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Dubé C, Rabeneck L. Seven-day postcolonoscopy emergency department visits: What do they really measure? Gastrointest Endosc 2018; 87:526-528. [PMID: 29406932 DOI: 10.1016/j.gie.2017.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/22/2017] [Indexed: 02/08/2023]
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Murthy SK, Dubé C, Rostom A, Benchimol EI, Ducharme R, Sutradhar R, Rabeneck L, Paszat L, Tinmouth J. Risk of colorectal cancer after a negative colonoscopy in low-to-moderate risk individuals: impact of a 10-year colonoscopy. Endoscopy 2017; 49:1229-1236. [PMID: 28915524 DOI: 10.1055/s-0043-117402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background and study aims National societies recommend colorectal cancer (CRC) screening 10 years after a normal ("negative") colonoscopy in low-risk individuals. We studied the impact of a 10-year repeat colonoscopy on the risk of early incident CRC. Patients and methods We used health administrative data from Ontario, Canada, to conduct a population-based retrospective cohort study in 50 - 74-year-old individuals at low-to-moderate risk of CRC who had a negative colonoscopy between 1996 and 2001. We approximated exposure to repeat colonoscopy using an 8 - 12-year window. We excluded individuals who underwent lower endoscopy or colectomy, developed CRC, or were lost to follow-up between the baseline and repeat colonoscopies. We matched exposed individuals 1:1 to individuals who did not undergo lower endoscopy within 12 years for age, sex, and calendar year of baseline colonoscopy, and followed matched pairs for incident CRC. The primary analysis was multivariable hazards regression, adjusting for competing risks. Results A total of 13 350 matched pairs were observed for a median of 4.5 years (interquartile range 3.2 - 5.9 years). The cumulative probability of CRC following the matching date was 0.70 % (95 % confidence interval [CI] 0.42 % - 1.11 %) in individuals who underwent repeat colonoscopy and 0.77 % (95 %CI 0.48 % - 1.2 %) in individuals who did not undergo repeat colonoscopy. The adjusted hazard ratio for CRC was 0.91 (95 %CI 0.68 - 1.22). Conclusions We did not find an association between a second colonoscopy performed 10 years after a negative colonoscopy and early incident CRC. Our findings support the need for further studies on the utility of 10-year re-screening with colonoscopy in this setting.
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Dubé C, Yakubu M, McCurdy BR, Lischka A, Koné A, Walker MJ, Peirson L, Tinmouth J. Risk of Advanced Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality in People With Low-Risk Adenomas at Baseline Colonoscopy: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:1790-1801. [PMID: 29087393 DOI: 10.1038/ajg.2017.360] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 08/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis of the risk of advanced adenomas (AAs), colorectal cancer (CRC), and/or CRC-related death among individuals with low-risk adenomas (LRAs). METHODS We searched PubMed and Embase for studies published between January 2006 and July 2015. Quality and strength of the evidence were rated using the Newcastle-Ottawa Scale (NOS) and the GRADE framework, respectively. RESULTS Eleven observational studies (n=64,317) were included. A meta-analysis of eight cohort studies (n=10,139, 3 to 10 years' follow-up) showed a small but statistically significant increase in the incidence of AAs in individuals with LRAs compared with those with a normal baseline colonoscopy (RR 1.55 (95% CI 1.24-1.94); P=0.0001; I2=0%). The pooled 5-year cumulative incidence of AA was 3.28% (95% CI: 1.85-5.10%), 4.9% (95% CI: 3.18-6.97%), and 17.13% (95% CI: 11.97-23.0%) for the no adenoma, LRA, and AA baseline groups, respectively. Two studies, which could not be pooled, showed a reduction in the risk of CRC in individuals with LRAs compared with the general population (standardized incidence ratio 0.68 (95% CI 0.44-0.99) at a median follow-up of 7.7 years and OR 0.4 (95% CI 0.2-0.6) at 3-5 years). One large retrospective cohort study found a 25% reduction in CRC mortality in individuals with LRAs compared with the general population (SMR 0.75 (95% CI 0.63-0.88) at a median follow-up of 7.7 years). CONCLUSIONS We observed a small but significant increase in the risk of AAs in people with LRAs compared with those with a normal baseline colonoscopy, but compared with the general population, people with LRAs have significantly lower risks of CRC and of CRC-related mortality.
