Prediction of compliance with preventive measures among teachers in the context of the COVID-19 pandemic.

The objective of this study is to examine, in primary and high schools, teachers' compliance with preventive infection control measures (in the context of the COVID-19 pandemic). Inspired by the technology acceptance model (TAM) and occupational health and safety (OHS) literature on personal protective equipment (PPE) use, we propose a model of compliance with preventive measures among teachers. Data were collected following an observational, cross-sectional design. The data for the study were collected via a questionnaire survey of teachers working in the province of Quebec, Canada. To study the impact of the explanatory variables on the dependent variable, we developed a multiple linear regression model. This model was estimated to assess the preventive measures as a whole (six items). Results show that having tested positive for a COVID test in the last year, judging that the situation does not require the use of the mask or the protective glasses, training received on preventive measures, factors related to comfort and use of protective eyewear, as well as age influence teacher compliance with COVID-19 preventive measures.

One down, fifty to go: managers' perceptions of their workload and how they cope with it to maintain their psychological health.

Background: Like many other countries, healthcare services in Canada face numerous organizational changes with the main objective of doing more with less. The approach taken within different healthcare networks has brought about a reform in healthcare facilities in Quebec, leading to several mergers and eliminating over 1,000 managerial positions. As a result, this has placed a progressively heavier workload on the shoulders of the remaining managers. Research on mental health in the workplace has mainly focused with the workforce and generally neglects managers. However, studies have shown that workload is a risk factor for managers. Therefore, the objectives of our study are to (1) better understand the elements that make up a manager's workload and the factors that influence it and (2) identify the coping strategies used by managers to deal with their workloads. Methods: Employing a qualitative approach, we analyzed 61 semistructured interviews through an abductive method, utilizing diverse frameworks for data analysis. The participants came from the same Quebec healthcare establishment. Results: Our findings align with the notion that workload is a multifaceted phenomenon that warrants a holistic analysis. The workload mapping framework we propose for healthcare network managers enables pinpointing those factors that contribute to the burden of their workload. Ultimately, this workload can detrimentally impact the psychological wellbeing of employees. Conclusion: In conclusion, this study takes a comprehensive look at workload by using a holistic approach, enabling a more comprehensive understanding of this phenomenon. It also allows for the identification of coping strategies used by managers to deal with their workloads. Finally, our results can provide valuable guidance for the interventions aimed at addressing workload issues among healthcare network managers in Quebec by utilizing the specific elements we have identified.

Management behaviors during the COVID-19 pandemic: The case of healthcare middle managers.

Background: The spread of COVID-19 has disrupted the lifestyles of the world's population. In the workplace, the pandemic has affected all sectors and has changed the way work is organized and carried out. The health sector has been severely impacted by the pandemic and has faced enormous challenges in maintaining healthcare services while providing care to those infected by the virus. At the heart of this battle, healthcare managers were key players in ensuring the orchestration of operations and the physical and mental availability of employees during the crisis. Although few studies have been conducted to identify organizational practices or leadership skills to be adopted in a crisis context, the concrete behaviors of managers have not been documented yet. Therefore, this study aims at filling this gap by studying middle managers' behaviors facing COVID-19 crisis in the healthcare sector. Methods: Using a qualitative approach, eight focus groups were conducted online during the pandemic with 37 middle managers from the healthcare community of a Quebec health establishment (Canada) from April to June 2020. Thematic analyses were conducted, and a mixed-methods approach was used to analyse the data based on Viitala's hierarchical model of management skills. Results: Based on the six managerial skills proposed in the model of Viitala, 21 specific management behaviors were identified as having been deployed by middle managers at the beginning of the pandemic. Considering that the health sector has been profoundly shaken by this health crisis, in addition to being an environment likely to experience other crises, managers need to develop practical skills in various crisis management situations. Thus, the results guide practitioners by highlighting the importance of team-oriented management behaviors (leadership, supervisory competencies), especially in a crisis context.

Revisiting presenteeism to broaden its conceptualization: A qualitative study.

