Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

Water quality and zooplankton in tanks with larvae of Brycon Orbignyanus (Valenciennes, 1949)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Topographical characteristics and evaluating water quality in watershed management

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Carcass and cut yields and meat qualitative traits of broilers fed diets containing probiotics and prebiotics

This study evaluated the use of different probiotics, prebiotics and symbiotics on the quality of carcasses and meat of broiler chickens. One hundred and eight day-old Cobb male broilers were used (n=108) in a completely randomized design according to a 3x3 factorial, with 3 probiotics in the diet (no probiotics, probiotics 1, probiotics 2) and 3 prebiotics in the diet (no prebiotics, prebiotics 1, prebiotics 2). There were nine treatments with 4 replicates and 3 birds per replicate. The results showed that the carcass and cut yields, color (L* - lightness, a* - redness, and b* - yellowness), pH, cooking losses, shearing force and sensory analysis were not affected by the use of different growth promoters at 42 days of age. It was concluded that growth promoters supplemented to the diet did not affect the studied quantitative and qualitative parameters of the carcass and breast meat of broiler chickens.

Effects of energy and protein levels on egg quality and performance of laying hens at early second production cycle

One hundred sixty-two commercial 70-wk-old ISA Brown laying hens, previously subjected to induced molting by feed restriction, were distributed in a completely randomized design with 3 x 3 factorial arrangement (i.e., 3 metabolizable energy levels: 2,850; 2,950, and 3,050 kcal of ME/kg) and 3 protein levels (16, 18, and 20% CP), which totaled 9 treatments with 3 replicates of 6 birds each. Experimental diets were offered to birds after the feed restriction period. Performance and egg quality parameters were evaluated in 14-d intervals from the 4th to 12th weeks after forced molting for a total of 4 evaluation periods. Increases in dietary energy and protein levels did not improve performance or egg quality. The levels of 2,850 kcal of ME and 16% protein were sufficient for laying hens starting the second production cycle without decreasing their performance or egg quality.

Effect of supplementation of diets for quails with vitamins A, D and E on performance of the birds and quality and enrichment of eggs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Quality parameters of the tibiae and femora of ostriches

An experiment was carried out to establish mean bone quality values of the tibiae and femora of ostriches and to evaluate these bones. The right leg bones of 10 males and 10 female African Black ostriches were evaluated. Birds were radiographed immediately after slaughter (during bleeding), with the aid of a portable X-ray apparatus. The obtained radiographs were scanned and bone mineral density means were obtained using software. Bone strength, Seedor index, and dry matter percentage were evaluated and correlated to weight gain during the finishing period (3-13 months of age). Mean values of the evaluated bone quality traits, not previously found in literature, were established. There were no significant differences between males and females in performance or bone quality parameters. It was concluded that male and female ostriches present similar performance and bone quality at slaughter age.

Ground annatto seeds (Bixa orellana L.) in sorghum-based commercial layer diets and their effects on performance, egg quality, and yolk pigmentation

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efficiency of prebiotics and probiotics on the performance, yield, meat quality and presence of Salmonella spp in carcasses of free-range broiler chickens

Two trials were carried out in the present study. Trial I evaluated the performance, carcass yield and breast meat quality, whereas Trial II evaluated the efficacy of utilizing prebiotics + probiotics on the control of Salmonella spp incidence in the carcasses of free-range broilers. In Trial I, 688 one-day-old male chicks of the Naked Neck Label Rouge strain were used, distributed in a randomized block design arranged according to a 2 x 2 factorial: control diet or diet supplemented with probiotics and prebiotics; and two rearing systems (confined or with access to paddocks - 3m²/bird), using four replicates with 35 birds each. The birds were reared until 84 days of age following the recommendations of management and nutrition for free-range strains, and had access to paddocks after 35 days of age. Water and food were given inside the experimental poultry house. Birds fed probiotics and prebiotics in the diet and the confined birds showed better performance, carcass yield and meat quality compared to the birds of the other treatments. In Trial II, 128 one-day-old male chicks of the free-range Naked Neck Label Rouge strain were used. The birds were distributed into four treatments: NCC (non-challenged control), NCS (non-challenged supplemented), CC (challenged control) and CS (challenged supplemented). There were no significant effects of adding probiotics and prebiotics in the diet in regard to Salmonella enteritidis recovery from the carcasses.

