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Susinski S, Bouchard K, Stragapede E, Dozois S, Sterling E, Tulloch H. Psychological interventions targeting mental health and stress among females with cardiac disease: a scoping review. Can J Physiol Pharmacol 2024. [PMID: 38587177 DOI: 10.1139/cjpp-2023-0416] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.
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Affiliation(s)
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Elisa Stragapede
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Sophie Dozois
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Evan Sterling
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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2
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Moran C, Bouchard K, Stragapede E, Tulloch H. The Collateral Damage of Cardiovascular Disease: Comparing the Physical and Mental Health Status of Spousal Caregivers and Patients. Can J Cardiol 2024; 40:347-350. [PMID: 37923126 DOI: 10.1016/j.cjca.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Chelsea Moran
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Calgary, Calgary, Alberta, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Elisa Stragapede
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
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3
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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4
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Bouchard K, Liu PP, Dautenhahn K, Fiedorowicz JG, Afrin J, Dans M, McGuinty C, Tulloch H. Cardiology professionals' views of social robots in augmenting heart failure patient care. Eur Heart J Digit Health 2024; 5:69-76. [PMID: 38264699 PMCID: PMC10802821 DOI: 10.1093/ehjdh/ztad067] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 01/25/2024]
Abstract
Aims Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Methods and results Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. Conclusion The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Peter P Liu
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Kerstin Dautenhahn
- Faculty of Engineering, University of Waterloo, 200 University Ave W., Waterloo, N2L 3G1 ON, Canada
| | - Jess G Fiedorowicz
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
- Department of Mental Health, The Ottawa Hospital/Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, K1H 8L6 ON, Canada
| | - Jenifar Afrin
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Michael Dans
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
| | - Caroline McGuinty
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y 4W7 ON, Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave E., Ottawa, K1N 6N5 ON, Canada
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5
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Bouchard K, Lalande K, Coutinho T, Mulvagh S, Pacheco C, Liu S, Saw J, So D, Reed JL, Chiarelli A, Stragapede E, Robert H, Lappa N, Sun L, Wells G, Tulloch H. Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation. J Am Heart Assoc 2023; 12:e032141. [PMID: 38084731 PMCID: PMC10863752 DOI: 10.1161/jaha.123.032141] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. METHODS AND RESULTS Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. CONCLUSIONS This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Thais Coutinho
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Sharon Mulvagh
- Division of CardiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christine Pacheco
- Department of CardiologyUniversity of Montréal Hospital CentreMontréalQuebecCanada
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jacqueline Saw
- Division of CardiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Derek So
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Jennifer L. Reed
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Elisa Stragapede
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Helen Robert
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Nadia Lappa
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Louise Sun
- Stanford MedicineStanford UniversityStanfordCAUSA
| | - George Wells
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Heather Tulloch
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
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6
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Bouchard K, Gareau A, McKee K, Lalande K, Greenman PS, Tulloch H. Dyadic patterns of mental health and quality of life change in partners and patients during three months of cardiac rehabilitation. J Fam Psychol 2023; 37:1315-1321. [PMID: 34292032 DOI: 10.1037/fam0000898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The effects of mental health on quality of life (QoL) over the course of a couple's recovery from a patient's cardiac event are unknown as partner outcomes are rarely considered within cardiac rehabilitation. To capture the transactional nature of recovery from a cardiac event, this research investigated the link between longitudinal changes in the mental health of couples in which at least one of the partners had cardiac disease and changes in their QoL during cardiac rehabilitation. Participants (N = 184 dyads) completed questionnaires measuring anxiety, depression, and QoL at baseline (enrollment) and 3 months (discharge). Dyadic data were analyzed using the Actor-Partner Interdependence Model with integrated latent change scores. The results indicated that improved anxiety was associated with significant positive changes in physical and emotional QoL for both the patient and partner (actor effects). A reduction in depression in both partners from baseline to follow-up predicted an increase in emotional QoL for patients and partners, and an increase in physical QoL for partners (actor effects). Patients whose depression decreased from enrollment to the completion of cardiac rehabilitation were associated with partners' greater positive changes in emotional QoL than were patients whose depression did not decrease, and reductions in partners' anxiety over time predicted positive changes in patients' physical QoL (partner effects). Findings underscore the need to screen for and attend to patients' and partners' mental health outcomes postcardiac event, as positive changes in mental health symptoms may optimize changes in patients' and partners' emotional and physical QoL. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | | | | | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | - Paul S Greenman
- Department of Psychoeducation and Psychology, Universite du Quebec en Outaouais
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
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7
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Bouchard K, Gareau A, Sztajerowska K, Greenman PS, Lalande K, Tulloch H. Better together: Relationship quality and mental health among cardiac patients and spouses. Fam Process 2023; 62:1624-1639. [PMID: 36404415 DOI: 10.1111/famp.12836] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Reductions in marital relationship quality are pervasive post-cardiac event. It is not yet understood how relationship quality is linked to mental health outcomes in couples where one member has established cardiovascular disease (CVD) and the interdependence within dyads is seldom measured. This research is required as psychological distress has been independently linked to CVD incidence, morbidity, and mortality. This study assessed associations of relationship quality with depression and anxiety among patients with CVD and their spouses. Participants completed questionnaires measuring four dimensions of relationship quality and mental health. Data were analyzed using an Actor-Partner Interdependence Model with hierarchical moderation analyses. 181 dyads (N = 362 participants) comprised the study sample. Most patients had coronary artery disease (66.3%) and 25.9% were female. Patients reported higher relationship satisfaction and fewer anxiety symptoms than did spouses. Patients and spouses with high dyadic consensus and affectional expression reported fewer mental health symptoms, but only when the other partner also perceived high levels of consensus and affectional expression in the relationship. Patients and spouses with low dyadic cohesion reported worse mental health symptoms (actor effects), but those effects were no longer significant when both the patient and the spouse appraised the relationship as having high levels of dyadic cohesion. Taken together, relationship quality is linked to mental health symptoms in patients with CVD and their spouses. Longitudinal and experimental studies are now warranted to further substantiate the cross-sectional findings of this study.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Paul S Greenman
- Université du Québec en Outaouais, Gatineau, Québec City, Canada
| | | | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
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8
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Bouchard K, Coutinho T, Tulloch H. Cardiovascular disease prognosis among women with anxiety: Just the tip of the iceberg? Eur J Prev Cardiol 2023:zwad246. [PMID: 37494721 DOI: 10.1093/eurjpc/zwad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Thais Coutinho
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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9
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Bouchard K, Gareau A, Greenman PS, Lalande K, Sztajerowska K, Tulloch H. What's love got to do with it? Relationship quality appraisals and quality of life in couples facing cardiovascular disease. Health Psychol Behav Med 2023; 11:2237564. [PMID: 37484832 PMCID: PMC10360988 DOI: 10.1080/21642850.2023.2237564] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Changes in couples' relationship quality are common post-cardiac event but it is unclear how relationship quality is linked to patients' and spouses' quality of life (QoL). The purpose of the present study was to examine the association between relationship quality on QoL in patient-spouse dyads within six months of a cardiac event. Methods Participants (N = 181 dyads; 25.9% female patients), recruited from a large cardiac hospital, completed validated questionnaires measuring demographic, relationship (Dyadic Adjustment Scale; DAS) and QoL variables (Heart-QoL & Quality of life of Cardiac Spouses Questionnaire). An Actor-Partner Interdependence Model was used to investigate actor (i.e. responses influencing their own outcome) and partner effects (responses influencing their partner's outcome) of relationship quality and QoL. Results Patients' and spouses' perceptions of relationship quality were in the satisfied range (DAS > 108; 65% of sample) and, as expected, patients reported lower general physical QoL than did their spouse (t(180) = -10.635, p < .001). Patient and spouse relationship quality appraisals were positively associated with their own physical (patient β = .25; spouse β = .05) and emotional/social (patient β = .21; spouse β = .04) QoL. No partner effects were identified. Conclusion High quality relationship appraisals appear to matter for patients' and spouses' QoL after the onset of CVD.
