Application of the "Plan-Do-Check-Action" plan in improving the pass rate of the "National Medical Licensing Examination".

BACKGROUND: The National Medical Licensing Examination (NMLE) is the only objective, standardized metric to evaluate whether a medical student possessing the professional knowledge and skills necessary to work as a physician. However, the overall pass rate of NMLE in our hospital in 2021 was much lower than that of Peking Union Medical College Hospital, which was required to be further improved. METHODS: To find the reasons for the unsatisfactory performance in 2021, the quality improvement team (QIT) organized regular face-to-face meetings for in-depth discussion and questionnaire, and analyzed the data by "Plato analysis" and "Brainstorming method". After finding out the reasons, the "Plan-Do-Check-Action" (PDCA) cycle was continued to identify and solve problems, which included the formulation and implementation of specific training plans by creating the "Gantt charts", the check of effects, and continuous improvements from 2021 to 2022. Detailed information about the performance of students in 2021 and 2022, and the attendance, assessment, evaluation and suggestions from our hospital were provided by the relevant departments, and the pass rate-associated data was collected online. RESULTS: After the PDCA plan, the pass rate of NMLE in our hospital increased by 10.89% from 80.15% in 2021 to 91.04% in 2022 (P = 0.0109), with the pass rate of skill examination from 95.59% in 2021 to 99.25% in 2022 (P = 0.0581) and theoretical examination from 84.5% in 2021 to 93.13% in 2022 (P = 0.027). Additionally, the mean scores of all examinees increased with the theoretical examination score increasing from 377.0 ± 98.76 in 2021 to 407.6 ± 71.94 in 2022 (P = 0.004). CONCLUSIONS: Our results showed a success application of the PDCA plan in our hospital which improved the pass rate of the NMLE in 2022, and the PDCA plan may provide a practical framework for future medical education and further improve the pass rate of NMLE in the next year.

National tertiary public hospital performance appraisal: Using FOCUS-PDCA to improve external quality assessment.

PURPOSE: To innovatively use the FOCUS-PDCA quality improvement strategy to establish an external quality assessment (EQA) working group to continuously improve EQA performance, an important indicator of the national tertiary public hospital performance appraisal. METHODS: The project was carried out at the National Center for Clinical Laboratories. Using FOCUS-PDCA, which combines problem-focused steps (FOCUS) and improvement steps (PDCA), a project team was established to carry out improvement work. Root cause analysis was carried out to analyze the problems in quality control from EQA project application to results analysis and an improvement plan was implemented according to the steps of FOCUS-PDCA. The project was executed in three cycles from 2019 to 2021 to obtain more satisfactory results. RESULTS: After implementing three cycles of FOCUS-PDCA, the EQA participation rate increased from 66.5% in 2018 to 100% in 2021, and the EQA pass rate increased from 94.9% in 2018 to 99.3% in 2021. Consequently, the hospital moved into the top 50 in performance assessment for the first time in 2020 and ranked 27th in 2021. CONCLUSION: The use of the FOCUS-PDCA quality improvement strategy can improve the EQA performance of national tertiary public hospitals and help them achieve satisfactory results in the national examination.

Referral Process Enhancement: Innovative Approaches and Best Practices.

OBJECTIVE: This study aimed to enhance the efficiency of the referral system at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) in Muscat, Oman by reducing the average time for new patients' acceptance and the delay between patient acceptance and their first appointment. METHODS: A one-group pretest-posttest quasi-experimental project was conducted from Quarter 2 of 2022 to Quarter 2 of 2023. Data collected during the pretest and posttest phases were compared to evaluate the impact of interventions on the average days for patient acceptance and the time to first appointment after acceptance. The intervention involved developing a comprehensive referral system incorporating technology development, improved accessibility, orientation materials, internal training, policy formulation, criteria definition, and tailoring acceptance criteria to specialty programs. Awareness campaigns were also conducted to educate patients about the referral process and available transportation options. The project followed the FOCUS PDCA (Find, Organize, Clarify, Understand, Select, Plan, Do, Check, Act) approach for implementation. RESULT: Significant improvements were observed in the oncology referral process, with the average days for patient acceptance decreasing from 4.3 days to 1.3 days post-implementation. Statistical analysis confirmed the significance of this change (F-value = 46.25, p < .0001). Similarly, the average days to first visit appointment after acceptance decreased from 8.6 days to 4.0 days, with statistical support (F-value = 6.29, p < .0). CONCLUSION: This study represents a significant advancement in optimizing the oncology referral process. When considered in conjunction with previous research findings, it underscores the importance of ongoing efforts to enhance efficiency in patient referrals.

