Impact de l'étude du Women's Health Initiative sur les taux d'utilisation, les caractéristiques cliniques et la persistance associés à la prise d'hormonothérapie substitutive

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Treating delusional disorder : a comparison of cognitive-behavioural therapy and attention placebo control

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs

: Une catégorie de la pensée médiévale?

Cet ouvrage examine l'hypothèse selon laquelle la logique de l'intus (l'intérieur) et du foris (l'extérieur) constitue un cadre de pensée majeur au Moyen Âge, une grille de lecture qui s'actualise dans de nombreux discours. Cette distinction paulinienne, systématisée par Augustin, détermine la manière dont la théologie médiévale pense l'être humain, composé d'un " homme intérieur " et d'un " homme extérieur ". Mais elle excède largement ce champ. Le couple paraît également opératoire dans des domaines aussi variés que le droit canonique, la médecine, le théâtre, l'architecture ou encore la pratique épistolaire. Plus encore, la dialectique de l'intérieur et de l'extérieur dépasse le simple niveau de la personne et pourrait être considérée comme un schème applicable à différentes réalités conçues à partir du paradigme humain : définition de la communauté, construction de l'espace en espace social, rapport entre le microcosme et le macrocosme..

Intus et foris. Une catégorie de pensée médiévale ?

Actes des journées d'étude "Intus et foris", Questes, ENS, Université Paris Sorbonne, Paris, 12 et 13 juin 2009.International audienc

Examining the contribution of motivation in the job search of youth with developmental language disorder

Background & aims Youth with developmental language disorder (DLD) are at risk of experiencing challenges during their job search. It is thus crucial to promote efficient job search behaviors in terms of effort, intensity, and self-regulation. Based on self-determination theory (SDT), we verified the role of autonomous and controlled motivations in enhancing these behaviors. Methods Study 1 included 37 young adults with DLD who have finished school, and Study 2 included 52 youth with DLD transitioning from school to work. They completed a questionnaire examining their job search behaviors and their motivation toward their job search. Results Autonomous motivation positively predicted job search effort, intensity, and self-regulation. Small to moderate relations were observed in Study 1, and moderate to strong ones in Study 2. Controlled motivation was unrelated to the three behaviors. Conclusions In line with SDT, autonomous motivation is an important foundation for positive job search behaviors among youth with DLD. Implications Supporting the development of autonomous motivation is thus encouraged in transition services for this population

Analyse comparative des coûts d’utilisation des agents inhalés et des médicaments utilisés en myringotomie, amygdalectomie et cure de hernie inguinale chez les enfants

Résumé Objectif : Présenter une analyse descriptive des coûts de l’anesthésie de chirurgies en pédiatrie (amygdalectomie, myringotomie, cure hernie inguinale). Méthode : Analyse rétrospective de coûts effectuée à partir de dossiers (du 01-03-1998 au 30-11-1999).Resultats : Des 420 dossiers sélectionnés, 374 ont répondu aux critères d’inclusion. Il existe des différences significatives entre les trois chirurgies quant aux données de base, à l’intervention anesthésique, aux durées, à l’état d’éveil à 15, 30 et 45 minutes, au profil d’effets indésirables en salle d’opération et en salle de réveil. Au moment de l’étude, l’halothane est l’agent le plus souvent utilisé en maintien (dans 67 à 79 % des cas, selon la chirurgie). Il existe des différences significatives entre les coûts associés à chacune des trois chirurgies en ce qui a trait aux coûts des médicaments en maintien et en post-chirurgie, au coût total des agents inhalés par minute et au coût total des médicaments et agents inhalés par minute, et ce, selon les deux approches de calcul. Conclusion : Il existe peu de données économiques sur l’utilisation des agents inhalés et des médicaments au bloc opératoire en pédiatrie. Cette étude présente une analyse comparative des coûts d’utilisation des agents inhalés et des médicaments. Abstract Objective: To present a descriptive analysis of the cost of anesthesia in pediatric surgeries (tonsillectomy, myringotomy, inguinal hernia repair). Method: Retrospective analysis of costs based on a review of medical records (from 03-01-1998 to 11-30- 1999). Results: From the 420 records selected, 374 met the inclusion criteria. Significant differences exist between the three surgeries regarding base-line information, anesthetic intervention, durations, wakefulness at 15, 30 and 45 minutes, and side effects in the operating room and in the recovery room. At the time of the study, halothane was the main agent used in maintenance (in 67 to 79% of cases, depending on the surgery). Significant differences exist between the costs associated with each surgery, relating to medication costs in maintenance and in the post-operative period, as well as to total costs of inhaled agents per minute and to total costs of medications and inhaled agents per minute. Conclusion: Few economic data exist regarding the use of inhaled agents and medications used in a pediatric surgery ward. This study draws a comparative analysis of the cost-in-use of inhaled agents and medications. Key words: pharmacoeconomy, inhaled agents, myringotomy, tonsillectomy, inguinal hernia, pediatrics

