Quality assurance in the management of chronic disease

1993 ◽  
Vol 101 ◽  
pp. 165-182
Author(s):  
J. C. Petrie
Keyword(s):  
Quality Assurance ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Medical Information ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Daily Practice ◽  
High Profile ◽  
Adequate Quality

SynopsisThis chapter focuses on application of quality assurance procedures to the management of patients with chronic diseases. The three principal themes developed are amongst the most central to effective and efficient long-term management, namely medical information systems, clinical guidelines and protocols, and patient and clinical outcomes.The present state of play of the three themes is outlined, potential methodologies and technology to apply quality assurance techniques are described, and some implementation strategies for the management of chronic disease are described.Consideration of these topics strongly suggests that quality assurance must have a high profile in the care of patients with chronic diseases. Purchasers of care now have to be confident that adequate quality assurance policies are in place. Providers of care also recognise that quality control has to be implicit in their daily practice and that quality assessment of the service that they provide is an acceptable and necessary exercise. The challenge is to involve the professions and the patient in the process of quality assurance and to prove that it is a cost-effective tool in achieving such benefits as may, or may not, be identified in the care of patients with chronic diseases.

Quality Assurance Methods Applied For Exposed-Aggregate Concrete Pavement Construction

2021 ◽  
Author(s):  
Adam Glinicki ◽  
Michal Glinicki
Keyword(s):  
Quality Assurance ◽  
Early Stage ◽  
Traffic Noise ◽  
Cost Effective ◽  
Weather Conditions ◽  
Special Treatment ◽  
Aggregate Concrete ◽  
Adverse Weather ◽  
Pavement Construction

The exposed aggregate pavement technology for construction of concrete highways is used in European countries, including Poland, mostly for heavy trafficked roads. It is mainly a two-lift slip-form technology with a special treatment of the top surface after the final smoothing operation. This is a demanding technology that leaves a little margin for mistakes. When properly done the pavement layer with exposed aggregates ensures designed skid resistance for vehicle wheels even in adverse weather conditions without excessive traffic noise. The challenge is to provide its cost-effective long term performance including both the adequate roughness and the desired smoothness of the pavement. The paper presents tools and methods for construction quality assurance specific for exposed aggregate concrete pavements. Required monitoring of the stability of concrete mix properties is discussed. The importance of concrete curing is analyzed in respect to the long term durability in wet-freeze regions with heavy use of deicing salts. Macrotexture assessment at the early stage of pavement construction is seen as the key factor for assurance of the proper skidding resistance. Local evaluation of smoothness is also a useful approach to assure the target IRI. Examples of quality assurance efforts applied on concrete highways recently constructed in Poland are presented.

Patterns of alcohol consumption among people with major chronic diseases

2019 ◽  
Vol 25 (2) ◽  
pp. 163 ◽  
Author(s):  
Thi Thu Le Pham ◽  
Sarah Callinan ◽  
Michael Livingston
Keyword(s):  
Mental Illness ◽  
Chronic Disease ◽  
Alcohol Consumption ◽  
Chronic Diseases ◽  
Household Survey ◽  
Drinking Patterns ◽  
Risky Alcohol ◽  
National Drug ◽  
Increased Risk

Risky alcohol use places those with existing chronic conditions at increased risk of medical complications. Yet, there is little research assessing the alcohol consumption among this group. The aim of this study is to assess the prevalence of risky drinking among people with a range of chronic diseases. As part of the 2013 National Drug Strategy Household Survey (NDSHS), 22684 Australians aged ≥18 years answered questions about their experience of chronic diseases and their drinking patterns. Nearly 18% (CI: 17.2–19.3) of people with chronic disease reported drinking at a long-term risky level, roughly the same rate as those without chronic disease (19.3%, (CI: 18.6–20.2)). Nearly one-quarter, 24% (CI: 23.0–25.3), of people with chronic diseases drank at levels of increased short-term risk, significantly less than the rest of the sample. Respondents with mental illness were more likely to drink at risky levels than the rest of the sample, while the reverse was true of those with diabetes. Overall, those with chronic diseases have similar drinking patterns to the rest of the population, despite increased risks associated with this consumption. Regular screening and subsequent brief interventions for those with chronic disease, particularly mental illness and cancer, are recommended.

