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Search Results: 1 - 10 of 756 matches for " Lise Poissant "
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Exploring Factors in the Systematic Use of Outcome Measures: A Multi-Disciplinary Rehabilitation Team Perspective  [PDF]
Diana Zidarov, Lise Poissant
Open Journal of Therapy and Rehabilitation (OJTR) , 2014, DOI: 10.4236/ojtr.2014.22013
Abstract: Purpose: The implementation of routine outcome measurement was initiated as a quality improvement initiative in a unit delivering intensive functional rehabilitation for people with lower limb amputation. Two years post-implementation, completion rates remained low which raised the need to gain an indepth understanding of the factors that might impact the systematic use of Outcome Measures (OMs). Method: A qualitative exploratory study embedded in the ongoing quality improvement initiative was designed. Data were gathered through a focus group with members of a multidisciplinary rehabilitation team. A deductive content analysis was performed using Consolidated Framework for Implementation Research (CFIR) as a guide to explore factors that impact routine outcome measurement. Results: Respondents perceived OMs as valid and offering clear advantages in clinical practice. At the organizational level, lack of fit with clinical practice, loss of project leaders and lack of clear management directives had negative repercussions on the use of OMs. Conclusion: Our results suggest that a dedicated project leader throughout the implementation process and effective communication may contribute to bypassing barriers associated to practice changes leading to a more systematic use of OMs among clinicians.
Assessing the accuracy of an inter-institutional automated patient-specific health problem list
Lise Poissant, Laurel Taylor, Allen Huang, Robyn Tamblyn
BMC Medical Informatics and Decision Making , 2010, DOI: 10.1186/1472-6947-10-10
Abstract: Data for this study were obtained from 121 general practitioners and all medical services provided for 22,248 of their patients. At the opening of a patient's file, all health problems detected through medical service utilization or single-indication drug use were flagged to the physician in the MOXXI system. Each new arising health problem were presented as 'potential' and physicians were prompted to specify if the health problem was valid (Y) or not (N) or if they preferred to reassess its validity at a later time.A total of 263,527 health problems, representing 891 unique problems, were identified for the group of 22,248 patients. Medical services claims contributed to the majority of problems identified (77%), followed by therapeutic indications from electronic prescriptions (14%), and single-indication drugs (9%). Physicians actively chose to assess 41.7% (n = 106,950) of health problems. Overall, 73% of the problems assessed were considered valid; 42% originated from medical service diagnostic codes, 11% from single indication drugs, and 47% from prescription indications. Twelve percent of problems identified through other treating physicians were considered valid compared to 28% identified through study physician claims.Automation of an inter-institutional problem list added over half of all validated problems to the health problem list of which 12% were generated by conditions treated by other physicians. Automating the integration of existing information sources provides timely access to accurate and relevant health problem information. It may also accelerate the uptake and use of electronic medical record systems.In its second report 'Crossing the Quality Chasm'[1], the Institute of Medicine identified patient safety and free flow of information as key issues to improve care. Functionalities of electronic health records (EHR) such as electronic prescribing[2-6], clinical decision support systems[7] and automated reminders [8] have been shown to be effectiv
NON-PARTICIPATION BIAS IN HEALTH SERVICES RESEARCH USING DATA FROM AN INTEGRATED ELECTRONIC PRESCRIBING PROJECT: THE ROLE OF INFORMED CONSENT SESGO POR FALTA DE PARTICIPACIóN EN LA INVESTIGACIóN DE LOS SERVICIOS DE SALUD AL USAR DATOS DE UN PROYECTO INTEGRADO DE RESCRIPCIóN ELECTRóNICA: EL PAPEL DEL CONSENTIMIENTO INFORMADO SESGO PELA FALTA DE PARTICIPA O NA PESQUISA DOS SERVI OS DE SAúDE AO USAR DADOS DE UM PROJETO INTEGRADO DE PRESCRI O ELETR NICA: O PAPEL DO CONSENTIMENTO INFORMADO
Gillian Bartlett,Robyn M Tamblyn,Yuko Kawasumi,Lise Poissant
Acta Bioethica , 2005,
Abstract: Electronic prescribing potentially reduces adverse outcomes and provides critical information for drug safety research but studies may be distorted by non-participation bias. 52,507 patients and 28 physicians were evaluated to determine characteristics associated with consent status in an electronic prescribing project. Physicians with less technology proficiency, seeing more patients, and having patients with higher fragmentation of care were less likely to obtain consent. Older patients with complex health status, higher income, and more visits to the study physician were more likely to consent. These systematic differences could result in significant non-participation bias for research conducted only with consenting patients La prescripción electrónica reduce, potencialmente, los resultados adversos. y proporciona información crítica para una investigación segura en drogas, pero los estudios pueden ser distorsionados por un sesgo por falta de participación. Se evaluó a 52.505 pacientes y a 28 médicos para determinar características asociadas con el estatus del consentimiento en un proyecto de prescripción electrónica. Los médicos con menor eficiencia tecnológica, con más cantidad de pacientes que, además, mostraban mayor fragmentación en su atención, presentaban menor opción de obtener consentimiento. Los pacientes de más edad, con estatus de salud complejo, mayor ingreso y con más visitas al médico a cargo, manifestaban mayor disposición a consentir. Estas diferencias sistemáticas podrían desembocar en un sesgo significativo por falta de participación en la investigación llevada a cabo sólo con pacientes con consentimiento A prescri o eletr nica reduz potencialmente os resultados adversos e proporciona informa o crítica para uma pesquisa segura em drogas, porém os estudos podem ser destorcidos por um sesgo por falta de participa o. Avaliou-se 52.505 pacientes e a 28 médicos para determinar características associadas com o estatus do consentimento num projeto de prescri o eletr nica. Os médicos com menor eficiência tecnológica, com mais quantidade de pacientes que os outros, mostravam maior fragmenta o em sua aten o, apresentavam menos op o para conseguir o consentimento. Os pacientes mais idosos, com estudos de saúde mai s complexos, maiores salários e com mais visitas ao médico, manifestavam maior disposi o de consentir. Estas diferen as sistemáticas poderiam desembocar num erro significativo por falta de participa o na pesquisa levada a cabo somente com pacientes que consentiram
