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A focus group was held July 13, 2007 to receive feedback Key Results of M&M Focus Group: from residents about the perceived strengths and weaknesses of the Provide more time at the end of the sessions for action plancurrent structure of M&M conferences. This evaluation was conning. ducted in response to ongoing quality improvement for medical Expand opportunities for residents to be involved in quality education in Internal Medicine. improvement groups. Create balance between systems improvement and clinical The current M&M conferences were restructured in the decision making conferences. fall of 2004 to help meet national requirements for the integration of systems quality improvement into resident curriculum. Future M&Ms: As a result of these recommendations, and through conThe ACGME institutional requirements include the statement that tinued planning by the M&M faculty facilitators, these recommento the degree possible and in conformance with state law, residents dations will be implemented in the M&M format. Beginning in should participate in appropriate components of the institution's August , watch for the following modifications: performance improvement program. Focus of cases will alternate monthly between systems problems and clinical decision making. The Association of American Medical Colleges AAMC ; in 2001 More time will be provided for small group and large group wrote that schools of medicine need to develop a program of action planning for systems issues. learning in medical school to educate students about the assess- Residents will be given more opportunities to volunteer for ment and improvement of the quality of healthcare. quality improvement groups and to provide updates on progress. Also, the Institute of Medicine IOM ; 2003 ; wrote a report called Health Professions Education A Bridge to Quality, in Thank you for your input into improving the M&M conwhich it is stated that all health professionals should be educated ferences. Internal Medicine will continue to evaluate the effectiveto deliver patient-centered care as members of an interdisciplinary ness of this learning opportunity over time. , Please continue to team, emphasizing evidence-based practice, quality improvement provide feedback for improvement in both the conference evaluaapproaches, and informatics. A reviewer of that report was our tion forms and future focus and work groups. own Dr. Linda Headrick, Assistant Dean, School of Medicine, University of Missouri. Even if you're on the right track, you'll get run over if you just sit there. - Will Rogers and accupril!
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The United States. Qual Life Res 2000; 9: 887-900. Chren M.M. Understanding research about quality of life and otherhealth outcomes. J Cutaneous Med Surg 1999; 3 6 ; : 312-5. 38. Carr AJ, Higginson IJ. Are quality of life measures patient centered? Br Med J 2001; 322: 1357-60. Carr AJ, Gibson B, Robinson PG. Is quality of life defined by expectations or experience? Br Med J 2001; 322: 1240-3. Schipper H, Clinch JJ, Olweny CL. Quality of life studies: Definitions and conceptual issues. In: Spilker B, editor. Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia: Lippincott-Raven; 1996. p. 11-24. 41. Leidy NK, Revicki DA, Geneste B. Recommendations for evaluating the validity of quality of life claims for labeling and promotion. Value Health 1999; 2: 113-27. Drummond MF, O'Brien BJ, Stoddart GL, Torrance WG. Methods for the economic evaluation of health care programmes. York, UK: Oxford University Press; 1997. 43. Cummins RA. Directory of Instruments to Measure Quality of Life and Cognate Areas. 2nd ed. Melbourne: School of Psychology, Deakin University; 1996. 44. Liu BC. Quality of life indicators in US metropolitan areas: a statistical analysis. NewYork: Praeger Publishers; 1976. 45. Jenney M, Campbell S. Measuring quality of life. Arch Dis Child 1997; 77 4 ; : 347-50. 46. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intemal Med 1993; 118: 622-9. Muldoon MF, Barger SD, Flory JD, Manuck SB. What are quality of life measurements measuring? Br Med J 1998; 316 7130 ; : 542-5. 48. Dempster M, Donnelly M. Selecting a measure of health related quality of life. Soc Work Health Care 2000; 32 1 ; : 45-56. 49. Kishner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985; 38: 27-36. Wilkin D, Hallam L, Doggett MA. Measures of need and outcome for primary health care. Oxford: Oxford University Press; 1992. 51. Salyers MP, Bosworth HB, Swanson JW, Lamb-Pagone J, Osher FC. Reliability and validity of the SF-12 health survey among people with severe mental illness. Med Care 2000; 38 11 ; : 1141-50. 52. Kopec JA, Schultz SE, Goel V, Ivan Williams J. Can the health utilities index measure change? Med Care 2001; 39 6 ; : 56274. 53. Liang MH. Longitudinal construct validity: establishment of clinical meaning in patient evaluative instruments. Med Care 2000; 38 Suppl 9: 84-90. 54. Wrosch C, Scheier MF. Personality and quality of life: the importance of optimism and goal adjustment. Qual Life Res 2003; 12 Suppl 1: 59-72. 55. Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev 1989; 96: 234-54. Hemingway H, Stafford M, Stansfeld S, Shipley M, Marmot M. Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. Br Med J 1997; 315 7118 ; : 1273-9. 57. Guyatt GH, Deyo RA, Charlson M, Levine MN, Mitchell A. Responsiveness and validity in health status measurement: a clarification. Clin Epidemiol 1989; 42: 403-8. Ware JE Jr. Standards for validating health measures: definition and content. J Chronic Dis 1987; 40: 473-80. Centers for Disease Control and Prevention CDC ; . Public, because zovirax ophthalmic.
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Cal activity and using the prostheses will help your pain, there is no cure for this pain but it usually gets less with time, are all important messages. Information will become available on follow-up data after cessation of medication to look for any sustained improvement. Conclusions It was possible to run an effective intervention for neuropathic pain in Sierra Leone with intermittent expert involvement. There are unmet needs in the area of pain, and simple measures can make an impact on them. Logistical constraints, in particular the national medical infrastructure and training, make it difficult for such an intervention to function in the long-term. MSF have been able to develop a protocol for the assessment and treatment of neuropathic pain that may be useful in the other difficult settings in which they work.
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