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Contexte : L’intégration des sages-femmes aux systèmes de santé varie selon les provinces. Au Québec, même si la profession de sage-femme est règlementée depuis 1999, actuellement, moins de 5 % des femmes ont accès à leurs services. Objectifs : Les objectifs de cette étude sont : 1) d’identifier et analyser les contextes, les stratégies et les facteurs ayant influencé l’intégration de la profession de sage-femme et 2) Comprendre comment les acteurs perçoivent l’intégration de la profession sage-femme en fonction des différents types. Méthode : Une étude de cas unique suivant une approche rétrospective a été utilisée afin d’évaluer qualitativement l’évolution et les initiatives déployées pour intégrer la profession de sages-femmes au Québec. Les données proviennent d’une analyse documentaire et d’entrevues semi-dirigées réalisées auprès de 13 experts (gestionnaires, décideurs, médecins/infirmières, chercheurs) recrutés selon une approche par choix raisonné. Le cadre théorique de Singer et al. (2020) sur les relations entre les différentes dimensions de l’intégration a guidé l’élaboration du guide d’entrevue et l’analyse des données. Ces dernières ont été analysées de façon itérative et chronologique selon une analyse thématique. Résultats : Trois concepts principaux ont été explorés : le contexte, les facteurs d’influences et les impacts observés. Nos résultats suggèrent que le contexte ayant mené à la légalisation de la profession et les décisions politiques qui ont suivi ont restreint la portée du rôle joué par les sages-femmes au sein du système de santé. Les principaux facteurs d’influence identifiés sont : l’exclusivité du modèle de pratique, le manque de proximité médecins/sages-femmes ainsi que des limites au niveau du cadre professionnel et organisationnel. Pour les impacts terrain les plus observés, on retrouve : les difficultés de rétention de la profession, une faible présence des sages-femmes au sein des systèmes de gouvernance (locaux, régionaux et centr, Background: The integration of midwives into health systems varies by province. In Quebec, even though the midwifery profession has been regulated since 1999, currently less than 5% of women have access to their services. Objectives: 1) to identify and analyze the contexts, strategies and factors that have influenced the integration of the midwifery profession and 2) to describe the perceived impacts of these on the level of the profession and the health system. Method: A unique case study following a retrospective approach was used to qualitatively assess the evolution and the initiatives deployed to integrate the profession of midwifery in Quebec. The data comes from a documentary analysis and semi-directed interviews conducted with 13 experts (managers, decision-makers, doctors/nurses, researchers) recruited using a reasoned choice approach. The theoretical framework of Singer et al. (2020) on the relationships between the different dimensions of integration guided the development of the interview guide and the analysis of the data. These were analyzed iteratively and chronologically according to a thematic analysis. Results: Three main concepts were explored: the context, the influencing factors and the observed impacts. Our results suggest that the context that led to the legalization of the profession and the political decisions that followed have restricted the reach of midwives within the health system. The main influencing factors identified are the exclusivity of the practice model, the lack of proximity between doctors and midwives, as well as limits at the level of the professional and organizational framework. For the most observed impacts on the ground, we find: the difficulties of retaining the profession, a weak presence of midwives within the governance systems (local, regional and central), limited accessibility to services for the population and an inefficient functional organization. Conclusion: Our results suggest that the integration

This multi-methods study describes the development of a pediatric rehabilitation telehealth intervention fidelity checklist, estimates its inter-rater reliability, and documents raters' implementation experience. A literature scan and expert consultation identified eighteen key behaviors and categorized them into three subdomains, measured using a 5-point measurement system. To estimate the checklist’s inter-rater reliability, three raters scored 33 video recordings. A Shrout and Fleiss Class 1,1 intraclass correlation (ICC)) and 95% confidence intervals (CI) calculated ICCs = 0.5 (CI: 0, 0.9) for both the Therapist and the Parent-Therapists subdomains, and the Parent subdomain an ICC = 0.3 (CI: 0, 0.8). In the implementation surveys, raters reported high levels of satisfaction (100%), ease of use (84% to 88%), and confidence in their video ratings (87% to 100%). Changes in procedures and scoring were recommended. Capturing raters’ implementation experiences is crucial in the early evaluation of the fidelity checklists for telehealth.