Machine learning model based on RCA-PDCA nursing methods and differentiating factors to predict hypotension during cesarean section surgery.

BACKGROUND: Intraoperative hypotension during cesarean section has become a serious complication for maternal and fetal healthy. It is commonly encountered by subarachnoid anesthesia. However, currently used control methods have varying degrees of side effects, such as drugs. The Root Cause Analysis (RCA) - Plan, Do, Check, Act (PDCA) is a new model of care that identifies the root causes of problems. The study aimed to demonstrate the usefulness of RCA-PDCA nursing methods in preventing intraoperative hypotension during cesarean section and to predict the occurrence of intraoperative hypotension through a machine learning model. METHODS: Patients who underwent cesarean section at Traditional Chinese Medicine of Southwest Medical University from January 2023 to December 2023 were retrospectively screened, and the data of their gestational times, age, height, weight, history of allergies, intraoperative vital signs, fetal condition, operative time, fluid out and in, adverse effects, use of vasopressor drugs, anxiety-depression-pain scores, and satisfaction were collected and analyzed. The statistically different features were screened and five machine learning models were used as predictive models to assess the usefulness of the RCA-PDCA model of care. RESULTS: (1) Compared with the general nursing model, the RCA-PDCA nursing model significantly reduces the incidence of intraoperative hypotension and postoperative complications in cesarean delivery, and the patient experience is comfortable and satisfactory. (2) Among the five machine learning models, the RF model has the best predictive performance, and the accuracy of the random forest model in preventing intraoperative hypotension is as high as 90%. CONCLUSION: Through computer machine learning model analysis, we prove the importance of the RCA-PDCA nursing method in the prevention of intraoperative hypotension during cesarean section, especially the Random Forest model which performed well and promoted the application of artificial intelligence computer learning methods in the field of medical analysis.

[A framework for promoting and evaluating "Kayoi-no-ba" initiatives according to the Plan-Do-Check-Action cycle: The ACT-RECIPE framework].

Objective　In 2019, the Ministry of Health, Labour and Welfare emphasized the importance of promoting "Kayoi-no-ba" (or "places to go") initiatives according to the Plan-Do-Check-Action (PDCA) cycle. However, it proposed no specific promotion measures or standardized evaluation frameworks. This study is intended to propose a framework for local government officials to promote and evaluate "Kayoi-no-ba" initiatives according to the PDCA cycle.Methods　The working group (WG) conducted a narrative review of research and extracted evaluation models and indicators that could be used to create the framework. The co-researcher review committee discussed a draft framework prepared by the WG, and the WG revised it based on the discussion; this process was repeated four times. Using the completed framework, we calculated the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and conducted regional correlation analyses on the relationship between the score of the "Kayoi-no-ba" initiatives in 50 Tokyo municipalities and the number of "Kayoi-no-ba" per 1,000 older persons.Results　The completed framework (named "ACT-RECIPE" by rearranging the underlined characters below) comprised the following six evaluation phases: (1) Comprehension: understanding the key lessons around disability and frailty prevention, and the necessity for "Kayoi-no-ba"; (2) Research and Planning: clarifying the current status of "Kayoi-no-ba," the strengths of the community, and the issues to be addressed through a community assessment, and developing a plan to resolve the issues; (3) Team Building and Collaboration: building a team by collaborating with organizations to solve problems; (4) Implementation: implementing the initiatives necessary to solve problems; (5) Evaluation: verifying changes in output and outcome indicators from the initiatives; and (6) Adjustment and Improvement: re-examining plans, teams, content, and goals based on the evaluation results. In these six phases, we designated 10 core items and accompanying subitems. The median score rate of the ACT-RECIPE framework in 50 municipalities was 75% for "Comprehension," 61% for "Research and Planning," 69% for "Team Building and Collaboration," 64% for "Implementation," 31% for "Evaluation," and 56% for "Adjustment and Improvement," and the mean ACT-RECIPE score rate was 57%. A significant positive correlation (rs=0.43, P=0.002) was observed between the ACT-RECIPE mean score rate and the number of "Kayoi-no-ba" per 1,000 older persons.Conclusion　We proposed the ACT-RECIPE as a framework for promoting and evaluating "Kayoi-no-ba" initiatives according to the PDCA cycle. We hope that this framework will lead to further progress in "Kayoi-no-ba" initiatives and facilitate evaluation of their effectiveness according to the PDCA cycle.

