Implementing a safer and more reliable system to monitor test results at a teaching university-affiliated facility in a family medicine group: a quality improvement process report.

INTRODUCTION: Prescribers have the medicolegal responsibility to ensure a sufficiently reliable system is in place to securely monitor the process of efficiently communicating laboratory results. With added complexity of technologies such as electronic medical record systems, few studies address the monitoring, verification and improvement of test results follow-up especially within a teaching facility including resident prescribers. METHOD: The main goal of this quality improvement project was to ensure safety of care through reliable test results follow-up and adapting processes to available technology by (1) implementing an improved, more reliable and efficient system for tracking test results in the setting; and (2) increasing perceived reliability of test results monitoring system of prescribers in the clinical setting. Through three Plan-Do-Study-Act cycles, changes were implemented: (1) family medicine residents recognised as prescribers; (2) connection of prescribers to regional techno-centre; and (3) computer protocol eliminating duplicates. Patients and clinical staff completed surveys (satisfaction, perceived safety and reliability). ANALYSIS: Quantitative and qualitative data were collected, reported incidents, requested prescriptions and received results and time spent communicating normal results. Immediate feedback from prescribers and staff members was considered to improve the process. Microsoft Excel software was used to calculate mean and SD of error rate. Shewhart chart rules were used to determine special cause of change and sustainability. RESULTS: Implemented changes led to decrease in mean error rate (from 6.1% to 1.9%), variation of range (from 2.7-12.1% to 0-4.8%) and SD (from 2.1% to 1.2%). The improvement is sustained over 24 months after the last cycle. 100% of the 30 patients surveyed were satisfied with the changes implemented. Prescribers (75% response rate) including residents (15.8% response rate) perceived the improved system to be safer, more reliable and efficient. CONCLUSION: Implemented changes improved reliability, efficiency and perceived safety of the test results monitoring system while ensuring patient satisfaction.

Periodontal effects of surgically assisted rapid palatal expansion evaluated clinically and with cone-beam computerized tomography: 6-month preliminary results.

INTRODUCTION: Transverse maxillary deficiency is frequently observed in patients who seek orthodontic treatment. In skeletally mature patients, transverse maxillary deficiency can be treated with surgically assisted rapid palatal expansion (SARPE). Forces delivered by the expander produce areas of compression in the periodontal ligament, which could lead to alveolar bone resorption and possible changes in the attachment level. The aim of this prospective clinical study was to evaluate the periodontal effects of SARPE by means of a complete clinical evaluation and cone-beam computerized tomography (CBCT) evaluation. METHODS: The sample included 14 patients (5 males, 9 females), with a mean age of 23.0 ± 1.9 years (range: 16.4 to 39.7 years). All patients were treated using a bonded Hyrax-type expander, and the mean expansion was 9.82 mm (7.5 to 12.0 mm). All patients had a 1-year retention period. CBCT scans were taken, and periodontal charts were completed at time points T0 (initial) and T1 (6 months after expansion). RESULTS AND DISCUSSION: SARPE seemed to have little detrimental clinical effects on the periodontium. Radiographic data demonstrated statistically significant changes: a significant decrease in the buccal alveolar bone thickness on most teeth, a significant increase in the palatal alveolar bone thickness on most teeth, a decrease in the buccal alveolar crest level of all canines and posterior teeth, and a tendency toward a decrease in the interproximal alveolar crest level on the mesial aspect of both central incisors. CONCLUSIONS: SARPE seems to have little detrimental effects on the periodontium clinically. However, radiographic data demonstrated some statistically significant changes, which could eventually have a significant clinical impact on the periodontium.

Assessing the impact of the primary school-based nutrition intervention Petits cuistots--parents en réseaux.

OBJECTIVES: This study sought to provide an intermediate impact assessment of the nutrition intervention Petits cuistots--parents en réseaux (Little Cooks--Parental Networks) on: 1) knowledge, attitude, capacity and experience with regard to nutrition, diet and cookery, and 2) parental and/or family participation in school. PARTICIPANTS: A total of 388 students from grades 5 (participants) and 6 (non-participants). SETTING: The evaluation of the nutrition intervention took place in each of the seven participating elementary schools, all of which are located in Montreal's most disadvantaged neighbourhoods. INTERVENTION: The program component "Little Cooks" is a nutrition workshop run by community dieticians. Each of the eight annual workshops features a food item and nutrition theme with a recipe for a collective food preparation and tasting experience. Classroom teachers participate to provide classroom management and program support. The "Parental Networks" component of the program invites parents to assist with the nutrition workshop, and offers additional parent and family activities which link to nutrition workshop themes (e.g., dinners or visits to local food producers). OUTCOME: The program had some impact on knowledge of the nutrient content of food, food produce and cooking; attitude and experience with tasting of new or less common foods; and perceived cooking capacity. Families with students participating in the program participated more in school activities than did families of students not in the program. CONCLUSIONS: Our assessment indicates a potential program impact upon several intermediate impact measures, and in so doing highlights a promising nutrition capacity-promoting intervention.