Qualitative Study of Health Care Providers' Uptake of the Project Extension for Community Health Outcomes for Chronic Pain.

INTRODUCTION: There is an enormous need for pain education among all health care professions before and after licensure. The study goal was to explore generic and chronic pain-specific factors that influenced uptake of a continuous education program for chronic pain, the Project Extension for Community Health Outcomes (ECHO) CHUM Douleur chronique. METHODS: The study team conducted 20 semistructured virtual interviews among participants of the program. Interviews were transcribed verbatim, and two analysts used a reflexive thematic analysis approach to generate study themes. RESULTS: Five aspects facilitating engagement, continued participation, and uptake of the Project ECHO were identified: rapid access to reliable information, appraising one's knowledge, cultivating meaningful relationships, breaking the silos of learning and practice, and exponential possibilities of treatment orchestrations for a complex condition with no cure. Although participants' experiences of the program was positive overall, some obstacles to engagement and continued participation were identified: heterogeneity of participants' profiles, feelings of powerlessness and discouragement in the face of complex incurable pain conditions, challenges in applying recommendations, medical hierarchy, and missed opportunity for advocacy. DISCUSSION: Many disease-specific and contextual factors contributed to an increased motivation to participate in the ECHO program. Some elements, such as the complexity of diagnosis and treatment, and the multidisciplinary requirements to manage cases were identified as elements motivating one's participation in the program but also acting as a barrier to knowledge uptake. These must be understood in the broader systemic challenges of the current health care system and lack of resources to access allied health care.

Effects of a peer support programme for youth social services employees experiencing potentially traumatic events: a protocol for a prospective cohort study.

INTRODUCTION: The use of peer support programmes to help workers experiencing potentially traumatic events (PTE) has increased in high-risk organisations in the last decades. However, the scientific evidence of its effectiveness is still very limited. This paper aims to describe the protocol of a prospective cohort study that assesses the efficacy of a peer support programme among youth social services employees exposed to a PTE at work on psychological well-being, work functioning and needs of support. METHODS AND ANALYSIS: This is a mixed-methods prospective study that will examine workers' evolution four times over a 12-month period in Canada. This study involves: (1) quantitative data obtained through self-administrated questionnaires among 222 workers, and (2) qualitative in-depth interviews with a subsample of 45 workers. This study will compare findings from a cohort who received the support of a peer following a PTE (peer support-experimental protocol) as part of the experimental protocol of the Montreal Youth Social Services-University Institute (MYSS-UI), the second group of workers did not ask for the peer support (no peer support-experimental protocol) but was part of MYSS-UI, and the third group received standard organisational support from the Monteregie Youth Social Services (MYSS) (standard organisational protocol). ETHICS AND DISSEMINATION: The protocol and informed consent form complied with the ethics guidelines of the MYSS-UI. The Research Ethics Board of MYSS-UI and MYSS reviewed and accepted the protocol as required. The results of the study will be published in peer-reviewed journals, presented at research and general public conferences, disseminated via a public report for the institute that funded the project and for all workers. Results of this study will influence decision making regarding intervention policies following PTE and peer support interventions may be expanded throughout the youth social services in Canada and worldwide.

Impact of visiting an Onsite Casino information centre on perceptions about randomness and gambling behaviours.

At the beginning of 2000, some educational initiatives in the field of responsible gambling resulted in the implementation of Onsite Casino Information Centres (OCICs). However, no study has yet empirically evaluated the impact of visiting an OCIC. This paper includes two studies evaluating the OCIC Au Centre du Hasard, located in Montreal, Quebec. The goal of the first study was to identify the profile of the visitors and to assess their appreciation. After a visit, 336 patrons accepted to complete a pen and paper questionnaire. The goal of the second study was to evaluate the impact of a visit on the perceptions about randomness and the gambling behaviours of the visitors. For this study, 67 visitors were evaluated before, after, and 3 months following a visit and their results were compared to a control group. Data showed that most visitors were seniors, occasional slot machine gamblers, and in control of their gambling activities. The majority of guests greatly appreciated their visit. A visit to Au Centre du Hasard seemed to modify the misconceptions towards the notion of randomness but not the gambling behaviours. These gains were maintained at 3-month follow-up. Results with respect to other prevention programs are discussed, and future research avenues are suggested.

Affective learning in end-of-life care education: the experience of nurse educators and students.

