{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:17:34Z","timestamp":1790709454021,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n In low\u2010resource countries, cystic fibrosis (CF) care often falls below international standards, particularly regarding pulmonary outcomes, airway clearance, nutrition, cystic fibrosis transmembrane conductance regulator (CFTR) modulator availability, and multidisciplinary care. Quality improvement (QI) methodologies provide structured approaches to address these deficiencies.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether a 12 months Plan\u2010Do\u2010Study\u2010Act (PDSA)\u2010driven QI intervention could yield an absolute \u2265\u20095% increase in mean FEV1pp among people with cystic fibrosis (PwCF) with baseline FEV1pp\u2009\u2264\u200980%, and to distinguish the effects of the QI interventions over 12 months in patients who did not receive elexacaftor\/tezacaftor\/ivacaftor (ETI) at any time during the projec period (non\u2010ETI group), from those in patients who initiated ETI after 6 months, in order to assess the additional impact of therapy beyond the QI interventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Between May 2024 and May 2025, 45 PwCF aged 6\u201321 years were enrolled at Ain Shams University Pediatric Hospital, Egypt, in collaboration with the University of Michigan CF Center. Sequential PDSA cycles implemented personalized airway clearance, intensified nutritional support, caregiver education, and telehealth follow\u2010up. The project comprised Phase 1 (0\u20136 months, QI\u2010only) and Phase 2 (6\u201312 months), during which 56% initiated ETI. Outcomes included FEV1pp, BMI\u2010for\u2010age\n Z<\/jats:italic>\n \u2010scores, status, and antibiotic use.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline mean age was 9.9\u2009\u00b1\u20093.5 years, mean FEV1pp 60.6\u2009\u00b1\u200916.7%, and BMI\u2010for\u2010age\n Z<\/jats:italic>\n \u2010score \u22121.05\u2009\u00b1\u20091.29. In the non\u2010ETI group, mean FEV1pp increased from 57.9% at baseline to 65.0% at 12 months, yielding an absolute mean gain of +7.1% (\n p<\/jats:italic>\n \u2009<\u20090.001), surpassing the predefined target of \u2265\u20095%, while mean BMI\u2010for\u2010age Z\u2010scores improved from \u22120.88 to \u22120.13 (+0.75;\n p<\/jats:italic>\n \u2009<\u20090.001). ETI\u2010treated patients demonstrated greater improvements during phase 2, with mean FEV1pp rising from 66.4% to 78.6% (+12.2%;\n p<\/jats:italic>\n \u2009<\u20090.001) and mean BMI\n Z<\/jats:italic>\n \u2010score improving from \u22120.64 to \u22120.05 (+0.59;\n p<\/jats:italic>\n \u2009<\u20090.001). Antibiotic use declined significantly over the project period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A tailored multidisciplinary QI protocol significantly improved lung function and nutrition in PwCF in a resource\u2010limited setting, with CFTR modulators providing additional clinically meaningful benefits.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ppul.71621","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T08:05:29Z","timestamp":1776153929000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of a Standardized Multidisciplinary Quality Improvement Project to Improve Clinical Outcomes in Cystic Fibrosis: A 12\u2010Month Phased Project at Ain Shams University"],"prefix":"10.1002","volume":"61","author":[{"given":"Mahitab Morsy","family":"Hussein","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Pulmonology Ain Shams University Pediatric Hospital Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samya Zaki","family":"Nasr","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Pulmonology, Michigan Medicine University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terez Boshra","family":"Kamel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Pulmonology Ain Shams University Pediatric Hospital Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Rashad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Endocrinology Ain Shams University Pediatric Hospital Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina Nabil","family":"Kamel","sequence":"additional","affiliation":[{"name":"Department of Community, Environmental and Occupational Medicine Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7187-8686","authenticated-orcid":false,"given":"Eman Abdelnaeem","family":"Fawzy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Pulmonology Ain Shams University Pediatric Hospital Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.10"},{"key":"e_1_2_12_3_1","volume-title":"2024 Patient Registry Highlights [Internet]","author":"Cystic Fibrosis 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