Monitoring the degree of implementation of an integrated delivery system

INTRODUCTION: The aim of the study was to develop a method to measure the implementation of specific components of an Integrated Service Delivery system for the frail elderly. The system includes six mechanisms and tools: (1) coordination of all organizations involved in delivering health and social services, (2) a single entry point, (3) case management, (4) a single assessment tool with a case-mix classification system, (5) an individualized service plan, and (6) a computerized clinical chart. METHOD: Focus groups of researchers, clinicians, managers and policy-makers identified quantitative indicators for each component. The six components were weighted according to their relative importance in order to generate a total score. Data were collected every six months over 30 months to establish the implementation degree in the three experimental areas: Sherbrooke, Granit and Coaticook in the Province of Quebec, Canada. RESULTS: After 30 months, coordination is the most developed component in the three experimental areas. Overall, in July 2003, the Integrated Service Delivery system was implemented at the rate of 73%, 71% and 70% in Sherbrooke, Granit and Coaticook, respectively. DISCUSSION: This type of quantitative assessment provides data for managers and researchers to monitor the implementation. Moreover, when there is an outcome study, the results of the outcome study can be correlated with the degree of implementation, thus allowing for dose-response analyzes and helping to decrease the “black box” effect

The 24-h lung-function profile of once-daily tiotropium and olodaterol fixed-dose combination in chronic obstructive pulmonary disease

Background: This study investigated the effects on 24-h lung function and lung volume of a once-daily fixed-dose combination (FDC) of the long-acting muscarinic antagonist tiotropium and the long-acting beta(2)-agonist olodaterol in patients with chronic obstructive pulmonary disease. Methods: This was a randomised, double-blind, placebo-controlled, Phase III trial with an incomplete crossover design. Patients received four of the following six treatment options for 6 weeks each: placebo, olodaterol 5 mu g, tiotropium 2.5 mu g, tiotropium 5 mu g, tiotropium + olodaterol FDC 2.5/5 mu g and tiotropium + olodaterol FDC 5/5 mu g, all delivered via the Respimat (R) inhaler. The primary end point was forced expiratory volume in 1 s (FEV1) area under the curve from 0 to 24 h (AUC(0-24)) response after 6 weeks of treatment; key secondary end points were FEV1 AUC from 0 to 12 h and AUC from 12 to 24 h, and further end points included lung-volume parameters measured using body plethysmography (subset of patients), measures of peak and trough FEV1, and incidence of adverse events. Results: A significant improvement in FEV1 AUC(0-24) response was observed with tiotropium + olodaterol 5/5 mu g and 2.5/5 mu g versus placebo and monotherapies after 6 weeks of treatment; mean response with tiotropium + olodaterol 5/5 mu g versus placebo was 0.280 L (p < 0.0001). Differences to monotherapies with tiotropium + olodaterol 5/5 mu g were 0.115 L versus olodaterol 5 mu g, 0.127 L versus tiotropium 2.5 mu g and 0.110 L versus tiotropium 5 mu g (p < 0.0001 for all comparisons). Secondary end points supported these data. No safety concerns were identified. Conclusions: Overall, this study demonstrated improvements in lung function over 24 h with an FDC of tiotropium + olodaterol over tiotropium or olodaterol alone, with no observed difference in tolerability. ClinicalTrials.gov number: NCT01559116

Impact of oral melatonin on the electroretinogram cone response

<p>Abstract</p> <p>Background</p> <p>In the eye, melatonin plays a role in promoting light sensitivity at night and modulating many aspects of circadian retinal physiology. It is also an inhibitor of retinal dopamine, which is a promoter of day vision through the cone system. Consequently, it is possible that oral melatonin (an inhibitor of retinal dopamine) taken to alleviate circadian disorders may affect cone functioning. Our aim was to assess the impact of melatonin on the cone response of the human retina using electroretinography (ERG).</p> <p>Methods</p> <p>Twelve healthy participants aged between 18 to 52 years old were submitted to a placebo-controlled, double-blind, crossover, and counterbalanced-order design. The subjects were tested on 2 sessions beginning first with a baseline ERG, followed by the administration of the placebo or melatonin condition and then, 30 min later, a second ERG to test the effect.</p> <p>Results</p> <p>Following oral melatonin administration, a significant decrease of about 8% of the cone maximal response was observed (mean 6.9 μV ± SEM 2.0; P = 0.0065) along with a prolonged b-wave implicit time of 0.4 ms ± 0.1, 50 minutes after ingestion.</p> <p>Conclusion</p> <p>Oral melatonin appears to reach the eye through the circulation. When it is administered at a time of day when it is not usually present, melatonin appears to reduce input to retinal cones. We believe that the impact of melatonin on retinal function should be taken into consideration when used without supervision in chronic self-medication for sleep or circadian disorder treatment.</p

Protocole d’évaluation de la sécurité à domicile (PESAD) : version francophone du SAFER-HOME v.3

Les intervenants de la santé sont appelés à se prononcer sur la sécurité des aînés vivant à domicile et ils ont, à cet effet, très peu d’outils francophones à leur disposition. Le Protocole d’évaluation de la sécurité à domicile (PESAD) est issu de la traduction et de la validation transculturelle du SAFER-HOME. Le processus de validation et l’étude de la fidélité des résultats ont mis en lumière un outil intéressant et possédant de bonnes qualités métrologiques. Il permet aux intervenants francophones d’obtenir des résultats d’évaluation complets et rigoureux relativement à la sécurité à domicile des aînés francophones.Health workers are called upon to give their opinion on the safety of elderly people living at home and they have very few French-language tools at their disposal. The Protocole d’évaluation de la sécurité à domicile (PESAD) is the result of a translation and cultural validation of SAFER-HOME. The validation process and testing of the reliability of the results suggest that PESAD is an interesting and high quality measurement tool. It enables Francophone health-care workers to obtain complete and accurate evaluation results about the home safety of elderly Francophones