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Vivion M, Reid V, Dubé E, Coutant A, Benoit A, Tourigny A. How older adults manage misinformation and information overload - A qualitative study. BMC Public Health 2024; 24:871. [PMID: 38515081 PMCID: PMC10956171 DOI: 10.1186/s12889-024-18335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19. METHODS A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis. RESULTS Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information. CONCLUSIONS This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.
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Affiliation(s)
- M Vivion
- Department of Social and Preventive Medecine, Université Laval, Quebec, Canada.
- CHU de Québec-Université Laval Research Center, Quebec, Canada.
| | - V Reid
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
| | - E Dubé
- CHU de Québec-Université Laval Research Center, Quebec, Canada
- Department of Anthropology, Université Laval, Quebec, Canada
| | - A Coutant
- Laboratoire sur la communication et le numérique (LabCMO), Montreal, Canada
- Université du Québec à Montréal (UQAM), Montreal, Canada
| | - A Benoit
- GDR AREES (Groupe de recherche: Arctique: Enjeux pour l'environnement et les sociétés) du CRNS, Paris, France
| | - A Tourigny
- Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada
- VITAM Centre de recherche en santé durable, Quebec, Canada
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Tremblay Z, Mumbere D, Laurin D, Sirois C, Furrer D, Poisblaud L, Carmichael PH, Farrell B, Tourigny A, Giguere A, Vedel I, Morais J, Kröger E. Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2021; 10:e25200. [PMID: 34889771 PMCID: PMC8704115 DOI: 10.2196/25200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions. Objective This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ≥60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing. Methods Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2). Results The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes. Conclusions This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866 International Registered Report Identifier (IRRID) PRR1-10.2196/25200
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Affiliation(s)
- Zoë Tremblay
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - David Mumbere
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | | | | | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Lise Poisblaud
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Barbara Farrell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Anik Giguere
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
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3
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Lamarre M, Marcotte M, Laurin D, Furrer D, Vedel I, Tourigny A, Giguère A, Carmichael PH, Martines R, Morais J, Kröger E. Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes. Arch Osteoporos 2021; 16:133. [PMID: 34524561 DOI: 10.1007/s11657-021-01000-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk. RESULTS The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks. CONCLUSION Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained.
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Affiliation(s)
- Marianne Lamarre
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Anik Giguère
- Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.,Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada.,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada
| | - Rosa Martines
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSS Capitale Nationale, Quebec City, Quebec, Canada. .,Faculté de pharmacie, Université Laval, Quebec City, Quebec, Canada. .,Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec, Canada. .,VITAM Centre de recherche sur la santé durable, Quebec City, Quebec, Canada. .,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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Lebrasseur A, Fortin-Bédard N, Lettre J, Raymond E, Bussières EL, Lapierre N, Faieta J, Vincent C, Duchesne L, Ouellet MC, Gagnon E, Tourigny A, Lamontagne MÈ, Routhier F. Impact of the COVID-19 Pandemic on Older Adults: Rapid Review. JMIR Aging 2021; 4:e26474. [PMID: 33720839 PMCID: PMC8043147 DOI: 10.2196/26474] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. OBJECTIVE This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. METHODS A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. RESULTS A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. CONCLUSIONS Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.
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Affiliation(s)
- Audrey Lebrasseur
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Noémie Fortin-Bédard
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- School of Social Work and Criminology, Université Laval, Québec, QC, Canada
| | - Josiane Lettre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Emilie Raymond
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- School of Social Work and Criminology, Université Laval, Québec, QC, Canada
| | - Eve-Line Bussières
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Nolwenn Lapierre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Julie Faieta
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Claude Vincent
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Louise Duchesne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Speech-Language Pathology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marie-Christine Ouellet
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- School of Psychology, Université Laval, Québec, QC, Canada
| | - Eric Gagnon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Sociology, Université Laval, Québec, QC, Canada
| | - André Tourigny
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
- Department of Rehabilitation, Université Laval, Québec, QC, Canada
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Aubin M, Vézina L, Verreault R, Simard S, Hudon É, Desbiens JF, Fillion L, Dumont S, Tourigny A, Daneault S. Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial. Ann Fam Med 2021; 19:117-125. [PMID: 33685873 PMCID: PMC7939706 DOI: 10.1370/afm.2643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Collaboration between family physicians (FPs) and oncologists can be challenging. We present the results of a randomized clinical trial of an intervention designed to improve continuity of care and interprofessional collaboration, as perceived by patients with lung cancer and their FPs. METHODS The intervention included (1) supplying FPs with standardized summaries related to each patient, (2) recommending that patients see their FP after receiving the cancer diagnosis, (3) supplying the oncology team with patient information resulting from FP visits, and (4) providing patients with priority access to FPs as needed. A total of 206 patients with newly diagnosed lung cancer were randomly assigned to the intervention (n = 104) or control group (n = 102), and 86.4% of involved FPs participated. Perceptions of continuity of care and interprofessional collaboration were assessed every 3 months for patients and at baseline and at the end of the study for FPs. Patient distress and health service utilization were also assessed. RESULTS Patients and FPs in the intervention group perceived better interprofessional collaboration (patients: P <.0001; FPs: P = .0006) than those in the control group. Patients reported better informational continuity (P = .001) and management continuity (P = .05) compared to the control group, but no differences were found for FPs (information: P = .22; management: P = .13). No effect was found with regard to patient distress or health service utilization. CONCLUSIONS This intervention improved patient and FP perception of interprofessional collaboration, but its effectiveness on continuity of care was less clear for FPs than for patients. Additional strategies should be considered to sustainably improve continuity of care and interprofessional collaboration.
