Développement des habiletés sémiologiques et relationnelles. Implantation d’un dispositif pédagogique recourant à des patients standardisés pour les étudiants en troisième année à la faculté de médecine de Nantes

Contexte : Les étudiants présentent des difficultés pour un apprentissage individuel et actif. Pour développer les habiletés sémiologiques et relationnelles, une séquence d'enseignement replaçant l'étudiant au centre du processus d'apprentissage a été introduite en utilisant les principes de la perspective constructiviste. Buts : L'objectif était de décrire l'organisation de cette séquence et d’évaluer les habiletés sémiologiques et relationnelles des étudiants. Méthodes : Chaque étudiant bénéficiait de quatre consultations simulées ambulatoires immédiatement suivies d’un débriefing en petit groupe. À la fin du semestre, un débriefing avec l’ensemble de la promotion était organisé. Les patients standardisés étaient assurés par des comédiens professionnels formés sur les aspects médicaux et relationnels, et sur les outils de mesure. L’évaluation des habiletés sémiologiques explorait les capacités d’interrogatoire et d’examen physique à l’aide de listes d’items (checklists) établies selon une méthode Delphi. Les habiletés relationnelles étaient évaluées à l'aide d’échelles visuelles analogiques. Les moyennes étaient comparées selon le scénario clinique et l’évolution de l’étudiant dans la séquence (tests t de Student). Résultats : 960 consultations ont été réalisées par 240 étudiants. La moyenne globale était de 52 % d’items correctement recherchés (habiletés sémiologiques : 44 % ; habiletés relationnelles : 68 %). Les habiletés à l’interrogatoire et à l’examen physique variaient selon le scénario (respectivement p < 0,0001 et p = 0,003). Les habiletés relationnelles augmentaient avec l’évolution dans la séquence (p = 0,01). Conclusion : Ces éléments démontrent la faisabilité, à grande échelle, de consultations simulées dans le contexte universitaire français. La séquence pourrait être améliorée en augmentant le nombre et l’espacement des consultations

Identification of sources of DIF using covariates in patient-reported outcome measures: a simulation study comparing two approaches based on Rasch family models

When analyzing patient-reported outcome (PRO) data, sources of differential item functioning (DIF) can be multiple and there may be more than one covariate of interest. Hence, it could be of great interest to disentangle their effects. Yet, in the literature on PRO measures, there are many studies where DIF detection is applied separately and independently for each covariate under examination. With such an approach, the covariates under investigation are not introduced together in the analysis, preventing from simultaneously studying their potential DIF effects on the questionnaire items. One issue, among others, is that it may lead to the detection of false-positive effects when covariates are correlated. To overcome this issue, we developed two new algorithms (namely ROSALI-DIF FORWARD and ROSALI-DIF BACKWARD). Our aim was to obtain an iterative item-by-item DIF detection method based on Rasch family models that enable to adjust group comparisons for DIF in presence of two binary covariates. Both algorithms were evaluated through a simulation study under various conditions aiming to be representative of health research contexts. The performance of the algorithms was assessed using: (i) the rates of false and correct detection of DIF, (ii) the DIF size and form recovery, and (iii) the bias in the latent variable level estimation. We compared the performance of the ROSALI-DIF algorithms to the one of another approach based on likelihood penalization. For both algorithms, the rate of false detection of DIF was close to 5%. The DIF size and form influenced the rates of correct detection of DIF. Rates of correct detection was higher with increasing DIF size. Besides, the algorithm fairly identified homogeneous differences in the item threshold parameters, but had more difficulties identifying non-homogeneous differences. Over all, the ROSALI-DIF algorithms performed better than the penalized likelihood approach. Integrating several covariates during the DIF detection process may allow a better assessment and understanding of DIF. This study provides valuable insights regarding the performance of different approaches that could be undertaken to fulfill this aim.</jats:p

Attention Deficit Hyperactivity Disorder and Gaming Disorder: Frequency and Associated Factors in a Clinical Sample of Patients with Gaming Disorder

