Biomedical subjects

Robert Gagnon

Publications and source records attributed to Robert Gagnon.

27 records · Page 2Linked to original sources

PubMed2003

Breaking bad news: impact of a continuing medical education workshop.

OBJECTIVE: To evaluate the impact of an interactive continuing medical education workshop designed to help physicians in breaking bad news to their patients. METHODOLOGY: Analysis of post-workshop questionnaires from 539 physicians assessing the retention of the key concepts and the perception of the potential impact of the workshop on their practice immediately after the workshop and six months later. RESULTS: The most significant concepts retained by the respondents are: the need to take into consideration the whole patient (42.7% post-workshop and 45.6% of follow-up responses), the need to be prepared for the consultation (11.6% and 15%), the importance of better guiding the interview (18.8% and 13.6%), and the value of taking more time during the consultation (5.8% and 8.3%). Analysis of paired responses on the post-workshop and the follow-up questionnaires shows that 35% of the concepts retained are identical. CONCLUSION: The majority of physicians retained the key concepts, both immediately following the workshop and in the longer term.

Adaptation, Psychological↗

PubMed2002

Assessment of clinical reasoning competence in urology with the script concordance test: an exploratory study across two sites from different countries.

OBJECTIVES: The script concordance (SC) test is designed to measure the organisation of knowledge that allows interpretation of data in clinical reasoning. This study explores the use of this new written examination tool in urology. MATERIALS AND METHODS: An 80 items SC test was administered to participants from a French and a Canadian university. Three levels of experience were tested: urologists (n = 22), residents in urology (n = 25) and students (n = 23). Scores between groups were compared by analysis of variance. Reliability analysis was studied with Cronbach alpha coefficient. RESULTS: Mean global scores were 51.45 +/- 5.29 for students, 58.19 +/- 3.81 for residents and 62.27 +/- 5.46 for urologists. The difference between the three groups was statistically significant (P < 0.00001). Interaction between levels of expertise and sites was apparently not significant (P = 0.326). Cronbach alpha was 0.79 for the test. CONCLUSIONS: This study shows that the SC test is able to discriminate among participants according to their levels of clinical experience in urology. The results are similar in two different learning environments. The SC test appears as a simple and direct approach to testing organisation and use of knowledge in urology.

Clinical Competence↗

PubMed2002

Amniotic fluid and fetal urinary responses to severe placental insufficiency in sheep.

OBJECTIVE: Our purpose was to test the hypothesis that severe placental insufficiency leads to reductions in fetal urine production and amniotic fluid volume in late-gestation fetal sheep. STUDY DESIGN: At 0.85 of gestation, chronically catheterized fetal sheep with ligated urachus were either embolized for 5 days by repeated injection of boluses of 15-microm microspheres into the common fetal umbilical artery until fetal arterial oxygen content was reduced by 50% (n = 6) or were infused with saline solution (n = 6). Amniotic fluid volume was measured daily before embolization by means of an indicator dilution technique and by drainage at autopsy. Fetal urine production, heart rate, and mean arterial blood pressure were measured continuously for 1 hour before embolization and 1 hour after embolization each day. Fetal arterial blood gases, oxygen content, electrolytes, and osmolality were also monitored. RESULTS: Five days of placental insufficiency, which reduced fetal arterial oxygen content by 50% and arrested fetal growth, resulted in a reduced amniotic fluid volume without a reduction in fetal urine production. Compared with that of controls, amniotic fluid volume was reduced over the 5-day period by 547 +/- 144 mL (-62%, P <.01). Amniotic fluid composition was also altered, with a significant increase in lactate and sodium concentrations and osmolality on days 4 to 5. On days 2 to 5, there was a progressive increase in amniotic fluid osmolality above that of controls, which paralleled the changes in amniotic fluid sodium concentration (P <.05). Fetuses became hypertensive on days 2 to 4 of embolization, although this response was attenuated by day 5. CONCLUSIONS: Chronic severe placental insufficiency caused a reduction in amniotic fluid volume not attributable to reduced fetal urine production. Changes in amniotic fluid composition induced by placental insufficiency suggest an excess intramembranous absorption of amniotic fluid water, in relation to solutes, into the fetal and maternal compartments, which may lead to the development of oligohydramnios.

Amniotic Fluid↗

PubMed2002

Stability of clinical reasoning assessment results with the Script Concordance test across two different linguistic, cultural and learning environments.

The Script Concordance (SC) test is designed to measure the organization of knowledge that allows interpretation of data in clinical reasoning. An originality of the test is that answer keys use an aggregate scoring method based on answers given by a panel of experts. Previous studies have shown that the SC test has good construct validity. This study, done in urology, explores (1) the stability of the construct validity of the test across two different linguistic and learning environments and (2) the effect of the use of experts who belong to different environments. An 80-item SC test was administered to participants from a French and a Canadian university. Two levels of experience were tested: 25 residents in urology (11 from the French university and 14 from the Canadian university) and 23 students (15 from the French faculty, eight from the Canadian faculty). Reliability analysis was studied with Cronbach's alpha coefficient. Scores between groups were compared by analysis of variance. Reliability coefficient of the 80 items test was 0.794 for the French participants and 0.795 for the Canadian participants. Scores increased with clinical experience in urology in the two sites. Candidates obtained higher scores when correction was done using the answer key provided by the experts from the same country. These data support the stability of the construct validity of the tool across different learning environments.

Adult↗

PubMed2002

Methods for data mining from large multinational surveillance studies.