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Affiliation(s)
- Michèle Aubin
- CORRESPONDING AUTHOR Michèle Aubin Département de médecine familiale et médecine d’urgence Université Laval, Pavillon Ferdinand-Vandry 1050 Ave de la Médecine, Room 4617 Quebec, Canada, G1V 0A6
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Patry J, Tourigny A, Mercier MP, Dionne CE. Outcomes and prognosis of diabetic foot ulcers treated by an interdisciplinary team in Canada. Int Wound J 2020; 18:134-146. [PMID: 33236835 PMCID: PMC8244008 DOI: 10.1111/iwj.13505] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to determine the wound healing outcomes of patients with a plantar diabetic foot ulcer (DFU) treated with an interdisciplinary team approach, and to identify associated variables. A retrospective observational cohort study of 140 adult patients, with a plantar DFU, treated between 2012 and 2018 at a wound care clinic of a University affiliated hospital was conducted. Predictive and explicative analyses were conducted with logistic multivariate methods and with a Receiver Operating Characteristics curve. The best predictor of wound healing at 3 months was a 41.8% wound size reduction at 4 weeks (AUC: 0.86; sensitivity: 83.1%; specificity: 67.2%, positive predictive value: 72.8%; negative predictive value: 78.9%; positive and negative likelihood ratios: 2.53 and 0.25, respectively). Main baseline variables independently associated with this predictor were: a monophasic Doppler waveform (OR 7.52, 95% CI [2.64–21.39]), cigarette smoking (OR 4.7, 95% CI [1.44–15.29]), and male gender (OR 3.58, 95% CI [1.30–9.87]). The health care provider should be cautious and intensify its management of DFUs particularly with patients of male gender; smoking, having a monophasic waveform with a hand‐held Doppler, and not achieving a minimal 41.8% wound area reduction at 4 weeks of treatment.
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Affiliation(s)
- Jérôme Patry
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada.,Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - André Tourigny
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada
| | - Marie-Philippe Mercier
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Clermont E Dionne
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Québec, Canada
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7
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Patry J, Tourigny A, Mercier MP, Dionne CE. Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study. Can J Diabetes 2020; 45:327-333.e2. [PMID: 33229195 DOI: 10.1016/j.jcjd.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Diabetic foot ulcer (DFU), a serious complication of diabetes, is associated with increased morbidity and mortality and presents a substantial socioeconomic burden. However, DFU quality of care has been insufficiently studied. Therefore, the aim of this study was to evaluate the quality of DFU care at an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics. METHODS This was a retrospective cohort study of 140 adult patients with diabetes who were treated between 2012 and 2018 at a wound care clinic in a university-affiliated hospital in the Québec City area of Canada. Twenty-two internationally recognized quality-of-care indicators were identified from the literature. Data were collected from medical files, and the results were used to document the selected quality-of-care indicators. RESULTS The principal indicators regarding structure and process were met, and outcome indicators were influenced by study population characteristics, particularly peripheral artery disease and critical limb ischemia. Moreover, this study highlights that quality-of-care indicators are essential when evaluating DFU outcomes, as structure and process indicators can also affect wound healing outcomes. CONCLUSIONS This study suggests that DFU care at a Canadian wound care clinic, with an interdisciplinary approach, meets most quality-of-care indicators. The socioeconomic burden of DFUs for patients, health-care organizations and policymakers, and the paucity of quality and performance evaluations, call for more studies evaluating DFU care.
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Affiliation(s)
- Jérôme Patry
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada; Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
| | - André Tourigny
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec, Canada
| | - Marie-Philippe Mercier
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada; Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Clermont E Dionne
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Duchaine CS, Talbot D, Nafti M, Giguère Y, Dodin S, Tourigny A, Carmichael PH, Laurin D. Vitamin D status, cognitive decline and incident dementia: the Canadian Study of Health and Aging. Can J Public Health 2020; 111:312-321. [PMID: 32016921 DOI: 10.17269/s41997-019-00290-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Vitamin D could prevent cognitive decline because of its neuroprotective, anti-inflammatory and antioxidant properties. This study aimed to evaluate the associations of plasma 25-hydroxyvitamin D (25(OH)D) concentrations with global cognitive function and incident dementia, including Alzheimer's disease (AD). METHODS The Canadian Study of Health and Aging is a 10-year cohort study of a representative sample of individuals aged 65 years or older. A total of 661 subjects initially without dementia with frozen blood samples and follow-up data were included. Global cognitive function was measured using the validated Modified Mini-Mental State (3MS) examination. A consensus diagnosis of all-cause dementia and AD was made between the physician and the neuropsychologist according to published criteria. Cognitive decline for a 5-year increase in age at specific 25(OH)D concentrations was obtained using linear mixed models with repeated measures. Hazard ratios of incident dementia and AD were obtained using semi-parametric proportional hazards models with age as time scale. RESULTS Over a mean follow-up of 5.4 years, 141 subjects developed dementia of which 100 were AD. Overall, no significant association was found between 25(OH)D and cognitive decline, dementia or AD. Higher 25(OH)D concentrations were associated with an increased risk of dementia and AD in women, but not in men. CONCLUSION This study does not support a protective effect of vitamin D status on cognitive function. Further research is needed to clarify the relation by sex.
