A collaboration to improve perioperative acute pain care at the University Teaching Hospital of Butare, Rwanda

BACKGROUND: A perioperative acute pain care program integrating standardized assessment and treatment forms into pain care was developed and implemented at an urban hospital in Rwanda through a collaboration between Rwandan and Canadian experts. This study evaluated the perioperative acute pain care program using a quality improvement lens. METHODS: Using the Model for Improvement: Plan, Do, Study, Act (PDSA) cycle, a mixed methods evaluation was performed. Over one year, 519 randomized patient chart audits were conducted and analyzed through control charts. Through purposeful sampling, focus groups comprised ofsurgeons and nurses (N=34) involved in pain care in surgery, obstetrics, and anesthesiology were performed and analyzed via thematic coding. RESULTS: The average attempted form completion rate across all forms varied monthly between 56-93% (mean=79%; median=81%). Across all forms, both the mean and median total number of errors per form were 12.5. Enablers of form use included improved pain care for patients and feelings of professional satisfaction. Program implementation was challenged by resource constraints, form integration, and health care provider training. CONCLUSION: Future quality improvement collaborations should identify and address improved pain care while working with local experts to ensure PDSA cycles are continuous, and evidence based

Effet de l’exercice physique sur les processus immunologiques chez les diabétiques de type 2 : évolution de l’interleukine-6.

Le diabète de type 2 est une pathologie dont les complications peuvent souvent engendrer des processus inflammatoires chroniques. Notre étude a pour objectif de déterminer si l’interleukine-6 constitue un paramètre d’évaluation des complications du diabète de type 2 et si sa modulation par l’exercice physique peut être considérée comme un moyen thérapeutique pour cette maladie. Cette étude, effectuée auprès de 30 femmes diabétiques du Burundi, âgées de 30 à 60 ans, a permis de conclure que l’élévation du taux de l’IL-6 sous l’effet de l’exercice physique soutenu, régule non seulement l’activité inflammatoire chez les diabétiques de type 2 mais elle améliore également leur profil métabolique. Il constitue en outre un indice diagnostique de la complication du diabète de type 2.Mots clés : Diabète de type 2, interleukine-6, exercice physique.English AbstractThe diabetes of the type 2 is a pathology of which the complications can often generate chronic inflammatory processes. Our study aims to determine if the interleukin-6 constitutes a parameter of evaluation of the complications of the type 2 diabetes and if its modulation by the physical exercise can be regarded as a therapeutic means for this disease.This study, carried out near 30 diabetic women of Burundi, old from 30 to 60 years, made it possible to conclude that the rise in the rate of the IL-6 under the effect of the constant physical exercise controls not only the inflammatory activity in the type 2 diabetics but it improves also their metabolic profile. It constitutes moreover a diagnostic index of the complication of the type 2 diabetes.Key words: Type 2 diabetes, interleukin- 6, and physical exercise