BACKGROUND: Presenteeism is generally viewed as a symptom of organizational or individual dysfunction and is rarely considered as a behavioral response to positive triggering factors. Our study examines this issue in small enterprises (SEs), which are an unexplored environment in terms of presenteeism. OBJECTIVE: Through in-depth analysis, this study aims to understand the positive and negative factors that impact presenteeism in the context of small and medium enterprises (SMEs), with a particular focus on SEs. METHODS: We adopt a qualitative methodological approach in which we conducted 17 semi-structured interviews with employees and owner-managers of SEs with between 20 and 49 employees. RESULTS: Our thematic analysis shows that presenteeism can be explained by factors related to pressure to attend work, by individuals' constraints and commitment, by organizational and individual characteristics and by a congenial work environment. Presenteeism can also be a type of "therapy" which helps individuals to avoid focusing on being sick and enables them to stay active and avoid social isolation. CONCLUSIONS: Our study differs from earlier research by providing a more in-depth analysis of the positive and negative factors that trigger presenteeism. This article will help to expand the current theoretical knowledge about presenteeism and encourage a more holistic interpretation of the phenomenon.

Presenteeism in small and medium-sized enterprises: Determinants and impacts on health.

BACKGROUND: Small and medium sized enterprises are yet uncharted territory in terms of presenteeism. In addition, the Demand-Control-Support (DCS) and Siegrist's Effort-Reward Imbalance (ERI) models are proposed to predict stress-related health problems, but not for sickness behaviors such as presenteeism. OBJECTIVE: This study aims to examine the relationships between psychosocial risk factors, presenteeism, mental and physical health in the context of small and medium-sized enterprises (SMEs). This study also examines the moderating effect of company size on these associations. METHODS: To test the association between psychosocial risks, presenteeism, and health, only people working in small and medium-sized enterprises (SMEs) of between 2 and 199 employees were included in the sample, giving a total of 2,525 SME employees surveyed. To test the differences in exposure to psychosocial risk and presenteeism, and the moderating impact of size on the relationship between psychosocial risks, presenteeism, and health, we took the original sample (4608) of the EQCOTESST. RESULTS: The results confirm the associations between job demands, social support and effort-reward imbalance, and presenteeism. Also, the associations between presenteeism and health problems in SMEs' context. Multi-group analyses show that the business's size does not moderate the strength of the relationships between psychosocial risks, presenteeism and health. CONCLUSION: The current study highlights that SMEs are somehow protected from certain psychosocial constraints such as high job demands, and low social support, but are more exposed to others such as effort-reward imbalance.

Organizational constraints as root causes of role conflict.

PURPOSE: The purpose of this paper is to gain a better understanding of the difficulties encountered in the hybrid roles of physician-managers (P-Ms), examine the impact of organizational constraints on the role conflicts experienced by P-Ms and explore the different ways their two roles are integrated. DESIGN/METHODOLOGY/APPROACH: A qualitative approach was adopted, using six focus groups made up of clinical co-managers, medical directors and P-Ms. In all, 43 different people were interviewed to obtain their perceptions of the day-to-day realities of the role of the P-M. The data collected were subsequently validated. FINDINGS: Although the expectations of the different groups involved regarding the role of P-Ms are well understood and shared, there are significant organizational constraints affecting what P-Ms are able to do in their day-to-day activities, and these constraints can result in role conflicts for the people involved. Such constraints also affect the ways P-Ms integrate the two roles. The authors identify three role hybridization profiles. PRACTICAL IMPLICATIONS: The results afford a better understanding of how organizational constraints might be used as levers of organizational change to achieve a better hybridization of the dual roles of P-Ms. ORIGINALITY/VALUE: This paper seeks to reach beyond a simple identification of constraints affecting the dual roles of P-Ms by analyzing how such constraints impact on these professionals' day-to-day activities. Results also enable us to further refine Katz and Kahn's (1966) role model, in addition to identifying hybridization profiles.

A case report of sustained resolution of cancer pain by continuous perineural infusion of local anaesthetic.

BACKGROUND: Opioids are currently offered as first-line treatment for chronic pain from cancer. Continuous regional analgesia could be an alternative to opioids. However, the required duration of catheterization and the sustained analgesic effects of this technique after catheter removal have yet to be clarified. CASE REPORT: We report the case of a patient with a shoulder desmoid tumour for which monitoring of tumour progression was the sole therapeutic strategy. Analgesia took the form of patient-controlled infusion of local anaesthetics through an interscalene catheter. Due to the need of an MRI control 45 days later, the pump was stopped. The persistence of pain relief 48 hr later led to the decision to remove the perineural catheter. No pain was reported by the patient over the following 42 days. CONCLUSIONS: In this patient, it would seem that continuous analgesia allowed for a sustained resolution of pain from the shoulder-located tumour. One hypothesis is that local anaesthetics play a direct role in the erasure of pain memory. This hypothesis needs to be tested with a large patient cohort. SIGNIFICANCE: This case report provides new insights into the treatment of cancer pain. The most interesting finding is that the pain did remained absent after 45 days of continuous infusion of local anaesthetics through an interscalene catheter. We postulated that local anaesthetic drugs have an impact on pain memory.

