French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC).

BACKGROUND: Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner's organizational theory, the "Organizational Readiness for Implementing Change" (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties. METHODS: (1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach's alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis. RESULTS: A French 10-item scale named the Réceptivité organisationnelle à l'implantation d'un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach's alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC's items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC's model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12). CONCLUSIONS: The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.

[Promoting home support for elderly people with neurocognitive disorders: Caregiver perception of the help-seeking process]. / Favoriser le maintien à domicile des personnes âgées atteintes de troubles neurocognitifs. Perception par les proches aidants de leur processus de recherche d'aide.

BACKGROUND: Caregivers play an essential role in maintaining home care for elderly people with dementia. However, it is difficult for caregivers to target their own needs as well as those of the person with neurocognitive disorders they support on a daily basis. Identifying the needed resources can also be difficult. In order to better assist caregivers in identifying resources needed to support their role, this study aims to understand the factors that influence their help-seeking process. METHODS: This qualitative and descriptive study focuses on the point of view of the main people affected by this problem: caregivers. Eleven caregivers of elderly people with dementia living at home were recruited by convenience sampling. Semi-structured interviews were conducted, and the data were analyzed according to Mast's typology. RESULTS: The factors influencing caregivers help-seeking process were categorized into five themes: 1) service-related (e.g. wait times); 2) personal (e.g. feeling intrusive); 3) experiential (e.g. positive use of a service); 4) relational (e.g. rejection of the elder), and 5) informational (e.g. directed to the right service). CONCLUSION: Caregivers face many challenges in their help-seeking process and want to be more proactively accompanied in a way adapted to their changing needs.

Cross-Cultural Adaptation of a Decision Support System for AT Selection.

Older adults may benefit from decision support systems for the selection of assistive technologies. We present a case study cross-cultural adaptation in Canada of a system developed in the United Kingdom. We describe a conceptual framework for examining challenges with cultural and literacy issues and ways to address them.

Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations.

BACKGROUND: Although antineoplastic agents are critical in the treatment of cancer, they can potentially cause hypersensitivity reactions that can have serious consequences. When such a reaction occurs, clinicians can either continue the treatment, at the risk of causing a severe or a potentially fatal anaphylactic reaction, or stop the treatment, although it might be the only one available. The objective of the present work was to evaluate the effectiveness of methods used to prevent and treat hypersensitivity reactions to platinum- or taxane-based chemotherapy and to develop evidence-based recommendations. METHODS: The scientific literature published to December 2013, inclusive, was reviewed. RESULTS: Premedication with antihistamines, H2 blockers, and corticosteroids is not effective in preventing hypersensitivity reactions to platinum salts. However, premedication significantly reduces the incidence of hypersensitivity to taxanes. A skin test can generally be performed to screen for patients at risk of developing a severe reaction to platinum salts in the presence of grade 1 or 2 reactions, but skin testing does not appear to be useful for taxanes. A desensitization protocol allows for re-administration of either platinum- or taxane-based chemotherapy to some patients without causing severe hypersensitivity reactions. CONCLUSIONS: Several strategies such as premedication, skin testing, and desensitization protocols are available to potentially allow for administration of platinum- or taxane-based chemotherapy to patients who have had a hypersensitivity reaction and for whom no other treatment options are available. Considering the available evidence, the Comité de l'évolution des pratiques en oncologie made recommendations for clinical practice in Quebec.

'I don't want to burden my family': handling communication challenges in geriatric oncology.

Oncologists need excellent communication skills to effectively handle challenging conversations regarding prognosis, transition to palliative care, code status, and other sensitive topics. Foundational skills include: 1) posing open-ended, exploratory questions, 2) allowing for appropriate silence in the conversation, 3) listening actively, 4) recognizing emotions, 5) responding to emotions with empathy rather than biomedical information, and 6) speaking with clarity by avoiding technical jargon and offering small chunks of information. Conversations about sensitive topics can be particularly challenging with geriatric patients, who experience functional and sensory limitations. The risk-benefit ratio of diagnostic and therapeutic interventions tips precariously in older patients as many develop geriatric syndromes. Older cancer patients have the unique perspective of looking back on a long life and looking forward to impending death. Higher order skills can be very powerful in helping geriatric cancer patients find meaning and dignity at the end of life. These skills include exploring spirituality and coping strategies and engaging the patient in conversation and reflection about their legacy.

