Yes / Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. / The Lifestyle Matters RCT was funded by the Medical Research Council (grant number G1001406); Sheffield Health and Social Research Consortium; National Institute for Health Research Public Health Research programme (project number 09/ 3004/01)

Yes / Living well with dementia is promoted nationally and internationally (Department of Health, 2009: Global Action Against Dementia, 2013). UK health policy recommends post-diagnostic support to enable people to live well in the community for as long as possible (Department of Health, 2015; NHS England, 2017; Scottish Government, 2017; Welsh Government, 2017). This is important given that a cure for dementia is not imminent. A growing evidence base demonstrates that psychosocial interventions can benefit people with mild to moderate dementia, by improving cognition, performance in valued activities or daily living skills, maintaining quality of life or carer coping. (Clare et al., 2011;2017; Graff et al.,2006,2007; Streater et al.,2016). Occupational therapists offer interventions to people living with mild to moderate dementia and family carers (Swinson et al.,2016;Streater et al.,2016;Yuill and Hollis,2011). The National Institute for Clinical Excellence and Social Care Institute for Excellence (2006) recommended occupational therapists provide skills training for activities of daily living. Also, the Memory Services National Accreditation Programme recommends people with dementia have access to occupational therapy and other psychosocial interventions such as reminiscence, life story work or cognitive stimulation therapy, for the cognitive, emotional, occupational and functional aspects of dementia (Hodge et al.,2016). Such interventions can be delivered by occupational therapists. The focus on the benefits of non-pharmacological interventions provides occupational therapists with an opportunity, to deliver services that improve lives and the experience of dementia (Collier and Pool, 2016). Understanding what may influence uptake of such interventions is important if people with dementia and their carers are to benefit from what occupational therapists can offer. Yet what supports the uptake of such interventions, specifically by people with mild to moderate dementia and their family carers, living in the community is poorly understood and limited research about this topic exists. ‘Uptake’, in this paper, is defined as initial acceptance of an offer, of intervention, support or services, rather than continued engagement or adherence to an intervention over time. / National Institute for Health Research’s Programme Grants for Applied Research Programme (RP-PG 0610-10108)

Yes / National policies and evidence reviews recommend psychosocial interventions (PIs) as an essential support, particularly in the period following dementia diagnosis. However, the availability and uptake of these interventions is comparatively low. One of the reasons for this is that clinicians lack information about what might be provided and the potential benefits of different interventions. This paper identifies and describes psychosocial interventions for community dwelling people following diagnosis of mild to moderate dementia and presents the available evidence to inform practice decisions. A systematic scoping review was employed to map the evidence relating to PIs for this group. This identified 63 relevant studies, testing 69 interventions, which could be grouped into six categories; 20 cognition-oriented interventions; 11 behaviour-oriented; 11 stimulation-oriented; 13 emotion-oriented, 5 social-oriented and 9 multi-modal. There were three targets for outcome measurement of these PIs; the person with dementia, the family carer and the person-carer dyad. Over 154 outcome measures were identified in the studies with outcomes measured across 11 main domains. The lack of a classification framework for PIs means it is difficult to create a meaningful synthesis of the breadth of relevant evidence to guide clinical practice. Possible dimensions of a classification framework are proposed to begin to address this gap.

Yes / Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements. / We gratefully acknowledge financial support from the Health Foundation (grant number 1274233).

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur. / Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal. / La thèse porte sur le développement et la mise à l'essai d'interventions pédagogiques en enseignement de l'art dramatique. Elle vise la réduction de problèmes comportementaux au moyen de l'application de concepts de la communication interactive et pragmatique. La recherche implique l'étude de la relation entre le fonctionnement de la communication et les procédés utilisés. La méthodologie adoptée est de type exploratoire avec niveau d'analyse qualitative. Elle permet de mettre au point 17 plans d'intervention regroupés par thèmes selon les caractéristiques des situations problématiques et d'établir des modes d'observation des effets produits en considérant un certain nombre de variables. La conclusion rappelle l'ensemble des procédés utilisés en art dramatique et indique que les techniques paradoxales peuvent contribuer à la réduction des problèmes de communication entre élève (s) et enseignant. Les limites de l'étude concernent le nombre restreint de procédés utilisés, la durée relative des changements et le temps nécessaire à l'élaboration et à la maîtrise de l'intervention. L'originalité de la thèse réside dans la métaphorisation de messages pédagogiques qui peuvent provoquer des changements autant chez les élèves que chez les enseignants.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12 month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12 second epochs 5 minutes before, during and 5 minutes after oral care. The mixed effect repeated measures ANOVA model indicated that there was a statistically significant increase in ICP in response to oral care (p=0.0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of pre-existing elevated ICP.

