Quality assessment (QA) of magnetic resonance imaging (MRI) encompasses several factors such as noise, contrast, homogeneity, and imaging artifacts. Quality evaluation is often not standardized and relies on the expertise, and vigilance of the personnel, posing limitations especially with large datasets. Machine learning based on convolutional neural networks (CNNs) is a promising approach to address these challenges by performing automated inspection of MR images. In this study, a CNN for the detection of random head motion artifacts (RHM) in T1-weighted MRI as one aspect of image quality is proposed. A two-step approach aimed to first identify images exhibiting pronounced motion artifacts, and second to evaluate the feasibility of a more detailed three-class classification. The utilized dataset consisted of 420 T1-weighted whole-brain image volumes with isotropic resolution. Human experts assigned each volume to one of three classes of artifact prominence. Results demonstrate an accuracy of 95% for the identification of images with pronounced artifact load. The addition of an intermediate class retained an accuracy of 76%. The findings highlight the potential of CNN-based approaches to increase the efficiency of post-hoc QAs in large datasets by flagging images with potentially relevant artifact loads for closer inspection.

OBJECTIVE: Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis, and its management should be grounded in well-developed clinical practice guidelines (CPG). Thus, we critically assess the methodological quality of the available CPG for pharmacological treatments for PAH.
METHODS: A systematic review (CRD42023387168) was performed in PubMed, Cochrane, Embase, and Tripdatabase (Jan-2023). Eligible records were appraised by four reviewers using the Appraisal of Guidelines, Research, and Evaluation Collaboration tool (AGREE II) and the complementary tool for assessing recommendations\' quality and certainty, AGREE REX. Descriptive statistics were used to summarize the data.
RESULTS: Overall, 31 guidelines, mainly authored by professional societies (90%), targeting only physicians as primary users (84%), were identified. Guidelines presented a moderate overall quality (scores of 63% and 51% in AGREE II and AGREE REX, respectively), with a few domains showing slight improvements over the years. AGREE II \"Scope and Purpose\" (94%) and \"Presentation Clarity\" (99%) domains obtained the highest scores. The items related to \"Stakeholder involvement,\" \"Editorial independence,\" and \"Clinical applicability\" (AGREE REX) were fairly reported. Conversely, CPG lacks rigor in development (32% score, AGREE II), scarcely discusses the role of stakeholders, and provides deficient data on the implementation of recommendations (scores of 35% and 46% in AGREE II and AGREE REX, respectively). No differences in the quality of guidelines published by different developers or countries were observed (p > 0.05).
CONCLUSIONS: Methodological weaknesses are common among guidelines addressing PAH treatment, especially regarding scientific rigor, stakeholders\' values and preferences, and facilitators and barriers to implementability. Particular attention should be given to developing future guidelines.

BACKGROUND: The increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency.
OBJECTIVE: 1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system\'s technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management.
METHODS: A computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL\'s procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient\'s data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients\' Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured.
RESULTS: QA scores from the geriatric nurse, with and without system\'s support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system\'s assistance, highlighting the system\'s efficiency potential in clinical practice.
CONCLUSIONS: The QA system based on QATP, produces scores consistent with an experienced nurse\'s assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.

暂无摘要。

OBJECTIVE: To assess the quality of hydroxychloroquine (HCQ)-induced retinopathy screening at a Canadian tertiary center, we concentrate on risk factor documentation within the electronic health record, in accordance with the 2016 AAO guidelines.
METHODS: We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l\'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions.
RESULTS: Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women\'s charts, tamoxifen use wasn\'t documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%.
CONCLUSIONS: Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.

Long-range sequencing grants insight into additional genetic information beyond that which can be accessed by both short reads and modern long-read technology. Several new sequencing technologies are available for long-range datasets such as \"Hi-C\" and \"Linked Reads\" with high-throughput and high-resolution genome analysis, and are rapidly advancing the field of genome assembly, genome scaffolding, and more comprehensive variant identification. In this article, we focused on five major long-range sequencing technologies: high-throughput chromosome conformation capture (Hi-C), 10x Genomics Linked Reads, haplotagging, transposase enzyme linked long-read sequencing (TELL-seq), and single tube long fragment read (stLFR). We detailed the mechanisms and data products of the five platforms, introduced several of the most important applications, evaluated the quality of sequencing data from different platforms, and discussed the currently available bioinformatics tools. We hope this work will benefit the selection of appropriate long-range technology for specific biological studies.

