Références aux patients dans les référentiels de compétences CanMEDS 2005 et 2015

Background: Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks. Methods: We used document analysis to examine how the term ‘patient(s)’ is referenced in the 2005 and 2015 CanMEDS Frameworks. Results: Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME.  Conclusion: There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.Contexte : La participation des patients dans la formation médicale postdoctorale (FMPD) peut aider les résidents à améliorer leur professionnalisme et leurs compétences en matière de communication et de collaboration. Le référentiel CanMEDS définit les compétences des médecins et oriente les activités d’enseignement et d’évaluation dans la formation médicale postdoctorale. Cependant, la manière dont les patients sont décrits dans le référentiel CanMEDS n’est pas claire et il n’est pas certain que cette description encourage la participation active des patients dans la FMPD. Pour éclairer la description des patients dans les révisions du référentiel CanMEDS, dont la publication est prévue en 2025, notre objectif était d’examiner comment ils sont présentés dans les référentiels CanMEDS de 2005 et 2015. Méthodes : Nous avons utilisé l’analyse de documents pour examiner les références au terme « patient(s) » dans les référentiels CanMEDS 2005 et 2015. Résultats : Dans les référentiels CanMEDS de 2005 et 2015, les patients sont mentionnés dans la description de certains rôles, mais ils ne le sont pas dans la description des compétences qui y sont associées. Dans d’autres cas, ni la description du rôle ni celle des compétences correspondantes ne font référence aux patients, ce qui peut minimiser l’importance de la participation de ces derniers. Actuellement, le rôle de promoteur de la santé dans le référentiel de 2015 est le seul qui comprend une description et une référence aux patients comme travaillant avec le médecin à titre de partenaires de soins, et qui favorise ainsi la possibilité de faire participer les patients dans la FMPD.  Conclusion : Les référentiels CanMEDS passés et présents contiennent des incohérences quant à la description des patients comme partenaires potentiels dans la FMPD. La compréhension de ces incohérences peut éclairer la révision de CanMEDS, dont la publication est prévue en 2025

An expanded multilocus sequence typing scheme for propionibacterium acnes : investigation of 'pathogenic', 'commensal' and antibiotic resistant strains

The Gram-positive bacterium Propionibacterium acnes is a member of the normal human skin microbiota and is associated with various infections and clinical conditions. There is tentative evidence to suggest that certain lineages may be associated with disease and others with health. We recently described a multilocus sequence typing scheme (MLST) for P. acnes based on seven housekeeping genes (http://pubmlst.org/pacnes). We now describe an expanded eight gene version based on six housekeeping genes and two ‘putative virulence’ genes (eMLST) that provides improved high resolution typing (91eSTs from 285 isolates), and generates phylogenies congruent with those based on whole genome analysis. When compared with the nine gene MLST scheme developed at the University of Bath, UK, and utilised by researchers at Aarhus University, Denmark, the eMLST method offers greater resolution. Using the scheme, we examined 208 isolates from disparate clinical sources, and 77 isolates from healthy skin. Acne was predominately associated with type IA1 clonal complexes CC1, CC3 and CC4; with eST1 and eST3 lineages being highly represented. In contrast, type IA2 strains were recovered at a rate similar to type IB and II organisms. Ophthalmic infections were predominately associated with type IA1 and IA2 strains, while type IB and II were more frequently recovered from soft tissue and retrieved medical devices. Strains with rRNA mutations conferring resistance to antibiotics used in acne treatment were dominated by eST3, with some evidence for intercontinental spread. In contrast, despite its high association with acne, only a small number of resistant CC1 eSTs were identified. A number of eSTs were only recovered from healthy skin, particularly eSTs representing CC72 (type II) and CC77 (type III). Collectively our data lends support to the view that pathogenic versus truly commensal lineages of P. acnes may exist. This is likely to have important therapeutic and diagnostic implications

Tert-butyl benzoquinone: mechanism of biofilm eradication and potential for use as a topical antibiofilm agent