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Affiliation(s)
- Karen Bouchard
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Paul S. Greenman
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Université du Québec en Outaouais, Gatineau, Canada
- Monfort Hospital, Ottawa, Canada
| | - Kathleen Lalande
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Heather Tulloch
- Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
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10
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Affiliation(s)
- K Lalande
- University of Ottawa Heart Institute, Ottawa, Canada,.
| | - K Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada,; University of Ottawa, Ottawa, Canada
| | - H Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada,; University of Ottawa, Ottawa, Canada
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11
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Tulloch H, Bouchard K, Brownrigg J, Coutinho T. Depression and Anxiety Before and After Cardiac Rehabilitation: Comparing Patients With and Without Spontaneous Coronary Artery Dissection. Can J Cardiol 2023; 39:350-352. [PMID: 36646281 DOI: 10.1016/j.cjca.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Affiliation(s)
- Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Jane Brownrigg
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
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12
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Bouchard K, Dans M, Higdon G, Quinlan B, Tulloch H. Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management. Curr Cardiol Rep 2022; 24:2081-2096. [PMID: 36418650 DOI: 10.1007/s11886-022-01810-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Caregivers of patients with coronary artery disease (CAD) are integral to the health care system and contribute substantially to patients' management. The purpose of this review is to provide a narrative synthesis of existing research on caregiving for patients who experienced an acute coronary syndrome (MI/unstable angina) and/or coronary revascularization (PCI/CABG). RECENT FINDINGS Thirty-one articles are included in this review. Overall, caregiver distress is low to moderate, ranging from 6 to 67% of caregivers, and seems to dissipate over time for most caregivers. Interventions have demonstrated success in reducing the distress of caregivers of patients with CAD. Due to the heterogeneity in study samples, measurements used, and timing of assessments and programming, these results are far from definitive. Although evidence is accumulating, further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient's illness trajectory.
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Affiliation(s)
- Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Michael Dans
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Gloria Higdon
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Bonnie Quinlan
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
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13
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Bouchard K, Dans M, Liu P, Dautenhahn K, Ghafurian M, Fiedorowicz J, Tulloch H. THE SOCIAL ROBOTS ARE COMING: HEALTH CARE PROVIDERS' PERSPECTIVES OF SOCIAL ROBOTS AS A FORM OF VIRTUAL CARE IN CARDIOVASCULAR MEDICINE. Can J Cardiol 2022. [PMCID: PMC9595436 DOI: 10.1016/j.cjca.2022.08.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Laflamme SZ, Bouchard K, Sztajerowska K, Lalande K, Greenman PS, Tulloch H. Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease. PLoS One 2022; 17:e0269366. [PMID: 36121800 PMCID: PMC9484654 DOI: 10.1371/journal.pone.0269366] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.
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Affiliation(s)
- Simone Zofia Laflamme
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karolina Sztajerowska
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul S. Greenman
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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15
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.).,University of Ottawa, Canada (K.B., P.P.L., H.T.)
| | - Peter P Liu
- University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.).,University of Ottawa, Canada (K.B., P.P.L., H.T.)
| | - Heather Tulloch
- University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.).,University of Ottawa, Canada (K.B., P.P.L., H.T.)
