Quality assessment systems for business organisations and also for vocational schools were established in Estonia at the beginning of 2000s. Almost ten years later, corresponding systems were introduced also for highe...Quality assessment systems for business organisations and also for vocational schools were established in Estonia at the beginning of 2000s. Almost ten years later, corresponding systems were introduced also for higher education institutions （HEIs）. All these assessment systems are based on the European Foundation of Quality Management （EFQM） excellence model. The aim of this paper is to analyse benefits, difficulties, and success factors of quality assessment processes in Estonian business organisations, vocational schools, and HEIs. The study is based on the analysis of feedback questionnaire of 404 representatives from participating organisations （HEIs, vocational schools, and business enterprises） and assessors. Our analysis revealed that quality assessment processes including self-assessment reporting had a positive effect on organisation development and it has given the participants certain benefits and new challenges. As a consequence, knowledge about quality management as well as the self-assessment skills has been improved. The main difficulties were connected to limited time resources and with problems to recognize direct benefits of quality assessment. As substantial difficulties, limitations of analytical and report-writing skills were considered. As the biggest success factor, an involvement of managers on different levels decision making was recognized. The analysis revealed that there are a number of similar benefits and difficulties in the quality assessment systems of different organizations.展开更多
In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since u...In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since updated,is now very widely accepted around the world.Nevertheless,the authoritative United States Preventative Task Force had in August 2012acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD.More recently,the American Society of Nephrology and the American College of Physicians,two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for"CKD screening"among the asymptomatic population.In this review,we revisit the various angles and perspectives of these conflicting arguments,raise unanswered questionsregarding the validity and veracity of the NKF KDOQI CKD staging model,and raise even more questions about the soundness of its evidence-base.We show clinical evidence,from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin,United States,of the pitfalls of the current CKD staging model,show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice.The impacts of acute kidney injury on CKD initiation and CKD propagation and progression,the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation,CKD propagation and CKD progression to end stage renal disease all demand further study and analysis.Yet more research on CKD staging,CKD prognostication and CKD predictions are warranted.Finally and most importantly,cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model,the need to individualize CKD care,both in terms of patient care and prognostication,cannot be overemphasized.展开更多
文摘Quality assessment systems for business organisations and also for vocational schools were established in Estonia at the beginning of 2000s. Almost ten years later, corresponding systems were introduced also for higher education institutions （HEIs）. All these assessment systems are based on the European Foundation of Quality Management （EFQM） excellence model. The aim of this paper is to analyse benefits, difficulties, and success factors of quality assessment processes in Estonian business organisations, vocational schools, and HEIs. The study is based on the analysis of feedback questionnaire of 404 representatives from participating organisations （HEIs, vocational schools, and business enterprises） and assessors. Our analysis revealed that quality assessment processes including self-assessment reporting had a positive effect on organisation development and it has given the participants certain benefits and new challenges. As a consequence, knowledge about quality management as well as the self-assessment skills has been improved. The main difficulties were connected to limited time resources and with problems to recognize direct benefits of quality assessment. As substantial difficulties, limitations of analytical and report-writing skills were considered. As the biggest success factor, an involvement of managers on different levels decision making was recognized. The analysis revealed that there are a number of similar benefits and difficulties in the quality assessment systems of different organizations.
文摘In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since updated,is now very widely accepted around the world.Nevertheless,the authoritative United States Preventative Task Force had in August 2012acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD.More recently,the American Society of Nephrology and the American College of Physicians,two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for"CKD screening"among the asymptomatic population.In this review,we revisit the various angles and perspectives of these conflicting arguments,raise unanswered questionsregarding the validity and veracity of the NKF KDOQI CKD staging model,and raise even more questions about the soundness of its evidence-base.We show clinical evidence,from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin,United States,of the pitfalls of the current CKD staging model,show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice.The impacts of acute kidney injury on CKD initiation and CKD propagation and progression,the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation,CKD propagation and CKD progression to end stage renal disease all demand further study and analysis.Yet more research on CKD staging,CKD prognostication and CKD predictions are warranted.Finally and most importantly,cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model,the need to individualize CKD care,both in terms of patient care and prognostication,cannot be overemphasized.
