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1.
BMC Cancer ; 23(1): 369, 2023 Apr 22.
Article in English | MEDLINE | ID: covidwho-2324741

ABSTRACT

BACKGROUND: Centre hospitalier de l'Université de Montréal in Canada introduced accompanying patients (APs) into the breast cancer care trajectory. APs are patients who have been treated for breast cancer and have been integrated into the clinical team to expand the services offered to people affected by cancer. This study describes the profiles of the people who received the support and explores whether one-offs vs ongoing encounters with APs influence their experience of care, on self-efficacy in coping with cancer, and on their level of psychological distress. METHODS: An exploratory cross-sectional study was carried out among patients to compare patients who had one encounter with an AP (G1) with those who had had several encounters (G2). Five questionnaires were administered on socio-demographic characteristics, care pathway, evaluation of the support experience, self-efficacy in coping with cancer, and level of psychological distress. Logbooks, completed by the APs, determined the number of encounters. Linear regression models were used to evaluate the associations between the number of encounters, patient characteristics, care pathway, number of topics discussed, self-efficacy measures in coping with cancer, and level of psychological distress. RESULTS: Between April 2020 and December 2021, 60% of 535 patients who were offered support from an AP accepted. Of these, one hundred and twenty-four patients participated in the study. The study aimed to recruit a minimum of 70 patients with the expectation of obtaining at least 50 participants, assuming a response rate of 70%. There were no differences between G1 and G2 in terms of sociodemographic data and care pathways. Statistical differences were found between G1 and G2 for impacts on and the return to daily life (p = 0.000), the return to the work and impacts on professional life (p = 0.044), announcement of a diagnosis to family and friends (p = 0.033), and strategies for living with treatment under the best conditions (p = 0.000). Significant differences were found on the topics of cancer (p = 0.000), genetic testing (p = 0.023), therapeutic options (p = 0.000), fatigue following treatment (p = 0.005), pain and discomfort after treatment or surgery (p = 0.000), potential emotions and their management (p = 0.000) and the decision-making processes (p = 0.011). A significant relationship was found between the two groups for patients' ability to cope with cancer (p = 0.038), and their level of psychological distress at different stages of the care pathway (p = 0.024). CONCLUSIONS: This study shows differences between one-time and ongoing support for cancer patients. It highlights the potential for APs to help patients develop self-efficacy and cope with the challenges of cancer treatment.


Subject(s)
Breast Neoplasms , Psychological Distress , Humans , Female , Cross-Sectional Studies , Stress, Psychological/psychology , Self Efficacy , Adaptation, Psychological , Breast Neoplasms/therapy , Breast Neoplasms/psychology , Surveys and Questionnaires
3.
AUANews ; 28(2):5-7, 2023.
Article in English | Academic Search Complete | ID: covidwho-2271948
4.
Health Expect ; 26(2): 847-857, 2023 04.
Article in English | MEDLINE | ID: covidwho-2276711

ABSTRACT

INTRODUCTION: Since 2018, four establishments in Quebec, Canada, have decided to implement the PAROLE-Onco programme, which introduced accompanying patients (APs) in healthcare teams to improve the experience of cancer patients. APs are patient advisors who have had a cancer treatment experience and who conduct consultations to complement the service offered by providing emotional, informational and educational support to patients undergoing treatments (e.g., radiotherapy, chemotherapy, surgery), mostly for breast cancer. We aimed to explore the evolution of APs' perspectives regarding their activities within the clinical oncology teams as well as the perceived effects of their intervention with patients, the clinical team and themselves. METHODS: A qualitative study based on semistructured interviews and focus groups was conducted with APs at the beginning of their intervention (T1) and 2 years afterwards (T2). The themes discussed were APs' activities and the perceived effects of their interventions on themselves, on the patients and on the clinical team. RESULTS: In total, 20 APs were interviewed. In T2, APs' activities shifted from listening and sharing experiences to empowering patients by helping them become partners in their care and felt generally more integrated into the clinical team. APs help patients feel understood and supported, alleviate stress and become partners in the care they receive. They also alleviate the clinical team's workload by offering a complementary service through emotional support, which, according to them, helps patients feel calmer and more prepared for their appointments with healthcare professionals. They communicate additional information about their patients' health journey, which makes the appointment more efficient for healthcare professionals. When APs accompany patients, they feel as if they can make a difference in patients' lives. Their activities are perceived by some as an opportunity to give back but also as a way of giving meaning to their own experience, in turn serving as a learning experience. CONCLUSION: By mobilizing their experiential knowledge, APs provide emotional, informational, cognitive and navigational support, which allows patients to be more empowered in their care and which complements professionals' scientific knowledge, thereby helping to refine their sensitivity to the patients' experiences. PATIENT OR PUBLIC CONTRIBUTION: Two patient-researchers have contributed to the study design, the conduct of the study, the data analysis and interpretation, as well as in the preparation and writing of this manuscript.


Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/psychology , Medical Oncology , Qualitative Research , Focus Groups , Patients
5.
Psicoperspectivas ; 20(3):1-14, 2021.
Article in Spanish | APA PsycInfo | ID: covidwho-2011263

ABSTRACT

The results of a study, carried out in Santiago, Chile, are presented, which aimed to identify the work experiences of workers in the psychosocial area of the programs that make up the Chile Crece Contigo social protection system and in the context of the pandemic, taking Axel Honneth's recognition theory as a frame of reference. This is a qualitative study in which a semi-structured interview was applied to 15 professionals from eight districts of the Region Metropolitana. The results are structured in four categories: Work in the air;Lack of implementation supports: Exposed lives;Personal costs: Working without conditions, and In COVID mode: Scenario for new agencies. It is concluded that professionals have been exposed to negative forms of recognition and that could be explained by the precarious work conditions and the lack of institutional support for intervention and the new demands for assistance caused by the health crisis. It is highlighted that this precarious scenario has mobilized new labor agencies in which creativity and criticism are key. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Se presentan los resultados de un estudio llevado a cabo en Santiago, Chile, que tuvo por objeto identificar las experiencias laborales de trabajadores del area psicosocial de los programas que componen el sistema de proteccion social Chile Crece Contigo en el contexto de la pandemia, tomando como marco de referencia la teoria del reconocimiento de Axel Honneth. Se trata de un estudio cualitativo en el que se aplico una entrevista semiestructurada a 15 profesionales de ocho comunas de la Region Metropolitana. Los resultados se estructuran en cuatro categorias: Trabajar en el aire;Ausencia de soportes de implementacion: Vidas expuestas;Costos personales: Trabajar sin condiciones, y En modo COVID: Escenario para nuevas agencias. Se concluye que los profesionales se han visto expuestos a formas de reconocimientos negativas y que se podrian explicar por las condiciones de precariedad del trabajo y la falta de soportes institucionales para la intervencion y las nuevas demandas de asistencia provocada por la crisis sanitaria. Se destaca que este escenario de precariedad ha movilizado nuevas agencias laborales en que la creatividad y la critica son claves. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

6.
J Pediatr Urol ; 18(4): 411.e1-411.e7, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1936864

ABSTRACT

INTRODUCTION: COVID-19 pandemic required that health systems made great efforts to mitigate the impact of high demands of patients requiring treatment. Triaging surgical cases reduced operating room capacity. Immunizations, massive testing, and personal protective equipment enabled re-activation of operating rooms. Delayed and newly added cases has placed stress on the system. We hypothesize that standardization in practice for tasks performed between anesthesia ready and surgery start time, also known as "prepping time", can reduce operative time, improve efficiency and increase capacity. The aim of our project was to create and implement a best practice standardized prepping protocol, to explore its impact on operating room capacity. METHODS: Once local policies allowed re-opening of the operating rooms, our multidisciplinary group developed a working plan following Adaptive Clinical Management (ACM) principles to optimize surgical prepping time. Using electronic medical record (EMR) data, surgeons with the lowest surgical prepping times were identified (positive deviants). Their surgical prepping time workflows were reviewed. A clinical standard work (CSW) protocol was created by the team leader. New CSW protocol was defined and implemented by the leader and then by the rest of the surgeons. Baseline data was automatically extracted from EMR and analyzed by statistical process control (SPC) charts using AdaptX. Balancing measures included "last case end time" and rates of surgical site infections. RESULTS: A total of 2506 patients were included for analysis with 1333 prior to intervention and 1173 after. Team leader implementated the new CSW prepping protocol showing a special cause variation with an average time improvement from 14.6 min to 11.6 min and for all surgeons from 13.8 to 12.0 min. Total cases per month increased from 70 to 90 cases per month. Baseline 'Last Case End Time' was 15.7 min later than the scheduled. New CSW improve end time with an average of 20.8 min before the schedule. Baseline surgical site infection was 0.1% for the study population. No difference was seen after implementation. DISCUSSION: Variations in performance can be quantified using funnel plots showing individual practices allowing best practice to be identified, tested and scaled. Implementation of our surgical prepping time protocol showed a sustainable increase in efficiency without affecting quality, safety or workload. This additional increase is estimated to represent approximately $2-2.5M additional revenue per year. CONCLUSION: Adaptive clinical management is a practical solution to increase OR capacity by improving efficiency to reduce extra burden presented during COVID19 pandemic.