[Development of self-regulation and inhibition in children exhibiting attention deficit disorder with or without hyperactivity (ADHD)]. / Développement de l'autorégulation et de l'inhibition chez des enfants présentant un trouble déficitaire de l'attention avec ou sans hyperactivité (TDAH).

INTRODUCTION: Self-regulation shares several affinities with executive functions. However, the specificity of self-regulation deficits in attention deficit/hyperactivity disorder (ADHD) remains unclear. The typical child starts around the age of four to develop a self-control mechanism along with an internal language that allows the child to modulate impulsively. Conversely, a child with ADHD seems to have greater difficulties delaying or retaining an action or response. OBJECTIVE: In this study we aim to evaluate self-regulation of comprehension in ADHD. RESULTS: Our results show that children with ADHD fail to recognize inconsistencies in presented stories at a rate ranging between 72 (eight years) and 54% (ten years). We also found a positive correlation between a better control of self-regulation and our behavioral inhibition measurement. The attentional deficits exhibited through markedly longer reaction times to continuous performance test (CPT) could be responsible for a poor ability to self-regulate. Fast reaction times were found to be associated with increased vigilance/attention that in turn would permit better self-regulation. Furthermore, our findings show that older subjects with ADHD have shorter reaction times to CPT approaching this group to the typical children. DISCUSSION: This suggests that improvement overtime in self-regulation processes may be attributed to the associated development of vigilance/attention in children with ADHD. Improved vigilance/attention would result in optimal reaction times during tasks that require self-regulation. In addition, our findings suggest that subjects with ADHD have developmental trajectories similar to those observed in healthy subjects. CONCLUSION: In the present study, the lack of a comparison group does not allow us to conclude if such trajectory is delayed compared to typical subjects. Finally, there was no significant relation between the degree of intelligence and the rate of self-regulation, which makes it possible to distinguish the two functions. However, in ADHD self-regulation is favourably influenced by age as observed in developmental studies on typical children. Thus, maturation independent of intelligence, influences self-regulation processes.

Development and evaluation of a liquid chromatography-mass spectrometry assay and its application for the assessment of renal function.

In the present study we evaluated two commonly used iodinated contrast agents, iohexol and iodixanol, as potential markers of impaired renal function. A reversed phase LC-MS method has been developed in order to separate and quantify the two substances. The assay was linear between 0.02 and 9.7 micromol/L for iohexol and between 0.4 and 49.3 micromol/L for iodixanol (r(2) > 0.998). The recovery during sample preparation ranged from 89.1 to 112.4%. The intra- and inter-assay RSD values were 3.06-13.6% for iohexol and 4.32-12.7% for iodixanol. The validated method was subsequently applied to 17 patients scheduled for angiographic procedure displaying normal and impaired renal function. A mixture of iohexol and iodixanol was intra-arterially injected and their corresponding plasma levels were determined periodically over a 24h period following administration. The elimination of both contrast agents followed by the LC-MS approach allowed us to discriminate between patients with normal and impaired renal function at 4, 8 and 24h after administration. Our preliminary results support the predictive value of iohexol and/or iodixanol clearance in a clinical environment to screen and identify patients at risk of developing CIN.

Adaptive control of uncertain continuously stirred tank reactors with unknown actuator nonlinearities.

Adaptive nonlinear control is investigated for continuously stirred tank reactor (CSTR) systems using neural networks. The CSTR plant under study belongs to a class of nonaffine nonlinear systems, and contains an unknown parameter that enters the model nonlinearly. Using adaptive backstepping and neural network (NN) approximation techniques, an alternative adaptive NN controller is developed that achieves asymptotic output tracking control. A novel integral-type Lyapunov function, which includes both system states and control input as its arguments, is constructed to solve the difficulty associated with the nonaffine control problem. Numerical simulation is performed to show the feasibility of the proposed approach for chemical process control.