scholarly journals Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks

2021 ◽  
Vol 8 ◽  
Author(s):  
Lee Crosby ◽  
Brenda Davis ◽  
Shivam Joshi ◽  
Meghan Jardine ◽  
Jennifer Paul ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Diet Quality ◽  
Disease Risk ◽  
Epidemiological Studies ◽  
Short Term ◽  
Chronic Disease Risk ◽  
Ketogenic Diets ◽  
Low Carbohydrate

Very-low-carbohydrate ketogenic diets have been long been used to reduce seizure frequency and more recently have been promoted for a variety of health conditions, including obesity, diabetes, and liver disease. Ketogenic diets may provide short-term improvement and aid in symptom management for some chronic diseases. Such diets affect diet quality, typically increasing intake of foods linked to chronic disease risk and decreasing intake of foods found to be protective in epidemiological studies. This review examines the effects of ketogenic diets on common chronic diseases, as well as their impact on diet quality and possible risks associated with their use. Given often-temporary improvements, unfavorable effects on dietary intake, and inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits.

scholarly journals Systematic review and meta analysis of differential attrition between active and control arms in randomized controlled trials of lifestyle interventions in chronic disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bevens W ◽  
Shoushtari A ◽  
Jelinek P ◽  
Jelinek GA ◽  
Weiland TJ
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Lifestyle Intervention ◽  
Meta Analysis ◽  
Research Question ◽  
Lifestyle Interventions ◽  
And Control

Abstract Background Attrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial. When the degree of attrition differs between active and control arms this is termed differential attrition and is an important consideration during initial stages of trial planning. Objectives The primary research question of this study was: what is the differential attrition between treatment arms in lifestyle interventions for prevalent chronic diseases? Methods We performed a systematic review and meta-analysis of 23 studies involving a lifestyle intervention component in cohorts with chronic diseases. The search accessed three databases: Scopus, Medline Ovid and Web of Science. Attrition between treatment arms was analysed using a random-effects model and examined the relationship between the relative attrition and potential moderators, such as time to final follow-up, time to first follow-up, type of disease, type of control, type of intervention and length of treatment. Results The pooled risk ratio was 1.00 (95% CI 0.97 – 1.03) and only one study fell outside this range. A univariable association was described between the pooled risk ration and length (years) to final follow-up, which did not remain in the multivariable model. Conclusions Ultimately, we found no evidence of differential attrition in medium-to-long term lifestyle intervention studies for chronic disease, increasing confidence in conducting such studies with minimal potential of attrition bias. Trial registration PROSPERO registration number CRD42018084495.

scholarly journals Long-term mortality in young and middle-aged adults hospitalised with chronic disease: a Danish cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038131 ◽  
Author(s):  
Nils Skajaa ◽  
Anne Gulbech Ording ◽  
Bianka Darvalics ◽  
Erzsebet Horvath-Puho ◽  
Henrik Toft Sørensen
Keyword(s):  
Cohort Study ◽  
Chronic Disease ◽  
General Population ◽  
Chronic Diseases ◽  
Low Income ◽  
Years Of Life Lost ◽  
Mortality Risks ◽  
Risk Of Death ◽  
Psychiatric Conditions

ObjectivesTo examine the long-term outcomes for patients hospitalised with chronic diseases at age 30, 40 or 50 years.DesignNationwide, population-based cohort study.SettingAll Danish hospitals, 1979–1989, with follow-up through 2014.ParticipantsPatients hospitalised during the study period with one, two or three or more chronic diseases and age-matched and sex-matched persons from the general population without chronic disease leading to hospitalisation: age-30 group: 13 857 patients and 69 285 comparators; age-40 group: 24 129 patients and 120 645 comparators; and age-50 group, 37 807 patients and 189 035 comparators.Main outcome measuresTwenty-five-year mortality risks based on Kaplan-Meier estimates, years-of-life-lost (YLLs) and mortality rate ratios based on Cox regression analysis. YLLs were computed for each morbidity level, as well as in strata of income, employment, education and psychiatric conditions.ResultsTwenty-five-year mortality risks and YLLs increased steadily with increasing number of morbidities leading to hospitalisation and age, but the risk difference with general population comparators remained approximately constant across age cohorts. In the age-30 cohort, the risk differences for patients compared with comparators were 35.0% (95% CI 32.5 to 37.5) with two diseases and 62.5% (54.3% to 70.3%) with three or more diseases. In the age-50 cohort, these differences were, respectively, 48.4% (47.4 to 49.3) and 61.7% (60.1% to 63.0%). Increasing morbidity burden augmented YLLs resulting from low income, unemployment, low education level and psychiatric conditions. In the age-30 cohort, YYLs attributable to low income were 2.4 for patients with one disease, 6.2 for patients with two diseases and 11.5 for patients with three or more diseases.ConclusionsAmong patients with multiple chronic diseases, the risk of death increases steadily with the number of chronic diseases and with age. Multimorbidity augments the already increased mortality among patients with low socioeconomic status.

