Régis Vaillancourt

A Globally Optimal k-Anonymity Method for the De-Identification of Health Data

BACKGROUND Explicit patient consent requirements in privacy laws can have a negative impact on health research, leading to selection bias and reduced recruitment. Often legislative requirements to obtain consent are waived if the information collected or disclosed is de-identified. OBJECTIVE The authors developed and empirically evaluated a new globally optimal de-identification algorithm that satisfies the k-anonymity criterion and that is suitable for health datasets. DESIGN Authors compared OLA (Optimal Lattice Anonymization) empirically to three existing k-anonymity algorithms, Datafly, Samarati, and Incognito, on six public, hospital, and registry datasets for different values of k and suppression limits. Measurement Three information loss metrics were used for the comparison: precision, discernability metric, and non-uniform entropy. Each algorithms performance speed was also evaluated. RESULTS The Datafly and Samarati algorithms had higher information loss than OLA and Incognito; OLA was consistently faster than Incognito in finding the globally optimal de-identification solution. CONCLUSIONS For the de-identification of health datasets, OLA is an improvement on existing k-anonymity algorithms in terms of information loss and performance.

Occupational exposure to cyclophosphamide in nurses at a single center.

Objective: To evaluate biological and environmental exposure to cyclophosphamide in nurses at a single institution. Methods: Biological exposure to cyclophosphamide in nurses administering cyclophosphamide compared with two control groups: nononcology nurses not administering cyclophosphamide and community members without recent hospital exposure. Environmental exposure to chemotherapy was measured using surface wipes taken from oncology and nononcology areas in the hospital. Results: More than one third of all nurses and no community controls tested positive for urinary cyclophosphamide. Oncology and nurse controls tested positive in equal numbers. Surface wipes were positive only in the oncology ward. Conclusion: We have demonstrated elevated levels of cyclophosphamide in one third of all nurses and cyclophosphamide contamination of surfaces within the oncology patient environment. This suggests that environmental contamination plays a major role in biological exposure to cyclophosphamide.

The Effectiveness of Written Action Plans in Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic dermatosis requiring a stepwise and dynamic approach to management. The use of written action plans has been shown to improve outcomes in other chronic diseases that require a similar incremental approach. A systematic review was performed to evaluate the effect of a written eczema action plan (EAP) in AD management and to identify characteristics of effective action plans in children with eczema. Only two trials were identified as eligible, which highlights the need for more research on EAPs.

A comparative cost-minimization analysis of providing paediatric palliative respite care before and after the opening of services at a paediatric hospice

A palliative care service provider may add or decrease overall operational costs to the healthcare system. This study assessed the costs of managing respite care for children with life-limiting illness at the Childrens Hospital of Eastern Ontario for the 12-month period both before and after services at Rogers House (RH, a paediatric hospice) was made available. The opening and operation of RH for providing respite care resulted in a minimization of operational costs (n = 66 patients, mean decrease of

The use of pictograms to convey health information regarding side effects and/or indications of medications

4,251.95 per month per patient).

Evaluation, Modification and Validation of a Set Of Asthma Illustrations in Children with Chronic Asthma in the Emergency Department

Abstract The use of pictograms to communicate health information to people with language barriers or limited health literacy may improve patient understanding and increase the efficiency of treatment of such individuals. The ability to communicate potential side effects of medications to all patients, regardless of age, gender, education level, or personal background, is an important aspect of pharmaceutical therapy. The current study assesses pictogram preferences of 28 different medication side effects or indications based on the responses of 2719 participants with diverse characteristics and backgrounds. The results show that country of residence, as well as level of education, have an influence on pictogram preference. Culture-specific and education level-specific pictograms may be essential for the effective communication of health information. Future studies may help to further elucidate pictogram preferences that are universally understood.

Evaluation, Modification, and Validation of Pictograms Depicting Medication Instructions in the Elderly

OBJECTIVES To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and⁄or their parents) with chronic asthma who presented to the emergency department at the Childrens Hospital of Eastern Ontario, Ottawa, Ontario. METHODS Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and⁄or translucency median score <6, were reviewed by the study team and modified by the studys graphic designer. Modifications were made based on key concepts identified by study participants. RESULTS A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. CONCLUSION The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. PRACTICE IMPLICATIONS These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.

Evaluation, validation, and modification of pictograms depicting potential side effects to medication

Poor health literacy has been recognized as a limiting factor in the elderly’s ability to comprehend written or verbal medication information and also to successfully adhere to medical regimens. The objective of this study was to validate a set of pictograms depicting medication instructions for use among the elderly to support health literacy. Elderly outpatients were recruited in 3 community pharmacies in Canada. One-on-one structured interviews were conducted to assess comprehension of 76 pictograms from the International Pharmaceutical Federation. Comprehension was assessed using transparency testing and pictogram translucency, or the degree to which the pictogram represents the intended message. A total of 135 participants were enrolled in this study, and 76 pictograms were assessed. A total of 50 pictograms achieved more than 67% comprehension. Pictograms depicting precautions and warnings against certain side effects were generally not well understood. Gender, age, and education level all had a significant impact on the interpretation scores of certain individual pictograms. When all pictograms were included, younger males had a significantly higher comprehension score than older females, and participants with a higher level of education provided significantly higher translucency scores. Even when pictograms reached the comprehension threshold set by the International Organization for Standardization in the general populations, only 50 of these pictograms achieved more than 67% comprehension among the elderly, confirming that validation in this subpopulation should be conducted prior to using specific pictograms. Accompanying pictograms with education about these pictograms and important counseling points remains extremely important.

Design and validation of pictograms in a pediatric anaphylaxis action plan

Abstract Rationale Health literacy and discordant languages are important barriers to communicating and educating patients about their treatment. Pictograms have shown to be an effective communication tool by increasing comprehension, information recall, and adherence. Objectives To evaluate, modify, and validate a set of pictograms that depict potential side effects to medication. Methods Children inpatient and outpatient were recruited at a Canadian pediatric hospital. Participants in Phase I completed a ‘guessability’ test in order to identify the best pictogram for 27 side effects. In Phase II, structured interview using ‘guessability’ and translucency questionnaires tested the comprehensibility of 28 side effects pictograms. Results Phase I: one hundred and six patients were enrolled and the best pictogram for each category was selected for Phase II. For the side effect ‘headache’, both pictograms achieved 100% of correct answer, so both of them were used in Phase II. For the pictogram ‘general pain 2’, 93.8% of the patients thought it was ‘back pain’, so we decided to use it as ‘back pain’ pictogram in Phase II. Phase II: sixty-seven patients were interviewed, we found that 11 out of 28 pictograms were not guessed correctly by 80% or more participants and six out of 28 pictograms did not achieve a score 5 or greater from 80% or more participants. We found a significant association between the comprehension of the pictogram ‘dizzy when getting up’ and taking three medications or more. Conclusion Sixteen pictograms were validated whereas 12 failed the validation. Five of them failed at both ‘guessability’ and translucency tests.

Improved Practices for Safe Administration of Intravenous Bolus Morphine in a Pediatric Setting

Current anaphylaxis action plans (AAPs) are based on written instructions without inclusion of pictograms.