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A roundtable discussion: hospital leaders discuss QI implementation issues.

To address critical questions regarding the practical application of quality improvement (QI) concepts within health care, the Joint Commission visited six hospitals that have been implementing QI for several years. After the site visits, the leaders of these hospitals participated in a roundtable discussion of QI issues. The discussion centered around nuts-and-bolts topics, such as leadership, implementing QI, barriers/resistances, medical staff involvement, cultural change, institutionalizing QI, and external environment. The roundtable discussion is excerpted in full from a new book, Striving Toward Improvement: Six Hospitals in Search of Quality, which tells the stories of the six hospitals and their transitions to QI.

Attitude↗

Acupuncture needle sensations associated with De Qi: a classification based on experts' ratings.

BACKGROUND: Many English language words have been used to describe the acupuncture needle sensation known as de qi, words such as dull, aching, and spreading. However, there is little agreement on which actual words are acceptable as descriptors. In experimental trials of acupuncture in which the needle sensation is an important variable, a quantitative measure is needed to monitor and control for variability in de qi. METHODS: An established scale in the literature provides a list of 25 sensations associated with acupuncture needling that patients might experience. An international group of acupuncture experts rated these 25 sensations in two categories: those predominantly associated with de qi and those with acute pain at the site of needling. For each category, sensations were classified into hierarchic clusters, one for de qi and one for acute pain, and the results were presented in dendrograms. RESULTS: Twenty-nine international experts were invited to participate; 22 (76%) responded and 20 completed the questionnaire. On average, they had 21 years' experience in acupuncture practice (range 10-30 years). Seven sensations were found to be in the cluster associated with de qi: aching, dull, heavy, numb, radiating, spreading, and tingling. Nine sensations were found to be in a cluster associated with acute pain at the site of needling: burning, hot, hurting, pinching, pricking, sharp, shocking, stinging, and tender. The experts also raised a number of issues regarding the limitations of the questionnaire used, providing useful data for future research. CONCLUSIONS: Data from experienced acupuncturists have been analyzed to provide two separate clusters of sensations associated with acupuncture needling: a de qi cluster and an acute pain cluster. In the design of experimental trials involving acupuncture needling, researchers will find these two clusters of sensations useful for monitoring and controlling for variation in needle sensation.

Acupuncture Points↗

The radioprotective effects of bu-zhong-yi-qi-tang: a prescription of traditional Chinese medicine.

We evaluated the effect of bu-zhong-yi-qi-tang, a prescription of traditional Oriental medicine, and its major ingredients on protection of the intestine and hematopoietic organs against radiation damage in this study. The jejunal crypt survival, endogenous spleen colony formation, and apoptosis in jejunal crypt cells were investigated in mice irradiated with high and low doses of gamma-rays. bu-zhong-yi-qi-tang administration before irradiation protected the jejunal crypts (p < 0.0001), increased the formation of the endogenous spleen colony (p < 0.05) and reduced the frequency of radiation-induced apoptosis (p < 0.05). In experiments on the effects of the individual ingredient of bu-zhong-yi-qi-tang, Rensan (Radix Ginseng), Danggui (Radix Angelicae gigantis), Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) might have major radioprotective effects, and each might have different degrees of effect on these three endpoints. These results indicated that bu-zhong-yi-qi-tang might be a better agent than any one of its ingredients to satisfy all three endpoints. Although the mechanisms of this inhibitory effect remain to be elucidated, these results indicated that bu-zhong-yi-qi-tang might be a useful radioprotector, especially since it is a relatively non-toxic natural product. Further studies are needed to better characterize the protective nature of bu-zhong-yi-qi-tang extract and its ingredients.

Animals↗

Qi-training enhances respiratory burst function and adhesive capacity of neutrophils in young adults: a preliminary study.

The main objective of this study is to examine the effect of Qi-training on the immune system, especially neutrophil bactericidal function. Nine healthy male subjects were studied for the effects of one bout of ChunDoSunBup (CDSB) Qi-training on superoxide (O2- production and adhesion capacity of neutrophils at times immediately after (Post I) and 2 hours after the Qi-training (Post II). The Qi-training enhanced O2- production, reaction velocity and neutrophil adhesion capacity and there were significant differences at Post I compared to before Qi-training (Pre). In addition, the number of white blood cells (WBC), monocytes and lymphocytes were changed significantly through Qi-training.Therefore, it seems that CDSB Qi-training may increase the resistance of trained individuals against common infection and inflammation.

