The Challenges of a Complex and Innovative Telehealth Project: A Qualitative Evaluation of the Eastern Quebec Telepathology Network

Abstract Background: The Eastern Quebec Telepathology Network (EQTN) has been implemented in the province of Quebec (Canada) to support pathology and surgery practices in hospitals that are lack of pathologists, especially in rural and remote areas. This network includes 22 hospitals and serves a population of 1.7 million inhabitants spread over a vast territory. An evaluation of this network was conducted in order to identify and analyze the factors and issues associated with its implementation and deployment, as well as those related to its sustainability and expansion. Methods: Qualitative evaluative research based on a case study using: (1) historical analysis of the project documentation (newsletters, minutes of meetings, articles, ministerial documents, etc); (2) participation in meetings of the committee in charge of telehealth programs and the project; and (3) interviews, focus groups, and discussions with different stakeholders, including decision-makers, clinical and administrative project managers, clinicians (pathologists and surgeons), and technologists. Data from all these sources were cross-checked and synthesized through an integrative and interpretative process. Results: The evaluation revealed numerous socio-political, regulatory, organizational, governance, clinical, professional, economic, legal and technological challenges related to the emergence and implementation of the project. In addition to technical considerations, the development of this network was associated with major changes and transformations of production procedures, delivery and organization of services, clinical practices, working methods, and clinicaladministrative processes and cultures (professional/organizational). Conclusion: The EQTN reflects the complex, structuring, and innovative projects that organizations and health systems are required to implement today. Future works should be more sensitive to the complexity associated with the emergence of telehealth networks and no longer reduce them to technological considerations

Nouvelle grammaire et ponctuation /

Tiré de l'écran-titre (visionné le 27 mars 2013)

Vers une approche théorique pour une communication des risques efficace en adaptation

The mandate of the Chair in Public Relations and Marketing Communication at the Université du Québec à Montréal is to further the understanding of issues relating to climate change, risk communications, and crisis communications. The authors outline the basic components of a research project whose objective is to identify and analyze the issues, constraints, and potential for developing a weather risk communication model that could optimize information transmission vectors and thus help vulnerable populations develop greater resilience

Henry Wanton Jones

The authors briefly contemplate the recent paintings by the sculptor Jones. Biographical notes. 17 bibl. ref

Élaboration et validation d’un test de concordance de script pour évaluer le raisonnement clinique des infirmières en contexte de détérioration de la condition clinique

Contexte : La complexité des situations cliniques en milieu hospitalier exige, chez les infirmières, un raisonnement clinique solide pour interpréter les signes de détérioration clinique de leurs patients. But : Élaborer un test de concordance de script (TCS) évaluant le raisonnement clinique infirmier en contexte de détérioration clinique en milieu hospitalier et évaluer ses qualités psychométriques et son appréciation. Méthode : Un TCS de 22 scénarios et de 88 items a été élaboré, puis administré à 47 infirmières novices et 21 expertes. Un coefficient alpha de Cronbach a servi à évaluer la cohérence interne et un test-retest avec 12 participantes, la stabilité temporelle. La validité du contenu a été évaluée à l’aide des indices de la validité du contenu (IVC) et la validité de construit discriminante, avec l’étude des groupes extrêmes. Résultats : Après son optimisation, le TCS contient 20 scénarios et 68 items. Son coefficient alpha de Cronbach est de 0,76. L’étude de la stabilité temporelle a révélé une corrélation intra-classe modérée (r = 0,554 ; IC à 95 % = 0,002, 0,847). L’IVC de la pertinence et de la clarté du TCS étaient respectivement de 0,995 et de 0,993. Les scores des novices étaient moins élevés que ceux des expertes (p < 0,05). Il y avait une relation linéaire positive significative entre les scores et l’expertise clinique (p < 0,05). Son appréciation est généralement bonne. Conclusion : Cette étude a rendu disponible un TCS standardisé pour évaluer le raisonnement clinique d’infirmières en contexte de détérioration clinique en milieu hospitalier

Transition Detection and Turbulence Measurements on Alinghi Yacht SUI-64 at Sea, Advances in Turbulence XI, Springer Proceedings in Physics 117,2007

Peer reviewed: YesNRC publication: Ye

Patterns of benzodiazepines use in primary care adults with anxiety disorders

Background: Benzodiazepines are among the most commonly prescribed drugs for anxiety disorders. While they are indicated as adjunctive treatment for short-term use according to clinical practice guidelines, previous studies have shown patterns of long-term use of benzodiazepines, which is problematic due to side effects, dependence and potential of abuse. The aims of this study were to examine among a large sample of primary care adults suffering from anxiety disorders: 1) benzodiazepine use patterns; and 2) correlates of long-term benzodiazepine use. Methods: Data were drawn from the “Dialogue” project, a large primary care study conducted in 64 primary care clinics in the province of Quebec, Canada. Following a mental health screening in waiting rooms, patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). A sample of 740 adults meeting DSM-IV criteria for Generalized Anxiety Disorder, Panic Disorder or Social Anxiety Disorder in the past 12 months took part in this study. Results: Benzodiazepines were used by 22.6% of participants with anxiety disorders in our primary care sample. A large majority of benzodiazepine users (88.4%) met our indicator of long-term use, as defined by utilization for more than 12 weeks including regular and as-needed use. Based on a logistic regression model, individual correlates associated with long-term benzodiazepine use included: being 30 years or older, having a comorbid physical illness, meeting criteria for comorbid agoraphobia, reporting the use of sleep-aids, and concurrent SSRI utilization. Limitation: Data collection with self-reported questionnaires may be subject to information bias. Conclusions: Despite knowledge of the risks of long-term use of benzodiazepines, this remains a pervasive problem. Clinicians need to be mindful of patterns and risk factors leading to long-term use of benzodiazepines in patients with anxiety disorders. Results of this study should raise awareness regarding appropriate prescription practices for benzodiazepines, including decision-making in initiation, duration of prescription, and use of strategies for discontinuation in current long-term benzodiazepine users