Introduction à la gouvernance clinique : historique, composantes et conceptualisation renouvelée pour l’amélioration de la qualité et de la performance des organisations de santé

La recherche de l’efficience et de l’excellence dans le domaine de la santé amène organisations et professionnels à travailler conjointement à l’amélioration des processus cliniques. La gouvernance clinique se veut un lieu d’action collective, de mobilisation de relations et de savoirs entre les acteurs impliqués dans l’organisation et la dispensation des soins et des services de santé. Elle est un espace où s’exerce l’autorité des différents acteurs en vue d’améliorer la qualité des soins et des services de santé. Elle vise à rapprocher la perspective organisationnelle et la perspective professionnelle par le développement et l’implantation d’initiatives visant les meilleures pratiques cliniques et organisationnelles.Pour améliorer la qualité des soins, Ferlie et al(MilbankQ2001.79:281)[1] suggèrent de créer un alignement entre les différents niveaux de soins: l’individu, l’équipe, l’organisation et le système. Les principes de la gouvernance clinique tentent de produire cette synergie en impliquant les professionnels dans le renouvellement de l’organisation et enimpliquant l’organisation dans l’instrumentation et la régulation des pratiques des professionnels en agissant aux différents niveaux de soins. Notre objectif est de présenter les origines du concept de gouvernance clinique, de décrire ses composantes et de proposer des assises théoriques afin demieux comprendre les dynamiquesde changement associées à la gouvernance clinique et faciliter son implantation. Nous exposons le courant britannique fondateur puis la notion de gouvernance développée par HatchuelA (Paris: ÉAube ; 2000) [2] et présentons les caractéristiques de l’organisation pouvant soutenir l’engagement des professionnels envers les principes de qualité. Enfin, nous proposons une modélisation renouvelée de la gouvernance clinique permettant de concilier l’organisationnel et la clinique, et de potentialiser les capacités d’action de chacun

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives

Introduction: Public health and primary care are often conceived as two entities providing complementary services within the health system. This scoping review aims to better understand how the two sectors interact by identifying their shared functions, and by identifying organizational models that could facilitate the interaction between the two domains. Methodology: We conducted a review of published literature using PubMed and CINAHL journal indices. Our search yielded 179 articles. We reviewed abstracts and retained 55 relevant articles. We developed an extraction grid, based on a conceptual framework of functions of public health and primary care, in order to evaluate the relevance of selected articles, classify the information according to their functional connection, and identify interactions between them. Results: Our search identified various activities through which public health can contribute to more effective primary care, and functions usually performed by primary care that seemed to support a population health approach. Most authors identified screening and immunization as actions that are carried out in primary care, but that can benefit from the support of public health. Health promotion and lifestyle modification are also shared responsibilities that can take the form of collective or individual intervention. The surveillance and protection function of public health, which actually takes place in primary care, consists of case identification for prevention or early treatment. Primary care is the setting where patients present, whereas public health has the role of investigation and of providing advice to clinical settings. Planning and evaluation are also emerging activities that concern both public health and primary care. Many authors recognized that public health provides tools that enhance the planning of primary care activities and are more aligned with the actual needs of populations. Others noted that public health is able to assess primary care in light of the changing health of populations, which may lead to better results for groups of patients. Conclusion: One of the routes to a better understanding of how public health and primary care organizations can better interact is to identify the different contexts in which they collaborate successfully. Our scoping review of the scientific and gray literature identified various ways by which public health and primary care either reinforce each other through their respective functions, or increasingly act in a collaborative manner to increase population health and improve health systems performance

Technical assistance to the Uganda AIDS Commission for operationallisation of the performance monitoring and management plan

The Uganda AIDS Commission (UAC) has committed to rolling out and making operational a new National Performance Monitoring and Management Plan (PMMP) to monitor and evaluate the national response to the HIV/AIDS epidemic. The PMMP has at its core the collection and processing of 58 national indicators, 47 district output indicators, and 22 outcome indicators covering prevention, care, treatment, and social support. The rollout is challenging because at least seven organizations must collaborate at the national level, and appropriate staff at the district level need to be in place and trained in new procedures of data collection. In addition, these data are to be supplied to district planning organizations that may or may not be functioning and the cooperation of civil society organizations is necessary even though their participation is voluntary. The Population Council and Makerere University School of Public Health were funded by USAID/Uganda to assist the UAC in assessing these challenges and determining appropriate procedures for creating a successful rollout of the new PMMP system. This final report focuses on recommendations for successful completion of the rollout

Systems, methods and apparatus for generation and verification of policies in autonomic computing systems

Described herein is a method that produces fully (mathematically) tractable development of policies for autonomic systems from requirements through to code generation. This method is illustrated through an example showing how user formulated policies can be translated into a formal mode which can then be converted to code. The requirements-based programming method described provides faster, higher quality development and maintenance of autonomic systems based on user formulation of policies.Further, the systems, methods and apparatus described herein provide a way of analyzing policies for autonomic systems and facilities the generation of provably correct implementations automatically, which in turn provides reduced development time, reduced testing requirements, guarantees of correctness of the implementation with respect to the policies specified at the outset, and provides a higher degree of confidence that the policies are both complete and reasonable. The ability to specify the policy for the management of a system and then automatically generate an equivalent implementation greatly improves the quality of software, the survivability of future missions, in particular when the system will operate untended in very remote environments, and greatly reduces development lead times and costs

Effective Scheduling of Multi-Load Automated Guided Vehicle in Spinning Mill: A Case Study

