Favoriser le développement de compétences non techniques chez les étudiants en médecine grâce à la participation des patients : revue rapide

Background: To train physicians who will respond to patients’ evolving needs and expectations, medical schools must seek educational strategies to foster the development of non-technical competencies in students. This article aims to synthetize studies that focus on patient engagement in medical training as a promising strategy to foster the development of those competencies.Methods: We conducted a rapid review of the literature to synthetize primary quantitative, qualitative and mixed studies (January 2000-January 2022) describing patient engagement interventions in medical education and reporting non-technical learning outcomes. Studies were extracted from Medline and ERIC. Two independent reviewers were involved in study selection and data extraction. A narrative synthesis of results was performed.Results: Of the 3875 identified, 24 met the inclusion criteria and were retained. We found evidence of a range of non-technical educational outcomes (e. g. attitudinal changes, new knowledge and understanding). Studies also described various approaches regarding patient recruitment, preparation, and support and participation design (e.g., contact duration, learning environment, patient autonomy, and format). Some emerging practical suggestions are proposed.Conclusion: Our results suggest that patient engagement in medical education can be a valuable means to foster a range of non-technical competencies, as well as formative and critical reflexivity. They also suggest conditions under which patient engagement practices can be more efficient in fostering non-instrumental patient roles in different educational contexts. This supports a plea for sensible and responsive interventional approaches.Contexte : Pour former des médecins aptes à répondre aux besoins et attentes évolutifs des patients, les facultés de médecine doivent trouver des stratégies éducatives pour stimuler le développement de compétences non techniques chez les étudiants. Cet article vise à synthétiser les études qui traitent de la participation des patients à la formation médicale comme stratégie prometteuse pour favoriser le développement de ces compétences. Méthodes : Nous avons effectué une revue rapide de la littérature pour synthétiser les études primaires quantitatives, qualitatives et mixtes (janvier 2000-janvier 2022) qui décrivent des interventions visant l’engagement des patients dans la formation médicale et qui font état de résultats d’apprentissage non technique. Les études ont été extraites de Medline et d’ERIC. Deux examinateurs indépendants ont participé à la sélection des études et à l’extraction des données. Une synthèse narrative des résultats est présentée. Résultats : Parmi les 3875 études recensées, 24 répondaient aux critères d’inclusion et ont été retenues. Ces études font état d’apprentissages non techniques (par exemple, des changements d’attitude, des compréhensions et connaissances nouvelles). Les études décrivent également diverses approches de recrutement et de préparation des patients, et diverses manières de concevoir leur participation (par exemple, la durée du contact, l’environnement d’apprentissage, l’autonomie du patient et le format) et le soutien pédagogique qui en découle. Quelques suggestions pratiques émergentes sont proposées. Conclusion : D’après nos résultats, l’engagement du patient dans l’éducation médicale constitue une avenue prometteuse pour favoriser le développement d’une panoplie de compétences non techniques, tout comme la réflexivité formative et critique des étudiants. Ils indiquent également certaines conditions et contextes éducatifs qui favorisent la participation non instrumentale des patients. Il s’agit d’un plaidoyer en faveur d’interventions éducatives centrées sur les besoins et préoccupations des acteurs impliqués et sur les particularités des contextes locaux

Impact of mash feeding versus pellets on propionic/butyric acid levels and on total Escherichia coli load in the gastrointestinal tract of growing pigs

Feed characteristics may influence the bacterial community composition and metabolic activities in the pig gastrointestinal tract, known to be associated with positive effects on the gut. Use of mash feed is associated with reduced Salmonella excretion, but little is known of its effect on the Escherichia coli population or of the mechanism of action. Our objectives were to assess the effect of feed texture combined with feed particle size on VFA profiles and levels, total E. coli count, and the presence of genes encoding virulence factors of pathogenic E. coli strains in the digestive tract along with their impact on pig performance of fattening pigs. Pigs (n = 840) on a commercial farm received mash or pellet diets of different particle sizes during the fattening period. Caecal and colon contents from 164 pigs were sampled at the slaughterhouse for enumeration of E. coli by quantitative PCR (qPCR) and for VFA quantification by capillary gas chromatography. The yccT gene was used to enumerate total E. coli. Improved pig performances associated with pellet texture and a 500-μm size were observed. Caecal (P = 0.02) and colon (P < 0.01) propionic acid concentrations were lower for pigs receiving pellet rather than mash feed. Similarly, caecal (P = 0.01) and colon (P < 0.001) butyric acid concentrations were also lower for pigs receiving pellet rather than mash feed, as determined by capillary gas chromatography. Moreover, caecal (P = 0.03) and colon (P < 0.001) butyric acid concentrations were higher for pigs receiving a feed with a 1,250-μm particle size rather than a 500-μm particle size. On the other hand, total caecal and colon E. coli levels were higher for pigs receiving pellet feed than for those receiving mash feed. For total E. coli enumeration, caecal (P < 0.01) and colon (P < 0.01) yccT gene copies were higher for pigs receiving pellet rather than mash feed. No effect of particle size on fatty acid concentrations or on E. coli numbers was observed. Virulence gene quantification revealed no trend. Taken together, results showed that mash feed is associated with lower growth performance but with favorable intestinal changes linked to VFA levels and E. coli reduction in the intestine