The development and preliminary validation of a Preference-Based Stroke Index (PBSI)
Lise Poissant, Nancy E Mayo, Sharon Wood-Dauphinee, Ann E Clarke
Health and Quality of Life Outcomes , 2003, DOI: 10.1186/1477-7525-1-43
Abstract: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score.Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001).Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI.There is increasing recognition that clinical benefits from the patient's point of view can best be quantified in terms of health-related quality of life (HRQL). This concept emerged in the mid 80's when the need was identified for a construct that would capture the impairments, functional states, perceptions and social opportunities that can be influenced by disease [1]. HRQL has been clearly identified as being influenced by an individual's capacity to perform and participate in various activities [2-4] and thus becomes highly meaningful in a disease such as stroke where the impact is often life-long and multidimensional. One approach to assess HRQL in various populations is to use health profiles. Health profiles, whether generic, like the SF-36 [5] or specific, like the Stroke Impact Scale (SIS)[6] have been used in many studies of stroke[7-11]. They are useful in identifying t
NON-PARTICIPATION BIAS IN HEALTH SERVICES RESEARCH USING DATA FROM AN INTEGRATED ELECTRONIC PRESCRIBING PROJECT: THE ROLE OF INFORMED CONSENT
Bartlett,Gillian; Tamblyn,Robyn M; Kawasumi,Yuko; Poissant,Lise; Taylor,Laurel;
Acta bioethica , 2005, DOI: 10.4067/S1726-569X2005000200005
Abstract: electronic prescribing potentially reduces adverse outcomes and provides critical information for drug safety research but studies may be distorted by non-participation bias. 52,507 patients and 28 physicians were evaluated to determine characteristics associated with consent status in an electronic prescribing project. physicians with less technology proficiency, seeing more patients, and having patients with higher fragmentation of care were less likely to obtain consent. older patients with complex health status, higher income, and more visits to the study physician were more likely to consent. these systematic differences could result in significant non-participation bias for research conducted only with consenting patients
Synergizing expectation and execution for stroke communities of practice innovations
Lise Poissant, Sara Ahmed, Richard J Riopelle, Annie Rochette, Hélène Lefebvre, Deborah Radcliffe-Branch
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-44
Abstract: We will develop an e-collaborative platform that will include various social networking and collaborative tools. We propose to create online brainstorming sessions ('jams') around each best practice recommendation. Jam postings will be analysed to identify emergent themes. Syntheses of these analyses will be provided to members to help them identify priority areas for practice change. Discussions will be moderated by clinical leaders, whose role will be to accelerate crystallizing of ideas around 'how to' implement selected best practices. All clinicians (~200) involved in stroke care among the MSN will be asked to participate. Activities during face-to-face meetings and on the e-collaborative platform will be documented. Content analysis of all activities will be performed using an observation grid that will use as outcome indicators key elements of communities of practice and of the knowledge creation cycle developed by Nonaka. Semi-structured interviews will be conducted among users of the e-collaborative platform to collect information on variables of the knowledge-to-action framework. All participants will be asked to complete three questionnaires: the typology questionnaire, which classifies individuals into one of four mutually exclusive categories of information seeking; the e-health state of readiness, which covers ten domains of the readiness to change; and a community of practice evaluation survey.This project is expected to enhance our understanding of collaborative work across disciplines and organisations in accelerating implementation of best practices along the continuum of care, and how e-technologies influence access, sharing, creation, and application of knowledge.Each year, over 50,000 Canadians suffer a stroke [1,2]. With improved awareness and with enhanced system responses, specialized diagnostics and therapeutic procedures, a large majority of individuals now survive their stroke. With declining stroke-related mortality rates and the aging po
Victimization and PTSD in Ugandan Youth  [PDF]
Lise Mandrup, Ask Elklit
Open Journal of Epidemiology (OJEpi) , 2014, DOI: 10.4236/ojepi.2014.43020
Abstract:

Background: Little is known about post-traumatic stress (PTSD) prevalence rates in community samples. This is especially true for the African continent where child-soldiers, HIV/AIDS affected and orphans have been the target for PTSD prevalence studies. Objectives: The aim of this study is to investigate the indirect and direct exposure to 20 potentially traumatic events and its relation with PTSD in a Ugandan sample of senior 3rd year students and to perform cross-cultural comparisons with previous studies examining this age group. Socio-economic status, coping styles, negative affect, and somatization are further examined. Method: A convenience sample of 408 senior secondary school students, from eight schools, across three major towns, Kampala, Mbarara, and Jinja, were selected. The Harvard Trauma Questionnaire (HTQ) was used to establish PTSD prevalence rates, The Coping Style Questionnaire (CSQ) was used to assess coping styles, and the Trauma Symptom Checklist (TSC) were used to measure negative affect and somatization. Results: The subjects had been exposed to a mean of 6.6 direct events and a mean of 7.2 indirect events. The estimated prevalence rate of PTSD was 37.7% and a further 28.2% reached a subclinical level, missing one symptom to have the full diagnosis. Variables related to a PTSD diagnosis were female gender, number of directly experienced events, emotional coping, negative affect, and somatization. Conclusions: Ugandan youth have been exposed to significantly more potentially traumatic events and negative life events than European youth, and subsequently PTSD prevalence rates are higher. In addition, fewer gender differences are found in the Ugandan sample compared to the European samples.

