Type 2 diabetes mellitus (T2DM) continues to be a national challenge for Canadians. African and Caribbean Immigrants are among the most affected groups and those at risk of developing comorbidities and related complications. It continues to prove challenging to treat T2DM for the affected individuals. Effectively treating the disease can help mitigate risk factors for related comorbidities and complications while improving the quality of life for those affected. There is increasing research, outside of Canada, showing the evidence for the effectiveness of culturally sensitive and adapted interventions to immigrant patients affected with T2DM. In light of the effectiveness of such interventions in many industrialized nations, a systematic review (SR) can offer the best evidence for the scope and consideration of such treatment approaches in Canada. This SR aimed to determine whether community-based diabetic interventions in Canada, are culturally sensitive to African and Caribbean minorities living with type II diabetes. A narrative synthesis was employed to report the effect of interventions seeking to affect outcomes of T2DM patients in Canada. Of the 63 articles included for full review, 60 were excluded for not meeting the criteria of having the target population explicitly identified and also not having any mention of cultural sensitivity. Three articles were included for the final review because the target population was explicitly identified. The final results showed that all interventions were found not to be culturally sensitive to African and Caribbean T2DM patients in Canada. Our results suggest a lack in Canadian literature. To the best of our knowledge, this is the very first systematic review on this subject matter in Canada. This review provides dependable information and recommendations to researchers, educators, clinicians, and policy makers for future research with T2DM African and Caribbean patients in Canada. RÉSUMÉ Le diabète de type 2 demeure un défi national pour les Canadiens. Les immigrants d’origine d’Afrique et des Caraïbes sont parmi les groupes les plus frappés et l'un des plus à risque de développer des troubles comorbides et de complications liées au diabète. Traiter le diabète continue à poser un défi chez les personnes affectées. Traiter efficacement cette maladie peut contribuer à réduire des principaux facteurs de risque quant aux troubles comorbides et complications, tout en améliorant la qualité de vie chez les personnes affectées. Un nombre grandissant de recherche, hors du Canada, démontrent avec des preuves concluantes que les interventions sensibles et culturellement adaptées aux immigrants affectés par le diabète sont efficaces. Étant donné l'efficacité de ces interventions dans nombreux pays industrialisés, une revue systématique peut nous offrir la meilleure preuve pour l'envergure relative à ce genre de traitement au Canada. La présente étude méthodique vise à déterminer si les interventions contre le diabète, en milieu communautaires au Canada, sont culturellement adaptées aux minorités ethniques d’origines d’Afrique et des Caraïbes souffrant de diabète de type II. Une synthèse narrative a été utilisée afin de signaler les effets des interventions par rapport aux résultats des patients souffrant du diabète de type 2. Parmi les 63 articles considérés pour une évaluation complète, 60 ont été exclus car ni la population cible ou la mention de la sensibilité culturelle n’a été explicitement identifiée. Trois articles ont été inclus pour l’évaluation finale car la population cible fut explicitement identifiée. Aucune des interventions n’est culturellement sensible aux patients Africains et Caribéen affecté par le diabète de type 2. Nos résultats démontrent un écart dans la littérature Canadienne. A ce que nous sachons, cette revue systématique est la première qui touche à cette question au Canada. Cette revue fournie des données fiables et recommandations qui permettront aux chercheurs, enseignants, cliniciens, et aux décideurs en matière de politiques de santé pour des recherches futures auprès des patients Africains et Caribéen souffrants du diabète de type 2 au Canada.

Introduction: Thromboprophylaxis recommendations for hospitalized cancer are based on trials done for the general medically patients, as there are no randomized clinical trials(RCTs) looking at thromboprophylaxis in medically ill patients with cancer. Methods: To determine if thromboprophylaxis is safe and effective to prevent VTE these patients, a Systematic Review(SR) was done. A survey was performed to assess: clinical equipoise, trial design and minimally clinically important difference(MCID) for a potential trial. Lastly, a pilot study for an RCT was designed. Results: The pooled RR of VTE was 0.91 (95%CI:0.21 to 4.0;I2:68%) among hospitalized cancer patients receiving thromboprophylaxis compared to placebo. 63.9% believe there is clinical equipoise and 58.3% would consider participating in a RCT comparing different agents/dosing. The MCID for absolute reduction in symptomatic VTE between two arms was 2% and for “acceptable” increase in major bleeding events was 1%. Conclusion: The risk-benefit ratio of current doses of thromboprophylaxis administered to hospitalized cancer patients is unclear and additional RCTs are necessary.

