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Bernard-Arevalo SP, Laforce RJ, Khayat O, Bouchard V, Bruneau MA, Brunelle S, Caron S, Chamelian L, Chénard M, Côté JF, Crépeau-Gendron G, Doré MC, Fortin MP, Gagnon N, Gagnon PR, Giroux C, Jean L, Létourneau G, Marceau É, Moreau V, Morin M, Ouellet C, Poulin S, Radermaker S, Rousseau K, Touchette C, Dumais A. Clinical Assessment of Judgment in Adults and the Elderly: Development and Validation of the Three Domains of Judgment Test-Clinical Version (3DJT-CV). J Clin Med 2023; 12:jcm12113740. [PMID: 37297934 DOI: 10.3390/jcm12113740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: This article discusses the first two phases of development and validation of the Three Domains of Judgment Test (3DJT). This computer-based tool, co-constructed with users and capable of being administered remotely, aims to assess the three main domains of judgment (practical, moral, and social) and learn from the psychometric weaknesses of tests currently used in clinical practice. (2) Method: First, we presented the 3DJT to experts in cognition, who evaluated the tool as a whole as well as the content validity, relevance, and acceptability of 72 scenarios. Second, an improved version was administered to 70 subjects without cognitive impairment to select scenarios with the best psychometric properties in order to build a future clinically short version of the test. (3) Results: Fifty-six scenarios were retained following expert evaluation. Results support the idea that the improved version has good internal consistency, and the concurrent validity primer shows that 3DJT is a good measure of judgment. Furthermore, the improved version was found to have a significant number of scenarios with good psychometric properties to prepare a clinical version of the test. (4) Conclusion: The 3DJT is an interesting alternative tool for assessing judgment. However, more studies are needed for its implementation in a clinical context.
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Affiliation(s)
- Simon-Pierre Bernard-Arevalo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Robert Jr Laforce
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Olivier Khayat
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vital Bouchard
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Marie-Andrée Bruneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
| | - Sarah Brunelle
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Stéphanie Caron
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Laury Chamelian
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Department of Psychiatry, Centre Hospitalier Universitaire de Montréal, Montreal, QC H2X 0C1, Canada
| | - Marise Chénard
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Jean-François Côté
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Gabrielle Crépeau-Gendron
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Marie-Claire Doré
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Marie-Pierre Fortin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Nadine Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Pierre R Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Chloé Giroux
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Léonie Jean
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Geneviève Létourneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Émilie Marceau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vincent Moreau
- Institut de Réadaptation en Déficience Physique de Québec, Quebec City, QC G1W 1P7, Canada
| | - Michèle Morin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Sainte-Marie, QC G6E 3E2, Canada
| | - Christine Ouellet
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Stéphane Poulin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Steve Radermaker
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Katerine Rousseau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Catherine Touchette
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Morisson L, Laferrière-Langlois P, Carrier FM, Pagé G, Godbout C, Fortier LP, Ogez D, Létourneau G, Jarry S, Denault A, Fortier A, Guertin MC, Verdonck O, Richebé P. Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia). PLoS One 2021; 16:e0255852. [PMID: 34375362 PMCID: PMC8354438 DOI: 10.1371/journal.pone.0255852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth. Objective The objective of this trial is to investigate–in patients ≥ 70 years old undergoing major non-cardiac surgery–the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform). Material and methods This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8–1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups. Study registration NCT04825847 on ClinicalTrials.gov.