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Affiliation(s)
- Caroline S Duchaine
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Denis Talbot
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Mohamed Nafti
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yves Giguère
- CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Sylvie Dodin
- CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec, Canada
| | - André Tourigny
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada.,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada.,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada
| | - Danielle Laurin
- Centre d'excellence sur le vieillissement de Québec, 1050 Chemin Sainte-Foy, Local L2-32, Quebec, QC, G1S 4L8, Canada. .,CHU de Québec-Université Laval Research Centre, Quebec, QC, Canada. .,Institut sur le vieillissement et la participation sociale des aînés de l'Université Laval, Quebec, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, CIUSSS-CN, Quebec, QC, Canada. .,Institut sur la nutrition et les aliments fonctionnels, Laval University, Quebec, Canada. .,Faculty of Pharmacy, Laval University, Quebec, QC, Canada.
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Levasseur M, Dubois MF, Filliatrault J, Vasiliadis HM, Lacasse-Bédard J, Tourigny A, Levert MJ, Gabaude C, Lefebvre H, Berger V, Eymard C. Effect of personalised citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomised controlled trial (RCT). BMJ Open 2018; 8:e018676. [PMID: 29605819 PMCID: PMC5884338 DOI: 10.1136/bmjopen-2017-018676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the Accompagnement-citoyen Personnalisé d'Intégration Communautaire (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation. METHODS AND ANALYSIS A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated. ETHICS AND DISSEMINATION The Research Ethics Committee of the CIUSSS Estrie - CHUS has approved the study (MP-31-2018-2424). An informed consent form will be read and signed by all study participants. Findings will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT03161860; Pre-results.
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Affiliation(s)
- Mélanie Levasseur
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Dubois
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Johanne Filliatrault
- Research Centre, Institut universitaire de gériatrie de Montreal (CRIUGM), Montréal, Quebec, Canada
- School of Rehabilitation, Université de Montréal, Montréal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Research Centre, Charles-Le Moyne Hospital, Université de Sherbrooke Longueuil Campus, Longueuil, Quebec, Canada
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Joanie Lacasse-Bédard
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | - André Tourigny
- Department of Social and Preventive Medicine, Laval University, Québec City, Quebec, Canada
- Institute on Aging and Seniors’ Social Participation, Saint-Sacrement Hospital, Québec City, Quebec, Canada
| | - Marie-Josée Levert
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Gabaude
- French Institute of Transport, Development and Network Science and Technology (IFSTTAR), Marne-la-Vallée, France
| | - Hélène Lefebvre
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
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Abstract
Large Analysis and Review of European Housing and Health Status (LARES) was conducted in Europe in 2002 to 2003 to study the relationship between citizens' health and built environments. One of its objectives was to put public health priorities on the agenda of local decision-makers to implement solutions for the community. We adapted the LARES protocol as a pilot project in a small French-Canadian town in Quebec Province in 2012. The distinguishing feature of this project was the collaborative approach taken with local actors, especially the municipality, which was committed a priori to using survey data from an urban planning perspective. The project produced interesting results that were used to motivate actions concerning people living in bad sanitary conditions; to draft the urban plan including the development of parks, green spaces, and bicycle paths; and to allow the municipality to meet eligibility criteria for access to renovation programs. If a partnership with the local actors and their commitment to promote and realize the project were obtained at the beginning, then the survey could be replicated in other communities.
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Affiliation(s)
- Benoit Lévesque
- The authors are with Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Vicky Huppé
- The authors are with Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - André Tourigny
- The authors are with Institut national de santé publique du Québec, Quebec City, Quebec, Canada
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Levasseur M, Lefebvre H, Levert MJ, Lacasse-Bédard J, Desrosiers J, Therriault PY, Tourigny A, Couturier Y, Carbonneau H. Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility, accomplishment of social activities and frequency of leisure activities in older adults having disabilities. Arch Gerontol Geriatr 2016; 64:96-102. [PMID: 26952383 DOI: 10.1016/j.archger.2016.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/19/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Social participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC's impact on this population is unknown. OBJECTIVE This study explored the impact of APIC on older adults with disabilities. METHODS A mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66-91 (79.4±8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews. RESULTS APIC increased older adults' functional autonomy (p=0.02), accomplishment (p<0.01) and satisfaction (p=0.02) with social participation, and frequency of leisure practice (p<0.01). Post-intervention, participants wished to modify the practice (p<0.01) and frequency (p<0.01) of leisure activities, and difficulties in their social environment diminished (p=0.03). Their attitude toward leisure (p=0.04) as well as their health (p<0.01) and psychological (p=0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network. CONCLUSION APIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.