Traditionally, large surveillance studies have been analyzed by the use of the MICs at which 90% of isolates tested are inhibited (MIC(90)s), MIC(50)s, frequency distributions, and percent susceptibility. In the past, these approaches have proved satisfactory for the monitoring of resistance. From these traditional uses, one can readily detect an increase in MICs for organism and drug combinations. Now that large surveillance studies have been conducted for a number of years and databases have grown to include a large number of datum points, new approaches to the extraction of useful information from these studies are needed. The present study proposes approaches, including the use of antibiotypes, principal components analysis, phylogenetics, and population genetic analysis, to the evaluation of data from large multinational surveillance studies. Application of these types of analyses can be used to describe genetic diversity, analyze changes in susceptibility patterns over time, and possibly, shed light on the origins and evolution of antimicrobial resistance. As global surveillance studies become more common and new questions concerning the evolution of resistance are raised, innovative approaches to analysis of the data will increase in importance.

Algorithms↗

PubMed2002

Comparison of an aggregate scoring method with a consensus scoring method in a measure of clinical reasoning capacity.

BACKGROUND: Diversity of clinical reasoning paths of thought among experts is well known. Nevertheless, in written clinical reasoning assessment, the common practice is to ask experts to reach a consensus on each item and to assess students on a unique "good answer." PURPOSES: To explore the effects of taking the variability of experts answers into account in a method of clinical reasoning assessment based on authentic tasks: the Script Concordance Test. METHODS: Two different methods were used to build answer keys. The first incorporated variability among a group of experts (criterion experts) through an aggregate scoring method. The second was made with the consensus obtained from the group of criterion experts for each answer. Scores obtained with the two methods by students and another group of experts (tested experts) were compared. The domain of assessment was gynecology-obstetric clinical knowledge. The sample consisted of 150 clerkship students and seven other experts (tested experts). RESULTS: In a context of authentic tasks, experts' answers on items varied substantially. Amazingly, 59% of answers given individually by criterion group experts differed from the answer they provided when they were asked in a group to provide the "good answer" required from students. The aggregate scoring method showed several advantages and was more sensitive to detecting expertise. CONCLUSIONS: The findings suggest that, in assessment of complex performance in ill-defined situations, the usual practice of asking experts to reach a consensus on each item reduces and hinders the detection of expertise. If these results are confirmed by other researches, this practice should be reconsidered.

Cluster Analysis↗

PubMed2002

Participants' perception of impact of a workshop on their preventive practices.

A 90-minute interactive workshop, offered to small groups on request, was developed to help physicians include evidence-based preventive interventions in their practices. Between 25 September 1996 and 10 December 1997, 593 family physicians throughout the Province of Quebec (Canada) participated in one of the 40 workshops presented in all the regions of Quebec. Almost all participants (98%) completed the self-administered questionnaire. Their opinion of the achievement of three workshop objectives were evaluated using a seven-point Likert scale (-3 to +3)as their perception of the direct impact of the workshop on their practice. The workshop objectives were reached to a high degree: 2.1 (sd 0.90) for prescribing a proper check-up for adults; 1.83(sd 1.02) for explaining to the patient the reasons motivating his/her choice to include or exclude certain tests; 2.09 (sd 0.93)for using concrete and useful tool facilitating the integration of preventive measures in his/her professional practice. Female physicians and those under 40 perceived that the objectives were reached to a greater degree. Participants indicate their intention to modify their practice according to the clinical practice guidelines presented in the workshop.

Adult↗

PubMed2002

Performance assessment. Family physicians in Montreal meet the mark!

OBJECTIVE: To assess the clinical performance of a representative non-volunteer sample of family physicians in metropolitan Montreal, Que. DESIGN: Assessment of clinical performance was based on inspection visits to offices, peer review of medical records, and chart-stimulated recall interviews. The procedure was the one usually followed by the Professional Inspection Committee of the Collège des médecins du Québec. SETTING: Family physicians' practices in metropolitan Montreal. PARTICIPANTS: One hundred randomly selected family physicians. INTERVENTIONS: For each physician, 30 randomly chosen patient charts with data on three to five previous visits were reviewed using explicit criteria and a standard scale using global scores from 1 to 5 (unacceptable to excellent). MAIN OUTCOME MEASURES: Scores were assigned for office practices; record keeping; number of continuing medical education (CME) activities; and quality of clinical performance assessed in terms of investigation plan, diagnostic accuracy, treatment plan, and relevance of care. RESULTS: Overall performance was judged to be good to excellent for 98% of physicians in their private practices; for 90% of physicians concerning CME activities; for 94% of physicians concerning their clinical performance in terms of quality of care; and for 75% of physicians as to record keeping. There was a link between record keeping and quality of care as well as between the number of CME activities and quality of care. CONCLUSION: The overall clinical performance of family physicians in the greater Montreal region is excellent.

Adult↗

PubMedDate not supplied

Pulmonary elastin synthesis and deposition in developing and mature sheep: effects of intrauterine growth restriction.

Hypoxia and nutrient restriction during gestation restrict fetal growth and alter lung development. As elastin is intimately involved in lung development, our aim was to assess pulmonary elastin synthesis and deposition following intrauterine growth restriction (IUGR) induced by umbilicoplacental embolization (UPE). Pulmonary tropoelastin expression and elastin content were examined at 128 days (5 days UPE) and 140 days (20 days UPE) of the 147- days gestation and at 8 weeks and 2.3 years after birth (both approximately 27 days UPE) in sheep. UPE induced hypoxemia, hypoglycemia, and fetal growth restriction but did not affect pulmonary tropoelastin mRNA levels or elastin deposition at any age; furthermore, elastin content was unaltered apart from being lower at 140 days. The authors conclude that hypoxemia and undernutrition associated with IUGR do not affect elastin synthesis and deposition in fetal lungs; alterations in lung structure following IUGR must have other causes.

Animals↗