UNASSIGNED: Integrated nature-based interventions in healthcare facilities are gaining importance as promising health and biodiversity promotion strategies. This type of interventions combines the restoration of biodiversity in the vicinity of the healthcare facility with guiding patients in that natural environment for health outcomes. However, quality appraisal of these interventions is still poorly developed. Based on a recent scoping review, the authors developed a preliminary quality framework in support of healthcare facilities designing, implementing and evaluating integrated nature-based interventions. This present study aims to fine-tune the practical relevance of the quality framework within the emerging practice.
UNASSIGNED: A qualitative interview study was conducted in seven healthcare facilities in Belgium. Using a combination of snowball and purposive sampling, 22 professionals, involved in the integrated nature-based intervention in their facility, participated in the study. The semi-structured interviews were transcribed and imported into NVivo. A deductive and inductive thematic analysis was used to explore the practical relevance of the quality framework. A stakeholders\' assembly review and a member checking of the findings were also part of the study.
UNASSIGNED: Twenty-two interviews with nature management coordinators, healthcare professionals, and healthcare managers were conducted by three principal investigators in seven healthcare facilities implementing integrated nature-based interventions. The contextualization and complexity of integrated nature-based interventions in the participating healthcare facilities demonstrated the need for an evidence-based quality framework describing nature-based interventions. The study led to nine quality criteria, confirming the eight quality criteria derived from a previous scoping review, and the identification of a new quality criterion \'Capacity building, leverage and continuity\'. These quality criteria have been refined. Finally, a proposal for a quality framework was developed and operationalized in a checklist. Deployment of the quality framework should be embedded in a continuous cyclical, adaptive process of monitoring and adjusting based on evaluations at each phase of an integrated nature-based intervention.
UNASSIGNED: Bridging the domains of healthcare and nature management in the context of an integrated nature-based intervention in a healthcare facility requires a transdisciplinary approach. Scientific frameworks such as \"complex interventions,\" Planetary Health and One Health can support the co-design, implementation and evaluation of integrated nature-based interventions within a cyclical, adaptive process. In addition, the importance of the quality of the interactions with nature could gain from more sophisticated attention. Finally, the implications for healthcare facilities, policymakers and education are discussed, as well as the strengths and limitations of the study.

A nationwide survey of inorganic components of tap water all over Japan was conducted from 2019 to 2024. In this survey, 1564 tap water samples were collected, and an additional 194 tap water samples were collected from 33 other countries. The water samples were analyzed for 27 dissolved inorganic components, with a primary focus on the distribution of major and trace components, including Ca, Mg, K, Na, Cl-, NO3-, SO42-, total-hardness, Al, Fe, Cu, Mn, and Zn. The Japanese tap water hardness was 50.5 ± 30.2 (± 1σ SD) mg/L, classified as soft water according to the World Health Organization (WHO) classification. The average content of each major component in Japanese tap water tended to be lower than those in other countries. Furthermore, Piper trilinear diagrams were used to categorize Japanese tap water types. The dominating water types were the Ca-HCO3 and mixed types, which had a nationwide distribution. Japanese tap water generally complied with Japanese and WHO drinking water criteria, with only 1% (17/1564 sites) of the samples exceeding water quality standards. Observations of water quality changes for 2 years at three household faucets revealed that fluctuations in major components and trace metals (Al, Fe, Cu, Mn, and Zn) varied in different patterns. This suggests that the behavior of trace metal elements is influenced by local infrastructure, such as supply pipes, distinct from the variability in source water quality.

In April 2020, the Aboriginal and Torres Strait Islander COVID-19 Point-of-Care (POC) Testing Program was initiated to improve access to rapid molecular-based SARS-CoV-2 detection in First Nations communities. At capacity, the program reached 105 health services across Australia. An external review estimated the program contributed to averting between 23,000 and 122,000 COVID-19 infections within 40 days of the first infection in a remote community, equating to cost savings of between AU$337 million and AU$1.8 billion. Essential to the quality management of this program, a customised External Quality Assessment (EQA) program was developed with the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP). From July 2020 to May 2022, SARS-CoV-2 EQA participation ranged from 93 to 100%. Overall concordance of valid EQA results was high (98%), with improved performance following the first survey. These results are consistent with those reported by 12 Australian and 4 New Zealand laboratories for three SARS-CoV-2 RNA EQA surveys in March 2020, demonstrating that SARS-CoV-2 RNA POC testing in primary care settings can be performed to an equivalent laboratory analytical standard. More broadly, this study highlights the value of quality management practices in real-world testing environments and the benefits of ongoing EQA program participation.