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Affiliation(s)
- Mélanie Levasseur
- Research Centre on Aging, Eastern Townships Integrated University Centre for Health & Social Services-Sherbrooke Hospital University Centre, 1036, Belvedere Street South, Sherbrooke, Quebec J1H 4C4, Canada; Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada.
| | - Hélène Lefebvre
- Université de Montréal & Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
| | - Marie-Josée Levert
- Université de Montréal & Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
| | - Joanie Lacasse-Bédard
- Research Centre on Aging, Eastern Townships Integrated University Centre for Health & Social Services-Sherbrooke Hospital University Centre, 1036, Belvedere Street South, Sherbrooke, Quebec J1H 4C4, Canada
| | | | - Pierre-Yves Therriault
- Université du Québec à Trois-Rivières & Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
| | - André Tourigny
- Université Laval & Institut sur le Vieillissement et la Participation Sociale des Aînés, Canada
| | - Yves Couturier
- Université de Sherbrooke & Research Centre on Aging, Canada
| | - Hélène Carbonneau
- Université du Québec à Trois-Rivières & Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
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Dubuc N, Bonin L, Tourigny A, Mathieu L, Couturier Y, Tousignant M, Corbin C, Delli-Colli N, Raîche M. Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people. Int J Integr Care 2013; 13:e017. [PMID: 23882166 PMCID: PMC3718273 DOI: 10.5334/ijic.976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people. THEORY AND METHOD A RIGOROUS PROCESS WAS APPLIED ACCORDING TO A SERIES OF STEPS: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team. RESULTS ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans. CONCLUSION Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients.
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Affiliation(s)
- Nicole Dubuc
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Lévesque JF, Feldman DE, Lemieux V, Tourigny A, Lavoie JP, Tousignant P. Variations in patients' assessment of chronic illness care across organizational models of primary health care: a multilevel cohort analysis. Healthc Policy 2012; 8:e108-e123. [PMID: 23968619 PMCID: PMC3517876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. METHODS We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. RESULTS The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care. CONCLUSION Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. Variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness.
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Affiliation(s)
- Jean-Frédéric Lévesque
- Scientific Director, Institut National de Santé Publique du Québec, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, QC.
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Lévesque JF, Feldman D, Lemieux V, Tourigny A, Lavoie JP, Tousignant P. Variations in Patients’ Assessment of Chronic Illness Care across Organizational Models of Primary Healthcare: A Multilevel Cohort Analysis. Healthc Policy 2012. [DOI: 10.12927/hcpol.2012.23105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Feldman D, Lévesque JF, Lemieux V, Tourigny A, Lavoie JP, Tousignant P. Primary Healthcare Organization and Quality-of-Life Outcomes for Persons with Chronic Disease. Healthc Policy 2012. [DOI: 10.12927/hcpol.2013.22777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Feldman DE, Lévesque JF, Lemieux V, Tourigny A, Lavoie JP, Tousignant P. Primary Healthcare Organization and Quality-of-Life Outcomes for Persons with Chronic Disease. Healthc Policy 2012; 7:59-72. [PMID: 23372581 PMCID: PMC3298022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
PURPOSE To explore the association between primary healthcare (PHC) organizational model and health-related quality of life (HRQoL) in persons with chronic disease. METHODS We recruited 776 patients with a primary diagnosis of one of four chronic diseases from 33 PHC clinics. Patients were interviewed at baseline, 6, 12 and 18 months. We categorized PHC model by administrative type and by a taxonomy according to organizational attributes. HRQoL was measured by disease-specific questionnaires. RESULTS Mean age was 67 years and 55.3% were female. PHC models differed with respect to case mix: community models served older patients with higher co-morbidity and lower health status. Multilevel logistic regression revealed that none of the PHC organizational models was associated with HRQoL. Having fewer co-morbidities, higher self-rated health and not using home care services were associated with higher HRQoL. CONCLUSION Despite their having patients with more complex health problems, HRQoL in patients of community practices was equivalent to that of patients in other types of PHC organizations.
