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Hudon C, Lambert M, Aubrey-Bassler K, Chouinard MC, Doucet S, Ramsden VR, Zed J, Luke A, Bisson M, Howse D, Schwarz C, Rubenstein D, Taylor J. Fostering collective leadership to improve integrated primary care: lessons learned from the PriCARE program. Arch Public Health 2024; 82:24. [PMID: 38388457 PMCID: PMC10882827 DOI: 10.1186/s13690-024-01258-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
Case management (CM) is an intervention for improving integrated care for patients with complex care needs. The implementation of this complex intervention often raises opportunities for change and collective leadership has the potential to optimize the implementation. However, the application of collective leadership in real-world is not often described in the literature. This commentary highlights challenges faced during the implantation of a CM intervention in primary care for people with complex care needs, including stakeholders' buy-in and providers' willingness to change their practice, selection of the best person for the case manager position and staff turnover. Based on lessons learned from PriCARE research program, this paper encourages researchers to adopt collective leadership strategies for the implementation of complex interventions, including promoting a collaborative approach, fostering stakeholders' engagement in a trusting and fair environment, providing a high level of communication, and enhancing collective leadership attitudes and skills. The learnings from the PriCARE program may help guide researchers for implementing complex healthcare interventions.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada.
| | - Mireille Lambert
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, Room 426, 4th Floor Janeway Hostel, Health Sciences Centre, 300 Prince Philip Dr, Saint John, NL, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, 2375, Chemin de la Côte-Ste-Catherine, Montréal, QC, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, 3311 Fairlight Drive, Saskatoon, SK, Canada
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Mathieu Bisson
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, Room 426, 4th Floor Janeway Hostel, Health Sciences Centre, 300 Prince Philip Dr, Saint John, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Donna Rubenstein
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, Canada
| | - Jennifer Taylor
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
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Delahunty-Pike A, Lambert M, Schwarz C, Howse D, Bisson M, Aubrey-Bassler K, Burge F, Chouinard MC, Doucet S, Luke A, Macdonald M, Zed J, Taylor J, Hudon C. Stakeholders' perceptions of a nurse-led telehealth case management intervention in primary care for patients with complex care needs: a qualitative descriptive study. BMJ Open 2023; 13:e073679. [PMID: 37844984 PMCID: PMC10582901 DOI: 10.1136/bmjopen-2023-073679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE With the onset of the COVID-19 pandemic, telehealth case management (TCM) was introduced in primary care for patients requiring care by distance. While not all healthcare needs can be addressed via telehealth, the use of information and communication technology to support healthcare delivery has the potential to contribute to the management of patients with chronic conditions and associated complex care needs. However, few qualitative studies have documented stakeholders' perceptions of TCM. This study aimed to describe patients', primary care providers' and clinic managers' perceptions of the use of a nurse-led TCM intervention for primary care patients with complex care needs. DESIGN Qualitative descriptive study. SETTING Three primary care clinics in three Canadian provinces. PARTICIPANTS Patients with complex care needs (n=30), primary care providers (n=11) and clinic managers (n=2) participated in qualitative individual interviews and focus groups. INTERVENTION TCM intervention was delivered by nurse case managers over a 6-month period. RESULTS Participants' perceptions of the TCM intervention were summarised in three themes: (1) improved patient access, comfort and sense of reassurance; (2) trusting relationships and skilled nurse case managers; (3) activities more suitable for TCM. TCM was a generally accepted mode of primary care delivery, had many benefits for patients and providers and worked well for most activities that do not require physical assessment or treatment. Participants found TCM to be useful and a viable alternative to in-person care. CONCLUSIONS TCM improves access to care and is successful when a relationship of trust between the nurse case manager and patient can develop over time. Healthcare policymakers and primary care providers should consider the benefits of TCM and promote this mode of delivery as a complement to in-person care for patients with complex care needs.
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Affiliation(s)
- Alannah Delahunty-Pike
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mathieu Bisson
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint. John, New Brunswick, Canada
| | - Marilyn Macdonald
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanna Zed
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Bisson M, Aubrey‐Bassler K, Chouinard M, Doucet S, Ramsden VR, Dumont‐Samson O, Howse D, Lambert M, Schwarz C, Luke A, Rabbitskin N, Gaudreau A, Porter J, Rubenstein D, Taylor J, Warren M, Hudon C. Patient engagement in health implementation research: A logic model. Health Expect 2023; 26:1854-1862. [PMID: 37309078 PMCID: PMC10485341 DOI: 10.1111/hex.13782] [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: 12/13/2022] [Revised: 03/31/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Growing evidence supports patient engagement (PE) in health implementation research to improve the quality, relevance and uptake of research. However, more guidance is needed to plan and operationalize PE before and throughout the research process. The aim of the study was to develop a logic model illustrating the causal links between context, resources, activities, outcomes and impact of PE in an implementation research programme. METHODS The Patient Engagement in Health Implementation Research Logic Model (hereafter the Logic Model) was developed using a descriptive qualitative design with a participatory approach, in the context of the PriCARE programme. This programme aims to implement and evaluate case management for individuals who frequently use healthcare services in primary care clinics across five Canadian provinces. Participant observation of team meetings was performed by all team members involved in the programme and in-depth interviews were conducted by two external research assistants with team members (n = 22). A deductive thematic analysis using components of logic models as coding categories was conducted. Data were pooled in the first version of the Logic Model, which was refined in research team meetings with patient partners. The final version was validated by all team members. RESULTS The Logic Model highlights the importance of integrating PE into the project before its commencement, with appropriate support in terms of funding and time allocation. The governance structure and leadership of both principal investigators and patient partners have significant effects on PE activities and outcomes. As an empirical and standardized illustration that facilitates a shared understanding, the Logic Model provides guidance for maximizing the impact of patient partnership in various contexts for research, patients, providers and health care. CONCLUSION The Logic Model will help academic researchers, decision makers and patient partners plan, operationalize, and assess PE in implementation research for optimal outcomes. PATIENT OR PUBLIC CONTRIBUTION Patient partners from the PriCARE research programme contributed to developing the research objectives and designing, developing and validating data collection tools, producing data, developing and validating the Logic Model and reviewing the manuscript.