Factors affecting fertilisation and early embryo quality in single- and superovulated dairy cattle

Data on fertilisation and embryo quality in dairy cattle are presented and the main factors responsible for the low fertility of single-ovulating lactating cows and embryo yield in superovulated dairy cattle are highlighted. During the past 50 years, the fertility in high-producing lactating dairy cattle has decreased as milk production increased. Recent data show conception rates to first service to be approximately 32% in lactating cows, whereas in heifers it has remained above 50%. Fertilisation does not seem to be the principal factor responsible for the low fertility in single-ovulating cows, because it has remained above 80%. Conversely, early embryonic development is impaired in high-producing dairy cows, as observed by most embryonic losses occurring during the first week after fertilisation. However, in superovulated dairy cattle, although fertilisation failure is more pronounced, averaging approximately 45%, the percentage of fertilised embryos viable at 1 week is quite high (>70%). Among the multifactorial causes of low fertility in lactating dairy cows, high feed intake associated with low concentrations of circulating steroids may contribute substantially to reduced embryo quality. Fertilisation failure in superovulated cattle may be a consequence of inappropriate gamete transport due to hormonal imbalances.

Impact of proximal cytoplasmic droplets on quality traits and in-vitro embryo production efficiency of cryopreserved bull spermatozoa

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Quality of life and stimulus perception in patients' rehabilitated with complete denture

The objective of this study was to evaluate and correlate quality of life (QoL), and stimulus perception of complete denture users, before and after the insertion of new prostheses. We selected 60 patients using bimaxillary complete conventional dentures who needed to replace their prostheses. During anamnesis, we collected demographic data and applied the Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT) questionnaire and stimulus perception questionnaire (PERCEPTION). Before installation of new prostheses, the patients responded to OHIP-EDENT questionnaire, and on the day of installation, they responded to PERCEPTION questionnaire. At the patients 3-month follow-up, we re-administered the OHIP-EDENT and PERCEPTION questionnaires. The Wilcoxon and MacNemar tests were used to compare patient responses between the time points analysed. Most of the OHIP-EDENT items showed a highly significant impact of the new prostheses on oral health (P = 0.003). The PERCEPTION questionnaire data indicated that the patients experienced significant improvements (P < 0.05) in terms of their sensations with the new prostheses. Cross-lagged data analysis did not show any causality between the OHIP-EDENT and PERCEPTION questionnaires (ZPF test, P = 0.772). We concluded that the treatment was effective with respect to the patients QoL and their adaptation to the new prostheses.

Sensory acceptability of raw and extruded bovine rumen protein in processed meat products

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Calcium in pre-laying and laying rations on the performance and quality of laying hens' eggshell

O ensaio experimental objetivou avaliação do efeito de diferentes níveis de cálcio (Ca) nas rações de pré-postura e postura sobre o desempenho e qualidade dos ovos de poedeiras comerciais. Foram alojadas 256 frangas da linhagem Hisex Brown com 16 semanas de idade em galpão convencional de postura. O delineamento experimental foi inteiramente casualizado em arranjo fatorial 4 x 2 (4 níveis de cálcio - 0,8; 1,3; 1,8 e 2,3% na pré-postura e 2 níveis de cálcio - 2,5 e 3,5% na postura), totalizando oito tratamentos com quatro repetições de oito aves por unidade experimental. Iniciou-se com a ração de pré-postura às 16 semanas de idade das aves, sendo que a mesma foi fornecida até as aves atingiram 18 semanas de idade, quando então, iniciou-se com a ração de postura. Foram avaliadas durante quatro ciclos de 28 dias as seguintes variáveis: produção e peso dos ovos, consumo de ração, conversão alimentar, massa de ovos e qualidade da casca dos ovos. Através dos resultados obtidos pode-se concluir que um bom desempenho foi obtido com 0,8% de cálcio na fase de pré-postura. Na fase de postura o nível de 3,5% de cálcio promoveu maior peso de ovo e melhor qualidade de casca.

Plant spacing and pollen quantity on yield and quality of squash seeds

O rendimento e a qualidade de sementes de abóbora podem ser aprimorados por uma densidade populacional de plantas adequada, além da quantidade de pólen, que influi na qualidade da polinização e fertilização. Para este estudo, aplicaram-se nove tratamentos, que resultaram da combinação fatorial de três espaçamentos entre plantas (0,8 x 0,3; 0,8 x 0,6 e 0,8 x 0,9 m) com duas quantidades de pólen (50% de uma antera e uma antera inteira) e a polinização natural por insetos. Foram avaliados parâmetros de produção de frutos e sementes, além da qualidade física e fisiológica das sementes. O delineamento experimental adotado foi em blocos ao acaso com cinco repetições e dez plantas úteis por amostragem. O aumento do espaçamento entre plantas elevou o número médio de frutos maduros e a produção de sementes por planta. A produtividade de sementes foi diretamente proporcional à quantidade de pólen usada durante a polinização. Já o fator espaçamento entre plantas não afetou a produção de sementes por área. A maior quantidade de pólen resultou em uma maior produção de sementes por planta e por área. A polinização manual, com a utilização de uma antera inteira, não diferiu da polinização natural com insetos, tanto para rendimento como para a qualidade de sementes.