Appropriate training and retention of community doctors in rural areas: a case study from Mali

Background While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Methods Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. Results and discussion The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Conclusion Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale

Knowledge mobilization in the context of health technology assessment: an exploratory case study

<p>Abstract</p> <p>Background</p> <p>Finding measures to enhance the dissemination and implementation of their recommendations has become part of most health technology assessment (HTA) bodies' preoccupations. The Quebec government HTA organization in Canada observed that some of its projects relied on innovative practices in knowledge production and dissemination. A research was commissioned in order to identify what characterized these practices and to establish whether they could be systematized.</p> <p>Methods</p> <p>An exploratory case study was conducted during summer and fall 2010 in the HTA agency in order to determine what made the specificity of its context, and to conceptualize an approach to knowledge production and dissemination that was adapted to the mandate and nature of this form of HTA organization. Six projects were selected. For each, the HTA report and complementary documents were analyzed, and semi-structured interviews were carried out. A narrative literature review of the most recent literature reviews of the principal knowledge into practice frameworks (2005-2010) and of articles describing such frameworks (2000-2010) was undertaken.</p> <p>Results and discussion</p> <p>Our observations highlighted an inherent difficulty as regards applying the dominant knowledge translation models to HTA and clinical guidance practices. For the latter, the whole process starts with an evaluation question asked in a problematic situation for which an actionable answer is expected. The objective is to produce the evidence necessary to respond to the decision-maker's request. The practices we have analyzed revealed an approach to knowledge production and dissemination, which was multidimensional, organic, multidirectional, dynamic, and dependent on interactions with stakeholders. Thus, HTA could be considered as a knowledge mobilization process per se.</p> <p>Conclusions</p> <p>HTA's purpose is to solve a problem by mobilizing the types of evidence required and the concerned actors, in order to support political, organizational or clinical decision-making. HTA relies on the mediation between contextual, colloquial and scientific evidence, as well as on interactions with stakeholders for recommendation making. Defining HTA as a knowledge mobilization process might contribute to consider the different orders of knowledge, the social, political and ethical dimensions, and the interactions with stakeholders, among the essential components required to respond to the preoccupations, needs and contexts of all actors concerned with the evaluation question's issues.</p

A targeted next-generation sequencing assay for the molecular diagnosis of genetic disorders with orodental involvement.

BACKGROUND: Orodental diseases include several clinically and genetically heterogeneous disorders that can present in isolation or as part of a genetic syndrome. Due to the vast number of genes implicated in these disorders, establishing a molecular diagnosis can be challenging. We aimed to develop a targeted next-generation sequencing (NGS) assay to diagnose mutations and potentially identify novel genes mutated in this group of disorders. METHODS: We designed an NGS gene panel that targets 585 known and candidate genes in orodental disease. We screened a cohort of 101 unrelated patients without a molecular diagnosis referred to the Reference Centre for Oro-Dental Manifestations of Rare Diseases, Strasbourg, France, for a variety of orodental disorders including isolated and syndromic amelogenesis imperfecta (AI), isolated and syndromic selective tooth agenesis (STHAG), isolated and syndromic dentinogenesis imperfecta, isolated dentin dysplasia, otodental dysplasia and primary failure of tooth eruption. RESULTS: We discovered 21 novel pathogenic variants and identified the causative mutation in 39 unrelated patients in known genes (overall diagnostic rate: 39%). Among the largest subcohorts of patients with isolated AI (50 unrelated patients) and isolated STHAG (21 unrelated patients), we had a definitive diagnosis in 14 (27%) and 15 cases (71%), respectively. Surprisingly, COL17A1 mutations accounted for the majority of autosomal-dominant AI cases. CONCLUSIONS: We have developed a novel targeted NGS assay for the efficient molecular diagnosis of a wide variety of orodental diseases. Furthermore, our panel will contribute to better understanding the contribution of these genes to orodental disease. TRIAL REGISTRATION NUMBERS: NCT01746121 and NCT02397824.journal articleresearch support, non-u.s. gov't2016 Feb2015 10 26importe

Stable polymethacrylate nanocapsules from ultraviolet light-induced template radical polymerization of unilamellar liposomes.

We employed UV-induced template polymerization to create hollow nanometer-sized polymer capsules. Homogeneous, unilamellar liposomes served as a two-dimensional template for the cross-linking of either butyl methacrylate or hydroxyethyl methacrylate with the bifunctional ethyleneglycol dimethacrylate. Different molar ratios of lipid/hydrophobic monomer/bifunctional monomer/photoinitiator were tested and dynamic light scattering revealed negligible changes of size at a defined molar ratio of 2/1/10/20, respectively. Cryo-transmission electron microscopy provided clear evidence that incorporation of the methacrylate monomers into and polymerization in the hydrophobic bilayer phase does not disrupt vesicle integrity. Moreover, after solubilization of the lipids, the polymethacrylate nanocapsules were stable at conditions needed for negative staining and could be visualized by atomic force microscopy. In contrast to previous findings, the nanocapsule size and shape did not change considerably after removal of the template phase, and the size distribution remained strictly monomodal. The employed method is not only an advance to fortify liposomes, but the nanocapsules themselves can be functionalized

Cartographie morpho-sédimentaire et des habitats benthiques de l'archipel de Chausey à partir de données satellitales, aéroportées et acoustiques.

International audienceL'archipel des Chausey, situé dans le golfe normand-breton, fait l'objet depuis 2002 d'un vaste programme de cartographie de son estran pour répondre à la demande des gestionnaires en matière d'inventaire des habitats benthiques. Cet archipel est inscrit à l'inventaire ZNIEFF et fait l'objet, dans le cadre de la directive européenne "habitats", d'un recensement des milieux naturels d'intérêt européen. Ce travail permet aussi de répondre à certaines problématiques abordées dans le volet littoral "eaux côtières et eaux de transitions" de la directive cadre sur l'eau et d'anticiper la prochaine extension du programme REBENT aux eaux normandes. Outre un important travail de terrain, trois sources de données ont été utilisées pour établir les cartes des habitats benthiques, des figures et des faciès sédimentaires: une image SPOT5 à 2.5 m de résolution, des photographies aériennes au 1:10.000, et des images acoustiques acquises par un sonar latéral. L'ensemble de ces données a été inséré dans un Système d'Information à Références Spatiales compatible avec celui du REBENT Bretagne. La méthodologie et la typologie utilisées sont similaires avec celles du REBENT ; seule l'échelle de numérisation diffère. En effet, les objets ont tous été cartographiés à l'échelle du 1:1000 à l'exception des ceintures algales et des banquettes à lanices issues des classifications de l'image SPOT5. Certaines informations spatiales, dont la carte des herbiers de zostères, sont déjà utilisées dans le cadre de l'intégration géomatique des données biologiques du système MAXSEA embarqué à bord des unités de navigation à fin d'optimisation des prises de pêche liées aux arts traînants