Pierre Frémont

Systematic Review of Factors Influencing the Adoption of Information and Communication Technologies by Healthcare Professionals

This systematic review of mixed methods studies focuses on factors that can facilitate or limit the implementation of information and communication technologies (ICTs) in clinical settings. Systematic searches of relevant bibliographic databases identified studies about interventions promoting ICT adoption by healthcare professionals. Content analysis was performed by two reviewers using a specific grid. One hundred and one (101) studies were included in the review. Perception of the benefits of the innovation (system usefulness) was the most common facilitating factor, followed by ease of use. Issues regarding design, technical concerns, familiarity with ICT, and time were the most frequent limiting factors identified. Our results suggest strategies that could effectively promote the successful adoption of ICT in healthcare professional practices.

Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review.

ObjectiveTo review randomized controlled trials evaluating the effectiveness of therapeutic exercise and orthopedic manual therapy for the treatment of impingement syndrome. Data SourceReports up to October 2002 were located from MEDLINE, the Cochrane Database of Systematic Reviews, the Physiotherapy Evidence Database (PEDro), the TRIP database, and the Cumulative Index to Nursing & Allied Health Literature (CINAHL) using “shoulder” and “clinical trial”/“randomized controlled trial” as search terms. Study SelectionStudies were included if (1) they were a randomized controlled trial; (2) they were related to impingement syndrome, rotator cuff tendinitis, or bursitis; (3) one of the treatments included therapeutic exercise or manual therapy. Data ExtractionTwo independent observers reviewed the methodological quality of the studies using an assessment tool developed by the Cochrane Musculoskeletal Injuries Group. Differences were resolved by consensus. Data SynthesisSeven trials met our inclusion criteria. After consensus, the mean methodological score for all studies was 13.9 ± 2.4 (of 24). Four studies of 7, including the 3 trials with the best methodological score (67%), suggested some benefit of therapeutic exercise or manual therapy compared with other treatments such as acromioplasty, placebo, or no intervention. ConclusionsThere is limited evidence to support the efficacy of therapeutic exercise and manual therapy to treat impingement syndrome. More methodologically sound studies are needed to further evaluate these interventions.

Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome.

Objective:First, to validate an ultrasonographic measure of the acromio-humeral distance (AHD); second, to compare the AHD variation during active abduction in patients with shoulder impingement syndrome (SIS) and healthy subjects; and third, to evaluate the relationship between functional status and AHD variations before and after rehabilitation in SIS subjects. Design:This study has 3 components: (1) a reliability study, (2) a case-control study, and (3) a preliminary pretreatment/posttreatment clinical trial. Setting:Primary care hospital setting. Participants:Seven SIS patients and 13 healthy subjects. Interventions:For the clinical trial, the SIS subjects participated in 12 sessions of a rehabilitation program over 4 weeks. Main Outcome Measures:First, intraclass correlation coefficient for interobserver reliability; second, AHD measured at 0°, 45°, and 60° of active abduction; and third, Western Ontario Rotator Cuff Index. Results:Intraclass correlation coefficient for interobserver reliability ranged from 0.86 to 0.92 for the 3 shoulder positions. A significant reduction of the AHD was found within groups between rest and active abduction (P < 0.05). Comparison of AHD between groups was not statistically different (P = 0.06; β< 0.80). In pre-post rehabilitation analysis, improvement of the Western Ontario Rotator Cuff Index score was positively correlated to the reduction of the AHD narrowing as the arm was abducted (r = 0.86; P = 0.01). Conclusions:The ultrasound measure of AHD is reliable and sensitive. Although a distinct pattern of AHD variation in SIS patients could not be confirmed, a strong positive relationship was found between the reduction of AHD narrowing and functional improvement following rehabilitation. Ultrasound measurement of AHD might help identify SIS patients who will benefit from rehabilitation.

Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis.

Background Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists. Methods A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies. Results Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67–0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it. Conclusions Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option.

Translating shared decision-making into health care clinical practices: Proof of concepts

BackgroundThere is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective.MethodsParticipants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol.DiscussionThis study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.