Psychosocial risks, burnout and intention to quit following the introduction of new software at work.

BACKGROUND: Despite a rich literature on association between psychosocial factors, the demand-control-support (DCS) model and burnout, there are few integrated frameworks encompassing the DCS model, burnout and intention to quit, particularly in a technological context. OBJECTIVE: This manuscript examines the relationships between psychosocial risks, the demand-control-support (DCS) model, burnout syndrome and intention to quit following the introduction of new software at work. METHODS: Data was collected from agents and advisors working at a Canadian university and using newstudy management software. An online questionnaire was sent via the university's internal mail. Finally, 112 people completed the online survey for a response rate of 60.9% . RESULTS: The results of structural equation modeling show that psychological demands, decision latitude and social support are associated with burnout. It is also clear that burnout, in particular depersonalization and emotional exhaustion, is positively associated with intention to quit. CONCLUSIONS: The few studies that raise the negative consequences of technology on quality of life in the workplace, and particularly on health, have not succeeded in establishing a direct link between a deterioration of health and the use of technology. This is due to the fact that there are few epidemiological studies on the direct consequences of the use of ITC on health.

Guidelines on smoking management during the perioperative period.

Smoking is a public health problem of particular importance during the perioperative period, since it exposes patients scheduled for surgery to risk increases of 20% in hospital mortality and 40% in major postoperative complications. In addition, current smoking increases almost all specific surgical complications. The perioperative period offers a genuine opportunity for smoking cessation. The rate of preoperative smoking cessation can be increased significantly by offering behavior management and the prescription of a nicotine substitute before any scheduled surgical intervention. Preoperative smoking cessation should be routinely recommended independently of the timing of the intervention, even though the benefits increase in proportion with the length of cessation. All professionals of the care pathway (general practitioners, surgeons, anesthetists-intensivists, caregivers) must inform smokers of the positive effects of smoking cessation and offer them dedicated management and personalized follow-up. In children, cessation of parental smoking or removal of the child from environmental tobacco smoke as long before surgery as possible is indispensable.

Chest trauma: First 48hours management.

Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48hours. The "Société française d'anesthésie réanimation" and the "Société française de médecine d'urgence" worked together on the 7 following questions: (1) criteria defining severity and for appropriate hospital referral; (2) diagnosis strategy in both pre- and in-hospital settings; (3) indications and guidelines for ventilatory support; (4) management of analgesia; (5) indications and guidelines for chest tube placement; (6) surgical and endovascular repair indications in blunt chest trauma; (7) definition, medical and surgical specificity of penetrating chest trauma. For each question, prespecified "crucial" (and sometimes also "important") outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic Grade® approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method.

Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer.

PURPOSE: Pain after tumorectomy and sentinel lymph node dissection is poorly reported in the literature. We carried out a prospective survey aimed at assessing pain three months after such minor surgery for breast cancer. METHODS: The study was approved by the local ethics committee. Most surgeries followed a standard protocol involving general anesthesia with no regional analgesia technique, laryngeal mask, sufentanil and propofol for induction, and multimodal analgesia during the postoperative period. Three months after the surgery, a questionnaire was sent to the patients with a pre-stamped envelope for return. The questions probed responses required to calculate a Brief Pain Inventory score and modified neuropathic pain score (DN3). RESULTS: Over a 5-month period, 150 patients (aged 60 (11) years, body mass index of 25 (6) kg/m2) were included in the final analysis. In the recovery room, 43% of patients required morphine at a mean dose of 5.2 (1.8) mg. Three months post surgery, 60 patients (40%) reported persistent pain for which 62% took analgesic drugs. We found no risk factor associated with this persistent pain among our studied population. Neuropathic pain was noted in 61% of patients who reported persistent pain primarily associated with periareolar incision. CONCLUSIONS: Pain persisted up to three months after minor surgery for breast cancer in 40% of patients with mostly a neuropathic component (61%).

