Online survey to assess parents’ experience and preferences for follow-up visits for children living with type 1 diabetes in Quebec, Canada : a study protocol

Introduction It is accepted that although patients may initiate a visit to a healthcare provider, follow-up visits are often based on recommendations from providers. This suggests that follow-up care, since not initiated by patients, may not reflect patients' perception of a need for care. However, few studies have examined the burden of regular follow-up care and patients' perceived value of such care. For parents of children with type 1 diabetes (T1D), follow-up visits are scheduled regardless of how well controlled the diabetes is. Our study examines how benefits and burden from the parents' perspective could affect their preferences in regard to the frequency of regular follow-up care. Methods We aim to develop an online patient survey to be distributed to parents of children living with T1D in the province of Quebec, Canada. The survey will be available in French and English, and distributed through diabetes clinics, on social media groups and forums for parents of children with T1D. The survey will be developed in collaboration with parents of children with T1D to ensure that it appropriately reflects the services in regular followup care and that the language is understandable and clear. Ethics and dissemination All participants will be informed of the requirements and objectives of the survey at the beginning of the questionnaire and that the data collected will remain anonymous and confidential. Ethics approval for the study was obtained from the research ethics committee of the CHU de Québec-Université Laval. Results of the study will be shared with relevant stakeholders with the aim of improving practices and better meeting patients' and families' needs

Parents’ preferences for follow-up care in a type 1 diabetes paediatric population : a survey-based study in Quebec, Canada

Objectives: Examine variations in parent’s preferences for their child’s type 1 diabetes (T1D) follow-up care and the determinants of the preferred intensity of care. Clinical guidelines recommend multidisciplinary management of T1D, with follow-up visits with an endocrinologist at least every 3 months in the paediatric population. However, there could be heterogeneity in parents’ needs, and preferences in terms of care management may deviate from clinical guidelines. Setting: Not applicable. Participants: Parents who have a child living with T1D and who reside in Quebec, Canada. Intervention: In collaboration with a patient-partner (a parent of a child with T1D), we developed a survey to collect data from parents of children living with T1D. Our primary outcome of interest was the preferred time in months between two appointments. We ran a probit model to analyse longer time (over 3 months between appointments), compared with the standard of care (3 months or less). Results: Results suggest that about one-third (33%) of parents want to deviate from the guideline. Parents who want to increase the time between appointments are more experienced in the management of the disease and have higher costs than those who wish to follow the 3-month guideline. The number of years since the diagnosis is positively associated with a preference for a longer time between appointments, while the perceived useful of information provided during the consultation, and a parent having made a change in their professional life were negatively associated with a desire to space out appointments. The child’s gender is not a significant factor in parents’ preferences. Conclusions: Adapting visit protocols could make the health system more efficient to respond to T1D patients and their parent’s needs

From diagnosis to routine care in type 1 diabetes in children : parents' experiences

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for parents and educators. Furthermore, most parents felt overwhelmed at the hospital, and not ready for the intense self-management education (SME). They suggested it could be split over an extended period and discussed from a more practical perspective. Parents' burden is highest in the post-discharge adaptation stage especially for school reintegration, management of blood glucose levels and calculation of carbohydrates. Finally, returning to a social life was difficult, but contacts with diabetic families was a relief. In conclusion, the SME ought to be flexible and adapted to parents' needs. Spreading it over a longer period would ease families' experience. Efforts should also be made to alleviate the parents' burden on the post-discharge adaptation perceived as the most difficult stage, especially for school reintegration where training and resources on T1D should be given to key staff. Public education campaigns would raise awareness and ensure better knowledge of T1D by general population

From diagnosis to routine care in type 1 diabetes in children: Parents’ experiences

Having a child who lives with a Type 1 Diabetes (T1D) can represent a high burden for parents. The objective of our study is to identify and analyze the main challenges expressed by parents so that health care services better meet the needs of parents of T1D children. Semi-structured interviews were conducted with parents of 19 T1D children regarding detection and diagnosis, initial management at the hospital, post-discharge adaptation including daycare or school reintegration, and long-term T1D monitoring. Data analysis was performed following an inductive approach. The results showed a lack of knowledge regarding T1D in the society, especially for parents and educators. Furthermore, most parents felt overwhelmed at the hospital, and not ready for the intense self-management education (SME). They suggested it could be split over an extended period and discussed from a more practical perspective. Parents’ burden is highest in the post-discharge adaptation stage especially for school reintegration, management of blood glucose levels and calculation of carbohydrates. Finally, returning to a social life was difficult, but contacts with diabetic families was a relief. In conclusion, the SME ought to be flexible and adapted to parents\u27 needs. Spreading it over a longer period would ease families’ experience. Efforts should also be made to alleviate the parents’ burden on the post-discharge adaptation perceived as the most difficult stage, especially for school reintegration where training and resources on T1D should be given to key staff. Public education campaigns would raise awareness and ensure better knowledge of T1D by general population. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

