Le référential CanMEDS en médecine de laboratoire : une étude phénoménographique explorant la manière dont les rôles professionnels sont appliqués en dehors de l'environnement clinique

Background: The CanMEDS Competency Framework is an internationally recognized model used to outline the proficiencies of a physician. It has predominantly been studied in clinical environments but not all medical specialties take part in direct patient contact. In laboratory medicine, the role of the physician is to promote and enhance patient diagnostics by managing and overseeing the functions of a diagnostic laboratory. Methods: This phenomenographic study explores the lived experiences of biochemistry, microbiology, and pathology residency program directors to better understand how they utilize the CanMEDS competencies. Eight laboratory medicine program directors from across Canada were individually interviewed using a semi-structured interview, and the data was analysed using inductive thematic analysis. Results: The findings show that the current framework is disconnected from the unique context of laboratory medicine with some competencies appearing unrelatable using the current standardized definitions and expectations. Nevertheless, participants considered the framework to be an appropriate blueprint of the competencies necessary for their professional environment, but to make it accessible more autonomy is required to adapt the framework to their needs. Conclusion: Newer renditions of the CanMEDS Competency Framework should better consider the realities of non-clinical disciplines.Contexte : Le référentiel CanMEDS est un modèle reconnu à l'échelle internationale qui décrit les compétences nécessaires d'un médecin. Cependant, il a été principalement étudié dans des environnements cliniques, mais ce ne sont pas toutes les spécialités médicales qui ont des contacts directs avec les patients. En médecine de laboratoire, le rôle du médecin est de promouvoir et d'améliorer les analyses diagnostiques des patients en supervisant les fonctions d'un laboratoire diagnostic. Méthodes : Cette étude phénoménographique explore les expériences vécues de directeurs de programmes de résidence en biochimie, microbiologie et pathologie afin de mieux comprendre comment leurs programmes de formation utilisent les compétences CanMEDS. Huit directeurs de programme Canadiens en médecine de laboratoire ont participé à une entrevue semi-structurée individuelle et les données recueillies ont été analysées par une analyse thématique inductive. Résultats : Les résultats démontrent que le référentiel actuel est déconnecté de la médecine de laboratoire et que certaines compétences semblent incompatibles en utilisant les définitions normalisées en vigueur. Néanmoins, les participants considèrent que le référentiel est un schéma approprié des compétences nécessaires dans leur environnement professionnel, mais une plus grande autonomie est nécessaire pour l’adapter à leurs besoins. Conclusion : Les prochaines révisions du référentiel de compétences CanMEDS devraient mieux tenir compte des réalités des disciplines non cliniques

Médicaments, sexe et genre [Medicines, sex and gender]

Sex-related differences affecting pharmacokinetic and pharmacodynamic processes result mostly from sex dimorphisms in body composition, and liver and kidney function, in addition to hormonal regulation of enzymes, transporters and drug receptors. Gender biases have long compromised the identification of these differences in clinical trials. They also modulate prescription patterns and therapeutic benefits. Men and women would benefit from different standard dosages of some anti-infectives, anticancer agents and other treatments requiring precise dosage adjustment. This would alleviate the well-documented excess of adverse reactions affecting women. However, the variability of pharmacological responses within each sex exceeds the average male-female difference, highlighting the importance of other criteria for therapeutic individualisation

Residual Partial Least Squares Learning: Brain Cortical Thickness Simultaneously Predicts Eight Non-pairwise-correlated Behavioural and Disease Outcomes in Alzheimer's Disease.

Alzheimer's Disease (AD) is the leading cause of dementia. It results in cortical thickness changes and is associated with a decline in cognition and behaviour. Such decline affects multiple important day-to-day functions, including memory, language, orientation, judgment and problem-solving. Recent research has made important progress in identifying brain regions associated with single outcomes, such as individual AD status and general cognitive decline. The complex projection from multiple brain areas to multiple AD outcomes, however, remains poorly understood. This makes the assessment and especially the prediction of multiple AD outcomes - each of which may unveil an integral yet different aspect of the disease - challenging, particularly when some are not strongly correlated. Here, uniting residual learning, partial least squares (PLS), and predictive modelling, we develop an explainable, generalisable, and reproducible method called the Residual Partial Least Squares Learning (the re-PLS Learning) to (1) chart the pathways between large-scale multivariate brain cortical thickness data (inputs) and multivariate disease and behaviour data (outcomes); (2) simultaneously predict multiple, non-pairwise-correlated outcomes; (3) control for confounding variables (e.g., age and gender) affecting both inputs and outcomes and the pathways in-between; (4) perform longitudinal AD disease status classification and disease severity prediction. We evaluate the performance of the proposed method against a variety of alternatives on data from AD patients, subjects with mild cognitive impairment (MCI), and cognitively normal individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Our results unveil pockets of brain areas in the temporal, frontal, sensorimotor, and cingulate areas whose cortical thickness may be respectively associated with declines in different cognitive and behavioural subdomains in AD. Finally, we characterise re-PLS' geometric interpretation and mathematical support for delivering meaningful neurobiological insights and provide an open software package (re-PLS) available at https://github.com/thanhvd18/rePLS