L'autisme est un trouble universel et plusieurs études confirment la présence de l'autisme en Inde. Il y a de plus en plus d'études en Inde mais il manque encore d'informations précises sur les types d'interventions les plus utilisés. La qualité de vie des parents d'enfant avec autisme, reste un champ de recherche, encore peu exploité au niveau international. La qualité de vie parentale peut apporter une richesse d'informations afin d'adapter au mieux les interventions aux besoins de l'enfant et de sa famille. Les représentations sociales sur l'autisme nous permettent d'identifier des cognitions liées à l'autisme chez les parents et des professionnels indiens. Dans cette étude nous décrivons les caractéristiques de 15 enfants les interventions mise en place et la qualité de vie des mères et nous analysons les liens entre ces trois aspects. Nous établissons également une comparaison entre l'Inde et la France. Les résultats montrent des liens entre le nombre d'heures d'interventions et les caractéristiques adaptatives et psychologiques de l'enfant ainsi qu'avec la qualité de viedes mères. L'étude comparative montre des différences dans le profil adaptatif des enfants et les interventions des deux pays. Une deuxième partie aborde les questions des représentations sociales de l'autisme de 30 parents et 30 professionnels indiens et montre des différences entre les représentations des deux groupes. / Autism has been now established to be universal and several studies have confirmed the presence of Autism in India. There are an increasing number of studies in India but there is not much precise information on the most commonly used intervention techniques. The quality of life of parents of children with autism is an area of research that has not been sufficiently exploited despite its potential to influence intervention techniques and its adaptation to the child's and the family's unique situation. Social representations of autism will allow us to identify cognitions of parents and professionnels related to autism. In this study, we describe the characteristics of 15 children with autism, the quality of life of their mothers and the intervention techniques used. We also study the relationship between these three factors. A comparative study of these aspects between India and France is done. The results show links between the hours of interventions and the children's adaptive behaviour and psychological characteristics as well as with the quality of life of mothers. The comparative study shows differences in adaptive behaviour and intervention techniques between the two countries.A second part of the study deals with social representation of autism in 30 parents and professionals of autism. This study shows differences in the representations between the two groups.