Subject(s)
COVID-19 , Operating Rooms , Humans , Pandemics/prevention & control , Efficiency, Organizational , Operative Time
7.
Can J Kidney Health Dis ; 9: 20543581221074566, 2022.
Article in English | MEDLINE | ID: covidwho-1745530

ABSTRACT

PURPOSE OF PROGRAM: Given the growing interest in patient-oriented research (POR) initiatives, there is a need to provide relevant training and education on how to engage with patients as partners on research teams. SOURCES OF INFORMATION: As part of its mandate to develop appropriate training materials, the patient-oriented renal research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), established a training and Mentorship Committee (TMC). METHODS: The committee brings together a unique combination of Indigenous and non-Indigenous patient partners (including caregivers, family members, and living donors), researchers, as well as patient engagement and knowledge translation experts, combining a multitude of perspectives and expertise. Following an assessment of training needs within the network, the TMC undertook the co-development of 5 learning modules to address the identified gaps. Subsequently, the committee divided into working groups tasked with developing content using a consultive and iterative approach informed by the DoTTI framework for building web-based tools for patients. In addition, the TMC embodied the guiding principles of inclusiveness, support, mutual respect, and co-building as set out by the Patient Engagement Framework through the Strategy for Patient-Oriented Research (SPOR) of the Canadian Institutes of Health Research. KEY FINDINGS: The 5 new modules include: A Patient Engagement Toolkit, Storytelling for Impact, Promoting Kidney Research in Canada (KidneyPRO), Wabishki Bizhiko Skaanj Learning Pathway, and Knowledge Translation. The TMC's approach to developing these modules demonstrates how a diverse group of stakeholders working together can create tools to support high-quality POR. This also provides a roadmap for other health research entities interested in developing similar tools within their unique domains. LIMITATIONS: The landscape of patient engagement in research is constantly evolving. This underscores the need for sustained resources to keep POR tools and training relevant and up-to-date. Sustaining such resources may not be feasible for all research entities. IMPLICATIONS: Collaborative approaches integrating patients in the development of POR tools ensure the content is relevant and meaningful to patients. Broader adoption of such approaches has great potential to address existing gaps and enhance the Canadian POR landscape.