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Affiliation(s)
- Louis Morisson
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
| | - François Martin Carrier
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Department of Anesthesiology and Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Research Center of the CHUM (Centre Hospitalier de l’Université de Montréal), Université de Montréal, Montréal, Québec, Canada
| | - Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CHUM (Centre Hospitalier de l’Université de Montréal), Université de Montréal, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Cédric Godbout
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Louis-Philippe Fortier
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - David Ogez
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Létourneau
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Jarry
- Department of Anesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - André Denault
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Department of Anesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - Annik Fortier
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, Québec, Canada
| | - Marie-Claude Guertin
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, Québec, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Québec, Canada
- Research Center of the CIUSSS de L’Est de l’Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
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Hudon C, Jean M, Létourneau G. Temporal (1970-2016) changes in human pressures and wetland response in the St. Lawrence River (Québec, Canada). Sci Total Environ 2018; 643:1137-1151. [PMID: 30189531 DOI: 10.1016/j.scitotenv.2018.06.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
Temporal changes (1970-2016) in St. Lawrence River wetlands were assessed between Cornwall and Québec (≈400 km) to assess wetland response to cumulative anthropogenic pressures in the watershed. Emergent wetlands area and biomass of submerged aquatic vegetation (SAV) were contrasted among five regions subjected to sharply different water level/discharge regime (stabilized, semi-natural, tidal), nutrient concentrations and shoreline use (rural to urbanized). Between 1970 and 2016, over the growing season (April-Sept.), St. Lawrence River mean water level at Sorel dropped by ≈1 m and mean water temperature increased by ≈3 °C. Reductions in phosphorus concentrations (by ≈2-fold) were observed over time both in water and in SAV tissues, in phase with improvements of urban wastewater treatment and P-reduction in upstream Lake Ontario. Nitrate concentrations in water increased and SAV biomass decreased between the 1970s and 2008 in the downstream regions of Lake Saint-Pierre and fluvial corridor subjected to the cumulative impacts from urban centers and intensively farmed watersheds. Over the 1970-2010 period, dropping water levels yielded slightly increasing wetland areas, owing to the downslope colonization of emergent and submerged plants. In urbanized regions, emergent wetlands shifted towards drier assemblages dominated by invasive reed species. Encroachment of wetlands by agriculture accounted for most wetland losses in rural Lake Saint-Pierre, which holds the single largest area (197 km2) of continuous wetland habitat of the entire watershed. Our results highlight the strong response of riverine wetlands to a wide range of human pressures, including dropping water levels, changing nutrient concentrations, rising population and intensifying agriculture.
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Affiliation(s)
- C Hudon
- Environment and Climate Change Canada, Water Sciences and Technology, St. Lawrence Centre, 105 McGill, Montreal, QC H2E 2Y7, Canada.
| | - M Jean
- Environment and Climate Change Canada, Water Sciences and Technology, St. Lawrence Centre, 105 McGill, Montreal, QC H2E 2Y7, Canada.
| | - G Létourneau
- Environment and Climate Change Canada, Water Sciences and Technology, St. Lawrence Centre, 105 McGill, Montreal, QC H2E 2Y7, Canada.
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Paquette I, Amyot A, Létourneau G. [The history of geriatric psychiatry at the University of Montreal: Pioneers, milestones, and future outlook]. Sante Ment Que 2015; 40:205-227. [PMID: 26559216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Geriatric psychiatry became an official psychiatric subspecialty in Canada in 2009. The first board examinations from the Royal College of Physicians and Surgeons of Canada (RCPSC) took place in 2013. Geriatric Psychiatry focuses on the assessment, diagnosis, and treatment of complex mental disorders in late life, a time when the interface between physical and mental health issues often adds a new level of complexity.Little has been written on the history of geriatric psychiatry in Québec and in Canada. A lesser-known aspect is that from the 1970's onwards, the department of psychiatry at the Université de Montréal (UdeM) and its network of teaching hospitals have played a pioneering role in the development of geriatric psychiatry services and training. We seek to recount the history of geriatric psychiatry at UdeM, by tracing the milestones and identifying the main actors responsible for its development, from the inception of the department of psychiatry 50 years ago. This leads us to share reflections on some of the issues geriatric psychiatry is facing in Québec. METHODS We interviewed several key actors, past and present, of geriatric psychiatry at