Implementation Strategies for Improving the Care of Depressed Elderly Persons—Summary of an International Workshop  [PDF]
Elisabeth Severinsson, Anne Lise Holm
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.411076
Abstract: The aim of the study was to identify the most important research priorities as well as future strategies for promoting and implementing evidence-based care of depressed elderly persons. An interdisciplinary workshop was organized using a focus group format and the transcript of the discussion was interpreted by means of the qualitative content analysis. The most important research priorities for improving the care of depressed elderly persons, implementation levels, theoretical approaches as well as possible outcomes were analysed on individual consumer, healthcare system, and policy level. A wide range of theories and methods are necessary to identify and explain implementation processes and results. Qualitative and quantitative methodologies in combination with knowledge synthesis were discussed. In addition, the need to summarize the literature in terms of specific issues was emphasized. In conclusion, the implementation strategies for improving the care of depressed elderly persons should be addressed on three levels: individual consumer, healthcare system and policy. Although some aspects of the implementation model may need to be enhanced, the fact that it includes conditions on individual level, i.e. self-management support, is of importance. The expansion and maintenance of evidence-based care generate potential for change in mental healthcare, thus improving outcomes for individual elderly patients. Areas that require further research are organization, cost and leadership. The use of mixed methods could strengthen future studies. Implementation researchers need a broad repertoire in order to plan and perform evidence-based research. To improve practice, implementation strategies should be developed in clinical and community guidelines.
Understanding and Improving Quality of Care in the Context of Depressed Elderly Persons Living in Norway  [PDF]
Elisabeth Severinsson, Anne Lise Holm
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.412086
Abstract:

Effective leadership plays an important role in safe patient care. The aim of this paper was to understand and improve the implementation outcomes identified by empirical studies based on Proctors et al.’s key concepts, acceptability appropriateness, feasibility and fidelity, and to propose recommendations for further research. Methods: An interdisciplinary approach using mixed methods. Results: A total of twenty papers based on data from this interdisciplinary study have been published. Overall, our published empirical studies revealed that the CCM intervention had positive results due to staff members’ engagement to improve care, their awareness of the need for collaboration and willingness to assume responsibility for patient care. From the perspective of the depressed elderly persons the results of the research project indicated their need for support to increase self-management. In conclusion, an improved understanding of the implementation outcomes will have an impact on best practice for depressed elderly persons and dissemination purposes. Quality management and highly action-oriented involvement are necessary in implementation research. These will also affect the professional development of interdisciplinary teams as well as constitute a basis for further research on understanding and improving the care of depressed elderly individuals.

Mapping Psychosocial Risk and Protective Factors in Suicidal Older Persons—A Systematic Review  [PDF]
Anne Lise Holm, Elisabeth Severinsson
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.53030
Abstract: Social disconnectedness in combination with depression, somatic disease, stigma, social exclusion and functional impairment has been described as a major risk factor for suicide in old age. However, protective factors have not been focused on in the same way. The aim was to identify psychosocial risk and protective factors in suicidal older persons. A systematic review was performed in Academic Search Premier (34), Ovid Medline (0), PsycInfo (0), PubMed (66), CINAHL (3) and ProQuest (1078) for the period May - September, 2014. Results: Twelve studies were included in the final analysis. Psychosocial risk factors were categorized under four themes: Being a burden to others increases depression and hopelessness, the struggle due to poor social integration, the strain of physical illness and old age and Negative aspects of religious activity. A total of four protective factors emerged: a sense of belonging, maintaining social dignity, satisfaction with relationships and feeling useful and positive aspects of religious activity. In conclusion, the context of a suicidal older person in a home healthcare service may create a “vulnerable psychosocial state” in which she/he is confronted by stressful psychosocial life events including physical illness and social network changes. The fact that protective factors are solely related to social factors needs to be taken into account in future prevention studies.
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