Preparing future nurses to care for dying patients and their families represents a challenge for nursing education. Affective learning, essential to nurture a caring perspective in end-of-life care, can elicit strong emotional reactions in students, to which nurse educators must remain keenly sensitive. This article presents the experience of nurse educators and students with experiential and reflective activities addressing the affective domain of learning, within an intensive 4-week undergraduate course on end-of-life care, developed with a competency-based approach. It stressed the importance of strategic teaching for developing interpersonal competencies in end-of-life care, but revealed difficulties for both nurse educators and students in assessing outcomes derived from affective learning.

Improved self-exclusion program: preliminary results.

The gambling industry has offered self-exclusion programs for quite a long time. Such measures are designed to limit access to gaming opportunities and provide problem gamblers with the help they need to cease or limit their gambling behaviour. However, few studies have empirically evaluated these programs. This study has three objectives: (1) to observe the participation in an improved self-exclusion program that includes an initial voluntary evaluation, phone support, and a mandatory meeting, (2) to evaluate satisfaction and usefulness of this service as perceived by self-excluders, (3) to measure the preliminary impact of this improved program. One hundred sixteen self-excluders completed a questionnaire about their satisfaction and their perception of the usefulness during the mandatory meeting. Among those participants, 39 attended an initial meeting. Comparisons between data collected at the initial meeting and data taken at the final meeting were made for those 39 participants. Data showed that gamblers chose the improved self-exclusion program 75% of the time; 25% preferred to sign a regular self-exclusion contract. Among those who chose the improved service, 40% wanted an initial voluntary evaluation and 37% of these individuals actually attended that meeting. Seventy percent of gamblers came to the mandatory meeting, which was a required condition to end their self-exclusion. The majority of participants were satisfied with the improved self-exclusion service and perceived it as useful. Major improvements were observed between the final and the initial evaluation on time and money spent, consequences of gambling, DSM-IV score, and psychological distress. The applicability of an improved self-exclusion program is discussed and, as shown in our study, the inclusion of a final mandatory meeting might not be so repulsive for self-excluders. Future research directives are also proposed.

Differences in the sensations of cold on the anterior torso of control and spinal-cord-transected individuals.

Application of cold stimuli to the sentient portion of the anterior torso of 12 spinal-cord-transected individuals (patients) and to comparable sites of 11 control participants showed that thresholds are lower for women than for men and that the difference between the sexes is maintained following spinal-cord transection. Patients of both sexes were more sensitive to cold stimuli than were controls. Estimates of stimulus intensity showed that participants reliably distinguished the 3 cool stimuli but that control women offered significantly larger estimates than control men. Spinal-cord transection produced an increase in the intensity of the sensations in women and a reduction in men. The changes in sensory perception that follow spinal-cord injury extend throughout the somatosensory system and involve all modalities. These changes cannot be explained as a simple release from inhibition.

Eliciting information on differential sensation of heat in those with and without poststroke aphasia using a visual analogue scale.

BACKGROUND AND PURPOSE: Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS. METHODS: Five groups of participants were assessed: those without stroke, those with stroke but without aphasia, and 3 groups with varying degrees of aphasia. A 10-cm vertical VAS was used to measure responses to varying thermal intensities delivered on the participant's forearm. RESULTS: Across all 5 groups, a similar proportion demonstrated ability to discriminate between 2 temperatures (chi2=1.899; P=0.75). When presented with 4 temperatures, all groups performed more poorly, yet with similar success rates across groups (chi2=0.1267; P=0.88). The repeated-measures ANOVA revealed no effect of group but a significant effect of temperature (P<0.0001). CONCLUSIONS: A VAS may be useful in clinical identification of differing intensities of stimuli in a substantial proportion of those with aphasia.

Differences in the sensations of warmth on the anterior torso of normal and spinal-cord transected individuals.

The threshold to warming was measured at 10 sites on the anterior torso between the umbilicus and the clavicle of normal and spinal-cord transected individuals. In normal individuals, thresholds were higher on the thorax than on the abdomen. Men had higher and more variable thresholds than women. Magnitude estimations of supra-threshold stimuli showed that men offer verbal estimates of warmth that are about half of the size of the estimates given by women to the same stimuli. The psychometric function shows that in women, the sensation of warmth grows more rapidly than in men after starting from a higher initial value. After spinal-cord injury, thresholds for detection of warming were elevated. This effect was most noticeable within 8 cm of the anesthetic zone, but farther away, thresholds were still elevated but uniform as a function of distance, being about 30% higher than in normal individuals. After spinal-cord injury, the psychometric functions show that small stimuli elicit relatively large sensations and that these sensations grow more slowly with increasing skin temperatures than for normal individuals. Thus, for small warm stimuli spinal-cord-injured patients (both men and women) have a response similar to normal women but the slope of the psychometric function is flat, being similar to the slope observed for normal men.