Adult↗

[Experimental study on Qi-replenishing and Yin-nourishing in inhibiting tumor metastasis].

OBJECTIVE: To study the effect of Qi-replenishing and Yin-nourishing in inhibiting tumor metastasis. METHODS: Fifty mice were randomly divided into replenishing Qi group, replenishing Yin group, replenishing Qi and Yin group, chemotherapy group and control group. Models of Lewis lung cancer and B(16) melanoma were observed in vivo. The tumor weight inhibiting rate, metastatic lung tumor, concentrations of t-PA and TXB(2) in tumor tissue and IL-2 and TNF-alpha in spleen were observed. RESULTS: The tumor weight inhibiting rates of replenishing Qi and Yin group for Lewis lung cancer and B16 melanoma were both 42.9%. Replenishing Qi and Yin could decrease the contents of TXB(2) and 6-keto-PGF(1alpha), and increase the levels of IL-2 and TNF-alpha. CONCLUSION: Replenishing Qi and Yin can promote the healthy energy to inhibiting tumor metastasis.

Animals↗

[Clinical and experimental study on shen-qi injection with chemotherapy in the treatment of malignant tumor of digestive tract].

Shen-Qi (Ginseng-Astragalus) injection was used with chemotherapy in the treatment of 176 cases of malignant tumor of the digestive tract. Results showed that Shen-Qi injection could reduce the toxic effects produced by chemical agents and increase the patient's body weight, as compared with that treated by chemotherapy alone (P < 0.001). It could protect the body's hematopoietic function. In Shen-Qi injection with chemotherapy group; the WBC count changed insignificantly but in chemotherapy group the WBC count reduced markedly, in which the rate of chemotherapy failure was 26.5% the difference between these two groups appeared to be significant (P < 0.01). Shen-Qi injection could increase the cellular immunologic function of the body, including phagocytic index and percentage of phagocytes, T lymphocyte transformation rate(cpm) as well as esterase stain. Further more, Shen-Qi injection could promote blood circulation to remove blood stasis and reduce the whole blood specific viscosity (P < 0.05). In the animal experiment, the total number of bone marrow cells and karyocytes of combined treatment group was found to be higher (P < 0.001) and the average weight of thymus was heavier (P < 0.05) than that in chemotherapy group. Shen-Qi injection could also prolong the survival time and increase the tumor inhibiting rate of experimental mice.

Adenocarcinoma↗

[Adjustive effect of yi qi tong lin chongji on the three growth factors in rats prostatic tissues].

OBJECTIVE: To study the mechanisim of Yi Qi Tong Lin Chingji in treating benign prostatic hyperplasia. METHOD: The expressions of VEGF, bFGF and TGF beta 1 in prostatic hyperplasia model rats were examined by immunohistochemistry. 8 rats were in contrastive group, 24 influenced by Yi Qi Tong Ling Chingji and Prostacar. RESULT: The expressions of VEGF and bFGF were significantly difference, but the expression of TGF beta 1 was not significant. (P < 0.01). The expression of VEGF and bFGF were significant in contrastive group to the high-dose of Yi Qi Tong Ling Chingji and Prostacar group (P < 0.05) but were not significant to the low-dose of Yi Qi Tong Ling Chingji group. There was no significant difference between high-dose of Yi Qi Tong Ling Chingji and Prostacar group and three growth factors. CONCLUSION: Yi Qi Tong Ling Chingji inhibit the expression of VEGF and bFGF in BPH so as to decrease the volume of prostate.

Aconitum↗

Acute effect of qi-training on natural killer cell subsets and cytotoxic activity.

This study assesses the effects of Qi-training on natural killer cell cytotoxicity. Nine experimental subjects did 1 h of Qi-training, and 9 control subjects relaxed during the same time. Natural killer cell cytotoxicity increased 60% immediately after Qi-training (p<.01) and returned to the basal level within 2 h after training. Natural killer cell subset number did not change after Qi-training. Natural killer cell cytotoxicity and cell number were not significantly correlated. These data suggest that Qi-training has an acute stimulatory effect on natural killer cell activity, but has no effect on phenotypical changes in the natural killer cell subset.

Adult↗

Qi-training and immunological parameters: a cross-sectional study.

