Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study.

BACKGROUND: Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l'Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. OBJECTIVE: This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention's cost-effectiveness. METHODS: Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. RESULTS: In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. CONCLUSIONS: The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54440.

["Breaking the Silence Barrier", a simulation program to address psychological distress]. / "Briser la barrière du silence", un programme de simulation pour adresser la détresse psychologique.

Although several strategies have been developed to support medical students during their studies in order to prevent burnout, depression and suicide, not all of them are equally effective. Simulation is an interesting strategy: it gives students the tools to detect and intervene in signs of distress in their colleagues, and helps them break the barrier of silence in the face of psychological distress.

Simulation-based education to improve management of refractory anaphylaxis in an allergy clinic.

BACKGROUND: High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy improved performance in the clinical setting. METHODS: Advanced anaphylaxis scenarios were designed by a panel of emergency, intensive care unit, anesthesiology and allergy-immunology specialists and then adapted for the adult allergy clinic setting. This simulation activity included a first part in the high-fidelity simulation-training laboratory and a second at the adult allergy clinic involving actors and a high-fidelity mannequin. Participants filled out a questionnaire, and qualitative interviews were performed with staff after they had managed cases of refractory anaphylaxis. RESULTS: Four nurses, seven allergy-immunology fellows and six allergy/immunologists underwent the simulation. Questionnaires showed a perceived improvement in aspects of crisis and anaphylaxis management. The in-situ simulation revealed gaps in the process, which were subsequently resolved. Qualitative interviews with participants revealed a more rapid and orderly response and improved confidence in their abilities and that of their colleagues to manage anaphylaxis. CONCLUSION: High-fidelity simulations can improve the management of anaphylaxis in the allergy clinic and team confidence. This activity was instrumental in reducing staff reluctance to perform high-risk challenges in the ambulatory setting, thus lifting a critical barrier for implementing oral immunotherapy at our adult center.

Efficacy and cost-feasibility of the Timely Chest Compression Training (T-CCT): a contextualized cardiopulmonary resuscitation training for personal support workers participating during in-hospital cardiac arrests.

OBJECTIVES: The Timely Chest Compression Training (T-CCT) was created to promote more frequent training in chest compressions for personal support workers. This study aims to assess the efficacy of the T-CCT on the chest compression performance and to examine costs related to this intervention. METHODS: A prospective single group, before-after study was conducted at a university-affiliated hospital. The T-CCT is adapted for support workers and lasts 20 min during working hours. Guided by peer trainers, live feedback devices and mannikins, the T-CCT targets chest compression training. Using an algorithm, chest compression performance scores were gathered before and after the intervention. RESULTS: Of 875 employed support workers, 573 were trained in 5 days. Prior to the intervention, the median performance score was 72%. Participants significantly improved after the intervention (p < 0.001) and the median of the differences was 32% (95% CI 28.5-36.0). Support workers in critical care units and those with an active basic life support (BLS) certification performed better at baseline and were less inclined to have large changes in performance scores after the intervention. When compared to basic life support training, the T-CCT is over three times less expensive. CONCLUSIONS: The T-CCT was an effective and low-cost initiative that allowed to train a large group of support workers in a short amount of time. Since they are actively involved in resuscitation efforts in Quebec (Canada), it may promote the delivery of high-quality compressions during in-hospital cardiac arrests. Our inquiry can incite and guide other organizations in the implementation of similar interventions.

RéSUMé: OBJECTIFS: Le Timely Chest Compression Training (T-CCT) a été créé pour promouvoir une formation plus fréquente en compressions thoraciques pour les préposés aux bénéficiaires. Cette étude vise à évaluer l'efficacité du T-CCT sur la performance en compressions thoraciques et à examiner les coûts liés à cette intervention. MéTHODES: Une étude prospective avant-après avec un seul groupe a été menée dans un hôpital universitaire. Le T-CCT est adapté aux préposés aux bénéficiaires et dure 20 min pendant les heures de travail. Guidé par des pairs formateurs, des appareils de rétroaction en direct et des mannequins, le T-CCT cible l'entraînement des compression thoraciques. À l'aide d'un algorithme, les scores de performance en compression thoraciques ont été recueillis avant et après l'intervention. RéSULTATS: Sur les 875 préposés aux bénéficiaires employés, 573 ont été formés en cinq jours. Avant l'intervention, le score de performance médian était de 72 %. Les participants se sont nettement améliorés après l'intervention (p < 0.001) et la médiane des différences était de 32 % (IC à 95 %, 28.5−36.0). Les préposés aux bénéficiaires dans les unités de soins intensifs et ceux avec une formation de réanimation cardiorespiratoire de base (BLS) active ont obtenu de meilleurs résultats au départ et étaient moins enclins à avoir de grands changements dans leurs scores de performance après l'intervention. Comparé à la formation BLS, le T-CCT est trois fois moins cher. CONCLUSIONS: Le T-CCT était une initiative efficace et peu coûteuse qui a permis la formation d'un grand groupe de préposés aux bénéficiaires en peu de temps. Étant donné qu'ils sont activement impliqués dans les efforts de réanimation au Québec (Canada), cela pourrait favoriser la réalisation de compressions de grande qualité pendant les arrêts cardiorespiratoires en milieu hospitalier. Notre démarche pourra inciter et guider d'autres organisations dans la mise en œuvre d'interventions similaires.

A qualitative evaluation of a family nursing intervention.

Congestive heart failure is a major source of anxiety for both patients and their family. This article presents the results of a qualitative case study aimed at evaluating family nursing interventions from the perspective of the family members and a clinical nurse specialist (CNS). A CNS applied a family nursing intervention program with 4 couples. Data were obtained through semistructured interviews preintervention and postintervention for the couples and postintervention for the CNS. The transcripts of the interviews were submitted for content analysis. For the couples, results show both spouses subject to a high level of suffering, which can be alleviated through a family nursing meeting that allows them to obtain a better understanding of each other's experience. For the CNS, family interventions were considered a privilege since they helped relieve suffering and her own feelings of powerlessness. These results have the potential to improve family nursing interventions and enhance CNS practice.