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Affiliation(s)
- Mathieu Bisson
- Département de médecine de famille et de médecine d'urgenceUniversité de SherbrookeSherbrookeQuébecCanada
| | - Kris Aubrey‐Bassler
- Primary Healthcare Research Unit, Faculty of MedicineMemorial UniversitySt. John'sNewfoundland and LabradorCanada
| | | | - Shelley Doucet
- Department of Nursing and Health SciencesUniversity of New BrunswickFrederictonNew BrunswickCanada
| | - Vivian R. Ramsden
- Department of Academic Family MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Olivier Dumont‐Samson
- Département de médecine de famille et de médecine d'urgenceUniversité de SherbrookeSherbrookeQuébecCanada
| | - Dana Howse
- Primary Healthcare Research Unit, Faculty of MedicineMemorial UniversitySt. John'sNewfoundland and LabradorCanada
| | - Mireille Lambert
- Département de médecine de famille et de médecine d'urgenceUniversité de SherbrookeSherbrookeQuébecCanada
| | - Charlotte Schwarz
- Department of Nursing and Health SciencesUniversity of New BrunswickFrederictonNew BrunswickCanada
| | - Alison Luke
- Department of Nursing and Health SciencesUniversity of New BrunswickFrederictonNew BrunswickCanada
| | - Norma Rabbitskin
- Department of Academic Family MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | | | | | | | | | | | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgenceUniversité de SherbrookeSherbrookeQuébecCanada
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Bisson M, Spinetti C, Gianardi R, Strehlow K, De Beni E, Landi P. High-resolution mapping and dispersion analyses of volcanic ballistics emitted during the 3rd July 2019 paroxysm at Stromboli. Sci Rep 2023; 13:13465. [PMID: 37596336 PMCID: PMC10439199 DOI: 10.1038/s41598-023-39600-w] [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: 12/07/2022] [Accepted: 07/27/2023] [Indexed: 08/20/2023] Open
Abstract
A detailed mapping of volcanic ballistic projectiles emplaced in a defined area, represents the starting point to derive preparatory data in hazard and risk studies of ballistics phenomena. Considering as case study the 3rd July 2019 paroxysmal eruption occurred at Stromboli volcano, we map and analyse at very high spatial resolution (8 cm) the distribution of the ballistic spatter clasts emplaced on the E flank of the volcano. The resulting map identifies and reproduces as geospatial polygon elements 152,228 spatter clasts with areal dimensions from 0.03 to 4.23 m2. Dispersed on 0.407 km2, the spatters cover an area of 29,000 m2 corresponding to an erupted products volume from 2.3 to 7.0 × 103 m3, calculated here for the first time. Spatial analyses indicate that the area mostly affected by the clasts emplacement is between N67.5 and N135 directions, identifying a preferential deposition between N112.50 and N123.75 directions. The clasts size distribution rapidly decreases with the size increase, highlighting a nearly constant ratio small/large clasts regardless the distance from the vent. Finally, additional investigations reveal that clasts dispersion parameters decrease progressively with the distance from the vent only along one direction (N67.5), highlighting how the morphology influences the deposition and remobilisation of mapped ballistics.
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Affiliation(s)
- M Bisson
- Istituto Nazionale di Geofisica e Vulcanologia - Sezione di Pisa, Pisa, Italy.
| | - C Spinetti
- Istituto Nazionale di Geofisica e Vulcanologia - ONT, Rome, Italy
| | - R Gianardi
- Istituto Nazionale di Geofisica e Vulcanologia - Sezione di Pisa, Pisa, Italy
| | - K Strehlow
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Kiel, Germany
- Mitiga Solutions SL, Barcelona, Spain
| | - E De Beni
- Istituto Nazionale di Geofisica e Vulcanologia - Osservatorio Etneo, Sezione di Catania, Catania, Italy
| | - P Landi
- Istituto Nazionale di Geofisica e Vulcanologia - Sezione di Pisa, Pisa, Italy
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Hudon C, Bisson M, Chouinard MC, Delahunty-Pike A, Lambert M, Howse D, Schwarz C, Dumont-Samson O, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Scott C, Warren M, Wilhelm L. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res 2023; 23:377. [PMID: 37076851 PMCID: PMC10116737 DOI: 10.1186/s12913-023-09379-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Case management is one of the most frequently performed interventions to mitigate the negative effects of high healthcare use on patients, primary care providers and the healthcare system. Reviews have addressed factors influencing case management interventions (CMI) implementation and reported common themes related to the case manager role and activities, collaboration with other primary care providers, CMI training and relationships with the patients. However, the heterogeneity of the settings in which CMI have been implemented may impair the transferability of the findings. Moreover, the underlying factors influencing the first steps of CMI implementation need to be further assessed. This study aimed to evaluate facilitators and barriers of the first implementation steps of a CMI by primary care nurses for people with complex care needs who frequently use healthcare services. METHODS A qualitative multiple case study was conducted including six primary care clinics across four provinces in Canada. In-depth interviews and focus groups with nurse case managers, health services managers, and other primary care providers were conducted. Field notes also formed part of the data. A mixed thematic analysis, deductive and inductive, was carried out. RESULTS Leadership of the primary care providers and managers facilitated the first steps of the of CMI implementation, as did the experience and skills of the nurse case managers and capacity development within the teams. The time required to establish CMI was a barrier at the beginning of the CMI implementation. Most nurse case managers expressed apprehension about developing an "individualized services plan" with multiple health professionals and the patient. Clinic team meetings and a nurse case managers community of practice created opportunities to address primary care providers' concerns. Participants generally perceived the CMI as a comprehensive, adaptable, and organized approach to care, providing more resources and support for patients and better coordination in primary care. CONCLUSION Results of this study will be useful for decision makers, care providers, patients and researchers who are considering the implementation of CMI in primary care. Providing knowledge about first steps of CMI implementation will also help inform policies and best practices.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre Hospitalier Universitaire de Sherbrooke Research Centre, Sherbrooke, QC, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | | | | | - Mireille Lambert
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Olivier Dumont-Samson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Pavillon Z7-Room 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, NL, Canada
| | - Fred Burge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Judy Porter
- Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Cathy Scott
- Canadian Cancer Society, Toronto, ON, Canada
| | - Mike Warren
- Patient Advisory Council, Newfoundland and Labrador SPOR SUPPORT Unit, St. John's, NL, Canada
| | - Linda Wilhelm
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
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Burke A, Bisson M, Schilt F, Tolan S, Museba J, Drapeau MSM, Aleman JC, Peros MC. The archaeological potential of the northern Luangwa Valley, Zambia: The Luwumbu basin. PLoS One 2023; 18:e0269209. [PMID: 36917590 PMCID: PMC10013907 DOI: 10.1371/journal.pone.0269209] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/14/2022] [Indexed: 03/15/2023] Open
Abstract
The Luangwa Basin, Zambia, which forms part of the Zambezi drainage, is strategically located between the Central African plateau and the East African Rift system. The Luangwa River and major tributaries, such as the Luwumbu River, are perennial water sources supporting essential resources that sustain human communities and a rich and diverse fauna and flora. The archaeological record of Luangwa is relatively unknown, despite early archaeological exploration hinting at its potential. Recent research in the southern Luangwa valley, however, suggests that it preserves a long record of hominin occupation spanning the Early to Late Stone Age. The research described here details fieldwork carried out in northeastern Luangwa, in the Luwumbu Basin, that confirms that a relatively deep package of Quaternary deposits, containing evidence of the Stone Age occupation of the region persists in the upper piedmont zone.
