Involvement of family physicians in structured programs for chronic diseases or multi-morbidity in Switzerland.

The increasing prevalence of chronic diseases and multi-morbidity represents challenges for health systems worldwide. In that perspective, the current organization of healthcare delivery, fragmentation of care, limited use of evidence-based guidelines and patients'insufficient empowerment are some reasons explaining the current limited effectiveness of the management of chronically ill patients. Based on theoretical models such as the Chronic Care Model (CCM), initiatives targeting improvements in the care of patients with chronic diseases have been implemented worldwide since more than a decade. Their development in Switzerland, a health system where more than half of practices are still single handed [6], is only recent and infrequent. Structured programs for patients with chronic diseases or multimorbidity usually propose patient-centered interventions and consider an integrative multidisciplinary approach. Currently, little is known on the existence of such programs and on the role of family physicians (FPs)within these programs, in Switzerland. The objective of this study was to identify and describe current structured programs targeting chronic diseases or multi-morbidity in Switzerland. This may help in examining innovative approaches that are only developed locally but would deserve wider interest for further implementation. We conducted a telephone-based survey between June and November 2013 and contacted systematically key institutions, informants and stakeholders nationwide and in the 26 cantons...

Abolishing mammography screening programs?

Biller-Andorno and Jüni (2014), in a widely debated commentary published in the May 22 issue of the New England Journal of Medicine, accept the concept that mammography every 2 years from age 50 can decrease breast cancer mortality by 20%, that is, from five to four deaths per 1000 women over a 10-year period. Both the absolute and the relative risk of breast cancer death may vary depending on the baseline mortality rates in various populations and on the impact of screening mammography in reducing breast cancer mortality, which may well vary around the 20% estimate adopted. We accept, therefore, that there are still uncertainties in the absolute and relative impact of mammography screening on breast cancer mortality, given the different study schemes and mammography intervals, the differences in populations, and the continuous improvements in technology (Warner, 2011; Independent UK Panel on Breast Cancer Screening, 2012). We also agree on the observation that mammography has an appreciable impact on breast cancer mortality (Bosetti et al., 2012), but clearly a much smaller one on total mortality.

Tuning Performance of Multi-threaded programs

Diplomityö tarkastelee säikeistettyä ohjelmointia rinnakkaisohjelmoinnin ylemmällä hierarkiatasolla tarkastellen erityisesti hypersäikeistysteknologiaa. Työssä tarkastellaan hypersäikeistyksen hyviä ja huonoja puolia sekä sen vaikutuksia rinnakkaisalgoritmeihin. Työn tavoitteena oli ymmärtää Intel Pentium 4 prosessorin hypersäikeistyksen toteutus ja mahdollistaa sen hyödyntäminen, missä se tuo suorituskyvyllistä etua. Työssä kerättiin ja analysoitiin suorituskykytietoa ajamalla suuri joukko suorituskykytestejä eri olosuhteissa (muistin käsittely, kääntäjän asetukset, ympäristömuuttujat...). Työssä tarkasteltiin kahdentyyppisiä algoritmeja: matriisioperaatioita ja lajittelua. Näissä sovelluksissa on säännöllinen muistinkäyttökuvio, mikä on kaksiteräinen miekka. Se on etu aritmeettis-loogisissa prosessoinnissa, mutta toisaalta huonontaa muistin suorituskykyä. Syynä siihen on nykyaikaisten prosessorien erittäin hyvä raaka suorituskyky säännöllistä dataa käsiteltäessä, mutta muistiarkkitehtuuria rajoittaa välimuistien koko ja useat puskurit. Kun ongelman koko ylittää tietyn rajan, todellinen suorituskyky voi pudota murto-osaan huippusuorituskyvystä.

The Swiss reform of the allocation of tasks : The conventions-programs as a new partnership model for vertical cooperation ?

