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INTRODUCTION With effective highly active antiretroviral therapy (HAART), individuals with human immunodeficiency virus (HIV) infection now enjoy life expectancies approaching those of uninfected individuals. Prolonged longevity has increased the prevalence of non-communicable comorbidities within the HIV patient population. HIV is a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), imparting a 1.5-2 -fold higher incidence of major adverse cardiovascular events (MACE) on infected patients. Deaths from ASCVD have increased as a result, despite a decline in total mortality. The Center of Excellence for HIV/AIDS care established a Cardiovirology Clinic (CvC) focused on providing primary and secondary preventative cardiovascular care to its patients. To date, there are no known data on the efficacy of such an intervention. We sought to define the performance of this care model for primary prevention. METHODS Unique CvC patients (n=68) with a treatment delivery window between September 1, 2017 to August 31, 2018 were identified through billing records. All patients were receiving HAART as prescribed by their infectious disease provider. Those with established ASCVD (n=10) were excluded from analysis to limit the study to primary prevention patients. We collected data on ASCVD risk factors (family history of premature ASCVD and personal histories of smoking, diabetes, hypertension [with degree of control], dyslipidemia, drug and alcohol use, and exercise) from the electronic health record. Body-mass index and systolic (SBP) and diastolic (DBP) blood pressures were also collected. Laboratory values including CD4 cell count, HIV-1 viral load, proteinuria, glomerular filtration rate, total cholesterol (TC), triglycerides (TG), and high (HDL) and low density (LDL) lipoprotein were included in the data collection. Estimates of 5-year risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or need for major revascularization was calculated using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) equations. Patient data were de-identified. Two-tailed, paired T-testing was performed for each factor comparing the initial and most recent follow-up values. Significance was defined as p value <0.05. RESULTS Using univariate analysis, reductions in D:A:D risk (relative 32.01%, absolute 1.49%, p CONCLUSION In this initial assessment, treated HIV patients appeared to enjoy meaningful reductions in MACE risk through the preventive care they received in this clinic, suggesting that CvCs could be a partial solution to the growing ASCVD morbidity and mortality among HIV-infected individuals. Limitations of this study include a small patient population (n=58) (limiting us to univariate analyses) and short duration of follow up (≤ 1 year). Data collection will continue annually for 4 additional years. With increasing subject numbers, multivariate analyses to determine if components of ASCVD risk reduction show interactions, and which factors, interactions and interventions impart the greatest risk reduction, will be performed in improve the quality of care.

This study was a sub-study based on the MIDWIZE capacity building program for public health officials in maternal and child health. This is a leadership program where participants conduct a quality improvement project at a selected health facility in their respective country. Implementing quality improvements with evidence-based methods such as dynamic positions, perineal protection, and intrapartum support can have a positive effect on the mothers and newborns outcomes, essential to reach the relevant goals of Agenda 2030.  The study aimed to describe maternity nurses’ experiences of implementing a quality improvement project at a health facility in Nairobi, Kenya.  The chosen design for this study included a qualitative method with nine individual semi- structured interviews. The participants were maternity nurses working in the antenatal, labour, and postnatal ward at the facility, Kianda 42. Data analysis was processed through inductive content analysis.  The findings resulted in two main categories, where the first category was titled Implementing dynamic positions, perineal protection, and intrapartum support with the subcategories The quality improvements positive effects, and Challenges with implementing the quality improvements The second category was titled Necessities needed to move forward with the subcategories Emotional necessities, Material and political necessities, and also Proposals on how to spread knowledge onwards.  Through implementing quality improvements, the maternity nurses had the opportunity of developing professionally. With methods such as dynamic positions, perineal protection, and intrapartum support there is a big possibility of reducing interventions and minimising complications for mothers and newborns. This study is of great importance due to it presenting the maternity nurses’ experience of implementing quality improvements, which can improve this project and future similar projects / Denna delstudie var baserad på programmet MIDWIZE capacity building för ledare inom offentlig förvaltning med inriktning på kvinnors och barns hälsa. Det är ett program avsett för ledarskap, där deltagarna i respektive land utför ett kvalitetsförbättrande arbete på angiven sjukvårdsinrättning. Att implementera kvalitetsförbättrande arbete med evidensbaserade metoder som dynamiska positioner, perinealskydd och intrapartum stöd kan ha positiva effekter på utfallen hos mödrar och nyfödda, nödvändigt för att nå angivna mål i Agenda 2030.  Studien ämnar beskriva sjuksköterskors upplevelser av att implementera kvalitetsförbättringar på en sjukvårdsinrättning i Nairobi, Kenya.  Designen tillämpad för denna studie var en kvalitativ metod med nio individuella semistrukturerade intervjuer. Deltagarna var sjuksköterskor som jobbade på antenatal-,förlossnings- och postnatal avdelning på sjukvårdsinrättningen, Kianda 42. Dataanalysen genomfördes med hjälp av en induktiv innehållsanalys.  Resultatet sammanställdes till två huvudkategorier, den första benämndes Att implementera dynamiska positioner, perinealskydd och intrapartum stöd med underkategorierna Det kvalitetsförbättrande arbetets positiva effekter och Utmaningar med att implementera det kvalitetsförbättrande arbetet. Den andra kategorin benämndes Nödvändigheter för att fortskrida med underkategorierna Emotionella nödvändigheter och Materiella och politiska nödvändigheter samt Förslag på hur kunskapen ska spridas vidare.  Genom att implementera kvalitetsförbättringar får sjuksköterskorna tillfälle att utvecklas professionellt. Med metoder som dynamiska positioner, perinealskydd och intrapartum stöd minskar risken för interventioner och komplikationer hos mödrar och nyfödda. Studien är av värde då den speglar sjuksköterskornas upplevelser av att implementera kvalitetsförbättringar, vilket kan effektivisera detta projekt och liknande projekt i framtiden.

