Sainte-Justine du futur : des patients et des parents parlent aux soignants

Contexte Le Président-directeur général du Centre hospitalier universitaire (CHU) Sainte-Justine a offert à un jeune médecin chercheur de former un groupe pour réfléchir au futur de l’institution. Le moyen choisi pour y arriver a été de le demander aux personnes bénéficiant de ses services, soit les patients et leurs proches. Objectif Le projet de recherche réalisé visait à donner la parole aux personnes qui bénéficient des soins et services au CHU Sainte-Justine pour savoir comment les patients et leurs proches voudraient vivre leur expérience s’ils revenaient dans quelques années au CHU Sainte-Justine. Méthode Il y a eu 13 groupes de discussion, ainsi que 3 entrevues individuelles pour un total de 59 personnes rencontrées, dont 19 patients et 40 proches. Comme il s’agit d’un projet exploratoire, l’hypothèse de travail se résume à l’unique préoccupation de recueillir le plus d’idées possible des participants aux groupes de discussion. La méthode de recherche retenue est une analyse exploratoire et descriptive (Miles et Huberman, 2003). Résultats Le constat général à la suite de l’analyse de leurs propos est que les finalités du partenariat patient-famille-soignants s’ancrent dans ce dont les patients et les proches disent avoir besoin. Les résultats démontrent toute la complexité de leur réalité de la vie avec la maladie, et le besoin de reconnaissance de cette complexité, le besoin d’être compris, considérés et soutenus pour mieux composer avec la maladie et les transformations de la vie qu’elle engendre. Nous avons aussi démontré qu’ils demandent à avoir une relation de partenaires avec les soignants, et qu’ils demandent aussi que toutes les personnes qu’ils côtoient au CHU Sainte-Justine se considèrent comme des soignants, car chacune d’entre elles a un rôle important dans leur parcours au CHUSJ. Conclusion Les patients et leurs proches souhaitent que les personnes œuvrant au CHU et le CHU Sainte-Justine comme organisation se transforment pour répondre aux besoins et aux demandes exprimés par les participants aux groupes de discussion. Cette transformation désirée prend racine dans deux grands domaines, celui de l’éthique clinique, soit dans la relation patient-famille-soignants, et celui de l’éthique organisationnelle, soit dans la transformation organisationnelle nécessaire pour soutenir l’éthique clinique sur le terrain. La transformation du CHU Sainte-Justine dans chacun de ces deux domaines soulève un défi propre. Au niveau clinique, le défi est humain, soit d’oser la relation au-delà des soins et des services offerts. Au niveau organisationnel, le défi est politique, soit la transformation organisationnelle du CHU Sainte-Justine.Context The Chairman and CEO of the University Hospital Sainte-Justine offered a young physician and researcher to form a group to reflect on the future ef the institution. The mean chosen to do so was to ask the people receiving these services, both the patients and their relatives. Objective This research project is aimed at giving a voice to the people who benefit from the care and services at CHU Sainte-Justine. This is a chance for staff at CHUSJ to know how patients and their families would like to relive their experience if they returned to CHU Sainte-Justine within a few years. Methods There were 13 focus groups, as well as 3 individual interviews for a total of 59 people met, consisting of 19 patients and 40 relatives. Since it is an exploratory project, the working hypotheses is to collect as many ideas as possible from participants. The research method chosen is an exploratory and descriptive analysis (Miles et Huberman, 2003). Results We have demonstrated that they wish to have a relationship of partners with the caregivers, and that they ask that all the people they meet at CHU Sainte-Justine consider themselves as caregivers, being as each of them has an important role in their experience at the CHUSJ. The general observation following the analysis of the proposals is that the aims of the patient-family-caregivers partnership are centered on what patients and relatives say they need. The results show the complexity of their reality of life with a disease, the need to recognize this complexity, the need not only to be understood, but considered as well as supported to better cope with the illness and the transformations of life that it entails. Conclusion Patients and their families want the people working at CHU /CHU Sainte-Justine as an organization to reinvent themselves to meet the needs and requests expressed by the focus group participants. These desired changes can be divided into two main areas: that of clinical ethics, in the patient-family-caregivers relationship, and that of organizational ethics, or in the organizational evolution needed to support clinical ethics in the field. The transformation of CHU Sainte-Justine in each of these two areas raises challenges of its own. At the clinical level, the challenge is human; to dare to make changes in the relationship beyond the level of current care and services offered. At the organizational level, the challenge is political; namely the organizational transformation of CHU Sainte-Justine

Immune Responses to Plague Infection in Wild Rattus rattus, in Madagascar: A Role in Foci Persistence?

Plague is endemic within the central highlands of Madagascar, where its main reservoir is the black rat, Rattus rattus. Typically this species is considered susceptible to plague, rapidly dying after infection inducing the spread of infected fleas and, therefore, dissemination of the disease to humans. However, persistence of transmission foci in the same area from year to year, supposes mechanisms of maintenance among which rat immune responses could play a major role. Immunity against plague and subsequent rat survival could play an important role in the stabilization of the foci. In this study, we aimed to investigate serological responses to plague in wild black rats from endemic areas of Madagascar. In addition, we evaluate the use of a recently developed rapid serological diagnostic test to investigate the immune response of potential reservoir hosts in plague foci.We experimentally infected wild rats with Yersinia pestis to investigate short and long-term antibody responses. Anti-F1 IgM and IgG were detected to evaluate this antibody response. High levels of anti-F1 IgM and IgG were found in rats one and three weeks respectively after challenge, with responses greatly differing between villages. Plateau in anti-F1 IgM and IgG responses were reached for as few as 500 and 1500 colony forming units (cfu) inoculated respectively. More than 10% of rats were able to maintain anti-F1 responses for more than one year. This anti-F1 response was conveniently followed using dipsticks.Inoculation of very few bacteria is sufficient to induce high immune response in wild rats, allowing their survival after infection. A great heterogeneity of rat immune responses was found within and between villages which could heavily impact on plague epidemiology. In addition, results indicate that, in the field, anti-F1 dipsticks are efficient to investigate plague outbreaks several months after transmission

Invasive Meningococcal Disease in Québec, Canada, Due to an Emerging Clone of ST-269 Serogroup B Meningococci with Serotype Antigen 17 and Serosubtype Antigen P1.19 (B:17:P1.19)

During periods of endemic meningococcal disease, serogroup B Neisseria meningitidis is responsible for a significant percentage of invasive diseases, and no particular clone or strain predominates (F. E. Ashton and D. A. Caugant, Can. J. Microbiol. 47: 293-289, 2001), However, in the winter of 2004 to 2005, a cluster of serogroup B meningococcal disease occurred in one region in the province of Québec, Canada. The N. meningitidis strain responsible for this cluster of cases was identified as sequence type ST-269 with the antigenic formula B:17:P1.19. Retrospective analysis of isolates from 2000 onwards showed that this clone first emerged in the province of Québec in 2003. The emergence of this clone of serogroup B meningococci occurred after a mass vaccination against serogroup C N. meningitidis, suggesting possible capsule replacement

Top management team characteristics and life insurer performance: Do top managers make a difference?

This study examines the impact of top management team characteristics on life insurer performance. The authors argue that greater social cohesion among team members makes it less likely that the insurer will be able to adapt to the changes that have characterized the U.S. life insurance industry over the past decade and will, therefore, be detrimental to performance. Our findings support this assertion and suggest that life insurers driven by more diversified top management teams outperform life insurers with more homogenous top management teams