Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Quality assurance and quality control in the laboratory andrology

Quality assurance （QA） and quality control （QC） are fundamental aspects of any laboratory measurement. However, in comparison with other medical disciplines, the need for QA and QC in laboratory andrology has been recognized only recently. Furthermore, there is evidence that the effort required to undertake QA and QC has not been wholly welcomed by some clinicians. Nevertheless, accrediting bodies and regulatory authorities increasingly require evidence that laboratories have effective QA and QC measures in place because both are central to the quality management processes. Following the publication of the 5th edition of the World Health Organization Laboratory Manual, existing QA and QC systems will need to be updated to take into account some of the methodological changes recommended by the manual. Three of these are discussed in this commentary; they relate to： （i） the move to infer semen volume from its weight; （ii） the re-classification of sperm motility grades from four to three; and （iii） the publication of a lower reference limit for morphology of 4% （with a corresponding 95% confidence interval of 3%-4%）. The importance of QA and QC in all laboratory tests, including up and coming new tests to assess sperm DNA integrity, is discussed. The need for adequate initial training and continuing professional development programmes to support laboratory scientists performing andrology is also described.

Dynamic estimation and reliability control of quality assurance for bored piles

A systematic method was proposed to estimate the occurrence probability of defective piles(OPDP) from a site according to quality assurance inspection. The OPDP was firstly suggested as the criterion to weight the performance of a pile foundation. Its prior distribution and updating distribution were deduced to follow Beta distributions. To calibrate the OPDP, a dynamic estimation model was established according to the relationships between prior mean and variance and updating mean and variance. Finally, a reliability-control method dealing with uncertainties arising from quality assurance inspection was formalized to judge whether all the bored piles from a site can be accepted. It is exemplified that the OPDP can be substantially improved when more definite prior information and sampling formation become available. For the example studied herein, the Bayesian estimator of updating variance for OPDP is reduced from 0.0037 to 0.0014 for the first inspection, from 0.0014 to 0.0009 for the second inspection, and with less uncertainty by incorporating experience information.

Application of Statistical Process Control for Setting Action Thresholds as Quality Assurance of Dose Verifications in External Beam Radiotherapy

Purpose: To test the concept of Statistical Process Control (SPC) as a Quality Assurance (QA) procedure for dose verifications in external beam radiation therapy in conventional and 3D Conformal Radiotherapy (3D-CRT) treatment of cervical cancer. Materials and Methods: A study of QA verification of target doses of 198 cervical cancer patients undergoing External Beam Radiotherapy (EBRT) treatments at two different cancer treatment centers in Kenya was conducted. The target doses were determined from measured entrance doses by the diode in vivo dosimetry. Process Behavior Charts (PBC) developed by SPC were applied for setting Action Thresholds (AT) on the target doses. The AT set was then proposed as QA limits for acceptance or rejection of verified target doses overtime of the EBRT process. Result and Discussion: Target doses for the 198 patients were calculated and SPC applied to test whether the action limits set by the Process Behavior Charts could be applied as QA for verified doses in EBRT. Results for the two sub-groups of n = 3 and n = 4 that were tested produced action thresholds which are within clinical dose specifications for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. Conclusion: Action thresholds set by SPC were within the clinical dose specification of ±5% uncertainty for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. So the concept of SPC could be applied in setting QA action limits for dose verifications in EBRT.

Development and Challenge of HIV/AIDS Testing Laboratory Network and Quality Assurance System in China

This paper describes the development and challenge of HIV/AIDS testing laboratory network and quality assurance system in China. At present,the HIV/AIDS testing laboratories includes three classes,the National AIDS Reference Laboratory,HIV/AIDS confirmatory laboratories and HIV/AIDS screening laboratories. All of them are accredited by the health authorities,and each class of laboratories take charge of their function strictly according to the "National Management of HIV/AIDS Detection (2006)". A complete quality assurance and quality control system for HIV/AIDS testing has been developed,which includes technical training,strict laboratory monitoring and approval,examination or proficiency testing on HIV/AIDS detection,and quality evaluation and supervision of HIV/AIDS diagnostic kits. Besides conduct the routine anti-HIV antibody test,more and more laboratories began to conduct other tests,such as CD4+ T lymphocyte cell counting,HIV viral load,HIV DNA PCR,genotyping,drug resistance,and HIV-1 recent infection test. The primary challenges faced by the HIV/AIDS testing laboratory network are in the areas of laboratory management and quality control. For example,the provincial PT program is inefficient,the internal quality control is conducted perfunctorily,personnel training can not met the needs of the workplace,which need to be improved.