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16
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Bouchard K, Gareau A, Gallant NL, Lalande K, Greenman PS, Sztajerowska K, Tulloch H. Dyadic effects of anxiety and depression on quality of life among couples facing cardiovascular disease. J Psychosom Res 2021; 149:110601. [PMID: 34419759 DOI: 10.1016/j.jpsychores.2021.110601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/01/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Anxiety and depression are frequently comorbid in patients with cardiovascular disease (CVD) and a patient's poor mental health may implicate the quality of life (QoL) of a partner. The bidirectional effects of comorbid anxiety and depression on patient and partner outcomes are inadequately understood. The aim of this study was to investigate associations of the combined role of depression and anxiety on patients' and partners' QoL. METHOD In this cross-sectional study, patients with CVD and their partners completed questionnaires measuring anxiety, depression, and QoL. Dyadic data was analyzed using the Actor-Partner Interdependence Model and polynomial interaction for examining the synergistic and dysergistic effects of anxiety and depression (i.e., in combination). RESULTS 181 dyads comprised the study sample (66.3% coronary artery disease; 25.9% female patients). Anxiety and depression, in synergy was associated with poorer QoL in patients and partners (actor effects). Patients that are more anxious than depressed have greater physical QoL whereas partners that are more depressed than anxious have greater emotional QoL (dysergistic actor effects). Patients' more severe symptoms of anxiety and depression, in synergy, was associated with partners' poorer QoL (partner effect). CONCLUSION Anxiety and depression are comorbid and associated with poor QoL in patients and their partners. The results may have implications for secondary prevention programming but future longitudinal studies are warranted to substantiate the cross-sectional findings.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada
| | | | | | - Kathleen Lalande
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada
| | | | | | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada; University of Ottawa, Ottawa, Canada.
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17
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Bouchard K, Coutinho T, Reed J, Lalande K, Tarannum CN, So D, Saw J, Mulvagh S, Tulloch H. Recovering from spontaneous coronary artery dissection: Patient-reported challenges and rehabilitative intervention needs. Health Psychol 2021; 40:472-479. [PMID: 34435799 DOI: 10.1037/hea0001086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome that disproportionally affects younger women. The underlying etiology is incompletely understood, postmorbid psychological distress is high, and treatment plans are predominantly based on clinician experience. There remains uncertainty on how to adequately address the needs of patients with SCAD as part of secondary prevention. METHOD As a Define and Refine phase of the ORBIT model (Phase 1), this study investigated SCAD patients' challenges and rehabilitative intervention needs using a qualitative research design. Patients with SCAD were purposively recruited to participate in structured interviews that were analyzed using inductive thematic coding techniques. RESULTS Patients with SCAD (n = 15; 86.7% female; mean age = 47.5 years; data saturation reached with patient sample) expressed challenges in (a) navigating uncertainty associated with the disease; (b) living with anxiety; (c) reconciling pre and post-SCAD identities; (d) accurately identifying symptoms and experiencing a sense of isolation in recovery due to gender and young age; and (e) managing changing family dynamics and family members' stress. Intervention needs included (a) addressing unique demographic and cardiovascular profiles when designing programs for cardiac rehabilitation; (b) providing more psychological and peer support resources to address anxiety and sense of isolation; (c) disseminating information on rapidly evolving SCAD research; and (d) acknowledging and providing support to the family system. CONCLUSIONS The results signal curricula to be included in tailored SCAD programming and underscore the need for further study and dissemination of optimal secondary preventative care for this patient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | - Jennifer Reed
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | | | - Derek So
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
| | | | | | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute
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Lalande K, Greenman PS, Bouchard K, Johnson SM, Tulloch H. The Healing Hearts Together Randomized Controlled Trial and the COVID-19 Pandemic: A Tutorial for Transitioning From an In-Person to a Web-Based Intervention. J Med Internet Res 2021; 23:e25502. [PMID: 33729984 PMCID: PMC8025918 DOI: 10.2196/25502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/23/2021] [Accepted: 02/15/2021] [Indexed: 12/31/2022] Open
Abstract
Supportive couple relationships are associated with reduced risk of chronic illness development, such as cardiovascular disease, as well as improved secondary prevention. Healing Hearts Together (HHT) is an 8-week couples-based intervention designed to improve relationship quality, mental health, quality of life, and cardiovascular health among couples in which one partner has experienced a cardiac event. A randomized controlled trial began in October 2019 to test the efficacy of the in-person, group-based HHT program as compared to usual care. In March of 2020, all recruitment, assessments, and interventions halted due to the COVID-19 pandemic. Guided by optimal virtual care principles, as well as by Hom and colleagues’ four-stage framework—consultation, adaptation, pilot-testing, and test launch—this paper is a tutorial for the step-by-step transition planning and implementation of a clinical research intervention from an in-person to a web-based format, using the HHT program as an example. Clinical and research considerations are reviewed, including (1) privacy, (2) therapeutic aspects of the intervention, (3) group cohesion, (4) research ethics, (5) participant recruitment, (6) assessment measures, (7) data collection, and (8) data analyses. This tutorial can assist clinical researchers in transitioning their research programs to a web-based format during the pandemic and beyond.
