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Type d'Item : Item , Advancing the Care Experience for Patients Receiving Palliative Care as They Transition from Hospital to Home (ACEPATH): A Mixed Methods Approach on Evaluating the Readiness for Hospital Discharge of Palliative Care Patients and Caregivers(Université d'Ottawa | University of Ottawa, 2026-09-01) Rasaputra, Prabasha; Isenberg, SarinaObjective: To examine the association between receipt of the ACEPATH intervention and readiness for hospital discharge, comparing readiness scores pre- and post- intervention administration, as well as integrating RHDS scores with qualitative open-text responses to better understand the “how” of the effectiveness of ACEPATH in improving readiness for hospital discharge. Methods: We conducted a single-arm pilot intervention study, where palliative care patients and their caregivers received the ACEPATH intervention in the form of a guidebook and the delivery of the guidebook by a healthcare provider. We evaluated readiness for hospital discharge using an adapted RHDS for this context, and collected reflection question responses once participants were at home. Results: 13 participants completed the RHDS before and after the ACEPATH intervention was administered, with a median overall increase from 7.20 before the intervention to 7.87 after the intervention (p=0.002). Participants also experienced increased scores among the Knowledge, Personal status, and Coping ability domains, which may be partly attributable to the intervention. Mixed-methods integration suggested that the intervention impacted participants by providing information and reassurance through the guidebook and discussions with the facilitators, although medical complexity and limited social supports constrained benefits for some participants. Conclusions: This pilot study provides preliminary evidence that the ACEPATH intervention may increase participant readiness to be discharged, with the adapted RHDS showing good internal consistency in assessing readiness. Improvements in the knowledge and coping ability domains suggest that structured information sharing, and facilitator-guided discussions may be valuable components of supporting a hospital-to-home transition.Type d'Item : Item , Mieux comprendre les services cliniques dans l'Est ontarien pour les adultes en situation de handicap intellectuel qui présentent des comportements à défis(Université d'Ottawa | University of Ottawa, 2026-09-01) Quenneville, Danika; Cobigo, VirginieCette thèse vise à mieux comprendre le fonctionnement des services cliniques communautaires spécialisés destinés aux adultes en situation de handicap intellectuel (HI) présentant des comportements à défis dans l’Est ontarien. Malgré l’existence de modèles de services et de lignes directrices cliniques, les connaissances demeurent limitées quant à la manière dont ces services sont concrètement mis en œuvre dans la pratique, particulièrement dans des contextes caractérisés par une complexité clinique et organisationnelle importante. Cette recherche adopte une approche qualitative et s’appuie sur deux études complémentaires. L’Étude 1 vise à décrire l’organisation et le fonctionnement du modèle de services à partir d’entrevues menées auprès de membres de l’équipe clinique et de l’analyse de dossiers cliniques. Cette étude permet de documenter les trajectoires de services, les étapes du processus de prestation ainsi que les rôles des différents acteurs impliqués. L’Étude 2 vise à approfondir cette compréhension en explorant la mise en œuvre du modèle de services dans la pratique, à partir des perspectives des adultes en situation de HI ayant reçu les services ainsi que de celles des intervenants. Cette thèse contribue à la littérature en offrant une compréhension intégrée des dimensions cliniques et organisationnelles de la mise en œuvre des services, en mettant en lumière les mécanismes par lesquels ces dimensions interagissent pour soutenir ou entraver la prestation de services. Les résultats mettent en évidence l’importance de la flexibilité, de la collaboration interdisciplinaire, de la continuité des services et de l’adaptation aux besoins complexes des personnes, tout en soulignant les tensions liées aux contraintes de ressources et aux exigences organisationnelles. Dans l’ensemble, cette thèse offre des pistes concrètes pour le développement, l’organisation et l’amélioration des services communautaires spécialisés destinés aux adultes en situation de HI présentant des comportements à défis, tout en contribuant à l’avancement des connaissances sur la mise en œuvre de modèles de services dans des contextes complexes.Type d'Item : Item , A Hybrid Approach to Supported Attachment of Clinically Complex Patients With Multimorbidity: A Patient