Évaluation des impacts cliniques, fonctionnels et économiques d'un hôpital de jour psychiatrique pour personnes adultes et âgées avec divers troubles mentaux

Problématique : Les hôpitaux de jour psychiatriques sont parmi les types de services intensifs et ambulatoires en santé mentale qui connaissent un essor significatif mais dont on ne connaît pas clairement les effets. Objectifs. L'objectif général de la présente étude visait à comparer les effets d'un hôpital de jour psychiatrique pour personnes adultes et âgées à ceux de l'hospitalisation, sur les symptômes, la participation sociale, l'estime de soi, de même que la satisfaction face aux services, la consommation de services sociosanitaires et leurs coûts associés. Méthodologie. L'hôpital de jour psychiatrique évalué était celui de l'Hôpital Louis-H. Lafontaine. Un dispositif quasi expérimental a été utilisé. Le groupe expérimental était composé des usagers de l'hôpital de jour ciblé. Le groupe de comparaison incluait des personnes qui ont consulté l'urgence psychiatrique du même établissement, qui ont été hospitalisées et qui étaient cliniquement comparables au groupe expérimental. Les deux groupes ont été divisés selon leur catégorie diagnostique principale : troubles psychotiques; troubles de l'humeur et anxieux; troubles de la personnalité du groupe B. En plus des caractéristiques sociodémographiques, les variables cliniques et fonctionnelles évaluées étaient la symptomatologie, l'estime de soi et la participation sociale. Dans les deux groupes, les données ont été colligées à trois moments: T1: première semaine suivant le début de l'intervention index (hôpital de jour, hospitalisation); T2: entre cinq et huit semaines plus tard et T3: six mois suivant le T2. Un questionnaire sur la satisfaction face aux services fut administré à T2. Afin de comprendre plus en profondeur l'impact de l'hôpital de jour dans le temps, des entrevues individuelles ont été réalisées à T3 avec 18 participants du groupe expérimental. Par ailleurs, concernant le volet économique, une analyse de la consommation des services sociosanitaires dans les six mois précédant et suivant les deux interventions index et les coûts associés à ces services a été effectuée. Résultats. Entre les T1 et T2, le degré d'amélioration était significativement plus important dans le groupe hôpital de jour en ce qui concerne la gravité des symptômes, l'estime de soi, la réalisation et la satisfaction de la participation sociale. Entre les T2 et T3, aucune différence dans le degré de changement entre les deux groupes n'a été trouvée. Les participants de l'hôpital de jour étaient significativement plus satisfaits de plusieurs dimensions des services reçus. Lorsque les trois clientèles cliniques traitées à l'hôpital de jour ont été comparées, le degré d'amélioration durant le suivi à l'hôpital de jour était significativement moins important chez les personnes avec des troubles psychotiques que dans les deux autres groupes par rapport à la gravité des symptômes, la détresse et l'estime de soi. À la suite du congé, le degré de changement était comparable entre les trois groupes. Sur le plan qualitatif, au T3, les participants aux entretiens ont exprimé que l'expérience à l'hôpital de jour a été particulièrement aidante pour améliorer les symptômes et la relation à soi et a permis d'amorcer un processus de transformation personnelle qui s'est poursuivi par la suite. La terminaison a créé chez plusieurs participants un vide abrupte. Les enjeux durant les premiers six mois après le congé sont la continuité de soins, le soutien social et la mise en pratique des apprentissages faits à l'hôpital de jour. Les analyses de consommation de services ont démontré qu'il n'y avait pas de différence entre les deux groupes six mois avant l'intervention index. Six mois suivant le congé des interventions index, le nombre de personnes réhospitalisées était significativement plus élevé dans le groupe hospitalisation. La comparaison des coûts totaux moyens des services consommés six mois avant et six mois après l'intervention index a démontré une réduction de coûts de 38 % pour le groupe hôpital de jour et de 7 % pour le groupe hospitalisation. Conclusions. Les résultats de cette étude suggèrent que l'hôpital de jour est une alternative à l'hospitalisation efficace cliniquement et économiquement pour des personnes adultes et âgées présentant divers troubles mentaux aigus. Malgré le fait que la très grande majorité des participants de l'hôpital de jour consomment des services de santé mentale après leur suivi, selon l'expérience décrite par les participants, la transition vers les services en externe est difficile pour plusieurs et devrait faire partie de réflexions futures dans l'organisation des services des hôpitaux de jour psychiatriques

Perspective francophone sur la science de l'occupation : enfin !

