The applicability of Papanicolaou Society of Cytopathology system on reporting endoscopic ultrasound-guided fine needle aspiration cytology specimens of pancreatic lesions in situations with limited availability of ancillary tests. Experience at a single laboratory.

INTRODUCTION: The Papanicolaou Society of Cytopathology (PSC) system of reporting pancreatobiliary cytology is a standardised reporting nomenclature that uses a six-tiered scheme of diagnostic categories utilising routine microscopy and ancillary tests such as biochemical and molecular analysis of cyst fluids and immunochemistry. The objective of this study was to determine the applicability of the PSC system on endoscopic ultrasound-guided fine needle aspiration cytology samples reported at the cytopathology laboratory, Mubarak Al Kabeer Hospital, in Kuwait with special emphasis on situations with limited availability of ancillary tests. METHODS: In total, 132 cases of endoscopic ultrasound-guided fine needle aspiration cytology samples from pancreatic lesions were categorised according to PSC system guidelines after examining the glass slides and reviewing the clinical, imaging and ancillary test findings. These review diagnoses were compared with the diagnoses rendered during initial reporting. Correlation with histopathology reports was done wherever available. RESULTS: In 23 (17.42%) of 132 cases, re-categorisation was necessary between initial and reviewed diagnoses. In 16 cases, re-categorisations were because of non-analogous categories between initial and reviewed diagnosis. In the remaining seven, they were due to identification of newer cytomorphological and imaging findings or because of issues arising from unavailability of sufficient material for ancillary investigations. CONCLUSION: All cases could be categorised using the PSC system with a moderate number of re-categorisations between initial and reviewed diagnoses. In certain circumstances, limited availability of ancillary tests, resulted in non-diagnostic categories whereas in other such circumstances, diagnostic categories could be assigned with certain conceptual modifications to the PSC guidelines.

Towards a common framework for defining ancillary material quality across the development spectrum.

Ancillary materials (AMs) play a critical role in the manufacture of cell and gene therapies, and best practices for their quality management are the subject of ongoing discussion. Given that the final product cannot be sterilized, AM quality becomes increasingly critical to the clinical advancement of cell and gene therapies. Despite a lack of direct legislative direction regarding AM quality, internationally harmonized guidance is available from several industry-standard bodies that describe the principles and application of a risk-based approach to AM qualification and related supply-chain risk management. According to a best-practice risk-based approach, AMs must be adequately qualified to a degree that reflects the level of risk the material presents to patient safety and the drug product's specification. This general approach can be implemented in different ways, and balancing quality with cost of goods is critical to the cost-effective manufacture of advanced therapy medicinal products. In some cases, it may be preferable or necessary to use AMs that are produced in compliance with current Good Manufacturing Practice. However, developers may be able to suppress manufacturing costs without undermining safety or regulatory compliance in the case that a material presents a lower risk profile. Despite a great deal of attention and interest in the quality of AMs in the cell and gene therapy space, there is still a need for greater harmonization to create a shared understanding of what constitutes a risk-based approach to AM production and sourcing. In this article, we propose a staged approach to AM quality that achieves a balance between the competing demands of risk mitigation and cost of goods containment at the various stages of AM quality development. Our novel, heuristic framework for communication among AM suppliers, users and regulators aims to bring down development and manufacturing costs and lessen the workload around regulatory compliance.

The application of hospitality elements in hospitals.

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

Procedimientos técnicos en el tratamiento del dolor / Technical procedures for treating pain

Actualmente las unidades de tratamiento de dolor crónico están constituidas por equipos multidisciplinares de trabajo, donde la acción de cada uno de los profesionales implicados contribuye finalmente al manejo y control del dolor. De todas las actividades desarrolladas con los pacientes atendiendo sus necesidades biopsicosociales implicadas en su experiencia de dolor, en el artículo se exponen, exclusivamente, los procedimientos tecnológicos e invasivos que con más frecuencia se realizan en las unidades de tratamiento de dolor. En este sentido la actividad enfermera tiene una participación activa en los procedimientos que se realizan, fundamentalmente en el hospital de día donde el paciente es tratado de forma ambulatoria(AU)

Nowadays, chronic pain treatment units are comprised by multidisciplinary work teams on which the contribution by each professional involved contributes to the team objective to handle and control pain. Out of all the forms of treatment and action plans developed for patients which deal with all the biological, psychological and social needs related to their experiences with chronic pain, in this article the authors concentrate exclusively on those technological and invasive procedures that are most frequently carried out by medical teams in chronic pain units. In this sense, nurses play an active participatory role in those procedures carried out, mainly in outpatient clinics where a patient is treated as an outpatient and nurses perform clinical services without the need of hospitalization(AU)

Factors for satisfaction among providers of ancillary health services in a community-based cancer prevention program: a pilot study in Nevada.

