A collaborative model to implement flexible, accessible and efficient oncogenetic services for hereditary breast and ovarian cancer : the C-MOnGene study

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics

Preparedness for Pediatric Office Emergencies: A Multicenter, Simulation-Based Study

OBJECTIVES Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices. METHODS This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated. RESULTS Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2–81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2–80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations. CONCLUSIONS Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS

Thalamic neuromodulation and its implications for executive networks

The thalamus is a key structure that controls the routing of information in the brain. Understanding modulation at the thalamic level is critical to understanding the flow of information to brain regions involved in cognitive functions, such as the neocortex, the hippocampus, and the basal ganglia. Modulators contribute the majority of synapses that thalamic cells receive, and the highest fraction of modulator synapses is found in thalamic nuclei interconnected with higher order cortical regions. In addition, disruption of modulators often translates into disabling disorders of executive behavior. However, modulation in thalamic nuclei such as the midline and intralaminar groups, which are interconnected with forebrain executive regions, has received little attention compared to sensory nuclei. Thalamic modulators are heterogeneous in regards to their origin, the neurotransmitter they use, and the effect on thalamic cells. Modulators also share some features, such as having small terminal boutons and activating metabotropic receptors on the cells they contact. I will review anatomical and physiological data on thalamic modulators with these goals: first, determine to what extent the evidence supports similar modulator functions across thalamic nuclei; and second, discuss the current evidence on modulation in the midline and intralaminar nuclei in relation to their role in executive function

Institutional Racism and Individual Agency: A Case Study using Foucault’s Disciplinary Power

Institutional racism is a principal factor in the exclusion and oppression of racialized groups.  Social work scholars have examined the organizational indicators, attitudes, and actions of staff that contribute to institutional racism in order to elucidate its function.  However, an understanding of the interplay between institutions and individuals within institutional racism has remained largely elusive. This paper aims to address this gap.  Using the work of French philosopher Michel Foucault and his theorization of disciplinary power, this paper presents a case study of one social worker’s efforts to address racism in her organization. The result is a unique understanding of institutional racism that considers the dynamic interactions between institutional constraints and individual agency. Such an analysis enables those in direct practice as well as in leadership roles who are committed to anti-oppression social work to understand the barriers and routes to anti-racist institutional change

Race, power and social action in neighbourhood community organizing: a case study

This thesis asks the following question: "how does race and ethnicity emerge in the daily practice of community organizers who work in low-income, multi-racial, multi-ethnic neighbourhoods?" Given that the concepts of race and ethnicity are understood to be social constructs, community organizing practice is analysed in this thesis in terms of its' constitutive role. By examining community organizing practice in one neighbourhood in Québec, Canada, I argue that issues of race and ethnicity are largely constructed in community organizing practice as distinct from relations of power. I demonstrate this construction of race and ethnicity using data gathered from 16 community organizers through interviews, textual analysis and observations. I analyse the data from three angles: first, actions regarding issues of race and ethnicity that are normalized (i.e. "possible"); second, actions regarding issues of race and ethnicity that are constrained (i.e. "not possible"); and, lastly, actions that are resistant to normalized and/or constrained practices, and that link race and ethnicity to power relations. In this way, I delineate Foucault's "field of action" (1982, p. 221) regarding race and ethnicity in neighbourhood community organizing and demonstrate how the structure of power in community organizing functions to render the connection between race and power largely invisible.Cette thèse pose la question suivante : «Comment la race et l'ethnicité émergent dans la pratique quotidienne des organisateurs communautaires qui oeuvrent dans des quartiers à faible revenu, multiraciaux et multiethniques ?» Étant donné que les concepts de race et d'appartenance ethnique sont compris pour être des constructs sociaux, la pratique d'organisation des communautés est analysée dans cette thèse en termes de son rôle constitutif.En examinant la pratique d'organisation des communauté dans un quartier de Québec au Canada, je soutiens que les questions de race et d'appartenance ethnique sont en grande partie construites dans la pratique d'organisation de communauté par opposition aux relations de pouvoir. Je démontre cette construction de race et d'appartenance ethnique utilisant des données rassemblées auprès de 16 organisateurs communautaires par des interviews, l'analyse de textes et des observations. J'analyse les données de trois angles : d'abord, les actions quant aux questions de race et d'appartenance ethnique qui sont normalisées (c'est-à-dire «possible»); deuxièmement, des actions quant aux questions de race et d'appartenance ethnique qui sont contraintes (c'est-à-dire «non possible»); et, finalement, les actions qui sont résistantes aux pratiques normalisées et/ou contraintes et qui relie race et appartenance ethnique pour faire fonctionner des relations. De cette façon, je définis «le champ d'action» de Foucault (1982, p. 221) quant à la race et l'appartenance ethnique dans les organisations communautaires de quartier et démontrent comment la structure de pouvoir dans la communauté organisant des fonctions pour rendre la connexion entre la race et le pouvoir en grande partie invisible