International audienceBackground and aims: Since June 2018, gaming disorder (GD) has been recognized as a disease. It is frequently associated with attention deficit hyperactivity disorder (ADHD), as there are common vulnerability factors and bidirectional interactions between the two disorders. This study aims to evaluate the presence of ADHD symptoms and predictive factors of ADHD among patients with GD. Methods: Ninety-seven patients ≥16 years old referred to the University Hospital of Nantes between 2012 and 2020 for GD were included. The diagnosis of GD was given a posteriori in accordance with the new ICD-11 GD definition. ADHD was screened using the Adult-ADHD Self-Report Scale and the Wender-Utah Rating Scale. A multivariate logistic regression model was used to identify explanatory factors for ADHD-GD comorbidity. Results: The rate of GD patients who screened positive for ADHD was 39%. Predictive factors of ADHD-GD comorbidity were impulsivity (higher score on the negative urgency dimension) and low self-esteem. Discussion: The rate of ADHD found among patients with GD is consistent with that from the literature on internet GD but higher than that found for other behavioural addictions. The identification of a higher negative urgency score and low self-esteem as predictive factors of AHDH-GD comorbidity indicates that gaming could be considered a dysfunctional way to cope with emotional dysregulation in ADHD or to virtually escape. Conclusions: Comorbid ADHD must be taken into consideration to minimize its functional impact on GD patients and gamingrelated damage. In contrast, the evaluation of gaming habits in patients with ADHD could be useful for both prevention and care

On comparison of clustering methods for pharmacoepidemiological data

International audienceThe high consumption of psychotropic drugs is a public health prob- lem. Rigorous statistical methods are needed to identify consumption characteristics in post-marketing phase. Agglomerative hierarchical clustering (AHC) and latent class analysis (LCA) can both provide clusters of subjects with similar characteristics. The objective of this study was to compare these two methods in pharmacoepidemiology, on several criteria: number of clusters, concordance, interpretation and stability over time. From a data set on bromazepam consump- tion, the two methods present a good concordance. AHC is a very stable method and provides homogeneous classes. LCA is an inferen- tial approach and seems to allow identifying more accurately extreme deviant behaviour

Évaluation préliminaire de la validité de construit d’un dispositif cartographique (carte procédurale) pour l’étude du raisonnement clinique

Contexte : L’étude du raisonnement clinique conduit à distinguer : 1) des stratégies de résolution de problème (SRP) inductives pendant lesquelles les hypothèses diagnostiques s’établissent à partir des faits et 2) des stratégies déductives reposant sur une collecte de signes orientée par la génération initiale d’hypothèses. Objectif : Explorer la viabilité d’un dispositif cartographique codifié, élaboré par des tiers observateurs, pour rendre compte de la structure des processus de raisonnement clinique développés en situation expérimentale, respectivement par des novices et par des experts. Méthode : Trois groupes de participants de niveaux d’expertise différents ont été constitués (étudiants en médecine 3e année; 5e année et médecins internistes). Des représentations cartographiques apparentées aux cartes conceptuelles, dénommées cartes procédurales ont été transcrites par une tierce personne au fur et à mesure que les participants résolvaient à haute voix quatre problèmes complexes simulés par écrit. Cinq séquences unitaires de raisonnement préalablement définies (raisonnement non analytique, par résumé syndromique, par organigrammes décisionnels, catégoriel et déductif) ont été systématiquement recherchées et dénombrées sur les cartes. Leurs fréquences ont été établies en fonction du degré d’expertise et du type de problème. Résultats : Les séquences unitaires prédéterminées d’après les données de la littérature ont toutes été observées et répertoriées sur les cartes. Le raisonnement déductif a prédominé chez les experts (3,6 séquences inductives (SI) en moyenne par carte pour 6,2 séquences déductives). Les experts comme les novices ont utilisé des stratégies mixtes, inductives et déductives pour résoudre les problèmes cliniques (taux de SI de 0,4 et 0,6). La fréquence de certaines séquences a varié en fonction de l’expertise et du type de dossier. Conclusion : Ce travail exploratoire montre que l’utilisation d’une méthode cartographique originale de représentation du raisonnement clinique retrouve les différentes SRP rapportées dans la littérature et suggère l’utilisation de stratégies mixtes chez les novices comme chez les experts, confrontés à des problèmes cliniques complexes simulés par écrit. Cet outil d’évaluation des processus impliqués dans le raisonnement clinique pourrait s’avérer utile pour dépister des dysfonctionnements chez des étudiants en difficulté