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Affiliation(s)
- Debbie Ehrmann Feldman
- Institut national de santé publique du Québec and Direction de santé publique de Montréal, Professor, Université de Montréal, Montreal, QC
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Tourigny A, Aubin M, Haggerty J, Bonin L, Morin D, Reinharz D, Leduc Y, St-Pierre M, Houle N, Giguère A, Benounissa Z, Carmichael PH. Patients' perceptions of the quality of care after primary care reform: Family medicine groups in Quebec. Can Fam Physician 2010; 56:e273-e282. [PMID: 20631263 PMCID: PMC2922830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate how a primary care reform, which aimed to promote interprofessional and interorganizational collaborative practices, affected patients' experiences of the core dimensions of primary care. DESIGN Before-and-after comparison of patients' perceptions of care at the beginning of family medicine group (FMG) implementation (15 to 20 months after accreditation) and 18 months later. SETTING Five FMGs in the province of Quebec from various settings and types of practice. PARTICIPANTS A random sample of patients was selected in each FMG; a total of 1046 participants completed both the baseline and follow-up questionnaires. MAIN OUTCOME MEASURES Patients' perceptions of relational and informational continuity, organizational and first-contact accessibility, attitude and efficiency of the clinic's personnel and waiting times (service responsiveness), physician-nurse and primary care physician-specialist coordination, and intra-FMG collaboration were assessed over the telephone, mostly using a modified version of the Primary Care Assessment Tool. Additional items covered patients' opinions about consulting nurses, patients' use of emergency services, and patients' recall of health promotion and preventive care received. RESULTS A total of 1275 patients were interviewed at the study baseline, and 82% also completed the follow-up interviews after 18 months (n = 1046). Overall, perceptions of relational and informational continuity increased significantly (P < .05), whereas organizational and first-contact accessibility and service responsiveness did not change significantly. Perception of physician-nurse coordination remained unchanged, but perception of primary care physician-specialist coordination decreased significantly (P < .05). The proportion of participants reporting visits with nurses and reporting use of FMGs' emergency services increased significantly from baseline to follow-up (P < .05). CONCLUSION This reorganization of primary care services resulted in considerable changes in care practices, which led to improvements in patients' experiences of the continuity of care but not to improvements in their experiences of the accessibility of care.
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Affiliation(s)
- André Tourigny
- Research Center of the Centre hospitalier affilié universitaire de Québec, Quebec city, Canada.
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Tourigny A, Durand PJ, Bonin L, Hébert R, Rochette L. Quasi-experimental Study of the Effectiveness of an Integrated Service Delivery Network for the Frail Elderly. Can J Aging 2010. [DOI: 10.1353/cja.2004.0038] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTThe aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year period (T1, T2, T3); 482 people aged 75 years or older from 2 communities, 272 in the experimental and 210 in the control group, were followed. Analyses were conducted using parametric and non-parametric statistics, a generalized linear model, and Cox regression for survival analysis. A declining trend in institutionalization was observed and the desire to be institutionalized was lower in the study group. When absence of deterioration on follow-up was analysed in terms of the level of autonomy, the ISD network produced positive effects on the frailer clientele at T1, effects that tended to be maintained at T2. In regard to caregivers' burden, the ISD network seemed to have been effective, with caregivers' burden being less at T1 and T2. The ISD network did not have a marked effect on the utilization of services. The ISD network did, in fact, produce some effects that should be seen as important for the elderly population.
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Demers L, Tourigny A. [Can one import an integrated model of health services for the aged in the context of autonomy in mental health?]. Sante Ment Que 2009; 34:239-44. [PMID: 19475206 DOI: 10.7202/029771ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Louis Demers
- Ecole nationale d'administration publique; chercheur, Centre de recherche du CHA universitaire de Québec
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St-Pierre M, Sévigny A, Gauthier JB, Tourigny A, Dallaire C. Une nouvelle approche pour la gestion de l'intégration dans le système de santé : le cas des bénévoles et des professionnels. ACTA ACUST UNITED AC 2009. [DOI: 10.3917/mav.026.0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kröger E, Tourigny A, Morin D, Côté L, Kergoat MJ, Lebel P, Robichaud L, Imbeault S, Proulx S, Benounissa Z. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia. BMC Health Serv Res 2007; 7:195. [PMID: 18047668 PMCID: PMC2225401 DOI: 10.1186/1472-6963-7-195] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 11/29/2007] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics) and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work), from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a) agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b) agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88%) were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88%) of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out of 29 patients. Four indicators could be measured with the help of a validated questionnaire on patient satisfaction. Inter-observer reliability was moderate (Kappa = 0.57). Conclusion A multidisciplinary panel of experts judged a large majority of the initial indicators valid for use in integrated care systems for vulnerable older adults in Quebec, Canada. Most of these indicators can be measured using patient files or patient or caregiver interviews and reliability of assessment from patient-files is moderate.
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Affiliation(s)
- Edeltraut Kröger
- Laval University Geriatrics Research Unit, Hôpital du Saint-Sacrement, Quebec, Canada.
