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As proposed in 2019 Annual Congress of the Chinese Society of Organ Transplantation, the overall objective of the development of organ transplantation in China is to deepen the structural reform of the supply side comprehensively, to promote the transition of organ transplantation from the quantitative scale model to the quality-lifting type, and to promote the scientific, balanced, standardized and high-quality development of organ transplantation. This paper introduces the construction of quality management system and the implementation of quality improvement program in the field of surgery and transplantation in the United States, summarizes the preliminary work of how to combine foreign experience to promote the construction of quality improvement program of renal transplantation in our country, and proposes the idea of extending the quality improvement program of organ transplantation.
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ABSTRACT: This paper aimed to analyze the evolution of the quality of raw milk produced by producers in the Zona da Mata region, in the state of Minas Gerais, between 2012 and 2018. For this purpose, we used the linear mixed-effects model to analyze the monthly evolution of the results of milk composition indicators (fat, protein, and defatted dry extract - DDE), somatic cell count - SCC, and total bacterial count - TBC, from the official monthly registry of 94 milk producers, suppliers of a region's dairy. Results indicate a continuous reduction in the milk composition indicators between 2014 and 2018. For the SCC and TBC indicators, we identified only one-off reductions. The supply of a larger volume of milk was associated with increased TBC. Seasonality influenced all quality indicators analyzed. According to these results, we concluded that the analyzed quality of chilled raw milk offered by producers was proven worse from 2012 to 2018, despite the actions implemented by the National Milk Quality Improvement Program - PNMQL.
RESUMO: Este artigo objetivou analisar a evolução da qualidade do leite cru refrigerado produzido por produtores da região da Zona da Mata, do Estado de Minas Gerais, entre os anos de 2012 e 2018. Para tal, foi utilizado o modelo linear de efeitos mistos, a fim de analisar a evolução mensal dos resultados de indicadores de composição do leite (gordura, proteína e extrato seco desengordurado - ESD), contagem de células somáticas - CCS, e contagem bacteriana total - CBT, provenientes de análises oficiais mensais de 94 produtores de leite, fornecedores de um laticínio da região. Os resultados indicaram uma redução contínua dos indicadores de composição do leite entre os anos de 2014 e 2018. Para os indicadores de CCS e CBT foram observadas apenas reduções pontuais. O fornecimento de um maior volume de leite foi associado ao aumento da CBT. A sazonalidade influenciou todos os indicadores de qualidade analisados. De posse desses resultados, pode-se afirmar que, apesar das ações implementadas pelo Programa Nacional de Melhoria de Qualidade do Leite - PNMQL, a qualidade do leite cru refrigerado, proveniente dos produtores avaliados, piorou ao longo do período em análise.
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Objective To explore the application effect of "Disease-Characteristics Nursing Quality Improvement" Program (DNQIP) based on Kotter's change model in continuous improvement of patients' satisfaction and nursing quality. Methods Applicate Kotter's Change Model to implement DNQIP among 61 wards. The differences of patients' satisfaction and nursing quality among 2012 were compared (DNQIP had not been carried out by the whole hospital), 2014 (DNQIP had been carried out by the whole 61 wards) and 2016 (the 5-year-strategy had been realized). Results The 3-year-scores of patients' satisfaction were(95.94 ± 1.53), (98.18 ± 0.69), (99.43 ± 0.18) points and they were statistically significant (F=31 768.863,P=0.000).The 3-year-scores of nursing quality were (93.96 ± 0.56), (98.56 ± 0.43), (99.62 ± 0.23) points and they were statistically significant (F=3 004.598,P=0.000). The sores of 2014 were statistically improved compared with 2012 and the sores of 2016 were statistically improved compared with 2014 (P＜0.01). Conclusions DNQIP based on Kotter's change model is an effective method to improve the patients′satisfaction and nursing quality.