Providers of ancillary health services are essential members of any health care delivery system. They supply laboratory, radiology, and other diagnostic modalities necessary for quality medical care. Assessment of the providers' factors for satisfaction in participating in cancer prevention programs can contribute to better services and can serve as a model for other community-based health programs. We conducted a pilot survey of providers of ancillary services in the Nevada Women's Health Connection, a community breast and cervical cancer prevention program. Of the 93 participating providers, a total of 44 providers completed the survey. We subjected the survey data to factor analysis using iterative principal axis factoring with Varimax rotation. Three components of satisfaction were identified, comprising satisfaction with the (1) reimbursement process, (2) positive perception of the program, and (3) familiarity with program's requirements. All three components accounted for 72.08% of the total variance before the rotation. Amount of financial gain was not a significant factor for satisfaction among participating providers. Providers of ancillary health services were satisfied in their participation in this community-based cancer prevention program. There were three components of satisfaction identified. Further attention should be given on these issues as they have implications for quality improvement in health services for community-based programs dealing with low income and uninsured patients.

Applying quality management tools to medical photography services: a pilot project.

The Medical Photography Department at Peterborough Hospitals NHS Trust set up a pilot project to reduce the turnaround time of fundus fluorescein angiograms to the Ophthalmology Department. Quality management tools were used to analyse current photographic practices and develop more efficient methods of service delivery. The improved service to the Ophthalmology Department demonstrates the value of quality management in developing medical photography services at Peterborough Hospitals.

[On approaches toward licensing and accreditation of the therapeutic-prophylaxis institutions in the Orlov region and certain results of this service]. / O podkhodakh k litsenzirovaniiu i akkreditatsii lechebno-profilakticheskikh uchrezhdenii v Orlovskoi oblasti i nekotorykh rezul'tatakh raboty étoi sluzhby.

A method of the experts' evaluation of the medical care quality in licensing and accrediting the therapeutic-and-prophylaxis institutions (TPI) in the Orel Region is presented; the dynamics of experts evaluations of the material-and-technical outfit and of the personnel potential in the region's during 1993-2002 is described. The influence (produced on promoting the medical care quality) of the structural-and-organizational standards used in licensing and accrediting the TPIs in the Orel Region is analyzed. A comparative analysis of dynamics of the medical care quality by region's TPIs (including district, city and region TPIs) is made for the period of 1993-2002 on the basis of experts' evaluations.

Ancillary services in the health care industry: is Six Sigma reasonable?

Within the naval medical center construct, the disparate disciplines encompassed within ancillary services lend themselves to formal quality analysis and process improvement. This analysis uses the Six Sigma approach. Error rates were investigated and calculated for various processes within ancillary services at Naval Medical Center, San Diego. These were translated into the common metric of defects per million opportunities (DPMO). DPMO rates vary between 21.5 and 420,000. These correspond to Sigma values from 1.7 to approaching 6. Rates vary with biological complexity of the system and the degree of automation available. Some ancillary services translate well into a Six Sigma schema. Systems with high potential patient risk if performed poorly and those amenable to second checking and computer oversight may be candidates for such optimization. This should be undertaken in a local environment conducive to individual error reporting, and in a corporate environment with the will and funding to support the transition.

Análisis de la calidad de la petición de estudios de radiodiagnóstico / Radiodiagnostic request quality analysis

El objetivo de este trabajo es analizar la cumplimentación de las peticiones de estudios solicitados al Servicio de Radiodiagnóstico en dos hospitales de tercer nivel. De esta forma se valorará uno de los aspectos que tienen importancia en la calidad asistencial hospitalaria al facilitar la coordinación entre niveles asistenciales, aportar orientación diagnóstica y evitar errores administrativos con repercusiones asistenciales negativas (AU)

Association between ancillary services and clinical and behavioral outcomes among HIV-infected women.

The purpose of this study was to evaluate the association between ancillary services, including case management, and clinical and behavioral outcomes for human immunodeficiency virus (HIV)-infected women. Data were obtained from databases systematically maintained by Family Advocacy, Care and Education Services (FACES) and the HIV Outpatient Program (HOP) in New Orleans. HIV-infected women receiving primary care from HOP and ancillary services from FACES between January 1, 1997 and December 31, 1998 were eligible. Data were analyzed using generalized estimating equations (GEE) with STATA software. The majority of women included in the study were African American (86.7%), infected heterosexually (78.8%), and had absolute CD4 counts greater than 200 (58.6%). After adjusting for age, time, entry time into HOP, pregnancy, CD4 count, substance abuse status, and social and clinical stressors, receipt of more than four combined case manager contacts or ancillary services per month was significantly associated with being prescribed a protease inhibitor, improved adherence and retention in primary care, and enrolling on a research protocol. Receiving more than one transportation service per month was significantly associated with improved adherence, improved retention, one or more emergency room visits per month, and one or more hospitalizations per month. Receiving more than one contact with case managers per month was associated with improved retention in primary care. Findings suggest that receipt of case management and ancillary services is associated with improvements in multiple outcomes for HIV-infected women. A client-centered approach to providing ancillary services appears to be effective in improving behavioral and utilization characteristics in this population of low-income, high-risk women.