Depuis une dizaine d’années, la thérapeutique de pulpotomie totale est proposée dans la littérature pour le traitement pérenne de l’inflammation pulpaire des dents permanentes matures. De nombreuses publications de type essai clinique, étude de cohorte, série de cas ou revue systématique rapportent des résultats convergents qui placent la pulpotomie totale comme une alternative au traitement endodontique conventionnel. Cependant, la procédure reste peu enseignée, la variabilité méthodologique des études, les influences potentielles des fabricants de matériaux et les interprétations dogmatiques peuvent constituer un frein à la diffusion de cette thérapeutique. Des arguments complémentaires semblent nécessaires pour que les cliniciens, les enseignants et les chercheurs puissent appuyer leurs pratiques de soins, d’enseignements et de recherches selon la démarche fondée sur la preuve. Cette thèse constitue une démarche réflexive essentielle à la compréhension des phénomènes qui régissent la guérison à long terme de l’inflammation pulpaire et aux choix méthodologiques qui permettront d’évaluer cette guérison. Ce travail interroge les données bibliographiques pour argumenter les trois questions suivantes : 1°) Pourquoi et comment la pulpotomie totale peut-elle être considérée comme une thérapeutique de l’inflammation pulpaire ; 2°) Quelles procédures doit-on respecter et quels matériaux peut-on utiliser pour considérer la pulpotomie totale comme une thérapeutique à part entière ? 3°) Quels critères peut-on utiliser pour évaluer le succès d’une pulpotomie totale sur dents permanentes ? Ce travail bibliographique est complété par une étude expérimentale au cours de laquelle la fiabilité et la stabilité d’un guide de lecture des images radiologiques ont été vérifiées afin de proposer un outil de formation susceptible d’être appliqué lors de l’évaluation des résultats de la pulpotomie totale. / Full pulpotomy is a therapeutic in which the coronal pulp portion is removed surgically followed by the capping of the remaining radicular pulp. During the last decade, this therapeutic has been reinvestigated as a definitive treatment of pulp pathologies in mature permanent teeth. Converging datas from published studies suggested that full pulpotomy could be recognized as an alternative to root canal treatment. Furthermore, few clinical trials and a meta analysis aimed to evaluate the effect of initial pulp state or pulp capping material on the success of this treatment. However, large variations in the methodology of the studies, potential influence of laboratories of materials and endodontic dogmas are the major obstacles to the promotion of this therapeutic. An evidence-based approach is necessary because incorporates the best evidence in making decisions. This strategy will help clinicians, teachers and researchers to include full pulpotomy in a daily practice This thesis consists to question the scientific literature in order to answer three following questions: 1) Why and how the full pulpotomy should be considered as a treatment of pulp pathologies ? 2) Which procedures could be applied for full pulpotomy ? 3) Which criteria’s could be used to evaluate the outcomes of full pulpotomy ? These literature reviews are completed with an experimental study about an enriched version of a practical guide for the interpretation of PAI score. Its reliability and reproducibility were verified among French undergraduate students. This practical guide will be a useful tool in evaluation of outcomes in endodontics.