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Affiliation(s)
- A. Burke
- Dept. d’Anthropologie, Université de Montréal, Montréal, QC, Canada
- * E-mail:
| | - M. Bisson
- Anthropology Dept., McGill University, Montréal, QC, Canada
| | - F. Schilt
- Interdisciplinary Center for Archaeology and Evolution of Human Behavior (ICArEHB), FCHS, Universidade do Algarve, Faro, Portugal
| | - S. Tolan
- Chipembele Conservation Centre, Mfuwe, Zambia
| | - J. Museba
- National Heritage Conservation Commission, Northern Region, Kasama, Zambia
| | - M. S. M. Drapeau
- Dept. d’Anthropologie, Université de Montréal, Montréal, QC, Canada
| | - J. C. Aleman
- CNRS, IRD, INRA Coll France, CEREGE, Aix Marseille Univ, Aix-en-Provence, France
| | - M. C. Peros
- Department of Environment and Geography, Bishop’s University, Sherbrooke, QC, Canada
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Béland S, Lambert M, Delahunty-Pike A, Howse D, Schwarz C, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Danish A, Dumont-Samson O, Bisson M, Luke A, Macdonald M, Gaudreau A, Porter J, Rubenstein D, Sabourin V, Scott C, Warren M, Wilhelm L, Hudon C. Patient and researcher experiences of patient engagement in primary care health care research: a participatory qualitative study. Health Expect 2022; 25:2365-2376. [PMID: 35593113 PMCID: PMC9615076 DOI: 10.1111/hex.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/11/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Studies have highlighted common challenges and barriers to patient engagement in research, but most were based on patient partners' or academic researchers' experiences. A better understanding of how both groups differentially experience their partnership could help identify strategies to improve collaboration in patient engagement research. Aim This study aimed to describe and compare patient partners' and academic researchers' experiences in patient engagement research. Methods Based on a participatory approach, a descriptive qualitative study was conducted with patient partners and academic researchers who are involved in the PriCARE research programme in primary health care to examine their experience of patient engagement. Individual semi‐structured interviews with patient partners (n = 7) and academic researchers (n = 15) were conducted. Academic researchers' interview verbatims, deidentified patient partners' summaries of their interviews and summaries of meetings with patient partners were analysed using inductive thematic analysis in collaboration with patient partners. Results Patient partners and academic researchers' experiences with patient engagement are captured within four themes: (1) evolving relationships; (2) creating an environment that fosters patient engagement; (3) striking a balance; and (4) impact and value of patient engagement. Evolving relationships refers to how partnerships grew and improved over time with an acceptance of tensions and willingness to move beyond them, two‐way communication and leadership of key team members. Creating an environment that fosters patient engagement requires appropriate structural support, such as clear descriptions of patient partner roles; adequate training for all team members; institutional guidance on patient engagement; regular and appropriate translation services; and financial assistance. For patient partners and academic researchers, striking a balance referred to the challenge of reconciling patient partners' interests and established research practices. Finally, both groups recognized the value and positive impact of patient engagement in the programme in terms of improving the relevance of research and the applicability of results. While patient partners and academic researchers identified similar challenges and strategies, their experiences of patient engagement differed according to their own backgrounds, motives and expectations. Conclusion Both patient partners and academic researchers highlighted the importance of finding a balance between providing structure or guidelines for patient engagement, while allowing for flexibility along the way. Patient or Public Contribution Patient partners from the PriCARE research programme were involved in the following aspects of the current study: (1) development of the research objectives; (2) planning of the research design; (3) development and validation of data collection tools (i.e., interview guides); (4) production of data (i.e., acted as interviewees); (5) validation of data analysis tools (code book); (6) analysis of qualitative data; and (7) drafting of the manuscript and contributing to other knowledge translation activities, such as conference presentations and the creation of a short animated video.
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Affiliation(s)
- Sophie Béland
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | | | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St-John's, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | | | | | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Alya Danish
- Institut national d'excellence en santé et en services sociaux, Montréal, Canada
| | - Olivier Dumont-Samson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | | | | | | | | | | | | | | | | | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de recherche du centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
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Bisson M, Hudon C, Burge F, Lambert M, Doucet S, Howse D, Dumont-Samson O, Aubrey-Bassier FK, Chouinard MC, Porter J, Ramsden V, Gaudreau A, Schwarz C, Rubenstein D, Scott C, Wilhelm L, Macdonald M, Delanunty-Pike A. Planning, operationalizing, and evaluating patient partners' engagement in primary care research: a logic model. Ann Fam Med 2022; 20:2798. [PMID: 38270680 PMCID: PMC10549048 DOI: 10.1370/afm.20.s1.2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Context. There is growing evidence supporting patients' engagement (PE) in primary care research to improve the quality, relevance, and uptake of research. However, guidance is still needed to plan and operationalize this engagement during the research process. Objective. To develop a logic model illustrating empirically the causal links between context, resources, activities, and expected outcomes of PE in an implementation research program in primary care. Study design. Instrumental case study. Setting. A research program (PriCARE) aiming to implement and evaluate a case management intervention (CMI) in primary care clinics across five provinces in Canada. Population studied. Research team members. Methods. Data collection. Participant observation and in-depth interviews (n=22) conducted by two independent research assistants with research team members: principal investigators (n=5); co-investigators (n=2); research coordinators and assistants (n=8); and patient partners (n=7). Analysis. Deductive thematic analysis using components of the logic model as coding categories. All data were coded using NVivo 12 software. Data were reduced and organized in a first logic model version. Team meetings helped to refine the logic model. The final version was validated by all research team members. Results. The logic model provides an empirical illustration of the relationship between context, resources, activities, and expected outcomes for PE. Mobilized resources (human, financial, organizational, and communicational) allow research team members to be involved in many activities related to PE: recruitment, training, and support of patient partners; development of a governance structure; participation in research activities; agreement on decision-making processes; training and support of clinicians; development of tools for patients' involvement in the CMI. These activities lead to the following benefits for health research: improved communication amongst all team members, results and knowledge translation; development of a PE culture; capacity building; democratization of health research; and for healthcare: improved implementation of the intervention; improved patient engagement in their care; better health outcomes and resource utilization; support of decision-makers and clinicians; and better practices. Conclusions. The logic model may be useful for the planning, operationalization and evaluation of PPE in primary care research programs.