OBJECTIF DU PROGRAM: L'intérêt croissant pour les initiatives de recherche axée sur le patient met en évidence le besoin de sensibiliser les chercheurs et d'offrir une formation pertinente sur les façons d'impliquer les patients comme partenaires dans les équipes de recherche. SOURCES: Dans le cadre de son mandat consistant à élaborer des documents de formation appropriés, le réseau dédié à l'avancement de la recherche en santé rénale axée sur le patient, le réseau CAN-SOLVE CKD (Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease), a créé un Comité de formation et de mentorat (CFM). MÉTHODOLOGIE: Le CFM réunit une combinaison unique de patients partenaires autochtones et non autochtones (incluant soignants, membres des familles, donneurs vivants), des chercheurs et des experts de l'application des connaissances et de l'implication des patients à la recherche, ce qui permet de conjuguer une multitude de points de vue et d'expertises. Après une évaluation des besoins en formation dans le réseau, le CFM a entrepris l'élaboration conjointe de cinq modules d'apprentissage pour combler les lacunes mises en évidence. Le comité s'est ensuite divisé en groupes de travail chargés d'en élaborer les contenus par le biais d'une approche consultative et itérative guidée par le cadre de perfectionnement DoTTI pour la création d'outils Web destinés aux patients. De plus, le CFM a intégré les principes directeurs d'inclusion, de soutien, de respect mutuel et de co-création énoncés dans le Cadre d'engagement des patients de la stratégie de recherche axée sur le patient (RAP) des Instituts de recherche en santé du Canada. PRINCIPAUX RÉSULTATS: Les cinq nouveaux modules sont: une trousse d'outils sur l'implication des patients, le partage de récits qui ont un impact, la promotion de la recherche dans le domaine rénal au Canada (KidneyPRO -Promoting Kidney Research in Canada), le cheminement d'apprentissage Wabishki Bizhiko Skaanj et l'application des connaissances. L'approche adoptée par le CFM pour développer ces modules a montré comment un groupe diversifié d'intervenants qui travaille ensemble peut mener à la création d'outils pour soutenir une RAP d'excellente qualité. Ces travaux ont également fourni une feuille de route pour d'autres entités de recherche en santé qui souhaiteraient élaborer des outils similaires dans leurs domaines respectifs. LIMITES: L'implication des patients dans la recherche est en constante évolution. Cette étude souligne le besoin de ressources durables pour garder les outils et les formations en RAP pertinents et à jour. Le maintien de telles ressources pourrait ne pas être possible pour toutes les entités de recherche. IMPLICATIONS: Les approches collaboratives qui impliquent les patients dans le développement d'outils de RAP garantissent que les contenus soient pertinents et significatifs pour les patients. L'adoption à plus grande échelle de telles approches a le potentiel de combler les lacunes existantes et d'améliorer le domaine de la RAP au Canada.

8.
Psicoperspectivas ; 20(3):1-14, 2021.
Article in Spanish | ProQuest Central | ID: covidwho-1538701

ABSTRACT

Palabras claves: precariedad, reconocimiento, trabajadores psicosociales The results of a study, carried out in Santiago, Chile, are presented, which aimed to identify the work experiences of workers in the psychosocial area of the programs that make up the Chile Crece Contigo social protection system and in the context of the pandemic, taking Axel Honneth's recognition theory as a frame of reference. Keywords: precariousness, psychosocial workers, recognition En Chile, la crisis sanitaria provocada por la pandemia COVID-19 se ha acompañado de una crisis social y económica cuya magnitud hasta ahora es desconocida. En Chile, el trabajo de Illanes (2007) ilustra el nacimiento y desarrollo, de un dispositivo estatal de intervención social sobre la familia popular, femenino y feminizante, que descansó en la acción de una multitud de mujeres acomodadas, comprometidas y vigilantes que se acercan a los pobres para intervenir a través de prácticas asistenciales. Por otro lado, la fuerte influencia de los organismos internacionales en el diseño de estos sistemas, conjugan un gobierno de lo social con carácter transnacional, perfilando modalidades de políticas públicas y modelos de intervención desde lineamientos internacionales promovidos por el Banco Mundial o el FMI, en lo que se conoce como el nuevo management público (Djupvik et al., 2021;Fardella et al., 2016;Harris, 1998;Zelnik & Abramovitz, 2020).

9.
BMJ Open Quality ; 10(Suppl 2):A4-A5, 2021.
Article in English | ProQuest Central | ID: covidwho-1505720

ABSTRACT

5 Figure 1Adaptive clinical management. A framework for clinicians to dynamically use real-world data to drive improvement in both clinical and operational processes[Figure omitted. See PDF]Abstract 5 Figure 2Surgical prep time – historical baseline system performance (above). Funnel plot -Stratifies individual surgeon’s performance and identifies best practice (below)[Figure omitted. See PDF]Abstract 5 Figure 3Team leader adapts personal workflow – improvement demonstrated by special cause variation (highlighted)[Figure omitted. See PDF]Abstract 5 Figure 4Team adapts workflow – improvement demonstrated by centerline shift from 13.8 to 11.9 minutes[Figure omitted. See PDF]Abstract 5 Figure 5Team increases monthly volume by 25% – Improvement demonstrated by centerline shift from 70 to 88 cases a month[Figure omitted. See PDF]ConclusionsResource-neutral, data driven small system improvements, resulted in a 25% increase in case volumes post intervention, creating >$2.5M additional revenue.