Multicenter preclinical studies have been suggested as a method to improve potential clinical translation of preclinical work by testing reproducibility and generalizability of findings. In these studies, multiple independent laboratories collaboratively conduct a research experiment using a shared protocol. The use of a multicenter design in preclinical experimentation is a recent approach and only a handful of these studies have been published. In this thesis, I aimed to provide insight into preclinical multicenter studies by 1) systematically synthesizing all published preclinical multicenter studies; and 2) exploring the experiences of, barriers and enablers to, and the extent of collaboration within preclinical multicenter studies. In Part One, I conducted a systematic review of preclinical multicenter studies. The database searches identified 3150 citations and 13 studies met inclusion criteria. The multicenter design was applied across a diverse range of diseases including stroke, heart attack, and traumatic brain injury. The median number of centers was 4 (range 2-6) and the median sample size was 133 (range 23-384). Most studies had lower risk of bias and higher completeness of reporting than typically seen in single-centered studies. Only five of the thirteen studies produced results consistent with previous single-center studies, highlighting a central concern of preclinical research: irreproducibility and poor generalizability of findings from single laboratories. In Part Two, I performed semi-structured interviews with researchers who have been involved in a preclinical multicenter study. Braun and Clarkes’ thematic analysis was used to identify emerging themes, and the extent of collaboration was evaluated using an established theory of collaboration developed by Wood and Gray. Twelve researchers from 6 studies were interviewed. Most participants indicated that funding and the culture of the scientific community were barriers, and that established relationships and transparency with collaborators were enablers to multicenter studies. Some participants felt that a harmonized protocol was optimal, while others stated that variability in the protocol across sites was more appropriate. Most participants indicated that multicenter studies had a purpose and place in preclinical research. My findings also suggest that multicenter preclinical studies may provide a method to robustly assess therapies prior to considering clinical translation. These insights will allow for more effective planning and execution of future preclinical multicenter projects and may support the development of best practices and guidelines.

Background: Construct validity refers to the degree to which tests that claim to measure a “construct” (i.e., an inferred concept that is intangible regarding an individual’s health or internal state such as a disease, or postulated attribute) are truly reflective of that specific construct. It is suggested that construct validity is an important concept in preclinical research, as it may help reduce misinterpretations of study results allowing for better ability to predict the success of clinical translation of preclinical studies. However, there is a lack of empirical evidence to confirm its impact on preclinical research efficacy. Objectives: (I) Conduct a scoping review of the construct validity literature as it relates to the design of in vivo animal studies. (II) Conduct an overview of systematics reviews evaluating the application and reporting of construct validity within systematic reviews of in vivo animal studies. Methods: For the scoping review, we searched Embase, MEDLINE, and Google Scholar. Eligibility criteria was intentionally broad as we included any article that mentioned construct validity in preclinical in vivo research. Further review of citations was performed on eligible studies that provided substantial discussion on construct validity. For the overview, we searched MEDLINE, Embase, and TOXLINE for systematic reviews of preclinical in vivo interventions. The outcomes of interest were the prevalence of systematic reviews that mentioned construct validity and the prevalence of reviews that assessed construct validity. Results: The literature searches for the scoping and overview yielded 3657 and 2356 articles, respectively. After screening 372 and 444 met inclusion criteria for the scoping and overview. Six codes were generated (theory; mechanism; matches the human condition; measures what it reports to; experimental conditions; and outcomes) from the content analysis for the definition of construct validity. Of the 444 systematic reviews, seven mentioned construct validity, but only three used the term construct validity directly. None of the systematic reviews assessed construct validity. Discussion/Conclusion: Construct validity was not defined uniformly among studies suggesting it is not clearly understood. There was limited reporting on construct validity in systematic reviews and entirely no assessment of it; this may reflect a lack of awareness of this concept. Future research should aim to find a consensus on the definition of construct validity in order to develop tools and frameworks to help researchers assess construct validity.