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Bruneau M, Bier N, Bourbonnais A, Ménard C, Dubé C. [P2–481]: BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: A TELECONSULTATION AND MENTORING PROJECT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tinmouth J, Vella ET, Baxter NN, Dubé C, Gould M, Hey A, Ismaila N, McCurdy BR, Paszat L. Colorectal Cancer Screening in Average Risk Populations: Evidence Summary. Can J Gastroenterol Hepatol 2016; 2016:2878149. [PMID: 27597935 PMCID: PMC5002289 DOI: 10.1155/2016/2878149] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.
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Dubé C, Rostom A. Training in gastrointestinal endoscopy: Preface. Best Pract Res Clin Gastroenterol 2016; 30:337-8. [PMID: 27345642 DOI: 10.1016/j.bpg.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 01/31/2023]
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Dubé C, Rostom A. Acquiring and maintaining competency in gastrointestinal endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:339-47. [PMID: 27345643 DOI: 10.1016/j.bpg.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 01/31/2023]
Abstract
In recent years, an important transformation has taken place in the field of gastrointestinal endoscopy training. Two important movements have helped initiate this transformation: patient centered quality and competency based training. Patient centered quality in endoscopy became an important focus for colorectal cancer screening programs, as it was acknowledged that colonoscopy services played a central role in the outcomes of screening. This prompted the need to close the quality loop through the development of innovative endoscopist training and upskilling programs. As well, the importance of leadership skills and leadership training was highlighted as a key factor in effective quality improvement. Competency-based training depends on well-defined goals of training and on the regular documentation and review of the learner's progress. This is facilitated by objective assessment and performance enhancing feedback, enabled by measurement tools that can provide a quantitative or qualitative assessment and identify areas in need of further development. Simulators and scope imagers can aid the acquisition of technical skills, particularly in the novice phase. These important advances in our evolving concepts around endoscopy training have also raised many questions, highlighting important knowledge gaps which, we hope, will be addressed in coming years.
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Ryczko D, Cone JJ, Alpert MH, Goetz L, Auclair F, Dubé C, Parent M, Roitman MF, Alford S, Dubuc R. A descending dopamine pathway conserved from basal vertebrates to mammals. Proc Natl Acad Sci U S A 2016; 113:E2440-9. [PMID: 27071118 PMCID: PMC4855556 DOI: 10.1073/pnas.1600684113] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dopamine neurons are classically known to modulate locomotion indirectly through ascending projections to the basal ganglia that project down to brainstem locomotor networks. Their loss in Parkinson's disease is devastating. In lampreys, we recently showed that brainstem networks also receive direct descending dopaminergic inputs that potentiate locomotor output. Here, we provide evidence that this descending dopaminergic pathway is conserved to higher vertebrates, including mammals. In salamanders, dopamine neurons projecting to the striatum or brainstem locomotor networks were partly intermingled. Stimulation of the dopaminergic region evoked dopamine release in brainstem locomotor networks and concurrent reticulospinal activity. In rats, some dopamine neurons projecting to the striatum also innervated the pedunculopontine nucleus, a known locomotor center, and stimulation of the dopaminergic region evoked pedunculopontine dopamine release in vivo. Finally, we found dopaminergic fibers in the human pedunculopontine nucleus. The conservation of a descending dopaminergic pathway across vertebrates warrants re-evaluating dopamine's role in locomotion.
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Candas B, Jobin G, Dubé C, Tousignant M, Abdeljelil AB, Grenier S, Gagnon MP. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review. Endosc Int Open 2016; 4:E118-33. [PMID: 26878037 PMCID: PMC4751006 DOI: 10.1055/s-0041-107901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/05/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIM Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. METHODS We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. RESULTS We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. CONCLUSION Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.
