A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:Coping skills training interventions have been found to be efficacious in helping both patients and their partners manage the physical and emotional challenges they face following a cancer diagnosis. However, many of these interventions are costly and not sustainable. To overcome these issues, a self-directed format is increasingly used. The efficacy of self-directed interventions for patients has been supported; however, no study has reported on the outcomes for their partners. This study will test the efficacy of Coping-Together&mdash;a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners.Methods and analysis:The proposed three-group, parallel, randomised controlled trial will recruit patients diagnosed in the past 4 months with breast, prostate, colorectal cancer or melanoma through their treating clinician. Patients and their partners will be randomised to (1) a minimal ethical care (MEC) condition&mdash;selected Cancer Council New South Wales booklets and a brochure for the Cancer Council Helpline, (2) Coping-Together generic&mdash;MEC materials, the six Coping-Together booklets and DVD, the Cancer Council Queensland relaxation audio CD and login to the Coping-Together website or (3) Coping-Together tailored&mdash;MEC materials, the Coping-Together DVD, the login to the website and only those Coping-Together booklet sections that pertain to their direct concerns. Anxiety (primary outcome), distress, depression, dyadic adjustment, quality of life, illness or caregiving appraisal, self-efficacy and dyadic and individual coping will be assessed before receiving the study material (ie, baseline) and again at 3, 6 and 12 months postbaseline. Intention-to-treat and per protocol analysis will be conducted.Ethics and dissemination:This study has been approved by the relevant local area health and University ethics committees. Study findings will be disseminated not only through peer-reviewed publications and conference presentations but also through educational outreach visits, publication of lay research summaries in consumer newsletters and publications targeting clinicians.</div

A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (July 2017) in accordance with the publisher’s archiving policyObjective The cost of implementing professionally-led psychosocial interventions has limited their integration into routine care. To enhance the translation of effective psychosocial interventions in routine care, a self-administered format is sometimes used. The meta-analysis examined the efficacy of written self-administered, psychosocial interventions to improve outcomes among individuals with a physical illness. Methods Studies comparing a written self-administered intervention to a control group were identified through electronic databases searching. Pooled effect sizes were calculated across follow-up time points using random-effects models. Studies were also categorised according to three levels of guidance (self-administered, minimal contact, or guided) to examine the effect of this variable on outcomes. Results Forty manuscripts were retained for the descriptive review and 28 for the meta-analysis. Findings were significant for anxiety, depression, distress, and self-efficacy. Results were not significant for quality of life and related domains as well as coping. Purely self-administered interventions were efficacious for depression, distress, and self-efficacy; only guided interventions had an impact on anxiety. Conclusions Findings showed that written self-administered interventions show promise across a number of outcomes. Practice implications Self-administered interventions are a potentially efficacious and cost-effective approach to address some of the most common needs of patients with a physical illness

Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

<p>Abstract</p> <p>Background</p> <p>The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care.</p> <p>Objectives</p> <p>In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The <b>goal </b>of the present research project is to track the <it>evolution </it>of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance.</p> <p>Methods/Design</p> <p>This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC.</p> <p>Discussion</p> <p>The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.</p

Evaluation of the implementation of an integrated primary care network for prevention and management of cardiometabolic risk in Montréal

<p>Abstract</p> <p>Background</p> <p>The goal of this project is to evaluate the implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk (PCMR). The intervention is based on the Chronic Care Model. The study will evaluate the implementation of the PCMR in 6 of the 12 health and social services centres (CSSS) in Montréal, and the effects of the PCMR on patients and the practice of their primary care physicians up to 40 months following implementation, as well as the sustainability of the program. Objectives are: 1-to evaluate the effects of the PCMR and their persistence on patients registered in the program and the practice of their primary care physicians, by implementation site and degree of exposure to the program; 2-to assess the degree of implementation of PCMR in each CSSS territory and identify related contextual factors; 3-to establish the relationships between the effects observed, the degree of PCMR implementation and the related contextual factors; 4-to assess the impact of the PCMR on strengthening local services networks.</p> <p>Methods/Design</p> <p>The evaluation will use a mixed design that includes two complementary research strategies. The first strategy is similar to a quasi-experimental "before-after" design, based on a quantitative approach; it will look at the program's effects and their variations among the six territories. The effects analysis will use data from a clinical database and from questionnaires completed by participating patients and physicians. Over 3000 patients will be recruited. The second strategy corresponds to a multiple case study approach, where each of the six CSSS constitutes a case. With this strategy, qualitative methods will set out the context of implementation using data from semi-structured interviews with program managers. The quantitative data will be analyzed using linear or multilevel models complemented with an interpretive approach to qualitative data analysis.</p> <p>Discussion</p> <p>Our study will identify contextual factors associated with the effectiveness, successful implementation and sustainability of such a program. The contextual information will enable us to extrapolate our results to other contexts with similar conditions.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01326130">NCT01326130</a></p

Valeur accordée à l'école, estime de soi et performance scolaire à l'adolescence

Bureau de recherches géologiques et minières - Orléans (brgm) / SudocSudocFranceF

Evaluation de la pratique des macrobiopsies mammaires stéréotaxiques réalisées dans le service de sénologie du département d'imagerie médicale du centre Jean Perrin entre le 01-07-2007 et le 30-06-2009 (541 procédures)