Using the business excellence model to effectively manage change within clinical support services.

This article describes the journey of managing the change from seven separate health providing units to one overall team providing a range of services. To facilitate the change the Malcolm Baldrige National Quality Award self-assessment model was used. The benefits and limitations of the model are described as are the activities undertaken to achieve a goal of delivering quality care within a customer driven rather than service driven focus. Finally the learning gained from the change is shared in an attempt to help others undertaking a similar journey.

Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service.

BACKGROUND AND OBJECTIVES: Limited information is available on the level of satisfaction of clinicians with services delivered by blood banks. The purpose of this study was to evaluate the satisfaction of clinicians with our blood transfusion service. MATERIALS AND METHODS: We prepared a questionnaire based on SERVQUAL, a method used to measure customers' appreciation of quality of service, by assessing the gap between perceived and expected quality. The questionnaire consisted of 14 items grouped according to five dimensions of quality of service: assurance, empathy, responsiveness, reliability, tangibles. Clinicians were asked to give two scores on a scale from 1 to 7 for each item, score (e) representing what they expected from an 'excellent' service, score (r) how they graded the service received. We considered wide differences in scores of service expectation and receipt for a question to be indicative of either service above expected levels (r > e) or service below expectation (r < e); similar scores for both expected and received service (within 1 point on the grading scale) were taken to indicate that the service received was that which was expected. RESULTS: A total of 184 questionnaires (49%) were returned. For the 14 items considered, the proportion of clinicians expressing levels of satisfaction similar to or above expectation ranged from 67 to 96%. Three critical areas, which clinicians considered important (expectation scores 6-7) were associated with satisfaction below expectation in more than 20% of responders. They were: clarity of procedures, clarity of blood request forms, and convenience of blood request and issuing times, which were rated as important by 77, 80 and 72% of clinicians, respectively. CONCLUSION: SERVQUAL was useful to gather information on the level of clinicians' satisfaction with our transfusion service.

Using partner hospitals in collaborative benchmarking..

In May 1994 the Physiotherapy Department at John Hunter Hospital received a Commonwealth Best Practice in the Health Sector grant to design a critical pathway for the treatment of stroke. The implementation of the pathway at John Hunter Hospital and the introduction of the methodology to secondary sites (The Alfred Healthcare Group, Melbourne, and Royal Hobart & Repatriation General Hospitals, Hobart) resulted in the development of a Benchmarking Consortium. This paper will discuss the importance of benchmarking in understanding clinical processes, and the methodology employed to ensure that meaningful benchmarks were achieved.

The development of a massage service for cancer patients.

Despite major technological advances in the treatment of cancer, many patients are dissatisfied with conventional biomedical interventions. This is largely because they fail to resolve long term intractable problems such as chronic pain or stress. More emphasis is now being placed on quality of life. This shift in attitude has opened the door for complementary therapies as adjuvants to traditional models of cancer care. Changes within the NHS have facilitated this transition, by the creation of the 'internal market' and the development of central funding to individual clinical directorates. To exploit these opportunities, complementary, therapists must develop new skills and be prepared to adopt NHS standards of assessment to evaluate the efficacy of their work. Standards are a component of 'Quality assurance'. They are observable, achievable and measurable, and contribute towards an acceptable evaluation process. Standards are used by health care purchasers to assess which therapies should be made available to patients within the NHS. This paper describes the development of a massage service that has been integrated into the Hammersmith Oncology Department. The massage standard is seen to be fundamental and essential to the continued development and evaluation of the project.

Multidisciplinary approach used to improve infant care.

Many of the implemented changes have required the rewriting of standards of care and policies, as well as the education of staff. Staff education was addressed through a variety of approaches, including one-hour inservice training sessions and eight-hour courses. In the final analysis, the multidisciplinary QA committee has had a significant impact on improving the processes involved in caring for infants with RDS. Because of this success, committee members have acknowledged that all aspects of patient care may be examined and changes implemented when caregivers keep an open mind and are willing to change the way "things have always been done." This commitment to examine all aspects of care and to implement change has been, for Presbyterian Hospital, the key to genuine quality improvement. As a result of these and other efforts, Presbyterian Hospital has improved the care given to all of its patients. In March 1992, the hospital received accreditation with commendation.