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Lewis N, Dorjee S, Dubé C, VanLeeuwen J, Sanchez J. Assessment of Effectiveness of Control Strategies Against Simulated Outbreaks of Highly Pathogenic Avian Influenza in Ontario, Canada. Transbound Emerg Dis 2015; 64:938-950. [PMID: 26666400 DOI: 10.1111/tbed.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Indexed: 11/28/2022]
Abstract
The North American Animal Disease Spread Model (NAADSM) is a stochastic model framework developed to simulate the spread of highly contagious diseases of livestock and poultry, such as foot-and-mouth disease and highly pathogenic avian influenza (HPAI). The objective of this study was to make recommendations on the most effective HPAI control policy for Canada, specifically, on the effect of different speeds of detection, effectiveness of movement restrictions and stamping-out and ring-culling strategies on the magnitude of an HPAI outbreak. In addition, the effect of introduction of infection in a range of multiple farms simultaneously was also evaluated. A total of 21 060 scenarios, defined as different combinations of parameters for various epidemiological conditions and control measures, were created to simulate the number of poultry flocks that would become infected as a result of an incursion of HPAI. Each scenario was parameterized in NAADSM and replicated 1000 times, generating the median number of flocks infected at the end of the simulated outbreak for each scenario. Negative binomial regression analysis was used to model significant explanatory variables of the median number of flocks infected at the end of each simulated outbreak for each of the 21 060 scenarios. The final model included the following explanatory variables: number and type initially infected flock(s), density of flocks within the county where the initially infected flock(s) was located, probability of transmission through indirect contact, subclinical spread of the infection, speed of detection and a two-way interaction between intensity of bird destruction strategy and movement restriction effectiveness to reduce transmission through direct and indirect contacts. The modelling results suggested that stamping out of the detected infected flocks, without ring culling, in combination with effective movement restrictions on direct and indirect contacts, would be the most appropriate policy for Ontario.
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Sanduleanu S, Dubé C. Monitoring postcolonoscopy colorectal cancers: dangerous crossroads? Gut 2015; 64:1188-90. [PMID: 25520266 DOI: 10.1136/gutjnl-2014-308908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/29/2014] [Indexed: 01/10/2023]
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Dubé C, Monetta L, Martínez-Cuitiño MM, Wilson MA. Independent effects of imageability and grammatical class in synonym judgement in aphasia. PSICOTHEMA 2014; 26:449-56. [PMID: 25340890 DOI: 10.7334/psicothema2014.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The grammatical class effect in aphasia, i.e. dissociated processing of words according to their respective grammatical class, has been attributed to either grammatical, lexical or semantic (i.e., imageability) deficits. This study explores the hypotheses of impaired semantic treatment as the source of the grammatical class effect in aphasia. METHOD A synonym judgement task that includes nouns and verbs of high and low imageability has been administered to 30 Spanish-speaking patients suffering from receptive or productive aphasia and 30 controls. RESULTS Normal controls performed significantly better than aphasic patients. Although globally the productive aphasics performed significantly better than the receptive aphasics, grammatical class (nouns better than verbs) and imageability (high imageability better than low imageability) affected performance in both subgroups. No significant interaction emerged between these two factors. CONCLUSION The results suggest that the grammatical class effect may emerge from semantic impairment and that it is -at least partially- independent of the imageability of words.