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Objective To reduce the noise level of surgical intensive care unit through quality improvement program based on one-meter rule. Methods Measure the status quo of noise level and find out the main noise resources. Implement one-meter rule for three weeks and retest the noise level for a period of seven days. Investigate the satisfaction of medical staff and patients. T-test was performed to compare the noise level and satisfaction. Results The mean noise level were (58.58 ± 0.95) dB before implementation of quality improvement program and was lowered to (55.89 ± 0.92)dB. There was a significant difference(t=4.890, P=0.001). The five time points except eleven o′clock during which the noise levels were over 60 dB decreased significantly after implementation of one-meter rule (t=2.858-6.643, P<0.05). After intervention, satisfaction related to noise level of medical staff and patients scored 10.97±0.93 and 10.63±1.15 respectively, which were higher than before (8.68±1.49, 8.13±1.18) and there were significant differences (t=-11.231,-10.701,P<0.01). Conclusions One-meter rule intervention can decrease the noise level significantly, and increase medical staff′s and patients′ satisfaction, which is worthy of extensive promotion and application.
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Objective@#To explore the application effect of "Disease-Characteristics Nursing Quality Improvement" Program (DNQIP) based on Kotter's change model in continuous improvement of patients' satisfaction and nursing quality.@*Methods@#Applicate Kotter's Change Model to implement DNQIP among 61 wards. The differences of patients' satisfaction and nursing quality among 2012 were compared (DNQIP had not been carried out by the whole hospital), 2014 (DNQIP had been carried out by the whole 61 wards) and 2016 (the 5-year-strategy had been realized).@*Results@#The 3-year-scores of patients' satisfaction were(95.94±1.53), (98.18±0.69), (99.43±0.18) points and they were statistically significant (F=31 768.863, P=0.000).The 3-year-scores of nursing quality were (93.96±0.56), (98.56±0.43), (99.62±0.23) points and they were statistically significant (F=3 004.598, P=0.000). The sores of 2014 were statistically improved compared with 2012 and the sores of 2016 were statistically improved compared with 2014 (P<0.01).@*Conclusions@#DNQIP based on Kotter's change model is an effective method to improve the patients′ satisfaction and nursing quality.
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Objective@#To reduce the noise level of surgical intensive care unit through quality improvement program based on one-meter rule.@*Methods@#Measure the status quo of noise level and find out the main noise resources. Implement one-meter rule for three weeks and retest the noise level for a period of seven days. Investigate the satisfaction of medical staff and patients. T-test was performed to compare the noise level and satisfaction.@*Results@#The mean noise level were (58.58±0.95) dB before implementation of quality improvement program and was lowered to (55.89±0.92)dB. There was a significant difference(t=4.890, P=0.001). The five time points except eleven o′clock during which the noise levels were over 60 dB decreased significantly after implementation of one-meter rule (t=2.858-6.643, P<0.05). After intervention, satisfaction related to noise level of medical staff and patients scored 10.97±0.93 and 10.63±1.15 respectively, which were higher than before (8.68±1.49, 8.13±1.18) and there were significant differences (t=-11.231,-10.701,P<0.01).@*Conclusions@#One-meter rule intervention can decrease the noise level significantly, and increase medical staff′s and patients′ satisfaction, which is worthy of extensive promotion and application.
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Objective To explore the application of "disease-characteristics nursing quality improvement" program in the nursing practice of atrial fibrillation patients. Methods On basis of patient-centered and evidence-based nursing, the cardiovascular department of Peking University First Hospital made the "disease-characteristics nursing quality improvement" program. The differences of patients′ satisfaction, the index of work satisfaction of nurses, the index of disease management before (2014)and after(2015)the implementation of "disease-characteristics nursing quality improvement"program were observed and compared. Results Before and after the "disease-characteristics nursing quality improvement" program, the patients′ satisfaction were 90.0%(135/150) and 96.8%(149/154), the rate of well warfarin knowledge were 74.3%(78/105) and 90.2%(101/112), the compliance rate of international standardization ratio were 79.0%(83/105) and 91.1%(102/112), the rate of telephone follow-up as requested were 57.3%(86/150) and 85.7%(132/154), the rate of outpatient follow-up as requested were 72.0%(108/150) and 83.1%(128/154). The differences all above were statistically significant (χ2=5.408-30.171,all P<0.05).Before and after the"disease-characteristics nursing quality improvement"program, the scores of the index of work satisfaction were(135.19±19.17)and(178.37±18.46)points.The difference was statistically significant (t=-13.577, P<0.05). Conclusions The "disease-characteristics nursing quality improvement"program is an effective method to improve the nursing quality of patients with atrial fibrillation.