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Bisson M, Hudon C, Lambert M, Alannah DP, Howse D, Aubrey-Bassier FK, Chouinard MC, Doucet S, Schwarz C, Dumont-Samson O, Macdonald M. Implementation analysis of case management interventions for frequent users of healthcare services: A multiple-case study. Ann Fam Med 2022; 20:2757. [PMID: 36857192 PMCID: PMC10548958 DOI: 10.1370/afm.20.s1.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Context. Case management interventions (CMIs) are recognized to improve patients' experience of integrated care, to promote better utilization of healthcare resources, and to reduce emergency department visits, hospitalizations and health care costs. However, contextual factors influencing implementation of CMIs in primary care settings in Canada still need to be studied. Objective. To examine facilitators and barriers influencing implementation planning, engagement of key actors and the start-up phases of a CMI led by nurse case managers for frequent users of healthcare services with chronic diseases and complex care needs. Study design. Qualitative multiple case study design. Setting. Six primary care clinics across four provinces in Canada. Population studied. Frequent users of healthcare services with chronic diseases and complex care needs. Intervention. A CMI led by nurse case managers that included four main components: 1) patient needs assessment; 2) care planning, including an individual services plan (ISP); 3) coordination of services among health and social services partners; 4) self-management support for patients and families. Methods. Data collection: in-depth interviews with nurse case managers (n=10), clinic managers (n=5), and other healthcare professionals (n=5); six focus groups with family physicians (n=20), and other healthcare professionals (n=8); and field notes by research coordinators. Analysis: Mixed descriptive thematic analysis; intra-case histories; systematic comparison among cases by means of a descriptive and interpretative matrix; investigator and patient partners triangulation. Outcome Measures. Factors influencing the implementation of the CMI in primary care settings. Results. Difficulty of access to patient hospital information is a common barrier to all cases, as well as identification and recruitment of patients with the greatest needs of a CMI. Nurse case managers need extra time in the short term, especially when preparing and conducting the ISP. On the other hand, a culture of patient-centredness and collaboration; managerial and clinical leadership and support; and a positive perception of the CMI alongside provider engagement helps to overcome these barriers. Conclusions. This study may help researchers, decision-makers and clinicians plan the implementation of CMIs in primary care settings for frequent users of healthcare services with chronic diseases and complex care needs.
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Howse D, Delahunty-Pike A, Dumont-Samson O, Bisson M, Lambert M, Doucet S, Chouinard MC, Hudon C, Scott C, Burge F, Wilhelm L, Warren M, Porter J, Schwarz C, Rubenstein D, Gaudreau A. Patient engagement works: Patient and researcher experiences of patient partnership in primary healthcare research. Ann Fam Med 2022; 20:2908. [PMID: 38270736 PMCID: PMC10548982 DOI: 10.1370/afm.20.s1.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Context: Health researchers are increasingly engaging patients and their families as partners in the research process, from inception to knowledge translation. The trend toward 'patient-oriented' research is encouraged by a growing view that studies which integrate the patient perspective will make better use of resources to produce more relevant evidence that can be more easily translated to clinical settings. While there is an emerging literature on best practices, challenges, and learnings related to patient engagement (PE), few studies consider the experiences of patient partners (PP) and researchers in the same project. This presentation will present PP and researcher experiences of PE, highlighting important similarities and differences and proposing recommendations. Objectives: To characterize PE experience from the perspective of researchers and PP working together on the same research program, PriCARE; to identify successes and challenges; to ascertain contributions of PE in health research. Study Design: Qualitative. Setting or Dataset: This study was conducted within the larger 5-province PriCARE study examining a nurse-led case management intervention for primary care patients with complex needs. Population studied: 22 members of the study team (7 PP, 8 coordinators, 2 co-investigators, 5 principal investigators). Methods: Data collection: In-depth interviews using guides co-created by researchers and PP covering topics such as PE-related training and knowledge, and reflections on PE processes and impact. Research assistants external to the PriCARE study conducted interviews, transcribed researcher interviews, and generated a summary of PP interviews. Analysis: Data were analyzed thematically using a coding framework that was co-developed with PP. Outcome Measures: Researcher and patient experiences of PE, PP contributions to health research. Results: All team members need PE training at the beginning of and throughout the research process. Evolving trust and flexibility helped team members to navigate different experiences and priorities. PP make integral contributions to study and instrument design, data analysis, and knowledge translation. Clear expectations about the degree and nature of PE and team members' roles are critical. Conclusions: Meaningful PE requires patient-researcher partnership and clear expectation setting at the outset and throughout the research process, and ongoing flexibility to adapt.
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Hudon C, Chouinard MC, Bisson M, Danish A, Karam M, Girard A, Bossé PL, Lambert M. Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research. Ann Fam Med 2021; 19:540-546. [PMID: 34750129 PMCID: PMC8575520 DOI: 10.1370/afm.2717] [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: 07/10/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 11/09/2022] Open
Abstract
The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. It also aims to propose best practice recommendations when using this case study approach. We distinguish between the participatory case study with full co-construction and co-governance, and the case study with a participatory approach whereby stakeholders are consulted in certain phases of the research. We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alya Danish
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marlène Karam
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
| | - Ariane Girard
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre-Luc Bossé
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Lambert
- Integrated University Health and Social Services Centre, Chicoutimi, Quebec, Canada
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12
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Hudon C, Danish A, Lambert M, Howse D, Cassidy M, Dumont-Samson O, Porter J, Rubenstein D, Sabourin V, Doucet S, Ramsden VR, Bisson M, Schwarz C, Chouinard MC. Reconciling validity and challenges of patient comfort and understanding: Guidelines to patient-oriented questionnaires. Health Expect 2021; 25:2147-2154. [PMID: 34668630 PMCID: PMC9615088 DOI: 10.1111/hex.13373] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient‐reported outcome measures (PROMs) are widely recognized as important tools for achieving a patient‐centred approach in health research. While PROMs are subject to several stages of validation during development, even questionnaires with robust psychometric properties may challenge patient comfort and understanding. Aim Building on the experience of patient engagement in the PriCARE research programme, this paper outlines the team's response to concerns raised by patient partners regarding the administration of the questionnaire. Methods Based on a participatory action research design and the patient engagement framework in the Strategy for Patient‐Oriented Research of the Canadian Institutes of Health Research, PriCARE team members worked together to discuss concerns, review the questionnaires and come up with solutions. Data were collected through participant observation of team meetings. Results This paper demonstrates how patient partners were engaged in PriCARE and integrated into the programme's governance structure, focusing on the challenges that they raised regarding the questionnaires and how these were addressed by PriCARE team members in a six‐step approach: (1) Recognizing patient partner concerns, discussing concerns and reframing the challenges; (2) Detailing and sharing evidence of the validity of the questionnaires; (3) Evaluating potential solutions; (4) Searching the literature for guidelines; (5) Creating guidelines; and (6) Sharing and refining guidelines. Conclusion This six‐step approach demonstrates how research teams can integrate patient partners as equal members, develop meaningful collaboration through recognition of individual experiences and expertise and ensure that the patient perspective is taken into consideration in research and healthcare innovation. Patient or Public Contribution All patient partners from the PriCARE programme were actively involved in the six‐step approach. They were also involved in the preparation of the manuscript.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de recherche du centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Alya Danish
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St. John's, Canada
| | - Monique Cassidy
- Department of Interdisciplinary Studies, University of New Brunswick, Saint John, Canada
| | - Olivier Dumont-Samson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
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Hudon C, Bisson M, Dubois MF, Chiu Y, Chouinard MC, Dubuc N, Elazhary N, Sabourin V, Vanasse A. Correction to: CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 2021; 21:321. [PMID: 33836732 PMCID: PMC8034114 DOI: 10.1186/s12913-021-06216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Marie-France Dubois
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Yohann Chiu
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Maud-Christine Chouinard
- Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Nicole Dubuc
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Véronique Sabourin
- Integrated University Health and Social Services Centre of Saguenay-Lac-Saint-Jean, 930 rue Jacques-Cartier E, Chicoutimi, QC, G7H 7K9, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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Hudon C, Bisson M, Dubois MF, Chiu Y, Chouinard MC, Dubuc N, Elazhary N, Sabourin V, Vanasse A. CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 2021; 21:157. [PMID: 33596929 PMCID: PMC7891167 DOI: 10.1186/s12913-021-06154-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population. Methods This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs. Results Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively. Conclusions The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06154-4.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Marie-France Dubois
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Yohann Chiu
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Maud-Christine Chouinard
- Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Nicole Dubuc
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Véronique Sabourin
- Integrated University Health and Social Services Centre of Saguenay-Lac-Saint-Jean, 225 rue Saint-Vallier, Chicoutimi, Quebec, G7H 5H6, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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15
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Abstract
This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O’Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics.
