Collaborative quality improvement to manage pain in acute care hospitals.

Objective. Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. Design.To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). Setting.A teaching hospital of 2,096 beds in Geneva, Switzerland. Patients.All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). Interventions.Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. Outcome Measures.Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). Results.After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P = 0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P = 0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P = 0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P = 0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P = 0.046). Conclusion.Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Evaluation des technologies médicales : travaux présentés pendant le Congrès TEKMED 87 = Assessment of medical technologies : the papers presented during the TEKMED 87 Congress

[Table des matières] Technology assessment in health care in the United States: an historical review / S. Perry. - The aims and methods of technology assessment / JH Glasser. - Evaluation des technologies de la santé / A. Griffiths. - Les données nécessaires pour l'évaluation des technologies médicales / R. Chrzanowski, F. Gutzwiller, F. Paccaud. - Economic issues in technology assessment/DR Lairson, JM Swint. - Two decades of experience in technology assessment: evaluating the safety, performance, and cost effectiveness of medical equipment / JJ Nobel. - Demography and technology assessment / H. Hansluwka. - Méthodes expérimentale et non expérimentale pour l'évaluation des innovations technologiques / R. Chrzanowski, F. Paccaud. - Skull radiography in head trauma: a successful case of technology assessment / NT Racoveanu. - Complications associées à l'anesthésie: une étude prospective en France / L. Tiret et al. - Impact de l'information publique sur les taux opératoires: le cas de l'hystérectomie / G. Domenighetti, P. Luraschi, A. Casabianca. - The clinical effectiveness of acupuncture for the relief of chronic pain / MS Patel, F. Gutzwiller, F. Paccaud, A. Marazzi. - Soins à domicile et hébergement à long terme: à la recherche d'un développement optimum / G. Tinturier. - Economic evaluation of six scenarios for the treatment of stones in the kidney and ureter by surgery or ESWL / MS Patel et al. - Technology assessment and medical practice / F. Gutzwiller. - Technology assessment and health policy / SJ Reiser. - Global programme on appropriate technology for health, its role and place within WHO / K. Staehr Johansen.

Perspectivas tecnológicas: educación superior en Iberoamérica 2012-2017

La sèrie d'informes Horizon és el resultat més tangible del Projecte Horizon del New Media Consortium, un esforç de recerca qualitativa iniciat el 2002, que identifica i descriu les tecnologies emergents amb més potencial d'impacte en l'ensenyament, l'aprenentatge, la recerca i la expressió creativa en l'àmbit educatiu global. Aquest volum, Perspectivas tecnológicas: educación superior en Iberoamérica 2012-2017, és la segona edició del Projecte Horizon Iberoamèrica i se centra en la investigació en els països de la regió Iberoamericana (incloent-hi tota Llatinoamèrica, Espanya i Portugal) i en l'àmbit de l'educació superior. Ha estat produït pel NMC i l'eLearn Center de la Universitat Oberta de Catalunya.

Perspectives tecnològiques: educació superior a Iberoamèrica 2012-2017

La sèrie d'informes Horizon és el resultat més tangible del Projecte Horizon del New Media Consortium, un esforç de recerca qualitativa iniciat el 2002, que identifica i descriu les tecnologies emergents amb més potencial d'impacte en l'ensenyament, l'aprenentatge, la recerca i la expressió creativa en l'àmbit educatiu global. Aquest volum, Perspectives tecnològiques: educació superior a Iberoamèrica 2012-2017, és la segona edició del Projecte Horizon Iberoamèrica i se centra en la investigació en els països de la regió Iberoamericana (incloent-hi tota Llatinoamèrica, Espanya i Portugal) i en l'àmbit de l'educació superior. Ha estat produït pel NMC i l'eLearn Center de la Universitat Oberta de Catalunya.

Technology Outlook: Iberoamerican Tertiary Education 2012-2017

La sèrie d'informes Horizon és el resultat més tangible del Projecte Horizon del New Media Consortium, un esforç de recerca qualitativa iniciat el 2002, que identifica i descriu les tecnologies emergents amb més potencial d'impacte en l'ensenyament, l'aprenentatge, la recerca i la expressió creativa en l'àmbit educatiu global. Aquest volum, Technology Outlook: Iberoamerican Tertiary Education 2012-2017, és la segona edició del Projecte Horizon Iberoamèrica i se centra en la investigació en els països de la regió Iberoamericana (incloent-hi tota Llatinoamèrica, Espanya i Portugal) i en l'àmbit de l'educació superior. Ha estat produït pel NMC i l'eLearn Center de la Universitat Oberta de Catalunya.

Key cognitive and collaborative aptitudes in ambulance people

The aim of our study was to identify and document some key cognitive aptitudes used by ambulance people in emergency situations. Better knowing such aptitudes is necessary for a school of ambulance people in order to improve the selection and education of students. The idea was to better consider real work activity requirements and characteristics, and to develop and implement genuine educational content and selection tools. We followed the work activity of ambulance professionals involved in real emergency situations. Some interventions were filmed and post-analyzed. We completed and validated our analysis by means of interviews with ambulance personnel. We selected some video sequences and used them as a support for the interviews. We identified and documented many different key aptitudes like orientation and spatial sense, the capacity to perform complex cognitive tasks and delicate manipulations in the context of divided attention, as well as diverse aptitudes relevant in collaborative work.

The Adoption of Technologies, Policies, and Systems for Improving Fleet Fuel Performance, 2007

The dramatic rise in fuel prices and growing environmental concerns are pressing freight transportation companies to pursue new systems and methods to improve fuel efficiency and reduce their environmental impact. While select major carriers appear to be leading efforts to adopt technologies that support a dramatic improvement in fuel performance, there appears to be little understanding as to the breadth and depth of efforts being taken by the broader motor carrier community, consisting of over 20,000 companies of all sizes. The purpose of this study was to investigate the level of adoption of technologies and policies to support improved fuel efficiency among motor carrier fleets.

Report of the Workshop on Intelligent Construction for Earthworks: April 14-16, 2009

The objectives of this workshop were to update the strategies identified during the 2008 workshop; provide a collaborative exchange of ideas and experiences; share research results; increase participants' knowledge; develop research, education, and implementation initiatives for intelligent compaction (IC) and automated machine guidance (AMG) technologies; and develop strategies to move forward. The 2 1/2 day workshop was organized as follows: Day 1: Review of 2008 workshop proceedings, technical presentations on IC and AMG technologies, and participating state department of transportation (DOT) briefings. Day 2: Industry/equipment manufacturer presentations and breakout interactive sessions on three topic areas. Day 3: Breakout session summary reporting and panel discussion involving state DOT, contractor, and industry representatives. The results of the breakout sessions on day 2 were analyzed to identify the priorities for advancement in each of the three topic areas. Key issues for each topic were prioritized by reviewing the recorder's notes in detail, finding common topics among sessions, and summarizing the participant votes.