Adaptive control for a class of second-order nonlinear systems with unknown input nonlinearities.

An adaptive controller is developed for a class of second-order nonlinear dynamic systems with input nonlinearities using artificial neural networks (ANN). The unknown input nonlinearities are continuous and monotone and satisfy a sector constraint. In contrast to conventional Lyapunov-based design techniques, an alternative Lyapunov function, which depends on both system states and control input variable, is used for the development of a control law and a learning algorithm. The proposed adaptive controller guarantees the stability of the closed-loop system and convergence of the output tracking error to an adjustable neighbour of the origin.

Comparison of the reaction time, the Berg Scale and the ABC in non-fallers and fallers.

Postural sway, reaction time, the Berg Scale and the Activities-specific Balance Confidence Scale (ABC) were administered to 80 elderly subjects (40 fallers and 40 healthy non-fallers) in order to determine reliable predictor for those at risk of falling. Non-fallers showed significantly faster reaction times when compared with fallers experimental group. Postural sway results show a higher oscillation displacement in the Y axis (lateral) than the X axis (anterior-posterior) and that fallers oscillate at a higher frequency than non-fallers. All variables were submitted to a multiple regression analysis. Only three of the four variables were found to be significant predictors of fall status. The variables in order of their inclusion are reaction time, Total Berg Balance Score and mean ABC. It was further determined that reaction time was indeed the best predictor of fall status in the present study.

Burden of chickenpox on families: A study in Quebec.

OBJECTIVE: To estimate the nonhospital costs of treating chickenpox and to ascertain the opinion of parents regarding the usefulness of vaccination. DESIGN: Retrospective postal survey. SETTING: Province of Quebec. PARTICIPANTS: Random sample of 3333 families with children aged six months to 12 years. OUTCOME MEASURES: For cases of chickenpox that occurred between September 1, 1997 and August 31, 1998, the use of health services, time away from school or work, patient care required, direct and indirect costs for the families and the health care system, and the opinion of parents regarding chickenpox and the vaccine were evaluated. RESULTS: The response rate was 64.7%, and 18.8% of households reported a history of chickenpox, a total of 693 cases. A physician was consulted in 45.8% of these cases, and medication was used in 91.7%. The frequency of hospitalizations was 0.6%. Time away from work or school caused by the disease was 4.1 days on average, with 46.5% of absences being attributed to the risk of contagion. The total average cost of a case of chickenpox was $225. Direct expenses for households accounted for 11% of the total cost, public sector direct costs 7%, indirect costs related to absence from work 38% and caregiving time 45%. A majority of parents (70%) were in favour of a systematic childhood immunization program. CONCLUSIONS: Chickenpox without complications is disruptive for families, but the direct costs for families and the public sector are relatively small.

The effects of different knowledge of results spacing and summarizing techniques on the acquisition of a ballistic movement.

The present study crossed three knowledge of results summarizing techniques (single-trial KR, summary KR, and average KR) with two spacing conditions (KR on every fifth trial-20%- and KR on every trial-100%). Participants (n = 10 per group) performed 80 acquisition trials of a ballistic movement task involving both a temporal and spatial goal, followed by 30 immediate (10 min) and 30 delayed (2 days) no-KR transfer trials. For the spatial goal, performance was less accurate (absolute constant error) for the 20% spacing condition than the 100% condition during acquisition, but more accurate during delayed transfer. No effects were significant for variable error. For the temporal goal, performance was more accurate for the summary and average conditions than the single-trial KR condition; however, this effect was only present within the 20% spacing condition and only during Block 1 of acquisition. A similar effect held for variable error as well, except that the effect persisted for acquisition and transfer. It was concluded that the spacing of KR is more influential in promoting spatial accuracy than the summarizing of KR.

Performance of the 'unaffected' upper extremity of elderly stroke patients.

