Patient's perspective on an integrated knowledge translation tool in homecare occupational therapy

Background

Patient engagement and integrated knowledge translation (IKT) approaches involving end-users of knowledge are increasingly documented for their social benefits in the subsequent application of health innovations. Algo is an IKT-based algorithm conceived with occupational therapists (OTs; supervisors) and non-OTs (users) in Quebec's (Canada) public homecare services (HCS) to support skill mix for bathing equipment selection. However, the unknown patient experience related to Algo's utilization in HCS hinders the deployment of adjusted facilitation strategies for the beneficiaries.

Methods

A multiple case study (case: a HCS minimally including an OT, a non-OT and a manager) was performed with semi-structured interviews and focus groups, based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) model. For intra-case analysis, extracts related to patient's experience were analyzed thematically according to the i-PARIHS components (Innovation, Recipients and Context) by a patient collaborator who shares its recommendations.

Results

Seventy-four (74) extracts from 5 cases referring to different trajectories of Algo's IKT process were analyzed by the patient collaborator and discussed through 5 interviews over 14 months. The following themes were identified: the promotion of Algo's relative advantage (Innovation) adjusted to the recipients' mandates, the consolidation of interprofessional collaboration between OTs, non-OTs, and managers (Recipients) and the development of their leadership abilities through the HCS instances (Context).

Conclusions

Patient's recommendations on Algo's IKT process in public HCS will orientate next facilitation orientations for supporting its utilization with patients living occupational difficulties during hygiene care at home. The integration of these findings expands the epistemic perspectives considered for developing public health policies to positively impact on quality of patient care.

Key messages

Patient’s perspective should be involved in integrated knowledge translation studies in order to expand end-users’ consideration in the development and application of knowledge. Patient’s feedback on the knowledge translation process (i.e., knowledge, recipients and context characteristics) offers a holistic perspective of analysis for improving facilitation orientations.

Pain assessment of elderly with neurocognitive disorders in long-term care: an occupational lens

Background

Occupational performance of older adults living in long-term care facilities is influenced by environmental possibilities and service provision. Pain among older adults with neurocognitive disorders might be a factor mitigating functional status. However, pain evaluation during daily routine through advanced stages of the disorder is scarce.

Objective

Identify pain-related behaviors of older adults with neurocognitive disorders during their morning routine in long-term care facilities.

Methods

A multiple-case study based on an embedded concurrent mixed methods design (quan-QUAL) was conducted in Quebec (Canada) in three long-term care units. Older adults with a neurocognitive disorder were observed (from 7:00 to 12:00 AM) and evaluated through the accomplishment of their morning routine. Through inter- and intra-case analyses, pain assessment scales (PACSLAC-II, Algoplus and DS-DAT) and morning routine assessment (occupational therapist's observations of the person, occupations and environment, functional autonomy measure, field notes) were integrated in mixed methods matrixes.

Results

Sixteen (n = 16) participants (average age: 76 years old [59, 93]) with various but advanced functional declines and pain symptoms were included. Participants' significant occupations all related to basic activities of daily living. Hygiene care and getting dressed were occupations for which an alteration of occupational performance was identified.

Conclusions

During their morning routine, older adults with a neurocognitive disorder living in long-term care facilities are facing pain symptoms and occupational deprivation, limiting the fulfilment of their needs and their engagement in occupations. Accordingly, older adults' occupations in relation to their environment should also be considered in future studies investigating pain.

Key messages

Occupational performance of older adults with a neurocognitive disorder living in long term care facilities is limited to basic activities of daily living. Assessment of pain of patients with a neurocognitive disorder in long-term care units should include the identification of environmental and occupational factors contributing to this pain.

French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC)

BACKGROUND

Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner's organizational theory, the "Organizational Readiness for Implementing Change" (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties.

METHODS

(1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach's alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis.

RESULTS

A French 10-item scale named the Réceptivité organisationnelle à l'implantation d'un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach's alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC's items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC's model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12).

CONCLUSIONS

The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.

