The goal of this pilot randomized clinical trial is to test the efficacy of an intervention combining virtual reality and hypnosis on decreasing pain and improving quality of life in elderly patients with hand arthritis. The main questions it aims to answer are:
* Does the intervention allow for an improvement of patient reported outcomes related to pain and quality of life?
* Does the intervention allow for an improvement of physiological variables related to pain? Researchers will compare intervention group to a passive control group (i.e., waiting list with treatment as usual).
Participants in the intervention group will be provided a virtual reality headset allowing them to beneficiate from the virtual reality and hypnosis modules.

开始日期2025-04-01

申办/合作机构

CIUSSS de lEst-de-lÎle-de-Montréal

NCT06817759

/ Not yet recruitingN/AIIT

Study Protocol for the Development of an Intervention Integrating Procedures Combining Hypnosis and Virtual Reality in the Support of Patients with Myeloma and Lymphoma During Stem Cell Transplant: a Pilot Randomized Clinical Trial

Research into cancer patients has shown that quality of life is significantly altered by the disease and its associated treatments and is also reported to be a predictor of significant emotional distress. Blood cancer patients are among those most affected in terms of quality of life, facing stem cell transplantation after high-dose chemotherapy, a treatment that is recognized as one of the most stressful of cancer therapy, due to the many adverse effects, including pain, and the uncertainty linked to the fear of graft failure. Hypnosis interventions are proving effective in treating common side effects: nausea, pain, fatigue, anxiety, depressive symptoms and improving overall quality of life, and other interventions, based on virtual reality, have shown promising effects on patients' distress and acute pain. The aim of this study is to evaluate the effects of an intervention program combining hypnosis and virtual reality in assisting myeloma and lymphoma patients during stem cell transplantation, with a view to improving their quality of life during this period. The project aims to assess the validity of the intervention, and to evaluate the effects of the intervention on patients' anxiety, pain and fatigue during transplantation. The validity of the intervention will be measured by a questionnaire assessing the relevance and acceptability of the intervention, expected effects, and practical implementation. Socio-demographic and clinical data will be collected from patients, including axiety, pain, fatigue and quality of life, studied at pre (one week after transplantation) and post (one month after transplantation) intervnention, and at follow-up (three month after transplantation).

开始日期2025-02-01

申办/合作机构

CIUSSS de lEst-de-lÎle-de-Montréal

NCT06684197

/ Not yet recruitingN/AIIT

The Impact of a Dexmedetomidine Perfusion on Intraoperative Remifentanil Consumption: a Randomized Controlled Trial

Opioids analgesic are the gold standard for intraoperative pain management. Their short- and long-term adverse effect motivate anesthesiologists to explore opioid sparing strategies. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist that could help minimize opioid consumption both intraoperative and postoperative due to its sedative, analgesic and sympatholytic properties. This new randomized controlled trial (RCT) will answer the question whether an intraoperative dexmedetomidine infusion compared to placebo has a clinically significant impact on intraoperative remifentanil consumption during a laparoscopic abdominal elective surgery.

开始日期2024-11-01

申办/合作机构

CIUSSS de lEst-de-lÎle-de-Montréal

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2025-03-01·Nursing Ethics

Exploring inappropriate levels of care in intensive care

Article

作者: Ahern, Stéphane ; Vandal, Esther ; D’Anjou, Bénédicte ; Saint-André, Anne-Charlotte ; Martel, Valérie ; Racine, Eric ; Royer, Laetitia

BackgroundLevels of care deemed as inappropriate generate moral distress among nurses and other intensive care professionals. Inappropriate levels of care and related moral distress are frequently broached as individual and psychological phenomena, reduced to how individuals feel and think about specific cases. However, this tends to obscure the complex context in which these situations occur, and on which healthcare professionals can act. There is thus a need for a more contextual and team-level lens on inappropriate levels of care.Research objectiveThis study aims to explore and understand the issue of inappropriate levels of care in an intensive care unit (ICU) through a contextual and team-level lens.Research designSemi-structured interviews were conducted with nurses, respiratory therapists, and intensivists. Thematic analysis focused on understanding the causes and consequences of inappropriate levels of care, as well as potential avenues for improvement. This study is part of a 5-phase participatory living lab project on inappropriate levels of care conducted in the ICU of a Montreal (Quebec, Canada) hospital. This paper relates the initial phases of the project, focusing on understanding the issue, with reported events spanning from June 2022 to May 2023.Ethical considerationsEthics approval was sought and granted by the Research Ethics Board of the CIUSSS de l’Est-de-l’Île-de-Montréal.Findings/DiscussionFive broad themes intrinsically related to the phenomenon of inappropriate levels of care were explored with and by participants: (1) the process of determining levels of care, (2) the distinction between appropriate and inappropriate levels of care, (3) causes of inappropriate levels of care, (4) consequences of inappropriate levels of care and (5) potential avenues for improvement.ConclusionThis research provides a comprehensive understanding of inappropriate levels of care in the ICU and emphasizes the relevance of team-level explorations of complex ethical issues.