Autologous adipose-derived stromal vascular fraction in patients with systemic sclerosis: 12-month follow-up.

OBJECTIVE: Impaired hand function greatly contributes to disability and reduced quality of life in SSc patients. Autologous adipose-derived stromal vascular fraction (ADSVF) is recognized as an easily accessible source of regenerative cells. We reported positive 6-month safety and efficacy results from an open-label clinical trial assessing s.c. injection of autologous ADSVF into the fingers in SSc patients. The objective of this report is to describe the effects at 12 months. METHODS: Twelve females, mean age 54.5 years (s.d. 10.3), were assessed 1 year after ADSVF injection. Patients were eligible if they had a Cochin Hand Function Scale score >20/90. ADSVF was obtained from lipoaspirate using an automated processing system and subsequently injected into the s.c. tissue of each finger in contact with neurovascular pedicles in a one-time procedure. Endpoints were changes in hand disability and skin fibrosis, vascular manifestations, pain and quality of life at the 12 month follow-up. During the visit, patients estimated the benefit of the procedure with a specific self-completed questionnaire. RESULTS: A significant decrease from baseline of 51.3% (P < 0.001) for Cochin Hand Function Scale score, 63.2% (P < 0.001) for RP severity and 46.8% (P = 0.001) for quality of life (Scleroderma Health Assessment Questionnaire) was observed. A significant improvement of finger oedema, skin sclerosis, motion and strength of the hands and of the vascular suppression score was also noted. The reduction in hand pain approached statistical significance (P = 0.052). The questionnaire revealed a benefit in daily activities, housework and social activities. CONCLUSION: ADSVF injection is a promising therapy and appears to have benefits that extend for at least 1 year.

[Ultrasound-guided peripheral venous access]. / Abords veineux périphériques échoguidés.

International guidelines advocate the use of first-line ultrasound for central venous catheter, particularly for the internal jugular vein. The role of ultrasound in peripheral venous access remains questionable. In some specific situations, such as pediatrics, obesity and patients with poor venous network, problems to cannulate peripheral vein may occur. Success rate of peripheral intravenous access increases with the diameter of the vein and for a depth of the vein between 0.3 and 1.5 cm. The type of puncture (long-axis or short-axis) and the type of catheters have little influence on the success rate. Specific considerations have to be taken concerning infection control.

Guidelines on the use of ultrasound guidance for vascular access.

Insertion of vascular access is a common procedure with potential for iatrogenic events, some of which can be serious. The spread of ultrasound scanners in operating rooms, intensive care units and emergency departments has made ultrasound-guided catheterisation possible. The first guidelines were published a decade ago but are not always followed in France. The French Society of Anaesthesia and Intensive Care has decided to adopt a position on this issue through its Guidelines Committee in order to propose a limited number of simple guidelines. The method used was the GRADE(®) method using the most recently published meta-analyses as the source of references. The level of evidence found ranged from low to high and all the positive aspects associated with ultrasound guidance, i.e. fewer traumatic complications at puncture, probably or definitely outweigh the potential adverse consequences regardless of whether an adult or child is involved and regardless of the site of insertion.

Basics of dermal filler rheology.

BACKGROUND: Hyaluronic acid injectable fillers are the most widely used dermal fillers to treat facial volume deficits, providing long-term facial aesthetic enhancement outcomes for the signs of aging and/or facial contouring. OBJECTIVES: The purpose of this article was to explain how rheology, the study of the flow of matter, can be used to help physicians differentiate between dermal fillers targeted to certain areas of the face. METHODS: This article describes how rheological properties affect performance when filler is used in various parts of the face and exposed to mechanical stress (shear deformation and compression/stretching forces) associated with daily facial animation and other commonly occurring external forces. RESULTS: Improving facial volume deficits with filler is linked mainly to gel viscoelasticity and cohesivity. These 2 properties set the level of resistance to lateral and vertical deformations of the filler and influence filler tissue integration through control of gel spreading. CONCLUSION: Selection of dermal filler with the right rheological properties is a key factor in achieving a natural-looking long-lasting desired aesthetic outcome.

Safety, tolerability and potential efficacy of injection of autologous adipose-derived stromal vascular fraction in the fingers of patients with systemic sclerosis: an open-label phase I trial.