UdeM. We read through relevant sources such as articles and monographs on the local history of psychiatric services, information bulletins and annual reports from hospitals and from UdeM, as well as other documentation from personal archives. RESULTS One of the very first geriatric psychiatry services in Canada was founded in 1978 at the Institut universitaire en santé mentale de Montréal, with a dedicated inpatient unit for new admissions of elderly psychiatric patients. A geriatric psychiatry outpatient clinic was inaugurated the same year at the Pavillon Albert-Prévost. Throughout the years, geriatric psychiatry services were also developed in the remaining hospital sites affiliated with the department of psychiatry at the UdeM (Hôpital Maisonneuve-Rosemont, Centre hospitalier de l'Université de Montréal, Institut universitaire de gériatrie de Montréal), driven by dedicated individuals, in accordance with their respective historical background and mission. Clinical training is provided in each of these sites for medical students, psychiatry residents and more recently, for future geriatric psychiatrists. In 2014, the geriatric psychiatry residency program at UdeM was the first to be accredited in Québec by the RCPSC, as well as the first French language geriatric psychiatry program in North America. CONCLUSION Geriatric psychiatry in 2015 is a burgeoning field, in a challenging demographic context. Despite the clinical need, major obstacles remain, particularly in the absence of specific geriatric psychiatry positions. Furthermore, the Québec healthcare system is going through a major restructuration in 2015, adding to the uncertainty. The 50th anniversary of the department of psychiatry at UdeM is an opportunity to underline the contribution of UdeM to the development of geriatric psychiatry in Québec, and to emphasize the specific needs of the elderly in terms of mental health care and geriatric psychiatry services.
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Affiliation(s)
- Isabelle Paquette
- Programme de gérontopsychiatrie, Institut universitaire en santé mentale de Montréal; Département de psychiatrie, Université de Montréal
| | - Arthur Amyot
- Société psychanalytique de Montréal; Département de psychiatrie, Université de Montréal; Hôpital du Sacré-Coeur
| | - Geneviève Létourneau
- Institut universitaire en santé mentale de Montréal; Département de psychiatrie, Université de Montréal
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Abdel-Baki A, Létourneau G, Morin C, Ng A. Resumption of work or studies after first-episode psychosis: the impact of vocational case management. Early Interv Psychiatry 2013; 7:391-8. [PMID: 23347401 DOI: 10.1111/eip.12021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 09/16/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psychosis compromises the educational and professional projects of young patients. Vocational case management (VCM) offers comprehensive support for reintegration into work or studies within an early psychosis intervention programme. AIMS To evaluate the effectiveness of VCM in resumption of work or school and to identify the predictive factors of occupational outcome. METHODS This descriptive study focused on occupational status of an early psychosis cohort during the first 5 years of VCM. RESULTS 56.6% of 97 study subjects had a diagnosis of schizophrenia, 32% had type I bipolar disorder with psychotic features. 68% held a productive occupation the year prior to admission, and 47.4% at admission. The occupational rate rose from 57.1% at 12 months to over 70% after 48 months. 65.6% maintained or improved their occupational status. Most subjects held competitive employment, and the employment rate was similar to that of the general population. Prior employment and affective psychosis were associated with better outcome. [Correction added on 2 April 2013, after first online publication: 'Non-affective psychosis' has been changed to 'affective psychosis' in the Results section.] CONCLUSION The majority of individuals suffering from early psychosis resume productive activity rapidly when offered VCM within an early intervention programme during a follow-up period of up to 5 years.
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Affiliation(s)
- Amal Abdel-Baki
- Faculty of Medicine, Department of Psychiatry, University of Montreal; Clinique Jeunes Adultes Psychotiques (JAP), Centre hospitalier de l'Université de Montréal (CHUM) - Notre-Dame Hospital; CHUM Research center (CRCHUM), Montreal, Quebec, Canada
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Stip E, Zhornitsky S, Moteshafi H, Létourneau G, Stikarovska I, Potvin S, Tourjman V. Ziprasidone for Psychotic Disorders: A Meta-Analysis and Systematic Review of the Relationship Between Pharmacokinetics, Pharmacodynamics, and Clinical Profile. Clin Ther 2011; 33:1853-67. [DOI: 10.1016/j.clinthera.2011.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/26/2022]
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De Benedictis L, Dumais A, Sieu N, Mailhot MP, Létourneau G, Tran MAM, Stikarovska I, Bilodeau M, Brunelle S, Côté G, Lesage AD. Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. Psychiatr Serv 2011; 62:484-91. [PMID: 21532073 DOI: 10.1176/ps.62.5.pss6205_0484] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. METHODS A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. RESULTS Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace. CONCLUSIONS These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions.
