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1.  Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study 
Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice.
We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information.
One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and access to printed Dboxes in consultation rooms.
Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.
Electronic supplementary material
The online version of this article (doi:10.1186/s13012-014-0144-6) contains supplementary material, which is available to authorized users.
PMCID: PMC4201673  PMID: 25280742
Clinical practice guidelines; Knowledge translation; Decision support; Evidence-based practice; Barriers; Patient-centred care; User experience; Continuing professional development; Communication competency
2.  Detection of delirium by nurses among long-term care residents with dementia 
BMC Nursing  2008;7:4.
Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium.
In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses.
Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]).
Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.
PMCID: PMC2277396  PMID: 18302791
3.  Patients’ perceptions of the quality of care after primary care reform 
Canadian Family Physician  2010;56(7):e273-e282.
To evaluate how a primary care reform, which aimed to promote interprofessional and interorganizational collaborative practices, affected patients’ experiences of the core dimensions of primary care.
Before-and-after comparison of patients’ perceptions of care at the beginning of family medicine group (FMG) implementation (15 to 20 months after accreditation) and 18 months later.
Five FMGs in the province of Quebec from various settings and types of practice.
A random sample of patients was selected in each FMG; a total of 1046 participants completed both the baseline and follow-up questionnaires.
Patients’ perceptions of relational and informational continuity, organizational and first-contact accessibility, attitude and efficiency of the clinic’s personnel and waiting times (service responsiveness), physician-nurse and primary care physician–specialist coordination, and intra-FMG collaboration were assessed over the telephone, mostly using a modified version of the Primary Care Assessment Tool. Additional items covered patients’ opinions about consulting nurses, patients’ use of emergency services, and patients’ recall of health promotion and preventive care received.
A total of 1275 patients were interviewed at the study baseline, and 82% also completed the follow-up interviews after 18 months (n = 1046). Overall, perceptions of relational and informational continuity increased significantly (P < .05), whereas organizational and first-contact accessibility and service responsiveness did not change significantly. Perception of physician-nurse coordination remained unchanged, but perception of primary care physician–specialist coordination decreased significantly (P < .05). The proportion of participants reporting visits with nurses and reporting use of FMGs’ emergency services increased significantly from baseline to follow-up (P < .05).
This reorganization of primary care services resulted in considerable changes in care practices, which led to improvements in patients’ experiences of the continuity of care but not to improvements in their experiences of the accessibility of care.
PMCID: PMC2922830  PMID: 20631263
4.  Impact of gene expression data pre-processing on expression quantitative trait locus mapping 
BMC Proceedings  2007;1(Suppl 1):S153.
We evaluate the impact of three pre-processing methods for Affymetrix microarray data on expression quantitative trait locus (eQTL) mapping, using 14 CEPH Utah families (GAW Problem 1 data). Different sets of expression traits were chosen according to different selection criteria: expression level, variance, and heritability. For each gene, three expression phenotypes were obtained by different pre-processing methods. Each quantitative phenotype was then submitted to a whole-genome scan, using multipoint variance component LODs. Pre-processing methods were compared with respect to their linkage outcomes (number of linkage signals with LODs greater than 3, consistencies in the location of the trait-specific linkage signals, and type of cis/trans-regulating loci). Overall, we found little agreement between linkage results from the different pre-processing methods: most of the linkage signals were specific to one pre-processing method. However, agreement rates varied according to the criteria used to select the traits. For instance, these rates were higher in the set of the most heritable traits. On the other hand, the pre-processing method had little impact on the relative proportion of detected cis and trans-regulating loci. Interestingly, although the number of detected cis-regulating loci was relatively small, pre-processing methods agreed much better in this set of linkage signals than in the trans-regulating loci. Several potential factors explaining the discordance observed between the methods are discussed.
PMCID: PMC2367602  PMID: 18466498

Results 1-4 (4)