To evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals.
Twenty-eight hospitals enrolled in a 20-month (May 2015-December 2016) ...Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time.
Most hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring "appropriate delivery," 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers.
For 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27-2.07, P<.001). In the comparator analysis, vaginal delivery for all deliveries in the five São Paulo intervention hospitals increased from 16.1% to 23% (RI 1.43, P<.001) and from 11.0% to 13.0% (relative rate ratio 1.18, P<.001) in the eight nonintervention São Paulo hospitals. The relative increase in vaginal delivery between the São Paulo intervention and nonintervention groups was 1.21 (95% CI 1.05-1.41, P=.01). The rate of maternal adverse events and neonatal intensive care unit admissions for newborns who weighed at least 2,500 g did not differ significantly during the observation period.
Key interventions implemented with QI methods were associated with increased vaginal delivery. This approach may help address the global cesarean delivery epidemic.
Abstract
Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider ...compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles’ adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool—Kamishibai board (K-board)—during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles’ compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles’ compliance was addressed in the K-board. Audit data were recorded in ‘SimpleQI’. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.
Caracterização físico-química, reológica e sensorial de queijos tipo Prato com teor reduzido de gordura De Rensis, Christiane Maciel Vasconcellos Barros(UNOPAR); Petenate, Ademir José(Universidade Estadual de Campinas Instituto de Matemática, Estatística e Computação Científica); Viotto, Walkiria Hanada(Universidade Estadual de Campinas)
Ciência e tecnologia de alimentos,
2009, Letnik:
29, Številka:
3
Journal Article
Recenzirano
Odprti dostop
O objetivo deste trabalho foi caracterizar 3 marcas diferentes de queijos tipo Prato com teor reduzido de gordura, comercializados em Campinas - SP, quanto a sua composição, proteólise, capacidade de ...derretimento, propriedades reológicas e aceitação sensorial. Não houve diferença significativa (p > 0,05) na composição dos queijos. A extensão e a profundidade de proteólise foram significativamente maiores (p 0,05) ao final de 60 dias de armazenamento refrigerado para o queijo da marca B. Os queijos das marcas A e C se apresentaram menos macios e mais elásticos ao final de 60 dias de armazenamento refrigerado. Nos testes de aceitação sensorial, o queijo da marca B obteve notas significativamente mais altas (p 0,05) para os atributos sabor e impressão global, sendo que 70% dos consumidores certamente ou provavelmente comprariam esse queijo.
Composition, proteolysis, melting, reological properties, and sensory acceptability of three commercial reduced fat Prato cheese, found in the market of Campinas - SP, Brazil, were evaluated. There was no statistical difference (p > 0,05) in the cheese composition. The proteolysis extension and depth were significantly higher (p 0.05) at 60 days of refrigerated store for cheese B. Cheeses A and C were firmer and more elastic at 60 days of refrigerated store. Sensory acceptability tests indicated significant differences (p 0.05) among the cheeses for flavor and global impression. Cheese B was better graded than the other cheeses in the sensory acceptance test and its buying intention scores indicated that 70% consumers would certainly or probably buy this cheese.
Orientador: Jose Ferreira de Carvalho
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Matematica, Estatistica e Ciencia de Computação
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Previous issue date: 1979
Resumo: Este trabalho tem como finalidades: 1 - Revisar alguns resultados clássicos em Modelos Lineares, discutir as relações impostas ao espaço e parâmetros quando a matriz. de covariâncias é singular e interpretar geometricamente alguns resultados importantes. 2) Apresentar um conjunto de condições equivalentes sobre o modelo linear geral para que o estimador simples de mínimos quadrados de funções estimáveis covariância é arbitrária seja BLUE,quando a matriz de covariância é arbitraria., 3) Discutir alguns experimentos finitos aleatorizados amostra aleatória simples sem reposição, experimentos completamente ao acaso e blocos completamente ao acaso) e mostrar que para esses experimentos o estimador simples de mínimos quadrados de qualquer função estimável é BLUE, embora a matriz de covariância dos erros seja distinta de 'SIGMA POT.2' I e possivelmente singular.
Abstract: The scope of this work is: 1) To review some classical results in' Linear Models, to discuss the restrictions imposed on the parameter space when the covariance matrix 'is singular and to provide geometric interpretation of some relevant results. 2) To present a set of equivalent conditions on the general linear model in order that the simple least squares' estimator of any estimable function be BLUE, when the covariance matrix is arbitrary. 3) To discuss some finite randomized experiments (simple random sampling without replacement, the complete randomized design and the complete randomized block design) and to show that for these experiments the Simple Least Squares estimator of any estimable function is BLUE, although the covariance matrix of the errors is not 'SIGMA POT. 2' I and may be singular.