scholarly journals Telemedicine maybe an effective solution for management of chronic disease during the COVID-19 epidemic

2021 ◽  
Vol 22 ◽  
Author(s):  
Huan Wang ◽  
Xiaojie Yuan ◽  
Jiping Wang ◽  
Chenglin Sun ◽  
Guixia Wang
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Chronic Disease Management ◽  
Health Management ◽  
Clinical Care ◽  
Vital Role ◽  
Medical Resources ◽  
Care Services ◽  
And Control

Abstract Aim: Based on the development of telemedicine and the experience of using it during the COVID-19 epidemic, we aimed to explore its convenience and shortcomings to provide a reference for the further improvement of telemedicine. Background: Traditional healthcare has been significantly affected by the outbreak of COVID-19, which has increased fear in patients with chronic diseases and increased the difficulty of obtaining hospitalized treatment. Methods: This is a conceptual article. The literature search is based on Pubmed, including articles published between January 2015 and December 2020. The purpose was to determine whether telemedicine is effective in the management of chronic diseases in the epidemic situation and to develop telemedicine and chronic disease management for long-term epidemic situations in the future. Findings: Telemedicine has demonstrated its advantages during the COVID-19 epidemic and can provide diversified clinical care services for patients with chronic diseases; these services have played a vital role in epidemic prevention and control, greatly alleviated the shortage of medical resources, increased the utilization level of medical resources, and reduced the cross-infection risk during treatment in hospitals. Furthermore, the epidemic situation presents opportunities for the development of diagnosis and treatment methods via the internet and active health management modalities.

scholarly journals Long-term strict raw food diet is associated with favourable plasma β-carotene and low plasma lycopene concentrations in Germans

2008 ◽  
Vol 99 (6) ◽  
pp. 1293-1300 ◽  
Author(s):  
Ada L. Garcia ◽  
Corinna Koebnick ◽  
Peter C. Dagnelie ◽  
Carola Strassner ◽  
Ibrahim Elmadfa ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Prevention ◽  
Vitamin A ◽  
Chronic Diseases ◽  
Chronic Disease Prevention ◽  
Food Sources ◽  
Dietary Vitamin ◽  
Vitamin A Status ◽  
Β Carotene

Dietary carotenoids are associated with a reduced risk of chronic diseases. Raw food diets are predominantly plant-based diets that are practised with the intention of preventing chronic diseases by virtue of their high content of beneficial nutritive substances such as carotenoids. However, the benefit of a long-term adherence to these diets is controversial since little is known about their adequacy. Therefore, we investigated vitamin A and carotenoid status and related food sources in raw food diet adherents in Germany. Dietary vitamin A, carotenoid intake, plasma retinol and plasma carotenoids were determined in 198 (ninety-two male and 106 female) strict raw food diet adherents in a cross-sectional study. Raw food diet adherents consumed on average 95 weight% of their total food intake as raw food (approximately 1800 g/d), mainly fruits. Raw food diet adherents had an intake of 1301 retinol activity equivalents/d and 16·7 mg/d carotenoids. Plasma vitamin A status was normal in 82 % of the subjects ( ≥ 1·05 μmol/l) and 63 % had β-carotene concentrations associated with chronic disease prevention ( ≥ 0·88 μmol/l). In 77 % of subjects the lycopene status was below the reference values for average healthy populations ( < 0·45 μmol/l). Fat contained in fruits, vegetables and nuts and oil consumption was a significant dietary determinant of plasma carotenoid concentrations (β-carotene r 0·284; P < 0·05; lycopene r 0·168; P = 0·024). Long-term raw food diet adherents showed normal vitamin A status and achieve favourable plasma β-carotene concentrations as recommended for chronic disease prevention, but showed low plasma lycopene levels. Plasma carotenoids in raw food adherents are predicted mainly by fat intake.

scholarly journals Understanding the problem of long-term treatment adherence: a phenomenological framework

