Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review

In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.

The Associations between Self-Silencing and Delinquency in Adolescent Who Experienced Child Sexual Abuse

A large body of research reveals that child sexual abuse is an adverse experience associated with many negative socioemotional and behavioral consequences during adolescence. Notably, adolescent victims of child sexual abuse are more likely to engage in delinquent behavior, which has importance for their adaptation later in life. While research on the psychological antecedents of delinquent behavior has independently considered each core feature of silencing the self (i.e., low assertiveness and self-expression, conflict avoidance, presenting a non-authentic self, anger, and hostility), it has failed to jointly consider these as potential predictors of delinquent behaviors in adolescent victims of child sexual abuse. The purpose of this study was to examine the associations between the two dimensions of self-silencing (i.e., divided self and silencing the self) and delinquency in adolescent victims of child sexual abuse. A sample of 110 adolescents seeking services following child sexual abuse completed self-reported questionnaires, and case files were analyzed to gather information regarding child sexual abuse severity. Hierarchical regression analyses revealed that, after controlling for the effect of age, gender, parental monitoring, and child sexual abuse severity, self-silencing was positively associated with delinquent behaviors, affiliation with delinquent peers, as well as alcohol and drug use. Divided self contributed to the prediction of aggressive behaviors. Implementing interventions aimed at increasing adolescents' assertiveness, conflict management skills, and emotion regulation and promoting congruence between their behaviors and authentic selves may lower their involvement in delinquency.

Investigating a new C2-symmetric testosterone dimer and its dihydrotestosterone analog: Synthesis, antiproliferative activity on prostate cancer cell lines and interaction with CYP3A4

The synthesis of a 17α-linked C2-symmetric testosterone dimer and its dihydrotestosterone analog is reported. The dimers were synthesized using a short five-step reaction sequence with 28% and 38% overall yield for the testosterone and dihydrotestosterone dimer, respectively. The dimerization reaction was achieved by an olefin metathesis reaction with 2nd generation Hoveyda-Grubbs catalyst. The dimers and their corresponding 17α-allyl precursors were tested for the antiproliferative activity on androgen-dependent (LNCaP) and androgen-independent (PC3) prostate cancer cell lines. The effects on cells were compared with that of the antiandrogen cyproterone acetate (CPA). The results showed that the dimers were active on both cell lines, with an increased activity towards androgen-dependent LNCaP cells. However, the testosterone dimer (11) was fivefold more active than the dihydrotestosterone dimer (15), with an IC50 of 11.7 μM vs. 60.9 μM against LNCaP cells, respectively, and more than threefold more active than the reference drug CPA (IC50 of 40.7 μM). Likewise, studies on the interaction of new compounds with drug-metabolizing cytochrome P450 3A4 (CYP3A4) showed that 11 was a fourfold stronger inhibitor than 15 (IC50 of 3 μM and 12 μM, respectively). This suggests that changes in the chemical structure of sterol moieties and the manner of their linkage could largely affect both the antiproliferative activity of androgen dimers and their crossreactivity with CYP3A4.

Relationship quality among dating adolescents: Development and validation of the Relationship Quality Inventory for Adolescents

Relationship quality has implications for individuals’ and couples’ wellbeing, such as higher couple functioning and perceived quality of life. In adolescence, low relationship quality has been associated with poor mental health and relational outcomes. However, given the lack of instruments to assess satisfaction in dating relationships, most studies have relied on measures of marital satisfaction. The current study aimed to address this gap by elaborating and validating the Relationship Quality Inventory for Adolescents (RQI-A). Exploratory and confirmatory factor analyses were conducted among two samples of French-speaking dating adolescents (n₁ = 310; n₂ = 335). The two-factor structure (Connectedness and Commitment) was cross-validated, and dimensions showed high internal consistency coefficients (ω = 0.86–0.89). Results also provide evidence of convergent validity of the scale with related measures. The RQI-A may help study predictors and correlates of dating relationship quality.