Experience Survey(2026-08-24) Fitzsimon, Jonathan; St-Amant, Antoine; McLeese, LindsayIn July 2026, patients in the Supported Attachment Program (Renfrew County, Ontario) were invited to complete a short survey about their experiences. The survey was offered in two ways: online and by physical mail. This report includes a total of N=115 responses (89 online and 26 by mail). The survey asked questions about the program, rated on a five-point Likert-scale (Q1-Q7). An open-text question (Q8) invited additional feedback.Type d'Item : Item , Evaluating the Use and Impact of Hybrid Approaches in Primary Care: A Scoping Review Protocol(2026-08-24) Ornella Mefotse Saha, Cyrelle; St-Amant, Antoine; Fitzsimon, JonathanBackground: Hybrid approaches to primary care, which integrate in-person and virtual modalities within coordinated models of care, have expanded rapidly since the COVID-19 pandemic. However, evidence on their use, implementation, and impact remains diverse and unevenly synthesized. Objective: This scoping review will map the literature on the use and impact of hybrid approaches in primary care and examine reported outcomes across the Quintuple Aim Framework, with environmental impact considered as an additional domain. Methods: The review will follow established scoping review methodology and will be conducted in collaboration with a health sciences librarian at the University of Ottawa. Searches will be conducted in PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase, supplemented by grey literature and hand-searching. Eligible sources will describe or evaluate hybrid approaches to primary care or urgent care published in English or French from 2020 onward. Screening and data extraction will be conducted by two reviewers using Covidence, with discrepancies resolved through discussion or by a third reviewer. Conclusion: Findings will clarify how hybrid primary care approaches are defined, implemented, and evaluated, and will identify gaps to inform future research, policy, and practice.Type d'Item : Item , Successful corticosteroid-free management of anti-HMG–CoA reductase immune-mediated necrotizing myopathy with subcutaneous immunoglobulins monotherapy: a case report(2026-06-16) Wilk, Nikola; Cowan, Juthaporn; Booth, Ronald A.; Warman-Chardon, Jodi; Maltez, Nancy; Ivory, CatherineAbstract Background Given the high rate of cardiovascular comorbidities in anti-HMG–CoA reductase (HMGCR)–immune-mediated necrotizing myopathy (IMNM), a glucocorticosteroids (GC)-free treatment approach remains an appealing strategy. While intravenous immunoglobulins (IVIg) represents an effective therapy in most subgroups of idiopathic inflammatory myositis (IIM), there remains limited evidence supporting the use subcutaneous immunoglobulins (SCIg), a potentially safer, more convenient and cost-effective alternative. Case presentation We present a case of a 68-year-old male of European descent with a 2-year history of progressive proximal bilateral lower extremity weakness. He had been treated for his dyslipidemia with atorvastatin for 2 years, then with rosuvastatin for 2 additional years until discontinued a year before our assessment. His other comorbidities included hypertension and diabetes mellitus type II. Physical examination demonstrated proximal weakness of his bilateral hip flexors and deltoids, and no rash. His creatine kinase (CK) was elevated at 1644 IU/L. Electromyography revealed a generalized myopathic disorder with proximal predominance and muscle biopsy of the right quadriceps showed typical findings of an IMNM. Serum HMG–CoA reductase antibody was positive. Due to accumulating evidence supporting the effectiveness of IVIg in anti-HMGCR–IMNM, even without concomitant GC or other immunosuppressive agent, we opted for a GC-free approach through shared-decision making in light of patient’s preference regarding potential GC side effects with his comorbidities. As he lived a considerable distance from any center, where IVIg infusions could be offered, and given the patient was unable to drive himself due to his symptoms we opted for SCIg (0.5 g/kg/week). Within 1 month, his CK decreased and weakness resolved. SCIg monotherapy was tapered over 3 years and this patient remains in remission 7 years after SCIg initiation. The patient did not have any adverse effects related to SCIg use. Conclusions To our knowledge, this is the first case report describing a successful corticosteroid-free management of anti-HMGCR immune-mediated necrotizing myopathy using SCIg as monotherapy. This case highlights the potential for steroids-free induction and maintenance strategies in IMNM. Larger studies are required to confirm the effectiveness and safety of SCIg in IMNM and other subtypes of IIM, and to provide guidelines for dosing recommendations.