In the Flexible Manufacturing System (FMS), where material processing is carried out in the form of tasks from one department to another, the use of Automated Guided Vehicles (AGVs) is significant. The application of multiple-load AGVs can be understood to boost FMS throughput by multiple orders of magnitude. For the transportation of materials and items inside a warehouse or manufacturing plant, an AGV, a mobile robot, offers extraordinary industrial capabilities. The technique of allocating AGVs to tasks while taking into account the cost and time of operations is known as AGV scheduling. Most research has exclusively addressed single-objective optimization, whereas multi-objective scheduling of AGVs is a complex combinatorial process without a single solution, in contrast to single-objective scheduling. This paper presents the integrated Local Search Probability-based Memetic Water Cycle (LSPM-WC) algorithm using a spinning mill as a case study. The scheduling model’s goal is to maximize machine efficiency. The scheduling of the statistical tests demonstrated the applicability of the proposed model in lowering the makespan and fitness values. The mean AGV operating efficiency was higher than the other estimated models, and the LSPM-WC surpassed the different algorithms to produce the best result

Radio Detection of Cosmic Ray Air Shower by the CODALEMA Experiment

The possibilities of measuring Extremely High Energy Cosmic Rays (EHECR) by radio detection of electromagnetic pulses radiated during the development of extensive air showers in the atmosphere are investigated. We present the demonstrative CODALEMA experiment, set up at Nancay Radio-Observatory (France). The radio-decametric array has been adapted to measure radio transients in time coincidence between antennas.Comment: 4 pages, 4 figures, Proceedings of the 9th Pisa Meeting on Advanced Detectors, Isola d'Elba 2003, to be published in NIM

A Case Study of Processes Impacting Precipitation Phase and Intensity during the Vancouver 2010 Winter Olympics

Accurate forecasting of precipitation phase and intensity was critical information for many of the Olympic venue managers during the Vancouver 2010 Olympic and Paralympic Winter Games. Precipitation forecasting was complicated because of the complex terrain and warm coastal weather conditions in the Whistler area of British Columbia, Canada. The goal of this study is to analyze the processes impacting precipitation phase and intensity during a winter weather storm associated with rain and snow over complex terrain. The storm occurred during the second day of the Olympics when the downhill ski event was scheduled. At 0000 UTC 14 February, 2 h after the onset of precipitation, a rapid cooling was observed at the surface instrumentation sites. Precipitation was reported for 8 h, which coincided with the creation of a nearly 0°C isothermal layer, as well as a shift of the valley flow from up valley to down valley. Widespread snow was reported on Whistler Mountain with periods of rain at the mountain base despite the expectation derived from synoptic-scale models (15-km grid spacing) that the strong warm advection would maintain temperatures above freezing. Various model predictions are compared with observations, and the processes influencing the temperature, wind, and precipitation types are discussed. Overall, this case study provided a well-observed scenario of winter storms associated with rain and snow over complex terrain

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons : A systematic review of systematic reviews. The SENATOR project ONTOP series

This work was supported by the European Union Seventh Framework program (FP7/2007–2013) under grant agreement n° 305930Peer reviewedPostprin

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - Trial Protocol

Background: The aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients' current prescriptions by applying the published STOPP and START criteria, highlighting drug-drug and drug-disease interactions and providing non-pharmacological recommendations aimed at reducing the risk of incident delirium. Methods: We will conduct a multinational, pragmatic, parallel arm Prospective Randomized Open-label, Blinded Endpoint (PROBE) controlled trial. Patients with acute illnesses are screened for recruitment within 48 h of arrival to hospital and enrolled if they meet the relevant entry criteria. Participants' medical history, current prescriptions, select laboratory tests, electrocardiogram, cognitive status and functional status are collected and entered into a dedicated trial database. Patients are individually randomized with equal allocation ratio. Randomization is stratified by site and medical versus surgical admission, and uses random block sizes. Patients randomized to either arm receive standard routine pharmaceutical clinical care as it exists in each site. Additionally, in the intervention arm an individualized SENATOR-generated medication advice report based on the participant's clinical and medication data is placed in their medical record and a senior medical staff member is requested to review it and adopt any of its recommendations that they judge appropriate. The trial's primary outcome is the proportion of patients experiencing at least one adjudicated probable or certain, non-trivial ADR, during the index hospitalization, assessed at 14 days post-randomization or at index hospital discharge if it occurs earlier. Potential ADRs are identified retrospectively by the site researchers who complete a Potential Endpoint Form (one per type of event) that is adjudicated by a blinded, expert committee. All occurrences of 12 pre-specified events, which represent the majority of ADRs, are reported to the committee along with other suspected ADRs. Participants are followed up 12 (+/- 4) weeks post-index hospital discharge to assess medication quality and healthcare utilization. This is the first clinical trial to examine the effectiveness of a software intervention on incident ADRs and associated healthcare costs during hospitalization in older people with multi-morbidity and polypharmacy

Isostasie postglaciaire différentielle au lac-Saint-Jean (Québec) et implications sur la qualité de l’eau souterraine

Cette étude présente d’abord le pourtour complet du maximum marin (mer de Laflamme) au Lac-Saint-Jean (Québec) et la position du premier rivage lacustre développé pendant la remontée isostatique postglaciaire qui se poursuit toujours. Suit une discussion de l’origine possible des eaux salines diluées, localement présentes au Lac-Saint-Jean : eau marine postglaciaire, eaux sous glaciaires et vieilles eaux profondes du Bouclier canadien. This study describes first the complete outline of the highest marine level in the Lac-Saint-Jean area (Québec) as well as the position of the first shoreline of the fresh water lake that replaced the Laflamme sea during the last post glacial uplift (still ongoing). Then, the possible origin of the dilute salty waters found here and there in the Lac-Saint-Jean area is discussed: post glacial sea water, sub-glacial waters and deep Canadian Shield old waters