[Impact of lack of resources in dialysis practice in Quebec]. / L'impact de la rareté des ressources sur la pratique de la dialyse au Québec.

The purpose of this descriptive study was to assess the impact of limited resources on the practice of dialysis in Quebec and to highlight certain ethical issues. Twelve semi-structured interviews were done with nurses in charge of 14 dialysis centres in Quebec. A survey using self-administered questionnaires was also carried out between January 2000 and July 2001, with a convenience sample of 412 patients and 156 other persons involved, including 116 dialysis nurses. Two discussion groups brought together sixteen stakeholders from four dialysis centres. The results presented here were obtained by triangulating methods and data. They show that access to dialysis is not limited by Quebec nephrologists, that patients are increasingly old and sick, that teams are working to the utmost of their ability and that it is difficult for nursing staff to provide optimal care under these conditions.

Group counseling psychotherapy for patients with functional gastrointestinal disorders: development of new measures for symptom severity and quality of life.

Functional gastrointestinal disorders (FGID) can benefit from various psychological interventions. The main objective here was to define the contribution of a new psychotherapeutic intervention, group counseling psychotherapy, for the management of FGID patients. Secondary aims included validation of new measures for gastrointestinal symptoms and quality of life in patients with FGID. Fifty patients seen in a tertiary care center were included in a program of 10 weekly sessions of 2 hr each. Gastrointestinal symptoms, quality of life, and psychological conditions were measured before and after treatment by quantitative indices and by qualitative self-analysis. Gastrointestinal index and quality-of-life index were significantly (P < 0.02) improved at the end of the psychotherapeutic intervention (from 77.5 +/- 4.0 to 63.2 +/- 4.3 and from 67.7 +/- 3.9 to 54.9 +/- 3.9, respectively). In a control group of patients observed for a comparable period of time while waiting for the psychotherapy program, gastrointestinal and quality of life indices remained unchanged. The severity of gastrointestinal symptoms and the quality of life deterioration were highly correlated factors (r = 0.8) at entry into the trial, and their improvement with psychotherapy was also correlated (r = 0.6; P < 0.001). Psychological abnormalities were frequent in these patients (anxiety in 31%, somatization in 29%, depression in 26% of the patients). However, no specific disorder could predict the results of the psychotherapeutic intervention. Over the long term (6-24 months after conclusion of treatment), gastrointestinal status, quality of life, and psychological condition were estimated as improved by 53%, 63%, and 67% of the patients, respectively. The gastrointestinal index and quality of life index we developed were validated to detect the disease and to follow its evolution in response to treatment. In conclusion, group counseling psychotherapy offered a significant contribution for the management, improving gastrointestinal symptoms and quality of life, of FGID patients. New measures for symptom severity and quality of life are available.