This article examined the effects of qi-training on peripheral T lymphocyte concentrations in a cross-sectional study involving three groups of subjects: normal healthy subjects (n = 22) and two groups of qi trainees (group Q1: qi-training for 1-12 months, n = 52; and group Q2: qi-training for >12 months, n = 63). Nonparametric statistical tests revealed significant differences between the groups in TH/TS/C ratio (p < .001) and in the ratio of memory TH lymphocytes (CD45RA-) to naïve TH lymphocytes (CD45RA+) (p < .001). These findings suggest that qi-training modulates peripheral T lymphocyte concentrations. However, the functional modulation of T helper lymphocytes should be tested in a larger population and compared with other interventions.

Adolescent↗

The use of DC electrodermal potential measurements and healer's felt sense to assess the energetic nature of qi.

Because DC electrodermal potential measurements do not involve introducing a current into the body, it was postulated that temporal fluctuations in DC potential values on acupoints would be a useful method for assessing the subtle energetic changes of qi. DC potential measurements from acupoints and nonacupoints were therefore compared when energy healing practitioners were in an external focus state, were healing at a distance (external qi), or were self-healing (internal qi). The results show statistically significant differences between measurements obtained on and off acupoints and between external focus and healing states. Subjects' report of felt sense of the flow of qi moving in their body also correlated with DC potential readings, but only those readings taken on acupoints. The results support the hypothesis that pattern information from temporal fluctuations in DC potential electrodermal measurements reflects the movement and/or amount of a physical, electrical activity that corresponds to the traditional Eastern concept of qi circulating in the body.

Galvanic Skin Response↗

A Minnesota multiphasic personality inventory profile of ChunDoSunBup qi-trainees: a preliminary study.

The aim of this study is to explore the effects of ChunDoSunBup Qi-training on personality traits. Twenty-six normal healthy subjects (mean age = 26.58 +/- 6.56) and 26 CDSB Qi-trainees (mean age = 27.74 +/- 5.21) participated in this study. Analysis of MMPI profiles showed that CDSB Qi-trainees scored significantly lower on Depression (D), Hysteria (Hy), Paranoia (Pa), Schizophrenia (Sc) and Frequency (F) and significantly higher on the Correction (K) Scales. In addition, CDSB Qi-trainees reported a significantly lower Cook-Medley Hostility (Ho) scale than that of controls. This preliminary study suggests that CDSB Qi-training may be effective in protection as well as restoration of emotional, psychological symptomatology and personality trait disorder.

Adult↗

Clinical observation on 84 cases of ventricular premature beat with deficiency syndrome treated by qi lu tang.

From August 1989 to May 1994, 84 cases of ventricular premature beat (VPB) with deficiency syndrome were treated with our empirical prescription called Qi Lü Tang Decoction for Improving Abnormal Heart Beat). The total effective rate was 88.10%, being significantly different from that of the control group treated with the Western drug propafenone (P < 0.01). Qi Lü Tang exhibited a better therapeutic effect in cases of VPB with deficiency of qi, deficiency of both qi and blood, and deficiency of both qi and yin.

Adult↗

EEG findings during special psychical state (Qi Gong state) by means of compressed spectral array and topographic mapping.

Wallace first reported the changes in EEG during transcendental mediation [6]. Banquet [1] observed, on the basis of spectral analysis of the EEG, that the mediation state was a unique state of consciousness, and separate from wakefulness, drowsiness or sleep. The Qi Gong of China is not the same as either transcendental mediation or the Yoga Gong. The EEG during Qi Gong state is clearly different from those recorded during the resting state. The changes in the EEG during the Qi Gong have not been reported previously. The EEG alpha activity during the Qi Gong state occurs predominantly in the anterior regions. The peak frequency of EEG alpha rhythm is slower than the resting state. The change of EEG during Qi Gong between anterior and posterior half is negative correlation. These changes are statistically significant.

Brain Mapping↗

Inhibitory effects of Hu-qi-yin on the bleomycin-induced pulmonary fibrosis in rats.

