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May 2026 DOI 10.14302/issn.2574-4518.jsdr-25-5773
Peres de Sousa LucasCorresponding author
Introduction Sleep quality is a fundamental determinant of human health and well-being. Modified Intravascular Laser Irradiation of Blood (ILIB), a non-invasive therapeutic modality, has emerged as a potential intervention for sleep-related disturbances. Proposed mechanisms include reduced blood viscosity and platelet aggregation, activation of superoxide dismutase, increased oxygen bioavailability, enhanced microcirculation, elevated serotonin levels, and decreased cortisol concentrations—physiological processes intricately involved in sleep regulation, mood modulation, and the stress response. Objective To evaluate the effects of Modified Intravascular Laser Irradiation of Blood (ILIB) on sleep quality in individuals with self-reported sleep disturbances. Methods A randomized, placebo-controlled clinical trial was conducted with participants who reported poor sleep quality. Subjects were randomly assigned to one of two groups: the intervention group received ILIB using a 660 nm red laser, while the control group received a placebo treatment (light emission with sub-therapeutic power, <1 mW). Both groups underwent the same treatment schedule. Sleep quality was assessed at baseline and after six treatment sessions using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results Participants in the ILIB group showed statistically significant improvements in the primary outcome of global sleep quality. PSQI scores decreased from 10.24 at baseline to 6.47 post-treatment. ESS scores showed a non-significant change from 10.44 to 10.12. These results suggest enhanced overall sleep quality and reduced sleep latency, although the observed reduction in daytime sleepiness did not reach statistical significance. Conclusion Modified Intravascular Laser Irradiation of Blood appears to be a promising non-invasive approach for improving sleep quality. The clinical outcomes observed are comparable to those reported in both pharmacological and behavioral sleep interventions, particularly in terms of PSQI improvements. These preliminary findings support the need for further research to clarifyunderlying mechanisms, optimize treatment parameters (e.g., dosimetry and duration), and expand outcome assessments to include biomarkers and polysomnographic data.
Feb 2024 DOI 10.14302/issn.2641-4538.jphi-23-4871
Mba-Oduwusi NnennaCorresponding author
Background This study evaluates the effectiveness of quality improvement (QI) strategies in mid-level private healthcare facilities in Lagos State, with a focus on the structural components, healthcare processes, and healthcare outcomes. Employing the Donabedian model, the research aims to comprehensively assess and enhance healthcare service quality in these facilities. Methods A before-and-after study design was employed, involving a baseline assessment of 321 health facilities and endline assessment of 239 healthcare facilities, and a subsequent 10 - 12-month quality improvement intervention. Data were collected using facility assessments, client exit interviews, and interviews with key stakeholders. The analysis included a before and after analysis of the structural components, healthcare processes, and healthcare outcomes. Results The study demonstrates positive outcomes in mid-level private healthcare facilities in Lagos State following quality improvement (QI) interventions. Structural components, including, improved equipment availability, and enhanced compliance with standards, showcased significant improvements. Renovations and heightened registration compliance further underscored commitment to regulatory standards. Challenges in service availability, particularly in family planning and laboratory services, were identified. Importantly, the implementation of a QI scoring system revealed an overall positive impact, with the average score rising from 69% to 74%, signifying enhanced quality across diverse priority areas. Implications These findings highlight the success of QI interventions in transforming healthcare processes and structural components. Despite notable progress, persistent challenges in specific services call for targeted interventions. The substantial increase in patient satisfaction and overall QI scores underscores the transformative potential of sustained efforts and tailored interventions in mid-level private healthcare facilities in Lagos State. Conclusions This research comprehensively evaluates the effectiveness of quality improvement strategies implemented in mid-level private healthcare facilities in Lagos State, Nigeria, utilizing the Donabedian Model as a guiding framework. The findings provide valuable insights for policy recommendations, with the aim of aligning healthcare services with the Donabedian model to ensure the provision of high-quality care in mid-level private healthcare facilities in Lagos State. This study contributes to the ongoing efforts to improve healthcare quality in Lagos State. Contribution to Knowledge The research provides empirical insights into the effectiveness of quality improvement strategies in mid-level private healthcare facilities, particularly within the context of Lagos State, Nigeria. It highlights the significance of addressing structural components, optimizing healthcare processes, and monitoring healthcare outcomes to enhance the quality of care provided, aligning with the Donabedian model. These findings offer a valuable basis for policy recommendations and further research efforts aimed at improving healthcare quality in similar settings.