Cohesive, multicomponent, dense powder flow characterization by NIR

Non-aerated powder flows are frequently encountered in downstream pharmaceutical processes. Such flows occur at the entrance of powder compression units, and their characteristics are of great interest because any powder agglomeration or segregation can be detrimental to the quality of the final solid oral dosage form. This work was aimed at developing a process analytical technology (PAT) method, based on near-infrared spectroscopy (NIR) for the in-line powder flow characterization of pharmaceutical formulations. An Ibuprofen drug formulation was selected for study. A bench-scale hopper system was assembled to monitor powder flow behaviour. An in-line commercial NIR Axsun spectrometer and probe were chosen to collect in-line spectral data on dense, multicomponent, non-aerated powder flow prior to compression. Spectra were collected on flowing mannitol and pharmaceutical product blends. A specially designed, non-contact sampling interface allowed the collection of representative process powder flow spectra without affecting blend uniformity. A partial least squares chemometric model was developed for laboratory-prepared samples, to quantitatively determine the flowing powder's active pharmaceutical ingredient (API) level. Static sample spectra and flowing pure mannitol spectra proved to have a high degree of reproducibility. The model's standard error of calibration was 2.95% of the API level with a R2 of 0.991. Flowing blend powder spectra and API estimates showed variations consistent with those seen in model samples. The average values for flowing pharmaceutical blends were close to the API concentration, indicating that the proposed procedure was statistically acceptable. The model is considered very promising, and some improvements would lead to its final acceptance at production scale as a PAT tool.

Characterization of dual HIV-1 and HIV-2 serological profiles by polymerase chain reaction

OBJECTIVE

To evaluate the frequency of dual HIV-1 and HIV-2 DNA sequences in patients with dual serological profiles.

DESIGN

We tested 40 samples from AIDS patients living in Abidjan, Côte d'Ivoire.

METHODS

Dual serological reactivity was determined by double Western blot and two enzyme-linked immunosorbent assays with recombinant proteins and synthetic peptides as antigens. The Western blot was considered to show dual reactivity when sera reacted with at least two glycoproteins and one core protein of each virus. HIV DNA sequences were detected by hybridization to radiolabelled probes of polymerase chain reaction (PCR) products amplified using specific primers.

RESULTS

Both HIV-1 and HIV-2 DNA sequences were detected in four out of 11 samples with a dual serological profile and in four out of 24 samples with anti-HIV-1 antibodies only.

CONCLUSION

These results show that dual HIV-1 and HIV-2 serological profiles are not always due to infection by both viruses, and emphasize the need for a combination of serological and PCR assays for the appraisal of these viral infections.

Specificity of new peptide immunoassays versus other immunoassays and agglutination tests for detection of HIV antibody in African sera

The specificity of three HIV EIAs using synthetic peptides was evaluated and compared with that of four commercial EIAs using recombinant proteins or whole virus lysates of HIV-1 or of HIV-1 and HIV-2, and of two tests based on agglutination of sensitized particles. A total of 734 West African sera were screened. The best results were obtained with tests using recombinant proteins. HIV tests using synthetic peptides able to distinguish between HIV-1 and HIV-2 antibodies showed comparable specificity, but some false negative results represent a major handicap of these peptide EIAs in screening for HIV antibodies.

Competitive enzyme-immunoassays using native viral antigens to discriminate between HIV-1 and HIV-2 infections

Human immunodeficiency virus (HIV) strains can be separated into two serotypes: HIV-1 and HIV-2. In the study reported herein, we developed and evaluated competitive enzyme-immunoassays (CEIA-1 for the detection of antibody to HIV-1, CEIA-2 for the detection of antibody to HIV-2) to discriminate serologically between HIV-1 and HIV-2 infections. In most of the cases, the serotyping of known reactive serum samples was done easily with the CEIAs, showing a similar specificity to the Western blot. Such competitive assays could represent alternative procedures for serotyping HIV infection and would limit the need for expensive Western blots, especially in economically poor countries.