L'objectif est l'évaluation des pratiques de macrobiopsie mammaire avec évaluation des succès, tolérance, fiabilité diagnostique et pertinence des indications. Il s'agit d'une étude rétrospective de 502 patientes ayant bénéficié d'une macrobiopsie (système Vacora® 10-gauge) pour foyer de microcalcifications (98% des cas), opacité ou distorsion architecturale. 2% d'échecs de procédure, essentiellement liés à la mauvaise visibilité ou à la topographie du foyer. La tolérance globale était bonne dans 88%. Les résultats biopsiques ont conclu à 296 histologies bénignes, 104 frontières et 14 malignes. Une chirurgie complémentaire des lésions malignes et de la plupart des lésions frontières (excluant les AEP) a eu lieu dans 40% des cas. Concernant les lésions opérées, la sensibilité de la macrobiopsie était de 89%, la spécificité et la valeur prédictive positive de 100%, et la valeur prédictive négative de 84%. Le taux de sous-estimation des carcinomes canalaires au sein des hyperplasies canalaires atypiques macrobiopsiées était de 8%, et la sous-estimation du catactère invasif des carcinomes canalaires de 14%. L'ensemble de ces résultats rejoingnent ceux précédemment rapportés au centre Jean Perrin en 2002, et les données de la littérature. Aucune lésion plus péjorative n'a été découverte lors de la chirurgie lorsque le foyer radiologique d'HCA seule a été enlevé en totalité, ce qui pose la question de l'intérêt d'une chirurgie complémentaire systématique dans ce cas. Après relecture des mammographies, sans tenir compte des antécédents et des facteurs de risque, 16 anomalies ACR 4 ont été reclassées ACR 3, toutes non malignes à la biopsie. La valeur prédictive médiocre de la classification ACR a conduit à différencier les anomalies ACR 4 "faible" et "fort" selon le degré de suspicion de malignité, permettant une meilleure discrimination entre les lésions bénignes et malignes, mais avec un taux de cancers non négligeable parmi les lésions ACR 4 "faible" (35%). La macrobiopsie reste la meilleure approche diagnostique des lésions mammographiques. La sélection des indications doit privilégier la classification ACR. Une réunion de concertation pluri-disciplinaire pré-biopsique garde sa place dans la discussion des cas difficiles.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

The "sphere of care": A qualitative study of colorectal cancer patient and caregiver experiences of support within the cancer treatment setting.

IntroductionColorectal cancer is associated with considerable physical and psychosocial burden. Whilst social support is known to facilitate psychological adjustment to cancer, patients' and caregivers' experiences of social support within a treatment setting and their perceptions of the role of the treating team in providing this support is unknown. Specifically, there is a gap in the research that explores in detail who people affected by colorectal cancer consider to be supportive, and the function, timing and nature of this support, whilst receiving treatment. This study explored both patients' and caregivers' a) experiences of social support and how this relates to their experience of treatment; and b) what facilitates support in the treatment setting.MethodsIndividual interviews (N = 20) were conducted with patients diagnosed with colorectal cancer and caregivers of such patients. Audiotaped interviews were transcribed verbatim and analysed using the framework method.ResultsThree major themes emerged from the data: a) treating team as a source of support, highlighting the importance of connection with the treating team; b) changes in existing social supports, encompassing issues regarding distance in interpersonal relationships as a consequence of cancer; and c) differing dimensions of support, exploring the significance of shared experience, practical, financial, and emotional support.ConclusionsPatients and caregivers perceived the treating team as a major source of support. Support from the treating team was particularly important in the context of the changes that occur as a result of a diagnosis of colorectal cancer and the effects of subsequent treatment. Incidental support from others encountered in the treatment setting was also experienced and was equally important to both patients and caregivers. This has implications for the way health care professionals respond to both patients and caregivers in the treatment setting in terms of communication, interventions and environment

Étude cinétique de la cristallisation du poly(butylène téréphtalate) dans différentes formulations (influence des additifs et des autres polymères)

L'addition de colorants au poly(butylène téréphtalate) (PBT) - polyester semi-cristallin utilisé notamment dans le gainage protecteur des fibres optiques - induit des variations dimensionnelles (retrait, post-retrait) provoquées par les différences de cinétique de cristallisation selon le pigment utilisé. L'addition d'une charge minérale, particulièrement efficace en nucléation (talc) permet de contrôler la cristallisation et donc le post-retrait, une valeur minimale de 0.15% en masse est suffisante. les mélanges à partir de PBT et de PET ont permis d'obtenir des systèmes dont la température de transition vitreuse est ajustable en fonction de la teneur de chacun des constituants, utilisables comme matrice pour l'application "câbles chauffants auto-régulants" en mélange avec une polyoléfine chargée noir de carbone (le copolymère (éthylène-coacrylate d'éthyle) EEa). Par ailleurs, la présence d'interactions entre le PBT et l'EEA est responsable d'une miscibilité partielle entre les deux polymères, provoquant ainsi une cristallisation en deux étapes du PBT pour des teneurs en EEa supérieures à 30 %. Cette cristallisation retardée est favorisée par des courtes chaînes de PBT mais disparait en présence de faibles quantités de noir de carbone. Des morphologies originales avec formation de fibres ont été obtenues d'où une amélioration des propriétés mécaniques dans l'EEa est matrice. l'extrusion de mélanges entre le PBT et:ou le PET et l'EEA-noir de carbone a permis d'accéder à des matériaux conducteurs dont la résistivité augmente plus rapidement à partir de la température de transition vitreuse de la matriceLORIENT-BU (561212106) / SudocSudocFranceF