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Affiliation(s)
- Émilie Hudon
- Université de Sherbrooke, Québec, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | - Catherine Hudon
- Université de Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | | | - Maud-Christine Chouinard
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada.,Université de Montréal, Québec, Canada
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Danish A, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Bisson M, Cassidy M, Condran B, Lambert M, Penney C, Sabourin V, Warren M, Hudon C. Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs. BMJ Open 2020; 10:e038241. [PMID: 32487584 PMCID: PMC7265033 DOI: 10.1136/bmjopen-2020-038241] [Citation(s) in RCA: 3] [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] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3). METHODS AND ANALYSIS A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis. ETHICS AND DISSEMINATION This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.
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Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monique Cassidy
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brian Condran
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | | | - Mike Warren
- NL-SPOR Suppport Unit, St-John's, Newfoundland and Labrador, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke Research Centre, Sherbrooke, Québec, Canada
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Hudon C, Chouinard MC, Brousselle A, Bisson M, Danish A. Evaluating complex interventions in real context: Logic analysis of a case management program for frequent users of healthcare services. Eval Program Plann 2020; 79:101753. [PMID: 31835149 DOI: 10.1016/j.evalprogplan.2019.101753] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
Case management programs for frequent users of healthcare services are complex interventions which implementation and application are challenging to evaluate. The aim of this article was to conduct a logic analysis to evaluate a case management program for frequent users of healthcare services. The study proceeded in three phases: 1) establishing causal links between the program's components by the construction of a logic model, 2) developing an integrated framework from a realistic synthesis, and 3) making a new reading of the case management program in regard of the integrated framework. The study demonstrated, on one hand, strengths and weaknesses of the actual case management program, and, on the other hand, how logic analysis can create a constructive dialogue between theory and practice. The evaluative process with decision-makers, clinicians and patients has helped to make connexions between theory, practice, experience and services organization.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC Canada; Research Center of the University Hospital Center of Sherbrooke, Sherbrooke, QC Canada.
| | | | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, BC Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC Canada.
| | - Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC Canada.
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Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Bisson M, Tremblay F, St-Onge O, Robitaille J, Pronovost E, Simonyan D, Marc I. Influence of maternal physical activity on infant's body composition. Pediatr Obes 2017; 12 Suppl 1:38-46. [PMID: 27863167 DOI: 10.1111/ijpo.12174] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/28/2016] [Revised: 06/21/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical activity (PA) during pregnancy might contribute to reduce neonatal adiposity, a predictor of metabolic disturbances. OBJECTIVE The objective of the study was to evaluate the association between maternal PA intensity and neonatal body composition. METHODS Maternal PA measured by accelerometry and nutrition were documented during pregnancy, as well as neonatal body composition by dual-energy X-ray absorptiometry following delivery. Associations between PA at 17 and 36 weeks (time spent in moderate PA (MPA), vigorous PA (VPA) status and their interaction) and neonatal body composition were addressed by multivariate regression analyses. RESULTS From 104 women, 50 (48%) and 16 (18%) performed VPA at 17 and 36 weeks of pregnancy. Performing VPA at either time was associated with a decreased birthweight (BW), while only VPA at 17 weeks decreased neonatal adiposity (fat percentage: -2.3 ± 0.8%, p = 0.003). MPA at 36 weeks was associated with an increased lean mass (2.0 ± 0.8 g per min day-1 , p = 0.012). Significant interactions were found for BW and bone mineral content (BMC). MPA at 17 weeks tended to increase BW, but not BMC, in the no VPA strata. By contrast, high levels of MPA (≥112 min d-1 ) combined with VPA at 17 weeks reduced neonatal BMC and BW compared with no VPA (BMC: -5.4 ± 2.0 g, p = 0.008, BW: -302.8 ± 83.7 g, p = 0.0003). Differences were not significant with low MPA levels. CONCLUSIONS Exercise intensity modulates neonatal body composition. The long-term significance of a reduced BW, adiposity and BMC with VPA requires further study.
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Affiliation(s)
- M Bisson
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada.,Department of Kinesiology, Université Laval, Québec City, QC, Canada
| | - F Tremblay
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada
| | - O St-Onge
- Department of Radiology, CHU de Québec, Université Laval, Québec City, QC, Canada
| | - J Robitaille
- School of Nutrition, Laval University, Québec City, QC, Canada
| | - E Pronovost
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada
| | - D Simonyan
- Clinical and Evaluative Research Platform, CHU de Québec, Laval University, Québec City, QC, Canada
| | - I Marc
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada
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Bisson M, Rey N, Andres S. Identification of early effects induced in case of exceeding toxicological threshold value: A tool for risks manager for communication to exposed populations. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.06.1788] [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: 10/21/2022]
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Marlborough F, Bhat W, Bisson M. Ultrasound scanning in the post-operative assessment of flexor tendon repairs: A useful tool in the hand clinic. J Hand Surg Eur Vol 2015; 40:740-1. [PMID: 24759333 DOI: 10.1177/1753193414533226] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - W Bhat
- University Hospital of North Durham, Durham, UK
| | - M Bisson
- Plastic Surgery Department, Hutt Hospital, Wellington, New Zealand
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Bisson M, Alméras N, Plaisance J, Rhéaume C, Bujold E, Tremblay A, Marc I. Maternal fitness at the onset of the second trimester of pregnancy: correlates and relationship with infant birth weight. Pediatr Obes 2013; 8:464-74. [PMID: 23281128 DOI: 10.1111/j.2047-6310.2012.00129.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 06/20/2012] [Revised: 11/01/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED What is already known about this subject A healthy life begins in utero and a healthy pregnancy requires a fit and healthy mother. Physical activity during pregnancy provides a stimulation that is essential for promoting optimal body oxygenation and composition as well as metabolic fitness during pregnancy. Although a higher maternal fitness is expected to provide a beneficial fetal environment, it is still unclear whether physical fitness during pregnancy contributes to perinatal health. What this study adds Participation in sports and exercise previously and at the beginning of pregnancy can benefit maternal health by improving cardiorespiratory fitness during pregnancy, irrespective of maternal body mass index. Maternal strength, an indicator of muscular fitness, is an independent determinant of infant fetal growth and can positively influence birth weight. BACKGROUND It is still unclear whether maternal physical activity and fitness during pregnancy contributes to perinatal health. OBJECTIVES The aims of this study were to characterize maternal physical fitness at 16 weeks of pregnancy and to examine its effects on infant birth weight. METHODS Maternal anthropometry (body mass index [BMI] and skin-folds), physical activity, cardiorespiratory fitness (VO2 peak) and muscular fitness (handgrip strength) were assessed at 16 weeks of gestation in 65 healthy pregnant women. Offspring birth weight was collected from maternal charts after delivery. RESULTS A higher VO2 peak was associated with physical activity spent at sports and exercise before and in early pregnancy (P = 0.0005). Maternal BMI was negatively associated with cardiorespiratory fitness (P < 0.0001) but positively related to muscular strength (P = 0.0001). Unlike maternal cardiorespiratory fitness, handgrip strength was positively associated with infant birth weight (r = 0.34, P = 0.0068) even after adjustment for confounders (adjusted r = 0.27, P = 0.0480). CONCLUSION A positive relationship between maternal muscular fitness and infant birth weight highlighted maternal strength in pregnancy as a new determinant of infant birth weight.