An exact solution approach for multi-objective location-transportation problem for disaster response

This paper considers a three-objective location–transportation problem for disaster response. The location problem aims at determining the number, the position and the mission of required humanitarian aid distribution centers (HADC) within the disaster region. The transportation problem deals with the distribution of aid from HADCs to demand points. Three conflicting objectives are considered. The first objective minimizes the total transportation duration of needed products from the distribution centers to the demand points. The second objective minimizes the number of agents (first-aiders) needed to open and operate the selected distribution centers. The third objective minimizes the non-covered demand for all demand points within the affected area. We propose an epsilon-constraint method for this problem and prove that it generates the exact Pareto front. The proposed algorithm can be applied to any three-objective optimization problem provided that the problem involves at least two integer and conflicting objectives. The results obtained in our experimental study show that the computing time required by the pr oposed method may be large for some instances. A heuristic version of our algorithm yielded, however, good approximation of the Pareto front in relatively short computing times.Keywords: Emergency response; Location–transportation problems; Multi-objective combinatorial optimization; Exact method; Epsilon-constraint method

Profitability of Manufactured Feed Pellets for Small-Scale Crop-Livestock Farmers in Tunisia

The aim of this R4D Initiatives is to explore the profitability of manufactured feed pellets for small-scale crop-livestock farmers in Tunisia. During the past few growing seasons, within several R4D initiatives and projects (the SWC@Scale as part of the global GIZ ProSol Program; the CRP-Livestock “feed and forages”, and the International Fund for Agricultural Development (IFAD) funded CLCA phase 2), ICARDA and its national partners have introduced imported feed pellet machines that were donated with a 10% financial contribution (to ensure strong ownership of the technology) to some pre-selected professional farmer organizations (FO) (SMSA and GDA5) and individual farmers including agri-preneurs, with the idea of developing small feed businesses using these machines and boosting the nutrition of local herds. After assessing the available feed resources for each region (Northern, Center, and Southern), the leading members of each FO, under the supervision of the project’s scientific teams, developed various feeding formulas. Other farmers have been developing their own formulas based on consultation with local extension agents. Some of the formulas used by farmers are still under experimentation and will be the subject of this brief, aiming at validating their economic viabilities

Faisabilité technico-économique des bouchons alimentaires fabriqués pour les petits éleveurs en Tunisie

Les bouchons alimentaires représentent une technologie prometteuse pour l’alimentation du bétail en Tunisie. Cette Technologie offre des multiples intérêts économiques, financiers, et techniques pour les petits agriculteurs et éleveurs dans les systèmes mixtes "Culture-Elevage". Cette fiche démontre la faisabilité technico-économique des bouchons alimentaires fabriqués pour les petits éleveurs en Tunisie

الجدوى التقنية والإقتصادية للمكعبات الغذائية المصنعة لدى صغار المزارعين في البلاد التونسية

تناقش هذه الجذاذة الفنية تقنية المكعبات الغذائية للحيوانات، مبرزة مزاياها في تغذية الماشية. كما تبين حدود هذه التقنية، و العوامل التي تؤثر على جودة المكعبات الغذائية للحيوانات. وفي النهاية، تقترح البطاقة الفنية نموذج أعمال للإنتاج المحلي للمكعبات الغذائية للحيوانات، مع التركيز على الجوانب الاقتصادية والمالية لهذه النشاط، بالإضافة إلى الاستنتاجات والآفاق المتعلقة بالاستدام

Construction d'horaires de travail dans des environnements hautement flexibles

Problèmes de construction de quarts de travail -- Problèmes de construction de cycles de travail -- Problèmes de construction simultanée de cycles et de quarts de travail -- Impact des formes de flexbilité -- Formulation of the shift scheduling problem -- Equivalence between formulation (P1) and (P2) -- The tour scheduling -- Implicit shift scheduling with multiple breaks and work stretch duration restrictions -- Solving large shift scheduling problems

A Reputation Based Electronic Government Procurement Model

ABSTRACT E-procurement systems allow governments to efficiently management their contracts by improving interactions with suppliers, and by increasing transparency. Governments generally choose their suppliers based on the minimum price. However, other criteria than price may be considered to help governments choose the best suppliers. This paper proposes a formal reputation model that is intended to determine the winners of an eprocurement process. The proposed model combines three elements: (1) the direct reputation of the supplier, (2) the indirect reputation of the supplier, and (3) the difference in beliefs between the government and the supplier. Using a multi-agent approach, the proposed model compares between situations where reputation is integrated along price for selecting suppliers and when it is not. Results show that the proposed reputation model may lead to lower costs