and timely critical values notification, reaching 6σ, followed by the percentage of incorrect laboratory reports, with σ metrics ranging from 4.9σ to 5.1σ. In contrast, the percentage of tests covered by internal quality control (IQC) (1.5σ–1.7σ) and inter-laboratory comparison (0.1σ) remained consistently low. Compared to the QSs published by IFCC WG-LEPS, the QSs for the 15 QIs in Fujian Province in 2023 were stricter or roughly equivalent, except for the percentage of incorrect laboratory reports (Fujian Province: 0–0.221, IFCC WG-LEPS: 0–0.03). 1. The application of QIs has significantly improved the quality of testing in clinical laboratories in Fujian Province, but the percentage of tests covered by IQC and inter-laboratory comparison remain low; 2. Effective application of QIs requires the establishment of comprehensive LIS, unified calculation standards, and other supporting measures. [ABSTRACT FROM AUTHOR]

To evaluate urinalysis parameters useful for identifying mixed cultures in urine culture using an automated urinary particle analyzer to assess quality indicators (QIs) for urine sample contamination.A retrospective observational cross-sectional study was conducted with 2,527 urine samples from patients of a quaternary hospital in Brazil. Urine samples were processed simultaneously in Sysmex UF-5000 flow cytometry analyzer (urinalysis) and MALDI-TOF (culture).For all samples, a cutoff of 123.8 bacteria/µL was established to discriminate culture-negative specimens. ROC curve indicated the following cutoffs for females and males, respectively: 193.65 and 23.55 bacteria/µL, and 21.35 and 5.05 squamous epithelial cells (SEC)/µL, with the latter two related to scenarios of sample contamination/colonization through mixed cultures. Performing univariate logistic regression, we found a 2.78 (CI95 %: 2.12–3.65) times higher chance of probable mixed culture when SEC values were above the cutoffs for each sex, and 6.91(CI95 %: 4.56–10.47) times for bacteria. For multivariate logistic regression, the OR values were 1.62 (CI95 %: 1.21–2.15) and 5.82 (CI95 %: 3.77–8.98), respectively.The fluorescent flow cytometry analyzers could efficiently identify urinary bacteria counts associated with contamination/colonization scenarios using the cutoffs of 21.35 SEC/µL for women and 5.05 SEC/µL for men. The cutoffs for bacteria/µL (193.65 for females and 23.55 for males) indicated that the presence of bacteria in male samples may be more associated with urinary tract infections (UTIs), while in female samples, it may be associated with either UTIs or contamination/colonization scenarios. This makes the analyzer a helpful tool as QI of sample contamination in urine cultures. [ABSTRACT FROM AUTHOR]

The processing and control of liquid radioactive waste (LRW) in nuclear power plants (NPP) are critical aspects of nuclear energy management. This study details the principles of the methods and the measuring instruments used for control, and highlights the features and advantages of chemical and radiometric control in radioactive waste processing. The purpose is to systematize and analyze the results and methods used for chemical and radiometric monitoring, treatment technologies, and adherence to regulatory standards. The paper presents findings from an operating NPP with water–water energy reactor power units, showcasing the novelty of systematizing monitoring methods at each stage of LRW processing and ensuring compliance with regulatory standards. Moreover, the chemical and radiometric indicators in the LRW were analysed, which provides insight into the dynamics of waste processing and classification. In addition, the application of Pearson correlation analysis allowed us to identify the relationships between chemical and radiometric indicators in the LRW, which provides valuable information for waste management practices. The selection of appropriate chemical and radiometric methods is crucial given the complexity of LRW characteristics, making this study relevant for enhancing LRW monitoring and management practices. Highlights: The processing and control of liquid radioactive waste (LRW) in nuclear power plants (NPP) is a critical aspect of nuclear energy management. Both chemical and radiometric monitoring measures are essential to ensure the safe handling, treatment, and disposal of the LRW. Overall, effective monitoring of the LRW in NPP requires a comprehensive approach that includes compliance with regulatory standards. This study involved chemical and radiometric monitoring of the LRW for an operating NPP with water–water power reactors. [ABSTRACT FROM AUTHOR]

