Patient acceptability of tCBT

Abstract : Objective: Cognitive-behavior therapy (CBT) is a research-supported treatment for anxiety disorders. Transdiagnostic CBT protocols have been recently developed to manage multiple anxiety disorders. The efficacy of transdiagnostic CBT is directly dependent on acceptability as perceived by patients and health care providers. In this study, we sought to examine the acceptability of transdiagnostic CBT from the patient perspective within the context of a community-based group delivery for mixed anxiety disorders. Method: An embedded qualitative study was conducted as part of a pragmatic randomized clinical trial of group transdiagnostic CBT for anxiety disorders. Semi-structured interviews were conducted based on a meta-framework of the concept of acceptability. Acceptability of the therapy was examined with a thematic analysis of interview verbatims. Results: Seventeen patients were interviewed. Patients’ perception of acceptability of tCBT was classified into eight themes: 1) therapy features; 2) intervention components; 3) group format; 4) group cohesiveness; 5) co-therapists with different expertise; 6) quality of therapeutic alliance; 7) perceived effectiveness; and 8) access to the therapy. Conclusion: The acceptability of transdiagnostic group CBT for patients was generally perceived as adequate in the context of a community-based therapy. Recommendations to enhance acceptability of the group therapy were related to group size, group dynamics and exposure

Strategies identified by program directors to improve adoption of the CanMEDS framework

Background: Challenges associated with the use of the CanMEDS physician competency framework (CanMEDS) have been the subject of several studies. Most of these have focused on the adoption of specific roles in an Anglophone context. This study aims to investigate how Francophone postgraduate medical education (PGME) program directors have integrated the CanMEDS framework into their programs.Methods: We invited Francophone PGME program directors to participate in group interviews aimed at exploring their experiences using the CanMEDS framework. We used an open-ended interview guide and realized a thematic analysis of the transcripts.  Results: We held five group interviews between February and December 2014 with 17 Francophone program directors representing 13 out of a maximum of 62 different specialties/subspecialties. Although program directors endorsed the framework, its integration was seen as challenging, particularly the assessment of non-medical expert roles. To overcome these challenges, they relied on common strategies including a longitudinal approach to the framework, improving inter-program collaboration, and subcontracting the teaching of certain roles.Conclusion: While integrating the CanMEDS framework into their programs, Francophone program directors struggled with teaching and assessing non-medical expert roles and ensuring their longitudinal integration over time.  Directors relied on various strategies, some of which (e.g., subcontracting) may ultimately limit the adoption of the framework as a whole.___Contexte: Les défis associés à l'utilisation du référentiel de compétences CanMEDS pour les médecins ont fait l'objet de plusieurs études. La plupart de ces études ont portées sur l'adoption de rôles spécifiques dans un contexte anglophone. Cette étude vise à explorer comment les directeurs de programmes d’études médicales postdoctorales (EMP) francophones ont intégré CanMEDS dans leurs programmes.Méthodes: Nous avons invité les directeurs de programmes EMP francophones à participer à des entrevues de groupe. Ces entrevues visaient à explorer leur expérience de l’utilisation du référentiel CanMEDS. Nous avons utilisé un guide d'entrevue ouvert et nous avons fait une analyse thématique des transcriptions. Résultats: Nous avons tenu cinq entrevues de groupe entre février et décembre 2014 avec 17 directeurs de programmes de 13 des 62 spécialités/sous-spécialités. Bien que les directeurs de programmes appuient le référentiel, son intégration a été perçue comme un défi, notamment en ce qui a trait à l'évaluation des rôles autres que celui d'expert médical. Pour surmonter ces défis, ils se sont appuyés sur des stratégies communes, notamment une approche longitudinale du référentiel, l'amélioration de la collaboration entre les programmes et la sous-traitance de l'enseignement de certains rôles.Conclusions: À travers le processus d’intégration du référentiel CanMEDS, les directeurs de programmes EMP francophones ont de la difficulté à enseigner et à évaluer les rôles autres que celui d'expert médical ainsi qu’à veiller à leur intégration respective et continue au fil du temps. Ils ont eu recours à diverses stratégies, dont certaines (p. ex., la sous-traitance) pourraient ultimement limiter l'adoption du référentiel dans son ensemble