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Tourigny A, Paradis M, Bonin L, Bussières A, Durand PJ. Évaluation d’implantation d’une expérience novatrice : le réseau intégré de services aux aînés des Bois-Francs. SMQ 2007. [DOI: 10.7202/014560ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Résumé
Consciente de l'existence de problèmes liés à la coordination des services rendus aux aînés sur son territoire, la Table de concertation des services de santé et de services sociaux des Bois-Francs dans la région Mauricie et du Centre-du-Québec implanta en février 1997, après deux ans de planification, un nouveau modèle de coordination des soins et des services aux personnes âgées en perte d'autonomie. Ce modèle est novateur car il combine le guichet ou porte d'entrée unique, la gestion de cas, le plan de services individualisé et la présence de trois niveaux de concertation : stratégique, tactique et clinique. Il a aussi la particularité de couvrir tout le continuum de soins et de services aux aînés. Le présent article décrit les principaux résultats de l'évaluation d'implantation et de processus. Cette évaluation visait à documenter les activités et fonctions centrales du mécanisme de coordination des services afin de voir dans quelle mesure le modèle implanté et son fonctionnement s'approchent ou non du modèle visé et ce, dans la perspective d'apporter des ajustements qui pourraient s'avérer nécessaires. Les principaux résultats sur la clientèle rejointe, sur les fonctions assumées par l'équipe de gestion de cas et sur l'organisation de travail sont ici abordés et discutés à la lumière d'autres études sur la coordination des soins et des services aux personnes âgées en perte d'autonomie. Des suggestions sont faites en regard de ces résultats et de ceux portant sur l'efficacité et les coûts tirés d'une autre recherche afin d'améliorer l'efficacité et l'efficience de ce modèle de coordination de soins et de services aux aînés. Sans être généralisables d'emblée, plusieurs composantes de ce nouveau modèle pourraient être réutilisées auprès d'autres clientèles.
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Tousignant M, Desrosiers J, Tourigny A, Robichaud L. Costs of a home-based rehabilitation program for older adults after lower limb orthopedic surgery: a pilot study. Arch Gerontol Geriatr 2005; 41:51-60. [PMID: 15911038 DOI: 10.1016/j.archger.2004.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 11/09/2004] [Accepted: 11/12/2004] [Indexed: 11/24/2022]
Abstract
Little is known about the cost of home-based rehabilitation programs in Quebec, Canada. The objective of this pilot project was to test a cost estimation methodology in the context of rehabilitation services delivered at home and to provide preliminary data on the costs for lower limb orthopedic surgery patients. This pilot study examined a short-term home care program for adults, aged 65 and over who returned home after lower limb surgery and required rehabilitation services. Efficacy was determined as the functional autonomy changes between admission and discharge from home rehabilitation program, as measured by the functional autonomy measurement system (SMAF). Costs of professionals, including direct and indirect time related to the intervention, were also determined in order to document cost-effectiveness of the program. Eighteen subjects were recruited. From those, 14 had complete data available for the analysis. The result shows that costs related to the combined natural improvement and the effect of the home-based rehabilitation program were CAN dollars 419 per unit of change of functional autonomy. The results of this pilot study confirm the feasibility of the cost estimation methodology for a home-based rehabilitation program.
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Affiliation(s)
- M Tousignant
- Research Centre on Aging, Sherbrooke Geriatric University Institute, 1036 Belvédère Sud, Sherbrooke, Que., Canada J1H 4C4.
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Tourigny A, Durand P, Bonin L, Hébert R, Rochette L. Quasi-experimental study of the effectiveness of an integrated service delivery network for the frail elderly. Can J Aging 2004; 23:231-46. [PMID: 15660297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year period (T1, T2, T3); 482 people aged 75 years or older from 2 communities, 272 in the experimental and 210 in the control group, were followed. Analyses were conducted using parametric and non-parametric statistics, a generalized linear model, and Cox regression for survival analysis. A declining trend in institutionalization was observed and the desire to be institutionalized was lower in the study group. When absence of deterioration on follow-up was analysed in terms of the level of autonomy, the ISD network produced positive effects on the frailer clientele at T1, effects that tended to be maintained at T2. In regard to caregivers' burden, the ISD network seemed to have been effective, with caregivers' burden being less at T1 and T2. The ISD network did not have a marked effect on the utilization of services. The ISD network did, in fact, produce some effects that should be seen as important for the elderly population.
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Affiliation(s)
- André Tourigny
- Unite de recherche en geriatrie de l'Universite Laval, Hopital du St-Sacrement, 1050 chemin Ste-Foy, L2-34, Laval, Quebec G1S 4L8.
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Hébert R, Durand PJ, Dubuc N, Tourigny A. Frail elderly patients. New model for integrated service delivery. Can Fam Physician 2003; 49:992-7. [PMID: 12943358 PMCID: PMC2214268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PROBLEM BEING ADDRESSED Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions.
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Hébert R, Durand PJ, Dubuc N, Tourigny A. PRISMA: a new model of integrated service delivery for the frail older people in Canada. Int J Integr Care 2003; 3:e08. [PMID: 16896376 PMCID: PMC1483944 DOI: 10.5334/ijic.73] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Revised: 01/26/2003] [Accepted: 02/16/2003] [Indexed: 11/20/2022] Open
Abstract
PURPOSE PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations. DESCRIPTION The mechanisms and tools developed and implemented by PRISMA include: (1) co-ordination between decision-makers and managers, (2) a single entry point, (3) a case management process, (4) individualised service plans, (5) a single assessment instrument based on the clients' functional autonomy, and (6) a computerised clinical chart for communicating between institutions for client monitoring purposes. PRELIMINARY RESULTS The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised. CONCLUSION The on-going implementation and effectiveness study will show evidence of its real value and its impact on clienteles and cost.