Plasticity in the Sensitivity to Light in Aging: Decreased Non-visual Impact of Light on Cognitive Brain Activity in Older Individuals but No Impact of Lens Replacement

Beyond its essential visual role, light, and particularly blue light, has numerous non-visual effects, including stimulating cognitive functions and alertness. Non-visual effects of light may decrease with aging and contribute to cognitive and sleepiness complaints in aging. However, both the brain and the eye profoundly change in aging. Whether the stimulating effects light on cognitive brain functions varies in aging and how ocular changes may be involved is not established. We compared the impact of blue and orange lights on non-visual cognitive brain activity in younger (23.6 ± 2.5 years), and older individuals with their natural lenses (NL; 66.7 ± 5.1 years) or with intraocular lens (IOL) replacement following cataract surgery (69.6 ± 4.9 years). Analyses reveal that blue light modulates executive brain responses in both young and older individuals. Light effects were, however, stronger in young individuals including in the hippocampus and frontal and cingular cortices. Light effects did not significantly differ between older-IOL and older-NL while regression analyses indicated that differential brain engagement was not underlying age-related differences in light effects. These findings show that, although its impact decreases, light can stimulate cognitive brain activity in aging. Since lens replacement did not affect light impact, the brain seems to adapt to the progressive decrease in retinal light exposure in aging

Green Edge ice camp campaigns : understanding the processes controlling the under-ice Arctic phytoplankton spring bloom

The Green Edge initiative was developed to investigate the processes controlling the primary productivity and fate of organic matter produced during the Arctic phytoplankton spring bloom (PSB) and to determine its role in the ecosystem. Two field campaigns were conducted in 2015 and 2016 at an ice camp located on landfast sea ice southeast of Qikiqtarjuaq Island in Baffin Bay (67.4797∘ N, 63.7895∘ W). During both expeditions, a large suite of physical, chemical and biological variables was measured beneath a consolidated sea-ice cover from the surface to the bottom (at 360 m depth) to better understand the factors driving the PSB. Key variables, such as conservative temperature, absolute salinity, radiance, irradiance, nutrient concentrations, chlorophyll a concentration, bacteria, phytoplankton and zooplankton abundance and taxonomy, and carbon stocks and fluxes were routinely measured at the ice camp. Meteorological and snow-relevant variables were also monitored. Here, we present the results of a joint effort to tidy and standardize the collected datasets, which will facilitate their reuse in other Arctic studies

Les apprentissages retirés d'une expérience de stage à La Maison Bleue et leur applicabilité aux pratiques en première ligne : perceptions et vécu de médecins

Objectifs : Ce mémoire explore les apprentissages retirés d’une expérience de stage au sein d’un modèle alternatif d’organisation des services de première ligne et leur potentielle actualisation dans la pratique médicale ultérieure. Méthode : L’étude qualitative exploratoire repose sur douze entretiens avec des médecins en exercice ayant transité par La Maison Bleue (le milieu de recherche) lors de stages et trois entretiens avec des informateurs-clés de La Maison Bleue, du réseau de la santé et des services sociaux et du milieu universitaire, impliqués dans la gestion des stages. Résultats : Les principaux apprentissages retirés de l’expérience de stage seraient reliés à : (1) la considération des personnes dans leur globalité et leur contexte ; (2) une perspective réflexive de déconstruction des préjugés et de questionnement des normes, en faveur d’une approche moins stigmatisante ; (3) la richesse et la portée de la pratique bonifiée d’un regard interdisciplinaire ; (4) la définition de l’identité professionnelle. Des barrières organisationnelles à l’application des apprentissages, relevant de la philosophie du système et des caractéristiques propres au milieu de pratique, ont été identifiées. Les facteurs facilitants ont pour leur part davantage été identifiés sur le plan humain, mais semblent n’avoir, au final, qu’un effet marginal sur la réelle capacité des médecins à mettre en application les apprentissages. Conclusions : L’étude a permis de souligner la présence, au sein du système de santé et de services sociaux québécois, de médecins de première ligne exprimant une volonté de pratiquer la médecine autrement dans l’objectif de répondre aux besoins et aux attentes des populations en situation de vulnérabilité. Les résultats de notre étude suggèrent la nécessité d’une prise de conscience à l’échelle organisationnelle des barrières qu’expérimentent ces médecins à la mise en oeuvre d’une pratique en accord avec leurs valeurs, leurs idéaux et leur identité.Objectives: This master’s thesis explores the learning gained from an internship experience within an "alternative" model of organization of front-line services and its potential application in subsequent medical practice. Method: The exploratory qualitative study is based on twelve interviews with practicing doctors who completed an internship at La Maison Bleue, our research environment; and three interviews conducted with key informants from La Maison Bleue, and from the health and social services network and academic institutions, involved in the management of internships. Results: The main lessons learned from the internship experience are related to: (1) taking into account people in their globality and in their context; (2) a reflexive perspective favorable to the deconstruction of prejudices and the questioning of norms, leading to a less stigmatizing approach; (3) the richness and scope of enhanced practice from an interdisciplinary perspective; (4) the definition of professional identity. Organizational barriers to the application of learning, based on the philosophy of the health and social services system and characteristics specific to the practice environment, have been identified. Facilitating factors have, for their part, been more identified on the human level but seem to have, ultimately, only a marginal effect on the real capacity of physicians to implement learning into their practice. Conclusions: This study highlighted the presence, within the Quebec health and social services system, of primary care physicians who express a desire to practice medicine differently in order to meet the needs and expectations of populations in vulnerable situations. The results of our study suggest the need for organizational awareness of the barriers that these physicians experience in implementing a practice in accordance with their values, ideals and identities