UNASSIGNED: Telephone counseling is an important form of support for informal carers of persons with dementia. The quality and benefit of this kind of service have rarely been evaluated in Germany.
UNASSIGNED: We developed a survey to assess the quality of telephone counseling. We conducted an online survey among 201 users of the telephone hotline \"Alzheimer-Telefon\" (Alzheimer\'s telephone service) provided by the German Alzheimer\'s Association after the consultation. The aim of the study was to determine whether this form of telephone support meets certain quality criteria and the callers\' needs.
UNASSIGNED: Of the 201 participants, 80% were female. The mean age of the callers was 51 years. 74% of cases were one-off consultations; 26% of the callers sought advice twice or more often. The most common reasons for calling included behavioral changes (45%) and finding a nursing home (41%). Other family members were significantly (p=0.036) more likely to seek local respite options. Based on the 201 online questionnaires evaluated, most callers were highly satisfied with the counseling services provided by the Alzheimer\'s telephone service. Those seeking advice were particularly satisfied with the appreciative and empathetic communication style of the advisors and their professional competence. This also applies to the accessibility of the telephone. More than three quarters were fully satisfied with the information they received. Almost half of the callers were sure that the advice would help to solve their issue. 14% of people seeking advice were uncertain about how to implement the suggested solutions.A further survey would be worthwhile to determine to what extent the topics of the consultation can be implemented. The feedback from relatives who use the Alzheimer\'s telephone repeatedly could be used for this purpose - the repetition rate is currently 25% and the trend is rising. Results could be interesting for successful counseling and for the development of further support services.
UNASSIGNED: The telephone hotline is a useful component of dementia care in Germany and an important contribution to the National Dementia Strategy.
UNASSIGNED: Zu den Unterstützungsmöglichkeiten für Angehörige von Menschen mit Demenz zählt die telefonische Beratung. Seit 2002 bietet die Deutsche Alzheimer Gesellschaft Selbsthilfe Demenz e.V. mit ihrem Alzheimer-Telefon telefonische Beratung rund um Demenz kostenlos und bundesweit an. Qualität und Nutzen solcher Dienste wurden hierzulande bisher selten untersucht.
UNASSIGNED: Die vorliegende Studie zur kostenlosen Beratung am Alzheimer-Telefon der Deutschen Alzheimer Gesellschaft untersuchte, inwieweit die Beratungsleistung Qualitätskriterien telefonischer Beratungsangebote sowie den Erwartungen und Bedürfnissen der Ratsuchenden entspricht. Hierzu wurde ein Online-Fragenkatalog konzipiert, auf den die Anrufenden im Nachgang an das Beratungsgespräch Zugriff hatten.
UNASSIGNED: Von den 201 Teilnehmer:innen waren 80% weiblich; das Durchschnittsalter der Anrufer lag bei 51 Jahren. Bei 74% der Fälle handelte es sich um einmalige Beratungen, 26% der Anrufer suchten zweimal oder öfter Rat. Zu den häufigsten Gründen für den Anruf gehörten Verhaltensänderungen (45%) und die Suche nach einem Pflegeheim (41%). Andere Familienmitglieder waren signifikant (p=0.036) häufiger auf der Suche nach örtlichen Betreuungsmöglichkeiten. Auf Basis der 201 ausgewerteten Online-Fragebögen ergab sich eine hohe allgemeine Zufriedenheit der überwiegenden Mehrheit der Anrufenden mit den Beratungsgesprächen. Insbesondere mit dem wertschätzenden und empathischen Kommunikationsstil der Berater:innen sowie deren fachlicher Kompetenz waren die Ratsuchenden besonders zufrieden. Dies galt ebenso für die Erreichbarkeit des Telefons. Die Erwartungen der Anrufer:innen an den Anruf waren breit gestreut und reflektierten die vielfältigen Lebensbereiche, die im Rahmen einer Demenz betroffen sein können. Mehr als 75% der Anrufenden waren mit der Qualität der erhaltenen Informationen voll zufrieden. Knapp die Hälfte der Anrufenden waren sich sicher, dass die Beratung zur Lösung ihres Anliegens beitragen würde. 14% der Ratsuchenden war sich jedoch unsicher, inwieweit es ihnen gelingen würde, die besprochenen Lösungswege umzusetzen. Was es zusätzlich braucht, um die in der Beratung besprochenen Entlastungs- und Lösungsvorschläge umzusetzen, wäre eine weitere Erhebung wert. Untersucht werden könnten dafür die Rückmeldungen von Angehörigen, die das Alzheimer-Telefon wiederholt nutzen – die Wiederholungsrate liegt derzeit bei 25%, Tendenz steigend. Dies könnte interessant sein sowohl für die Beratung als auch für die Weiterentwicklung entsprechender Unterstützungsangebote. Verbesserungsmöglichkeiten des Alzheimer-Telefons könnten in dem verstärkten Angebot von Folgegesprächen, einem Fokus auf Angehörige mit besonderem Unterstützungsbedarf (bspw. frühe Diagnose oder nicht verwandte Personen, Personen mit Migrationshintergrund) und der Intensivierung der Zusammenarbeit mit nachgeschalteten Beratungsformen am Wohnort der Anrufenden bestehen.
UNASSIGNED: Die telefonische Beratung ist ein nützlicher Baustein der Demenzversorgung in Deutschland und ein wichtiger Beitrag im Rahmen der Nationalen Demenzstrategie – insbesondere im Hinblick auf den besonderen Bedarf an Information und Beratung von Angehörigen mit einer Demenzerkrankung.