The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts

Structural quality of soils cultivated with coffee and pasture in an environmental protection area

Studies of soils in Environmental Protection Areas (EPAs) are of great importance, because they are an essential component of ecosystems, directly interfering in environmental sustainability. The objective of this study was to evaluate the structural quality of soil cultivated with coffee and used as pasture in the Capituva's River microbasin, which is located in the Environmental Protection Area in Coqueiral, south of the state of Minas Gerais. Uniaxial compression test (preconsolidation test) and soil resistance to penetration were used. Undisturbed samples were taken from the surface layer (0-5 cm) of the soils in the area: a typic dystrophic Red Latosol (LVd - Oxisol), a typic eutrophic Red Argisol (PVe - Ultisol), and a typic dystrophic Haplic Cambisol (CXbd - Inceptisol). A significant linear positive correlation was observed between the results of the preconsolidation test and soil resistance to penetration. Load bearing capacity of soil could be estimated accordingly by means of penetration resistance for LVd, PVe, and CXbd. Cambisol - CXbd showed lower loading support capacity and resistance to penetration than LVd and PVe, due to the better crop management in this soil that resulted in higher physical quality which accounts for higher production and environmental sustainability.

Structural quality of a no-tillage red latosol 50 months after gypsum aplication

Gypsum application may enhance the soil quality for plants in terms of soil chemical and physical properties. The objective of this study was to evaluate the effects of gypsum application on the structural quality of a no-tillage Red Latosol. The experiment was initiated in September 2005 in Guarapuava-PR, with gypsum applications of 0; 4; 8; and 12 Mg ha-1 on the soil surface. In November 2009, two soil blocks were sampled from the 0-0.3 m layer for visual evaluation of the soil structure quality (Sq) and to determine the aggregate-tensile strength (ATS). Soil penetration resistance (PR) and gravimetric moisture (H%) of the 0-0.300 m layer were evaluated, and soil cores were collected (layers 0.000-0.075 and 0.075-0.150 m), to determine soil bulk density (BD), total soil porosity (TP), microporosity (Mi), and macroporosity (Ma). Data were subjected to analysis of regression at 5 %. No significant effects of gypsum application on ATS and H % of aggregates were observed, but for Sq, a quadratic effect (0.000-0.075 m) and linear increase (0.075-0.150 and 0.150-0.300 m) were stated, indicating soil quality decrease, although Sq remained mostly below 3.0, with good to intermediate soil quality. Soil PR increased with gypsum, but also remained below critical levels. No effect was observed for soil H % at the moment of PR determination on the field. The gypsum applications decreased BD in the 0.075-0.150 m layer, and increased PT and Ma, while in 0.000-0.075 m some Ma was converted to Mi, without affecting PT and BD. These last results indicate a gain in soil structural quality by gypsum applications, but the higher scores of soil structure and values of soil penetration resistance, though still below thresholds, should be monitored to prevent limitations to soil use in the future.

Structural quality of polyacrylamide-treated cohesive soils in the coastal tablelands of Pernambuco

Water-soluble polymers are characterized as effective flocculating agents due to their molecular features. Their application to soils with horizons with structural problems, e.g, a cohesive character, contributes to improvements in the physical quality and thus to the agricultural suitability of such soils. The purpose of this study was to evaluate the structural quality of soils with cohesive horizons of coastal tablelands in the State of Pernambuco treated with polyacrylamide (PAM) as chemical soil conditioner. To this end, three horizons (one cohesive and two non-cohesive) of a Yellow Argisol (Ultisol) were evaluated and to compare cohesive horizons, the horizon of a Yellow Latosol (Oxisol) was selected. The treatments consisted of aqueous PAM solutions (12.5; 50.0; 100.0 mg kg-1) and distilled water (control). The structural aspects of the horizons were evaluated by the stability (soil mass retained in five diameter classes), aggregate distribution per size class (mean weight diameter- MWD, geometric mean diameter - GMD) and the magnitude of the changes introduced by PAM by measuring the sensitivity index (Si). Aqueous PAM solutions increased aggregate stability in the largest evaluated diameter class of the cohesive and non-cohesive horizons, resulting in higher MWD and GMD, with highest efficiency of the 100 mg kg-1 solution. The cohesive horizon Bt1 in the Ultisol was most sensitive to the action of PAM, where highest Si values were found, but the structural quality of the BA horizon of the Oxisol was better in terms of stability and aggregate size distribution.