Challenges related to the analytical process in realist evaluation and latest developments on the use of NVivo from a realist perspective

Realist evaluation (RE) is a research design increasingly used in program evaluation, that aims to explore and understand the influence of context and underlying mechanisms on intervention or program outcomes. Several methodological challenges, however, are associated with this approach. This article summarizes RE key principles and examines some documented challenges and solutions when analyzing RE data, including the development of Context-Mechanism-Outcome configurations. An analytic method using NVivo features is also presented. This method makes it possible to respond to certain analytic difficulties associated with RE by facilitating the identification of patterns and ensuring transparency in the analytical process. -- Keywords : Realist evaluation ; qualitative data analysis software ; NVivo ; C-M-O configuration

Interprofessional Shared Decision Making in the NICU: A Survey of an Interprofessional Healthcare Team

Background: The purpose of this study was to determine how different membersof an interprofessional (IP) team (nurses, physicians, respiratory therapists, and other professionals) perceived collaboration and satisfaction with the decisionmaking process across three decision types (triage, chronic condition management, values-sensitive decisions) in a neonatal intensive care unit (NICU).Methods and Findings: All members of the team at a tertiary NICU in Canada who consented to the study received a modified version of the Collaboration and Satisfaction about Care Decisions (CSACD) instrument. A total of 96 completed surveys were returned (response rate of 81.4). Collaboration scores were calculatedfor each participant, professional group, and the IP team. The Pearson product-moment correlation coefficient was used to investigate the relationship between perceived collaboration about decision making and satisfaction with the decision-making process. Inter-group comparisons across different decision types were also calculated. The majority of statistically significant differences in professional perspectives about decision making were about triage decisions. Nurses and respiratory therapists were more likely than other groups to feel the decision-making process was inadequate. There was a strong, positive correlation between perceived collaboration in decision making, satisfaction with the decision-making process, and satisfaction with the decision.Conclusions: Findings from this survey suggest that healthcare professionals' views differ about what constitutes optimum interprofessional shared decision making(IPSDM), and the decision type is an important influencing factor for IPSDM

Implicaciones de los actores locales en las intervenciones para la promoción de la salud bucodental destinadas a niños de edad preescolar y escolar en entornos vulnerables

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Practitioners' validation of framework of team-oriented practice models in integrative health care: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>Biomedical and Complementary and Alternative Medicine (CAM) academic and clinical communities have yet to arrive at a common understanding of what Integrative healthcare (IHC) is and how it is practiced. The Models of Team Health Care Practice (MTHP) framework is a conceptual representation of seven possible practice models of health care within which teams of practitioners could elect to practice IHC, from an organizational perspective. The models range from parallel practice at one end to integrative practice at the other end. Models differ theoretically, based on a series of hypotheses. To date, this framework has not been empirically validated. This paper aims to test nine hypotheses in an attempt to validate the MTHP framework.</p> <p>Methods</p> <p>Secondary analysis of two studies carried out by the same research team was conducted, using a mixed methods approach. Data were collected from both biomedical and CAM practitioners working in Canadian IHC clinics. The secondary analysis is based on 21 participants in the qualitative study and 87 in the quantitative study.</p> <p>Results</p> <p>We identified three groups among the initial seven models in the MTHP framework. Differences between practitioners working in different practice models were found chiefly between those who thought that their clinics represented an integrative model, versus those who perceived their clinics to represent a parallel or consultative model. Of the scales used in the analysis, only the process of information sharing varied significantly across all three groups of models.</p> <p>Conclusions</p> <p>The MTHP framework should be used with caution to guide the evaluation of the impact of team-oriented practice models on both subjective and objective outcomes of IHC. Groups of models may be more useful, because clinics may not "fit" under a single model when more than one model of collaboration occurs at a single site. The addition of a hypothesis regarding power relationships between practitioners should be considered. Further validation is required so that integrative practice models are well described with appropriate terminology, thus facilitating the work of health care practitioners, managers, policy makers and researchers.</p

Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic

Purpose: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. Methods: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants’ attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. Results: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. Conclusion: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease

Intersectoral oral health promotion interventions for schoolchildren living in remote rural Andean communities: a realist evaluation

Background: Intersectoral oral health promotion entails the participation of local communities. IOHP interventions were introduced in Peru in primary schools in 2013 but oral health among schoolchildren living in rural Andean communities remains suboptimal. Objectives: To understand the contextual elements and the underlying mechanisms associated with intersectoral oral health promotion interventions’ current effects on schoolchildren living in remote rural Andean communities. Method: A realist evaluation was carried out in three rural Andean communities where intersectoral oral health promotion interventions aimed at schoolchildren have been implemented. Following an evaluation of the effects among schoolchildren, contextual elements and mechanisms were explored with various stakeholders involved in intersectoral oral health promotion through focus groups and semi-structured interviews. Subsequently, an iterative data analysis and a validation process resulted in the identification of context-mechanism configurations. Results: Previous positive experiences of collaboration, a focus on communication, feelings of being respected and considered, and development of leadership and trust among stakeholders involved in intersectoral oral health promotion were elements of configurations that positively influence intersectoral oral health promotion. On the other hand, unfavorable physical, social and political environments, previous negative health experiences, feelings of not being respected or considered, demotivation, development of mistrust and insufficient leadership were shown to negatively influence outcomes. Conclusion: This research highlights the complexity associated with the deployment of intersectoral oral health promotion interventions in rural communities. Local stakeholders should be further involved to build trust, to facilitate coordination processes among remote rural communities and oral health professionals, and to optimize deployment of intersectoral oral health promotion interventions. -- Keywords : oral health promotion ; schoolchildren ; rural communities ; realist evaluation

Mindfulness-Based Reduction Stress Reduction for Patients with Rheumatoid Arthritis and Depressive Symptoms: a Pilot Trial

Background : Despite their efficacy at controlling joint inflammation, current treatments of rheumatoid arthritis (RA) leave up to 40% of patients into non-remission. Non-remission, frequently due to persistently negative self-reported impact of RA, was found to be associated with significant persistent depressive symptoms 6-7 months after initiation of arthritis treatment. Mindfulness-Based Stress Reduction (MBSR) is proposed to improve depressive symptoms and RA-related clinical outcomes. To pave the way for an eventual randomized controlled trial, a feasibility and acceptability study of MBSR has been realized. Methods: A standardized 8-week MBSR program was offered to groups of patients with controlled inflammatory disease but high levels of depressive symptoms.Qualitative interviews based on a theoretical framework of acceptability were conducted. Change in depressive symptoms (CES-D tool), fatigue and pain (SF-36), anxiety (GAD-7), pain, disease activity (PtVAS and SDAI scores) was measured over a 6-month period. Results: 27 patients have been recruited (3 distinct MBSR groups). Factors leading to a higher rate of success in recruitment were identified. Despite the small sample, the intervention was found to have a clear impact on depressive symptoms (p=0.004), anxiety (p=0.005), and social functioning (from the SF-36; p=0.04). Patients reported that MBSR gave them the opportunity to control their reactions in face of stressful situations.Perceptions were almost uniformly positive towards MBSR, and most appear to have integrated some part of the intervention in their daily life. Conclusions: Although recruitment was challenging, a MBSR trial on depressed patients with controlled inflammatory disease was found acceptable and feasible within this population. Preliminary clinical results showed positive impacts of such intervention.