Assessment of SARS-CoV-2 tests costs and reimbursement tariffs readjustments during the COVID-19 pandemic.

While laboratories have been facing limited supplies of reagents for diagnostic tests throughout the course of the COVID-19 pandemic, national and international health plans, as well as billing costs, have been constantly adjusted in order to optimize the use of resources. We aimed to assess the impact of SARS-CoV-2 test costs and reimbursement tariff adjustments on diagnostic strategies in Switzerland to determine the advantages and disadvantages of different costs and resource saving plans. We specifically assessed the cost of diagnostic SARS-COV-2 RT-PCR using five different approaches: i) in-house platform, ii) cobas 6800® (Roche, Basel, Switzerland), iii) GeneXpert® SARS-CoV-2 test (Cepheid, Sunnyvale, CA, USA), iv) VIASURE SARS-CoV-2 (N1 + N2) Real-Time PCR Detection Kit for BD MAX™ (Becton Dickinson, Franklin Lake, NJ, USA), v) cobas® Liat® SARS-CoV-2 & Influenza A/B (Roche, Basel, Switzerland). We compared these costs to the evolution of the reimbursement tariffs. The cost of a single RT-PCR test varied greatly (as did the volume of tests performed), ranging from as high as 180 CHF per test at the beginning of the pandemic (February to April 2020) to as low as 82 CHF per test at the end of 2020. Depending on the time period within the pandemic, higher costs did not necessarily mean greater benefits for the laboratories. The costs of molecular reagents for rapid tests were higher than of those for classic RT-PCR platforms, but the rapid tests had reduced turnaround times (TATs), thus improving patient care and enabling more efficient implementation of isolation measures, as well as reducing the burden of possible nosocomial infections. At the same time, there were periods when the production or distribution of these reagents was insufficient, and only the use of several different molecular platforms allowed us to sustain the high number of tests requested. Cost-saving plans need to be thoroughly assessed and constantly adjusted according to the epidemiological situation, the clinical context and the national resources in order to always guarantee that the highest performing diagnostic solutions are available. Not all cost-saving strategies guarantee good analytical performance

Trajectoires d'étrangères en faculté de médecine:Les étudiantes de l'Empire russe à Paris (1868-1919)

Depuis l’admission des premières étudiantes en 1868 et jusqu’en 1919, des centaines de femmes originaires de l’Empire russe ont étudié sur les bancs de la Faculté de médecine de Paris. Hormis leur importance numérique, les destins de ces étudiantes restent encore largement méconnus. L’arrivée de ce corps étranger représente pourtant une perturbation considérable pour le champ médical français. Le corpus de leurs thèses de doctorat complété par des ego-documents permet de croiser les échelles collective et individuelle et de capter les obstacles rencontrés par ces étudiantes étrangères mais aussi leur agency face à ces difficultés. Si nombre d’entre elles tendent à se conformer aux attentes de la société française quant à leur place au sein de la discipline, elles ne se sont pas simplement fondues dans le système du champ médical français mais ont amené celui-ci à évoluer et, en particulier, à se féminiser

Trajectoires d'étrangères en faculté de médecine:Les étudiantes de l'Empire russe à Paris (1868-1919)

Depuis l’admission des premières étudiantes en 1868 et jusqu’en 1919, des centaines de femmes originaires de l’Empire russe ont étudié sur les bancs de la Faculté de médecine de Paris. Hormis leur importance numérique, les destins de ces étudiantes restent encore largement méconnus. L’arrivée de ce corps étranger représente pourtant une perturbation considérable pour le champ médical français. Le corpus de leurs thèses de doctorat complété par des ego-documents permet de croiser les échelles collective et individuelle et de capter les obstacles rencontrés par ces étudiantes étrangères mais aussi leur agency face à ces difficultés. Si nombre d’entre elles tendent à se conformer aux attentes de la société française quant à leur place au sein de la discipline, elles ne se sont pas simplement fondues dans le système du champ médical français mais ont amené celui-ci à évoluer et, en particulier, à se féminiser