JOB SATISFACTION: A QUALITY INDICATOR IN NURSING HUMAN RESOURCE MANAGEMENT

This descriptive study addresses the job satisfaction of nurse managers and clinical nurses working at the Hematology and Hemotherapy Services of a public hospital in Sao Paulo. The study objectives were to identify the factors that caused job satisfaction among nurse managers and clinical nurses, and support the results in the development of indicators to evaluate the quality of nursing human resource management. The components of the study were: autonomy, interaction, professional status, job requirements, organizational norms and remuneration. Participants were 44 nurses. Data were collected using a Job Satisfaction Index (JSI) questionnaire. In conclusion, this study permitted the identification of the clinical nurse group, which was the most satisfied, with a JSI of 10.5; the managerial group scored 10.0. Regarding the satisfaction levels in regards to the current activity, 88.9% of the nurse managers reported feeling satisfied, as did 90.9% of clinical nurses. For both groups, autonomy was the component with the highest level of professional satisfaction.

UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

Obstruction and infiltration: a proposal of a quality indicator.

Background The quest for continuous improvement of the quality of provided care is the objective of nursing care. However, the insertion and permanence of a peripheral venous catheter has been associated to complications, thus making a systematic evaluation of the performance of professionals and the management of health services important. Objective: Analyse complications that caused removal of intravenous catheters. Methods A prospective study with 64 patients of a health service of Portugal, from July to September/2015. Included patients with age 18 years, with a peripheral venous catheter. Descriptive analysis using SPSS. Ethical requirements were met. Results Two hundred three (203) intravenous catheters, in 64 patients, most elderly (section 95.3 %), with mean age of 80 years were evaluated. The catheters remained inserted between one and 12 days (mean 2 days), 66 % of the devices were removed because of complications, such as: removal by the patient (17.7 %), obstruction (17.2 %), infiltration (14.8 %), phlebitis (9.4 %) and fluid exiting the insertion site (6.4 %). The prevalence of obstruction and infiltration per patient was respectively 36 % and 39 %. Conclusions Obstruction and infiltration were the complications of higher prevalence that led to the removal and reinsertion of a new peripheral venous catheter with the possibility of increased pain, infection and hospital costs. Faced with the risk of compromising patient safety and being able to contribute to the improvement of health care, we suggest the inclusion of obstruction and infiltration in the indicators of quality of care, in order to have systematic evaluation of results, (re)plan and implement preventive measures.

Impacts of different management systems on the physical quality of an Amazonian Oxisol

The physical quality of Amazonian soils is relatively unexplored, due to the unique characteristics of these soils. The index of soil physical quality is a widely accepted measure of the structural quality of soils and has been used to specify the structural quality of some tropical soils, as for example of the Cerrado ecoregion of Brazil. The research objective was to evaluate the physical quality index of an Amazonian dystrophic Oxisol under different management systems. Soils under five managements were sampled in Paragominas, State of Pará: 1) a 20-year-old second-growth forest (Forest); 2) Brachiaria sp pasture; 3) four years of no-tillage (NT4.); 4) eight years of no-tillage (NT8); and 5) two years of conventional tillage (CT2). The soil samples were evaluated for bulk density, macro and microporosity and for soil water retention. The physical quality index of the samples was calculated and the resulting value correlated with soil organic matter, bulk density and porosity. The surface layers of all systems were more compacted than those of the forest. The physical quality of the soil was best represented by the relations of the S index to bulk density and soil organic matter.