10.
Arch Dis Child ; 2020 Oct 07.
Article in English | MEDLINE | ID: covidwho-1318010

ABSTRACT

BACKGROUND: The COVID-19 pandemic reached the Southern Hemisphere in the autumn of 2020, thus coinciding with its expected annual viral respiratory season. The potential impact of national strategies aimed at mitigating COVID-19 during the pandemic on the incidence of other critical viral lower respiratory tract infections (LRTIs) in children is unknown. METHODS: We analysed admission data for LRTIs from 22 paediatric intensive care units (PICUs) in four countries, part of a large international Latin American registry of children with acute respiratory failure (Red Colaborativa Pediátrica de Latinoamérica [LARed Network]). RESULTS: Between January and August, there were 83% fewer PICU admissions for LRTIs in 2020 compared to the 2018/2019 average over the same period. Similar decreases were noted for PICU admissions due to respiratory syncytial virus and influenza (92% and 78%, respectively). CONCLUSION: We observed a striking reduction in PICU admissions due to viral LRTIs over winter, during the COVID-19 pandemic in South America.

11.
Pediatr Surg Int ; 37(6): 827-833, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1103433

ABSTRACT

INTRODUCTION AND OBJECTIVE: SARS-COV-2 pandemic has affected the population worldwide requiring social distancing, quarantine and isolation as strategies to control virus propagation. Initial measures to reduce the burden to the health care system during the pandemic included deferring elective surgery. These damage control measures did not take into account the mid- and long-term implications. Management of congenital anomalies can be time sensitive with delays resulting in permanent disability, morbidity and increased costs to the healthcare system. This study reports the results of using a novel scoring system that enables triage of time sensitive congenital anomalies and pediatric surgical conditions and how implementation of Enhanced Recovery After Surgery (ERAS®) principles allowed optimization of resources and reduced the burden to the system while allowing for appropriate care of pediatric patients with urgent urologic surgical conditions. METHODS: We present a prospective case series of patients with congenital urological conditions scheduled and taken to surgery during COVID-19 pandemic. All pediatric urology cases that were pending and or scheduled for surgery at the moment the pandemic struck as well as all cases that presented to the emergency department with urological conditions were triaged and included for analysis using a modified Medically Necessary, Time-Sensitive Procedures: Scoring System (MeNTS). A modified MeNTS was implemented for pediatric patients, giving more priority to the impact of deferring surgical intervention on patient's prognosis. An individualized evaluation using this scoring system was applied to each patient. Intra- and postoperative ERAS® principles were applied to all cases operated during the pandemic between March 20th and April 24th to reduce the burden to the healthcare system. RESULTS: A total of 49 patients were triaged and included for analysis with a mean age of 6.47 years of age. Adjusted MeNTS showed that all clinically emergent cases had a score of 12 or less. Cases that could be postponed for 2 weeks but no longer had a score between 13 and 15. The ones that could wait 6 weeks or longer had scores higher than 16. Score results were not the same for similar procedures and individualized assessments resulted in scores based on an individual patient's conditions. From the total cases, implementation of ERAS® principles increased outpatient procedures from 68 to 90.4%. CONCLUSION: Our results provide a novel triaging method to rank pediatric urological surgical management based on individualized patient's clinical conditions. Cutoff values of 12 and 16 allowed appropriate triage preventing the postponement of urgent urologic cases during the COVID-19 pandemic. Implementation of ERAS® principles allowed for these procedures to be done in the outpatient setting, preserving valuable healthcare resources. TYPE OF STUDY: Prospective cohort study. LEVEL OF EVIDENCE: IV.


Subject(s)
COVID-19/prevention & control , Pediatrics/methods , Triage/methods , Urologic Diseases/surgery , Adolescent , Child , Child, Preschool , Cohort Studies , Enhanced Recovery After Surgery , Female , Humans , Infant , Infant, Newborn , Male , Pandemics , Prospective Studies , Risk Assessment , SARS-CoV-2
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