Major Advisors: Suzanne Martin, Ph.D., Laura Blasi, Ph.D. Universities in the United States of America are faced with numerous challenges concerning quality assurance such as the quest for Continuous Quality Improvement. Implementation of technology has been a priority of many developing institutions of higher education. A large metropolitan institution of higher education has put into practice a technology based, on-line program quality assessment system, for its academic and administrative programs. This dissertation was a study of the changes reported over four years, 2001-2005, within ten initial teacher preparation undergraduate programs at the College of Education at this institution. Using a mixed method approach, this study addressed the following primary questions: 1. Since the system was introduced; a. Has the process of monitoring quality in the academic units changed? b. If changes have occurred in the program plans, how have they been documented and implemented? 2. What are the limitations/benefits of the system, as perceived by its users? This study is a case for its readers to understand the process of quality improvement as practiced in a college of education within a metropolitan university.

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Bakgrund: Miljontals människor världen över avlider årligen till följd av sepsis. Tidigare forskning har visat att det råder bristande kunskaper bland sjuksköterskor att identifiera, hantera och behandla sepsis därför ansågs behovet av att utbilda dem ytterligare föreligga. Omvårdnad är sjuksköterskans huvudområde. Det innefattar exempelvis ansvar och kunskap i att bedöma patienters hälsotillstånd. Ett septiskt tillstånd kan i ett tidigt skede identifieras genom avvikande vitala parametrar. Speciellt framtagna mätinstrument samt riktlinjer finns att följa, dock krävs det att sjuksköterskorna har kunskapen för hur dessa ska användas. Septiska tillstånd har ett snabbt och negativt sjukdomsförlopp, därför är tidig identifiering och snabba åtgärder viktigt. Syfte: Syftet med denna litteraturstudie var att sammanställa vilka utbildningsinsatser som kan öka sjuksköterskors kunskaper för identifiering av sepsis. Metod: En deskriptiv litteraturstudie med tematisk dataanalys vars resultat har baserats på 13 artiklar med kvantitativ ansats samt en med mixad metod. Huvudresultat: I resultatet framkommer det att samtliga studier använde någon form av muntliga och/eller digitala utbildningar, ”escape room” eller simuleringar som lyckade utbildningsinsatser eftersom det resulterade i ökade kunskaper bland sjuksköterskorna gällande identifiering av septiska tillstånd. Syftet med flertalet av utbildningsinsatserna var att de låg till grund för olika typer av förbättringsarbeten inom varierande vårdkontexter med det gemensamma målet att förbättra vården vid sepsis. Slutsats: För att minska de konsekvenser som uppstår till följd av bristande kunskaper gällande sepsis bland sjuksköterskor, kan olika utbildningsinsatser genomföras inom olika vårdkontexter då det är bevisat att kunskap räddar liv. / Background: Millions of people worldwide die annually as a result of sepsis. Previous research has shown that there is a lack of knowledge among nurses in identifying, managing, and treating sepsis, therefore the need to further educate them was considered necessary. Nursing is the nurse's main area and includes for instance, responsibility, knowledge and the experience of evaluating patients' health conditions. A septic condition can be identified in its early stage through abnormal vital parameters. Specifically developed measurement tools and guidelines are available to follow, but it requires that nurses have the knowledge of how to use them. Septic conditions have a rapid and negative disease progression; therefore early identification and rapid measures are essential. Aim: The purpose of this literature review was to compile educational interventions which could increase the nurses' knowledge of sepsis identification. Method: A descriptive literature review with thematic data analysis, the results were based on 13 articles with a quantitative approach and a mixed method. Result: The results reveal that all studies used some form of verbal and/or digital education, "escape room" scenarios and simulations as successful educational interventions. They all resulted in increased knowledge among nurses regarding the identification of septic conditions. The majority of the studies educational interventions where included in different types of quality improvement projects within different kinds of healthcare contexts, all with the common goal of improve the septic care. Conclusion: To reduce the consequences of inadequate knowledge about sepsis among nurses, different educational interventions can be implemented within different healthcare contexts because knowledge is proven to save lives.

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This project provides the first comprehensive investigation into the experiences of people with dementia (PWD), their carers, and the staff who provide care in emergency departments (ED) in the UK. This is a mixed methods study which used a national survey (N=403) followed by ED observation (32 hours) and qualitative interviews with health professionals (N=29), in an iterative and sequential design to present a holistic evaluation of the current experiences of the key parties- patients, carers, and ED staff involved in receiving and providing care. The theoretical perspective of the Human Factors Approach to patient safety underpins this work. The project included people with dementia and carers as collaborators and co-designers in both the development of the research tools and in shaping the project outputs. This research explores the barriers and facilitators to safe and effective care, concluding that here are a number of barriers (poor integration of communication systems, inappropriate physical environments, misalignment of staff training and workplace staffing models), which may affect the healthcare team’s ability to provide effective dementia care. These systemic challenges both give rise to and exacerbate poor organisational and safety cultures. However, despite these challenges, there are examples of safe and effective care (positive deviants) where uncommonly good outcomes for this patient population are achieved. Examining these examples offers valuable insight into potential adaptions, which could be used to improve existing care.

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