User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions.</p> <p>Discussion</p> <p>This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.</p

Multiplicity of cerebrospinal fluid functions: New challenges in health and disease

This review integrates eight aspects of cerebrospinal fluid (CSF) circulatory dynamics: formation rate, pressure, flow, volume, turnover rate, composition, recycling and reabsorption. Novel ways to modulate CSF formation emanate from recent analyses of choroid plexus transcription factors (E2F5), ion transporters (NaHCO3 cotransport), transport enzymes (isoforms of carbonic anhydrase), aquaporin 1 regulation, and plasticity of receptors for fluid-regulating neuropeptides. A greater appreciation of CSF pressure (CSFP) is being generated by fresh insights on peptidergic regulatory servomechanisms, the role of dysfunctional ependyma and circumventricular organs in causing congenital hydrocephalus, and the clinical use of algorithms to delineate CSFP waveforms for diagnostic and prognostic utility. Increasing attention focuses on CSF flow: how it impacts cerebral metabolism and hemodynamics, neural stem cell progression in the subventricular zone, and catabolite/peptide clearance from the CNS. The pathophysiological significance of changes in CSF volume is assessed from the respective viewpoints of hemodynamics (choroid plexus blood flow and pulsatility), hydrodynamics (choroidal hypo- and hypersecretion) and neuroendocrine factors (i.e., coordinated regulation by atrial natriuretic peptide, arginine vasopressin and basic fibroblast growth factor). In aging, normal pressure hydrocephalus and Alzheimer's disease, the expanding CSF space reduces the CSF turnover rate, thus compromising the CSF sink action to clear harmful metabolites (e.g., amyloid) from the CNS. Dwindling CSF dynamics greatly harms the interstitial environment of neurons. Accordingly the altered CSF composition in neurodegenerative diseases and senescence, because of adverse effects on neural processes and cognition, needs more effective clinical management. CSF recycling between subarachnoid space, brain and ventricles promotes interstitial fluid (ISF) convection with both trophic and excretory benefits. Finally, CSF reabsorption via multiple pathways (olfactory and spinal arachnoidal bulk flow) is likely complemented by fluid clearance across capillary walls (aquaporin 4) and arachnoid villi when CSFP and fluid retention are markedly elevated. A model is presented that links CSF and ISF homeostasis to coordinated fluxes of water and solutes at both the blood-CSF and blood-brain transport interfaces

Validation Of The Turkish Version Of The Celiac Disease Questionnaire (Cdq)

Introduction The aim of the study was to translate, adapt and validate the Celiac Disease Questionnaire (CDQ), which was developed in Germany, for use in Turkey. Methods The questionnaire was translated by a forward-backward translation method. Total CDQ score and four subscores (emotional state, gastrointestinal symptoms, worries, social problems) were calculated and their reliability assessed by internal consistency. Reliability of scales was evaluated by internal consistency. Test-retest reliability was assessed by means of a retest after 15 days. Face validity was assessed by patient volunteers and physicians and construct validity was assessed by means of confirmatory factor analysis. Convergent validity was determined by comparing responses to the CDQ with similar subscale scores of the Short Form-36 (SF-36) health survey. Discriminative concurrent criterion validity was determined by comparing the CDQ scores of patients with celiac disease (CD) on a gluten-free diet (GFD) with CD patients not on a GFD. Results The Turkish version of the CDQ was completed by 205 patients with celiac disease (Female 146, mean age 31.1 year, ± 10.61). The Cronbach-α coefficent of the subscores ranged between 0.73 and 0.93. Test-retest reliability was 0.99 for all subscores. 42 patients with CD and five gastroenterologists assessed the items of the CDQ to be comprehensible and relevant to the health related quality of life (HRQOL) of CD patients. The confirmatory factor analysis demonstrated acceptable fit indices for the original four subscales of the CDQ. The correlations between the scales of the CDQ and the instrument for validation covering similar dimensions of the HRQOL ranged between 0.61 and 0.93. In all subscores and in the total score, patients not on a GFD showed a significantly reduced HRQOL (all p < 0.05) compared to patients on a GFD. Conclusion The Turkish version of the CDQ proved to be a reliable and valid instrument for measuring HRQOL in Turkish patients with celiac disease. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0272-y) contains supplementary material, which is available to authorized users.PubMedWoSScopu