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Catherine Backman

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Comment donner une valeur à la science de l'occupation ? Les méthodologies les plus utilisées dans les études actuelles

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The Development of Theory- and Evidence-based Educational Workshops for Occupational Therapists

The Do-Live-Well (DLW) framework is a health promotion approach developed by Canadian occupational therapists (OTs). As the DLW framework is relatively new, it has not been widely adopted by OTs. In order to facilitate OTs to incorporate the DLW concepts in their practice, there should be more learning opportunities, and online and in-person workshops have been chosen to be a specific interest of this study. The purpose of this project was to develop theory- and evidence-based in-person and online educational workshops for OTs as a pre-implementation study to increase the knowledge of the DLW framework among OTs. In order to develop workshops, we incorporated three different phases. First, we interviewed four OTs who have been applying the DLW concepts in practice to understand their use of the framework and training needs. It was identified that OTs experienced difficulty applying the DLW concepts in practice and wanted opportunities to learn more about the DLW framework. Next, problem-based learning (PBL) guided the workshop development, and the same eight key PBL principles were incorporated in both the in-person and online workshops. Finally, four different experts completed usability testing of the online workshop website to improve its learning environment. The online workshop website was improved based on the feedback from the usability testers. The next step of this research will be to compare effectiveness of in-person and online platforms for workshop delivery. The detailed development process described in this project may assist occupational therapy educators in developing theory- and evidence-based educational delivery methods

Addressing Suicide in Entry-to-Practice Occupational Therapy Programs: A Canadian Picture

Worldwide, over 800,000 people die each year by suicide, leaving many behind to grieve the loss. Preventing suicide involves reaching people before they are in crisis (prevention), helping them to navigate a crisis that could result in suicide (intervention), and addressing the aftermath of a suicide loss or attempt (postvention). Healthcare professionals, including occupational therapists, unitedly acknowledge the lack of skills, knowledge, and competence in all facets of suicide awareness and prevention in their professional training and in practice. To improve this situation, suicide prevention skills must be taught in entry to practice programs, so they will filter into the practice of all occupational therapists. Thus, the purpose of this study was to discover how competencies related to suicide prevention are currently taught to student occupational therapists in Canadian universities. A cross-sectional descriptive design was used to survey the 14 Canadian university occupational therapy programs. 12/14 programs responded. All endorsed the use of a range of pedagogical approaches, but there was little similarity from one university to another. Learning activities mainly related to mitigating imminent suicide risk (intervention) and illustrated a lack of attention to the continuum of suicidal behavior (prevention, intervention, and postvention). All universities showed a clear willingness to improve their approach, but there is no current gold standard to strive for. Future initiatives can support research in this regard to ensure student occupational therapists are better prepared to address the full continuum of prevention, intervention, and postvention with explicit attention to an occupational perspective

Contributorship and division of labor in knowledge production

Scientific authorship has been increasingly complemented with contributorship statements. While such statements are said to ensure more equitable credit and responsibility attribution, they also provide an opportunity to examine the roles and functions that authors play in the construction of knowledge and the relationship between these roles and authorship order. Drawing on a comprehensive and multidisciplinary dataset of 87,002 documents in which contributorship statements are found, this article examines the forms that division of labor takes across disciplines, the relationships between various types of contributions, as well as the relationships between the contribution types and various indicators of authors’ seniority. It shows that scientific work is more highly divided in medical disciplines than in mathematics, physics, and disciplines of the social sciences, and that, with the exception of medicine, the writing of the paper is the task most often associated with authorship. The results suggest a clear distinction between contributions that could be labeled as ‘technical’ and those that could be considered ‘conceptual’: While conceptual tasks are typically associated with authors with higher seniority, technical tasks are more often performed by younger scholars. Finally, results provide evidence of a U-shaped relationship between extent of contribution and author order: In all disciplines, first and last authors typically contribute to more tasks than middle authors. The paper concludes with a discussion of the implications of the results for the reward system of science