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Affiliation(s)
- M Bisson
- Department of Pediatrics, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, QC, Canada
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Bisson M. Risk assessment: A tool for the choice of toxicity reference value. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.873] [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: 10/18/2022]
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Bisson M. Short term exposures, proposal of a methodology. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.872] [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: 11/26/2022]
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Milner CS, Bisson M, Rose GK. A new technique for reduction of flexor tendon avulsions after delayed presentation. J Hand Surg Eur Vol 2008; 33:81. [PMID: 18332027 DOI: 10.1177/1753193407087867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C. S. Milner
- Department of Plastic Surgery, Leicester Royal Infirmary,
Infirmary Square, Leicester, LE1 5WW, UK
| | - M. Bisson
- Department of Plastic Surgery, Leicester Royal Infirmary,
Infirmary Square, Leicester, LE1 5WW, UK
| | - G. K. Rose
- Department of Plastic Surgery, Leicester Royal Infirmary,
Infirmary Square, Leicester, LE1 5WW, UK
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Bulstrode NW, Bisson M, Jemec B, Pratt AL, McGrouther DA, Grobbelaar AO. A prospective randomised clinical trial of the intra-operative use of 5-fluorouracil on the outcome of dupuytren's disease. ACTA ACUST UNITED AC 2004; 29:18-21. [PMID: 14734063 DOI: 10.1016/j.jhsb.2003.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [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: 11/18/2022]
Abstract
5-Fluorouracil reduces proliferation rates of fibroblasts, myofibroblast differentiation and contractility of ocular fibroblasts in vitro. This double-blind randomized clinical trial assesses whether intra-operative topical treatment with 5-fluorouracil reduces the recurrence rate after limited excision of Dupuytren's tissue. Patients with two-digit disease were randomized to having 5-fluorouracil (25mg/ml) treatment for 5 minutes on one digit and placebo on the other. Fifteen patients were enrolled with 18 months follow-up. There were no peri-operative complications. Wound healing was not delayed and there was no deterioration in the flexion deformity of the 5-fluorouracil treated digits. Patients were subsequently assessed by joint angle measurement at 3, 6, 12 and 18 months. There was no significant difference between control and 5-fluorouracil treated digits.
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Affiliation(s)
- N W Bulstrode
- From the RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, HA6 2RN, UK
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Nguyen DT, Frank-Soltysiak M, Bisson M. [Study of terminally ill patients' needs in an university hospital]. Sante Publique 2001; 13:339-47. [PMID: 11963531] [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: 02/24/2023]
Abstract
Within the framework of a project to create a Mobile Palliative Care Unit, in May 2000 we conducted an evaluation of the needs of patients undergoing palliative care in a university hospital centre. Thanks to the use of a standardised questionnaire, a team of doctors and nurses for each service was able to describe the symptoms, treatments and social and family situations as well as assess the eventual outcome of the patients hospitalised in their service who were in an advanced or terminal phase. In total, the study included 52 cases (5.5% of available beds). 81% of patients reported suffering from physical discomfort and 70% from psychological distress. A specific treatment for the disease in question was maintained in 28% of the cases. In 24% of the cases, the patient had social problems. Among all of the patients, 31% were on the waiting list to be transferred to a different location.
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Affiliation(s)
- D T Nguyen
- Service de Santé Publique et d'Epidémiologie, CHU de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Leblond VS, Bisson M, Hontela A. Inhibition of cortisol secretion in dispersed head kidney cells of rainbow trout (Oncorhynchus mykiss) by endosulfan, an organochlorine pesticide. Gen Comp Endocrinol 2001; 121:48-56. [PMID: 11161769 DOI: 10.1006/gcen.2000.7556] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/22/2022]
Abstract
The effects of endosulfan, an organochlorine pesticide, on cortisol secretion in vitro were investigated in enzymatically dispersed head kidney cells of rainbow trout, Oncorhynchus mykiss. First, the conditions for maximal cortisol secretion were characterized by selecting the optimal concentrations of adrenocorticotropin (ACTH) (1 IU/ml) and N(6), 2'-o-dibutyryladenosine 3':5'-cyclic monophosphate (dbcAMP) (2 mM), incubation temperature (15 degrees ) and time period (60 min for ACTH, 120 min for dbcAMP), number of cells per incubation well (75 x 10(6)/ml), and osmolarity of the medium (270 mosmol/L). Exposure of head kidney cells to endosulfan decreased ACTH- or dbcAMP-stimulated cortisol secretion and cell viability in a concentration-dependent pattern and the doses required to disrupt cortisol secretion were significantly lower than doses lethal to the head kidney cells. The median effective concentration of endosulfan (EC(50), the dose that inhibits cortisol secretion by 50%) was 17.3 microM while the median lethal concentration (LC(50), the dose that kills 50% of the cells) was 308 microM. Our study identified endosulfan as an environmental endocrine disrupting chemical that interferes with the normal secretory function of teleost interrenal steroidogenic cells. Multiple sites may be affected within the steroidogenic cells since dbcAMP could not restore cortisol secretion in endosulfan exposed cells.