Étude de cas d’une jeune orthorexique

La symptomatologie de l’orthorexie est de plus en plus objet d’intérêt, mais ce trouble et les caractéristiques associées demeurent peu circonscrits. Cette étude de cas portant sur une adolescente vise à mieux définir les caractéristiques de l’orthorexie et à tenter de les distinguer de celles de l’anorexie. Selon les données d’évaluation, cette adolescente estime avoir perdu trop de poids et souhaite en reprendre. Elle est excessivement préoccupée par les questions relatives à la santé et présente des traits obsessionnels se manifestant dans les conduites alimentaires ou l’exercice physique. Le fonctionnement personnel, social et familial est affecté par le trouble.Orthorexia symptomatology is an increasing object of interest, but this disorder and its associated characteristics remain sparely circumscribed. This case story is about an adolescent girl and aims to better define orthorexia characteristics, as well as try to distinguish them from those of anorexia. According to the evaluation results, the adolescent believes she has lost too much weight and wishes to regain some. She is extremely concerned about health issues and presents obsessive features expressed by her eating or physical exercise behavior. The personal, social and family functioning are affected by the disorder

Patients' and physicians’ perspectives on the burden and management of asthma: Results from the APPaRENT 2 study

International audienceBackground: The 2021 Global Initiative for Asthma (GINA) report recommends 2 treatment tracks depending on choice of reliever therapy: either inhaled corticosteroid (ICS)/formoterol, or short-acting β2-agonist (SABA) with ICS to be used whenever a SABA is taken.Objective: The Asthma Patients' and Physicians’ Perspectives on the Burden and Management of Asthma (APPaRENT) 2 study aimed to understand current real-world treatment approaches and their alignment with GINA recommendations.Methods: Patients and physicians were recruited for the online survey from online panels from August–November 2021. Inclusion criteria: adults, physician diagnosis of asthma, ≥6 months prescribed inhaler use (patients); primary care, ≥4 patients with asthma per month, ≥3 years clinical practice (physicians).Results: 1650 patients and 1080 physicians were included. For patients with moderate to severe asthma, physicians prescribed proactive regular dosing (PRD) with ICS/long-acting β2-agonist (LABA) combination with (47%) or without (15%) SABA as initial therapy. Most pulmonologists (75%) and general practitioners (57%) selected a PRD approach. The majority of patients, 85% (79–91%), considered to be using maintenance and reliever therapy (MART), were also prescribed non-ICS rescue inhaler.Conclusions: Physicians preferred a preventive regular dosing approach to achieve symptom control for patients with moderate to severe asthma, which is more aligned with GINA 2021 Track 2 recommendations than Track 1. Many patients on MART request additional rescue inhalers, suggesting that MART is being misapplied in most instances and that patients may perceive their asthma as inadequately controlled with MART therapy