Utilizing data platform management to implement "5W" analysis framework for preventing and controlling corruption in grassroots government.

In the era of information technology advancement, big data analysis has emerged as a crucial tool for government governance. Despite this, corruption remains a challenge at the grass-roots level, primarily attributed to information asymmetry. To enhance the efficacy of corruption prevention and control in grass-roots government, this study introduces the concept of data platform management and integrates it with the "5W" (Who, What, When, Where, Why) analysis framework. The research is motivated by the observation that existing studies on corruption prevention primarily concentrate on the formulation of laws and regulations, neglecting the potential improvement in actual effectiveness through the utilization of data platforms and analytical frameworks. The research employs methodologies grounded in the Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis framework, the Plan, Do, Check, Act (PDCA) cycle analysis framework, and the 5W analysis framework. Throughout the iterative process of implementing data platform management, various timeframes are established, and the impact of the three models is evaluated using indicators such as public participation and government satisfaction. The research reveals that the SWOT framework can formulate targeted strategies, the PDCA framework continuously optimizes work processes, and the 5W framework profoundly explores the root causes of corruption. The outcomes indicate a 10.76% increase in the public participation level score with the 5W model, rising from 71.67%, and a 23.24% increase in the governance efficiency score, reaching 66.12%. The SWOT model excels in case handling prescription and corruption reporting rate. The synergistic application of the three models demonstrates a positive impact. In conclusion, the amalgamation of data platform management and a multi-model approach effectively enhances the corruption prevention capabilities of grass-roots governments, offering insights for the establishment of transparent and efficient grass-roots governance.

A Robotics Experimental Design Method Based on PDCA: A Case Study of Wall-Following Robots.

There is a lack of research that proposes a complete and interoperable robotics experimental design method to improve students' learning outcomes. Therefore, this study proposes a student-oriented method based on the plan-do-check-act (PDCA) concept to design robotics experiments. The proposed method is based on our teaching experience and multiple practical experiences of allowing students to do hands-on experiments. It consists of eight steps, mainly including experimental goals, experimental activities, robot assembly, robot control, in-class evaluation criteria, and after-class report requirements. The after-class report requirements designed in the proposed method can help students improve their report-writing abilities. A wall-following robotics experiment designed using the PDCA method is proposed, and some students' learning outcomes and after-class reports in this experiment are presented to illustrate the effectiveness of the proposed method. This experiment also helps students to understand the fundamental application of multi-sensor fusion technology in designing an autonomous mobile robot. We can see that the proposed reference examples allow students to quickly assemble two-wheeled mobile robots with four different sensors and to design programs to control these assembled robots. In addition, the proposed in-class evaluation criteria stimulate students' creativity in assembling different wall-following robots or designing different programs to achieve this experiment. We present the learning outcomes of three stages of the wall-following robotics experiment. Three groups of 42, 37, and 44 students participated in the experiment in these three stages, respectively. The ratios of the time required for the robots designed by students to complete the wall-following experiment, less than that of the teaching example, are 3/42 = 7.14%, 26/37 = 70.27%, and 44/44 = 100%, respectively. From the comparison of learning outcomes in the three stages, it can be seen that the proposed PDCA-based design method can indeed improve students' learning outcomes and stimulate their active learning and creativity.