Multicenter evaluation of a new recombinant enzyme immunoassay for the combined detection of antibody to HIV-1 and HIV-2

A newly developed recombinant antigen-based anti-HIV-1/HIV-2 enzyme immunoassay (Abbott Recombinant HIV-1/HIV-2 EIA) was evaluated against a second generation anti-HIV-1 EIA (Abbott Recombinant HIV-1 EIA). Five thousand and twenty-nine sera from European blood donors and 403 sera from central African blood donors were used in the evaluation, along with four panels and one cohort. The panels included 99 'problem' sera, 733 sera with antibodies to HIV-1 from asymptomatic people and from patients at different disease stages, 25 serial bleeds from five plasmapheresis donors seroconverting for antibodies to HIV-1, and 202 sera with antibodies to HIV-2 collected from healthy and diseased people of European or west African origin. In addition, 734 sera collected from a west African cohort were tested. Using Western blot as the reference standard, the specificity obtained by the recombinant anti-HIV-1 EIA (HIV-i EIA) was 99.90% [99.81-99.99%; 95% confidence limits (95% CL)] with European blood donor sera; 99.50% (98.78-100%) with Central Africa blood donor sera; 92.93% (87.78-98.08%) with 'problem' sera and 99.43% (98.87-100%) with sera from a west African cohort. Using the same samples, the recombinant anti-HIV-1/HIV-2 EIA (HIV-1/HIV-2 EIA) yielded a specificity of 99.84% (99.73-99.95%), 99.50% (98.78-100%), 95.96% (92.00-99.92%) and 98.58% (97.69-99.47%), respectively. All 776 Western blot-confirmed anti-HIV-1 sera were reactive in both EIAs, and the EIA-reactive samples from seroconverting plasma donors were always observed for both assays in the same serial bleed. For HIV-2, the HIV-1 EIA yielded an overall sensitivity of 75.83% (69.93-81.72%) compared with 99.53% (98.58-100%) for HIV-1/HIV-2 EIA. The addition of a recombinant env-protein of HIV-2 to the recombinant env and core proteins of HIV-1 on the solid phase of HIV-1 EIA improved the detection of anti-HIV-2 while preserving the assay's overall specificity and sensitivity for the detection of anti-HIV-1.

Prevalence of antibody to human T cell leukemia virus type 1 (HTLV-1) in populations of Ivory Coast, West Africa

A large cross-sectional serologic survey for human T cell leukemia virus type 1 (HTLV-1) antibody was conducted in 3,177 Ivory Coast residents to evaluate the prevalence of HTLV-1 and to determine possible risk factors and correlates of HTLV-1 infection. Of the 3,177 serum samples, 110 (3.5%) were positive for antibody to HTLV-1 by indirect immunofluorescence assay and Western blot. The prevalence of HTLV-1 antibody in the general adult population was 1.8% and increased significantly with age. No difference between males (1.5%) and females (2%) was found. The highest prevalences were observed in female prostitutes (7.4%), patients with neurologic syndromes (5.8%), and lepers (13.7%). The high prevalence of HTLV-1 infection in prostitutes suggests that heterosexual contact is involved in the transmission of HTLV-1 and that prostitutes could play an important role in the spread of the virus in Africa. The high prevalence of HTLV-1 in patients with neurologic syndromes confirms the association between HTLV-1 and some type of neuropathies, as has been observed in the West Indies and Japan. The high prevalence observed in lepers deserves further investigation to find the cause of the association. Twenty-five individuals, including prostitutes, were coinfected with HTLV-1 and human immunodeficiency virus (HIV). Prospective studies are necessary to evaluate the exact role of HTLV-1 alone or in combination with HIV in inducing specific diseases.

[Serologic survey on Chlamydia trachomatis in different populations of the Ivory Coast]

Chlamydial serum antibodies were screened in more than 1,000 persons by immunofluorescence test. C. trachomatis antibodies (greater than or equal to 1/16 for males, greater than or equal to 1/64 for females) were found more frequently in risk group (prostitutes: 64.7%, prisoners: 64.0%) than in control groups (pregnant women: 18.8%, children: 6.6%). The presence of antibodies to C. trachomatis was correlated with presence of T. pallidum and HIV antibodies.