Le nouveau langage de la médecine : une affaire de socioterminologie

La médecine est une discipline plurimillénaire profondément ancrée dans l’histoire. Il n’est donc pas étonnant que le langage de la médecine — et par conséquent sa terminologie — ait toujours été influencé par ses utilisateurs. Le traducteur médical doit prendre conscience que le sociolecte médical, loin de reposer sur une terminologie rigoureuse et objective, est soumis à des variations tant synchroniques que diachroniques.An age-old science, medicine has had to follow in the steps of history for millenniums. Little wonder, then, if medical language - and, hence, terminology - has always been influenced, over the years, by its successive users. The medical translator is bound to realize that the medical sociolect, far from feeding on an exact and objective terminology, is in fact prey to synchronic as well as diachronic instability

Molecular characterization of methicillin-resistant Staphylococcus aureus isolates from a hospital in Ghana

Background: Methicillin-resistant  Staphylococcus aureus (MRSA) are a major cause of hospital- and community-acquired infection. They can colonize humans and cause a wide range of infections including pneumonia, endocarditis and bacteraemia. We investigated the molecular mechanism of resistance and virulence of MRSA isolates from a teaching hospital in Ghana.Methodology: A total of 91 S. aureus isolates constituted the initial bacterial sample. Identification of S. aureus was confirmed by the VITEK 2 system. The cefoxitin screen test was used to detect MRSA and antibiotic susceptibility was determined using the VITEK 2 system. The resistance (mecA, blaZ, aac-aph, ermC, and tetK) and virulence (lukS/F-PV, hla, hld and eta) genes were amplified by polymerase chain reaction (PCR) and positive samples subjected to DNA sequencing. Pulsed field gel electrophoresis (PFGE) was used to ascertain the relatedness of the isolates.Results: Fifty-eight of 91 (63.7%) isolates were putatively methicillin resistant by the phenotypic cefoxitin screen test and oxacillin MICs. However, 43 (47%) of the isolates were genotypically confirmed as MRSA based on PCR detection of the mecA gene. Furthermore, 37.9% of isolates displayed resistance to tetracycline, 19% to trimethoprim-sulphamethoxazole, 15.5% to clindamycin, 12.1% to gentamicin, 13.8% to ciprofloxacin and erythromycin, 6.9% to moxifloxacin and 7.0% to rifampicin. None of the isolates was positive for inducible clindamycin resistance. The prevalence of resistance (mecA, blaZ, aac(6’)-aph(2’’), tetK, and ermC) and virulence (hla and lukS/F-PV) genes respectively were 74%, 33%, 22%, 19%, 3%, 5% and 3%, with isolates organized in two highly related clades.Conclusion: Results indicate a fairly high occurrence of MRSA, which can complicate the effective therapy of S. aureus infections, necessitating surveillance and stringent infection control programmes to forestall its spread.Keywords: MRSA, mecA, blaZ, hla, lukS/F-P

Transfer Learning on Structural Brain Age Models to Decode Cognition in MS: A Federated Learning Approach.

Introduction. Classical deep learning research requires lots of centralised data. However, data sets are often stored at different clinical centers, and sharing sensitive patient data such as brain images is difficult. In this manuscript, we investigated the feasibility of federated learning, sending models to the data instead of the other way round, for research on brain magnetic resonant images of people with multiple sclerosis (MS). Methods. Using transfer learning on a previously published brain age model, we trained a model to decode performance on the symbol digit modalities test (SDMT) of patients with MS from structural T1 weighted MRI. Three international centers in Brussels, Greifswald and Prague participated in the project. In Brussels, one computer served as the server coordinating the FL project, while the other served as client for model training on local data (n=97). The other two clients were Greifswald (n=104) and Prague (n=100). Each FL round, the server sent a global model to the clients, where its fully connected layer was updated on the local data. After collecting the local models, the server applied a weighted average of two randomly picked clients, yielding a new global model. Results. After 22 federated learning rounds, the average validation loss across clients reached a minimum. The model appeared to have learned to assign SDMT values close to the mean with a mean absolute error of 9.04, 10.59 and 10.71 points between true and predicted SDMT on the test data sets of Brussels, Greifswald and Prague respectively. The overall test MAE across all clients was 10.13 points. Conclusion. Federated learning is feasible for machine learning research on brain MRI of persons with MS, setting the stage for larger transfer learning studies to investigate the utility of brain age latent representations in cognitive decoding tasks