10 research outputs found
An interdisciplinary guideline development process: the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines
<p>Abstract</p> <p>Background</p> <p>Evaluation of low-back pain guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) criteria has shown weaknesses, particularly in stakeholder involvement and applicability of recommendations. The objectives of this project were to: 1) develop a primary care interdisciplinary clinical practice guideline aimed at preventing prolonged disability from low-back pain, using a community of practice approach, and 2) assess the participants' impressions with the process, and evaluate the relationship between participant characteristics and their participation.</p> <p>Methods</p> <p>Ten stakeholder representatives recruited 136 clinicians to participate in this community of practice. Clinicians were drawn from the following professions: physiotherapists (46%), occupational therapists (37%), and family physicians (17%). Using previously published guidelines, systematic reviews, and meta-analyses, a first draft of the guidelines was presented to the community of practice. Four communication tools were provided for discussion and exchanges with experts: a web-based discussion forum, an anonymous comment form, meetings, and a symposium. Participants were prompted for comments on interpretation, clarity, and applicability of the recommendations. Clinical management recommendations were revised following these exchanges. At the end of the project, a questionnaire was sent to the participants to assess satisfaction towards the guidelines and the development process.</p> <p>Results</p> <p>Twelve clinical management recommendations on management of low-back pain and persistent disability were initially developed. These were discussed through 188 comments posted on the discussion forum and 103 commentary forms submitted. All recommendations were modified following input of the participants. A clinical algorithm summarizing the guidelines was also developed. A response rate of 75% was obtained for the satisfaction questionnaire. The majority of respondents appreciated the development process and agreed with the guideline content. Most participants thought recommendations improved between versions, and that participant comments contributed to this improvement. All stakeholders officially endorsed the guidelines.</p> <p>Conclusion</p> <p>The community of practice approach was a successful method to develop guidelines on low-back pain, with participants providing information to improve guideline recommendations. The information technology infrastructure that was developed remains for continuous interdisciplinary exchanges and updating of the guidelines.</p
An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project
<p>Abstract</p> <p>Background</p> <p>Low-back pain is responsible for significant disability and costs in industrialized countries. Only a minority of subjects suffering from low-back pain will develop persistent disability. However, this minority is responsible for the majority of costs and has the poorest health outcomes. The objective of the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) project was to develop a primary care interdisciplinary practice model for the clinical management of low-back pain and the prevention of persistent disability.</p> <p>Methods</p> <p>Using previously published guidelines, systematic reviews and meta-analyses, a clinical management model for low-back pain was developed by the project team. A structured process facilitating discussions on this model among researchers, stakeholders and clinicians was created. The model was revised following these exchanges, without deviating from the evidence.</p> <p>Results</p> <p>A model consisting of nine elements on clinical management of low-back pain and prevention of persistent disability was developed. The model's two core elements for the prevention of persistent disability are the following: 1) the evaluation of the prognosis at the fourth week of disability, and of key modifiable barriers to return to usual activities if the prognosis is unfavourable; 2) the evaluation of the patient's perceived disability every four weeks, with the evaluation and management of barriers to return to usual activities if perceived disability has not sufficiently improved.</p> <p>Conclusion</p> <p>A primary care interdisciplinary model aimed at improving quality and continuity of care for patients with low-back pain was developed. The effectiveness, efficiency and applicability of the CLIP model in preventing persistent disability in patients suffering from low-back pain should be assessed.</p
The Transmission Probabilities of Founder Genes in Five Regional Populations of Quebec