Objectives: Tert-butyl benzoquinone (TBBQ) is the oxidation product of tert-butyl hydroquinone (TBHQ), an antimicrobial food additive with >40 years of safe use. TBBQ displays potent activity against Staphylococcus aureus biofilms in vitro. Here, we report on studies to further explore the action of TBBQ on staphylococcal biofilms, and provide a preliminary preclinical assessment of its potential for use as a topical treatment for staphylococcal infections involving a biofilm component. Methods: The antibacterial properties of TBBQ were assessed against staphylococci growing in planktonic culture and as biofilms in the Calgary Biofilm Device. Established assays were employed to measure the effects of TBBQ on biofilm structure and bacterial membranes, and to assess resistance potential. A living skin equivalent was used to evaluate the effects of TBBQ on human skin. Results: TBBQ eradicated biofilms of S. aureus and other staphylococcal species at concentrations ≤64 mg/L. In contrast to other redox-active agents exhibiting activity against biofilms, TBBQ did not cause substantial destructuring of the biofilm matrix; instead, the antibiofilm activity of the compound was attributed to its ability to kill slow- and non-growing cells via membrane perturbation. TBBQ acted synergistically with gentamicin, did not damage a living skin equivalent following topical application, and exhibited low resistance potential. Conclusions: The ability of TBBQ to eradicate biofilms appears to result from its ability to kill bacteria regardless of growth state. Preliminary evaluation suggests that TBBQ represents a promising candidate for development as a topical antistaphylococcal biofilm agent

Rapid Prenatal Diagnosis and Exclusion of Epidermolysis Bullosa Using Novel Antibody Probes

Prenatal diagnosis of recessive dystrophic epidermolysis bullosa was successfully achieved at 19 weeks' gestation by indirect immunofluorescence examination of a fetal skin biopsy sample using the monoclonal antibody LH 7:2. The abortus displayed marked blistering and the diagnosis was confirmed by transmission electron microscopy (TEM). In 3 further pregnancies at risk for lethal junctional epidermolysis bullosa the diagnosis was excluded using the polyclonal antibody AA3. In all these studies the results were available within 4h of receiving the samples. These new techniques offer a quick and simple alternative to TEM for midtrimester prenatal diagnosis of 2 severe recessive forms of epidermolysis bullosa

Pharmacological Management of Behavioral and Psychiatric Symptoms in Older Adults with Intellectual Disability

Given medical and social advances, the life expectancy of individuals with intellectual disability (ID) has increased dramatically, leading to a generation of older individuals with such disabilities. This review focuses on the pharmacological treatment of behavioral and psychiatric symptoms and disorders in older adults with ID. Older adults with ID often present with medical co-morbidities and mental health issues. Medication management of behavioral and psychiatric problems is complicated by a higher risk for adverse events, lack of decision-making capacity, and complex care networks. Some studies have shown that individuals with ID and co-morbid mental disorders are undertreated in comparison with those with similar disorders in the general population, resulting in poorer outcomes. However, older adults with ID are also at risk of polypharmacy, and older age is a risk factor for development of side effects. A general principle is that medication treatment for psychiatric disorders in older individuals with ID should be started at low dosages and increased cautiously while monitoring response and side effects. The use of psychotropic drugs for older individuals with ID and behavioral problems remains controversial, particularly in those with dementia

Re-positioning SoTL toward the T-shaped Community

Amongst a range of changes that have taken place within tertiary education, perhaps the most revolutionary has been a shift to student-centred approaches focused on life-long learning. Accompanying this approach to holistic higher education (HE) has been a growing interest in, and understanding of, the Scholarship of Teaching and Learning (SoTL). SoTL has, at its core, a deep concern with student learning and is therefore well-aligned with higher education’s renewed focus on its students. In this conceptual paper, we examine the impact of the T-shaped person which many tertiary institutions are operationalizing to inform and connect the development of students’ deep disciplinary knowledge with non-academic and employment readiness skills (such as communication, problem-solving, teamwork, and critical thinking). Importantly, we argue for a re-positioning of SoTL to complement and support this model, with SoTL as both the fulcrum and the fluid, multiple threads of discourse that are intricately entwined around the structure of the T-shaped model. We encourage our colleagues to strive to be T-shaped practitioners and we cast a vision of a T-shaped community. Here, all stakeholders within HE connect both their academic knowledge and holistic skills in collaborative ways to produce learners who flourish in modern society. The SoTL community plays a pivotal role in achieving this vision and is well-positioned to expand the current notion of SoTL toward a more holistic, interconnected, central role in HE