Bakgrund: Frusen skuldra (FS) är ett smärttillstånd som drabbar 2-5% av befolkningen och som påverkar skulderfunktionen. I dagsläget finns det ingen konsensus kring den bästa behandlingsformen vid FS, dock anses proprioceptiv neuromuskulär facilitering (PNF) ge minskad smärta och ökad rörlighet (ROM) samt skulderfunktion.   Syfte: Att kartlägga evidensen av PNF som behandling vid FS. Det var även att granska kvaliteten i inkluderade studier och att studera effekten av PNF på skulderfunktion och ROM. Metod: En systematisk litteraturstudie. Sökningen utfördes i databaserna PubMed, Cochrane, Web of Science samt Google scholar. Artiklarna kvalitetsgranskades med PEDro scale och tillförlitligheten graderades med GRADEstud.  Resultatsammanfattning: Åtta artiklar inkluderades i studien med totalt 360 deltagare. Enligt PEDro scale varierade kvaliteten i studierna mellan tre till åtta poäng. Evidensgraderingen enligt GRADEstud visade mycket låg (+) evidens gällande skulderfunktion och låg (++) evidens gällande ROM. Graderingen baserades på fyra studier av hög kvalitet vid skulderfunktion respektive ROM. Studiernas resultat var motstridiga gällande huruvida PNF ger en signifikant positiv effekt på skulderfunktion och ROM vid FS. Konklusion: Det finns mycket låg (+) evidens för att PNF skulle ha en effekt på skulderfunktionen och en låg (++) evidens för att PNF har en effekt på ROM. För att förtydliga evidensen och användningen av PNF behövs fler studier av hög kvalitet och med liknande tillvägagångssätt. / Background: Frozen shoulder (FS) is a painful condition affecting 2-5% of the population and it affects the shoulder function. Currently there’s no consensus to which treatment is most effective in FS. However, proprioceptive neuromuscular facilitation (PNF) is assumed to bring pain relief and increase range of motion (ROM) and shoulder function.  Objective: To review the evidence regarding the effect of PNF as treatment in patients with FS. It’s also to examine the quality of included studies and to study the effect of PNF on shoulder function and ROM.  Method: A systematic review. The search was conducted in the databases of PubMed, Cochrane, Web of Science and Google scholar. The quality was assessed according to PEDro scale and the reliability with GRADEstud.  Results: Eight studies were included with a total of 360 participants. The quality of the studies ranged between three to eight points according to PEDro scale. According to GRADEstud PNF received very low (+) evidence for shoulder function and low (++) evidence for ROM. The grading was based on four, high quality studies for both shoulder function and ROM. The included studies were conflicting regarding whether PNF had a significant, positive effect on shoulder function and ROM in FS.   Conclusion: There’s very low (+) evidence that PNF would have an effect on shoulder function and low (++) evidence that PNF has an effect on ROM. In order to clarify the evidence there’s a need for future well-conducted studies with a similar approach.

Aims and objectives: To analyse the perceived characteristics of an effective nursing clinical instructor and methods for measure instructor effectiveness. This review also examined importance of characteristics based on student age. Background: The clinical instructor has a vital role in clinical education. While the role may be well defined, the characteristics these instructors need to do their jobs effectively are not. Design: An integrative review from 1985 to present using four key terms: nursing, clinical, teaching and effectiveness. This review revealed 37 articles that met the inclusion criteria for analysis. Methods: Inclusion criteria included studies related to nursing clinical teaching effectiveness of the clinical instructor in a direct patient care setting. An integrative review table of the studies was made by the author. Keywords were analyzed in the results column, and same concepts were grouped together. Results: A synthesis of current research revealed three dominant themes: competency, the ability to develop interpersonal relationships and certain personality traits. The analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor. The analysis also revealed a difference regarding the priority of characteristics based on age of the student. Conclusion: The analysis of the literature suggests the ability to develop interpersonal relationships is the most valued skill for clinical instructors. Overall, approachability emerged as the most important personality trait needed to be an effective clinical instructor. Relevance to clinical practice: Future studies should continue to evaluate the extent of the dominant themes especially considering the rise of the millennial student generation.

Emerging evidence has demonstrated the strong link between cardiorespiratory fitness and multiple aspects of health (i.e., physiological, physical, psychosocial, cognitive), independent of physical activity, among school-aged children and youth. Cardiorespiratory fitness is a trait that does not vary substantially from day-to-day, and provides an indication of recent physical activity levels, making it an important possible indicator of population health. Thus, the objective of this dissertation was to investigate the utility of cardiorespiratory fitness, measured using the 20 m shuttle run test, as a broad, holistic health indicator for population health surveillance among children and youth. To achieve this objective we completed seven manuscripts, all prepared for submission to peer-reviewed, scientific journals: 1. Systematic review of the relationship between 20 m shuttle run performance and health indicators among children and youth. 2. Review of criterion-referenced standards for cardiorespiratory fitness: What percentage of 1 142 026 international children and youth are apparently healthy? 3. Cardiorespiratory fitness is associated with physical literacy among Canadian children aged 8 to 12 years. 4. International variability in 20 m shuttle run performance in children and youth: Who are the fittest from a 50-country comparion? A systematic review with pooling of aggregate results. 5. Making a case for cardiorespiratory fitness surveillance among children and youth. 6. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. 7. Temporal trends in the cardiorespiratory fitness of 965 264 children and youth representing 19 countries since 1981. Combined, this dissertation provides support for the importance of cardiorespiratory fitness for health surveillance among school-aged children and youth. Results from the international analysis highlighted the variability across countries, with countries in North-Central Europe and Africa having the highest cardiorespiratory fitness, and countries in South America having the lowest cardiorespiratory fitness. The results indicated that declines in cardiorespirtory fitness may have stabilized in recent years in some high- and middle-income countries. This dissertation also identified two methods (criterion- and normative-referenced standards) to interpret cardiorespirtory fitness levels among children and youth, methods that could be used to inform future consensus, surveillance, and cardiorespiratory fitness guidelines.

