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Concept: W. Edwards Deming


The successful establishment of agricultural crops depends on sowing quality, machinery performance, soil type and conditions, among other factors. This study evaluates the operational quality of mechanized peanut sowing in three soil types (sand, silt, and clay) with variable moisture contents. The experiment was conducted in three locations in the state of São Paulo, Brazil. The track-sampling scheme was used for 80 sampling locations of each soil type. Descriptive statistics and statistical process control (SPC) were used to evaluate the quality indicators of mechanized peanut sowing. The variables had normal distributions and were stable from the viewpoint of SPC. The best performance for peanut sowing density, normal spacing, and the initial seedling growing stand was found for clayey soil followed by sandy soil and then silty soil. Sandy or clayey soils displayed similar results regarding sowing depth, which was deeper than in the silty soil. Overall, the texture and the moisture of clayey soil provided the best operational performance for mechanized peanut sowing.

Concepts: Soil, Erosion, Silt, Sand, Clay, Loess, Statistical process control, W. Edwards Deming


Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist’s criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other ‘inventory of actions’ (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.

Concepts: Health care, Psychology, Medicine, Systematic review, Definition, Operational definition, Operationalization, W. Edwards Deming


Hand hygiene is an important element of the WHO multimodal strategy for healthcare-associated infection control, whereas compliance of hand hygiene among healthcare workers (HCWs) remains a challenge to sustain. In order to increase the hand hygiene compliance of HCWs, a quality control circle (QCC) program was carried out in our hospital, and the plan-do-check-act (PDCA) method was applied for 12 months.

Concepts: Scientific method, Quality control, Management, Hygiene, Medical hygiene, W. Edwards Deming


The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders.

Concepts: Patient, Hospital, Community, Community building, Virtual community, Social media, W. Edwards Deming, Virtual communities


In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis.

Concepts: Quality, Root cause analysis, Control chart, Six Sigma, W. Edwards Deming, Quality control tools, Walter A. Shewhart, Seven Basic Tools of Quality


Horticulture was shown to represent a well-being source for older adults, encompassing the physical, mental and social domains. Aim of this pilot study was to contribute to extant literature through the investigation of the quality of experience associated with horticultural versus occupational activities. A group of 11 older residents of a nursing home were involved in a crossover study with a baseline measure. Participants attended weekly horticultural and occupational sessions for two six-week cycles. Experience Sampling Method was administered before the program and after each session, to assess participants' levels of happiness, concentration, sociability, involvement, challenges and stakes, and self-satisfaction. Altogether, 332 self-report questionnaires were collected. Findings showed that participants' levels of the cognitive and motivational variables increased during both activities, but horticulture was also perceived as providing higher challenges and stakes, and improving self-satisfaction. Results can have practical implications for well-being promotion among older adults through meaningful activity engagement.

Concepts: W. Edwards Deming


This study examined the correlates of burden of caregivers providing care to people living with HIV/AIDS in rural northern Namibia and the consequences of caregivers' burden on their physical health and mental health. A purposive sampling method was used to recruit a total of 97 primary caregivers (N = 97) in rural Namibia. We found that hunger and HIV stigma were both positively associated with caregiver burden. Caregiver burden was positively related to depression and negatively related to quality of life. The findings underscore the complex relationships between food insecurity and HIV stigma on caregiver burden and the outcomes of burden on quality of life and depressive symptoms. Policy and practice implications are also discussed.

Concepts: Caregiver, Health care, Nutrition, Sampling, Weight loss, South Africa, Personal life, W. Edwards Deming


The aim was to compare the effects of two evisceration methods under operational conditions, on the pelvic hygiene of sheep carcasses. Method 1: rectum sealed with plastic bag and pushed through the pelvic cavity. Method 2: rectum cut, placed back inside and pulled out from the carcass. The 18 largest Norwegian sheep abattoirs participated. Sampling areas were i) 400cm2 inside the pelvic cavity (n=623), ii) 100cm2 outside the circum-anal incision (n=622). There were pooled samples by swabbing the same area of five carcasses, representing totally 3115 carcasses. Mean E. coli results from Method 1: -1.61logCFU/cm2 inside and -0.25logCFU/cm2 for the outside area. Results from Method 2: -1.56logCFU/cm2 inside and -0.42logCFU/cm2 outside. There were no significant differences between the two methods. Both evisceration methods can produce carcasses that are of practically identical high hygienic quality.

Concepts: Comparison, Escherichia coli, Pelvis, Comparisons, Hygiene, Area, W. Edwards Deming, Bag-In-Box


The control of blood components specifications is a requirement generalized in Europe by the European Commission Directives and in the US by the AABB standards. The use of a statistical process control methodology is recommended in the related literature, including the EDQM guideline. The control reliability is dependent of the sampling. However, a correct sampling methodology seems not to be systematically applied. Commonly, the sampling is intended to comply uniquely with the 1% specification to the produced blood components. Nevertheless, on a purely statistical viewpoint, this model could be argued not to be related to a consistent sampling technique. This could be a severe limitation to detect abnormal patterns and to assure that the production has a non-significant probability of producing nonconforming components. This article discusses what is happening in blood establishments. Three statistical methodologies are proposed: simple random sampling, sampling based on the proportion of a finite population, and sampling based on the inspection level. The empirical results demonstrate that these models are practicable in blood establishments contributing to the robustness of sampling and related statistical process control decisions for the purpose they are suggested for.

Concepts: Sample, Scientific method, Sample size, Sampling, Stratified sampling, Survey sampling, W. Edwards Deming, Gy's sampling theory


According to the American Cancer Society, 1 in 23 Americans will be diagnosed with colorectal cancer (CRC) in their lifetime. Screening for CRC is an effective, yet underused preventive approach. This is especially true in rural areas, where only 35% of patients were found to be up to date on their screenings in 2014. Increasing CRC screening can produce positive patient outcomes by early recognition and removal of precancerous polyps. The purpose of this project was to use quality improvement (QI) interventions to increase CRC screening rates at a nurse-managed clinic in rural Indiana. Using Deming’s Plan-Do-Study-Act QI model, multiple interventions were implemented which resulted in a 37% increase in the number of screenings ordered on eligible patients and an overall increase of 28% in the completion of the screenings. This project contributes to healthcare quality knowledge by also suggesting that the fundamental principles of encouraging staff feedback to gain buy-in, improving processes informed by patient data, and valuing frequent performance feedback to staff, strengthened this QI project and ensured adoption and sustainability of these results.

Concepts: Health care provider, Cancer, Medical terms, Hospital, Colorectal cancer, American Cancer Society, PDCA, W. Edwards Deming