Patient and work flow and costs associated with staff time and facility usage at a comprehensive cancer centre in Quebec, Canada – a time and motion study

Abstract Background Mapping patient and work flow and cost analysis studies can help determine the most efficient and cost effective way of providing health services while still maintaining the best standards of care. This study used both time and motion methodology and hospital data to assess the contribution of staff time and facility usage to the overall cost of cancer care during patient visits to a comprehensive cancer centre in Quebec, using metastatic colorectal cancer as a model. Methods A workflow diagram was created mapping direct and indirect steps involved during a patient’s physician or treatment (FOLFOX/bevacizumab or XELOX/bevacizumab) visit. Staff were timed as they performed each task and this data together with compensation amounts were used to calculate personnel costs. Mean work times and 95% confidence intervals (CI) were calculated. Operation and maintenance (O&M) costs for the Centre were calculated using information from hospital databases. All costs were presented in constant Canadian dollars for the 2010–2011 fiscal year period. Results For physician visits, direct and indirect personnel costs were $9.25 (95$7.00-11.51) and O&M costs were 60.21, for a total of $69.46 (95$67.21-71.72). For treatment visits, personnel and O&M costs were 71.91 (95%CI:$45.53-$98.29) and $62.00 respectively for a total of$133.91 (95%CI:$107.53-$160.29). When calculated for treatment alone, the total cost was $136.06 (95$109.16-$162.95) for FOLFOX/bevacizumab and$119.94 (95%CI:$96.89-$142.99) for XELOX/bevacizumab. The highest cumulative personnel costs were for the pharmacists and nurses ($38.87 and$34.82 respectively). Regarding patient flow, total time in between steps was 77.6 and 49.5 minutes for a physician or treatment visit respectively. Conclusions This study from a health care provider’s perspective, demonstrated that in the context of increasingly expensive therapies, costs associated with staff time and facility usage do not contribute greatly to the overall cost of treating cancer at this cancer centre. It also illustrated the need for improvements in patient and work flow to reduce wait times in the clinic.</p

Bioactive micropatterning of biomaterials for induction of endothelial progenitor cell differentiation: Acceleration of in situ endothelialization

Synthetic grafts do not provide an appealing surface for endothelial cells to adhere and colonize the inner surface. To promote in situ endothelialization the following aspect has to be taken into account, endothelial progenitor cells (EPCs) needs to be mobilized on the surface of the graft. The surface of the graft has to be sufficiently biocompatible to create a prone environment for the EPCs to adhere, proliferate and, differentiate to form a layer and subsequently improve graft patency. In this work, two active molecules GRGDS and sitagliptin, were chosen for their abilities to recruit, enhance adhesion and induce differentiation of endothelial progenitor cells. They were grafted on PET surfaces in order to provide restrained cues triggering cell alignment and evaluate the influence of such structuration on EPCs fate. We then analyze cell behavior onto functionalized biomaterials. Their abilities to control EPCs fate were demonstrated via RT-qPCR, immunofluorescence, and enzymatic tests. The GRGDS/sitagliptin 100 × 10 surface enables to reduce the stemness phenotype on EPCs and induce the expression of endothelial lineage markers. These results highlight the importance of spatial patterning cues in guiding EPCs organization and function, which may have clinical relevance in the development of vascular grafts that promote patency