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Affiliation(s)
- Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Paul S Greenman
- Université du Québec en Outaouais, Gatineau, QC, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,International Centre for Excellence in Emotionally Focused Therapy, Ottawa, ON, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Susan M Johnson
- International Centre for Excellence in Emotionally Focused Therapy, Ottawa, ON, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Pomey MP, de Guise M, Desforges M, Bouchard K, Vialaron C, Normandin L, Iliescu-Nelea M, Fortin I, Ganache I, Régis C, Rosberger Z, Charpentier D, Bélanger L, Dorval M, Ghadiri DP, Lavoie-Tremblay M, Boivin A, Pelletier JF, Fernandez N, Danino AM. Correction to: The patient advisor, an organizational resource as a lever for an enhanced oncology patient experience (PAROLEonco): a longitudinal multiple case study protocol. BMC Health Serv Res 2021; 21:67. [PMID: 33446153 PMCID: PMC7807428 DOI: 10.1186/s12913-021-06065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M P Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada. .,Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada. .,École de santé publique de l'université de Montréal-Département de gestion, évaluation et politique de santé, 7101 Av du Parc, Montréal, Québec, H3N 1X9, Canada. .,Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada. .,Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada.
| | - M de Guise
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - M Desforges
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - K Bouchard
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - C Vialaron
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - L Normandin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - M Iliescu-Nelea
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - I Fortin
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - I Ganache
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - C Régis
- Université de Montréal - Faculté de Droit, 3101 chemin de la Tour, Montréal, Québec, H3T 1J7, Canada
| | - Z Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & McGill University, Gerald Bronfman Department of Oncology, 5100 de Maisonneuve Blvd West, Montréal, Québec, H4A 3T2, Canada
| | - D Charpentier
- Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
| | - L Bélanger
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - M Dorval
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada.,Université Laval - Faculté de pharmacie, 050, avenue de la Médecine, Québec, Québec, G1V 0A6, Canada.,Centre de recherche du CHU de Québec-Université Laval, 1050 chemin Sainte-Foy, Québec, Québec, G1S4L8, Canada.,Centre de recherche du CISSS Chaudière Pomey et al. BMC Health Services Research (2021) 21:10 Page 10 of 12 Appalaches, 143 rue Wolfe, Lévis, Québec, G6V 3Z1, Canada
| | - D P Ghadiri
- HEC Montréal, Department of management, 3000, chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | - M Lavoie-Tremblay
- McGill University, Ingram School of Nursing (IsoN), 680 Sherbrooke Street West, Montréal, Québec, H3A 2M7, Canada.,Centre Universitaire de Santé McGill (CUSM), 1650, avenue Cedar, Montréal, Québec, H3G 1A4, Canada
| | - A Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.,Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada.,Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - J F Pelletier
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.,Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, 7331 Rue Hochelaga, Montréal, Québec, H1N 3V2, Canada
| | - N Fernandez
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - A M Danino
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.,Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
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Pomey MP, de Guise M, Desforges M, Bouchard K, Vialaron C, Normandin L, Iliescu-Nelea M, Fortin I, Ganache I, Régis C, Rosberger Z, Charpentier D, Bélanger L, Dorval M, Ghadiri DP, Lavoie-Tremblay M, Boivin A, Pelletier JF, Fernandez N, Danino AM. The patient advisor, an organizational resource as a lever for an enhanced oncology patient experience (PAROLE-onco): a longitudinal multiple case study protocol. BMC Health Serv Res 2021; 21:10. [PMID: 33397386 PMCID: PMC7780212 DOI: 10.1186/s12913-020-06009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/09/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Quebec is one of the Canadian provinces with the highest rates of cancer incidence and prevalence. A study by the Rossy Cancer Network (RCN) of McGill university assessed six aspects of the patient experience among cancer patients and found that emotional support is the aspect most lacking. To improve this support, trained patient advisors (PAs) can be included as full-fledged members of the healthcare team, given that PA can rely on their knowledge with experiencing the disease and from using health and social care services to accompany cancer patients, they could help to round out the health and social care services offer in oncology. However, the feasibility of integrating PAs in clinical oncology teams has not been studied. In this multisite study, we will explore how to integrate PAs in clinical oncology teams and, under what conditions this can be successfully done. We aim to better understand effects of this PA intervention on patients, on the PAs themselves, the health and social care team, the administrators, and on the organization of services and to identify associated ethical