Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Analysis of the Ideological and Political Concepts and Teaching Strategies for Quality Improvement in Physical Education Courses in Colleges and Universities

In today’s higher education system,the physical education program is not only for teaching sports skills and exercising physical fitness but also an important position for cultivating students’character,emotions,and values.With the in-depth development of the concept of ideological education,the ideology of college physical education courses has become an important direction of educational reform.In this paper,we will discuss the connotation of the concept of ideology and politics in college physical education courses,analyze the methods to effectively integrate the ideology and politics elements while guaranteeing the quality of teaching,and put forward the corresponding strategies to improve the quality,with a view to providing new ideas and methods for the construction of ideology and politics in college physical education courses.

Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis

BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.

Improving the Quality of Public Space in Old Residential Areas Based on Superposition and Intervention:A Case Study of Baihuazhou District of Nanchang City

With the development of cities,China has entered an era of stock planning.The functions of old residential areas in urban development can no longer meet the needs of residents in the new era for a better life,and new standards have been put forward for the quality of public spaces for living.This paper analyzes and sorts out the characteristics and problems of the public space in the old residential areas of Baihuazhou district.Combining superposition and intervention techniques,the spatial,historical,cultural and other characteristic elements of the residential areas are preserved to the greatest extent.The public space in the old residential areas of Baihuazhou District is updated and reconstructed in order to achieve the goal of improving the quality of its public space.

Research on the Construction and Quality Improvement of Art Curriculum in Rural Primary Schools

Curriculum quality is the foundation of education development and the core element of primary education and teaching.It is a key indicator to measure and evaluate the level of educational development in a country and region.Curriculum quality needs to be examined not only from the perspective of the degree of achievement of the preset curriculum goals,but also from the perspective of students’subjective feelings and experiences.Art course is the core service provided by the school for students,and the quality of the course is judged by the acquisition and development of students.At the same time,the value of aesthetic education also calls for the reform and improvement of the fine arts curriculum,which requires the fine arts curriculum in all stages in rural areas to get closer and change in this direction.After the promulgation of art curriculum standards,the fine arts curriculum of rural primary schools should follow high quality standards,which is a process of optimization and iteration of various elements of primary art curriculum.The fine arts curriculum of rural primary schools needs to meet the exploration needs of current students,effectively and appropriately develop excellent local resources while enriching the curriculum content,introduce the essence of regional culture and art,improve the evaluation of curriculum quality,and form a scientific curriculum management system,so as to promote the sustainable development of students.According to this understanding,we can improve the quality of art curriculum in rural primary schools from four dimensions:curriculum objectives,curriculum content,curriculum implementation,and curriculum evaluation.

Assessment of Appropriateness of Diagnostic Lymph Node Tissue Collection from the Operating Theater and by Interventional Radiologist. A Clinical Audit

Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is not done according to certain standards. We conducted this study to assess the route of lymph node samples from requests to reaching the laboratories. Methods: We conducted an audit over a period from 4th June until 10th Aug 2023. Data for all the procedures performed over this period on lymph node samples (was entered into and analysed using Excel. Results: A total of eighteen samples for sixteen patients were obtained during this period. Median age of the patients was 34 years (19 - 73) with a M:F ratio of 5:11. Among the IR samples, nine samples were from the neck, three from inguinal area and one from axilla. Seven samples (53.8%) were tru-cut biopsies, six samples (46.15%) were FNA. All samples were sent to the pathology laboratory fixed in formalin. Samples for TB were sent only for five cases (31.25%) and for only two cases (12.5%) were samples sent for bacterial culture. For the OR samples, none were sent for either bacterial culture or TB. Overall, eight patients (50%) were not investigated for any infectious etiologies like brucella, toxoplasmosis, CMV, EBV plus other possible causes. Repeat sampling was required for 25% of patients (within and out of the audit period). Conclusions: to avoid delays in making diagnoses, it is paramount to consider infectious etiologies as possible diagnosis for lymphadenopathy and request appropriate investigations. This requires liaising with infectious diseases/clinical microbiology experts to guide regarding types of samples, types of media and timely dispatch to the correct laboratory.

In situ digital testing method for quality assessment of soft soil improvement with polyurethane

This study purposes an in situ testing method on quality assessment of soil improvement.Factual drilling data includes the spatial distribution and in situ strength of untreated and treated soil along three different drillholes measured by on-site drilling monitoring method.These factual drilling data can characterize the degree of soil improvement by penetration injection with permeable polyurethane.Result from on-site drilling monitoring shows that the linear zones represent constant drilling speeds shown in the plot of drill bit advancement vs.net drilling time,which indicates the spatial distributions of soil profile.The soil profile at the study site is composed of four layers,which includes fill,untreated silty clay,treated silty clay,and mucky soil.The results of soil profile are verified by the parallel site loggings.The constant drilling speeds profile the coring-resistant strength of drilled soils.By comparing with the untreated silty clay,the constant drilling speeds of the treated silty clay have been decreased by 13.0-62.8%.Two drilling-speed-based indices of 61.2%and 65.6%are proposed to assess the decreased average drilling speed and the increased in situ strength of treated silty clay.Laboratory tests,i.e.uniaxial compressive strength(UCS)test,have been performed with core sample to investigate and characterize in situ strength by comparing that with drilling speeds.Results show that the average predicted strengths of treated silty clay are 2.4-6.9 times higher than the average measured strength of untreated silty clay.The UCS-based indices of 374.5%and 344.2%verified the quality assessment(QA)results by this new in situ method.This method provides a cost-effective tool for quality assessment of soil improvement by utilizing the digital drilling data.

Assessment of the Physical Capabilities of Heart Failure Patients before and after Cardiovascular Rehabilitation: A Study of 125 Patients from West Africa, Dakar, Senegal

Background: Cardiac rehabilitation represents a critical therapeutic strategy for patients suffering from chronic heart failure. The physical capacity of patients with heart failure, assessed using the exercise test and the 6-minute walk test, is the measure of the patient’s overall functional ability to perform physical activities and tolerate exercise loads. The objective of this study was to assess the impact of cardiac rehabilitation on patients’ physical capabilities and to conduct a thorough comparison of data obtained via exercise testing and the 6-minute walk test before and after the rehabilitation programme. Methods: This was a descriptive and analytical cross-sectional study, conducted from 1 February 2021 to 31 June 2022. Included were heart failure patients who had participated in an outpatient cardiovascular rehabilitation programme. The collected data included anamnestic, clinical, paraclinical data, and the 6-minute walk test. Informed consent was obtained. Data analysis, word processing, and charting were performed using Microsoft Word 2016, Excel 2013, and Sphinx version 5.1.0.2. Data analysis was performed using SPSS (Statistical Package for Social Sciences) version 24.0. Any difference less than 0.05 was considered statistically significant. Results: In a Senegalese study, heart failure patients undergoing rehabilitation in a cardiac unit represented 45.59% of all cases, with a prevalence rate of 3.21%. The average participant was 57.97 years old, with those aged 61 to 70 forming the largest group (35.5%). The study noted a male predominance (sex ratio of 2.1) and identified dyslipidaemia (80.6%) and sedentarism (71%), as prevalent cardiovascular risk factors. All participants initially suffered from NYHA stage 2 or 3 dyspnoea, yet 80.65% showed no symptoms following rehabilitation. Significant improvements were recorded in resting heart rate (from 79 to 67 bpm), and the 6-minute walk test distance (from 328 m to 470 m). Enhanced exercise tolerance and walking test outcomes were particularly notable in patients with LVEF ≥ 50%, women, non-obese individuals, those initially walking less than 300 m, achieving more than 3 METs, and non-smokers. Conclusion: The findings underscore the effectiveness of cardiovascular rehabilitation in improving symptoms, physical capability, and overall quality of life for heart failure patients in Senegal.

Strategies for Enhancing the Affinity of College Ideological and Political Course Teachers

This article aims to explore effective ways to enhance the affinity of ideological and political course teachers in universities.By analyzing the connotation of affinity,the factors that affect the affinity of ideological and political course teachers are analyzed,and corresponding improvement strategies are proposed.Research suggests that strengthening the construction of teacher ethics and conduct,improving teaching skills,enhancing emotional engagement,and enhancing practical training are key paths to enhance the affinity of ideological and political course teachers.The implementation of these paths will help improve the teaching quality and effectiveness of ideological and political courses,and promote the comprehensive development of students.

Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics

Objective:To explore the effect of the Plan-Do-Check-Action(PDCA)cycle on hand hygiene and nosocomial infection quality of or thopedic medical staff.Methods:The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization.Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time,and compare the compliance of hand hygiene before and after implementation,and evaluate the quality of nosocomial infection.Results:The hand hygiene compliance of doctors and nurses in stage P was 82%.The compliance of medical staff in stage D was 93%.The compliance of stage C was 94%and that of stage A was 95%.The quality score of hospital self-examination nosocomial infection was also significantly increased.Conclusions:The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality,which is wor thy of circulatory application in or thopedic nosocomial infection quality control,especially improving the quality of hand hygiene.

Analysis of The Impact of Excellent Event Management on the Safety of Patients and Clinical Caregivers

Objective: To investigate the impact of excellent event management in improving patient safety and nursing staff care satisfaction. Methods: The study was analyzed by retrospective comparison, and routine management from January 2022 to December 2022 was set as the control group, and excellent event management from January 2023 to January 2024 was set as the study group. The differences in nursing outcomes between both groups were compared. Results: The rate of adverse events in the study group (0.61%) was lower than that in the control group (0.96%), and the rate of excellent events in the study group (2.57%) was higher than that in the control group (0.97%) (P < 0.05). Meanwhile, the satisfaction level of nursing safety in the study group reached 98.81%, which was much higher than in the control group (92.21%) (P < 0.05). Conclusion: Nursing excellent event management had a positive impact on improving patient care safety satisfaction, reducing the rate of adverse events, and increasing the rate of reporting excellent events.