BACKGROUND: In patients with systemic sclerosis (scleroderma, SSc), impaired hand function greatly contributes to disability and reduced quality of life, and is insufficiently relieved by currently available therapies. Adipose tissue-derived stromal vascular fraction (SVF) is increasingly recognised as an easily accessible source of regenerative cells with therapeutic potential in ischaemic or autoimmune diseases. We aimed to measure for the first time the safety, tolerability and potential efficacy of autologous SVF cells local injections in patients with SSc with hand disability. METHODS: We did an open-label, single arm, at one study site with 6-month follow-up among 12 female SSc patients with Cochin Hand Function Scale score >20/90. Autologous SVF was obtained from lipoaspirates, using an automated processing system, and subsequently injected into the subcutaneous tissue of each finger in contact with neurovascular pedicles. Primary outcome was the number and the severity of adverse events related to SVF-based therapy. Secondary endpoints were changes in hand disability and fibrosis, vascular manifestations, pain and quality of life from baseline to 2 and 6 months after cell therapy. FINDINGS: All enrolled patients had surgery, and there were no dropouts or patients lost to follow-up. No severe adverse events occurred during the procedure and follow-up. Four minor adverse events were reported and resolved spontaneously. A significant improvement in hand disability and pain, Raynaud's phenomenon, finger oedema and quality of life was observed. INTERPRETATION: This study outlines the safety of the autologous SVF cells injection in the hands of patients with SSc. Preliminary assessments at 6 months suggest potential efficacy needing confirmation in a randomised placebo-controlled trial on a larger population. FUNDING: GFRS (Groupe Francophone de Recherche sur la Sclérodermie). CLINICAL TRIALS NUMBER: NCT01813279.

New fat-derived products for treating skin-induced lesions of scleroderma in nude mice.

INTRODUCTION: Scleroderma is characterized by cutaneous manifestations that mainly affect the hands, arms and face. As of today, there is no treatment for fibrotic skin lesions of scleroderma. Previously we generated and validated a model of scleroderma-like skin sclerosis in nude mice, appropriate to inject human derived products. We showed that the subcutaneous injection of micro-fat (MF), purified and injected using small caliber cannulas, have anti-fibrotic and pro-angiogenic effects and appears more suitable for the treatment of skin lesions of scleroderma compared to the gold standard (Coleman's technique or macro-fat). Here we compared the long-term efficacy of micro-fat "enriched" with other therapeutic products including the stromal vascular fraction (SVF) of fat and platelet-rich plasma (PRP) from blood in our murine model of scleroderma. METHODS: We used 72 nude mice in this study. We formed six experimental groups: Macro-fat, MF, SVF, PRP, MF + SVF, MF + PRP. This project has three phases: i) Induction of skin sclerosis by daily subcutaneous injections of bleomycin (BLM) for 4 weeks in nude mice; ii) Purification and injection of the different cell therapy products; iii) Histological analyses done 8 weeks post-injections. RESULTS: MF + SVF and MF + PRP significantly reversed dermal and epidermal sclerosis (P <0.01). Macro-fat, SVF, PRP only corrected the dermal sclerosis (P <0.05). Epidermal sclerosis was reduced in treatments containing MF (P <0.01). MF was more stable. Products containing the SVF were associated with a significant increase of the local vascularization (P <0.01). CONCLUSIONS: All tested substances were effective in treating skin-induced lesions of scleroderma with different levels of fibrosis and vascular improvement; MF derived products are more stable and SVF demonstrated better pro-angiogenic effects. The observed efficacy of this combination of products in the animal model provides a rationale for potential clinical applications to treat human disease.

The influence of flexible management practices on the sharing of experiential knowledge in the workplace: a case study of food service helpers.

Previous studies have shown that the job knowledge and prudent knowledge of experienced workers constitute a wealth that needs to be shared in workplaces to promote worker integration, job retention and occupational health and safety. It appears, however, that certain management practices undermine this knowledge sharing process. This case study of food service helpers in institutional food service departments is part of a research project aimed at comparing the impact of different work organization methods on knowledge sharing in the workplace on the basis of case studies carried out in several organizations. The results of this case study reveal that by destabilizing and weakening the work teams, flexible management practices create an environment that is not conducive to experiential knowledge sharing.