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Affiliation(s)
- Luigi De Benedictis
- Department of Social Psychiatry, University of Montreal,Montreal, Quebec, Canada.
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Abstract
OBJECTIVE To review and rationalize the liberal use of antenatal betamethasone in the setting of threatened preterm birth. STUDY DESIGN A retrospective review was performed using the charts of all patients at Ste-Justine Hospital, Montreal QC, who received antenatal betamethasone between 01 April 1997 and 31 March 1998. Initial treatment consisted of 2 doses of 12 mg IM given 24 hours apart. Repeat doses of 12 mg weekly were administered at the discretion of the treating physician. Optimal antenatal betamethasone therapy was defined as delivery within 1 week of initial treatment, prior to 34 weeks. Aside from number and timing of doses, other factors analyzed included: gestational age at admission and delivery, diagnosis associated with threatened preterm birth (PTB), number of hospital admissions, and delay between re-admission and delivery. RESULTS Of the 334 patients identified, 82 (25%) received optimal treatment. Of the remaining 252 patients, 204 (81%) received repeat doses. In the repeat dose group, 112 (55%) women delivered after 34 weeks, while 70 of the 92 remaining patients were hospitalized until delivery. The other 22 patients who received serial doses were discharged at least once prior to delivery; of these patients, 8 were re-admitted more than 24 hours pre-delivery (i.e., adequate time for re-treatment), while 14 were not, but only 6 of these were delivered urgently. Thus, a maximum of 60 patients (25% of repeat doses) could potentially have benefited from this approach. Of the 48 patients not receiving repeat doses, 37 (77%) delivered after 34 weeks. Five remained hospitalized, and 6 were discharged prior to delivery and re-admitted (2 patients > 24 hr and 4 patients < 24 hr from delivery). This represented a potential underutilization of betamethasone by 3% (11/334) of the patients, but only 1.8% (6/334) were of less than 32 weeks' gestation. CONCLUSION This study demonstrated the difficulty in predicting which of the patients presenting with threatened preterm birth would actually go on to deliver during the window of benefit of antenatal betamethasone therapy. Our desire to permit all premature fetuses to profit from the positive effects of this therapy must be balanced by a reserve in exposing too many to too much. Use of antenatal betamethasone in our unit has significantly decreased since this review.
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Affiliation(s)
- Amanda Skoll
- Ste-Justine Hospital, University of Montreal, Montreal, QC, Canada
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Abstract
In 1979, a preliminary survey conducted in a district located near a copper smelter revealed elevated lead levels in the blood of some children and in the soil. In 1989, a more comprehensive study was undertaken to determine the blood lead contamination of the children and to determine soil contamination patterns. A method was devised for evaluating soil contamination by equally weighting each area of a predetermined grid. Three zones of contamination provided indirect evidence that suggested a contribution of diffuse emissions, compared with stack emissions, and assisted in the determination of priorities for remedial action.
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Affiliation(s)
- D Gagné
- Département de santé communautaire, Conseil régional de la santé, Rouyn-Noranda, Québec, Canada
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Beauchesne L, Létourneau G. [Drug abuse in youth.]. Sante Ment Que 1984; 9:99-105. [PMID: 17093824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In an on-going review of the literature dealing with the assessment of drug abuse treatment and prevention programs, the authors indicate that changes are occurring in basic concepts : the concept of addiction has been expanded and a more systemic approach to drug use and abuse is more prevalent. An examination of the relationship between adolescent drug use and the related psychosocial images leads to an outline of two main evaluative approaches : the moralistic a priori approach and the empirical social approach. To efficiently prevent youthful drug abuse, they propose that primary preventive actions should focus on demand factors and be complemented with secondary preventive actions focused on supply factors.
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Létourneau G. [Interaction of hallucinogens and culture]. Laval Med 1969; 40:91-6. [PMID: 5774379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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