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"Denis, Jennifer"
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Prescribing medications to patients living with a visual impairment: a qualitative study of physicians to explore their usual clinical practices
ObjectivesVisual impairment is a disability affecting a large number of people worldwide, who are more likely to experience difficulties in their daily lives, impacting on their quality of life, independence, mobility and state of health. However, there is a lack of progress in the field of healthcare for individuals living with a visual impairment. The objectives of this study were (1) to illustrate the usual clinical practices of physicians to support the care of individuals with a visual impairment and (2) to identify the components considered to reduce risks resulting from the prescription of medications to these individuals.Methods and analysisSemi-structured interviews were conducted with French-speaking physicians via videoconference in Belgium. Participants were recruited voluntarily and using the snowball method. An interview guide was developed to meet the objectives of the study. Interviews were carried out until theoretical data saturation, recorded, transcribed verbatim and analysed in a double-blind fashion using thematic analysis. Data were organised using NVivo V.14 software.ResultsThree themes were addressed in the 24 interviews: consultation with patients with a visual impairment, prescribing medications to patients with a visual impairment and medication risk management for patients with a visual impairment. Most participants reported that they had not received specific education in visual impairment. Some physicians reported that they did not differentiate between patients living with a visual impairment and other patients, while others reported taking some additional measures.ConclusionsThis qualitative study highlighted a lack of knowledge and awareness among physicians regarding visual impairment and at-risk medications in these patients. The development of recommendations and tools is a solution to improve the quality of care for patients living with a visual impairment.
Journal Article
Pharmaceutical care for visually impaired patients: a qualitative study of community pharmacists' needs and professional experience
BackgroundVisual impairment is a disability that can have a significant impact on the ability to take medication safely. As a result, pharmacists must adjust their practice to provide targeted and adapted support for this type of patient.AimThe aims of the present study were (1) to illustrate the usual clinical practice of community pharmacists to support the optimisation of medication use in visually impaired patients, and (2) to identify solutions to improve pharmaceutical care for visually impaired patients.MethodSemi-structured interviews with 18 French-speaking community pharmacists were conducted via videoconference in Belgium. Participants were recruited on a voluntary basis and through a snowball method. An interview guide was developed based on literature review. Interviews were carried out until theoretical saturation of the data, recorded, transcribed verbatim and analysed using thematic analysis. Data were organised by NVivo Software.ResultsFour themes were identified: community pharmacists’ training, identification of visually impaired patients by the pharmacist, communication with visually impaired patients and their proxies, and provision of appropriate pharmaceutical care. Participants stated that they had not received any training regarding visual impairment. They described that they did not always know how to recognise visually impaired patients and that communication was often difficult.ConclusionThis qualitative study has highlighted a lack of knowledge and skills among community pharmacists regarding visual impairment. One possible solution could be to develop recommendations and tools to improve the care of these patients.
Journal Article
Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department
Background
In head trauma cases involving antiplatelet agent treatment, the French Society of Emergency Medicine recommends performing computed tomography (CT) scans to detect brain lesions, 90% of which are normal. The value of CT is still debatable given the scarce number of studies and controversial results.
Methods
We used the RATED registry (Registry of patient with Antithrombotic agents admitted to an Emergency Department, NCT02706080) to assess factors of cerebral bleeding related to antiplatelet agents following head trauma.
Results
From January 2014 to December 2015, 993 patients receiving antiplatelet agents were recruited, 293 (29.5%) of whom underwent CT scans for brain trauma. Intracranial bleeding was found in 26 (8.9%). Multivariate analysis revealed these patients more likely to have a history of severe hemorrhage (odds ratio [OR]: 8.47, 95% confidence interval [CI]: 1.56–45.82), dual antiplatelet therapy (OR: 6.46, 95%CI:1.46–28.44), headache or vomiting (OR: 4.27, 95%CI: 1.44–2.60), and abnormal Glasgow coma scale (OR: 8.60; 95%CI: 2.85–25.99) compared to those without intracranial bleeding. The predictive model derived from these variables achieved 98.9% specificity and a negative predictive value of 92%. The area under the ROC curve (AUROC) was 0.85 (95%CI: 0.77–0.93).
Conclusions
Our study demonstrated that the absence of history of severe hemorrhage, dual antiplatelet therapy, headache or vomiting, and abnormal Glasgow coma scale score appears to predict normal CT scan following traumatic brain injury in patients taking antiplatelets. This finding requires confirmation by prospective studies.
Trial registration
ClinicalTrials.gov number:
NCT02706080
.
Journal Article
La place du concept d'objets flottants dans la littérature scientifique francophone et anglophone: analyse en réseaux des auteurs et analyse lexicale «Si une image vaut mille mots/maux»: comment s'y retrouver?»
Abstract The place of the \"objets flottants\" concept in the French- and English-language scientific literature: Lexical and network analysis. Is a picture worth a thousand words, or a thousand wounds? - The purpose of our study is to clarify the linguistic and conceptual vagueness that surrounds the use of \"objets flottants\", in order to answer the question: To this end, we carried out a network analysis of authors and a lexical analysis. The network analysis (conducted using VOSviewer) modeled the range of the publications related to our theme, while the lexical analysis - designed with Tropes - determined terminological profiles according to epistemological affiliations. En effet, la non-utilisation d'un vocabulaire commun, defini et coherent peut presenter plusieurs derives pour les lecteurs (professionnels de terrain, futurs professionnels de terrain, chercheurs mais aussi possiblement patients soucieux de mieux connaltre les soins et techniques experimentes).
