Clinical quality indicators

A variety of clinical quality indicators may be used to evaluate the efficacy of efforts to prevent nosocomial pneumonia. A clinical indicator may be defined as a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities ... 

In addition to measuring the rate of nosocomial pneumonia, other indicators could include the appropriateness of antimicrobial utilization or the proportion of staff compliant with handwashing policies. For each clinical quality indicator, a threshold above which a more detailed review is indicated needs to be set (13). However, the quality of the assessment depends on whether... 

This agent has a broad spectrum of activity encompassing several neurotransmitter systems. In this light, clozapine is similar to such phenothiazines as CPZ and thioridazine (519). It is also subject to a hepatic first-pass effect, which produces metabolites with low or unknown pharmacological activity. It has an elimination half-life ranging from 6 to 33 hours and a volume of distribution (V 5 l /kg) lower than most other antipsychotics. This last quality indicates less drug is sequestered in tissue sites. Plasma levels of the parent compound at or above 350 ng/mL may be associated with a better clinical response ( 66, 520). Plasma levels are lower in men than women, especially male smokers (329). 

With the HCQIP, there is an opportunity to restructure provider payments under the current Medicare program to emphasize the quality of care that beneficiaries receive. Medicare, as the purchaser of health care for over 39 million individuals in the U.S., has an opportunity to demand quality health care services. Quality indicators for HCQlP s six clinical areas have been developed these could serve as an early implementation phase of a new reimbursement program. 

However, only determining a provider s adherence to a set of quality indicators for a population with a particular clinical condition is not sufficient. Within a disease category, there are levels of severity and associated morbidity. It is presumed that the sicker the patients, the less likely they might be to exhibit improvements, and therefore less likely to have positive outcomes due to clinical care received. To ensure equitable payment based on the quality of care provided, the severity of illness of a provider s Medi-... 

UAAC> 2i To evaluate impact of clinical pharmacy interventions on cost and quality of patient care COD None Personnel costs Physician acceptance, DCA, various quality indicators Annual extrapolated cost savings 19,076 Documented cost and quality using daily patient data collection forms... 

Hertz E. 1990. Developing quality indicators for a clinical engineering department. In Plant, Technology and Safety Management Series Measuring Quality in PTSM. Chicago, Joint Commission on Accreditation of Healthcare Organizations. 

Denmark No Hospital (in addition to the HSOPS a pilot versions of the NHSOPS was used in nursing homes) European Society for Quality in Healthcare, Office for Quality Indicators, The Danish National Clinical Quality Improvement Programme, Central Denmark Region Solvejg Kristensen, Jan Mainz (Ollgaardm et al. 2011) Master Thesis... 

Safety and quality aspects are the main topics that must be addressed from a regulatory perspective at the pre-clinical phase of drug development. Indicative efficacy data will also be obtained, but authoritative data can be obtained only from clinical studies conducted with humans. Safety and preliminary efficacy indications... 

Clinical trials have indicated that omalizumab, a recombinant humanized monoclonal IgE antibody approved for use in moderate to severe persistent asthma in patients with reactivity to a perennial allergen, is effective in the treatment of SAR.25-27 Omalizumab inhibits the binding of IgE to mast cell and basophil receptors, resulting in a reduction of allergic mediator release.25 Additionally, serum free IgE levels are decreased.2 27 In SAR patients, omalizumab improves quality of life and nasal symptoms and reduces antihistamine needs. The most effective dose in SAR appears to be omalizumab 300 mg administered subcutaneously every 3 to 4 weeks depending on baseline IgE levels.26,27... 

The establishment of performance criteria for a given tumor marker test is not a simple process because accuracy and precision are unique for each type of analyte and its application. Establishing methodological limits for accuracy, precision, sensitivity, and specificity often requires standard reference materials, quality control materials, comparative studies, and actual clinical specimens. Accuracy and precision must be measured over the analyte reportable range for which the device is intended to be used. Sensitivity and specificity must be considered with respect to the intended clinical use of the device. Also, the indications for use should be carefully considered in the design of the study protocol. The indications for class II should be to monitor residual tumor after surgery (or radiation), the recurrence of tumor, or response to therapy. A 510(k) must provide clear evidence that the device is accurate, safe, effective, and substantially equivalent to a device legally marketed in the United States. 

Both clinical and sub-clinical mastitis are usually accompanied by an increase in the somatic cell count (SCC a measure of white blood cells (95%) such as macrophages, segmented neutrophil granulocytes or lymphocytes) in milk. SCCs above a certain level are an indication of immune-system activation and are used as an indicator of sub-clinical , latent or chronic udder infections/mastitis (Concha, 1986 Ostensson et al., 1988), which were shown to affect milk quality, composition and shelf life. Dairy companies therefore impose SCC thresholds or reduce payments to farmers if certain thresholds are exceeded (Hamann, 2001 Urech et al., 1999). 

The objective of mastitis treatments is to cure the infected udders from the infection, but cure is defined in very different ways. For example, in economic terms, the farmer needs to achieve a level of udder health that allows expected milk yields and quality parameters specified by processors/ national regulations to be achieved. On the other hand, cure with respect to antibiotic treatments, is often defined in terms of absence of bacterial pathogens in milk (bacterial cure), with the proportion of cows without detectable pathogen presence following treatment being defined as the bacterial cure rate (BCR). The main problem with using BCR as the main indicator of cure is that it was frequently shown to include a proportion of cows with drastically elevated SCC values (indicative of sub-clinical mastitis) after treatment, but without clinical (sensory) symptoms. 

Tables 12.9-5 and 12.9-6 summarize the results of the three months period when weekly measurements were conducted. The temperature and humidity of the clinic is relative constant at around 23 °C and 80 %, but the bioaerosol level changes by the hour and day-to-day depending on the number of patients and outside air quality. The Prototype Unit was placed in the doctor s consultation room and the airflow was set at normal-speed (Fig. 12.9-12c), allowing a complete exchange of the room s air every 30 minutes. The air sample from the reception and doctor s consultation room were sampled within 20 minutes of each other. The data in the tables show that the airborne microorganisms in the doctor s consultation room remained higher compared to the reception area. However, this is a significant improvement when compared to the level when the Prototype Unit was not in use. Data obtained by measuring the inlet and outlet bioaerosol in the Prototype Unit indicated that 60 % and 67 % reduction in airborne bacteria and fungi was obtained, respectively. The performance was maintained during the six months test.

Supply on a particular patient basis encompasses various categories of unauthorised use of medicinal products. A product maybe imauthor-ised because it has been specially formulated for use it may be at the clinical trial stage of development, but be requested by doctors for use outside a trial it may have been authorised previously and then withdrawn from the market for commercial reasons, or because of safety, efficacy or quality concerns or it may be authorised currently, but for a different indication or patient population, or in a different country. 

If the size of the literature is a reliable indicator, the analysis of compo-uents fotmd In nvironmfntnl samples has not been developed t the same extent as clinical applications of re versed-phase chromatography. More attention has been paid to the analysis of volatile species by gas phase chromatography. This is due in part to the difficulty in identifying large molecular weight complex molecules which are present in water at trace levels. However, determination of a variety of analytes in water, soil, or other matrices has been reported and the wider use of RPC in the evaluation of water quality especially can be expected. The apolar phases used in RPC may be a boon in the determination of dilute analytes. Frei (4M) has discussed how relatively unpolar compounds dissolved in water can be concentrated at the top of a reversed-phase column and then eluted as a narrow band with an appropriate solvent. This technique can be used for the analysis of environmental samples in which the analyte of interest is in exceedingly low concentration. 

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