[Evaluation of the Granada medium used for the determination of Streptococcus agalactiae at the eighth month of pregnancy]

Granada medium (GM) was evaluated for the detection of group B streptococci (GBS) in vaginal swabs compared with the standard culture on selective blood agar (BA) and classical identification methods. From May to November 2002, samples from 325 pregnant women (34 to 37 weeks of gestation) were processed and 44 of these women (13.5%) carried GBS. Comparatively, GM was found more sensitive than the selective BA (95% versus 91%) in GBS recovery. The characteristic red-orange colonies produced by GBS are so specific that further identification is unnecessary. The technique is simple and results are available after overnight incubation, improving the time to reporting a GBS-positive result by at least 24 h. The inconvenience of anaerobic incubation of GM plates can be avoided when a cover slide is placed upon the inoculum because the same pigmentation is obtained under these aerobic conditions. This study confirms that the routine use of GM appears to be an accurate, easy and highly sensitive method of identification of GBS in pregnant women.

Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy

STUDY DESIGN

A prospective double-blind randomized controlled trial was performed.

OBJECTIVE

To assess the efficacy of percutaneous radiofrequency articular facet denervation for low back pain.

SUMMARY OF BACKGROUND DATA

Uncontrolled observational studies in patients with low back pain have reported some benefits from the use of facet joint radiofrequency denervation. Because the efficacy of percutaneous radiofrequency had not been clearly shown in previous studies, a randomized controlled trial was conducted to assess the efficacy of the technique for improving functional disabilities and reduce pain.

METHODS

For this study, 70 patients with low back pain lasting of more than 3 months duration and a good response after intraarticular facet injections under fluoroscopy were assigned randomly to receive percutaneous radiofrequency articular facet denervation under fluoroscopic guidance or the same procedure without effective denervation (sham therapy). The primary outcomes were functional disabilities, as assessed by the Oswestry and Roland-Morris scales, and pain indicated on a visual analog scale. Secondary outcomes included spinal mobility and strength.

RESULTS

At 4 weeks, the Roland-Morris score had improved by a mean of 8.4% in the neurotomy group and 2.2% in the placebo group, showing a treatment effect of 6.2% (P = 0.05). At 4 weeks, no significant treatment effect was reflected in the Oswestry score (0.6% change) or the visual analog pain score (4.2% change). At 12 weeks, neither functional disability, as assessed by the Roland-Morris scale (2.6% change) and Oswestry scale (1.9% change), nor the pain level, as assessed by the visual analog scale (-7.6% change), showed any treatment effect.

CONCLUSIONS

Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.

Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder

OBJECTIVE

To determine whether the pain, contracture, and disability associated with idiopathic frozen shoulder are diminished by a series of 3 indirect bupivacaine suprascapular nerve blocks delivered in an ambulatory care clinic.

METHODS

A double blind randomized controlled trial of patients referred by primary care and specialty clinics in Montreal to an ambulatory tertiary care academic facility. Patients and controls underwent a series of 3 indirect suprascapular nerve blocks at 7 day intervals using either 10 c.c. bupivacaine 0.5 (Marcaine) in the treatment group or 10 c.c. of physiological saline in controls. Subjects in both groups were taught a program of shoulder range of motion exercises to be done at home. The primary outcome measure was the McGill-Melzack Pain Questionnaire (MPQ) short form at 1 month post-randomization (2 weeks after last injection). The secondary outcome measures were disability measured by the simple shoulder test and glenohumeral joint contracture measured by shoulder range of motion measurements.

RESULTS

Thirty-four subjects were randomized from 58 screened. Average age of subjects was 52 years. Mean duration of pain prior to randomization was one year. Dropout rate was 11% in the treatment group, 30% in the placebo group. A 64% reduction in pain in the treatment group versus 13% in the placebo group was observed at one month as measured by the MPQ multidimensional pain descriptors score (p = 0.03). A nonsignificant 15.8% improvement in shoulder function in the treatment group versus 4% in the placebo group (p = 0.24) was also noted. No improvement in shoulder range of movement was noted. No side effects other than transient vagal symptoms and local tenderness at the injection site were reported.