Application of Quality Control Circle Activity in Improving Effectiveness of Drug Intervention in Lung Cancer Patients with Moderate to Severe Pain

Objective:Lung cancer has the highest incidence and mortality of all malignant tumors in China.Cancer pain dramatically affects patients’comfort level,causing insomnia,anorexia,anxiety,fear,depression,and a decline in the quality of life(QOL).The literature suggests a shortage of adequate cancer pain management for 59.1% of patients in China.The quality control circle(QCC)activity reflects the people-oriented core idea of management.This study aimed to assess the efficacy of QCC in enhancing the effectiveness of drug interventions in lung cancer patients with moderate to severe pain.Methods:From January 2019 to July 2019,lung cancer patients with moderate to severe pain were treated with drugs.The total number of drug interventions was 3072.A QCC activity was performed following the ten steps of the plan-do-check-act(PDCA)model.The reasons for the poor effectiveness of drug intervention in lung cancer patients with moderate to severe pain were analyzed.Countermeasures were designed to improve the effectiveness of drug intervention,including setting up a pain college,writing a medication education manual,and formulating operational rules for the administration of narcotic drugs.The effectiveness of drug intervention in lung cancer patients with moderate to severe pain and activity ability scores of QCC members were analyzed statistically before and after QCC activity.The effectiveness of drug intervention was investigated and compared before and after establishing the QCC.Results:After establishing the PDCA model,the effectiveness of drug intervention for moderate to severe pain in lung cancer patients increased from 56.28% to 85.29%.Members had significant improvement in problem-solving ability,responsibility,communication,coordination,self-confidence,team cohesion,enthusiasm,QCC skills,and harmony.Conclusion:QCC activity can significantly improve the efficiency of drug intervention in lung cancer patients with moderate to severe pain and their quality of life.

Influence of quality assurance on patients dose reduction in some hospitals

The radiation dose received by patients undergoing chest radiography was included. 200 patients who attended these investigations in 10 hospitals in Iran were randomly selected from all ages groups and both female and male. Critically ill patients were excluded. This paper presents the work, which was implemented on 200 patients and evaluated using the entrance skin dose （ESD） in the posterior anterior （PA） chest projection measured directly at the center of the X-ray field. In addition, the machine room, and dark room .parameters, as well as work practices and repeat rates were studied. The quality control （QC） parameters and the ESD before and after QC were evaluated utilizing an anthropomorphic phantom to define the optimal exposure condition at all hospitals. This research shows that after using the QC parameters and after optimization of the exposure conditions, the ESD was decreased by 42% on average. Also the qua/ity of the radiographs generally increased. The reported method is easily implemented in any clinical situation where optimization of chest radiography is needed.

Reducing the Internal Difference Error Rate in Hospital Pharmacies:From the Angle of Quality Control Circle

Objective To improve the management level of pharmacy dispensing center,reduce dispensing errors and promote the safety of drug use.Methods Hospital pharmacies could be managed according to the theory of quality control circle(QCC).Based on the ten steps of QCC,the internal difference error rate in pharmacies could be reduced.Results and Conclusion The error rate of pharmacies was reduced from 2.74‰to 0.57‰,and the goal achievement rate was 108.466.Besides,the progress rate reached 84.82%.The abilities of circle members were improved,and the operation of pharmacy was more standardized.The activity of QCC is helpful to reduce the internal difference error rate,improve the operation level of pharmacy and ensure the safety of drug use.

Replacing liquid fyrite with digital to improve <i>in vitro</i>fertilization laboratory quality control procedures

In clinical in vitro fertilization (IVF), optimal culture conditions are required for production of high quality embryos and for achieving high pregnancy rates. Cell culture systems require vigilant attention to quality control and quality assurance, and upgrades to equipment and procedures require strenuous deliberation. During a 2-week maintenance period, we undertook an extensive analysis of incubator carbon dioxide (CO2) monitoring and the effect on culture media pH by comparing our traditional liquid Fyrite instruments to a certified and calibrated digital CO2 analyzer. The digital analyzer produced consistently lower CO2 readings and significantly greater precision than the liquid Fyrite. Media pH measurements showed significant variation depending on CO2 calibration device;however pH remained within manufacturers’ specifications. After superior performance by the digital analyzer, we incorporated this device into the incubator calibration and daily quality control procedures. A retrospective comparison of overall lab performance before and after this equipment switch demonstrated improved clinical pregnancy and implantation rates. This report illustrates the necessary caution when altering established laboratory procedures and equipment while highlighting the benefits of judiciously updating techniques and equipment in a laboratory setting that is often stubborn to change pre-existing, ingrained methodology.