Journal Article
Therapeutic Processes in Clinical Interventions : A View of Qualitative Methodological Approaches
This article examines several qualitative methods to capture and analyze processes in therapeutic and clinical interventions. The study of therapeutic processes provides an understanding of what leads to changes in clinical interventions. This is a goal of any therapeutic intervention. This interest should allow us to try to identify what the therapists do and think they are doing, how they do it, how they think about their interventions, and what happens during the session that might explain changes. These types of studies require that researchers provide clarifications about their epistemological and methodological choices. To meet that requirement, we propose to review a range of issues, methodologies, and tools – which come from qualitative research - that guide us in conducting research in the psychotherapeutic and clinical field. The aim of our article is to put forward a methodological framework for researchers to better explore the patient’s or the therapist’s lived-experience and better reveal, moment-to-moment, the clinical practice.
Journal Article
Vers une compréhension de l’intentionnalité de l’action d’accueillir
Accueillir est devenu un geste automatisé et internalisé pour lequel on ne s’interroge plus. Pourtant, ce primo-moment laisse des traces et influencera le devenir de la relation thérapeutique. Notre souhait est de replacer l’expérience de l’accueil au cœur de la clinique en explorant les actions mises en place par des professionnels exerçant en unités de crise et d’urgences psychiatriques. À partir de l’analyse par théorisation enracinée, nous vous proposons de comprendre, décrire et modéliser le processus d’accueillir en clinique de crise et de l’urgence. Les résultats ouvrent la réflexion sur le façonnage réciproque qu’induit l’accueil. Il ne relève pas de techniques spécifiques, mais plutôt d’attitudes, voire d’aptitudes singulières, de façons d’être avec, de façons de faire avec ses émotions, de façons de faire avec le patient et son entourage. Welcoming has become an unquestioned, automatic, internalized gesture. However, this inaugurating moment leaves traces and ultimately influences the therapeutic relationship for its duration. Our hope is to promote the welcoming experience as a prime focus of clinical practice by exploring the protocols set in place by professionals working in psychiatric crisis and emergency units. Based on an analysis from grounded theory, we have attempted to understand, describe, and model the process of welcoming in mental health crisis clinics. The results reveal the reciprocity prompted by the welcome. It is not a question of specific techniques but instead of attitudes or rather aptitudes, ways of interacting, self-control, and ways of acting toward the patient and loved ones.
Journal Article
Accueil et clinique de crise
L’accueil constitue l’amorce de tout processus thérapeutique. Cet instant fugace convoque les espoirs et les craintes des protagonistes de la relation de soin, mobilise les préjugés, amorce la dynamique transférentielle, provoque – ou pas – les résonances, et ouvre ou ferme les portes d’une possible rencontre. Malgré toute l’importance de ce premier instant qui balisera la rencontre, l’accueil fait relativement peu l’objet d’études approfondies. Notre recherche part de la question suivante : « Qu’est-ce qu’accueillir dans le champ de la santé mentale ? ». Elle vise à proposer une conceptualisation en explorant le sens donné par des professionnels au sein de services d’urgences psychiatriques. L’analyse par théorisation enracinée (Glaser et Strauss, 1967) a permis de dégager quatre catégories conceptuelles : (1) processus singulier ; (2) intentionnalité ; (3) entre je(u) ; (4) ritualisation de l’accueil.
Journal Article
Accueil et clinique de crise Conceptualisation d'un processus au cceur des soins en sante mentale
Abstract The Welcome and the Crisis Clinic: Conceptualization of a Process at the Heart of Mental Health Care - The welcome is the beginning of any therapeutic process. In spite of the importance of this first moment that lays the foundation for the encounter, the welcome has been the subject of relatively few in-depth studies. What is welcoming in the field of mental health? The grounded theory methodology (Glaser et Strauss 1967) has enabled the exploration of four conceptual categories: (1) singular process; (2) intentionality; (3) dyadic play; (4) ritualization of the welcome.
Journal Article
La place du concept d’objets flottants dans la littérature scientifique francophone et anglophone : analyse en réseaux des auteurs et analyse lexicale
L’objectif de notre étude est de clarifier le flou linguistique et conceptuel qui s’étend autour de l’utilisation des objets flottants, afin de répondre à la question suivante : « Comment se détermine sémantiquement l’utilisation des objets médiateurs dans le cadre d’interventions thérapeutiques systémiques ? ». Pour ce faire, une analyse de réseaux des auteurs et une analyse sémantique ont été élaborées. L’analyse de réseaux (VOSviewer) a modélisé l’étendue des publications relatives à notre thème tandis que l’analyse lexicale, conçue avec Tropes © a déterminé des profils terminologiques selon des appartenances épistémologiques. Ces analyses ont été opérationnalisées pour la littérature francophone et anglophone. Les résultats présentent des ponts linguistiques et des modes d’usages terminologiques variés en fonction des courants d’appartenance théoriques des auteurs.
Journal Article