L'environnement des éricacées des forêts de l'est du Québec

L’objectif principal de l’inventaire écologique réalisé est la caractérisation des sites avec présence d’éricacées : Rhododendron groenlandicum, Vaccinium sp. et Kalmia angustifolia, des forêts de la Côte-Nord, ainsi que de comprendre davantage leurs exigences écologiques. Quatre-vingt-dix-sept sites ont été étudiés au nord de Baie-Comeau, tous provenant de pessières noires à mousses (Picea mariana) vierges. Le Rhododendron est l’espèce éricacée dont le recouvrement moyen du parterre forestier est le plus important suivi par les Vaccinium et le Kalmia. Leur présence a été associée aux pessières noires ouvertes et aux sols acides, de textures grossières et pauvres en éléments nutritifs. Leur recouvrement diminuait avec la dominance des sapins (Abies balsamea). Quatre associations végétales ont été identifiées. L’une d’elles regroupait les trois espèces d’éricacées et trois espèces de Cladina. Les résultats de cette recherche pourront aider à classifier les sites selon leur niveau de vulnérabilité à l’envahissement par les plantes éricacées après coupe forestière.The objective of the present ecological inventory was to characterize the presence of three common ericad species: Rhododendron groenlandicum, Vaccinium species and Kalmia angustifolia, in Quebec North Shore forests, and to better understand their presence in relation to environmental factors. Ninety-seven sites within the undisturbed black spruce-feathermoss (Picea mariana) forest north of Baie-Comeau were selected for the study. Rhododendron had the highest mean cover, followed by Vaccinium and Kalmia. The presence of these species was associated with an open forest canopy, acid, coarse-textured and nutrient-poor soils. Ericads were strongly associated with black spruce-dominated forests, with presence decreasing as the balsam fir (Abies balsamea) component increased. Four vegetation associations were identified, including an Ericad-lichen group that included the three ericads and three Cladina species. Results may be used to help identify and classify sites vulnerable to ericaceous invasion after forest harvest

A physician-physiotherapist collaborative model in a family medicine teaching clinic

Persons with musculoskeletal disorders frequently seek care in family medicine clinics. However, musculoskeletal education provided in medical schools is often considered insufficient. The implementation of a collaborative model that integrates physiotherapists into teaching clinics may benefit the musculoskeletal training of medical residents. This paper describes a model developed in a family medicine teaching clinic by examining the interprofessional educational and collaborative activities implemented in this model. The model allowed to provide physiotherapy services, involve the physiotherapist in the training of family medicine residents and enhance interprofessional collaboration, particularly for the management of persons with musculoskeletal disorders._____Les personnes ayant des troubles musculosquelettiques consultent fréquemment en cliniques de médecine de famille. Cependant, l’enseignement musculosquelettique dispensé dans les programmes de médecine est souvent considéré comme insuffisant. L’implantation d’un modèle de collaboration qui intègre les physiothérapeutes aux cliniques d’enseignement pourrait améliorer la formation des médecins résidents. Cet article décrit un modèle développé dans une clinique d’enseignement en médecine familiale en examinant les activités interprofessionnelles d’éducation et de collaboration implantées dans ce modèle. Le modèle a permis d’offrir des services de physiothérapie, d’impliquer le physiothérapeute dans la formation des médecins résidents et d’améliorer la collaboration interprofessionnelle, particulièrement pour la prise en charge des personnes ayant des troubles musculosquelettiques

Getting ready for transition to adult care : tool validation and multi-informant strategy using the Transition Readiness Assessment Questionnaire in pediatrics