Mestrado
Mestre em Estatística
Kriging is a technique that has been used to interpolate a set of observed data points {(x(,i), z(x(,i))); x(,i) (ELEM) DcR('p), i = 1, ..., n}. The basic assumption is that the function z(x) is a ...realization of a stochastic process {Z(x); x (ELEM) R('p)}. The relation between Kriging and BLUP is shown. We restrict our attention to covariance stationary stochastic processes, and we discuss the optimal allocation of the points x(,1), ..., x(,n) when p = 1 and D = {0,1}. L-spline is another technique that is used for interpolation purposes. Although not always stated explicitly, there is a stochastic process that underlies an L-spline of interpolation such that Kriging and L-spline give the same interpolating function. The efficiency of the linear and cubic spline, with regard to Kriging, is evaluated for some covariance models that have been used in the geological area. The multiquadric method of interpolation is also compared with Kriging.
Avaliação do rendimento do queijo tipo prato obtido por modificações no processo tradicional de fabricação Spadoti, Leila M.(Universidade Estadual de Campinas Faculdade de Engenharia de Alimentos); Dornellas, José Raimundo F.(Universidade Estadual de Campinas Faculdade de Engenharia de Alimentos); Petenate, Ademir J.(Unicamp Instituto de Matemática e Estatística) ...
Ciência e tecnologia de alimentos,
12/2003, Letnik:
23, Številka:
3
Journal Article
Recenzirano
Odprti dostop
O objetivo deste trabalho foi comparar os efeitos das seguintes modificações no processo com o processo tradicional de fabricação de queijo Prato: uso de leite concentrado por ultrafiltração-(LCUF) ...até um FCV=4:1; pré-fermentação de parte deste LCUF e aquecimento indireto da massa sobre o rendimento-(R), rendimento ajustado-(RAJ) e a recuperação de gordura-(RGq) e de proteína-(RPq) no queijo. Foram realizados 3 processamentos, com 5 tratamentos cada, respectivamente: Tratamento 1-(T1), sem ultrafiltração; Tratamento 2-(T2), ultrafiltração sem pré-fermentação do LCUF; Tratamento 3-(T3), ultrafiltração com pré-fermentação de 10% do LCUF; Tratamento 4-(T4):, ultrafiltração com pré-fermentação de 20% do LCUF e com aquecimento direto da massa e Tratamento 5-(T5): ultrafiltração com pré-fermentação de 20% do LCUF e único com aquecimento indireto. Os resultados de composição, rendimento e recuperação de componentes dos 5 tratamentos foram avaliados estatisticamente. Os tratamentos T2, T3, T4 e T5 apresentaram menores valores de R, RAJ e RGq e maiores valores de RPq, porém, a pré-fermentação com cozimento indireto apresentou a tendência de melhores RGq e RAJ. Menores rendimentos e RGs possivelmente resultaram da estrutura fibrosa apresentada por esses coágulos, bem como pela dificuldade de corte e manipulação dos mesmos.
The objective of this research was to study the effect of the following modifications on the traditional manufacturing process of Prato cheese: use of milk concentrated by ultrafiltration (LCUF) up to a VCF=4:1; partial LCUF pre-fermentation; indirect curd cooking; on yield-(R), adjusted yield (RAJ) and fat (RGq) and protein (RPq) recovery on cheese, and comparison of the results with a standard cheese. Three processings with five treatments each were realized, respectively: treatment 1-(T1), without ultrafiltration; Treatment 2-(T2), ultrafiltration without LCUF pre-fermentation; Treatment 3-(T3), 10% LCUF pre-fermentation; Treatment 4-(T4), 20% LCUF pre-fermentation and direct curd heating; Treatment 5-(T5), 20% LCUF pre-fermentation and the only one indirect curd heating. It was realized composition, yield, and component recovery for all five treatments, and the results statistically evaluated. Treatments T2, T3, T4, and T5 presented lower values for R, RAJ and RGq, however, the pre-fermentation with indirect curd cooking presented a tendency of better values for RGq and RAJ. Lower yields and RGs possibly resulted from the fibrous structure presented by these curds as well as due to the difficulty on cutting and handling them.
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