Postoperative pain assessment in hospitalised patients: National survey and secondary data analysis

BackgroundMeasuring pain is important for the adequate pain management of postoperative patients. The actual compliance with pain assessment in postoperative patients after implementation of a national safety program is unknown.ObjectivesThe aim of this study is to examine the compliance with pain assessment in postoperative patients after implementation of a national safety program, according to the national quality indicators for pain assessment in postoperative patients. Furthermore, organisational factors associated with this compliance were determined.Study designIn this study, two data sources were used: 1) data from an evaluation study of the Dutch Hospital Patient Safety Program; and 2) data from a questionnaire survey.MethodsThe compliance with two different pain process indicators was determined: 1) 3 pain measurements a day, all three full days after surgery; and 2) ≥1 pain measurement a day, all three full days after surgery. Multilevel logistic regression analysis was used to investigate the association between organisational factors in hospitals and compliance with pain process indicators.ResultsData of 3895 patient records from 16 hospitals was included in this study. In 12% of the postoperative patients, pain was measured 3 times a day, all three full days after surgery. In 53% of the postoperative patients, pain was measured ≥1 time a day, all three full days after surgery. Compliance was highest in general hospitals compared to tertiary teaching and academic hospitals, and was statistically significantly higher at the surgery and surgical oncology department compared to the other departments.ConclusionsLow compliance was shown with pain assessment in postoperative patients, according to the process indicator pain after surgery in Dutch hospitals. This suggests that the implementation of measuring pain in hospitals is still insufficient.     

Effects of Individualized Bone Density Feedback and Educational Interventions on Osteoporosis Knowledge and Self-Efficacy: A 12-Yr Prospective Study

This is 12-yr follow-up of a randomized controlled trial aimed to evaluate the long-term effects of bone density feedback and osteoporosis education on osteoporosis knowledge and self-efficacy. We examined the effects of feedback of bone density-defined fracture risk (high [T-score <0] vs normal [T-score ≥0] risk) and 2 different educational interventions (the group-based Osteoporosis Prevention and Self-Management Course [OPSMC] vs an osteoporosis leaflet) on osteoporosis knowledge and self-efficacy in women aged 25–44. Seventy-four percent (N = 347) of 470 participants at baseline participated at 12 yr. Overall, the scores were higher for osteoporosis knowledge but lower for self-efficacy at 12 yr. However, neither intervention had an effect on the change in knowledge (T-score, β = 0.4, 95% confidence interval [CI] = −0.3 to 1.1; OPSMC, β = 0.2, 95% CI = −0.5 to 0.9) or self-efficacy (T-score, β = −1.1, 95% CI = −2.5 to 0.4; OPSMC, β = −0.2, 95% CI = −1.6 to 1.3). Women in households with an unemployed main financial provider had a decrease in knowledge at 12 yr compared with those in households with an employed main financial provider in whom knowledge increased (β = −1.95, 95% CI = −3.40 to −0.50), but there were no other predictors of change identified for knowledge or self-efficacy. In conclusion, beneficial effects of both OPSMC and feedback of high fracture risk on osteoporosis knowledge seen previously at 2 yr were not sustained after 12 yr although overall knowledge was still significantly higher than at baseline. Neither intervention improved osteoporosis self-efficacy. More frequent osteoporosis education and bone density feedback may be required to maintain knowledge, and other approaches to improve self-efficacy are necessary.     

A quality improvement initiative to increase Tdap (tetanus,diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children’s hospital

ObjectivesHealth care providers (HCP) are at high risk of acquiring and transmitting pertussis to susceptible family members, co-workers, and patients. Public health authorities recommend administering a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to all adults, including HCP, to increase adult immunity to pertussis. We set a quality improvement goal to increase Tdap vaccination coverage among HCP who provided direct patient care at a children’s hospital from 58% to 90% over 18 months.DesignA multidisciplinary working group comprised of Occupational Health Program (OHP) staff and representatives of various medical services drew from a variety of qualitative methods and previous studies of vaccination programs in the healthcare system to understand barriers to Tdap vaccination within the institution and to develop interventions to increase vaccination rates.InterventionsInterventions included changes to OHP processes, a general education campaign, improved access to vaccine, and personal engagement of HCP by task force members.ResultsOverall vaccination rates increased to 90% over 15 months, a rate that has been sustained by systematically assessing new employees’ vaccination status and vaccinating those without documentation of previous Tdap vaccination.ConclusionsTdap vaccination coverage in our institution was significantly increased by an intensive, multipronged educational campaign, and by improving processes of screening and vaccination of HCP. The use of direct engagement of vaccine hesitant populations to increase vaccination rates warrants further study.     

Dedicated teaching block for undergraduate geriatric medicine improves knowledge

Aim: This paper describes the performance of 5th year medical students in multiple choice question (MCQ) examinations before and after a geriatric medicine teaching block. Methods: A 30‐question MCQ test was administered at the start and a 45‐question one at the end of the course. Results: There was a statistically significant improvement in the MCQ scores from a mean of 62% (SD 10.4) to 75.2% (SD 7.9) (P < 0.001). Total mean scores for the University of California, Los Angeles (UCLA) Geriatrics Knowledge test improved from 65% (SD 10.4) to 73%(SD 11.7) (P < 0.001). Total mean scores for the American Geriatric Society (AGS) Geriatrics Review Syllabus MCQs improved from 59.3% (SD 17.0) to 78.1% (SD 12.1) (P < 0.001). Post‐course, students scored equally well in the new questions, the validated UCLA test and the AGS questions. Conclusion: An undergraduate geriatric medicine clinical teaching block in senior clinical years can increase students' knowledge in geriatric medicine.     

Why common carrier and network neutrality principles apply to the Nationwide Health Information Network (NWHIN)

The Office of the National Coordinator will be defining the architecture of the Nationwide Health Information Network (NWHIN) together with the proposed HealtheWay public/private partnership as a development and funding strategy. There are a number of open questions—for example, what is the best way to realize the benefits of health information exchange? How valuable are regional health information organizations in comparison with a more direct approach? What is the role of the carriers in delivering this service? The NWHIN is to exist for the public good, and thus shares many traits of the common law notion of ‘common carriage’ or ‘public calling,’ the modern term for which is network neutrality. Recent policy debates in Congress and resulting potential regulation have implications for key stakeholders within healthcare that use or provide services, and for those who exchange information. To date, there has been little policy debate or discussion about the implications of a neutral NWHIN. This paper frames the discussion for future policy debate in healthcare by providing a brief education and summary of the modern version of common carriage, of the key stakeholder positions in healthcare, and of the potential implications of the network neutrality debate within healthcare.     

上海市某健康社区居民健康知识与健康行为干预效果

目的 探索健康社区建设工作对提高居民健康知识知晓程度与促进居民健康行为形成水平的效果.方法 采用多阶段抽样方法,使用统一的调查问卷,分别在2009年4月和2011年10月,对上海市某健康社区所辖11个镇/街道的768名居民进行干预前的基线调查和干预后的追踪调查.结果 干预后该健康社区居民对健康知识的知晓率(82.69％)高于干预前(70.63％),干预后的健康行为形成率(74.36％)高于干预前(63.06％),干预前后健康知识知晓率的差异和干预前后健康行为形成率的差异均有统计学意义(P＜0.01).结论 健康社区建设工作可以有效提高居民对健康知识的知晓程度,可以有效促进居民健康行为的形成水平,应持续大力推广健康社区建设工作.