Discussion on the Status Quo of Non-Destructive Testing Technology in Highway Engineering and Strategies of Improving the Quality of Testing

Highway test and detection technology play a very important role in controlling the quality of road and bridge engineering and improving the maintenance of roads and bridges.The study of highway bridge test detection technology is both theoretically and practically useful.Road and bridge test and detection is a complicated task.With the development of science and technology,highway and bridge engineering test and detection technology has also made great progress.The continuous improvement of test and detection technology has brought good social benefits to road and bridge construction.This article discusses the problems in test and detection technology of highway bridges and how to improve the quality of test and detection.

The Impact of Information Technology on Service Quality,Satisfaction,and Customer Relationship Management(Case Study:IT Organization Individuals)

Recent research and studies have shown that Information Technology(IT)has a significant impact on service quality,customer satisfaction,and customer relationship development.With the proliferation and penetration of technology in all aspects of life,organizations are responding to the implications and opportunities that IT creates in relation to customer services.The main objective of using information technology in organizations is to increase customer satisfaction,service quality,and customer relationship management,which the authors will focus on here.Enhancing service quality,improving customer satisfaction,and establishing close and sustainable customer relationships are key advantages of leveraging information technology in this field.This article examines the impact of information technology on service quality,customer satisfaction,and customer relationship development and provides strategies and models for organizations to improve customer satisfaction and establish closer connections with them through the use of information technology.Seventy individuals from the IT field were used to evaluate the proposed model.The proposed model was compared with three models:SEM,regression,and decision tree,and the results demonstrated better performance of this approach.

Interventions to Improve HIV Viral Load Suppression among the Adolescents: Evidence of Improvement Science through a Quality Improvement Approach in Eastern Uganda

Introduction: Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. Method: Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. Results: The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. Conclusion: The use of quality improvement in addressing gaps in HIV service delivery is highly effective.

Empirical Research on Quality Improvement and Effect Increase of Rural Tourist Destination Under the Strategic Background of Rural Revitalization: A Case Study of Xishan District, Kunming City, Yunnan Province

As one of important channels in rural revitalization and development, rural tourism obtains a lot of remarkable achievements in rural development. However, relatively single product and homogenized development model make competition gradually intensify, and many once glorious rural tourist destinations gradually decline. Xishan District of Kunming City of Yunnan Province is taken as research object in this paper. Via literature research, field survey and depth interview, development process, status quo and existing problems of its rural tourism are deeply explored. Based on above research results, development idea, strategy and countermeasure for quality improvement and effect increase of traditional rural tourism destination are proposed, and cooperative development, mutual benefit and win-win are taken as the ultimate development goals.

Studying Design and Use of Healthcare Technologies in Interaction: The Social Learning Perspective in a Dutch Quality Improvement Collaborative Program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effects.

Influencing Factors and Improvement Strategy to the Quality of Nursing Work Life: A Review

This review introduces the definition, influencing factors and improvement strategy to the quality of nursing work life, which can provide references for nursing managers to understand the factors affecting the quality of nursing work life and choose effective measures to improve the quality of nursing work life.

Effects of Biochar on Tobacco-planting Soil Improvement and Tobacco Quality in Mudanjiang Area

This study was conducted to study the feasibility of biochar in soil im- provement and tobacco quality. The black soil in NinganCountry of Mudanjiang was used as the material in this study, and the effects of biochar on tobacco-planting soil C/N, soil microorganisms, the development of tobacco, and chemical compo- nents and neutral aroma components in flue-cured tobacco werestudied. The results showed that the application of biochar at a rate of 1 800 kg/hm2 could increase soil C/N by 31.79%, and the quantity of actinomycetes in the soil was 3.8 times as much as that in control. The growth wasobviously better after biochar application, plant height and effective leaf number were significantly higher than those ofcontrol, but total sugar and nicotine were not significantly different. The application of biochar at a rate of 1 200 kg/hm2 increased the potassium content by 11%, the application of biochar at a rate of 2 400 kg/hm2 improved total sugar content by 5.40%, and the application of biochar at a rate of 1 800 kg/hm2 made the tobacco solanone content 1.97 times as that of control. Comprehensive studies showed that the application of biochar 1 200-1 800 kg/hm2 could improvesoilenvironment, and promote tobacco growth and quality.

Rice Storage Proteins:Focus on Composition,Distribution,Genetic Improvement and Effects on Rice Quality

Rice storage proteins(RSPs)are plant proteins with high nutritional quality.As the second largest type of storage substance in rice,it is the main source of protein intake for people who consume rice as a staple food.The content and type of RSPs affect the appearance,processing quality and eating quality of rice.These effects involve the distribution of RSPs in rice grains as well as the interactions of RSPs with other components such as starch in rice grains.In the past two decades,some progress has been made in the genetic improvement of RSPs.However,the determination mechanism of protein content and composition in rice is still unclear,and the mechanism of the effect of RSPs on rice quality has not been elucidated.In this review,the composition,biosynthesis and distribution of RSPs,and quantitative trait loci mapping and cloning of RSP genes are summarized,the research progress of the influence of RSPs and their components on rice quality are reviewed,and the research directions in the future are proposed.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.