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Sanson R, Dubé C, Cork S, Frederickson R, Morley C. Simulation modelling of a hypothetical introduction of foot-and-mouth disease into Alberta. Prev Vet Med 2014; 114:151-63. [DOI: 10.1016/j.prevetmed.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/23/2014] [Accepted: 03/06/2014] [Indexed: 11/28/2022]
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Rostom A, Ross ED, Dubé C, Rutter MD, Lee T, Valori R, Bridges RJ, Pontifex D, Webbink V, Rees C, Brown C, Whetter DH, Kelsey SG, Hilsden RJ. Development and validation of a nurse-assessed patient comfort score for colonoscopy. Gastrointest Endosc 2013; 77:255-61. [PMID: 23317691 DOI: 10.1016/j.gie.2012.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/03/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comfort during colonoscopy is a critical component of safety and quality. OBJECTIVE To develop and validate the Nurse-Assessed Patient Comfort Score (NAPCOMS). DESIGN Prospective scale validation. SETTING Colorectal cancer screening centers in the United Kingdom and Canada. PATIENTS A total of 300 consecutive patients undergoing colonoscopy at participating colorectal cancer screening centers. INTERVENTION The NAPCOMS was developed by using a modified Delphi process. During colonoscopy, two endoscopy room nurses independently observed and rated patient comfort and tolerability by using NAPCOMS. In addition, endoscopists reported global comfort scores and patients' reported global comfort by using visual 4-point Likert and National Health Service-United Kingdom Global Rating Scales. MAIN OUTCOME MEASUREMENTS Reliability and validity of NAPCOMS was measured by using intraclass correlations (ICC) between nurse ratings of colonoscopies and between NAPCOMS, endoscopist ratings, and patient ratings of global comfort. RESULTS The ICC for the overall NAPCOMS was 0.84 (95% confidence interval [CI], 0.80-0.87). There was high agreement between the NAPCOMS and endoscopist ratings of comfort (ICC = 0.77; 95% CI, 0.72-0.81), moderate agreement between the NAPCOMS and patient ratings (ICC = 0.61; 95% CI, 0.53-0.67), and moderate agreement between the endoscopist and patient ratings (ICC = 0.52; 95% CI, 0.43-0.60). LIMITATIONS NAPCOMS was validated in outpatients who received colonoscopy with minimal to moderate sedation as part of a screening and surveillance program, so performance among inpatients or those requiring deep sedation was not tested. CONCLUSION NAPCOMS is a reliable and valid tool for assessing patient comfort in the setting of outpatient colonoscopy performed with minimal to moderate sedation.
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MacIntosh D, Dubé C, Hollingworth R, van Zanten SV, Daniels S, Ghattas G. The endoscopy Global Rating Scale-Canada: development and implementation of a quality improvement tool. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:74-82. [PMID: 23472242 PMCID: PMC3731117 DOI: 10.1155/2013/165804] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/10/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality highlight the need for endoscopy facilities to review the quality of the service they offer. OBJECTIVE To adapt the United Kingdom Global Rating Scale (UK-GRS) to develop a web-based and patient-centred tool to assess and improve the quality of endoscopy services provided. METHODS Based on feedback from 22 sites across Canada that completed the UK endoscopy GRS, and integrating results of the Canadian consensus on safety and quality indicators in endoscopy and other Canadian consensus reports, a working group of endoscopists experienced with the GRS developed the GRS-Canada (GRS-C). RESULTS The GRS-C mirrors the two dimensions (clinical quality and quality of the patient experience) and 12 patient-centred items of the UK-GRS, but was modified to apply to Canadian health care infrastructure, language and current practice. Each item is assessed by a yes⁄no response to eight to 12 statements that are divided into levels graded D (basic) through A (advanced). A core team consisting of a booking clerk, charge nurse and the physician responsible for the unit is recommended to complete the GRS-C twice yearly. CONCLUSION The GRS-C is intended to improve endoscopic services in Canada by providing endoscopy units with a straightforward process to review the quality of the service they provide.
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Sewitch MJ, Dubé C, Brien S, Jiang M, Hilsden RJ, Barkun AN, Armstrong D. Patient-identified quality indicators for colonoscopy services. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:25-32. [PMID: 23378980 PMCID: PMC3545623 DOI: 10.1155/2013/574956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/04/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current quality improvement tools for endoscopy services, such as the Global Rating Scale (GRS), emphasize the need for patient-centred care. However, there are no studies that have investigated patient expectations and/or perceptions of quality indicators in endoscopy services. OBJECTIVES To identify quality indicators for colonoscopy services from the patient perspective; to rate indicators of importance; to determine factors that influence indicator ratings; and to compare the identified indicators with those of the GRS. METHODS A two-phase mixed methods study was undertaken in Montreal (Quebec), Calgary (Alberta) and Hamilton (Ontario) among patients ≥18 years of age who spoke and read English or French. In phase 1, focus group participants identified quality indicators that were then used to construct a survey questionnaire. In phase 2, survey questionnaires, which were completed immediately after colonoscopy, prompted respondents to rate the 20 focus group-derived indicators according to their level of importance (low, medium, high) and to list up to nine additional items. Multiple logistic regression analysis was used to determine the factors that influenced focus group-derived indicator ratings. Patient-identified indicators were compared with those used in the GRS to identify novel indicators. RESULTS Three quality indicator themes were identified by 66 participants in 12 focus groups: communication, comfort and service environment. Of the 828 surveys distributed, 402 (48.6%) were returned and 65% of focus group-derived indicators were rated highly important by at least 55% of survey respondents. Indicator ratings differed according to age, sex, site and perceived colorectal cancer risk. Of the 29 patient-identified indicators, 17 (58.6%) were novel. CONCLUSIONS Patients identified 17 novel quality indicators, suggesting that patients and health professionals differ in their perspectives with respect to quality in colonoscopy services.
