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Boulanger J.,Institute National dExcellence en Sante et en Services Sociaux | Ducharme A.,Hopital du Sacre Coeur de Montreal | Dufour A.,Hopital Charles Le Moyne CSSS ChamplainCharles Le Moyne | Fortier S.,Hopital Royal Victoria MUHC | Almanric K.,Hopital de la Cite de la Sante CSSS de Laval
Supportive Care in Cancer | Year: 2015

Background: Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. The scarcity of evidence available makes it difficult to develop an optimal management scheme. The purpose of this guideline is to review the relevant scientific literature on the prevention, management, and treatment of extravasation occurring during the administration of chemotherapy to cancer patients. Method: A scientific literature review was conducted using the PubMed search tool. The period covered was from database inception to April 2014, inclusively. Since the literature on extravasation treatment is often empirical, anecdotal, and controversial, the review also identified clinical practice guidelines and expert consensuses published by relevant international organizations and cancer agencies. Results: Identification of potential risk factors and preventive measures can reduce the risk of extravasation. Recognition and management of symptoms are crucial in patients with this complication. Provision of adequate instruction to personnel responsible for administering chemotherapy and to patients on recognizing symptoms, preventing, and managing extravasation is essential. Extravasation can be treated with dry warm or cold compresses and various antidotes such as dimethyl sulfoxide, dexrazoxane, hyaluronidase, or sodium thiosulfate, depending on the agent that has caused extravasation. Patient monitoring to assess the progression or regression of symptoms and to thus take the appropriate measures is necessary. Conclusion: Several strategies must be established to ensure that extravasation is recognized and properly managed. Given the evidence available at this time, the Comité de l’évolution des pratiques en oncologie (CEPO) has made recommendations for clinical practice in Quebec. © 2015, Springer-Verlag Berlin Heidelberg.

Gagnon M.-P.,University of Quebec | Gagnon M.-P.,Laval University | Desmartis M.,University of Quebec | Gagnon J.,University of Quebec | And 8 more authors.
Health Expectations | Year: 2014

Background: The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made. Objective: To explore the practices, perceptions and views of the various HTA stakeholders concerning patient involvement in HTA at the local level. Method: Data were collected using semi-structured interviews with 24 HTA producers and hospital managers and two focus groups with a total of 13 patient representatives. Results: Patient representatives generally showed considerable interest in being involved in HTA. Our findings support the hypothesis that the patient perspective contributes to a more accurate and contextualized assessment of health technologies and produces HTA reports that are more useful for decision makers. They also suggest that participation throughout the assessment process could empower patients and improve their knowledge. Barriers to patient involvement in HTA at the local level are also discussed as well as potential strategies to overcome them. Discussion and conclusion: This study contributes to knowledge that could guide interventions in favour of patient participation in HTA activities at the local level. Experimenting with different patient involvement strategies and assessing their impact is needed to provide evidence that will inform future interventions of this kind. © 2012 John Wiley & Sons Ltd.

Moore L.,Laval University | Moore L.,Trauma Emergency Critical Care Medicine Unit | Stelfox H.T.,University of Calgary | Turgeon A.F.,Laval University | And 6 more authors.
Annals of Surgery | Year: 2014

OBJECTIVE:: This study aimed to (i) describe unplanned readmission rates after injury according to time, reason, and place; (ii) compare observed rates with general population rates, and (iii) identify determinants of 30-day readmission. BACKGROUND:: Hospital readmissions represent an important burden in terms of mortality, morbidity, and resource use but information on unplanned rehospitalization after injury admissions is scarce. METHODS:: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian provincial trauma system (1998-2010; n = 115,329). Trauma registry data were linked to hospital discharge data to obtain information on readmission up to 12 months postdischarge. Provincial admission rates were matched to study data by age and gender to obtain expected rates. Determinants of readmission were identified using multiple logistic regression. RESULTS:: Cumulative readmission rates at 30 days, 3 months, 6 months, and 12 months were 5.9%, 10.9%, 15.5%, and 21.1%, respectively. Observed rates persisted above expected rates up to 11 months postdischarge. Thirty percent of 30-day readmissions were due to potential complications of injury compared with 3% for general provincial admissions. Only 23% of readmissions were to the same hospital. The strongest independent predictors of readmission were the number of prior admissions, discharge destination, the number of comorbidities, and age. CONCLUSIONS:: Unplanned readmissions after discharge from acute care for traumatic injury are frequent, persist beyond 30 days, and are often related to potential complications of injury. Several patient-, injury-, and hospital-related factors are associated with the risk of readmission. Injury readmission rates should be monitored as part of trauma quality assurance efforts. © 2013 by Lippincott Williams and Wilkins.

Moore L.,Laval University | Stelfox H.T.,University of Calgary | Turgeon A.F.,Laval University | Nathens A.,University of Toronto | And 4 more authors.
Annals of Surgery | Year: 2014

OBJECTIVE:: To describe acute care length of stay (LOS) over all consecutive hospitalizations for the injury and according to level of care [intensive care unit (ICU), intermediate care, general ward], compare observed and expected LOS, and identify predictors of LOS. BACKGROUND:: Prolonged LOS has important consequences in terms of costs and outcome, yet detailed information on LOS after trauma is lacking. METHODS:: This multicenter retrospective cohort study was based on adults discharged alive from a Canadian trauma system (1999-2010; n = 126,513). Registry data were used to calculate index LOS (LOS in trauma center with highest designation level) and were linked to hospital discharge data to calculate total LOS (all consecutive hospitalizations for the injury). Expected LOS was obtained by matching general provincial discharge statistics to study data by year, age, and sex. Potential predictors of LOS were evaluated using linear regression. RESULTS:: Mean index and total LOS were 8.6 and 9.4 days, respectively. ICU, intermediate care unit, and general ward care constituted 8.9%, 2.5%, and 88.6% of total hospital days. Observed mean index and ICU LOS in our trauma patients were 2.9 and 1.3 days longer than expected LOS (P < 0.0001). The strongest determinants of index LOS were discharge destination, age, transfer status, and injury severity. CONCLUSIONS:: Results suggest that acute care LOS after injury is underestimated when only information on the index hospitalization is used and that ICU or intermediate care constitute an important part of LOS. This information should be used to inform the development of an informative and actionable quality indicator.Copyright © 2014 by Lippincott Williams & Wilkins.

Tessier A.,Institute National dExcellence en Sante et en Services Sociaux | Beaulieu M.-D.,University of Montreal | McGinn C.A.,Institute National dExcellence en Sante et en Services Sociaux | Latulippe R.,Institute National dExcellence en Sante et en Services Sociaux
Healthcare Policy | Year: 2016

The ageing of the population and the increasing need for long-term care services are global issues. Some countries have adapted homecare programs by introducing an intervention called reablement, which is aimed at optimizing independence. The effectiveness of reablement, as well as its different service models, was examined. A systematic literature review was conducted using MEDLINE, CINAHL, PsycINFO and EBM Reviews to search from 2001 to 2014. Core characteristics and facilitators of reablement implementation were identified from international experiences. Ten studies comprising a total of 14,742 participants (including four randomized trials, most of excellent or good quality) showed a positive impact of reablement, especially on health-related quality of life and service utilization. The implementation of reablement was studied in three regions, and all observed a reduction in healthcare service utilization. Considering its effectiveness and positive impact observed in several countries, the implementation of reablement is a promising avenue to be pursued by policy makers. © 2016, Longwoods Publishing Corp. All rights reserved.

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