Introduction : De nombreux facteurs peuvent contribuer à la qualité des soins. La présence d'un transfert interétablissements peut affecter la qualité des soins en induisant une fragmentation du parcours de soins qui peut entraîner des effets indésirables. De plus, la pandémie de SRAS-CoV-2 a entraîné des retards massifs et des annulations dans les chirurgies électives. Nous avons ainsi documenté les changements dans les indicateurs de la qualité des soins, pour les patients attendant une chirurgie élective en orthopédie pédiatrique pour les profils visés, entre les périodes pré et perpandémie et identifié les facteurs associés aux délais chirurgicaux. Méthode : Une analyse rétrospective des cas pédiatriques subissant des interventions orthopédiques électives dans les trois hôpitaux pédiatriques de Montréal a été réalisée. Trois profils de patients ont été sélectionnés: chirurgie du rachis, radicellectomie et chirurgie des membres chez des patients présentant une déficience motrice. Nous avons enregistré le taux de réadmission, le nombre d'incidents, de plaintes et le volume chirurgical. Nous avons ensuite comparé entre les périodes (septembre 2019-février 2020 vs septembre 2020-février 2021), les changements dans le nombre d'annulations chirurgicales, dans la mortalité, la duplication d'examens, la durée de séjour et les délais chirurgicaux à l'aide de tests du chi carré ou Mann-Whitney. Finalement, nous avons déterminé les facteurs associés aux délais à l’aide d’un modèle de régression de Cox multivariable. Résultats : 94 patients ont été inclus (47 pour chaque période). Aucune différence significative n’a été trouvée pour le nombre de réadmissions, le nombre d’incidents/plaintes, le nombre de décès, le nombre d’annulations chirurgicales, la duplication de tests et la durée de séjour entre les périodes prépandémie et perpandémie. Cependant, les délais chirurgicaux étaient plus longs en 2020- 2021 qu’en 2019-2020 avec des médianes respectives de 149 [ÉIQ=283] et 12, Introduction: Many factors can contribute to the quality of care. The presence of an inter- establishment transfer can affect the quality of care by inducing fragmentation of the care pathway, which can lead to adverse effects. Another contributor is the presence of the SARS- CoV-2 pandemic which cause massive delays and elective surgery cancellations. As such, we sought to document the differences in specific indicators, for patients awaiting elective surgery in pediatric orthopedics for the targeted profiles, between pre- and peri-pandemic periods and to identify factors associated with surgical delays. Methods: A retrospective analysis of pediatric cases undergoing elective orthopedic procedures in three Montreal pediatric hospitals was performed. Three patient profiles were selected: spine surgery, rhizotomy, and limb surgery in patients with motor impairment. We recorded the readmission rate, number of incidents, complaints, and surgical volume. We then compared between periods (September 2019-February 2020 vs September 2020-February 2021) the changes in the number of surgical cancellations, in mortality, duplication of examinations, length of stay and surgical delays using chi-square test or Mann-Whitney tests. Finally, we identified the factors associated with surgical delays using a multivariable Cox regression model. Results: 94 patients were included (47 for each period). No statistically significant difference was found for in the readmission rate, number of incidents or complaints, mortality rate, number of surgical cancellations, duplication of tests, and the length of stay between the pre-pandemic and the peri-pandemic periods. However, surgical delays were longer in 2020-2021 than in 2019-2020 with respective medians of 149 [IQR=283] and 120 days [IQR=218] (p = 0.002). Factors associated with delays were a primary surgical diagnosis of scoliosis (p = 0.032), or of upper limb procedure (p = 0.021), associated conditions of dysplasia (p = 0.02