Learning-based parameter prediction for quality control in three-dimensional medical image compression

Quality control is of vital importance in compressing three-dimensional(3D)medical imaging data.Optimal com-pression parameters need to be determined based on the specific quality requirement.In high efficiency video coding(HEVC),regarded as the state-of-the-art compression tool,the quantization parameter(QP)plays a dominant role in controlling quality.The direct application of a video-based scheme in predicting the ideal parameters for 3D medical image compression cannot guarantee satisfactory results.In this paper we propose a learning-based parameter prediction scheme to achieve efficient quality control.Its kernel is a support vector regression(SVR)based learning model that is capable of predicting the optimal QP from both vid-eo-based and structural image features extracted directly from raw data,avoiding time-consuming processes such as pre-encoding and iteration,which are often needed in existing techniques.Experimental results on several datasets verify that our approach outperforms current video-based quality control methods.

QUALITY ASSURANCE INFORMATION SYSTEM FOR AGILE MANUFACTURING

The customer driven dynamic global market and geographical distribution of collaborating partners bring new challenges to the development of quality assurance information system (QAIS) for agile manufacturing. With recent dramatic advances in information technology, firstly the requirements of QAIS are examined in agile manufacturing environment, then a new implementation framework of a distributed QAIS is presented, where a deve loping environment of QAIS is established and some critical techniques are studied. Finally a prototype system based on world wide web (WWW) is accomplished.

Study on Factors Influencing the Quality of Automatic Monitoring Data of Pollution Sources and Technical Assurance Measures

Automatic monitoring data of pollution sources is an important basis for environmental supervision and management.At present,it is difficult to guarantee the quality of automatic monitoring data of pollution sources,and it is difficult to play the role of the monitoring data.In response to this problem,the factors influencing the quality of automatic monitoring data of pollution sources were analyzed in detail,and technical assurance measures for the quality of automatic monitoring data of pollution sources in Shandong Province were studied.Besides,the dynamic management and control idea of automatic monitoring of pollution sources was proposed,and specific technical measures were analyzed from five aspects of standardizing automatic monitoring equipment of pollution sources,improving the data collection and transmission system,establishing a mechanism for reporting operating status information of monitoring equipment,setting alarm rules and alarm processing procedures,and statistically analyzing the operating status of the equipment.Practice has proved that the dynamic management and control system can effectively ensure the quality of automatic monitoring data of pollution sources.

Partial Quality Assessment of ⁶⁰Co-Teletherapy Machine Performance

The aim of this study was to assess the performance of 60Co-teletherapy unit at Radiation and Isotopes Center in Khartoum, using the common tools used for quality control (Front pointer, Graphic paper, Pin, Non-screen film, meter and Check plate). The collected and analyzed data revealed that: there was a difference between the calculated theoretical field size (FS) and the measured one relative to the change of SSD;and the average FS shift was 0.9 cm relative to the standard one, while the machine isocenter was almost fixed at 0° with a shift of 0.003 cm, which was within the standard limit (0.2 cm). The diaphragm isocenter showed a shift of ±0.36 cm (i.e. in clock and anti clock wise) in average relative to standard limit (±0.3 cm) and the couch vertical isocenter (CVI) relative to the SSD changes was exceeded the standard limit (0.2 cm) by a factor of 0.9 cm. Also the SSD determined by the optical distance indicator was greater than the actual SSD (determined by Front pointer and measured by scale meter) by an average of 0.8 cm;which exceeded the limit (0.3 cm) by an average factor of 0.5 cm. The study also showed that the penumbra profile (1.5 cm) was less than the actual specified for 60Co-teletherapy machine, while the radiation beam was so homogeneous across the field size.