Clinical application and nursing experience of the plan-do-check-act cycle in daytime varicocelectomy.

BACKGROUND: Varicocele is the most prevalent correctable cause of male infertility. Currently, surgical treatment is the primary method to enhance fertility.For many young varicocele patients who have postponed surgery due to time constraints, daytime surgery is especially crucial. Thus, this study aims to investigate the clinical and nursing application value of the Plan-Do-Check-Act (PDCA) cycle in daytime varicocelectomy. METHODS: Retrospective collection of clinical data was conducted on 130 patients undergoing laparoscopic varicocelectomy in the Third Affiliated Hospital of Southern Medical University, Guangzhou,China.Among them, 65 patients who underwent daytime surgery were assigned to the observation group, while 65 patients who underwent routine hospital surgeries were assigned to the control group.The former also implemented PDCA cycle management.A comparison was made between the two groups regarding hospitalization time, hospitalization costs, and patient satisfaction. RESULTS: The observation group exhibited a shorter hospitalization time and lower hospitalization costs compared to the control group, with higher patient satisfaction and pre-discharge visual analog scale (VAS) scores noted (P < 0.05).No significant difference was observed in the incidence of postoperative complications between the two groups during hospitalization (P > 0.05). The implementation of the PDCA cycle in the observation group has demonstrated its effectiveness, ensuring the smooth conduct of the daytime varicocelectomy. CONCLUSION: In conclusion,daytime varicocelectomy can reduce hospitalization time,lower hospitalization costs, improve patient satisfaction. The PDCA Cycle enhances the rationality and efficacy of the daytime varicocelectomy procedure and is highly recommended. Furthermore, it offers valuable reference for the application of the PDCA Cycle in various other diseases and nursing management approaches. TRIAL REGISTRATION: The Trial Registration Number: ChiCTR2300077465;Date of registration: November 9, 2023.

Effectiveness of Wait Time Targets and Patient Satisfaction Feedback in Decreasing Wait Times for Prescription Services in an Outpatient Pharmacy.

Background: Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy. Objective: To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy. Methods: This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from "waiting patients". The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks. Results: The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p < 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p < 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services. Conclusions: The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services.

Contexte: Les longs délais d'attente pour les services de délivrance de médicaments sur ordonnance à la pharmacie ambulatoire de l'Hôpital Dr. OEN SOLO BARU en Indonésie ont donné lieu à un nombre élevé de plaintes. En réponse, afin de réduire ces temps d'attente, l'hôpital a cherché à déterminer des objectifs de temps d'attente et à fournir des commentaires sur la satisfaction des patients au personnel de la pharmacie ambulatoire. Objectif: Mesurer l'incidence, sur le temps d'attente pour la délivrance de médicaments sur ordonnance à la pharmacie ambulatoire, de la remise aux pharmaciens d'objectifs de temps d'attente et de commentaires sur la satisfaction des patients. Méthodes: Cette étude de recherche quasi-expérimentale était conçue selon une série temporelle interrompue à groupe unique. Les données sur les temps d'attente et sur la satisfaction des patients ont été recueillies auprès des « patients en attente ¼. Au total, 35 employés (6 pharmaciens et 29 techniciens) ont participé à l'étude, et l'intervention consistait à remettre aux pharmaciens des objectifs de temps d'attente et des commentaires sur la satisfaction des patients chaque semaine pendant 5 semaines consécutives. Résultats: Les temps d'attente pour les services de délivrance de médicaments sur ordonnance ont diminué de 11,13 minutes (17 %) pour les ordonnances relatives aux préparations magistrales et de 12,70 minutes (37 %) pour les ordonnances relatives aux préparations non magistrales. Une différence significative a été observée entre les semaines 0 et 4 (p < 0,001) concernant le temps d'attente moyen pour les services de délivrance de médicaments sur ordonnance relatifs aux préparations magistrales et ceux relatifs aux préparations non magistrales. Une différence significative a également été observée dans la satisfaction des patients entre les semaines 0 et 4 (p < 0,001). La satisfaction des patients a augmenté de manière significative parallèlement à la diminution du temps d'attente pour les services de délivrance de médicaments sur ordonnance. Conclusions: La remise aux pharmaciens d'objectifs en matière de temps d'attente ainsi que de commentaires sur la satisfaction des patients a permis de réduire les temps d'attente des services de délivrance de médicaments sur ordonnance.