Le protocole Nutrition as Medication (NAM) est un moyen innovant d’administrer les suppléments nutritionnels oraux (SNO), afin de prévenir la perte de poids et la malnutrition dans les établissements de soins de longue durée (ESLD). Une boîte à outils a été développée pour soutenir son implantation et son utilisation. Cette étude vise à évaluer l’implantation du protocole NAM, en utilisant la boîte à outils. Trois ESLD ont été recrutés via un échantillonnage de convenance. De plus, des employés, proches-aidants et résidents des ESLD ont été recrutés pour les entrevues qualitatives individuelles. L’adhésion au traitement, les raisons de non-consommation des SNO et les données sur l’adéquation aux prescriptions NAM ont été extraites à partir des dossiers médicaux. Un test de Kruskal-Wallis a été effectué pour détecter toute différence entre les taux d’adhésion des différents ESLD. Des entrevues semi-dirigées ont été menées avec les participants afin d’identifier les barrières et les facilitateurs à l’implantation. Une analyse thématique a été réalisée pour identifier les thèmes. Le degré d’adhésion global aux SNO était de 90,8 % et aucune différence significative entre les ESLD n’a été détectée. La principale raison de non-consommation des SNO était le refus; cependant, plusieurs raisons de non-consommation n’étaient pas inscrites dans les feuilles d’administration des médicaments. Le rapport entre le nombre de prescriptions attendues et le nombre de prescriptions réelles variait entre 1,7 et 3,3, indiquant que le protocole NAM était sous-utilisé. Les personnes interviewées ont décrit quatre thèmes principaux : 1) la planification de l’implantation; 2) l’éducation et la diffusion de l’information; 3) les facteurs logistiques; et 4) la perception envers le protocole NAM. À travers ces thèmes, une communication efficace s’est révélée être d’une grande importance. Malgré certaines barrières, les participants ont exprimé leur appréciation envers le protocole NAM, notammen, The Nutrition as Medication (NAM) program is an innovative way to administer oral nutritional supplements (ONS) to counteract weight loss and malnutrition in long-term care (LTC) settings. A toolbox has been developed to sustain its implementation and use. This study aims to evaluate the implementation of the NAM program using this toolbox. To this end, three LTC settings were recruited using convenience sampling. LTC employees, caregivers and residents were recruited for qualitative interviews. Adherence to treatment, reasons for non-consumption of ONS and data on the adequacy of NAM prescriptions were extracted from patient charts. Kruskal-Wallis tests were performed to detect differences in adherence rates among LTC settings. Semi-structured interviews were conducted with participants to identify barriers and facilitators to the implementation of the NAM program. A thematic analysis was conducted to identify emerging themes. Overall adherence to treatment was 90.8 %, with no significant difference between settings. The main reason for non-consumption of ONS was refusal; however, in many cases, reasons for non-consumption were not mentioned in the Medication Administration Record. The ratio between expected and actual ONS prescriptions ranged from 1.7 to 3.3, suggesting that the NAM program as undersused. Interviewees described four main themes: 1) Implementation planning; 2) Education and dissemination of relevant information ;3) Logistic factors; and 4) Perceptions towards the NAM program. Through these themes, the importance of effective communication was highlighted. However, despite the communication barriers, participants expressed their appreciation towards the NAM program, notably because of the perceived benefits for the residents’ health and quality of life. To conclude, treatment adherence was high in all settings. LTC employees appreciated the NAM program and expressed their desire to maintain its use. However, elements related to communicati

Objectifs : Cette étude s'inscrit dans une initiative d’intégration des services péri-chirurgicaux interétablissements, pour les troubles musculosquelettiques pédiatriques complexes. Ses objectifs étaient : 1) Explorer les perceptions sur la collaboration interprofessionnelle (CIP) du personnel de santé impliqué dans la gestion des transferts interétablissements. 2) Identifier les facteurs facilitants et contraignants à la CIP. Méthodes : Une analyse qualitative descriptive interprétative transversale a été utilisée. Trois groupes de discussion et trois entretiens individuels ont été effectués avec 18 participants impliqués dans les transferts de jeunes patients entre quatre institutions participantes à Montréal. Le guide d’entretien et l’analyse sont fondées sur le cadre de la collaboration interprofessionnelle et inter-organisationnelle de D'Amour et collaborateurs, 2008. Résultats : Le rôle des coordonnatrices trajectoires interétablissements (CTI) a été nommé comme pilier central dans la coordination, la connectivité entre les lieux de soins, la confiance et le leadership. D’autres thèmes évoqués sont l’importance des moyens de communication entre les partenaires et le besoin de standardisation des procédures. Les facteurs facilitants à la CIP étaient : la proximité physique et organisationnelle entre deux établissements, l'autonomie des professionnels dans les tâches quotidiennes et disponibilité/accessibilité de la CTI en soutien aux équipes. Les facteurs contraignants identifiés incluaient : l’incapacité d’accéder au dossier médical à distance, l’absence d’un dossier harmonisé informatisé, les rares espaces d’échanges informels et la compréhension limitée des rôles/responsabilités des autres. Conclusion : La situation actuelle de la CIP dans le contexte étudié s’illustre particulièrement autour du besoin de formalisation des outils et des processus, ainsi que de la connaissance mutuelle limitée. En comprenant les facteurs qui facilitent ou entravent la CIP, t, Aims: This study is part of an initiative to integrate inter-establishment peri-surgical services for complex pediatric musculoskeletal disorders. Its objectives were: 1) To explore the perceptions of interprofessional collaboration (IPC) of healthcare personnel involved in the management of inter-establishment transfers. 2) Identify facilitating and constraining factors to IPC. Methods: A cross-sectional interpretative descriptive qualitative analysis was used. Three focus groups and three individual interviews were conducted with 18 participants involved in transfers of young patients between the four participating sites in Montreal. The interview guide and analysis are based on D'Amour's 2008 interprofessional and interorganizational collaboration framework. Results: The role of inter-establishment navigators (IEN) was identified as a central pillar in coordination, connectivity between care sites, trust and leadership. Other topics raised are the importance of means of communication between partners and the need for standardization of procedures. The facilitating factors of ICP were the physical and organizational proximity between two establishments, the autonomy of the professionals in daily tasks and the availability/accessibility of the IEN in support of the teams. The constraining factors identified included: the inability to access the medical file remotely, the absence of a harmonized electronic medical record, the rare spaces for informal exchanges and the limited understanding of the roles/responsibilities of others. Conclusion: The current situation of IPC in our context is particularly illustrated around the need for formalization of tools and processes, as well as limited mutual acquaintance. This study identified the factors that facilitate or hinder IPC that have generated leads for improvement in the next stages of the process of implementing trajectory innovations. The study also emphasized the importance of involving the stakeholders i