CONCLUSION

The use of bupivacaine suprascapular nerve blocks was effective in reducing the pain of frozen shoulder at one month. Clinical studies with a larger number of subjects and a longer study period will help determine the duration and nature of the effect of bupivacaine suprascapular nerve blocks in treating the pain, disability, and glenohumeral joint contracture of frozen shoulder.

Cognitive and familial contributions to conduct disorder in children

Although young children with conduct disorder (CD) are suspected of having verbal and executive function deficits, most studies that investigated this hypothesis did not control for attention deficit hyperactivity disorder (ADHD). Furthermore, relatively little is known about the interaction between cognitive deficits and familial factors in explaining the onset and persistence of CD in children. The participants in this study were 57 children with CD and 35 controls aged 7 to 12 years. At 1-year follow-up, 41 of the participants with CD were reassessed. Children with CD were found to be significantly impaired in four of five executive function measures after ADHD symptoms and socioeconomic status (SES) were controlled. Executive function test performance, number of ADHD symptoms, and familial characteristics (SES, parental punishment) together correctly classified 90% of the participants. Only the number of ADHD symptoms was found to significantly improve prediction of CD 1 year later beyond that afforded by number of CD symptoms a year earlier. Findings indicate that children with CD and ADHD symptoms are especially at risk for persistent antisocial behaviour. Results also highlight the importance of treatment programs that cover both cognitive and familial aspects associated with CD.

[Internalized and externalized disorders in children witness to conjugal violence and their associated variables: a literature review.]

This article presents a literature review on externalized and internalized disorders in children who are witness to conjugal violence as well as the major variables associated with the development of these disorders. Among these variables, there are age and gender of the child, the type of violence they witness, maternal stress, educational skills of parents as well as physical and sexual abuse. The limits of major studies published over the last two decades are also exposed. Finally, new avenues of research that might shed new light on a more recent knowledge of the issue, are proposed.

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit-hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

A cross-sectional study comparing the Oswestry and Roland-Morris Functional Disability scales in two populations of patients with low back pain of different levels of severity

STUDY DESIGN

This cross-sectional study compares the Oswestry and Roland-Morris disability scales in two groups of patients with low back pain of different clinical and electromyographic severity.

OBJECTIVES

To evaluate the correlation between functional disability and diagnoses.

SUMMARY OF BACKGROUND DATA

There is an increasing need for functional disability measurements to be applied to the evaluation of therapy and outcome in patients experiencing low back pain.

METHODS

Two very different groups of patients with low back pain completed the Oswestry and Roland-Morris self-administrated functional disability questionnaires. One group included patients presenting with an episode of mechanical low back pain with no clinical radiculopathy. The other group consisted of patients with low back pain and clinical and electromyographic evidence of radiculopathy.

RESULTS

Patients diagnosed with low back pain who exhibited signs of radiculopathy on electromyography had a mean score of 49.1 +/- 17.1 on the Oswestry disability questionnaire; a mean score of 33.0 +/- 14.7 was found for patients who experienced "simple" low back sprain (with no radiculopathy). This difference was statistically significant (P < 0.0001). On the Roland-Morris questionnaire, the mean score obtained by the group of patients with radiculopathy was 59.1 +/- 21.8 compared with 45.4 +/- 19.4 for those with no radiculopathy. This difference was also statistically significant (P < 0.0001). Moreover, there exists a moderate correlation between both functional scales within each group of patients: 0.72 (P < 0.0001) in the group with radiculopathy and 0.66 (P < 0.0001) among those without radiculopathy.

CONCLUSIONS

The authors conclude that both functional disability scales accurately discriminated between these two groups of patients with low back pain of very different clinical and electromyographic severity.