BACKGROUND AND PURPOSE: The main objective of this study was to compare the sensorimotor performance of the unaffected upper extremity (UE) of elderly stroke patients with that of healthy elderly people. METHODS: The group of stroke patients was composed of 43 hemiplegic/paretic subjects who had had a cerebrovascular accident at least 6 months earlier. They were > or = 60 years old, were right-handed before the stroke, had visual perception within normal limits, and showed no major cognitive impairments. A group of 43 healthy subjects matched for dominance, age, and sex was used for comparison. The main parameters of the performance of the unaffected UE of the stroke subjects and of the same side of the healthy subjects were measured with valid, reliable instruments. Some variables potentially related to the unaffected UE were also measured: affected UE motor function, functional independence, length of time since the stroke, self-perceived health status, activity level, and hand anthropometry. RESULTS: Statistical analyses showed significant deficits in the unaffected UE of hemiplegic/paretic subjects compared with normal subjects with regard to the following parameters: gross manual dexterity, fine manual dexterity, motor coordination, global performance, and kinesthesia (P < .01 to P < .0001). No significant clinical or statistical difference was found for grip strength (P < .81), static and moving two-point discrimination (P = .21 and P = .12), or touch/pressure threshold (P < .91). CONCLUSIONS: Many factors (frequency of use of the unaffected hand, sensorimotor interaction tasks, severity of the deficits in corticifugal projections, and deficits in postural stabilization) could interact to provide the clinical picture obtained in the present study.

Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

OBJECTIVE: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. METHODS: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. RESULTS: At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). CONCLUSION: Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Sudden sensorineural hearing loss.

Approximately 4000 new cases of sudden hearing loss (SHL) occur annually in the United States, and 15,000 annually worldwide, accounting for approximately 1% of all cases of SHL. Although prevalence studies do not necessarily distinguish between idiopathic and acquired SHL, most cases of spontaneous SHL have no identifiable cause. In this article, the authors assess the cause, history, diagnosis, and treatment of SHL.

Vocal fold medialization using autologous cartilage in a canine model: a preliminary study.

Unilateral vocal fold paralysis can alter phonation. Medialization of the vocal fold using cartilage augmentation dates to the early 1950s. Improved phonation after cartilage chordal augmentation has been reported, but no study has as yet documented cartilage viability or size in this setting over time. The authors of this study evaluated thyroid alar cartilage as a medializing material in three mongrel dogs. Grafts were inserted lateral to the inner thyroid perichondrium at the vocal fold level via a window in the thyroid cartilage. Changes in weight, size, and volume were assessed 6 months after implantation. The average graft weight declined by 15%, and the average square area declined by 3%. Importantly, the average volume maintained was 87%. The grafts remained rigidly fixed to the thyroid cartilage in their placement positions. Histologic examination documented minimal resorption. The data suggest that thyroid alar cartilage is a viable filler in type I thyroplasty procedures.

Long-term flap tracheostomy in a pediatric animal model.

OBJECTIVE: To investigate the short- and long-term complications of pediatric tracheostomy, emphasizing posttracheostomy tracheal stenosis in an animal model. DESIGN: Twenty-five New Zealand white rabbits were randomly assigned to three groups: flap tracheostomy, traditional vertical tracheostomy, and control. Interactive image analysis was used to compare the tracheal cross-section area and circumference between groups 16 weeks after surgery. The incidence of peristomal infections and accidental decannulations was also compared. RESULTS: The vertical tracheostomy group had a smaller circumference (P = .01) and smaller cross-sectional area (P = .006) than the control or flap tracheostomy groups. A 30% decrease in tracheal cross-sectional area occurred in the vertical tracheostomy group. The flap tracheostomy group had fewer problems with accidental decannulation and peristomal infection compared with the vertical tracheostomy group. CONCLUSIONS: We found no significant risk of tracheal stenosis or adverse effects on tracheal growth for the flap tracheostomy in a developing animal model. This tracheostomy technique may be useful in the management of pediatric patients who require long-term bypass of the upper airway.