and legal issues. METHODS/DESIGN We will conduct six mixed methods longitudinal case studies. Qualitative data will be used to study the integration of the PAs into clinical oncology teams and to identify the factors that are facilitators and inhibitors of the process, the associated ethical and legal issues, and the challenges that the PAs experience. Quantitative data will be used to assess effects on patients, PAs and team members, if any, of the PA intervention. The results will be used to support oncology programs in the integration of PAs into their healthcare teams and to design a future randomized pragmatic trial to evaluate the impact of PAs as full-fledged members of clinical oncology teams on cancer patients' experience of emotional support throughout their care trajectory. DISCUSSION This study will be the first to integrate PAs as full-fledged members of the clinical oncology team and to assess possible clinical and organizational level effects. Given the unique role of PAs, this study will complement the body of research on peer support and patient navigation. An additional innovative aspect of this study will be consideration of the ethical and legal issues at stake and how to address them in the health care organizations.
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Affiliation(s)
- M P Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.
- Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada.
- École de santé publique de l'université de Montréal-Département de gestion, évaluation et politique de santé, 7101 Av du Parc, Montréal, Québec, H3N 1X9, Canada.
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada.
| | - M de Guise
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - M Desforges
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - K Bouchard
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - C Vialaron
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - L Normandin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - M Iliescu-Nelea
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - I Fortin
- Centre Intégré Universitaire de santé et services sociaux de l'Est-de-l'Île-de Montréal, Hôpital de Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - I Ganache
- Institut national d'excellence en santé et services sociaux (INESSS), 2021, avenue Union, 12e étage, bureau 1200, Montréal, Québec, H3A 2S9, Canada
| | - C Régis
- Université de Montréal - Faculté de Droit, 3101 chemin de la Tour, Montréal, Québec, H3T 1J7, Canada
| | - Z Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & McGill University, Gerald Bronfman Department of Oncology, 5100 de Maisonneuve Blvd West, Montréal, Québec, H4A 3T2, Canada
| | - D Charpentier
- Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
| | - L Bélanger
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - M Dorval
- CHU de Québec-Université Laval, 10, Rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
- Université Laval - Faculté de pharmacie, 050, avenue de la Médecine, Québec, Québec, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, 1050 chemin Sainte-Foy, Québec, Québec, G1S4L8, Canada
- Centre de recherche du CISSS Chaudière Appalaches, 143 rue Wolfe, Lévis, Québec, G6V 3Z1, Canada
| | - D P Ghadiri
- HEC Montréal, Department of management, 3000, chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | - M Lavoie-Tremblay
- McGill University, Ingram School of Nursing (IsoN), 680 Sherbrooke Street West, Montreal, Québec, H3A 2M7, Canada
- Centre Universitaire de Santé McGill (CUSM), 1650, avenue Cedar, Montréal, Québec, H3G 1A4, Canada
| | - A Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
- Centre d'Excellence pour le Partenariat avec les Patients et le Public, 900, rue Saint-Denis, Porte S03.900, Montréal, Québec, H2X 0A9, Canada
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - J F Pelletier
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
- Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, 7331 Rue Hochelaga, Montréal, Québec, H1N 3V2, Canada
| | - N Fernandez
- Université de Montréal - Faculté de Médecine, 2900 boulevard Edouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - A M Danino
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
- Centre Hospitalier Universitaire de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
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Tulloch H, Johnson S, Demidenko N, Clyde M, Bouchard K, Greenman PS. An attachment-based intervention for patients with cardiovascular disease and their partners: A proof-of-concept study. Health Psychol 2020; 40:909-919. [DOI: 10.1037/hea0001034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tulloch H, Bouchard K, Clyde MJ, Madrazo L, Demidenko N, Johnson S, Greenman P. Learning a new way of living together: a qualitative study exploring the relationship changes and intervention needs of patients with cardiovascular disease and their partners. BMJ Open 2020; 10:e032948. [PMID: 32381534 PMCID: PMC7223018 DOI: 10.1136/bmjopen-2019-032948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners. DESIGN Qualitative study using directed and conventional content analysis. SETTING Single-centre, tertiary cardiac care hospital that serves a population of 1.4 million in the Champlain region of Ontario, Canada. PARTICIPANTS Patients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31-81 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia). RESULTS Five categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement. CONCLUSIONS Overall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.