Strategically reducing carbapenem-resistant Acinetobacter baumannii through PDCA cycle-driven antibiotic management.

PURPOSE: With the escalating global challenge of antibiotic resistance, particularly the resistance rate of Acinetobacter baumannii, the need to rationalize carbapenem antibiotic use in clinical settings has become paramount. Our study tapped into a fishbone diagram to uncover the irrationalities in applying these antibiotics and highlight potential influencing factors. METHODS: Based on these analyses, we initiated targeted intervention strategies. A PDCA cycle-based scientific management approach was implemented through the combined efforts of our antimicrobial stewardship team and relevant departments. RESULTS: Our study showed a significant post-intervention increase in the rational use of carbapenem antibiotics (P < 0.01) and a concurrent decrease in the detection of carbapenem-resistant Acinetobacter baumannii. CONCLUSION: Our findings underscore that carbapenem usage can be effectively minimized with the continuous refinements offered by the PDCA cycle, leading to a reduction in multidrug-resistant bacteria, thus fostering rational drug use in healthcare.

Improving the reproductive health literacy of couples on the verge of marriage through the FOCUS-PDCA model: Mixed-method study.

Background & Aims: Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage. Methods: This study was a mixed-methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA) model in nine steps during 2019-2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered. Results: The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension. Conclusion: The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples.

Time series analysis of using the PDCA method combined with the Teach-back method to improve spontaneous reports of adverse drug reactions in a grade IIIA hospital in China.

BACKGROUND: Spontaneous reporting of adverse drug reactions (ADRs) is essential for the post-marketing safety evaluation of drugs. Therefore, good monitoring of ADRs is vital for strengthening drug supervision, management, and guiding rational drug use. Chinese medical institutions are the primary source of ADR case reports, but the proportion of the reports in grade IIIA hospitals is still low due to serious under-reporting. The 3rd Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People's Hospital, also has such a problem. OBJECTIVE: To improve the quantity and quality of ADR reports and enhance the level of pharmacovigilance in hospitals, the Third Affiliated Hospital of Chengdu Medical College, People's Hospital of Chengdu Pidu District experienced 10 years to gradually establish a management model to improve the medical staff's reporting rate of spontaneous reporting of ADRs. The management model is led by clinical pharmacists and combines the PDCA with Teach-back methods. The purpose of this paper is to introduce the management model and discuss its advantages and shortcomings of this model. METHODS: This study was conducted at the Third Affiliated Hospital of Chengdu Medical College-Chengdu Pidu District People's Hospital. From 2016, the daily management of reporting, auditing, and data improvement of adverse drug reactions in the hospital was carried out by clinical pharmacists, who used the PDCA method combined with the Teach-back method to continuously improve the reporting program of ADRs in the hospital during 2016-2021. Then, the proportion of spontaneous reports of total, new, and serious ADRs was compared before and after the intervention. Also, we performed a time series analysis using an autoregressive moving average model to assess changes in the total number of spontaneous ADR reports before the intervention (2013-2015), the first intervention (2016-2018), and the second intervention (2019-2021). RESULTS: After the combined PDCA and Teach-back method intervention, the median number of reported ADRs per year increased from 50 (range 37-55) in the pre-intervention period to 88 (range 83-162) in the first intervention period and to 374 in the second (range 312-566). Breakpoint regression analysis of the spontaneous reporting rate of ADRs showed that the instantaneous increase after the first intervention was not statistically significant (P = 0.526). However, the reporting rate of ADRs increased at a month-by-month growth rate during the second intervention compared to the first intervention. Its spontaneous reporting rate improved 1.034 times (P = 0.002). After the second intervention, the spontaneous reporting rate of ADRs transiently increased 6.111-fold (P < 0.001), and the month-to-month growth rate increased 1.024-fold (P < 0.001) again. CONCLUSION: The management model that combines the PDCA and the Teach-back method significantly improves the reporting rate of adverse drug reactions.