The selection of needs indicators for regional resource allocation in the fields of health and social services in Québec

In Québec, recent political statements have strengthened the necessity to allocate resources according to regional population needs. A regional-provincial working group was set up to propose needs indicators in 8 different fields-or client-oriented programs-which subdivide the entire spectrum of health and social services in Québec. These programs include physical health, mental health, public health, functionally impaired elderly people, physical deficiency, intellectual deficiency, alcoholism and drug abuse and problems (abuse, neglect, delinquency) among young people and their families. The following paper summarizes the main proposals of the working group. Some comments are made on the definition of client-oriented programs, basic concepts, research questions and methodological approaches. Concrete examples are given in order to illustrate the type of data and methods used. Furthermore, the indicators selected for resource allocation (in each of the 8 client-oriented programs) are presented on a regional basis (n = 18) and introduced in a principal component analysis. Their variations are discussed and recommendations to facilitate their use and promote their development are made. Finally, the actual utilization of these indicators is reported.

Bursitis of the iliopsoas: four cases with pain as the only clinical indicator

Bursitis of the iliopsoas is a clinical entity rarely encountered, and may be underdiagnosed. Reports in the literature have usually considered the condition to result from an increase in bursal volume. Bursitis of the iliopsoas is most commonly observed in conjunction with pathologies such as rheumatoid arthritis or osteoarthritis of the hip, and is rarely reported as an isolated condition. We describe 4 cases of bursitis of the iliopsoas in which bursal swelling was absent and hip pain was the only clinical indicator. Diagnostic and therapeutic criteria based on clinical and radiological criteria are suggested.

Effects of TENS and topical skin anesthesia on soleus H-reflex and the concomitant influence of skin/muscle temperature

The purpose of this study was to determine, in ten healthy subjects, the extent of soleus motoneuronal excitability during conditions of increased (transcutaneous electrical nerve stimulation [TENS]), decreased (Xylocaine [lidocaine]a anaesthesia) and normal (placebo anaesthesia) cutaneous inputs. Increased cutaneous activity was evoked using a TENS unit, with the two pairs of electrodes placed respectively over the Achilles (S2 dermatome) and tibialis anterior (L5 dermatome) tendons. Experimental and placebo topical anaesthesia were obtained after rubbing Xylocaine (5%) and Vaselineb ointment, respectively, on the skin surface overlying the Achilles tendon. Sets of ten H-responses (Hmax/2) were evoked at a frequency of 1 shock/30s and averaged at regular time intervals before, during and after the testing conditions. The results showed a gradual increase (up to 40% after 20 minutes) of H-reflex amplitude during TENS regardless of whether it was applied on the L5 or S2 dermatome. Furthermore, placebo anesthesia (Vaseline) caused the same gradual facilitatory response (up to 100% after 50 minutes) as that obtained during Xylocaine anaesthesia. Power spectral analysis of the H-responses obtained over time showed that the increase in the peak-to-peak H-response value was accompanied by a shift of the spectral content toward low frequencies. This shift occurred concomitantly with a cooling of the skin overlying the soleus muscle.

[Selective attention in major depression: clinical retardation and cognitive inhibition]

Relationships between clinical retardation (measured by the Hamilton Depression Inventory) and selective attention (measured with a computerized version of the Stroop word colour test) were studied in a population of 21 depressed patients. Stroop interference was higher in depressed patients than in normals. Desynchronized presentations of the distractor and the target and intervals between responses and succeeding stimuli permitted depressed subjects to respectively apply and lift inhibition of the distractor so that their interference was reduced to control levels. Finally, successive inhibition scores were correlated with the retardation score in depressed subjects. The results are consistent with the hypothesis of a retardation in the application and the lifting of cognitive inhibition in depression.

De novo mania among elderly people

De novo mania is defined as the occurrence of a first manic episode in a patient with no history of mood disorder, after exclusion of organic etiologies. Although it is believed to be rare in elderly populations, the authors nonetheless report 6 cases encountered over a 2-year period. The literature regarding mania among elderly people is reviewed, and the authors formulate their recommendations in view of more frequent recognition and better management of these patients.