2020 ◽  
pp. medhum-2019-011836
Author(s):  
Francisca Stutzin Donoso
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Treatment Adherence ◽  
Term Treatment ◽  
Three Dimensions ◽  
Long Duration ◽  
Long Term Treatment ◽  
Phenomenological Perspective ◽  
Experience Of Illness

In light of the large burden of chronic disease and the low rates of long-term treatment adherence contributing to high rates of morbidity and mortality worldwide, this paper contributes to better understanding the particular kind of challenge that living with chronic illness and adhering to long-term treatment can imply. Both literature on the concept of chronic disease and the experience of illness suggest going outside specific diagnostic categories to better understand the problem of adherence. After introducing the distinction of a thin understanding of chronicity—merely as long duration—and a thick one—chronicity in a phenomenological sense, this paper analyses academic literature on the experience of illness and specifies it to the case of chronic diseases, introducing an original conceptual framework describing some main challenges arising from the experience of chronic disease. The framework is organised in three dimensions: failing to recover as a failure to belong, being at a loss and breaking-up with oneself. This work suggests a particular subjective state in which struggling to follow long-term treatment may seem understandable and reasonable, offering a phenomenological perspective that feeds into the ethical problems arising in chronic diseases, and shedding light on how to increase adherence without reproducing patterns of disadvantage.

A Chronic Disease Diet Recommendation System Based on Domain Ontology and Decision Tree

2017 ◽  
Vol 21 (3) ◽  
pp. 474-482
Author(s):  
Rung-Ching Chen ◽  
◽  
Chung-Yi Huang ◽  
Yu-Hsien Ting ◽  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Recommendation System ◽  
Expert Knowledge ◽  
Health Management ◽  
Healthy Foods ◽  
Dietary Recommendations ◽  
High Cholesterol ◽  
Aging Society

As society develops and science and technology improve, people have come to care more about a healthy diet. Diet types have gradually changed and focused more on health management. Taiwan is becoming an aging society in which individuals have irregular lifestyles, long-term unhealthy diets, stressful work, and chronic diseases such as diabetes, hypertension, and high cholesterol. However, most dietary recommendation systems cannot give dietary recommendations for patients with chronic diseases. Though healthy foods are recommended, the systems contain little information on whether nutrients are in balance. Therefore, this study constructed a diet recommendation system for chronic diseases using expert knowledge, which enables more convenient and precise dietary recommendations for chronic diseases. In this study, we use an ontology, decision trees, and Jena to construct the recommendation system. The dietary recommendations results are evaluated by dietitians, and the verification accuracy is 100%. Therefore, this system of dietary recommendations can provide convenient, healthy, dietary recommendations for nutrients for patients with chronic diseases.

scholarly journals Attitude towards adherence to long term therapy

2020 ◽  
Vol 32 (1) ◽  
pp. 39-42
Author(s):  
Paramita Sarkar ◽  
Abantika Bagchi ◽  
Dipanwita Sarkar ◽  
Rajesh K Dalal ◽  
Swarnanka Chakrabarty ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Public Health Problem ◽  
Term Treatment ◽  
Term Therapy ◽  
Attitude Score ◽  
Adherence To Treatment ◽  
Demographic Profile ◽  
Long Term Treatment

Background: Chronic disease is a common public health problem worldwide. Adherence to long-term treatment is a key determinant of therapeutic success in patients with chronic diseases. Aim & Objective: The purpose of the study was to know the people’s attitude towards intake of drug, medication adherence and their relationship with socio demographic profile. Settings and Design: Data were collected from 729 individuals chronic disease sufferers chosen randomly from all 81 villages of Amdanga Block West Bengal through a household-based survey in a cross- sectional design. Methods and Material: A pre designed, pre tested, semi structured schedule containing socio-demographic profile and attitude among the respondents regarding adherence to long-term treatment. Statistical analysis used: To compare Attitude scores among different groups, median (IQR) attitude score was calculated and compared with Mann-Whitney U test and Kruskal-Wallis test to know the level of significance of variables. p–value < 0.05 considered statistically significant. Results: Attitude towards long-term adherence to treatment to chronic diseases were significantly associated to caste (p=0.043), education (p=0.001) and occupation (p=0.001) of the study subject. Conclusions: Attitude towards long-term adherence to treatment to chronic diseases were significantly associated to caste, education and occupation.

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