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Affiliation(s)
- Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew J Clyde
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Susan Johnson
- Ottawa Couple and Family Institute, Ottawa, Ontario, Canada
| | - Paul Greenman
- Département de Psychoéducation et de Psychologie, Universite du Quebec en Outaouais, Gatineau, Quebec, Canada
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Abstract
Qualitative methods are integral to the systematic development of effective health behavioral interventions, as noted in recent translational models, such as the Obesity-Related Behavioral Intervention Trials model. To our knowledge, however, no scholarly literature describes how online qualitative research methods can be used to benefit the development and conduct of behavioral clinical trials. We emphasize the value of qualitative methodologies to behavioral clinical trial research more broadly and provide an introductory overview of online qualitative research methods. We highlight the specific affordances of these methods in maximizing the quality of behavioral clinical trials as well as note their potential limitations. Finally, we argue that online qualitative research methods ought to be incorporated in behavioral trial development and call for future research in this area.
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Cleophat JE, Nabi H, Pelletier S, Bouchard K, Dorval M. What characterizes cancer family history collection tools? A critical literature review. ACTA ACUST UNITED AC 2018; 25:e335-e350. [PMID: 30111980 DOI: 10.3747/co.25.4042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Many tools have been developed for the standardized collection of cancer family history (fh). However, it remains unclear which tools have the potential to help health professionals overcome traditional barriers to collecting such histories. In this review, we describe the characteristics, validation process, and performance of existing tools and appraise the extent to which those tools can support health professionals in identifying and managing at-risk individuals. Methods Studies were identified through searches of the medline, embase, and Cochrane central databases from October 2015 to September 2016. Articles were included if they described a cancer fh collection tool, its use, and its validation process. Results Based on seventy-nine articles published between February 1978 and September 2016, 62 tools were identified. Most of the tools were paper-based and designed to be self-administered by lay individuals. One quarter of the tools could automatically produce pedigrees, provide cancer-risk assessment, and deliver evidence-based recommendations. One third of the tools were validated against a standard reference for collected fh quality and cancer-risk assessment. Only 3 tools were integrated into an electronic health records system. Conclusions In the present review, we found no tool with characteristics that might make it an efficient clinical support for health care providers in cancer-risk identification and management. Adequately validated tools that are connected to electronic health records are needed to encourage the systematic identification of individuals at increased risk of cancer.