[Manic disorder in the aged: a review of the literature]

Very little has been written about mania in the elderly population. Most authors of the 1960s and 1970s situate the age of onset of affective disorders well before the geriatric period. In the 1980 some authors reached quite different conclusions about the age of onset. One study calculated an increased frequency of manic psychosis with advanced age. However, it seems difficult to compare these studies. A few cases of primary mania in the elderly have been published and it is important that more of these cases be reported. Mania diagnosis in this group of patients is not easy to make: past history may be difficult to assess, false first diagnosis may still occur in some cases, the course and the presentation of the illness may be less typical, there may be a picture of pseudodementia, confusion, depressed mood, etc. Mania may be secondary to physical illness (organic affective syndrome). Moreover, a frank manic picture may be mistaken for dementia (or for organic brain syndrome) even if it is indeed a primary affective illness.

Kinetic disposition of intravenous ceftriaxone in normal subjects and patients with renal failure on hemodialysis or peritoneal dialysis

The kinetic disposition of a single intravenous dose of ceftriaxone (250 to 665 mg) was studied in six normal subjects and nine patients with renal insufficiency and normal hepatic function. In normal subjects, ceftriaxone was eliminated with a t1/2 beta of 5.2 h (range, 4.1 to 5.8). The total body clearance (Qb) was 13.5 ml/kg per h (range, 8.4 to 23.3), and renal clearance was 8.3 ml/kg per h (range, 5.8 to 13.3). In patients with severe renal insufficiency requiring peritoneal or hemodialysis, the mean t1/2 beta was prolonged to 13.4 h (range, 7.7 to 15.8) and the mean Qb was reduced to 6.9 ml/kg per h (range, 3.4 to 12.8). The apparent volumes of distribution (Vc and Vss) were not different from those determined in normal subjects. Peritoneal dialysis did not remove ceftriaxone. The dialysate of three patients on continuous peritoneal dialysis did not contain any measureable ceftriaxone, and the kinetic disposition in these patients was similar to the hemodialysis patients between their dialysis treatment. During a 4-h hemodialysis session, the total body clearance of ceftriaxone was reduced, perhaps secondary to a decrease in hepatic blood flow induced by the hemodialysis procedure. After a 12- or 24-h dose regimen, predicted trough concentrations of ceftriaxone in plasma at steady state derived from kinetic data generated from the study and assuming linear pharmacokinetic behavior were well above the minimum inhibitory concentrations of most sensitive bacteria, suggesting the feasibility of a once-a-day dosage regimen especially for patients with severe renal insufficiency.

Combined hemodynamic effects of dobutamine and IV nitroglycerin in congestive heart failure

The combined and separate hemodynamic effects of dobutamine and IV nitroglycerin were compared in 12 patients with chronic congestive heart failure (nine with ischemic heart disease, two with idiopathic congestive cardiomyopathy, and one with valvular heart disease). Dobutamine (7.1 micrograms/kg/min) increased cardiac index from 2.4 +/- 0.4 to 3.4 +/- 0.9 L/min/m2 (P < 0.001) and decreased pulmonary wedge pressure from 28 +/- 5 to 16 +/- 4 mm Hg (P < 0.001) while nitroglycerin (127 micrograms/min) alone increased cardia index to 2.8 L/min/m2 (P < 0.001) and decreased wedge pressure to 14.3 mm Hg (P < 0.001). With both drugs, cardiac index increased to 3.5 +/- 0.6 L/min/m2; (NS compared to dobutamine alone) wedge pressure decreased to 11 +/- 4L/min/m2 (P < 0.05 compared to dobutamine alone). Those beneficial hemodynamic effects occurred without a significant change in the double product of heart rate and blood pressure, and were associated with an improvement in the transmyocardial gradient. Thus, the greatly enhanced ventricular performance with dobutamine + nitroglycerin was associated with a better relationship between myocardial oxygen demand and supply.