Tremblay Marc, Arsenault Julie, Heyer Evelyne.- The Transmission Probabilities of Founder Genes in Five Regional Populations of Quebec Certain rare hereditary diseases have an unusually high incidence in the population of Quebec. The deleterious genes associated with these disorders were probably introduced in the seventeenth century by immigrants whose descendants are the ancestors of a large part of the modern population of Quebec. The goal of this study is to measure the differential transmission of the genes of founders at the origin of five regional populations of Quebec (Beauce, Char- levoix, Rimouski, Saguenay and Terrebonne). Using gene dropping, 50,000 simulations were performed with an initial sample of 756 ascending genealogies. The results show certain founders to have a non-negligible probability of having transmitted their genes to at least 5% of the population in the Charlevoix and Saguenay regions. The probabilities of reaching carrier frequencies between 1% and 5% (this is the frequency level at which several recessive genes in the population are found) are much higher, and for a larger number of founders m the five regions. Nevertheless, the observed differences between the probabilities obtained for the founders of each region suggest distinct trajectories in the transmission of founder genes, attributable to differential migratory and reproductive behaviour among the descendants of the founders.Tremblay Marc, Arsenault Julie, Heyer Evelyne.- Les probabilitĂ©s de transmission des gènes fondateurs dans cinq populations rĂ©gionales du QuĂ©bec Certaines maladies hĂ©rĂ©ditaires rares ont une incidence anormalement Ă©levĂ©e dans la population quĂ©bĂ©coise. Les gènes dĂ©lĂ©tères associĂ©s Ă ces maladies ont Ă©tĂ© vraisemblablement introduits au XVIIe siècle par des immigrants dont les descendants sont les ancĂŞtres d'une grande partie de la population contemporaine du QuĂ©bec. L'objectif de cette Ă©tude est de mesurer la transmission diffĂ©rentielle des gènes de fondateurs qui sont Ă l'origine de cinq populations rĂ©gionales du QuĂ©bec (Beauce, Charlevoix, Rimouski, Saguenay et Terrebonne). 50 000 simulations ont Ă©tĂ© effectuĂ©es Ă partir d'un corpus de 756 gĂ©nĂ©alogies ascendantes, en utilisant la mĂ©thode du gene-dropping. Les rĂ©sultats rĂ©vèlent que quelques fondateurs ont une probabilitĂ© non nĂ©gligeable d'avoir transmis leurs gènes au moins Ă 5 % de la population des rĂ©gions de Charlevoix et du Saguenay. Les probabilitĂ©s d'atteindre une frĂ©quence de porteurs comprise entre 1 % et 5 % (intervalle Ă l'intĂ©rieur duquel se situent les frĂ©quences de plusieurs gènes rĂ©cessifs dans la population) sont beaucoup plus Ă©levĂ©es et ce, pour un plus grand nombre de fondateurs dans les cinq rĂ©gions. Cependant, les Ă©carts observĂ©s entre les probabilitĂ©s obtenues pour les fondateurs de chacune des rĂ©gions suggèrent des Ă©volutions distinctes de la transmission des gènes fondateurs, attnbuables Ă une diffĂ©renciation des comportements migratoires et reproducteurs parmi les descendants des fondateurs.Tremblay Marc, Arsenault Julie, Heyer Evelyne.- Las probabilidades de transmisiĂłn de los genes fundadores en cinco poblaciones rĂ©gionales de Quebec Ciertas enfermedades hereditanas raras tienen una incidencia anormalmente elevada entre la poblaciĂłn de Quebec. Los genes deleteros asociados a estas enfermedades fueron pro- bablemente introducidos durante el siglo XVII por inmigrantes cuyos descendientes son an- tepasados de gran parte de la poblaciĂłn actual de Quebec. El objetivo de este estudio es medir la transmisiĂłn diferenciál de los genes de fundadores de cinco poblaciones rĂ©gionales de Quebec (Beauce, Charlevoix, Rimouski, Saguenay y Terrebonne). Utilizando el mĂ©todo de gene-dropping se han realizado 50.000 simulaciones a partir de una base de 756 genealogias ascendentes. Los resultados revelan que existe una probabilidad no despreciable de que cier- tos fundadores hayan transmitido sus genes al menos al 5% de la poblaciĂłn de las regiones de Charlevoix y Saguenay. La probabilidad de que la frecuencia de portadores alcance entre el 1% y el 5% (intervalo en el interior del cual se sitĂşan las frecuencias de varios genes recesivos entre la poblaciĂłn) es mucho más elevada para un numero tambiĂ©n más elevado de fundadores en las cinco regiones. No obstante, las diferentes probabilidades observadas entre los fundadores de cada regiĂłn sugieren evoluciones distintas de la transmisiĂłn de los genes fundadores; tales diferencias serĂan atnbuibles a comportamientos migratorios y reproductivos distintos entre los descendientes de los fundadores.Tremblay M., Arsenault Julie Anne, Heyer É. The Transmission Probabilities of Founder Genes in Five Regional Populations of Quebec. In: Population (English edition), 58ᵉ annĂ©e, n°3, 2003. pp. 361-380
Les probabilités de transmission des gènes fondateurs dans cinq populations régionales du Québec