The currently accepted approaches to treatment of pulmonary fibrosis are based on the treatment of alveolitis and pulmonary fibrosis, however clinically available anti-inflammatory and antifibrotic agents are not often beneficial. Hu-qi-yin, one of the traditional Chinese herbal formulas, has been used for clinical therapy of pulmonary fibrosis in China. The aim of the present study is to evaluate the preventive effects of Hu-qi-yin on the bleomycin (BLM)-induced pulmonary fibrosis in rats. The degree of fibrosis was evaluated with hydroxyproline contents in serum and lung tissue 28 days post-BLM instillation. The semi-quantitative analyses of lung sections were conducted to evaluate the intensity of alveolitis and fibrosis. Furthermore, the expression of transforming growth factor-beta(1) (TGF-beta(1)) was quantitatively studied at the protein and mRNA levels by immunohistochemistry and in situ hybridization, respectively. Oral treatment with Hu-qi-yin improved the body weight loss of rats in doses of 3.8, 7.6g/kg compared with BLM-treated control group, and significantly inhibited the alveolitis and pulmonary fibrosis in a dose-dependent manner as reflected by decreases of the hydroxyproline contents of serum and lung, and amelioration of alveolitis and pulmonary fibrosis fraction 28 days after BLM administration. The one of the possible mechanisms of the protective effect of Hu-qi-yin was via reduction of the overexpression of TGF-beta(1) protein and mRNA. These results suggested a great potential that Hu-qi-yin might be effective in the treatment of pulmonary fibrosis.

Administration, Oral↗

Use of experimental and quasi-experimental methods for data-based decisions in QI.

BACKGROUND: Decisions made by quality improvement (QI) teams, as reported in the literature, are usually based on nonexperimental methods for data collection. Pretest-posttest designs, in particular; are common in reports of QI teams' evaluations of changes or interventions. Yet in such designs the results are inherently confounded; it is impossible to rule out alternative explanations for any differences found. USING EXPERIMENTAL METHODS TO MAKE QI DECISIONS: As suggested by one study, QI teams can design and implement experimental interventions in relevant organizational processes. In an attempt to reduce the no-show rate for first appointments at a Residents Clinic at the Medical University of South Carolina (Charleston), the Youth Outpatient Improvement Team designed an experiment to test two possible modifications to the admission process. Those seeking services were randomly assigned to one of three groups (the control group or one of the experimental groups). Not only did results not support the team's hypothesis that one of the experimental procedures would produce a lower no-show rate, subjects in the experimental groups were less likely to enter treatment. Given these data, the decision was made to maintain current admission procedures. CONCLUSIONS: Since the quality of a decision is dependent on the quality of the data on which it is based, QI teams should consider experimental methods when planning data collection to evaluate their recommended interventions. When such methods are not feasible, quasi-experimental strategies can be used to strengthen the quality of nonexperimental data.

Adolescent↗

Effect of Qi-training on blood pressure, heart rate and respiration rate.

To examine the physiological effects of Korean traditional Qi-training, we investigated the changes in blood pressure, heart and respiratory rates before, during and after ChunDoSunBup (CDSB) Qi-training. Twelve normal healthy CDSB Qi-trainees (19-37 years old; trained for 1.3 +/- 0.2 years; 9 men and 3 women) volunteered to participate in this study. Heart rate, respiratory rate, systolic blood pressure and rate-pressure product were significantly decreased during Qi-training. From these results, we suggest that CDSB Qi-training has physiological effects that indicate stabilization of cardiovascular system.

Adult↗

Qi-training enhances neutrophil function by increasing growth hormone levels in elderly men.

This article investigated the effects of Qi-training on the neuroendocrine response and superoxide generation by neutrophils in healthy elderly men. One hour of Qi-training significantly reduced the plasma concentration of cortisol, and increased plasma concentrations of growth hormone and melatonin. Generation of superoxide by neutrophils increased significantly immediately after Qi-training (p < .01). The change in neutrophil superoxide generation was significantly correlated with the change in growth hormone concentration after Qi-training (p < .01). These data indicate that, in elderly men, Qi-training enhances superoxide generation by neutrophils, possibly via the changes in plasma growth hormone concentration.

Aged↗

Changes in alpha wave and state anxiety during ChunDoSunBup Qi-training in trainees with open eyes.

We investigated the effects of ChunDoSunBup (CDSB) Qi-training, one of the Korean popular Qi-training systems, on EEG patterns, activation coefficients and state anxiety in 13 trainees with open eyes. CDSB Qi-training procedure consists of 3 stages: sound exercise, reciting Chunmoon, which is similar to a mantra; haeng-gong, a kind of body motion; and mediation. Compared to the control state (resting state before Qi-training), subjects reported less state anxiety, their activation coefficients decreased significantly during sound exercise and meditation in the occipital regions. Mean relative power and changes of mean absolute power of alpha wave increased significantly during sound exercise and meditation in the occipital regions. These results suggest that sound exercise and meditation in ChunDoSunBup Qi-training may reduce activation of the visual cortex and influence the thalamus and other functions of the brain. These could reduce anxiety levels and modulate the psychological, neurological, and physiological functions in man.

Adult↗