A refined management system focusing on medication dispensing errors: A 14-year retrospective study of a hospital outpatient pharmacy.

Objectives: This study aimed to evaluate the efficiency of a 14-year refined management system for the reduction of dispensing errors in a large-scale hospital outpatient pharmacy and to determine the effects of person-related and environment-related factors on the occurrence of dispensing errors. Methods: A retrospective study was performed. Data on dispensing errors, inventory and account management from 2008 to 2021 were collected from the electronic system and evaluated using the direct observation method and the Plan-Do-Check-Act (PDCA) cycle. Results: The consistency of the inventory and accounts increased substantially (from 86.93 % to 99.75 %) with the implementation of the refined management program. From 2008 to 2021, the total number of dispensing errors was reduced by approximately 96.1 %. The number of dispensing errors in quantity and name was reduced by approximately 98.2 % and 95.07 %, respectively. A remarkable reduction in the error rate was achieved (from 0.014 % to 0.00002 %), and the rate of dispensing errors was significantly reduced (0.019 % vs. 0.0003 %, p < 0.001). Across all medication dispensing errors, human-related errors decreased substantially (208 vs. 7, p < 0.05), as did non-human-related errors also (202 vs. 9, p < 0.05). There was a correlation between the occurrence of errors and pharmacists' sex (females generally made fewer errors than males), age (more errors were made by those aged 31-40 years), and working years (more errors were made by those with more than 11 years of work experience) from 2016 to 2021. The technicians improved during this procedure. Conclusions: Refined management using the PDCA cycle was helpful in preventing dispensing errors and improving medication safety for patients.

Study on thermal health and its safety management mode for the working environment.

Thermal health concerns have gained significant attention due to the heightened health risks faced by workers who are exposed to extreme thermal environments for prolonged periods. To ensure the occupational health and safety of such workers, and to enhance work efficiency, it is imperative to examine the characteristics of thermal health in the working environment. This study proposes three key elements of thermal health in the working environment, namely thermal health states, absence of heat-related illnesses, and heat adaptability, which can be used to develop a safety management framework for thermal health. By exploring the interconnections between these elements, the study summarizes their features and outlines the necessary precautions to safeguard them. The PDCA (plan/do/check/action) cycle management mode is utilized as a framework, with the three components of thermal health forming the core, to establish a safety management mode for thermal health. To ensure that employees work in a safe, healthy, comfortable, and productive environment, the assessment and control objectives of the thermal environment are regularly revised through the use of labor protection technology and thermal environment control technology. This paper presents a PDCA cycle safety management mode based on the characteristics of thermal health, which offers novel insights and approaches for assessing and managing workers' thermal health.

Continuous quality improvement: reducing informed consent form signing errors.