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Affiliation(s)
- Réjean Hébert
- Institute of Aging, 1036 Belvédère Sud, Sherbrooke, Québec, J1H 4C4, Canada.
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Tourigny A, Paradis M, Bonin L, Bussières A, Durand PJ. [Assessment of the implementation of an innovative experience: network of integrated services for the elderly in the Bois-Franc region.]. Sante Ment Que 2002; 27:109-135. [PMID: 18253635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Conscious of problems related to coordination of services for the elderly on its territory, the working group on health and social services of the Bois-Francs in the Mauricie and Centre-du-Québec regions implemented in February 1997, after two years of planning, a new coordination model of services for the frail elderly. This model is innovative because it combines the unique entry, case management, individualized services plan as well as the presence of three levels of concertation : strategic, tactical and clinical. The model also has the characteristic of offering comprehensive services to the elderly. This article describes the major results of an assessment of the implementation and process of this model. This assessment aimed at documenting the activities and functions of the coordination mecanism of services in order to see to what extent the model implemented and its functionning is close or not to the one proposed and this, in a perspective of bringing the necessary adjustments. The major results on clientele reached, various functions of a team of case managers and organization of work are discussed in the light of other studies on coordination of services for frail older people. Suggestions regarding these results and those pertaining to efficiency and cost in another study are made in order to improve the efficiency of the model. Many components of this new model could be applied to other clientele.
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Carrier M, Khalil A, Tourigny A, Solymoss BC, Pelletier LC. Metabolic recovery after global myocardial ischemia: effects of blood cardioplegic solutions. Can J Cardiol 1996; 12:607-11. [PMID: 8665424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine the effect of whole blood cardioplegia (WBC) and a mix of crystalloid in blood (CB) hyperkalemic cardioplegic solutions on recovery of the myocardium following global ischemia. DESIGN Twenty-one dogs were placed on normothermic cardiopulmonary bypass, and a pH probe was inserted in the anterior wall of the left ventricle. Global myocardial ischemia was obtained by clamping the ascending aorta until a decrease in myocardial tissue pH of 0.4 units from baseline value was obtained, at which time cardioplegic solutions were perfused over 30 mins. The aorta was then unclamped and 30 mins of reperfusion was allowed. RESULTS The aortic cross-clamping time necessary to decrease myocardial tissue pH 0.4 units from baseline averaged 13 +/- 8 mins. Whereas myocardial tissue pH returned to baseline value (6.9 +/- 0.1) after an average of 24 mins with cold (15 degrees C) and warm (35 degrees C) WBC, it took an average of 48 mins to reach control levels when warm CB solutions were used. Moreover, tissue pH decreased temporarily from 6.97 +/- 0.35 to 6.77 +/- 0.37 (P < 0.05) at initiation of normothermic myocardial reperfusion in cold WBC protected animals, and myocardial pH remained normal in the warm WBC group but remained severely acidic in warm CB animals (6.6 +/- 0.3). CONCLUSIONS Metabolic recovery after global ischemia was faster with WBC cardioplegic protection. Normothermic blood reperfusion in cold WBC protected animals caused a significant but temporary tissue acidosis.
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Affiliation(s)
- M Carrier
- Department of Surgery, Montreal Heart Institute, Quebec.
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Abstract
BACKGROUND The release of nitric oxide is decreased after myocardial ischemia and reperfusion. Whereas the precursor L-arginine can stimulate the release of nitric oxide, its effect on metabolic recovery after myocardial ischemia is unknown. METHODS To study the effect of L-arginine on metabolic recovery after myocardial ischemia, cardioplegia infusion, and reperfusion, 33 dogs were placed on cardiopulmonary bypass and subjected to a sequence of 30 minutes of normothermic global ischemia, 30 minutes of warm blood cardioplegic arrest, and 30 minutes of reperfusion. A pH probe was inserted in the anterior wall of the left ventricle, and tissue pH was measured throughout the experiment. Coronary blood flow in the left anterior descending coronary artery and the circumflex coronary artery was measured. Blood samples from the coronary sinus were taken to measure blood pH and levels of lactate, creatine kinase, and troponin T. RESULTS In the control group of 9 dogs, tissue pH averaged 6.4 +/- 0.1, 6.5 +/- 0.1, and 6.8 +/- 0.1 after the end of global ischemia, cardioplegia, and reperfusion, respectively. Tissue pH averaged 6.4 +/- 0.1, 6.6 +/- 0.1, and 6.9 +/- 0.1, respectively, in the experimental group of 9 animals with 2 mmol/L of L-arginine added to the cardioplegic solution. Tissue pH averaged 6.2 +/- 0.1, 6.7 +/- 0.1, 7.1 +/- 0.1, respectively, in the third group of 9 animals that received an additional infusion of L-arginine (10 mg.kg-1.min-1) during reperfusion. Tissue pH recovered faster in groups with L-arginine (p = 0.00001). A hyperemic response of coronary blood flow was shown at reperfusion in animals in the control group only. In 6 dogs, L-NAME (N-nitroarginine methyl ester), an inhibitor of nitric oxide synthesis, was injected and resulted in a slower pH recovery on reperfusion compared with that of animals that received L-arginine. CONCLUSIONS The addition of L-arginine to the cardioplegic solution and the systemic circulation during reperfusion resulted in a significant increase in coronary blood flow during cardioplegia infusion and in a faster recovery of myocardial tissue pH, possibly by increasing coronary blood flow through the release of nitric oxide.
