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OBJECTIVE: Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. DESIGN: We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was < or =3. We then implemented four separate "plan-do-study-act" cycles to improve pain assessment and treatment. MAIN OUTCOME MEASURES: We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment. RESULTS: Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%. CONCLUSION: Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.  相似文献
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The interest of social scientists in complexity theory has developed rapidly in recent years. Here, I consider briefly the primary characteristics of complexity theory, with particular emphasis given to relations and networks, non-linearity, emergence, and hybrids. I assess the 'added value' compared with other, existing perspectives that emphasise relationality and connectedness. I also consider the philosophical underpinnings of complexity theory and its reliance on metaphor. As a vehicle for moving away from reductionist accounts, complexity theory potentially has much to say to those interested in research on health inequalities, spatial diffusion, emerging and resurgent infections, and risk. These and other applications in health geography that have invoked complexity theory are examined in the paper. Finally, I consider some of the missing elements in complexity theory and argue that while it is refreshing to see a fruitful line of theoretical debate in health geography, we need good empirical work to illuminate it.  相似文献
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Systematic reviews of health care education have consistently reported a lack of long-term effects, failure to use theory, and inadequate methodological rigour. Such findings have highlighted the lack of a clear causality and predictability in health care education research and therefore the inadequacy of a traditional scientific framework with its focus on analysis, prediction and control. This article argues that in order to develop an effective and standardised framework we must go beyond such a restrictive agenda and toward one that appreciates education as a complex adaptive system. It uses the example of interprofessional education in the UK to showcase its discussion.  相似文献
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