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Dubé C, Sanchez J, Reeves A. Adapting existing models of highly contagious diseases to countries other than their country of origin. REV SCI TECH OIE 2012; 30:581-9. [PMID: 21961228 DOI: 10.20506/rst.30.2.2061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many countries do not have the resources to develop epidemiological models of animal diseases. As a result, it is tempting to use models developed in other countries. However, an existing model may need to be adapted in order for it to be appropriately applied in a country, region, or situation other than that for which it was originally developed. The process of adapting a model has a number of benefits for both model builders and model users. For model builders, it provides insight into the applicability of their model and potentially the opportunity to obtain data for operational validation of components of their model. For users, it is a chance to think about the infection transmission process in detail, to review the data available for modelling, and to learn the principles of epidemiological modelling. Various issues must be addressed when considering adapting a model. Most critically, the assumptions and purpose behind the model must be thoroughly understood, so that new users can determine its suitability for their situation. The process of adapting a model might simply involve changing existing model parameter values (for example, to better represent livestock demographics in a country or region), or might require more substantial (and more labour-intensive) changes to the model code and conceptual model. Adapting a model is easier if the model has a user-friendly interface and easy-to-read user documentation. In addition, models built as frameworks within which disease processes and livestock demographics and contacts are flexible are good candidates for technology transfer projects, which lead to long-term collaborations.
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Willeberg P, Grubbe T, Weber S, Forde-Folle K, Dubé C. The World Organisation for Animal Health and epidemiological modelling: background and objectives. REV SCI TECH OIE 2012; 30:391-405. [PMID: 21961212 DOI: 10.20506/rst.30.2.2046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The papers in this issue of the Scientific and Technical Review (the Review) examine uses of modelling as a tool to supportthe formulation of disease control policy and applications of models for various aspects of animal disease management. Different issues in model development and several types of models are described. The experience with modelling during the 2001 foot and mouth disease outbreak in the United Kingdom underlines how models might be appropriately applied by decision-makers when preparing for and dealing with animal health emergencies. This paper outlines the involvement of the World Organisation for Animal Health (OIE) in epidemiological modelling since 2005, with emphasis on the outcome of the 2007 questionnaire survey of model usage among Member Countries, the subsequent OIE General Session resolution and the 2008 epidemiological modelling workshop at the Centers for Epidemiology and Animal Health in the United States. Many of the workshop presentations were developed into the papers that are presented in this issue of the Review.
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Dubé C. Tackling colorectal cancer as a public health issue: what can the gastroenterologist do? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:417-8. [PMID: 22803014 PMCID: PMC3395440 DOI: 10.1155/2012/507989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 12/18/2022]
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McNab B, Dubé C, Alves D. Using simplified models to communicate the importance of prevention, detection and preparedness before a disease outbreak. REV SCI TECH OIE 2011; 30:591-602. [PMID: 21961229 DOI: 10.20506/rst.30.2.2060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Frontline farm workers and veterinary-policy-makers are arguably in the best positions to influence prevention, detection, and preparedness-for-control of farm animal diseases. It is important that such individuals make biologically sound decisions concerning the daily management and regulation of the health of animals. Such decisions should be based on a good understanding of key principles of disease spread and control. This paper summarises these principles, as described in previous publications, into simple models. These models may be used to communicate concepts to readers who may not have time to study more complex models. These models illustrate the relationship between the development of new disease cases (from existing cases, i.e., the reproductive ratio R) and (i) the duration of the period during which existing cases are available as infectious, (ii) contact rates, (iii) transmission rates and (iv) susceptibility. Understanding these concepts through models has great utility, facilitating better decisions for disease prevention, detection and preparedness-for-control, before an outbreak becomes unmanageable. These basic concepts apply to all animal species, including humans.