Mar 2018 DOI 10.14302/issn.2574-4518.jsdr-17-1785
W Chang-LitCorresponding author
Mount Sinai Beth Israel
Sleep is vital for the maintenance of physical health and mental wellbeing. Sleep also plays a cardinal role in the process of healing. It is estimated that 50 to 70 million Americans suffer chronically from sleep disturbances and insufficiency, which not only hinders daily functioning but also adversely affects health, quality of life and longevity.1 Deficient sleep is associated with an increased risk of developing chronic diseases such as hypertension, diabetes, obesity, heart disease, stroke, depression, frequent mental distress, as well as increased mortality, and reduced quality of life and productivity.1,2Aging, medical conditions, pain, and mental illness further aggravate sleep disturbances such as insomnia, sleep fragmentation and daytime sleepiness.3, 4, 5, 6, 7, 8 The a common treatment for sleep disturbances and insomnia is pharmacological therapy. Benzodiazepines may have negative long-term side effects including residual daytime sedation and tolerance development. Withdrawal difficulties may increase dependency. In the older patient there are safety issues related to daytime sedation including increase risk of falls. With the importance of sleep in hospital recovery and the side effects of sleep medication becoming more widely recognized, there has been an impetus to s use nonpharmacological alternatives , such as music.. This pilot study builds on the potential impact of music’s effectivity by introducing music therapy as a safe, cost effective and culturally sensitive intervention.
Jul 2023 DOI 10.14302/issn.2574-450X.jom-23-4654
Hodges StephanieCorresponding author
Background Nearly 40% of the adult population in the United States are considered obese by current standards, which equates to approximately 93 million people. Obesity is a chronic disease that is linked to more than 40 other diseases, including hypertension, heart disease, stroke, diabetes, and at least 13 distinct types of cancers. The direct and indirect costs of obesity have been estimated at up to $210 billion annually. Local Problem In Cumberland County, North Carolina, 34% of the adult population was considered obese. The aim of this quality improvement study was to increase effective care (screening, patient engagement, and referral to treatment) in adult patients with a BMI greater than 30 kg/m2 to 75% within 90 days. Methods A rapid cycle plan-do-study-act framework was used to evaluate four focus areas concurrently over 8 weeks with a small test of change completed in each 2-week cycle. Interventions An expanded screening with a checklist, shared decision-making tools (SDMTs), and a referral to treatment checklist were implemented. Activities from the team engagement plan were initiated. Results The effective care of patients increased by 42 percentage points while engaging both the patients and the staff. Conclusions Utilizing standardized communication, SDMTs, checklists, and management plans improved effective care while motivating and enabling patients to take control of their care and make sustainable lifestyle changes that enhance overall health.
Dec 2017 DOI 10.14302/issn.2997-2086.jfs-17-1846
Amin RuchiCorresponding author
Pediatric Surgery, Children’s Hospital of Wisconsin
Introduction: Data support the use of both ultrasound (US) and magnetic resonance imaging (MRI) in the prenatal prognostication of congenital diaphragmatic hernia (CDH). The aim of this study was to examine our experience and learning curve with both of these diagnostic tools in the setting of a new fetal program. Materials and Methods: This is a case series performed as a quality improvement measure. Fetuses were identified at a single tertiary institution with both ultrasound lung-to-head ratio (LHR) and MRI fetal lung volume from December 2012 until July 2016. Prenatal and postnatal data were collected. Statistical analysis was performed and a p-value of <0.05 was considered significant. Results: Twenty-one patients met inclusion criteria. Inaccurate LHRs were found in 26.9% (7/26) of patients, with the lack of a four-chamber heart view as the most common inaccuracy (5/26, 19.2%). Patients with only some or no stomach in the thoracic cavity on fetal MRI had 100% survival to discharge. Discussion: Accurate prenatal prognostication of CDH is challenging. We identified a pitfall in attaining LHR that can be easily identified, and that may influence the accuracy of the measurement. Furthermore, stomach position on MRI is a relatively newly described quick, easy, and reproducible metric for predicting prognosis.
Mar 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1468
Gibb JeanCorresponding author
University of California, Los Angeles Medical Center
Successful viral load programs rely on the presence of data systems and high quality of patient data. Using a cohort of 49 patients at Partners in Hope, a large, urban HIV clinic in Malawi, we performed a quality improvement assessment of a new viral load program with a focus on accuracy of data collected from patients as well as adherence to Malawi HIV Guidelines in regard to response to elevated viral loads (≥1,000 copies/mL). Data were obtained from three parallel medical record systems to investigate the proportion of patients with a repeat viral load and whether the three data systems agreed in regard to sociodemographic and clinical data. Fewer than 30% of patients had a repeat viral load within six months, as recommended in the Malawi HIV Guidelines. There were significant problems with data agreement across the three parallel databases used for care. Date of birth was consistent for 55.1% (N=27) of patients, while a different date of birth was noted in all three sources for 10.2% of patients (N=5). Viral load data from all three sources agreed for only 2.0% of patients (N=1). For 65.3% (N=32), the viral load from the laboratory did not match the recorded viral load in the electronic or paper record. Scale-up of viral load monitoring must be accompanied by the development of data systems that support workflow from sample collection to lab and back to provider. Education of providers and strategies for data collection with minimal errors can facilitate scale-up of high quality programs.