Background Transitioning from pediatric to adult healthcare can be challenging and lead to severe consequences if done suboptimally. The Transition Readiness Assessment Questionnaire (TRAQ) was developed to assess adolescent and young adult (AYA) patients' transition readiness. In this study, we aimed to (1) document the psychometric properties of the French-language version of the TRAQ (TRAQ-FR), (2) assess agreements and discrepancies between AYA patients' and their primary caregivers' TRAQ-FR scores, and (3) identify transition readiness contributors. Methods French-speaking AYA patients (n = 175) and primary caregivers (n = 168) were recruited from five clinics in a tertiary Canadian hospital and asked to complete the TRAQ-FR, the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0), and a sociodemographic questionnaire. The validity of the TRAQ-FR was assessed using confirmatory factor analyses (CFA). Agreements and discrepancies were evaluated using intraclass correlation coefficients and paired-sample t tests. Contributors of transition readiness were identified using regression analyses. Results The five-factor model of the TRAQ was supported, with the TRAQ-FR global scale showing good internal consistency for both AYA patients' and primary caregivers' scores (α = .85–.87). AYA patients and primary caregivers showed good absolute agreement on the TRAQ-FR global scale with AYA patients scoring higher than primary caregivers (ICC = .80; d = .25). AYA patients' age and sex were found to be contributors of transition readiness. Conclusions The TRAQ-FR was found to have good psychometric properties when completed by both AYA patients and primary caregivers. Additional research is needed to explore the predictive validity and clinical use of the TRAQ-FR

Le risque : un modèle conceptuel d'intégration

The following project report is the first of a sequence which will focus on integrated risk management. This report presents a conceptual model which goal is to define the concept of risk. This conceptual model integrates the definitions of multiple domains having an interest in risk management. With the model, a terminology is proposed. This conceptual model is a foundation upon which it will be possible to exchange methods and measures of risk between domains. Ce rapport de projet est le premier d'une série qui s'intéressera à la gestion intégrée du risque. Dans l'objectif de répondre à la question « qu'est-ce que le risque? », un modèle conceptuel définissant le concept du risque est proposé. Ce modèle conceptuel intègre les définitions du risque de différentes disciplines. Une terminologie a été élaborée pour accompagner le modèle. Ce modèle conceptuel tente d'élaborer une base à partir de laquelle pourra se faire l'échange de méthodes et de mesures entre les domaines s'intéressant au risque.Risk, integrated risk management, definition, integration, Risque, gestion intégrée du risque, définition, intégration

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Economic evaluations of interventions to optimize medication use in older adults with polypharmacy and multimorbidity : a systematic review

Purpose: To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. Methods: We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. Results: Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. Conclusion: Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients

Clinical services in community pharmacies : a scoping review of policy and social implications

Objectives Clinical services have allowed pharmacists to shift from product-oriented to patientoriented services. However, the policy and social implications of clinical services in community pharmacies are not well described. The purpose of this scoping review was to identify these implications. Key findings We searched Pubmed and Embase, from inception to March 2019, as well as grey literature for publications that discussed policy (e.g. pharmacy model and pharmacist status) or social (e.g. role of pharmacists and interprofessional collaboration) implications of clinical services. Publications had to address clinical services provided by pharmacists in community settings that target the global long-term care of patients. We extracted data related to the implications and classified them into themes thereafter. The search process identified 73 relevant publications, of which 13 were included in regard to policy implications and 60 relative to social implications. Two themes emerged from policy implications: implementation and characteristics of policies, and professional status. Pharmacists’ independence from distribution, financial coverage of clinical services and innovative models of practice were addressed. Social implications involved three themes: roles and interprofessional collaboration, changes in practice and barriers and model of practices and services. Perceptions of pharmacists’ skills, organisational barriers, time constraints, lack of self-confidence and cultural shifts required to implement clinical services were included in these themes. Summary Our review demonstrates the changing role of community pharmacists in provision of clinical services within the healthcare system. The range of clinical services varies widely from one setting to another. The context of community pharmacy is not well suited to these changes in practice

Study of the correlation between immunohistochemistry of thyroid carcinoma's primary tumor and FDG-PET/CT's result in case of recurrence.

International audienc

Relationship between the immunohistochemistry of the primary tumour and 18F-FDG-PET/CT at recurrence in patients with well-differentiated thyroid carcinoma.

International audienc