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Dubé C. Practical Plans for Difficult Conversations in Medicine: Strategies That Work in Breaking Bad News by Robert Buckman, MD, PhD. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827611398192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lapane KL, Waring ME, Dubé C, Schneider KL. E-PRESCRIBING AND PATIENT SAFETY: RESULTS FROM A MIXED METHOD STUDY. THE AMERICAN JOURNAL OF PHARMACY BENEFITS 2011; 3:e24-e34. [PMID: 24179595 PMCID: PMC3811029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe ambulatory care clinicians' perspectives on the effect of e-prescribing systems on patient safety outcomes. STUDY DESIGN We used a mixed-method study of clinicians and staff in 64 practices using one of six e-prescribing technologies in six U.S. states. METHODS We used clinician surveys (web-based and paper) and focus groups to obtain clinicians' perspectives on e-prescribing and patient safety. RESULTS Providers highly valued having medications prescribed by other providers on the medication list and the ability to access patients' medication lists remotely. Providers felt that there will always be prescription or medication errors and that the implementation of e-prescribing software changes rather than eliminates prescription or medication errors. New errors related to the dosing or scheduling of a medication, accidentally prescribing the wrong drug, or duplicate prescriptions. CONCLUSIONS Lessons from the ambulatory care trenches must be considered as technology moves forward so that the hypothesized patient safety gains will be realized.
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Dubé C, Dubois I, Struthers J. Intravenous and Intraosseous Fluid Therapy in Critically Ill Birds of Prey. J Exot Pet Med 2011. [DOI: 10.1053/j.jepm.2010.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lapane KL, Rosen RK, Dubé C. Perceptions of e-prescribing efficiencies and inefficiencies in ambulatory care. Int J Med Inform 2011; 80:39-46. [PMID: 21112243 PMCID: PMC3073364 DOI: 10.1016/j.ijmedinf.2010.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent studies have demonstrated that e-prescribing takes longer than handwriting. Additional studies documenting the perceived efficiencies realized from e-prescribing from those who have implemented electronic prescribing are warranted. METHODS We used a mixed method study design. We report on qualitative date from 64 focus groups with clinicians and office staff from six US states. Participants used one of six e-prescribing software packages. Qualitative data from the focus groups (276 participants) were coded and analyzed using NVivo software. Quantitative data regarding perceived efficiencies were extracted from a survey of 157 clinicians using e-prescribing. RESULTS Perceptions of e-prescribing included 64% reporting e-prescribing as very efficient. The next closest method was computer generated fax and prescriptions in which ∼25% rated the method as very efficient. Improvements in workflow and record keeping were noted. Perceived efficiencies were realized by decreased errors, availability of formularies at the point of prescribing and refill processing. Perceived inefficiencies noted included the need for dual systems owing to regulations preventing e-prescribing of scheduled medications as well as those introduced with incorrect information on formularies, pharmacy used, and warnings. DISCUSSION Overwhelmingly, clinicians and their staff confirmed the perceived efficiencies realized with the adoption of e-prescribing. Perceived efficiencies were realized in knowing formularies, processing refills, and decreasing errors. Opportunities to improve efficiencies could be realized by assuring correct information in the system.
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Jobin G, Gagnon MP, Candas B, Dubé C, Ben Abdeljelil A, Grenier S. User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol. Implement Sci 2010; 5:85. [PMID: 21044332 PMCID: PMC2988067 DOI: 10.1186/1748-5908-5-85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/02/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada. METHODS First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions. DISCUSSION This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.
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