Feasibility of Lifestyle Redesign® for community-dwelling older adults with and without disabilities : results from an exploratory descriptive qualitative clinical research design

Abstract : Introduction. Although Lifestyle Redesign® has been shown to be effective in improving older adults’ health and well-being, little is known about the feasibility of implementing this program to develop meaningful and health-promoting routines of community-dwelling older adults in Canada. This study thus aimed to explore the feasibility of implementing a culturally-adapted 6-month version of Lifestyle Redesign® with community-dwelling older French-Canadians with and without disabilities. Methods. An exploratory descriptive qualitative clinical research design was used with 17 older adults living at home or in a seniors’ residence, divided into two groups participating in Lifestyle Redesign®. Semi-structured interviews were conducted with participants and the occupational therapist who delivered the program and recorded clinical notes. Findings. Participants were aged between 65 and 90; they were mainly women (n=11; 64.7%) and 7 (41.2%) had disabilities. The intervention was tailored to the participants’ needs, interests and capacities in each group (e.g., modules selected, number of individual sessions, assistance of volunteer). Over the 6-month period, older adults participated in an average of about 25 group sessions with the occupational therapist and in four or five outings with their group (e.g., restaurant, market, museum) and attended between five and eleven individual sessions with the occupational therapist. The most common reasons for missing group sessions were being ill, working, or having another appointment. Personal facilitators and barriers to participation in the intervention were mainly related to abilities, needs, spiritual life, and health. Environmental facilitators were mostly the regularity of the sessions, group and external support, including human resources to deliver the intervention, while barriers were the residence’s time restrictions and staff’s attitudes, cost of some activities targeted in the program, and transportation problems. Conclusion. Lifestyle Redesign® is a feasible preventive occupational therapy intervention for community-dwelling older French-Canadians. These findings will guide future studies including large-scale clinical trials

Beyond funding: Acknowledgement patterns in biomedical, natural and social sciences

[EN] For the past 50 years, acknowledgments have been studied as important paratextual traces of research practices, collaboration, and infrastructure in science. Since 2008, funding acknowledgments have been indexed by Web of Science, supporting large-scale analyses of research funding. Applying advanced linguistic methods as well as Correspondence Analysis to more than one million acknowledgments from research articles and reviews published in 2015, this paper aims to go beyond funding disclosure and study the main types of contributions found in acknowledgments on a large scale and through disciplinary comparisons. Our analysis shows that technical support is more frequently acknowledged by scholars in Chemistry, Physics and Engineering. Earth and Space, Professional Fields, and Social Sciences are more likely to acknowledge contributions from colleagues, editors, and reviewers, while Biology acknowledgments put more emphasis on logistics and fieldwork-related tasks. Conflicts of interest disclosures (or lack of thereof) are more frequently found in acknowledgments from Clinical Medicine, Health and, to a lesser extent, Psychology. These results demonstrate that acknowledgment practices truly do vary across disciplines and that this can lead to important further research beyond the sole interest in funding.This research was supported by the Social Sciences and Humanities Research Council of Canada, Joseph-Armand Bombardier CGS Doctoral Scholarships, Paul-Hus; Insight Development [grant number 430-2014-0617], Lariviere and Desrochers; as well as by funding from the South African DST-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Rodrigo Costas.Paul-Hus, A.; Arias-Diaz-Faes, A.; Sainte-Marie, M.; Desrochers, N.; Costas, R.; Larivière, V. (2017). Beyond funding: Acknowledgement patterns in biomedical, natural and social sciences. PLoS ONE. 12(10). https://doi.org/10.1371/journal.pone.0185578S121