Lateral coupling in baroclinically unstable flows

Author Posting. © American Meteorological Society, 2008. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 38 (2008): 1267-1277, doi:10.1175/2007JPO3906.1.A two-layer quasigeostrophic model in a channel is used to study the influence of lateral displacements of regions of different sign mean potential vorticity gradient (Πy) on the growth rate and structure of linearly unstable waves. The mean state is very idealized, with a region of positive Πy in the upper layer and a region of negative Πy in the lower layer; elsewhere Πy is zero. The growth rate and structure of the model’s unstable waves are quite sensitive to the amount of overlap between the two regions. For large amounts of overlap (more than several internal deformation radii), the channel modes described by Phillips’ model are recovered. The growth rate decreases abruptly as the amount of overlap decreases below the internal deformation radius. However, unstable modes are also found for cases in which the two nonzero Πy regions are separated far apart. In these cases, the wavenumber of the unstable waves decreases such that the aspect ratio of the wave remains O(1). The waves are characterized by a large-scale barotropic component that has maximum amplitude near one boundary but extends all the way across the channel to the opposite boundary. Near the boundaries, the wave is of mixed barotropic–baroclinic structure with cross-front scales on the order of the internal deformation radius. The perturbation heat flux is concentrated near the nonzero Πy regions, but the perturbation momentum flux extends all the way across the channel. The perturbation fluxes act to reduce the isopycnal slopes near the channel boundaries and to transmit zonal momentum from the region of Πy > 0 to the region on the opposite side of the channel where Πy < 0. These nonzero perturbation momentum fluxes are found even for a mean state that has no lateral shear in the velocity field.This work was supported by NSF Grants OPP-0421904, OCE-0423975 (MAS), and OCE- 85108600 (JP)

Élargir les mandats de responsabilité sociale à la recherche biomédicale dans les facultés canadiennes

Background: Social accountability (SA), as defined by Boelen and Heck, is the obligation of medical schools to address the needs of communities through education, research and service activities. While SA is embedded within health profession education frameworks in medicine, they are rarely taught within graduate-level (MSc/PhD) education. Methods: As these programs train future medical researchers, we invited first-year graduate students enrolled in a mandatory professionalism class at our institution (n = 111) to complete a survey on their perceptions of the importance of SA in their research, training, and future careers. Results: Over 80% (n = 87) of respondents agreed that SA is relevant and felt committed to integrating it into their future research activities, only a limited number of students felt confident and/or supported in their abilities to integrate SA into their research. Conclusions: Specific SA training in graduate education is necessary for students to effectively incorporate elements of SA into their research, and as such support the SA mandates of their training institutions. We posit that awareness of SA principles formalizes the professional standards for biomedical researchers and is thus foundational for developing a professionalism curriculum in graduate education programs in medicine. We propose an expansion of the World Health Organization (WHO) partnership pentagon to include partners within the research ecosystem (funding partners, certification bodies) that collaborate with biomedical researchers to make research socially accountable.Contexte : La responsabilité sociale (RS), telle que définie par Boelen et Heck, est l'obligation pour les facultés de médecine de répondre aux besoins des communautés par l’entremise de l'éducation, de la recherche et des activités de service. Bien que la responsabilité sociale soit intégrée dans les cadres de formation des professionnels de santé en médecine, elle est rarement enseignée au niveau des études supérieures (MSc/PhD). Méthodes : Étant donné que ces programmes forment les futurs chercheurs médicaux, nous avons invité les étudiants de première année inscrits à un cours obligatoire sur le professionnalisme dans notre établissement (n = 111) à participer à une enquête sur leurs perceptions de l'importance de la RS dans leur recherche, leur formation et leur future carrière. Résultats : Plus de 80 % (n = 87) des répondants ont reconnu la pertinence de la RS et se sont engagés à l'intégrer dans leurs futures activités de recherche, mais seul un nombre limité d'étudiants se sont sentis confiants et/ou soutenus dans leurs capacités à intégrer la RS dans leur recherche. Conclusions : Une formation propre à la RS dans le cadre des études supérieures est nécessaire pour que les étudiants puissent intégrer efficacement des éléments de la RS dans leur recherche, et ainsi promouvoir les mandats de RS de leurs établissements de formation. Nous estimons que la sensibilisation aux principes de la RS formalise les normes professionnelles des chercheurs biomédicaux et qu'elle est donc fondamentale pour l'élaboration d'un programme de professionnalisme dans les programmes d'études supérieures en médecine. Nous proposons d'élargir le pentagone du partenariat de l'Organisation mondiale de la santé (OMS) pour y inclure les partenaires de l'écosystème de la recherche (partenaires financiers, organismes de certification) qui collaborent avec les chercheurs biomédicaux pour rendre la recherche socialement responsable

Developing Innovative Practices Through Third-Space Partnerships: Reflections on Project DARE (Dementia Knowledge, Art, Research and Education)

Partnerships between schools, universities, and community organizations have mutual benefits for all involved. These partnerships value the contributions of all participants and capitalize on the expertise and knowledge that each brings. This reflective paper details a collaborative third-space partnership between a university, a primary school, and a community organization. The partnership facilitated the design, development, and implementation of a unique program called Project DARE (Dementia knowledge, Art, Research, and Education). A research-based evaluation of the Project DARE feasibility study can be found elsewhere (Burns et al., 2020). The aim of this paper is to reflect upon the formation of the partnership and the roles that each party played. It also discusses implications for the future development of third-space partnerships