En la actualidad, los investigadores dedican una buena cantidad de tiempo en la detección y búsqueda de artículos científicos relevantes de forma manual. El desarrollo de estas investigaciones se realiza de forma empírica sin tener en cuenta un modelo tecnológico para el cumplimiento de estándares en su proceso. Por ello, de un tema particular, el proceso rara vez es sustentado con algún procedimiento sistemático para garantizar que se revisó de manera objetiva y que todo el material pertinente está incluido. Existen procedimientos y marcos de trabajo en otras disciplinas como la medicina, pero no son ampliamente conocidas o utilizadas en las demás carreras. Este proyecto propone un Modelo de Gestión, soportado por distintas herramientas de software, con el fin de automatizar la fase de planificación de la revisión sistemática. Esta propuesta se realizó mediante la necesidad de mejorar la satisfacción del investigador al momento de realizar búsquedas de papers relacionados a sus trabajos de investigación. Se desarrolló una interfaz web como canal entre el Modelo de Gestión propuesto y el investigador, con el fin de mostrar el resultado obtenido por el modelo indicando mejoras en tiempo y calidad al momento de realizar búsquedas de papers. Además, como Plan de continuidad se propone un proyecto en base a las siguientes fases de la revisión sistemática, apoyándonos en la revisión de la literatura obtenida en la etapa de análisis del modelo propuesto. / Currently, researchers spend a good amount of time detecting and searching for relevant scientific articles manually. The development of these investigations is done empirically without taking into consideration a technological model for compliance with standards and process. Therefore, on a particular issue, the process is rarely supported by any systematic procedure to ensure that it was objectively reviewed and that all relevant material is included. There are procedures and frameworks in other disciplines such as medicine, but they are not widely known or used in other careers. This project proposes a Management Model supported by different software tools, in order to automatize the planning phase of the systematic review. This proposal was made through the need to improve the satisfaction of the researcher when searching papers related to their research work. A web interface was developed as a link between the proposed Management Model and the researcher, in order to show the result obtained by the model giving improvements in time and quality when searching papers. In addition, as a Continuity Plan, a project is proposed based on the following phases of the systematic review, based on the review of the literature obtained in the analysis stage of the proposed model. / Tesis

OBJECTIVE: To conduct a cost-effectiveness analysis of riociguat and bosentan in the management of chronic thromboembolic pulmonary hypertension (CTEPH) from a United States payer perspective. METHODS: A Markov model was developed following the recommendations of the International Society of Pharmacoeconomics and Outcomes Research - Society for Medical Decision Making Modeling Good Research Practices. A cohort of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH were simulated over their lifetime. Health outcomes were measured as quality-adjusted life years (QALY). Efficacy and safety data were obtained from BENEFiT and CHEST-1 trials. Drugs costs, associated costs for the management of CTEPH, were obtained from Redbook and published information such as the Healthcare Cost and Utilization Project (HCUPnet) and Centers for Medicare & Medicaid Services Physician Fee Schedule. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model projections. RESULTS: Riociguat was more effective than bosentan with an incremental cost of $132,065 and an incremental quality-adjusted life year (QALY) of 0.20, corresponding to an incremental cost-effectiveness ratio (ICER) of -$649,380 per QALY (in favor of riociguat). Riociguat had a lower total discounted lifetime cost compared to bosentan ($2,307,488 versus $2,439,555). Probabilistic sensitivity analyses confirmed dominance of riociguat in 74% of the Monte Carlo simulations. CONCLUSIONS: Results of this model indicates that riociguat is more effective and less costly than bosentan in the management of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH.