Dynamique pédagogique et adaptation de l’enseignement

L’enseignant, l’étudiant ainsi que les savoirs sont au coeur des synergies en classe. Inspirées du « Triangle pédagogique » de Houssaye (1988) et de la « Situation pédagogique » de Legendre (1983), nous proposerons une réflexion visant à guider les actions pédagogiques. À partir d’exemples tirés de faits vécus en classe, nous proposerons des pistes susceptibles de structurer l’enseignement, avant (planification), pendant (diagnostic et ajustements) et après un cours (bilan), en mettant en relief l’adaptation de l’enseignant à l’étudiant et au savoir

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders

Classe renversée, ou quand les étudiants font le cours

La classe renversée (et non inversée) issue des travaux de Jean-Charles Cailliez propose aux apprenants de faire eux-mêmes le cours. Inspirées par ces travaux visant à stimuler les apprenants à construire leurs savoirs et à être actifs en classe, nous rendrons compte d’une démarche d’accompagnement pédagogique auprès de dix-huit enseignants de la formation générale et des secteurs pré-universitaire et technique dans une classe au mobilier innovateur. Nous présenterons les étapes de ce projet-pilote, les outils développés et l’appréciation de tous les participants

Impact d’un guide d’antibioprophylaxie chirurgicale pour les cholécystectomies et les hystérectomies en établissement de santé

Résumé Il s’agit d’une étude quasi expérimentale de type pré et post qui évalue l’impact de l’implantation d’un nouveau guide d’utilisation des antibiotiques en prophylaxie pour l’hystérectomie et la cholécystectomie. L’étude a permis de recruter 663 sujets, dont 601 ont été inclus dans notre analyse. On observe que le recours à l’antibioprophylaxie, selon les recommandations proposées, est conforme dans 54 % des cas dans le groupe préintervention contre 66 % dans le groupe postintervention, une différence statistiquement significative (p = 0,003). Parmi les patients ayant reçu des antibiotiques (n = 270), on note que la conformité globale (c’est-à-dire pour les quatre critères combinés, soit le choix, la dose, le délai et le lieu) passe de 31 % avant l’implantation du guide à 39 % après (p = 0,15). De même, aucune différence significative n’est observée entre les taux de conformité pour chacun des critères entre le groupe pré et le groupe post. Le taux de conformité global est plus élevé pour les cholécystectomies (59 %) que pour les hystérectomies (27 %) (p < 0,001). Au niveau des coûts, on observe une réduction significative de la moyenne des coûts pour l’ensemble des patients inclus dans l’étude entre le groupe contrôle (n = 301 – coût moyen 3,03 $± 2,16) et le groupe expérimental (2,56$ ± 2,18) (p = 0,01, test de t). La différence n’est toutefois plus significative quand on considère uniquement les patients ayant reçu une antibioprophylaxie entre le groupe contrôle (n = 121 – coût moyen 3,75 $± 6,22) et le groupe expérimental (n = 149 – 2,63$ ± 3,32) (p = 0,06, test de t). Bien que l’utilisation d’antibiotiques en prophylaxie chirurgicale ait été largement étudiée, on observe un taux de conformité limité par rapport aux lignes directrices publiées. Même si nous n’avons pas observé de différences quant à tous les paramètres de conformité à la suite de l’implantation du protocole, une intervention ponctuelle des pharmaciens peut contribuer à améliorer globalement la conformité de l’antibioprophylaxie en établissement de santé. Abstract This pre-post quasi-experimental study assesses the impact of the implementation of a new guide on prophylactic antibiotics use for hysterectomy and cholecystectomy. 663 subjects have been recruited, from which 601 have been included in our analysis. Antibioprophylaxis is used in accordance with the suggested guidelines in 54% of cases in the preintervention group, compared to 66% in the postintervention group, a statistically significant difference (p = 0.003). Among patients that have been treated with antibiotics (n = 270), global conformity (combination of the four criteria: choice, dose, administration time and place) goes from 31% before implementation of the guide to 39% afterwards (p = 0.15). Likewise, among pre and post groups, no statistically significant difference was noted between conformity rates for each of the criteria. Global conformity rate is higher for cholecystectomies (59%) than for hysterectomies (27%) (p < 0.001). As for costs, we note a significant decrease of the average cost as a whole between the control group (n = 301 – average cost $3.03 ± 2.16) and the experimental group ($2.56 ± 2.18) (p = 0.01, t-test). However, this difference is no longer significant if we only take into account patients who have received antibioprophylaxis, between the control group (n = 121 – average cost $3.75 ± 6.22) and the experimental group (n = 149 – average cost$2.63 ± 3.32) (p = 0.06, t-test). Although the use of antibiotics in surgical prophylaxis has been widely studied, we observe a limited conformity rate in relation to published guidelines. Despite the fact that we have not noticed any difference as to all conformity parameters following protocol implementation, a punctual intervention by the pharmacists may contribute to improve global conformity to antibioprophylaxis in healthcare facilities

Secular trends in incidence of invasive beta-hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996-2016.

OBJECTIVES:To examine secular changes in the incidence of invasive beta-hemolytic streptococcal infections, and to assess the efficacy of immunoglobulins and clindamycin as adjunctive therapies in the management of Streptococcus pyogenes infections. METHODS:Retrospective cohort study of all cases of invasive group A (GAS), B (GBS), C or G (GCGS) streptococcal infections managed in a Canadian tertiary center from 1996-2016. Population incidence was measured for diabetics and non-diabetics. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were calculated by logistic regression. RESULTS:741 cases were identified (GAS: 249; GBS: 304; GCGS: 188). While the incidence of invasive GAS infections fluctuated with no clear trend, incidence of invasive GBS and GCGS increased over time and were 8.4 and 6.3 times higher in diabetics. Mortality of invasive GAS infections decreased from 16% (6/37) in 1996-2001 to 4% (4/97) in 2011-15. Among patients with GAS infections, clindamycin administered concomitantly with a beta-lactam within 24 hours of admission decreased mortality (AOR: 0.04, 95%CI: 0.003-0.55, P = 0.02. Immunoglobulins had no such effect (AOR: 1.66, 95%CI: 0.16-17.36, P = 0.67). The protective effect of clindamycin was similar in patients with pneumonia/empyema compared to all others. CONCLUSION:Incidence of GBS and GCGS infections increased due to an expansion of the high-risk population (elderly diabetics), but also rose in non-diabetics. No such secular change was seen for invasive GAS infections. The decrease in mortality in patients with invasive GAS infections presumably reflects better case-management. Adjunctive clindamycin reduced mortality in invasive GAS infections; immunoglobulins did not, but power was limited. The highest mortality was seen in patients with GAS pneumonia/empyema, for whom clindamycin was protective but underused

Analysis of Shared Heritability in Common Disorders of the Brain

Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology