In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.

Many companies are entering the international manufacturing arena. The continued expansion of the global market suggests that international manufacturing will grow. Among other concerns, the difficulty of producing high quality in some countries suggests that it is critical that companies using international locations for manufacturing find methods to better monitor and improve quality. The purpose of this research was to develop and test a method for quality improvement in an offshore environment. This method would be specifically applicable to a third-party logistics company (3PL), where the 3PL is a United States company that brokers manufacturing in China, networks to multiple manufacturers for a variety of products within that country, and is responsible for the final quality of the products made in China. After designing a new quality method that focused on regular recording and reporting of data, it was implemented into a 3PL test-case company and tested and results reported. From the results salient points were identified that improve quality when working with a 3PL located in China with a parent company in the United States. These points include: structure for reporting quality, management involvement, employee dedication to quality, and cultural understanding and awareness. Recommendations for further research are also outlined. These include: extended time (beyond three months) to implement the method and test it, larger sample size to improve the quantitative analysis, cost benefit analysis for the implementation of the method, implementation in different nations, and implementation in a manufacturing company specific to a product.

Production by Additive Manufacturing creates opportunities to make customized products in small batches with less material than in traditional manufacturing. It is more sustainable and suitable for niche products, but entails new production demands to ensure quality. The goal of this study is to define the most crucial parameters when creating Additive Manufactured products in metal and suggest tools for quality improvement. This is done by analysing earlier studies and evaluating the standard production procedures for manufacturing by Selective Laser Melting. The results from this study stated that porosity and insufficiencies in shape are the most common factors leading to deviation in quality. To avoid it, the most crucial parameters to consider are; The laser freeform fabrication-system related parameters, hatch distance, laser power, layer thickness, fscanning pattern, scan speed and flowability of the powder. Concluded is also that crucial parameters within additive manufacturing are very dependent on the definition of quality for a certain product and can therefore vary. By continuous collection and analysis of data, the task of improving quality will be simplified. / Produktion genom Additiv Tillverkning möjliggör tillverkande av skräddarsydda produkter i små batcher och med mindre material än vid traditionell tillverkning. Det är ett mer hållbart tillverkningssätt och mer passande för nischprodukter, men innebär nya produktionskrav för att säkerhetsställa bra kvalitet. Målet med denna studie är att definiera de viktigaste parametrarna vid Additiv Tillverkning av produkter i metall och föreslå verktyg för att förbättra dem. Detta genom analys av tidigare studier och utvärdering av klassiska produktionsrutiner för Selective Laser Melting. Resultaten från denna studie visar att porositet och formfel är de vanligaste faktorerna som leder till bristande kvalitet. För att undvika detta är de viktigaste parametrarna att ta i beaktande; parametrar kopplade till "laser freeform fabrication"-system, distans mellan laserstrålar, kraft på lasern, lagertjocklek, skanningsmönster, fart på skanningen och flytbarhet på pulvret. Slutsatsen pekar även på att avgörande parametrar inom Additiv Tillverkning beror på definitionen av kvalitet för en speciell produkt och kan därför variera. Genom kontinuerlig insamling och analys av data kommer förbättringen av kvalitet förenklas markant.

Throughout the process of receiving healthcare, a patient is affected by several factors and processes. To just name a few, how long a patient must wait at the clinic, how friendly the front desk is, how the nurse treats the patient, how effective the physician is with his or her communication, what the cost of a patient's healthcare is, and how clean the clinic is all affect the patient's experience. When clinics excel in these factors, it promotes a favorable relationship between the patient and the clinic. Patients trust the healthcare provider and desire to continue attending that clinic when they need to. Unfortunately, not every clinic can succeed in all these factors. The purpose of this study was to investigate the relative importance of these factors in a patient satisfaction survey at a university health center.

Background: Valvular heart disease (VHS) can be lethal. An auscultated murmur could be a first indication of VHS. Lately auscultation has been evaluated as non-accurate, while a murmur also can be normal/functional. The next step of verifying VHS, is a transthoracic echocardiography (TTE). The echocardiography clinic at Uppsala University Hospital has seen a lot of non-pathological referrals regarding murmur evaluation. Therefore, a fast-track screening TTE, performed by a biomedical scientist was of interest. Aim: The aim was to evaluate pathological possibility, regarding remitted patients with a new heart murmur. Material: The clinical quality work was based on remitted patients of ages 18 to 50. Sampling took place between November 2022 and Mars 2024, by Radiology Information System. Method: Type of murmur, outcomes and referring clinic was documented. Normal outcome group consisted of: absent VHS and mild VHS. Pathological outcome group consisted of: moderate and severe VHS. Probability was calculated based on systolic- and non-specified murmur. Result: Normal outcome group had 116 referrals and pathological outcome group had three referrals. Possibility of a pathological outcome became 2,5 %. Majority of the referrals came from the primary care (92 %). Conclusion: A systolic- and non-specified murmur had low possibility of a pathological outcome, which could indicate that a shorter screening TTE by a biomedical scientist is an option. A limitation was that the type of the remitted murmur could not be trusted. Majority of the referrals came from the primary care, which indicates that further clinical work at these facilities is necessary.

No / There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. OBJECTIVES: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012). We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented. The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster-randomised controlled trials and two studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case-conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta-analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication-related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal. Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems, however evidence of an effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes.

No / Emergency laparotomies in the U.K., U.S.A. and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence-based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal-directed fluid therapy and postoperative intensive care. The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of case mix-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model. Risk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6.47 in the baseline interval (299 patients included) to 12.44 after implementation (427 patients included) (P < 0.001). The overall case mix-adjusted risk of death decreased from 15.6 to 9.6 per cent (risk ratio 0.614, 95 per cent c.i. 0.451 to 0.836; P = 0.002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient case-mix profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity risk (0.197 and 0.223 before and after implementation respectively; P = 0.395). Use of the ELPQuiC bundle was associated with a significant reduction in the risk of death following emergency laparotomy. / E. LPQuiC Collaborator Group

Yes / This study explored healthcare quality issues affecting the reporting and investigation levels of digital incident reporting systems. Methods: A total of 38 health information technology-related incident reports (free-text narratives) were collected from one of Sweden’s national incident reporting repositories. The incidents were analysed using an existing framework, i.e., the Health Information Technology Classification System, to identify the types of issues and consequences. The framework was applied in two fields, ‘event description’ by the reporters and ‘manufacturer’s measures’, to assess the quality of reporting incidents by the reporters. Additionally, the contributing factors, i.e., either human or technical factors for both fields, were identified to evaluate the quality of the reported incidents. Results: Five types of issues were identified and changes made between before-and-after investigations: Machine to software- related issues (n = 8), machine to use-related issues (n = 5), software to software-related issues (n = 5), use to software- related issues (n = 4) and use to use-related issues (n = 1). Over two-thirds (n = 15) of the incidents demonstrated a change in the contributing factors after the investigation. Only four incidents were identified as altering the consequences after the investigation. Conclusion: This study shed some light on the issues of incident reporting and the gap between the reporting and investigation levels. Facilitating sufficient staff training sessions, agreeing on common terms for health information technology systems, refining the existing classifications systems, enforcing mini-root cause analysis, and ensuring unit-based local reporting and standard national reporting may help bridge the gap between reporting and investigation levels in digital incident reporting.

Att värna och behålla en verksamhets mest värdefulla tillgång – dess mänskliga resurser – är av stor vikt för verksamhetens hållbarhet och framgång. Hälsa och ohälsa kopplat till arbetsmiljö- och kompetensförsörjningsfrågor har därför under en lång tid intresserat forskare. Den Svenska nationella statistiken över sjukskrivningar inom arbetslivet talar sitt tydliga språk: flest sjukfall har funnits och finns fortfarande bland vård- och omsorgsyrken. Med hänvisning till detta och med tanke på de utmaningar inom vård- och omsorg som avser svårigheter med kompetensförsörjning och rekrytering blir arbetsmiljöfrågor av ytterst vikt att fokusera på och undersöka vidare. Denna kvalitativa studie består av en intervjuundersökning med ett målstyrt urval. Syftet med studien är att belysa och fördjupa förståelsen för viktiga faktorer som medverkar till sjukskrivning av personal inom social omsorg. Resultaten bygger på svar från en semistrukturerad intervjuundersökning som genomfördes med 8 undersköterskor som arbetar i den kommunala hemtjänsten. Det empiriska materialet analyserades med hjälp av en tematisk innehållsanalys, vilket innebär att intervjumaterialet kategoriserades och analyserades utifrån ett index av centrala teman – de av intervjupersonerna beskrivna och identifierade huvudfaktorerna. Resultatet visar att fysiskt påfrestande arbetsuppgifter, väderaspekter, samt personalbrist är ergonomiska faktorer som leder till sjukfrånvaro i hemtjänsten. Psykosociala faktorer som beskrivs som medverkande till sjukfrånvaro anses utgöras av sammanhållningen i arbetslaget, ojämn arbetsbelastning som påverkas av brukaromsättning, mellanmänskliga relationer, strukturell organisering av arbetet, så som delade turer, när arbetsuppgifter utförs med minskad kvalitet, samt när personalen inte räcker. I uppsatsen redogörs först för den teoretiska bakgrunden och metod. Därefter belyses faktorer som bidrar till sjukfrånvaro och deras påverkan på personalens fysiska- och psykosociala arbetsmiljön. Uppsatsen avslutas med en diskussion om resultatet kopplat till kvalitetsförbättring.

The Czech School Inspectorate (CSI) is the only institution responsible for external evaluation of educational system in the Czech Republic. Its main purpose is improving the quality of education provided. The aim of the diploma thesis is to describe different CSI's activities and to find out which of them and how influence practice of primary schools in Prague. The results of the analysis of questionnaires, interviews with some headteachers and Deputy Chief School Inspector's comment show that majority of headteacher respondents act upon school inspection report, take inspectors' advice into consideration and follow them. The CSI also influences schools indirectly:  by setting Criteria for Evaluation of Conditions, Course and Outcomes of Education  by stakeholder pressure  by publishing of numerous outputs  by means of InspIS SET system The research shows that most headteacher respondents consider school inspections to be important for them. KEYWORDS CSI, external evaluation, primary school, headmaster, managing school, quality school, education quality improvement