Tremblay Marc, Arsenault Julie, Heyer Evelyne.- The Transmission Probabilities of Founder Genes in Five Regional Populations of Quebec Certain rare hereditary diseases have an unusually high incidence in the population of Quebec. The deleterious genes associated with these disorders were probably introduced in the seventeenth century by immigrants whose descendants are the ancestors of a large part of the modern population of Quebec. The goal of this study is to measure the differential transmission of the genes of founders at the origin of five regional populations of Quebec (Beauce, Charlevoix, Rimouski, Saguenay and Terrebonne). Using gene dropping, 50,000 simulations were performed with an initial sample of 756 ascending genealogies. The results show certain founders to have a non-negligible probability of having transmitted their genes to at least 5% of the population in the Charlevoix and Saguenay regions. The probabilities of reaching carrier frequencies between 1% and 5% (this is the frequency level at which several recessive genes in the population are found) are much higher, and for a larger number of founders in the five regions. Nevertheless, the observed differences between the probabilities obtained for the founders of each region suggest distinct trajectories in the transmission of founder genes, attributable to differential migratory and reproductive behaviour among the descendants of the founders.Tremblay Marc, Arsenault Julie, Heyer Evelyne.- Les probabilitĂ©s de transmission des gènes fondateurs dans cinq populations rĂ©gionales du QuĂ©bec Certaines maladies hĂ©rĂ©ditaires rares ont une incidence anormalement Ă©levĂ©e dans la population quĂ©bĂ©coise. Les gènes dĂ©lĂ©tères associĂ©s Ă ces maladies ont Ă©tĂ© vraisemblablement introduits au XVIIe siècle par des immigrants dont les descendants sont les ancĂŞtres d'une grande partie de la population contemporaine du QuĂ©bec. L'objectif de cette Ă©tude est de mesurer la transmission diffĂ©rentielle des gènes de fondateurs qui sont Ă l'origine de cinq populations rĂ©gionales du QuĂ©bec (Beauce, Charlevoix, Rimouski, Saguenay et Terrebonne). 50 000 simulations ont Ă©tĂ© effectuĂ©es Ă partir d'un corpus de 756 gĂ©nĂ©alogies ascendantes, en utilisant la mĂ©thode du gene-dropping. Les rĂ©sultats rĂ©vèlent que quelques fondateurs ont une probabilitĂ© non nĂ©gligeable d'avoir transmis leurs gènes au moins Ă 5 % de la population des rĂ©gions de Charlevoix et du Saguenay. Les probabilitĂ©s d'atteindre une frĂ©quence de porteurs comprise entre 1 % et 5 % (intervalle Ă l'intĂ©rieur duquel se situent les frĂ©quences de plusieurs gènes rĂ©cessifs dans la population) sont beaucoup plus Ă©levĂ©es et ce, pour un plus grand nombre de fondateurs dans les cinq rĂ©gions. Cependant, les Ă©carts observĂ©s entre les probabilitĂ©s obtenues pour les fondateurs de chacune des rĂ©gions suggèrent des Ă©volutions distinctes de la transmission des gènes fondateurs, attribuables Ă une diffĂ©renciation des comportements migratoires et reproducteurs parmi les descendants des fondateurs.Tremblay Marc, Arsenault Julie, Heyer Evelyne.- Las probabilidades de transmisiĂłn de los genes fundadores en cinco poblaciones rĂ©gionales de Quebec Ciertas enfermedades hereditarias raras tienen una incidencia anormalmente elevada entre la poblaciĂłn de Quebec. Los genes deleteros asociados a estas enfermedades fueron pro- bablemente introducidos durante el siglo XVII por inmigrantes cuyos descendientes son ante- pasados de gran parte de la poblaciĂłn actual de Quebec. El objetivo de este estudio es medir la transmisiĂłn diferenciál de los genes de fundadores de cinco poblaciones rĂ©gionales de Quebec (Beauce, Charlevoix, Rimouski, Saguenay y Terrebonne). Utilizando el mĂ©todo de gene-dropping se han realizado 50.000 simulaciones a partir de una base de 756 genealogias ascendentes. Los resultados revelan que existe una probabilidad no despreciable de que ciertos fundadores hayan transmitido sus genes al menos al 5% de la poblaciĂłn de las regiones de Charlevoix y Saguenay. La probabilidad de que la frecuencia de portadores alcance entre el 1% y el 5% (intervalo en el interior del cual se situan las frecuencias de varios genes recesivos entre la poblaciĂłn) es mucho más elevada para un numero tambiĂ©n más elevado de fundadores en las cinco regiones. No obstante, las diferentes probabilidades observadas entre los fundadores de cada regiĂłn sugieren evoluciones distintas de la transmisiĂłn de los genes fundadores; tales diferencias serĂan atribuibles a comportamientos migratorios y reproductivos distintos entre los descendientes de los fundadores.Tremblay M., Arsenault Julie Anne, Heyer É. Les probabilitĂ©s de transmission des gènes fondateurs dans cinq populations rĂ©gionales du QuĂ©bec. In: Population, 58ᵉ annĂ©e, n°3, 2003. pp. 403-423
Le pari de l’accompagnement pour la formation de praticiens réflexifs de l’enseignement : possibilités et limites d’un système de stages
Dès le début de l’implantation d’un nouveau système de formation pratique au BEPP de l’Université de Sherbrooke en 2003, notre équipe a mis en place un dispositif de collecte continu de données auprès de ses acteurs qui nous a permis d’en faire un objet de recherche. Notre article décrit d’abord brièvement le fonctionnement de ce système, puis pose les quatre problématiques qui ont fait l’objet d’une évaluation de notre part : l’organisation générale de la formation pratique, l’intégration cours-stages, le développement des compétences des stagiaires et l’accompagnement offert par les superviseurs et les enseignants associés. Les résultats des analyses, qui ont été réalisées à l’aide d’une grille dont les catégories ont émergé des données recueillies, nous permettent ensuite de discuter des enjeux et des conséquences du dispositif d’accompagnement de la pratique réflexive que nous avons mis en place. Nous terminons par un ensemble de propositions issues de cette analyse