Data from: Divergent in shape and convergent in function: adaptive evolution of the mandible in Sub-Antarctic mice

Convergent evolution in similar environments constitutes strong evidence of adaptive evolution. Transported with people around the world, house mice colonized even remote areas, such as Sub-Antarctic islands. There, they returned to a feral way of life, shifting towards a diet enriched in terrestrial macroinvertebrates. Here, we test the hypothesis that this triggered convergent evolution of the mandible, a morphological character involved in food consumption. Mandible shape from four Sub-Antarctic islands was compared to phylogeny, tracing the history of colonization, and climatic conditions. Mandible shape was primarily influenced by phylogenetic history, thus discarding the hypothesis of convergent evolution. The biomechanical properties of the jaw were then investigated. Incisor in-lever and temporalis out-lever suggested an increase in the velocity of incisor biting, in agreement with observations on various carnivorous and insectivorous rodents. The mechanical advantage related to incisor biting also revealed an increased functional performance in Sub-Antarctic populations, and appears to be an adaptation to catch prey more efficiently. The amount of change involved was larger than expected for a plastic response, suggesting microevolutionary processes were evolved. This study thus denotes some degree of adaptive convergent evolution related to changes in habitat-related changes in dietary items in Sub-Antarctic mice, but only regarding simple, functionally relevant aspects of mandible morphology

Mandible descriptors and PCs for comparison

Sheet 1: Mandible area and Fourier coefficients from A0 to B7 describing size and shape of the mandible. Sheet 2: Mechanical advantages (MAs) and axes for comparisons: PCclimate, PC for D-loop analysis, and PC for mitochondrial analysis

Impact of TR34/L98H, TR46/Y121F/T289A and TR53 Alterations in Azole-Resistant Aspergillus fumigatus on Sterol Composition and Modifications after In Vitro Exposure to Itraconazole and Voriconazole

International audienceBackground: Sterols are the main components of fungal membranes. Inhibiting their biosynthesis is the mode of action of azole antifungal drugs that are widely used to treat fungal disease including aspergillosis. Azole resistance has emerged as a matter of concern but little is known about sterols biosynthesis in azole resistant Aspergillus fumigatus. Methods: We explored the sterol composition of 12 A. fumigatus isolates, including nine azole resistant isolates with TR34/L98H, TR46/Y121F/T289A or TR53 alterations in the cyp51A gene and its promoter conferring azole resistance. Modifications in sterol composition were also investigated after exposure to two azole drugs, itraconazole and voriconazole. Results: Overall, under basal conditions, sterol compositions were qualitatively equivalent, whatever the alterations in the target of azole drugs with ergosterol as the main sterol detected. Azole exposure reduced ergosterol composition and the qualitative composition of sterols was similar in both susceptible and resistant isolates. Interestingly TR53 strains behaved differently than other strains. Conclusions: Elucidating sterol composition in azole-susceptible and resistant isolates is of interest for a better understanding of the mechanism of action of these drugs and the mechanism of resistance of fungi

Human intestinal microbiota gene risk factors for antibiotic-associated diarrhea: perspectives for prevention. Risk factors for antibiotic-associated diarrhea.: Diarrhea risk prediction from microbiota genes

8 pages, 4 figuresInternational audienceAntibiotic-associated diarrhea (AAD) is associated with altered intestinal microflora and other symptoms that may lead to possibly death. In critically ill patients, diarrhea increases rates of morbimortality. Assessing diarrhea risks is thus important for clinicians. For this reason, we conducted a hypothesis-generating study focused on AAD to provide insight into methods of prevention. We evaluated the hypothesis of predisposing factors within the resident intestinal microbiota in a cohort of outpatients receiving antibiotherapy. Among the pool of tested variables, only those related to bacterial 16S rRNA genes were found to be relevant. Complex statistical analyses provided further information: amid the bacteria 16S rRNA genes, eight were determined to be essential for diarrhea predisposition and characterized from the most important to the least. Using these markers, AAD risk could be estimated with an error of 2%. This molecular analysis offers new perspectives for clinical applications at the level of prevention