This research examines the impacts of the Swiss reform of the allocation of tasks which was accepted in 2004 and implemented in 2008 to "re-assign" the responsibilities between the federal government and the cantons. The public tasks were redistributed, according to the leading and fundamental principle of subsidiarity. Seven tasks came under exclusive federal responsibility; ten came under the control of the cantons; and twenty-two "common tasks" were allocated to both the Confederation and the cantons. For these common tasks it wasn't possible to separate the management and the implementation. In order to deal with nineteen of them, the reform introduced the conventions-programs (CPs), which are public law contracts signed by the Confederation with each canton. These CPs are generally valid for periods of four years (2008-11, 2012-15 and 2016-19, respectively). The third period is currently being prepared. By using the principal-agent theory I examine how contracts can improve political relations between a principal (Confederation) and an agent (canton). I also provide a first qualitative analysis by examining the impacts of these contracts on the vertical cooperation and on the implication of different actors by focusing my study on five CPs - protection of cultural heritage and conservation of historic monuments, encouragement of the integration of foreigners, economic development, protection against noise and protection of the nature and landscape - applied in five cantons, which represents twenty-five cases studies.

Finding an apprenticeship : hidden curriculum and social consequences

In Switzerland, the majority of students are oriented towards professional training after compulsory schooling. At this stage, one of the biggest challenges for them is to find an apprenticeship position. Matching supply and demand is a complex process that not only excludes some students from having direct access to professional training but also forces them to make early choices regarding their future sector of employment. So, how does one find an apprenticeship? And what do the students' descriptions of their search for apprenticeships reveal about the institutional determinants of social inequalities at play in the system? Based on 29 interviews conducted in 2014 with 23 apprentices and 6 recruiters in the Canton of Vaud, this article interrogates how the dimensions of educational and social trajectories combine to affect access to apprenticeships and are accentuated by recruiters using a "hidden curriculum" during the recruitment process. A hidden curriculum consists of knowledge and skills not taught by the educational institution but which appear decisive in obtaining an apprenticeship. By analysing the contrasting experiences of students in their search for an apprenticeship, we identify four types of trajectories that explain different types of school-to-apprenticeship transitions. We show how these determinants are reinforced by the "hidden curriculum" of recruitment based on the soft skills of feeling, autonomy, anticipation and reflexivity that are assessed in the context of recruitment interactions. The discussion section debates how the criteria that appear to be used to identify the "right apprentice" tend to (re)produce inequalities between students. This not only depends on their academic results but also on their social and cultural skills, their ability to anticipate their choices and, more widely, their ability to be a subject in their recruitment search. "The Subject is neither the individual, nor the self, but the work through which an individual transforms into an actor, meaning an agent able to transform his/her situation instead of reproducing it." (Touraine, 1992, p.476).

Helping medical students to acquire a deeper understanding of truth-telling.

PROBLEM: Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. INTERVENTION: We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news. CONTEXT: This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs. OUTCOME: Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. LESSONS LEARNED: Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

Facilitating coordination improvement efforts in cross-functional process development programs

Business process improvement is a common approach in increasing the effectiveness of an organization. It can be seen as an effort to increase coordination between units. Process improvement has proved to be challenging, and most management consultation firms facilitate organizations in this kind of initiatives. Cross-functional improvement is one of the main areas for internal consultants as well. However, the needs, challenges and means of cross-functional help have been rarely discussed in the literature. The objective of this thesis is on one hand to present a conceptual and descriptive framework to help understand the challenges of facilitating coordination improvement efforts in cross-functional improvement programs, and on the other hand to develop and test feasible solutions for some facilitation situations. The research questions are: 1. Why and in what kind of situations do organizations need help in developing coordination in cross-functional processes? 2. How can a facilitator help organizations in improving coordination to develop cross-functional processes? The study consists of two parts. The first part is an overview of the dissertation, and the second part comprises six research publications. The theoretical background for the study are the differentiation causing challenges in cross-functional settings, the coordination needed to improve processes, change management principles, methods and tools, and consultation practises. Three of the publications introduce tools for helping in developing prerequisites, planning responsibilities and supporting learning during the cross-functional program. The three other papers present frameworks to help understand and analyse the improvement situation. The main methodological approaches used in this study are design science research, action research and case research. The research data has been collected from ten cases representing different kinds of organizations, processes and developing situations. The data has been collected mainly by observation, semi-structured interviews and questionnaires. The research contributes to the rare literature combining coordination theories and process improvement practises. It also provides additional understanding of a holistic point of view in process improvement situations. The most important contribution is the addition to the theories of facilitating change in process improvement situations. From the managerial point of view, this study gives advice to managers and consultants in planning and executing cross-functional programs. The main factors increasing the need for facilitation are the challenges for differentiation, challenges of organizational change in general, and the novelty of initiatives and improvement practices concerning process development. Organizations need help in creating the prerequisites to change, in planning initiatives, easing conflict management and collaboration between groups, as well as supporting the learning of cross-functional improvement. The main challenges of facilitation are combining the different roles as a consultant, maintaining the ownership for the improvement project with the client, and supporting learning in the client organization.