Introduction: The aim of this study was to quantify the amount of deterioration in hearing and to document the trajectory of hearing loss in early identified children with unilateral hearing loss (UHL). We also examined whether clinical characteristics were associated with the likelihood of having progressive hearing loss. Methods: As part of the Mild and Unilateral Hearing Loss Study, we followed a population-based cohort of 177 children diagnosed with UHL from 2003 to 2018. We applied linear mixed models to examine hearing trends over time including the average amount of change in hearing. Logistic regression models were used to examine the relationship between age and severity at diagnosis, etiology, and the likelihood of progressive loss and amount of deterioration in hearing. Results: The median age of the children at diagnosis was 4.1 months (IQR 2.1, 53.9) and follow-up time was 58.9 months (35.6, 92.0). Average hearing loss in the impaired ear was 58.8 dB HL (SD 28.5). Over the 16-year period, 47.5% (84/177) of children showed deterioration in hearing in one or both ears from their initial diagnostic assessment to most recent assessment including 21 (11.9%) who developed bilateral hearing loss. Average deterioration in the impaired ear ranged from 27 to 31 dB with little variation across frequencies. Deterioration resulted in a change in category of severity for 67.5% (52/77) of the children. Analysis for children who were followed for at least 8 years showed that most lost a significant amount of hearing rapidly in the first 4 years, with the decrease stabilizing and showing a plateau in the last 4 years. Age and severity at diagnosis were not significantly associated with progressive/stable loss after adjusting for time since diagnosis. Etiologic factors (ENT external/middle ear anomalies, inner ear anomalies, syndromic hearing loss, hereditary/genetic) were found to be positively associated with stable hearing loss. Conclusion: Almost half of children wit, SCOPUS: ar.j, info:eu-repo/semantics/published

The purpose of this study was to describe the acceptability of a stroke telerehabilitation platform from the perspective of both patients and therapists. Two public rehabilitation centers participated in a pilot telerehabilitation trial. A theoretical framework was used to conceptualize acceptability. Semi-structured individual interviews with patients and focus groups of therapists were conducted. Most participants and therapists were satisfied with the intervention. Participants emphasized the advantages of staying at home to get their treatments. Therapists were more skeptical at first about their self-efficacy to deliver therapy remotely. There was a consensus among therapists about the need for a combination of telerehabilitation and in-person visits to optimize treatments. While we found overall good acceptability, effectiveness of this technology could be improved via an accessible user interface, complementary rehabilitation material, and ongoing training and technical just-in-time support with therapists.

