La gestion de la qualité des soins dans un contexte de contrat liant un établissement public et un partenaire privé

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade M.S. ès sciences (M. Sc) en sciences infirmières, option administration des sciences infirmièresLe vieillissement de la population et l'accroissement du nombre de personnes âgées présentant des problèmes de santé complexes ont fait augmenter la demande pour les services d'hébergement. Les ressources intermédiaires ont été créées suite au partenariat entre un Centre de Santé et de Services Sociaux (CSSS) et un partenaire du secteur privé. Selon l'entente légale, le CSSS est imputable de la qualité des soins offerts par les deux parties. Ce partenariat occasionne des problèmes de gestion de la qualité des soins causés par des valeurs et des objectifs différents. Les buts de ce travail dirigé sont d'une part suite à la recension des écrits et en utilisant le cadre de référence de la gouvernance clinique, d'identifier des conditions pour assurer la qualité des soins et services offerts aux personnes en perte d'autonomie en ressources intermédiaires et d'autre part de proposer des interventions de gestion.The aging of the population and the increase of the number of elderly presenting complex health problems consequently increase the demand for accomodation services. The intermediate resources were created subsequent to the partnership between a Centre de Santé et de Services Sociaux (CSSS) and a partner of the private sector. According to the legal agreement, the CSSS is accountable for the quality of care offered by both parts. This partnership creates problems of quality management of the care caused by different values and objectives. The purposes of this managed work are on one hand further to the recension of the writings and the clinical governance framework, to identify conditions to assure the quality of cares and services offered to the persons in loss of autonomy in intermediate resources and on the other hand to propose interventions of management

A 9-year follow-up study of the natural progression of upper limb performance in myotonic dystrophy type 1: a similar decline for phenotypes but not for gender

Abstract: This study aimed to document and compare the decline of upper limb performance among adults with myotonic dystrophy type 1 according to phenotype and gender. A longitudinal descriptive design compared upper limb performance at baseline and follow-up of 70 women and 38 men with the late-onset or adult phenotypes. Grip strength and pinch strength as well as gross dexterity and fine dexterity were assessed. All four performance measures decreased significantly (p < 0.001). The decline over time was similar for individuals with the late-onset and adult-onset phenotypes, but differed according to gender. For late-onset and adult-onset phenotypes respectively, women lost less grip strength than men: 0.4 and minus 0.8 kg (2.0% and -9.4%) in women vs. minus 7.4 and minus 3.1 kg (-19.2% and -30.7%) in men. A similar situation was found for gross dexterity: minus 3.0 and minus 3.2 blocks (-4.6% and -5.9%) in women vs. minus 12.4 and minus 8.7 blocks (-19.4% and -16.6%) in men. Pinch gauge had the smallest standard deviations and was one of the only measurement tools with significant detectable changes in relation to the standard error of measurement. Given these results, health professionals and researchers should consider phenotype and gender differently when planning health services or future studies. Indeed, as their upper limb strength and dexterity differed, even if their decline was similar, the phenotypes should not be pooled. Finally, the use of the pinch gauge to assess long-term change in upper limb ability seems preferable to the three other measurements

Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge

Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention

Known, lost, and recovered: Efficacy of formal-semantic therapy and spaced retrieval method in a case of semantic dementia

peer reviewedBackground: Few studies have addressed rehabilitation in semantic dementia. A potentially promising method is formal-semantic therapy, which consists of tasks in which the names of concepts and their semantic characteristics are presented. It could also be enhanced by spaced retrieval, a learning method improving retention through recalling information after increasing recall intervals. Aims: This study explores the efficacy of both a formal-semantic therapy and the spaced retrieval method to restore lost concepts in TBo, a woman with semantic dementia. Methods & Procedures: The formal-semantic therapy consisted of giving TBo semantic feedback followed by a cueing technique to facilitate naming. Formal-semantic therapy with simple repetition was compared to formal-semantic therapy with spaced retrieval. TBo's performance was measured throughout the study with picture naming and generation of verbal attributes. Two untrained lists were also measured for generalisation effects. Outcomes & Results: Results indicate that, after therapy, TBo could name 3/8 of the trained items, compared to no items on the untrained lists. She also showed an increase in performance for the evocation of specific semantic attributes of concepts, reaching 6/8 of correct responses. Moreover, she maintained her performance up to 5 weeks after the end of the study. Finally, when compared to simple repeated practice, spaced retrieval did not enhance learning and no generalisation was observed between trained and non-trained categories. Conclusions: Along with recent results reported in the literature, TBo's results confirm that people with semantic dementia can improve their naming performance with training but that this is limited. However, formal-semantic therapy seems very promising for retraining specific semantic attributes. Instead of focusing on naming, we suggest that therapies used in semantic dementia should aim at restoring specific and functionally relevant concepts to enable the individuals to be more autonomous in daily living