Contexte : L'insuffisance cardiaque (IC) est un syndrome aux étiologies variées, et hétérogène dans ses présentations cliniques, dont l'incidence augmente avec l'âge et dont le pronostic reste sombre. Les facteurs pronostiques dans l'IC ont été largement décrits dans la littérature, en particulier dans l'IC à fraction d'éjection réduite (ICFER), à plus ou moins long terme. Des interventions thérapeutiques médicamenteuses, chirurgicales, ou complexes sont recommandées pour traiter ce syndrome. Objectifs : Les objectifs de ce travail étaient d'évaluer la valeur pronostique des marqueurs de fibrose chez les patients hypertendus, de décrire la survie et d'identifier les facteurs pronostiques chez les patients en IC, à très long terme chez les ICFER, et à 1 an chez les IC à fraction d'éjection préservée (ICFEP), et de mesurer l'impact sur les hospitalisations de 2 interventions complexes recommandées. Méthodes : Une première étude de cohorte a été menée chez des patients hypertendus, avec un recueil à l'inclusion des dosages sériques des marqueurs du renouvellement de la matrice extracellulaire cardiaque (MRMEC) et un suivi pendant 6 ans. Deux autres études de cohorte ont permis d'identifier les facteurs pronostiques de décès à 15 ans chez des patients ICFER (EPICAL), et à 1 an chez les ICFEP (Odin). Enfin, les données du PMSI ont permis de mesurer l'impact pronostique de la prise en charge dans une unité spécialisée (UTIC) et d'une prise en charge de type disease management (ICALOR). Résultats : La première étude a mis en évidence la valeur pronostique des MRMEC chez des patients hypertendus. L'étude EPICAL a montré que l'âge avancé, le diabète, l'insuffisance rénale chronique, l'ancienneté de l'IC, les antécédents de décompensation, la tachycardie, une fraction d'éjection réduite, et une hyponatrémie étaient associés à une mortalité plus élevée à 15 ans chez les ICFER. L'étude ODIN a montré la valeur pronostique négative de facteurs sociaux comme le fait de vivre seul ou la limitation des activités, chez les ICFEP. Enfin, les prises en charge en UTIC et par le réseau ICALOR étaient associées à une diminution des hospitalisations pour IC, mesurable à l'échelle populationnelle. Conclusion : Ces travaux permettent d'envisager de nouvelles pistes de prévention primaire et secondaire, afin de diminuer l'incidence, la morbidité et la mortalité liées à l'IC / Context: Heart failure (HF) is a heterogeneous syndrome with various aetiologies. HF incidence increases with age, and the prognosis remains poor. Prognostic factors have been widely described in the literature, especially in HF with reduced ejection fraction with short-term or mid-term follow-up. Medications, surgical interventions, and complex interventions are part of the current guidelines. Objectives: To assess the prognostic value of fibrosis markers in hypertensive patients; to describe the survival and to detect prognostic factors, first at 15 years in HF patients with reduced ejection fraction (HFREF), and second at one year in HF patients with preserved ejection fraction (HFPEF); and to assess the prognostic impact of 2 complex interventions on HF hospitalisations. Methods: Cardiac extracellular matrix serum markers (CEMSM) were assessed at baseline in a first cohort of hypertensive patients followed-up for 6 years. Two other cohort studies were used to detect prognostic factors associated with very-long term mortality in HFREF (EPICAL), and with 1-year mortality in HFPEF (Odin). And the national diagnostic related group database was used to assess the prognostic impact of a HF unit (UTIC) and a disease management programme (ICALOR). Results: The first cohort study highlighted the prognostic value of CEMSM in hypertensive patients. In EPICAL study, older age, diabetes mellitus, chronic renal failure, time from HF onset, history of hospitalisations for worsening HF, tachycardia, a low left ventricular ejection fraction, and hyponatraemia were associated with a higher mortality in HFREF patients. In Odin study, we highlighted the negative prognostic impact of social factors, such as living alone or daily activity limitation, in HFPEF patients. Both UTIC and ICALOR were associated with a decrease in HF hospitalisations compatible with a population impact. Conclusion: These studies offer new insights for primary and secondary prevention strategies that could eventually lead to decrease HF incidence, HF morbidity, and HF mortality

Evidence-based practices utilized by social workers working with veterans experiencing physical (e.g., spinal cord injuries and loss of limbs) and/or mental health (e.g., posttraumatic stress disorder, depression, substance use) issues are widely used with this vulnerable population. The number of social workers integrating animal-assisted interventions (AAI) or animal-assisted therapy (AAT) as a complementary intervention to these practices is extremely limited. A significant amount of research has been published on AAI and AAT, yet there is a gap in research regarding AAI and AAT as effective complementary approaches when working with veterans. The qualitative method utilized in this study was interviews in which MSWs and LCSWs were asked to share personal experiences while employed at veteran-supported agencies and/or non-profit organizations. The qualitative method of interviews and content analysis were used to help identify the themes and sub-themes of this study. The themes and sub-themes supported the phrases and statements drawn from the seven interviews conducted for this study. Findings supported in this study addressed the value of the human-animal bond, how integrating AAI and AAT with evidence-based practices can assist the veteran in improving quality of life (e.g., a decrease in social isolation, increase in social activity, decrease in substance use), and how important it is to recognize the need to provide the education in this field to social workers. Findings from this study can help to provide the foundation for future research, can underscore the value of offering and integrating AAI and AAT education into more MSW programs, and can contribute to establishing policy where those who can benefit by AAI and AAT are given access to it.