Indicators for predicting the quality and vigor of fruit tree seedlings can be worthwhile if they are conveniently and visually assessable in various climatic regions. Since allometric relationships exist between plum seedling vigor index and morphological traits, this study evaluated morphological features in plum seedlings while determining their quality and vigor. The samples were of major commercial varieties from several regions of Iran, and the assessments followed path analysis and multiple linear regression. Plum seedlings of 8 commercial cultivars were harvested in three replicates from 11 nurseries in four provinces. Morphological indicators included seedling height, diameter above the graft line (DAGL) and at root-collar (RCD), root length, number of roots and branches, seedling vigor, dry weights of aerial parts and roots (ADW and RDW, respectively), and ratio of height to DAGL and seedling height to ADW. Simple correlations among these variables appeared diverse, and the correlation coefficients broke down into direct and indirect effects through path analysis, with vigor as the dependent variable. This variable increased with some of its components, including DAGL and dry weight. However, the ratio of height to DAGL decreased when the accumulated growing degree-days (AGDD) increased from 2700 to about 4500 °C per day in the various regions. Average vigor values of certified and uncertified seedlings were 11.7 and 19.2, respectively. Among the visually assessable traits in the nursery, DAGL showed a higher correlation with the vigor variable and other morphological features, thus making it the most important index for plum seedling evaluation. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe clinical variables and quality care indicators in pediatric stroke management at a high-complexity pediatric care center in Latin America. Methods: Retrospective study of patients with stroke, aged 2–18 years from 2011 to 2021. The principal outcomes were the mRs and mortality. Differences between groups were assessed using Fisher's exact test and the Mann–Whitney U test. We used logistic regression to explore the association between characteristics reported as relevant in literature and mortality. Results: One hundred thirty six patients included, with a median age of 11 years, 54% were male. 47% were hemorrhagic strokes, followed by ischemic strokes at 39%. One-third of the cases presented in hospital. 51% of the patients had no prior medical history. The most common symptoms were altered consciousness, headache, and hemiparesis. The median door-to-image time was 123 min. The most frequent etiologies in ischemic stroke were arteriopathies and cardiac pathology, while vascular malformation and coagulopathies were predominant in hemorrhagic stroke. No patient received reperfusion therapy. At discharge, 48% of patients had a favorable mRs. The mortality rate was 21%. Patients with in-hospital stroke have approximately 7.37 times the odds of dying compared to those with out-of-hospital stroke. Patients with hemorrhagic stroke have approximately 7.46 times the odds of dying compared to those with ischemic stroke. Conclusion: Significant gaps exist in the epidemiology and quality indicators of pediatric stroke care compared to adult protocols. Implementing a "Pediatric code stroke" protocol and conducting prospective studies are crucial for improving pediatric stroke care and outcomes. [ABSTRACT FROM AUTHOR]

Beef patties are highly consumed worldwide. However, its formulations often include synthetic antioxidants and antimicrobials. Murtilla (Ugni molinae Turcz.), a shrub native to southern Chile, has leaves with a polyphenolic concentration 3.2 times higher than its fruits. This study evaluated the effects of three concentrations of murtilla leaf powder (500, 1000, and 1500 mg/kg) on the microbiological, physicochemical, and sensory parameters of beef patties, compared to controls without antioxidants and with erythorbate (500 mg/kg). The patties were stored at 2 °C for 12 days in a modified atmosphere (80% O2/20% CO2). No changes were observed in proximal composition; however, the 1500 mg/kg concentration affected the redness (a*) of the beef patties (15.04 vs. 19.37 in the control) (p ≤ 0.05). Oxidative stability increased as follows: Mu1500 (88.21%) > sodium erythorbate (83.5%) > Mu500 (79.7%) > Mu1000 (78.8%). Natural antioxidants decreased the deterioration of essential fatty acids such as linoleic acid. Aerobic mesophilic microorganism growth in the murtilla treatment was lower than in the control (2.06 log cfu/g vs. 3.83 log cfu/g). Murtilla leaf powders show promising results as a substitute for synthetic antioxidants and antimicrobials. Mu500 treatment improved the physicochemical and microbiological quality parameters without compromising the sensory characteristics. [ABSTRACT FROM AUTHOR]

The Northeastern Black Soil Region in China is recognized as one of the three major black soil regions globally and is often regarded as a cornerstone of national food security. However, prolonged agricultural practices have led to increasingly severe soil degradation, and the mechanisms and driving factors behind the degradation of soil quality remain unclear. Therefore, this study examines the historical and current characteristics of soil quality, focusing on major influencing factors, such as the 70-year history of reclamation and climate change. By accessing different databases, reviewing the relevant literature, and performing Pearson correlation and redundancy analyses (RDA), this study investigated the variation patterns of significant soil quality indicators and their driving factors in the 0–20 cm soil layer along the latitudinal direction (Nenjiang, Beian, Hailun, and Harbin) in the typical black soil region of Northeast China. The main conclusions are as follows: the soil organic matter (SOM) content experienced a rapid decline in the 30 years preceding cultivation (1950~1980), with the greatest decline rate in the Beian area (about 1.10 g/kg per year). The SOM in the Beian, Hailun, and Harbin areas decreased from north to south, changing at rates of 9.40–21.67 g/kg/degree and 0.15–0.34 g/kg/m with latitude and elevation, respectively. Elevation impacts the annual rate of change in soil quality indicators through its influence on the annual mean maximum temperature (AMXT) and annual atmospheric pressure (AP). AMXT and AP exhibit a linear relationship with elevation, based on which regression models were established. The key factors influencing soil quality indicators in the black soil region include cultivation years (Y), annual mean maximum and minimum temperatures (AMXT and AMNT), annual relative humidity (ARH), and AP. An increase in chemical fertilizer application is among the critical factors affecting soil pH. Additionally, the extensive use of agricultural machinery can reduce soil porosity and cause water and salt accumulation, ultimately leading to a decline in soil pH. This study offers theoretical support for mitigating soil degradation in Northeast China's black soil region, thereby contributing to national food security and promoting sustainable development. [ABSTRACT FROM AUTHOR]

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, pO2, pCO2, 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, pO2 slightly increased, pCO2 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. [ABSTRACT FROM AUTHOR]

Background and Aims: In the realm of healthcare, device-associated hospital-acquired infections (DA-HAIs) pose significant challenges. These infections occur due to invasive medical devices and can lead to serious complications for patients. This study intends to assess the trends in device-associated infections over time in order to improve patient safety and quality through measurements and improvements in device-associated infections. Methods: The Department of Microbiology conducted a routine surveillance using a specific infection surveillance proforma for various healthcare-associated infections, including ventilator-associated events (VAEs), central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). The data were examined at the end of each month, and the infection rate was determined using CDC guidelines. Results: The overall rate of HAI was found to be 1.69 HAI cases per 1,000 patient days. The cumulative DAI rates for the years 2021 and 2022 were CAUTI 6.14/1,000 urinary catheter days, CLABSI 4.5/1,000 central line catheter days and VAE 16.3/1,000 ventilator days. Discussion: It was observed that the CAUTI and CLABSI rates in our institution were comparable to or slightly higher than the national standard benchmark and INICC report and were significantly higher compared to the CDC/NHSN benchmark. The VAE rate was comparable to INICC report but was significantly higher compared to the NSB and the CDC/NHSN reports. Conclusion: Individual hospitals should make efforts to generate and evaluate their DAI trends and overall HAI rates and implement and improve their infection control programme to collectively achieve the target in our country in bringing down HAIs. [ABSTRACT FROM AUTHOR]

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 areas for improvement and potential barriers to measuring the quality of nursing care in a regional health service. 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. [ABSTRACT FROM AUTHOR]

The potential health impacts of moderate alcohol consumption have long been debated. The COVID-19 pandemic has heightened public awareness of health concerns, creating a clear market opportunity for low-alcohol craft beer development. This study investigated the possibility of low-alcohol craft beer by co-fermentation with different ratios of Pichia kluyveri (P. kluyveri) and Saccharomyces cerevisiae (SC) according to the established quality indexes. Specifically, this study was conducted to identify the low-alcohol craft beer quality by fermentation kinetics, growth kinetics, apparent attenuation (AA), real attenuation (RA), residual sugar content, alcohol by volume (ABV), and volatile organic compounds. This study demonstrated that the co-fermentation of SC and P. kluyveri in a 1:10 ratio produced an ABV of 2.98% (v/v). In addition, high concentrations of isoamyl acetate and phenyl ethyl acetate revealed banana, rose, apple, and honey flavors, respectively. Overall, this study revealed that the fermentation of P. kluyveri and SC by co-fermentation and the fermentation process by adjusting the yeast composition developed a craft beer with low alcohol content and rich aroma while establishing the quality indicators. [ABSTRACT FROM AUTHOR]

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 (< 500mm3) 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Although a significant number of cases of Staphylococcus aureus bacteraemia (SAB) are managed at non-referral community hospitals, the impact of a bundle-of-care intervention in this setting has not yet been explored. Methods We performed a quasi-experimental before–after study with the implementation of a bundle of care for the management of SAB at five non-referral community hospitals and a tertiary care university hospital. Structured recommendations for the five indicators selected to assess quality of care were provided to investigators before the implementation of the bundle and monthly thereafter. Primary endpoints were adherence to the bundle intervention and treatment failure, defined as death or relapse at 90 days of follow-up. Results One hundred and seventy patients were included in the pre-intervention period and 103 in the intervention period. Patient characteristics were similar in both periods. Multivariate analysis controlling for potential confounders showed that performance of echocardiography was the only factor associated with improved adherence to the bundle in the intervention period (adjusted OR 2.13; 95% CI 1.13–4.02). Adherence to the bundle, performance of follow-up blood cultures, and adequate duration of antibiotic therapy for complicated SAB presented non-significant improvements. The intervention was not associated with a lower rate of 90 day treatment failure (OR 1.11; 95% CI 0.70–1.77). Conclusions A bundle-of-care intervention for the management of SAB at non-referral community hospitals increased adherence to quality indicators, but did not significantly reduce rates of 90 day mortality or relapse. [ABSTRACT FROM AUTHOR]

Systematic reviews of single-case experimental research (SCER) in special education often use the What Works Clearinghouse (WWC) Standards to assess the methodological rigor of studies within a given literature base. While significant changes were made between the two most recent versions of the WWC standards, no research to date has evaluated the extent to which these standards would result in different evaluation outcomes. To examine potential differences, we applied version 4.1 and 5.0 of the standards to a sample database of SCER addressing the challenging behavior of students with autism in general education settings. Systematic search, screening, and review procedures resulted in a total of 20 articles included for this review. Findings indicated a 27% change in overall ratings across the studies, with version 5.0 leading to lower ratings than version 4.1, due to factors such as a lack of assessment of procedural fidelity, therapeutic baseline trends, and insufficient data points in the first baseline phase. We discuss implications for research based on our findings and recommend future directions for SCER in the field of special education. [ABSTRACT FROM AUTHOR]

Background: The pandemic profoundly stressed practicing nurses and could have thereby affected trends in nursing-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. Objectives: The aim of the study was to determine if NSIs have worsened in response to the pandemic and then returned to prepandemic levels using data from 2019 through 2022. Methods:We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. Results: In decreasing order of prevalence, the mean prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% increase in CAUTI to 49% for CLABSI. Discussion: NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Modern ultrasound technology enables detailed tissue morphology analysis. A novel approach involves measuring viscoelasticity or viscosity. This pilot study investigates the potential of a novel high-end ultrasound system with dynamic quality indicators and the M-Ref tool. METHODS: Using a novel premium high-end ultrasound system (Resona A20/Mindray), comparative investigations were conducted on 52 patients, evaluating B-mode morphology, shear wave tissue elastography (STE), and viscosity (STVi) of the liver parenchyma. The study utilized a cohort of 25 healthy volunteers as a control group. The examinations were performed intercostally using a multifrequency convex probe SC7-1U (1–7 MHz) and breath-hold technique, ensuring that at least the highest or second-highest score in the dynamic quality control (5 stars) was achieved. Measurements were made in a color-coded region with a maximum 2 cm diameter and a depth of no more than 2 cm, avoiding bile ducts or blood vessels, at a depth up 2 cm from the liver capsule. RESULTS: A minimum of 10 measurements were taken for each parameter: liver steatosis (based on acoustic attenuation coefficient, USAT), viscosity (STVi), and shear wave elastography (STE) with correlation to fibrosis grade. Reference values for the control group were <1.4 m/s and <5 kPa for STE, with cirrhosis criteria defined as values >2.6 m/s and >15 kPa. For steatosis, values up to 0.5 dB/cm/MHz were considered normal, while values >0.8 dB/cm/MHz indicated fatty liver. Viscosity values <1.7 Pa.s were deemed normal, with >3.6 Pa.s indicating significant abnormality. Major causes of increased viscosity included severe steatosis, active hepatitis, hepatic tumors, or post-ablative states. In all cases, a high-quality indicator score (>93%) was achieved with at least 4/5 top reference markers in green. CONCLUSIONS: This pilot study confirms the comprehensive capabilities of multimodal imaging for tissue characterization using B-mode, elastography, and new techniques for assessing viscoelasticity. However, extensive multicenter evaluations will be needed to definitively establish reference values specific to the type of transducer and equipment used. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]