A collaborative model to implement flexible, accessible and efficient oncogenetic services for hereditary breast and ovarian cancer : the C-MOnGene study

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics

L'enseignement en tandem comme forme de mentorat pour favoriser l'insertion professionnelle et l'acquisition de compétences pédagogiques des enseignants débutants au collégial

Cette recherche a pour but de comprendre si l'enseignement en tandem peut constituer une forme de mentorat favorisant l' insertion professionnelle et l' acquisition de compétences pédagogiques chez les enseignants débutants au collégial. Les thèmes majeurs à l' étude dans le cadre de la présente recherche portent donc sur l'insertion professionnelle, l'enseignement en tandem, le mentorat et les compétences pédagogiques comme enseignant au collégial. À la suite d ' une recherche qualitative auprès de personnes expérimentant l'enseignement en tandem, nous avons pu constater que c'est un type d 'enseignement facilitant pour l'insertion professionnelle de la relève enseignante au collégial et pour l'acquisition plus rapide des compétences pédagogiques, en particulier dans un contexte où le tandem est composé d ' un débutant et d ' un enseignant plus expérimenté. La complémentarité de l'expérience de terrain du débutant (compétence disciplinaire) et de l'expérience pédagogique du mentor (compétences didactique et pédagogique), représente une formule enrichissante pour les deux parties. Malgré le fait que cette formule demande beaucoup de temps et d ' investissement et qu'elle est mal reconnue dans le calcul des tâches enseignantes, les répondants sont très positifs face à cette méthode d'enseignement. Il semble que ce soit une grande source de motivation et de dynamisme professionnel

Développement du raisonnement clinique chez des étudiantes en sciences infirmières par la méthode SNAPPS-A : une étude pilote

Contexte : Les étudiantes en sciences infirmières doivent développer leur raisonnement clinique. La méthode Summarize Narrow Analyse Probe Plan Select (SNAPPS) est une stratégie pédagogique centrée sur l’apprenante qui favorise l’expression du raisonnement clinique et des incertitudes. Objectifs : 1) Explorer l’utilisation de SNAPPS-A, une version adaptée aux sciences infirmières, lors de stages ; 2) Documenter le point de vue des étudiantes et des superviseures sur la pertinence et l’utilisation de SNAPPS-A. Méthodes : Une étude pilote exploratoire qualitative de 16 mois, dans trois milieux de stages universitaires auprès de sept dyades, utilisant une méthode d’échantillonnage de convenance a été réalisée. Les étudiantes devaient être inscrites en deuxième année de baccalauréat en sciences infirmières et accepter d’enregistrer au moins un échange SNAPPS-A. Leur superviseure devait accepter de participer à la recherche ou à l’utilisation de SNAPPS-A. Résultats : Douze enregistrements ont été réalisés auprès des sept dyades. Les étudiantes étaient des femmes (85 %) âgées entre 18 et 24 ans. Les superviseures étaient également des femmes (72 %) âgées entre 25 et 44 ans. La méthode, jugée pertinente et facile à appliquer dans tous les milieux cliniques, permet aux étudiantes d’être proactives et d’acquérir de l’autonomie. Elle a aidé les superviseures à mieux comprendre la démarche clinique et à adapter leur accompagnement en fonction des forces et faiblesses des apprenantes. Les barrières relevées sont identiques à celles mentionnées dans les écrits. Conclusion : La méthode SNAPPS-A peut s’avérer utile pour soutenir le développement du raisonnement clinique des étudiantes infirmières lors des stages