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Affiliation(s)
- V S Leblond
- Département des Sciences biologiques and TOXEN Research Centre, Université du Québec à Montréal, Montréal, Québec, H3C 3P8, Canada
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Clerc D, Berge E, Benichou O, Paule B, Quillard J, Bisson M. An unusual case of pigmented villonodular synovitis of the spine: benign aggressive and/or malignant? Rheumatology (Oxford) 1999; 38:476-7. [PMID: 10371292 DOI: 10.1093/rheumatology/38.5.476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
INTRODUCTION Though rare, observations of multiple liposarcomas show that the development of secondary tumors occur in sites usually considered as primary locations. This would be more frequent for myxoid liposarcomas than for other subtypes of the disease. Their origin, either multicentric (i.e., coexistence of several primary tumors) or due to metastatic spreading, is still debated. EXEGESIS We report a case of myxoid-type multicentric (i.e., right popliteal fossa, retroperitoneum and soft tissue of the left arm) liposarcomas of different sizes, without pulmonary, hepatic or osseous involvement. These liposarcomas were simultaneously diagnosed in a patient who presented with pain in the right knee. CONCLUSION This support the hypothesis that multiple liposarcomas have a multicentric origin. Initial and follow-up staging of such tumors must investigate not only usual metastatic sites but also classical primary locations.
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Affiliation(s)
- M Kemula
- Service de rhumatologie, hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Clerc D, Marfeuille M, Labous E, Desmoulins F, Quillard J, Bisson M. Spinal tophaceous gout. Clin Exp Rheumatol 1998; 16:621. [PMID: 9779316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Paule B, Clerc D, Rudant C, Coulombel C, Bonhomme-Faivre L, Quillard J, Bisson M. Enhanced expression of interleukin-6 in bone and serum of metastatic renal cell carcinoma. Hum Pathol 1998; 29:421-4. [PMID: 9563797 DOI: 10.1016/s0046-8177(98)90128-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/07/2023]
Abstract
Interleukin-6 (IL-6) is produced by renal cell carcinoma (RCC) cell lines and primary tumors. Using immunohistochemical staining in two RCC patients with hypercalcemia and high serum levels of free and total IL-6, we showed expression of IL-6 in metastatic bone tissue. The role of IL-6 in hypercalcemia and bone resorption would suggest that bisphosphonates or dexamethasone could be useful as adjuvant therapy for IL-6 dependent bone metastases which fail to respond to interferon alpha (IFN) alpha 2a and all trans retinoic acid (ATRA).
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Affiliation(s)
- B Paule
- Service de Rhumatologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Desmoulins F, Clerc D, Marfeuille M, Miquel A, Bisson M. Septic arthritis of the lumbar facet joints. Rev Rhum Engl Ed 1997; 64:859-60. [PMID: 9476282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Le Gars L, Clerc D, Cariou D, Lavabre C, Metral S, Bisson M. Systemic juvenile rheumatoid arthritis and associated Isaacs' syndrome. J Rheumatol Suppl 1997; 24:178-80. [PMID: 9002031] [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: 02/03/2023]
Abstract
We describe a patient with systemic onset juvenile chronic arthritis who developed clinical and electromyographic features of acquired Isaacs' syndrome. This association has not been reported before and possible links between the 2 diseases are discussed.
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Affiliation(s)
- L Le Gars
- Department of Rheumatology, Hôpital de Bicêtre, Kremlin-Bicêtre, France
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Claudepierre P, Clerc D, Cariou D, Lavabre C, Venencie PY, Bisson M. SAPHO syndrome and pyoderma gangrenosum: is it fortuitous? J Rheumatol Suppl 1996; 23:400-2. [PMID: 8882057] [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: 02/02/2023]
Abstract
Pyoderma gangrenosum is well known as an associated feature of inflammatory bowel disease (IBD). Recently, higher than normal prevalence of IBD in patients with the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome has been reported. However, the association of pyoderma gangrenosum with SAPHO syndrome without definitely excluded IBD has not been reported. We describe a case that suggests a possible connection between these 2 entities.
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Affiliation(s)
- P Claudepierre
- Service of Rheumatology, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
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Miquel A, Frouge C, Adrien C, Hibou I, Bittoun J, Bisson M, Bléry M. [Tuberculous tenosynovitis of the wrist: ultrasonographic diagnosis and contribution of MRI]. J Radiol 1995; 76:285-8. [PMID: 7783043] [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: 01/27/2023]
Abstract
Chronic tenosynovitis of the hand due to Mycobacterium tuberculosis has become rare. In the two cases presented here, the final diagnosis was obtained by isolation of the organism in the intercarpal fluid (1 case), or by a synovial biopsy (1 case). Ultrasonography showed a hypoechoic thickening of one or several tendon sheaths. MR enabled better differentiation between the thickening of the synovium itself and a fluid effusion. The criteria permitting to differentiate tuberculous from non-infectious tenosynovitis are: young age, male sex, specific epidemiological factors, elevated erythrocyte sedimentation rate, marked local swelling, association with other foci of tuberculosis, unusual exudation and synovial thickening, and association with osteitis.
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Affiliation(s)
- A Miquel
- Service de Radiologie Centrale, Hôpital de Bicêtre, Le Kremlin-Bicêtre
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Bisson M. [Paget's disease of bone. Diagnosis]. Rev Prat 1994; 44:1977-9. [PMID: 7939293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Bisson
- Service de rhumatologie, hôpital Bicêtre, Le Kremlin-Bicêtre
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Taya A, Morgan A, Baker ST, Humphreys JA, Bisson M, Collier CG. Changes in the rat lung after exposure to radon and its progeny: effects on incorporation of bromodeoxyuridine in epithelial cells and on the incidence of nuclear aberrations in alveolar macrophages. Radiat Res 1994; 139:170-7. [PMID: 8052692] [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: 01/28/2023]
Abstract
The aim of this study was to investigate some responses of cells in the rat respiratory tract as a function of time after inhalation exposure to various levels of radon and its progeny. Rats were exposed to a constant concentration of radon and its progeny to give cumulative exposure levels of 120, 225, 440 and 990 working level months (WLM). An additional unexposed group of rats served as controls. The end points selected for investigation were (a) the incorporation of bromodeoxyuridine (BrdU) in epithelial cells of the conducting airways and of the alveolar region of the respiratory tract and (b) the incidence of alveolar macrophages with nuclear aberrations. After exposure, the incidence of epithelial cells incorporating BrdU--the labeling index--increased in all regions of the respiratory tract examined, but the increase occurred later in alveolar than in airway epithelial cells. The highest labeling index was found in bronchial epithelial cells, which probably received the highest radiation dose. After an initial induction period, the incidence of alveolar macrophages with nuclear aberrations also increased. The possibility of using the labeling index of alveolar and airway epithelial cells, and/or the incidence of nuclear aberrations in alveolar macrophages, to estimate the radiation dose to various regions of the respiratory tract after exposure of rats to radon and its progeny is discussed.