2022年度国家康复医疗服务与质量安全报告

目的 从医疗机构康复医疗服务结构、环节和结局质量等方面,分析2021年全国综合医院康复医学科和康复医院的医疗服务和质量安全情况。方法 本报告数据来源于国家医疗质量管理与控制信息系统。2022年度调查共纳入全国9 328家医疗机构的康复医疗质量相关数据,涵盖全部二级以上综合医院、康复医院,也包含中医和中西医结合综合医院。数据清洗后实际纳入2 513家配置康复医学科病房的医院数据,对其进行康复医疗服务质量分析。结果 在2022年度纳入调查的9 328家综合医院中,仅2 713家设置有康复医学科病房。综合医院中,56.77%医院的平均每床配置医师数、80.36%医院的平均每床配置康复治疗师数、53.53%医院的平均每床配置护士数未达到国家要求,且各地区康复医学科每床平均配置康复医务人员数差距较大。综合医院骨科、神经内科和重症医学科病房早期康复介入率分别为13.45%、20.67%和29.74%。综合医院康复医学科出院患者平均日常生活活动能力改善率为77.87%,康复医院为69.01%。结论 2021年我国康复医疗服务和质量安全整体稳中有升,但全国多数综合医院仍未配置康复医学科病房,且康复医务人员总量未满足要求,康复早期介入仍有较大提升空间,重点评定和治疗项目开展存在欠缺,康复治疗效果尚有提升空间。需持续推动康复医疗服务能力建设,进一步提升康复医疗质量。

Top-down法评定EDTA络合滴定法测定海洋沉积物中碳酸钙含量的不确定度

依据Top-down技术中的质控图法对EDTA络合滴定法测定海洋沉积物中碳酸钙含量的不确定度进行评定。利用2021年质控样标准物质GBW 07333、GBW 07314和GBW 07316中CaCO_(3)测定值的时序数据进行评定,3组时序数据正态统计量A^(2*)(s)和独立性统计量A^(2*)(RM)均小于1,CaCO_(3)测定值、A_(EWMi)和移动极差控制图没有失控点,3组时序数据处于受控状态。当CaCO_(3)质量分数分别为2.05%、6.20%和38.56%时,计算得其扩展不确定度分别为0.08%、0.07%和0.20%。将测量不确定度与对应含量值进行线性拟合建立了不确定度预测模型,GBW 07309和GBW 07334中CaCO_(3)的测量不确定度预测值分别为0.09%和0.18%,预测值与Top-down技术获取的评定结果较为吻合。

建立中国运动神经元病医疗规范和持续质量改进体系

运动神经元病(motor neuron disease,MND)是一组神经变性疾病,肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)是其主要类型。目前ALS/MND缺乏特效诊疗手段,患者预后差。ALS/MND虽然较罕见,但目前我国该系列疾病住院患者有快速增长趋势,结合我国实际情况,存在ALS/MND临床医疗质量控制的迫切需求。国家神经系统疾病医疗质量控制中心于2022年设立了MND质控专病组,启动了ALS/MND临床医疗质量控制体系建设。以“建立中国运动神经元病医疗规范、持续质量改进体系”为核心理念,MND专病组通过系统调研,利用德尔菲法制定了ALS医疗质量控制指标,从统一诊断标准、形成疾病全面管理概念、规范治疗方案等方面系统完善ALS的住院医疗质量控制。除制订指标外,专病组还进行了推进临床诊疗核心数据元、MND质量控制信息平台建设以及通过全国同质化教学系列活动保证临床实践一致性等工作。质量控制的方案应是动态的,专病组将结合实际,确保质量控制方案在实际应用中的有效性和可行性。未来,该体系的不断发展和完善将为ALS/MND的临床医疗工作提供科学规范的质量控制系统。

某三级甲等医院构建基础医疗质量评价体系的实践探索

构建并完善基础医疗质量评价体系,提升医疗质量与安全。以某三级甲等医院为例,该院从患者服务、手术管理、危急重症、病历质量、合理诊疗、科室管理6个维度构建基础医疗质量评价体系,在体系中增加专项质控考核和平台科室质量评价体系,将评价结果与科主任管理绩效和科室绩效挂钩,并在此基础上构建科主任评价体系。该体系的构建形成了全方位医疗质量监管机制,激发科室主动参与质控管理,有助于发现医疗质量薄弱环节并持续改进,并可实现医疗质量安全的分层管理。基础医疗质量评价体系的建立有助于全方位了解全院科室医疗质量管理问题,提升质控管理成效,为医院夯实高质量发展根基。

基于人工智能的病历质控闭环系统应用与思考

目的为实现对电子病历全流程的全面质量控制,大型综合医院推出了基于人工智能的病历质控闭环系统。方法通过建立病历质控规则数据库,结合人工智能技术和闭环管理模式,形成智能化病历质控闭环系统。该系统包括事前提醒、事中实时监控与预警、事后反馈与改进以及多维度统计分析等。结果实现了病历质量控制全样本覆盖,与病历相关的质量指标稳步提升。结论人工智能病历质控闭环系统的应用显著提升了电子病历的质量和病案室的工作效率,提高了医院的精细化管理水平。