Effect of cropping systems in no-till farming on the quality of a Brazilian Oxisol

The no-till system with complex cropping sequences may improve the structural quality and carbon (C) sequestration in soils of the tropics. Thus, the objective of this study was to evaluate the effects of cropping sequences after eight years under the no-till system on the physical properties and C sequestration in an Oxisol in the municipality of Jaboticabal, Sao Paulo, Brazil. A randomized split-block design with three replications was used. The treatments were combinations of three summer cropping sequences - corn/corn (Zea mays L.) (CC), soybean/soybean (Glycine max L. Merryll) (SS), and soybean-corn (SC); and seven winter crops - corn, sunflower (Helianthus annuus L.), oilseed radish (Raphanus sativus L.), pearl millet (Pennisetum americanum (L.) Leeke), pigeon pea (Cajanus cajan (L.) Millsp), grain sorghum (Sorghum bicolor (L.) Moench), and sunn hemp (Crotalaria juncea L.). Soil samples were taken at the 0-10 cm depth after eight years of experimentation. Soil under SC and CC had higher mean weight diameter (3.63 and 3.55 mm, respectively) and geometric mean diameter (3.55 and 2.92 mm) of the aggregates compared to soil under SS (3.18 and 2.46 mm). The CC resulted in the highest soil organic C content (17.07 g kg-1), soil C stock (15.70 Mg ha-1), and rate of C sequestration (0.70 Mg ha-1 yr-1) among the summer crops. Among the winter crops, soil under pigeon pea had the highest total porosity (0.50 m³ m-3), and that under sunn hemp had the highest water stable aggregates (93.74 %). In addition, sunn hemp did not differ from grain sorghum and contained the highest soil organic C content (16.82 g kg-1) and also had the highest rate of C sequestration (0.67 Mg ha-1 yr-1). The soil resistance to penetration was the lower limit of the least limiting water range, while the upper limit was air-filled porosity for soil bulk densities higher than 1.39 kg dm-3 for all cropping sequences. Within the SC sequence, soil under corn and pigeon pea increased least limiting water range by formation of biopores because soil resistance to penetration decreased with the increase in soil bulk density.

Cohesion Metrics for Improving Software Quality

Abstract Software product metrics aim at measuring the quality of software. Modu- larity is an essential factor in software quality. In this work, metrics related to modularity and especially cohesion of the modules, are considered. The existing metrics are evaluated, and several new alternatives are proposed. The idea of cohesion of modules is that a module or a class should consist of related parts. The closely related principle of coupling says that the relationships between modules should be minimized. First, internal cohesion metrics are considered. The relations that are internal to classes are shown to be useless for quality measurement. Second, we consider external relationships for cohesion. A detailed analysis using design patterns and refactorings confirms that external cohesion is a better quality indicator than internal. Third, motivated by the successes (and problems) of external cohesion metrics, another kind of metric is proposed that represents the quality of modularity of software. This metric can be applied to refactorings related to classes, resulting in a refactoring suggestion system. To describe the metrics formally, a notation for programs is developed. Because of the recursive nature of programming languages, the properties of programs are most compactly represented using grammars and formal lan- guages. Also the tools that were used for metrics calculation are described.

Effect of cropping systems in no-till farming on the quality of a Brazilian Oxisol

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influence of the sputtering flow regime on the structural properties and magnetic behavior of Fe-Ga thin films (Ga ∼ 30 at.%)

In this paper we analyze the structure of Fe-Ga layers with a Ga content of ∼30 at.% deposited by the sputtering technique under two different regimes. We also studied the correlation between the structure and magnetic behavior of the samples. Keeping the Ar pressure fixed, we modified the flow regime from ballistic to diffusive by increasing the distance between the target and the substrate. X-ray diffraction measurements have shown a lower structural quality when growing in the diffusive flow. We investigated the impact of the growth regime by means of x-ray absorption fine structure (XAFS) measurements and obtained signs of its influence on the local atomic order. Full multiple scattering and finite difference calculations based on XAFS measurements point to a more relevant presence of a disordered A2 phase and of orthorhombic Ga clusters on the Fe-Ga alloy deposited under a diffusive regime; however, in the ballistic sample, a higher presence of D0_3/B2 phases is evidenced. Structural characteristics, from local to long range, seem to determine the magnetic behavior of the layers. Whereas a clear in-plane magnetic anisotropy is observed in the film deposited under ballistic flow, the diffusive sample is magnetically isotropic. Therefore, our experimental results provide evidence of a correlation between flow regime and structural properties and its impact on the magnetic behavior of a rather unexplored compositional region of Fe-Ga compounds.

Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.