BACKGROUND: Adherence to ethical guidelines and regulations and protecting and respecting the dignity and autonomy of participants by obtaining a valid informed consent form (ICF) prior to participation in research are crucial; The subjects did not add signatures next to the corrections made to signatures or dates on the ICF, Multiple signatures in other fields, ICF missing/missing signature, Incorrect ICF version Signed after modification, Correction tape used to correct signature, Impersonated signature, Non-research-member signature, however, ICFs are often not properly completed, which must be addressed. This study analyzed ICF signing errors and implemented measures to reduce or prevent these errors. METHODS: We used the plan-do-check-act (PDCA) cycle to help improve the correctness and validity of ICF signing. RESULTS: Interim and final reports from January 2016 to February 2020 including 363 ICFs were studied. The total proportion of correct ICF signatures (200, 83.3%) following the PDCA intervention was significantly higher than that before the intervention (P < 0.05). Analysis of the types of signing error demonstrated that signature errors were significantly reduced after the intervention, particularly for subjects did not add signatures next to the corrections made to signatures or dates on the ICF (16, 6.7%) and impersonated signature (0; P < 0.05). CONCLUSIONS: The proportions of other error types-multiple signatures in other fields, missing or unsigned ICF, incorrect signature order, incorrect ICF version, use of correction tape to correct signature, and non-medical profession members signing the ICF-did not differ significantly.

Acute toxicity of organoarsenic chemical warfare agents to Danio rerio embryos.

During the 20th century, thousands of tons of munitions containing organoarsenic chemical warfare agents (CWAs) were dumped into oceans, seas and inland waters around the world. As a result, organoarsenic CWAs continue to leak from corroding munitions into sediments and their environmental concentrations are expected to peak over the next few decades. There remains, however, a lack of knowledge about their potential toxicity to aquatic vertebrates, such as fish. The aim of this study was to fill in this gap in research, by investigating the acute toxicity of organoarsenic CWAs on fish embryos, using the model species, Danio rerio. To estimate the acute toxicity thresholds of organoarsenic CWAs (Clark I, Adamsite, PDCA), a CWA-related compound (TPA), as well as four organoarsenic CWA degradation products (Clark I[ox], Adamsite[ox], PDCA[ox], TPA[ox]), standardized tests were performed following the OECD no. 236 Fish Embryo Acute Toxicity Test guidelines. Additionally, the detoxification response in D. rerio embryos was investigated by analysing the mRNA expression of five genes encoding antioxidant enzymes (CAT, SOD, GPx, GR and GST). During the 96 h of exposure, organoarsenic CWAs induced lethal effects in D. rerio embryos at very low concentrations (classified as 1st category pollutants according to GHS categorization), and were therefore deemed to be serious environmental hazards. Although TPA and the four CWA degradation products caused no acute toxicity even at their maximum solubility, the transcription of antioxidant-related genes was altered upon exposure to these compounds, indicating the need for further testing for chronic toxicity. Incorporating the results of this study into ecological risk assessments will provide a more accurate prediction of the environmental hazards posed by CWA-related organoarsenicals.

The application of the PDCA cycle in the nutritional management of patients with nasopharyngeal carcinoma.

OBJECTIVE: This study is to explore the effect of the Plan-Do-Check-Act (PDCA) cycle on the nutritional management of patients with nasopharyngeal carcinoma (NPC). METHODS: A total of 100 NPC patients were randomly divided into a control group and a PDCA group, with 50 patients in each group. The control group adopted a routine nutritional management strategy, and the PDCA group adopted a PDCA cycle management strategy. The body weight, body mass index (BMI), hemoglobin, serum prealbumin, serum albumin, the Patient-Generated Subjective Global Assessment (PG-SGA) score, the Nutrition Risk Screening 2002 (NRS-2002) score, the incidence rate of nutritional risk, the grade of malnutrition, and the grade of oral mucositis were compared between the two groups. RESULTS: The body weight, BMI, and serum prealbumin in the PDCA group were higher than those in the control group, and the difference was statistically significant (p < 0.05). The NRS2002 score and PG-SGA score in the PDCA group were lower than those in the control group, and the differences were statistically significant (p < 0.05). The incidence of nutritional risk, the grade of malnutrition, and the grade of oral mucositis were less in the PDCA group than those in the control group (p < 0.05). There was no significant difference in hemoglobin and serum albumin between the two groups (p > 0.05). CONCLUSION: The PDCA cycle can improve body weight, BMI, and serum prealbumin in NPC patients. It can reduce the NRS2002 score, the PG-SGA score, the incidence of nutritional risk, the severity of malnutrition, and the severity of oral mucositis in NPC patients.

