Case Study With a Participatory Approach: Rethinking Pragmatics of Stakeholder Engagement for Implementation Research.

The case study design is particularly useful for implementation analysis of complex health care innovations in primary care that can be influenced by the context of dynamic environments. Case studies may be combined with participatory approaches where academics conduct joint research with nonacademic stakeholders, to foster translation of findings results into practice. The aim of this article is to clarify epistemological and methodological considerations of case studies with a participatory approach. It also aims to propose best practice recommendations when using this case study approach. We distinguish between the participatory case study with full co-construction and co-governance, and the case study with a participatory approach whereby stakeholders are consulted in certain phases of the research. We then compare the epistemological posture of 3 prominent case study methodologists, Yin, Stake, and Merriam, to present the epistemological posture of case studies with a participatory approach. The relevance, applications, and procedures of a case study with a participatory approach methodology are illustrated through a concrete example of a primary care research program (PriCARE). We propose 12 steps for designing and conducting a case study with a participatory approach that may help guide researchers in the implementation analysis of complex health care innovations in primary care.

[Personalisation in mental health: a promising way]. / La personnalisation des services de santé mentale : une voie d'avenir.

OBJECTIVES: To demonstrate the pertinence of putting personalisation at the heart of mental health services. METHODS: Review of littérature of personalisation research and intervention in the United Kingdom, the country where the personalisation is one of the key themes of the health and social services reform agenda. RESULTS: Presentation of the key challenges in the personalisation agenda and also of web tool directly inspired by research and practices in the UK. CONCLUSION: We think that individuals want to be treated as citizens that want control and choice over their destiny.

[Ethical deliberation: from case study to responsible citizenship]. / La délibération éthique: de l'étude de cas à la citoyenneté responsable.

This article wants to be a contribution reflecting on the theme of applied ethics aiming at nourishing professional and interdisciplinary practices. The authors examine the process of ethical deliberation which has four major ends : the development of reflective and ethical competences of professionals, the elaboration by professionals, of an ethical reflective structure facilitating professional praxis, orientation and quick coordination of action ; implementation of a structure of collective deliberation useful in the orientation of difficult decisions and future actions. Finally, this process also has an objective of evaluation and appears relevant in the apprenticeship drawn from experiences of each participant.

A second mechanism of increase of cerebellar hypermetria in humans.

So far, there is only one procedure known to increase hypermetria in cerebellar patients. Facing an increased inertia of the moving limb, patients presenting a lesion of the lateral cerebellum are able to increase appropriately the intensity of the agonist electromyographic (EMG) activity (the launching force), but are unable to adapt the intensity of the antagonist activity (the braking force). As a result, hypermetria is larger when the inertial load is artificially increased. Recent studies have demonstrated that hyperventilation increases hypermetria in patients presenting a spinocerebellar ataxia type 6 (SCA 6), a disorder associated with polyglutamine expansions in the alpha1A-voltage-dependent calcium channel. The mechanism of this increase of hypermetria has not been identified so far. In the present work, we combined kinematic, EMG and transcranial Doppler studies to understand the effects of hyperventilation on fast goal-directed movements in patients presenting a SCA 6. Both in the normal mechanical state and after increasing the inertial load of the moving hand, hyperventilation induced an increase of hypermetria. Hyperventilation increased the delay of the onset latency of the antagonist EMG activity and decreased the rate of rise of both the agonist and the antagonist EMG activities. Hyperventilation induced a marked decrease in cerebral blood flow velocities. The mechanism of this provocative test is original and is distinct from the mechanism of the load-induced increase of hypermetria.