2025-02-25·Canadian Liver Journal

Discrete choice experiments and conjoint analyses in health screening programs for type 2 diabetes and liver disease: a scoping review

作者: Dinh, Duy A ; Sebastiani, Giada ; Patel, Keyur ; Long, Clara ; Betel, Michael ; Ramji, Alnoor ; Swain, Mark ; Poder, Thomas G ; Gore, Genevieve ; Cinque, Felice ; Saeed, Sahar ; Dasgupta, Kaberi ; Bajaj, Harpreet S

Background: We aimed to summarize the evidence on the use of discrete choice experiments (DCEs) and conjoint analyses to quantify stakeholders’ preferences for screening programs for type 2 diabetes (T2D) and liver diseases, with a specific focus on metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: For this scoping review, five databases (MEDLINE [PubMed], PubMed Central, EMBASE [Ovid], Europe PMC, Google Scholar) were searched with the assistance of a librarian, and deduplicated records were screened by two independent reviewers. Inclusion criteria: using DCE/CA, addressing screening programs for T2D and liver disease, published in English, French, or Spanish after January 1990. Results: Among 2,282 studies, 9 (7 from high- and 2 from low-income countries) elicited preferences for screening for liver disease (n = 1), hepatitis C (n = 1), hepatitis B (n = 1), hepatocellular carcinoma (n = 2), noncommunicable diseases (n = 2), diabetic retinopathy (n = 1), and cardiovascular diseases (n = 1). No studies addressed MASLD screening in T2D. Stakeholders included patients (n = 3), health care providers (n = 1), patients plus health care providers (n = 1), and the general population (n = 3). Studies used 18 structure, 6 process, and 4 outcome attributes. Screening sensitivity, setting, duration, provider, and cost were the most important structure attributes in participant choices. Physician support for treatment was the preferred process attribute. Outcome attributes were the least used, but of major importance (screening adherence followed by treatment) when considered. Conclusions: With no study focusing on MASLD screening in T2D, our scoping review highlights the need to develop a DCE addressing this topic to better design a patient-centred continuum of care.

2025-02-01·Documenta Ophthalmologica

Hilbert transform analysis of the mouse scotopic electroretinogram reveals two distinct bursts of oscillatory potentials with progressively dimmer flashes

Article

作者: Lachapelle, Pierre ; Polosa, Anna ; Gauthier, Mercedes ; Lina, Jean-Marc

PURPOSEStudy the scotopic oscillatory potentials (OPs) in mice over a wide range of flash luminance levels using the Hilbert transform (HT) to extract new features of the high frequency components of the electroretinogram (ERG).METHODSScotopic ERGs [Intensity: - 6.3 to 0.9 log cd∙s∙m^-2; 12 h of dark-adaptation] were obtained from adult mice (C57BL/6; n = 7). The Hilbert transform (HT) was obtained within 3 consecutive frequency bands (65-90 Hz, 90-115 Hz and 115-140 Hz), with OPs being denoised, automatically identified and analyzed. Measurements included: number of OPs, duration of the OP response, surface-under-the-curve (SUC) of the HT envelopes, implicit times, and instantaneous frequency at the HT envelope peak, mean peak time differences (PTD) between the envelopes of each frequency band (measuring their synchrony), correlation coefficient and lag between consecutive HT envelopes, as well as the number of peaks on the HT envelopes.RESULTSThe OP response duration, number of OPs and PTD all peaked for flashes between the level corresponding to the RodVmax (maximal b-wave amplitude of the rod ERG; i.e., the first asymptote of the scotopic luminance-response curve) and K (the flash luminance at which the amplitude of the b-wave is half of that of the RodVmax;), i.e., between -3.9 and -2.4 log cd∙s∙m^-2. The correlation between consecutive envelopes is close to 1 at flashes > -1.2 log cd∙s∙m^-2, with small lags (min. = 1.93 ± 0.45 ms at - 1.2 log cd∙s∙m^-2), then gradually drops to 0.81 ± 0.02 at the dimmest flash intensity (with a max. lag = 14.76 ± 8.92 ms at - 5.1 log cd∙s∙m^-2). Finally, we found that the single OP burst (i.e., a single HT envelope peak) seen at flash intensities > - 1.2 log cd∙s∙m^-2 progressively divided in two (or more) OP bursts (i.e., multiple HT envelope peaks) with gradually dimmer flashes.CONCLUSIONSOur HT method enabled the analysis of the OP response without the subjective interpretation of the experimenter. Analysis of the scotopic OPs at dim flashes with the HT revealed a novel feature of the OP response not yet reported elsewhere, namely: a split of the OP response into two (or more) distinct bursts. Furthermore, the synchrony peak (measured with the PTD) matched the peak in OP response duration between K and RodVmax, suggesting a disorganization (or dephasing) of the retinal signal in ERGs evoked for weaker flashes. The increased synchronization and correlation of the single burst observed for the strongest flashes could suggest an optimization or saturation of the retinal response. We believe that these novel features of the OP components of the ERG went unnoticed given that previous studies did not use weak enough flashes and failed to recognize the added value that time and frequency domain analysis of the ERG (such as what is achieved with the HT) brings to the interpretation (and our understanding) of the retinal response.

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