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STUDY DESIGN: Retrospective cohort study. PURPOSE: The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates. OVERVIEW OF LITERATURE: Cervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013. Multivariate regression analysis was used to determine postoperative complications associated with transfusion and cervical fusion. RESULTS: We identified 11,588 patients who had cervical fusion between 2010 and 2013. The rate of blood transfusion following cervical fusion found to be 1.47%. All transfused patients were found to have increased risk of venous thromboembolism (TBE) (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 1.16–8.77), myocardial infarction (MI) (OR, 9.12; 95% CI, 2.53–32.8), increased length of stay (LOS) (OR, 28.03; 95% CI, 14.28–55.01) and mortality (OR, 4.14; 95% CI, 1.44–11.93). Single level fusion had increased risk of TBE (OR, 3.37; 95% CI, 1.01–11.33), MI (OR, 10.5; 95% CI, 1.88–59.89), and LOS (OR, 14.79; 95% CI, 8.2–26.67). Multilevel fusion had increased risk of TBE (OR, 5.64; 95% CI, 1.15–27.6), surgical site infection (OR, 16.29; 95% CI, 3.34–79.49), MI (OR, 10.84; 95% CI, 2.01–58.55), LOS (OR, 26.56; 95% CI, 11.8–59.78), and mortality (OR, 10.24; 95% CI, 2.45–42.71). Patients who had anterior cervical discectomy and fusion surgery and received a transfusion had an increased risk of TBE (OR, 4.87; 95% CI, 1.04–22.82), surgical site infection (OR, 9.73; 95% CI, 2.14–44.1), MI (OR, 9.88; 95% CI, 1.87–52.2), increased LOS of more than 2 days (OR, 28.34; 95% CI, 13.79–58.21) and increase in mortality (OR, 6.3; 95% CI, 1.76–22.48). While, transfused patients who had posterior fusion surgery had increased risk of MI (OR, 10.45; 95% CI, 1.42–77.12) and increased LOS of more than 6 days (OR, 4.42; 95% CI, 2.68–7.29). CONCLUSIONS: Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion. These patients are demonstrated to have higher rate of MI, TBE, wound infection and mortality when compared to those who do not receive transfusion.
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Humanos , Transfusão de Sangue , Estudos de Coortes , Discotomia , Tempo de Internação , Mortalidade , Infarto do Miocárdio , Pacientes Ambulatoriais , Complicações Pós-Operatórias , Prevalência , Melhoria de Qualidade , Estudos Retrospectivos , Coluna Vertebral , Cirurgiões , Infecção da Ferida Cirúrgica , Tromboembolia Venosa , Infecção dos FerimentosRESUMO
Objective To improve the compliance and prognosis of patients with atherosclerotic renal artery stenosis(ARAS) by using continuous quality improvement program(CQI).Methods Survey patients by the way of using the four-step problem-solving framework referred as the PDCA cycle,i.e.plan,do,check and act.Compare the results of patients which have obtained before and after CQI.Results The follow-up rate of patients was improved from 46.9% to 83.3%, and most of the patients are willing to enter the follow-up program.The patients are more likely to receive examinations of ARAS,such as blood pressure,renal function,renal artery color duplex sonography and renal scintigraphy.The control rate of blood pressure was also improved from 45.6% to 93.1% Conclusion CQI is a useful method to improve the compliance and prognosis for ARAS patients,and nurses have played an important role during the whole process.