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Affiliation(s)
- M Carrier
- Department of Surgery, Montreal Heart Institute, Quebec, Canada
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Carrier M, Tourigny A, Thoribé N, Montpetit M, Khalil A, Solymoss BC, Pelletier LC. Effects of cold and warm blood cardioplegia assessed by myocardial pH and release of metabolic markers. Ann Thorac Surg 1994; 58:764-7. [PMID: 7944701 DOI: 10.1016/0003-4975(94)90744-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The optimal temperature of blood cardioplegia remains controversial. Interstitial myocardial pH was monitored online with a probe that was inserted in the anterior wall of the left ventricle. Venous pH, lactate production, and creatine kinase and troponin T release were measured in coronary sinus blood obtained in 14 dogs after ischemic arrest periods of 5, 10, 20, and 40 minutes with warm (n = 7; mean myocardial temperature, 35 degrees +/- 2 degrees C) and cold (n = 7; mean myocardial temperature, 12 degrees +/- 1 degree C) blood cardioplegic protection. Blood cardioplegic solution was delivered at a rate of 100 mL/min during the 10 minutes between each ischemic arrest. The interstitial myocardial pH decreased significantly (p < 0.05) from 7.1 +/- 0.3 to 6.53 +/- 0.3 after ischemia in animals perfused with warm blood cardioplegia and from 7.04 +/- 0.3 to 6.64 +/- 0.1 in those receiving cold blood cardioplegic protection; however, the difference between the groups was not significant (p > 0.05). Lactate production and creatine kinase and troponin T release increased significantly after ischemia, but there was no difference in the changes between the warm and cold blood cardioplegia groups. In conclusion, ischemia caused significant changes in all variables measured, and these changes were directly proportional to the duration of ischemia. However, there was no significant difference (p > 0.05) in the myocardial metabolic changes between the warm and cold blood cardioplegia groups in terms of the duration of ischemic arrest studied.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Carrier
- Department of Surgery, Montreal Heart Institute, Quebec, Canada
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Ellencweig AY, Stark AJ, Pagliccia N, McCashin B, Tourigny A. The effect of admission to long-term care program on utilization of health services by the elderly in British Columbia. Eur J Epidemiol 1990; 6:175-83. [PMID: 2113871 DOI: 10.1007/bf00145791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Utilization patterns of elderly clients admitted to the British Columbia Long Term Care (LTC) program were recorded and analysed. Patients were either located at home or in facilities and were classified into one of five levels of care. Data on GP and specialist contacts, acute care hospital admissions and hospital length of stay were analysed for each client (N = 7251) for two consecutive years, one before and one after admission to the program. There was only a slight decline or no change in utilization of ambulatory health services following admission to the program but a more pronounced reduction in utilization of hospital related services particularly by clients located in facilities (60-70%). When utilization rates were controlled for peak levels in the period around admission, more moderate trends evolved. Yet, clients located in facilities showed a 20% decrease in hospital admission rates and a 40% decrease in GP hospital visits in the period following admission. The data suggests that admission to LTC may reduce acute hospital utilization and consequent physician utilization among clients who are cared for in an institution.
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Affiliation(s)
- A Y Ellencweig
- Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Abstract
Our previous work has shown that an increase in body temperature increases the acute toxicity of ethanol in mice. To determine whether a decrease in body temperature would have the opposite effect, we studied the effect of two substances that decrease body temperature (chlorpromazine (CPZ) and dithioerythritol (DE)) on ethanol toxicity. Matched groups of 10 mice were injected sc with CPZ (5 mg/kg), DTE (80 mg/kg), or saline (controls). CPZ and DTE significantly depressed the rectal temperature to 32.8 and 34.5 degrees C, respectively. One hour later, all three groups received a specified dose of ethanol (6.5-10.7 g/kg, 24% w/v, intraperitoneal). The experiment was repeated 17 times at different ethanol doses. The pretreatments increased the 1 hr LD50 from 7.8 +/- 0.1 g/kg for the controls to 8.6 +/- 0.2 g/kg (DTE) and 10.0 +/- 0.3 g/kg (CPZ) (p less than 0.001). The protective effect of CPZ was maximal around 5 mg/kg, and less at both lower and higher CPZ doses. When the temperature drop was prevented by directly heating the mice, the protective effect of DTE could be eliminated, but the effect of CPZ was only partially prevented. Placing the CPZ-treated mice in a warmer environment only produced a major reversal of CPZ protection when rectal temperature reached 38 degrees C. In conclusion, CPZ and DTE both decrease body temperature and protect against acute ethanol toxicity. The protection seems to be due at least partially to the decrease in body temperature prior to ethanol injection.
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