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Affiliation(s)
- A Taya
- Biomedical Research Department, AEA Technology, Oxfordshire, United Kingdom
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Mariette X, Agbalika F, Daniel MT, Bisson M, Lagrange P, Brouet JC, Morinet F. Detection of human T lymphotropic virus type I tax gene in salivary gland epithelium from two patients with Sjögren's syndrome. Arthritis Rheum 1993; 36:1423-8. [PMID: 8216402 DOI: 10.1002/art.1780361015] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate whether human T lymphotropic virus type I (HTLV-I) could be involved in the pathogenesis of Sjögren's syndrome (SS). METHODS Labial salivary gland (LSG) biopsy specimens from 9 patients with SS (4 with primary SS and 5 with SS secondary to rheumatoid arthritis) and 9 controls were studied for the presence of the tax gene of HTLV-I using in situ hybridization, and for the presence of tax, gag, pol, and env genes of HTLV-I using the polymerase chain reaction (PCR). Testing for antibodies to HTLV-I and examination of lymphocytes on blood smears were performed to determine whether systemic viral infection was present. RESULTS Using in situ hybridization and PCR, we detected the tax gene, but not the gag, pol, or env genes, of HTLV-I in LSG sections from 2 of 9 patients with SS and from none of the control subjects. Tax DNA was present mostly in nuclei of epithelial cells, but also in some lymphoid cells. Serum of the 2 affected patients did not contain antibodies to HTLV-I. In 1 patient, examination of blood smears revealed rare convoluted lymphocytes, sometimes with the appearance of "flower cells," as observed in the blood of HTLV-I-infected patients. CONCLUSION None of the known endogenous retroviral sequences is homologous to the tax gene. Thus, we suggest that HTLV-I (or another related retrovirus) can infect salivary epithelium. Transactivation properties of the tax protein could be implicated in the pathogenesis of SS. Alternatively, viral infection could cause de novo expression of HLA-DR antigens and favor the presentation of antigens by epithelial cells, leading, in some genetically predetermined subjects, to lymphoid infiltration of the gland.
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Affiliation(s)
- X Mariette
- Service d'Immuno-Hématologie, Hôpital Saint-Louis, France
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Paillaud E, Clerc D, Berge E, Durandin M, Bisson M. Pseudotumor of the craniocervical hinge in a patient receiving hemodialysis for 4 years. J Rheumatol 1993; 20:1634-5. [PMID: 8164237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cariou D, Clerc D, Durandin M, Berge E, Quillard J, Bisson M. [Pseudo-sarcoidosis form of Whipple's disease. Diagnostic value of treatment]. Rev Med Interne 1993; 14:351. [PMID: 7694348 DOI: 10.1016/s0248-8663(05)81314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lavabre C, Clerc D, Durandin M, Bergé E, Bisson M. [Rheumatoid arthritis and collagenous colitis. Apropos of a new case]. Rev Rhum Ed Fr 1993; 60:259-60. [PMID: 8293016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Berge E, Laurent-Puig P, Clerc D, Durandin M, Bisson M. [Psoriatic arthritis in a patient treated with interferon alpha]. Rev Rhum Ed Fr 1993; 60:77. [PMID: 8242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Xerri B, Clerc D, Durandin M, Berge E, Bisson M. [Association of sclerodermatomyositis and humero-scapular retractile capsulitis. A new case]. Rev Rhum Mal Osteoartic 1991; 58:901. [PMID: 1780677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mariette X, Gozlan J, Clerc D, Bisson M, Morinet F. Detection of Epstein-Barr virus DNA by in situ hybridization and polymerase chain reaction in salivary gland biopsy specimens from patients with Sjögren's syndrome. Am J Med 1991; 90:286-94. [PMID: 1848394] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine whether Epstein-Barr virus (EBV) could be involved in the pathogenesis of Sjögren's syndrome (SS). PATIENTS AND METHODS In situ hybridization using the BamH1-W fragment of EBV DNA was performed using labial salivary gland biopsy specimens from 14 patients with SS (eight with primary SS and six with secondary SS) and 39 control subjects. Furthermore, labial salivary gland biopsy specimens from 12 patients with SS (seven with primary SS and five with secondary SS) and 24 control subjects were submitted to the polymerase chain reaction to detect EBV DNA. RESULTS In situ hybridization detected EBV DNA in epithelial cells of labial salivary gland biopsy specimens from four of eight (50%) patients with primary SS, zero of six patients with secondary SS, and three of 39 (8%) control subjects. The difference between patients with primary SS and control subjects was statistically significant (p less than 0.02). The polymerase chain reaction detected EBV DNA in six of seven (86%) patients with primary SS, three of five (60%) patients with secondary SS, and seven of 24 (29%) control subjects. The difference between patients with primary SS and control subjects was statistically significant (p less than 0.01). CONCLUSION Both newly developed techniques showed that the presence of EBV DNA was significantly increased in patients with primary SS in comparison with control subjects. In all the positive SS patients who underwent in situ hybridization, epithelial cells of the labial salivary gland were the target of EBV infection. Our results suggest that this virus may play a role in the pathogenesis of SS. We cannot yet determine whether EBV is directly responsible for the destruction of the gland, or if its presence is a secondary event following gland injury.
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Affiliation(s)
- X Mariette
- Service de Rhumatologie, Hôpital de Bicêtre Le Kremlin, France
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Ebelin M, Mariette X, Quillard J, Bisson M, Mazas F. [Tuberculoid tenosynovitis of the hand. Apropos of 3 cases of unusual and various causes]. Ann Chir Main Memb Super 1991; 10:151-3. [PMID: 1716128 DOI: 10.1016/s0753-9053(05)80198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- M Ebelin
- Service de Chirurgie Orthopédique, Hôpital de Bicêtre, Kremlin
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Clerc D, Brousse C, Mariette X, Bennet P, Bisson M. Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone. Ann Rheum Dis 1991; 50:67. [PMID: 1847283 PMCID: PMC1004336 DOI: 10.1136/ard.50.1.67-b] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abella A, Clerc D, Francoual J, Chalas J, Baret A, Bauer D, Bisson M, Menkès CJ, Leluc R, Lindenbaum A. [Anti-radical enzymes, oxygenated free radicals and lipoperoxydation in rheumatoid polyarthritis. Effects of treatment with D-penicillamine]. Rev Rhum Mal Osteoartic 1990; 57:855-61. [PMID: 2080397] [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: 12/30/2022]
Abstract
Three aspects of the action of oxygenated free radicals were studied in 10 controls and 20 patients with rheumatoid arthritis, 11 not treated and 9 treated with D-penicillamine. Free radical production was evaluated in whole blood, malondialdehyde was measured in plasma, the concentration of antiradicular enzymes (copper and manganese superoxide dismutase, catalase and glutathion peroxydase) in hemolysate, platelets and plasma and copper superoxide dismutase activity in a chloroform erythrocyte extract. Only patients treated with D-penicillamine showed a significant decrease in the concentration of platelet anti-radicular enzymes and plasma manganese superoxide dismutase. The involvement of oxygenated free radicals in the pathophysiology of rheumatoid arthritis and in the mechanism of action of D-penicillamine in this pathology is discussed.
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Affiliation(s)
- A Abella
- Service de Biochimie, Hôpital Antoine Beclère, Clamart
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