Effect of plan-do-check-active method combined with air pressure wave therapy on the prevention of deep venous thrombosis in critically ill patients in neurosurgery.

BACKGROUND: Deep vein thrombosis (DVT) is prone to occur in the recovery of critically ill neurosurgical patients, increasing economic and psychological pressure, and even endangering life. Plan-Do-Check-Action (PDCA) cycle is a kind of quality management cycle procedure, which can help DVT treatment correctly understand the cause of disease and take effective preventive and nursing measures. The air wave pressure therapy instrument takes pressure therapy as the core, forming circulating pressure on limbs and tissues, promoting the flow of blood and lymph, improving the effect of microcirculation, accelerating the return of limb tissue fluid, and preventing thrombosis and limb edema. METHODS: A total of 98 critical neurosurgery patients were selected as the study subjects. On the basis of PDCA circulation treatment, the patients were treated with air pressure wave for 30 minutes/time, twice/day and 14 days. Before and after treatment, the indexes of coagulation function, hemorheology (plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity), lower limb circumference (15 cm above and below the patella) and Barthel index (BI) scores were observed and recorded. DVT was observed by vascular Doppler ultrasound before and after treatment, and the incidence was calculated. RESULTS: The prothrombin time (18.09 s) and thrombin time (17.66 s) after treatment were higher than those before treatment (12.98 s, 130.7 s), and fibrinogen decreased (4.21 vs. 3.31 g/L). The hemorheological indexes of the patients after treatment were plasma viscosity (1.49 mPa/s, 10.8 mPa/s), whole blood high shear viscosity (6.34 mPa/s, 4.47 mPa/s), whole blood low shear viscosity (9.89 mPa/s, 6.32 mPa/s), circumference at 15 cm below the patella (52.29 cm, 45.23 cm), and circumference at 15 cm above the patella (36.17 cm, 31.38 cm). The BI score showed that the number of patients with severe dependence on grade A (46/15) and moderate dependence on grade B (50/14) decreased after treatment, and the average BI score of patients with combined treatment increased (43.87 and 79.86). After treatment, the number of patients with DVT (20/4) and the incidence of DVT (20.40816327%, 4.081632653%) decreased significantly (P<0.05). CONCLUSIONS: PDCA circulation combined with barometric wave therapy can significantly improve DVT in critical neurosurgical patients.

Using the PDCA cycle to uncover sources of mental health disparities for Hispanics.

The Hispanic population is growing rapidly in U.S. rural states, yet limitations in Spanish-speaking behavioural health providers are a barrier to accessing care. In Montana, a new immigrant destination, mental health disparities may not yet be fully understood. We describe an interprofessional approach of nurses and engineers using the Plan-Do-Check-Act (PDCA) cycle to identify disparities in mental health access in a Hispanic community in a rural state. We recruited a community advisory board to inform researchers about potential disparities and to design interventions. The Plan phase consisted of naming the problem and its root causes. Researchers and a community advisory board created flowsheets and diagrams to uncover personal, environmental, political, and procedural contributors to poor mental health outcomes. The Do phase included implementation of a community screening for depression and anxiety. The Check phase revealed 43 mental health screenings where 21% screened positive for depression and 16% screened positive for anxiety. We made 16 referrals to a mental health intervention study. The Act phase led to plans for regular implementation of the health fairs and a study designed to provide Spanish-language mental health services. The success of our interprofessional work provides an example of how the PDCA cycle can be used to uncover potential causes for poor health outcomes and design and evaluate interventions targeted to mitigate those outcomes.