Quality Issues (quality + issues)

Distribution by Scientific Domains

Selected Abstracts

Concordance with community mental health appointments: service users' reasons for discontinuation

Tony Hostick MSc
Background., Quality issues are being given renewed emphasis through clinical governance and a drive to ensure service users' views underpin health service development. Aims., To establish service users' reasons for discontinuation of community based mental health appointments in one National Health Service Trust. Method., A two-phase survey of all non-completers over a year. Phase one using a structured postal questionnaire. Phase two using structured interviews with respondents to phase one by post, telephone and face to face. Results., A total of 243 discharges because of non-completion were identified by local services over the 12 months of the study and followed up by initial questionnaire. This represents 8.19% of all discharges (2967) within the same period. Forty-four users were engaged and followed up within phase two of the survey. Data were subject to both quantitative and qualitative analysis. Conclusions., Analysis of responses suggests that the main reasons for non-completion are because of dissatisfaction although the reasons are varied and the interplay between variables is complex. Whilst this user group are not apparently suffering from ,severe mental illness', there is clear, expressed need for a service. Relevance to clinical practice., Whoever provides such a service should be responsive to expressed need and a non-medical approach seems to be favoured. If these needs are appropriately met then users are more likely to be engaged and satisfaction is likely to be improved. Although this in itself does not necessarily mean improved clinical outcomes, users are more likely to stay in touch until an agreed discharge. Practical problems of applied health service research are discussed and recommendations are made for a review of referral systems, service delivery and organization with suggestions for further research. [source]


Peter Abelson
In late 2003 and early 2004 the Economic Society of Australia surveyed the Heads of Economics Departments in Australia to determine their views on three main issues: student standards; major factors affecting these standards; and policy implications. This paper describes the main results of the survey, reviews the conduct and value of this kind of survey, and discusses policy implications for economics in universities. Most respondents considered that student standards have declined and that the main causes include lower entry standards, high student/staff ratios, and a declining culture of study. However, some respondents argued that standards are multi-dimensional and that people may properly attach different weights to different attributes. Strong precautions assuring anonymity to respondents minimised strategic responses, but may not have eliminated them entirely. However, the respondents' views were based largely on experience rather than evidence and a major finding of this paper is the need for more evidence on standards and on the factors that influence them. Most respondents favoured a decentralised university-based approach to dealing with these issues, contending that centralised accreditation is inappropriate and that market forces would promote quality issues. In the writer's view, externally set and assessed exams as part of university examination procedures would lift standards and send out improved market signals. [source]

Power quality state estimation

Neville R. Watson
Abstract Due to the size and complexity of modern electrical power networks and the cost of monitoring and telecommunication equipment, it is unfeasible to fully monitor the system state. For this reason state estimation techniques are used. With strategically placed measurements, estimation techniques can determine the parameters at unmonitored locations. Fundamental frequency state estimation is now a standard tool in modern power systems. The emission and immunity levels of modern electrical equipment are different to that of the past, and this has resulted in power quality issues have become important. Knowledge of the source and location of the disturbances is desirable so that remedial action can be taken promptly. Recent contributions have extended the concept to: harmonic state estimation (HSE) and identification of harmonic sources, transient state estimation (TSE) and voltage sag state estimation (VSSE), which are all types of power quality state estimation (PQSE). This paper provides an overview of the state-of-the-art techniques currently available for PQSE in a large electrical power system. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Redox Processes and Water Quality of Selected Principal Aquifer Systems

GROUND WATER, Issue 2 2008
P.B. McMahon
Reduction/oxidation (redox) conditions in 15 principal aquifer (PA) systems of the United States, and their impact on several water quality issues, were assessed from a large data base collected by the National Water-Quality Assessment Program of the USGS. The logic of these assessments was based on the observed ecological succession of electron acceptors such as dissolved oxygen, nitrate, and sulfate and threshold concentrations of these substrates needed to support active microbial metabolism. Similarly, the utilization of solid-phase electron acceptors such as Mn(IV) and Fe(III) is indicated by the production of dissolved manganese and iron. An internally consistent set of threshold concentration criteria was developed and applied to a large data set of 1692 water samples from the PAs to assess ambient redox conditions. The indicated redox conditions then were related to the occurrence of selected natural (arsenic) and anthropogenic (nitrate and volatile organic compounds) contaminants in ground water. For the natural and anthropogenic contaminants assessed in this study, considering redox conditions as defined by this framework of redox indicator species and threshold concentrations explained many water quality trends observed at a regional scale. An important finding of this study was that samples indicating mixed redox processes provide information on redox heterogeneity that is useful for assessing common water quality issues. Given the interpretive power of the redox framework and given that it is relatively inexpensive and easy to measure the chemical parameters included in the framework, those parameters should be included in routine water quality monitoring programs whenever possible. [source]

Systematic review of the perceptions and experiences of accessing health services by adult victims of domestic violence

Louise Robinson RGN RHV BSc (Hons) MSc
Abstract This systematic review synthesises evidence on the perceptions and experiences of adult victims of domestic violence when accessing healthcare services. The review was concerned with disclosure of domestic violence by adult victims when accessing health services, the responses of healthcare professionals to these victims, victims' perceived barriers to support, and the appropriateness of support and referrals. These aims required the review to focus on studies using in-depth qualitative methods to explore victims' perceptions and experiences. A comprehensive systematic search of 12 databases was carried out in June/July 2005. Application of the review protocol and inclusion criteria resulted in 10 studies (conducted in the UK, USA and Australia) being considered eligible for the review. Data were extracted from these studies and a quality assessment completed. Thematic analysis was carried out to enable the identification of recurrent themes within the included studies. Findings indicate that victims of domestic violence experience difficulties when accessing healthcare services. Victims perceive that these difficulties can be attributed to inappropriate responses by healthcare professionals, discomfort with the healthcare environment, perceived barriers to disclosing domestic violence, and a lack of confidence in the outcomes of disclosure to a health professional. The methodological quality of included studies was variable, but no papers were rejected based on quality issues. These results can contribute to and inform a comprehensive assessment of the experiences of adult victims of domestic violence when accessing healthcare services. The health service is in a unique position to contribute towards the assessment and identification of domestic violence and to provide access to appropriate support. The messages of this study are important for policy-makers and practitioners. [source]

New Routes to the PhD: Cause for Concern?

Bill Johnston
Recent developments suggest that the PhD is at a turning point. Professional groups have criticised the so-called ,traditional PhD'. New routes to the PhD are proposed by several bodies and endorsed by one funding council. In light of these developments, it is appropriate to ask what the implications are for the PhD and for the academy. A focus group was used to gather student responses to these developments. The findings show qualified support: students agree that the PhD should cater for different careers but challenge what they see as a simplistic channelling of PhD routes. This paper demonstrates apparent consensus on the need for change in the PhD and reveals movement beyond reconceptualisation towards reconstruction. However, we argue that there is cause for concern in the lack of attention paid to student views and the continuing neglect of quality issues in the PhD. [source]

Attitudes and use of rubber dam by Irish general dental practitioners

C. D. Lynch
Abstract Aim, To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners. Methodology, A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice. Results, A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents (n = 231) worked in general dental practice and 23% (n = 69) worked in the Irish Health Board/Community Dental Service. Rubber dam was ,never' used by 77% of respondents (n = 228) when placing amalgam restorations in posterior teeth, 52% (n = 147) when placing composite restorations in posterior teeth, and 59% (n = 177) when placing composite restorations in anterior teeth. Rubber dam was ,never' used by 39% of respondents (n = 114) when performing root canal treatment on anterior teeth; 32% (n = 84) when performing root canal treatment on premolar teeth; and 26% (n = 51) when performing root canal treatment on molar teeth. Fifty-seven per cent (n = 171) considered rubber dam ,cumbersome and difficult to apply', and 41% (n = 123) considered throat pack ,as good a prevention against inhalation of endodontic instruments as rubber dam'. Conclusions, Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients. [source]

Using FTA® Elute MicroCards to address biosecurity and DNA quality issues in abalone aquaculture

Natasha A Carr
First page of article [source]

General practitioners' ranking of evidence-based prescribing quality indicators: a comparative study with a prescription database

Ifeanyi Okechukwu
Background To ensure that indicators for assessing prescribing quality are appropriate and relevant, physicians should be involved in their development. How general practitioners (GPs) rank these indicators is not fully understood. Aims (i) To determine how GPs in Ireland rank a set of evidence-based prescribing quality indicators in order of importance and relevance to their practice, and (ii) to compare the GPs' ranking of the defined set of indicators with actual prescribing practice using a prescription database. Methods A postal questionnaire was sent to 105 GPs, who were asked to rank a set of 11 prescribing quality indicators, identified from the literature from most to least important. The results were aggregated and a weighted score for each indicator determined. These same prescribing indicators were then applied to a prescription database to compare the ranking provided with actual prescribing practice. Results Eighty-six GPs (82%) returned the completed questionnaire. The higher ranks were for quality issues,use of inhaled corticosteroids, statins and benzodiazepines. Actual prescribing data showed prolonged use of benzodiazepines in over half of the prescriptions dispensed (n = 18 171), 52.48% (95% confidence interval 51.95, 53.01) and low usage of generic drugs, 17.78% (17.70, 17.90) despite their high ranking by the GPs. Conclusion While GPs have diverse views about the value of different prescribing quality indicators, the results suggest that they do rank evidence-based guidelines on patient management highly, but those based on costs and less evidence the lowest. There was considerable divergence between theory and practice in the application of quality indices. [source]