La Inclusió dels alumnes amb necessitats educatives especials. Accés al currículum ordinari a través dels Plans Individualitzats. Traducció i adaptació de l’SPOT (instrument per analitzar els PIs).

Actualment, és cada vegada més present en la nostra societat la paraula inclusió i més concretament en el nostre àmbit educatiu, el concepte d’educació inclusiva. Aquest treball pretén presentar una eina adaptada i traduïda al català anomenada Student Program Observation Tools, la qual serveix per fer un anàlisi d’una de les mesures d’atenció a la diversitat: els Plans Individualitzats, per tal de millorar-ne el contingut i ésser una ajuda per a les escoles però també perquè els alumnes amb necessitats educatives especials puguin tenir accés al currículum ordinari com la resta dels seus companys de classe.

La Incidencia de las nuevas tecnologías en los hábitos formativos de los estudiantes de magisterio = The Impact of new technologies in the learning habits of teacher students

Este trabajo persigue dos objetivos: el primero es analizar el uso de las TIC en un grupo de estudiantes de segundo curso de Magisterio de la Universidad de Girona; el segundo es analizar los documentos normativos legales que establecen el currículum de educación primaria en Cataluña para observar qué tipo de papel juegan las TIC en las nuevas programaciones educativas. La primera parte se ha llevado a cabo mediante una encuesta, cuyos resultados permiten observar tres aspectos distintos: el primero, que una parte considerable del grupo considera las TIC más como un complemento para el aprendizaje que como una forma de aprendizaje; el segundo, que a pesar de hacer un uso considerable de las TIC, el conocimiento que tienen de ellas es muy básico y utilizan aplicaciones muy genéricas; y el tercero es que una parte de sus propuestas didácticas para el uso de las TIC son propuestas tradicionales simplemente adaptadas a un nuevo instrumento, sin buscar realmente la innovación que puede suponer la incorporación de las TIC. En la segunda parte del artículo, a partir del análisis e interpretación de los documentos legales que establecen el currículum de Educación Primaria, se observa que en un mismo documento conviven aserciones sobre las TIC como complemento al aprendizaje de contenidos con otras formulaciones que consideran las TIC como constructoras de conocimiento. A partir del perfil de los estudiantes y del estado de los documentos legales, al final del artículo se hacen propuestas para formar al futuro maestro teniendo en cuenta las TIC como herramientas básicas de conocimiento

Building a Social Education curriculum based on Professional Competences : the experience of University of Girona

This article describes the process of adapting Social Education studies to the European Higher Education Area undertaken by a team of the teaching staff at the University of Girona (Spain). The aim of the experience is to build a curriculum based on thecompetencies recognized as such by professionals in the field of social education in our region. The article specifies the development of the various phases, each involving the active participation of professionals and teaching staff from the universities. To conclude, main characteristics of the curriculum are highlighted

Optimización y aproximación al problema de la regresión simbólica a través de Straight Line Programs (SLP's) y algoritmos genéticos : Entrenamiento genético de SLP's

El problema de la regresión simbólica consiste en el aprendizaje, a partir de un conjunto muestra de datos obtenidos experimentalmente, de una función desconocida. Los métodos evolutivos han demostrado su eficiencia en la resolución de instancias de dicho problema. En este proyecto se propone una nueva estrategia evolutiva, a través de algoritmos genéticos, basada en una nueva estructura de datos denominada Straight Line Program (SLP) y que representa en este caso expresiones simbólicas. A partir de un SLP universal, que depende de una serie de parámetros cuya especialización proporciona SLP's concretos del espacio de búsqueda, la estrategia trata de encontrar los parámetros óptimos para que el SLP universal represente la función que mejor se aproxime al conjunto de puntos muestra. De manera conceptual, este proyecto consiste en un entrenamiento genético del SLP universal, utilizando los puntos muestra como conjunto de entrenamiento, para resolver el problema de la regresión simbólica.