Les difficultés motrices sont reconnues comme ayant un impact sur l’enfant tout au long de sa vie; mais également sur ses parents qui seront plus à risque de vivre de la détresse psychologique. Les plus récentes recherches sur le sujet suggèrent la téléréadaptation pour offrir des services aux familles de ces enfants. Cependant, l’augmentation rapide de l’utilisation de la téléréadaptation en pédiatrie a fait naître des doutes concernant son acceptabilité. En général, les études sur le sujet rapportent que la téléréadaptation est utile pour supporter les familles, impacte positivement l’enfant, augmente l’accès aux services et permet de diminuer les fardeaux associés aux consultations en personne. L’intervention DESSIN consistant en une plateforme multimodale de réadaptation en ligne a été offerte à des familles québécoises ayant un enfant avec des difficultés motrices. Le présent projet évalue l’acceptabilité de cette plateforme du point de vue de ces parents. Méthode : Une étude qualitative descriptive exploratoire imbriquée dans un essai clinique pragmatique a été menée. L’échantillon était composé de mères d’un enfant âgé entre trois et huit ans présentant des difficultés motrices et provenant du groupe expérimental de l’étude principale. Une stratégie d’échantillonnage à variation maximale basée sur la région de résidence, le revenu familial et le moment de randomisation a été utilisée. Des entrevues semi-structurées inspirées du Theoretical Framework of Acceptability ont été réalisées. Les données ont été analysées de façon thématique. Résultats : 16 participants ont pris part aux entrevues. En général, les parents ont perçu l’intervention DESSIN comme étant acceptable. Les éléments contribuant à l’acceptabilité ont été regroupés en neuf thèmes :1) l’évolution de l’acceptabilité, 2) les interactions sur la plateforme, 3) les opportunités créées par DESSIN, 4) la cohérence et la compréhension de l’intervention, 5) l’implication de l’enfant, 6) l’adéquation avec, Introduction: Motor difficulties have a major impact on all spheres of child development. These difficulties will not only impact a child throughout his or her lifetime, but also his or her parents who are at risk of psychological distress. Recent evidence on the subject suggests telerehabilitation as a possible service solution for these children’s families. However, the recent rapid uptake of telerehabilitation in pediatrics has raised doubts about its acceptability. Overall, studies on the subject report positive impacts on children, its usefulness to support families, increased access to services and the reduction of burden associated with in-person consultations. The WECARE intervention, consisting of an online multimodal rehabilitation platform, was offered to Quebec families with children with motor difficulties. This project assesses the acceptability of this platform from the perspective of parents. Method: An exploratory descriptive qualitative study nested in a pragmatic clinical trial on a telerehabilitation web platform was conducted. The sample consisted of mothers of a child aged three to eight years with motor difficulties selected from the experimental group of the main study. A maximum-variation purposive sampling strategy based on region of residence, family income, and time of randomization was used. Semi-structured interviews inspired by the meta-framework of the Theoretical Acceptability Framework were conducted. Thematic analysis was conducted. Results: 16 participants were interviewed. Overall, parents perceived the WECARE intervention as acceptable. The elements contributing to acceptability could be classified into nine themes: 1) Evolving acceptability, 2) Interactions on the platform, 3) Opportunities created by WECARE, 4) Understanding and consistency of the intervention, 5) Child’s implication, 6) Suitability to families’ values, 7) Burden, 8) Perceived effects, 9) Therapeutic alliance. Conclusion: Telerehabilitation seems mor

This paper describes the new International Comprehensive Ocean-Atmosphere Data Set (ICOADS) near-real-time (NRT) Release, (R3.0.2), with greatly enhanced completeness over the previous version (R3.0.1). R3.0.1 had been operationally produced monthly from January 2015 onward, with input data from the World Meteorological Organization (WMO) Global Telecommunication Systems (GTS) transmissions in the Traditional Alphanumeric Codes (TAC) format. Since the release of R3.0.1, however, many observing platforms have changed, or are in the process of transitioning, to the Binary Universal Form for the Representation (BUFR) of meteorological data format. R3.0.2 combines input data from both BUFR and TAC formats. In this paper, we describe: input data sources; the BUFR decoding process for observations from drifting buoys, moored buoys, and ships; and the data quality control of the TAC and BUFR data streams. We also describe how the TAC and BUFR streams were merged to upgrade R3.0.1 into R3.0.2 with duplicates removed. Finally, we compare the number of reports and spatial coverage of essential climate variables (ECVs) between R3.0.1 and R3.0.2. ICOADS NRT R3.0.2 shows both quantitative and qualitative gains from the inclusion of BUFR reports. The number of observations in R3.0.2 increased by nearly one million reports per month, and the coverage of buoy and ship sea surface temperatures (SSTs) on monthly 2°×2° degree grids increased by 20%. The number of reported ECVs also increased in R3.0.2. For example, observations of SST and sea level pressure (SLP) increased by around 30% and 20%, respectively, as compared to R3.0.1, and salinity is a new addition to the ICOADS NRT product in R3.0.2.

Brigitte Vachon,1,2 Guylaine Giasson,3 Isabelle Gaboury,3,4 Dina Gaid,1 Véronique Noël De Tilly,5 Lise Houle,6 Jean Bourbeau,7 Marie-Pascale Pomey8,9 1School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 2Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada; 3Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada; 4Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Convergence Santé, Montreal, Québec, Canada; 6Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada; 7Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; 8Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 9Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, CanadaCorrespondence: Brigitte VachonSchool of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email brigitte.vachon@umontreal.caIntroduction: Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec.Methods: Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care