The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery

OBJECTIVE To examine the change in pain and function related to the knee scheduled for surgery, change in health-related quality of life (HRQoL) and change in contralateral knee pain during pre-surgery wait up until time of surgery. METHODS One hundred and fifty-three patients scheduled for knee replacement were recruited from three hospitals in Québec City, Canada, and followed until surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery wait list and surgery, was considered in five categories (< or =3, >3-6, >6-9, >9-12 and >12 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the medical outcomes study 36-item short form health survey. RESULTS Mean pre-surgery wait time was 183 (s.d. 121.9) days. Subjects having waited >9-12 months showed significant deterioration of the WOMAC pain (-9.9; 95% CI -19.2, -0.54) and function (-11.1; 95% CI -18.7, -3.4) scores. On the HRQoL SF-36 physical functioning scale, a significant deterioration was seen in subjects having waited >9-12 months (-11.3; 95% CI -18.4, -4.2) and >12 months (-7.1; 95% CI -12.9, -1.3). On the contralateral knee WOMAC pain score, a significant deterioration was observed in subjects having waited >6-9 months (-10.4; 95% CI -16.9, -3.9) and >12 months (-10.7; 95% CI -19.7, -1.7). CONCLUSION Pre-surgery wait time has a negative significant impact on pain, function and HRQoL at the time of surgery. The magnitude of deterioration seen in this study may be clinically important. The effects of this pre-surgery deterioration on post-surgery outcomes need to be investigated.

Prenatal screening for Down syndrome: a survey of willingness in women and family physicians to engage in shared decision‐making

To assess the willingness of women and their family physicians (FPs) to engage in shared decision‐making (SDM) as regards prenatal Down‐syndrome screening and the factors that might influence their willingness to do so.

Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine

Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field. Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin/Swiss Society of Sports Medicine (SGSM/SSSM), Sport Doctors Australia (SDrA), Swedish Society of Exercise and Sports Medicine (SFAIM), and CASEM.

Carbonic anhydrase III in skeletal muscle fibers: an immunocytochemical and biochemical study.

The objectives of the present study were to determine if carbonic anhydrase III (CA III) demonstrated a specific association for any particular organelle or structure of the skeletal muscle cell and to quantify the activity and content of this enzyme in different types of skeletal muscle fibers. Ultrastructural localization of CA III in the soleus (SOL), deep vastus lateralis (DVL), and superficial vastus lateralis (SVL), composed of predominantly type I, IIa, and IIb fibers, respectively, was performed using a high-resolution immunocytochemical technique and antibody specific for CA III on ultra-thin sections of skeletal muscle embedded in the water-soluble medium polyvinyl alcohol (PVA). The results indicated a uniform distribution of CA III within the sarcomere. Mitochondria, nuclei, triads, Z-, and M-bands were not specifically labeled. Immunoblotting of washed myofibril preparations did not show any detectable CA III associated with this structure. In addition to quantification of the immunogold labeling, CA III activity and content were assayed in the post-mitochondrial supernatant of the three muscles. In the SOL, these values were found to be 3.6-7.6 times higher than in the DVL. The SVL showed a labeling intensity slightly higher than background level, while the enzyme activity and content were indistinguishable from background levels. We therefore conclude that CA III is randomly distributed in the cytoplasm of the three muscle fiber types and that the relative CA III content and activity in the three muscles studied is SOL greater than DVL greater than SVL approximately equal to 0.

FACULTY EVALUATION IN DEPARTMENTS OF FAMILY MEDICINE: DO OUR UNIVERSITIES MEASURE UP?

Family medicine programmes at Canadian universities have expanded dramatically over the past several years. The development of effective means of faculty evaluation is a real concern for these departments as they strive to maintain the high quality of their teaching programmes in the face of rapid change. The literature on faculty evaluation, including reviews and articles discussing the application of faculty evaluations, is reviewed. The current state of faculty evaluation at three Canadian family medicine departments has also been surveyed. Student evaluations were found to be valid, accurate and well studied. They are not perfect, however, and require the use of additional methods such as peer review or video review in conjunction in order to provide a comprehensive evaluation of all areas of faculty activity. Faculty evaluation in family medicine teaching units and community‐based settings has not been well studied. Our survey of faculty evaluation at three Canadian universities shows much room for improvement, particularly in community‐based settings where evaluation is almost non‐existent. Expanding the use of faculty evaluations for formative means and linking evaluation to faculty development opportunities are essential if improvements to the currently used systems are to be successful and accepted by faculty. Special consideration must be given to community‐based settings where systems designed for use in larger university settings will need to be modified substantially before they can be used effectively. Further research is required in this area.