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Affiliation(s)
- J E Cleophat
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - H Nabi
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,inserm, U1018, Centre de recherche en épidémiologie et santé des populations, Villejuif, France
| | - S Pelletier
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - K Bouchard
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - M Dorval
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,Centre de recherche du cisss Chaudière-Appalaches, Lévis, QC
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Yu ZX, Qi S, Lasaro MA, Bouchard K, Dow C, Moore K, Wu Z, Barama A, Xu J, Johnson K, Marozsan AJ, Wang Y. Targeting Complement Pathways During Cold Ischemia and Reperfusion Prevents Delayed Graft Function. Am J Transplant 2016; 16:2589-97. [PMID: 27003920 DOI: 10.1111/ajt.13797] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 01/25/2023]
Abstract
The complement system plays a critical role in ischemia-reperfusion injury (IRI)-mediated delayed graft function (DGF). To better understand the roles of complement activation pathways in IRI in kidney transplantation, donor kidneys were treated ex vivo with terminal complement pathway (TP) inhibitor, anti-rat C5 mAb 18A10, or complement alternative pathway (AP) inhibitor TT30 for 28 h at 4°C pretransplantation in a syngeneic kidney transplantation rat model. All 18A10- and 67% of TT30-pretreated grafts, but only 16.7% of isotype control-pretreated grafts, survived beyond day 21 (p < 0.01). Inhibitor treatment in the final 45 min of 28-h cold ischemia (CI) similarly improved graft survival. Systemic posttransplant treatment with 18A10 resulted in 60% increased graft survival beyond day 21 (p < 0.01), while no TT30-treated rat survived > 6 days. Our results demonstrate that AP plays a prominent role during CI and that blocking either the AP or, more effectively the TP prevents ischemic injury and subsequent DGF. Multiple complement pathways may be activated and contribute to reperfusion injury; blocking the TP, but not the AP, posttransplant is effective in preventing reperfusion injury and increasing graft survival. These results demonstrate the feasibility of using complement inhibitors for prevention of DGF in humans.
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Affiliation(s)
- Z X Yu
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - S Qi
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - M A Lasaro
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - K Bouchard
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - C Dow
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - K Moore
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - Z Wu
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - A Barama
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - J Xu
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - K Johnson
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - A J Marozsan
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - Y Wang
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
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Lapointe J, Abdousa B, Camdem S, Bouchard K, Simard D, Dorval M. Effet de plan dans la mesure de variables psychosociales chez les familles canadiennes–françaises à haut risque de cancer héréditaire du sein et de l’ovaire, Québec, Canada, 2010. Rev Epidemiol Sante Publique 2010. [DOI: 10.1016/j.respe.2010.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
HYPOTHESIS The adhesive octylcyanoacrylate is not associated with significant inner ear toxicity in a guinea pig model. BACKGROUND Many cyanoacrylate adhesives have been investigated for use in otologic surgery, but variable ototoxicity has been reported. Octylcyanoacrylate is a medical-grade adhesive with many properties that make it ideal for use in the ear. It is free of contaminants; it forms a strong, flexible bond; and it inhibits the growth of gram-positive organisms in culture. This is the first study to assess the ototoxicity of this new adhesive. METHODS Fourteen adult guinea pigs were used. Preoperative auditory brainstem responses (ABRs) were determined. Bilateral antrotomies were performed, and the ears were randomized to adhesive and control (saline) groups. In the adhesive ears. 0.5 or 0.1 mL of octylcyanoacrylate was instilled into the middle ear. Eight weeks later, postoperative ABRs were determined, the animals were killed, and the temporal bones were removed. Middle ear changes were noted, and the ossicular chain was assessed. Cochlear hair cell analyses were performed. Histologic assessment of the middle ear mucosa was performed. RESULTS There was a higher incidence of conductive hearing loss in the adhesive group secondary to fixation of the ossicular chain, but there was no significant difference in bone conduction thresholds. The median postoperative bone conduction thresholds (dB peak sound pressure level) was 15.0 in the control group and 17.5 in the adhesive group, p = 0.89. There was also no significant difference in inner hair cell counts (0.4% vs. 0.5% median hair cell loss, p = 0.72) or outer hair cell counts (3.7% vs. 3.0% median hair cell loss, p = 0.23) for the adhesive and control groups, respectively. Histopathologic analysis of the middle ear mucosa demonstrated variable mild to moderate foreign body reaction with no evidence of mucosal ulceration or necrosis. CONCLUSIONS A large amount of octylcyanoacrylate placed in the middle ear of the guinea pig did not cause any morphologic or functional evidence of inner ear toxicity. This new adhesive is a promising tool for otologic surgery.
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Affiliation(s)
- J L Maw
- Michigan Ear Institute, Farmington Hills, USA
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