Solid-type Adenoid Cystic Carcinoma of the breast, a distinct molecular entity enriched in NOTCH and CREBBP mutations

Le carcinome adénoïde kystique (CAK) du sein de type solide est difficile à diagnostiquer avec certitude et à différencier des cancers du sein triple-négatifs (CSTN) basal-like, plus communs. Afin de mieux caractériser les CAK de forme solide, nous avons effectué une analyse comparative clinique, morphologique, immunohistochimique et moléculaire de 33 CAK du sein, comprenant 17 CAK solides et 16 CAK conventionnels. Les CAK de type solide présentaient une population de cellules épithéliales exclusive ou prédominante associée à une diminution de la différenciation myoépithéliale, tout en démontrant une surexpression de la protéine MYB similaire au CAK conventionnel. Une expression forte et diffuse de MYB par immunochimie a été observée dans 14/17 (82%) des CAK de type solide (H score > 150), tandis que des réarrangements de MYB ont été détectés par hybridation in situ à fluorescence (FISH) break apart chez seulement 3/16 (19%) des CAK de type solide. Inversement, une expression immunohistochimique de MYB faible n'a été observée que dans 7/204 (3%) des CSTN. Les CAK de type solide présentaient un profil transcriptomique distinct de celui des CAK classiques avec 549 gènes montrant une expression différentielle hautement significative entre les CAK classiques et les CAK de type solide [False Discovery Rate (FDR) |1|]. Les analyses EnrichR et Kegg Pathway ont révélé que PI3K-Akt et les voies de signalisation de l'adhésion focale étaient surexprimées de manière significative dans les CAK conventionnels par rapport aux CAK de type solide qui surexprimaient de manière significative la voie du métabolisme de l'azote. Les mutations de CREBBP et les mutations activatrices du gène NOTCH n'étaient présentes que dans les CAK de type solide, dans 5/16 (31%) des cas pour chaque gène. Les tumeurs avec des mutations activatrices de NOTCH présentaient une forte expression nucléaire diffuse de NICD1, un marqueur établi de l'activation de la voie de Notch, avec un score H médian de 150 (110-280). Les CAK de type solide différaient également des CSTN basal-like, avec moins de mutations de TP53 et un profil génomique plus stable lors de l'hybridation génomique comparative (CGH). En résumé, le CAK solide du sein est une entité moléculaire distincte de la famille des CAK et est différent du CSTN basal-like commun. Biomarqueur utile au diagnostic du carcinome adénoïde solide kystique, NOTCH pourrait également être une nouvelle cible thérapeutique potentielle dans 30% des cas.Adenoid cystic carcinoma (ACC) of the breast with a predominant solid pattern is difficult to diagnose with certainty and differentiate from more common triple-negative breast cancers (TNBC) of basal-phenotype. To better characterize solid-type ACC, we performed a clinical, morphological, immunohistochemical and molecular comparative analysis of 33 ACCs of the breast comprising 17 solid variant ACCs and 16 conventional ACCs. Solid-type ACCs displayed an exclusive or predominant epithelial cell population associated with decreased myoepithelial differentiation, while demonstrating MYB protein overexpression similar to the more common type of ACC. Strong and diffuse MYB expression by immunochemistry was observed in 14/17 (82%) of solid-type ACCs (H score > 150) while MYB rearrangements were detected by break apart fluorescence in situ hybridization (FISH) in only 3/16 (19%) of solid-type ACCs. Conversely, weak MYB immunohistochemical expression was observed in only 7/204 (3%) of TNBCs. Solid-type ACC displayed a transcriptomic profile distinct from conventional ACC with 549 genes showing a highly significant differential expression between conventional and solid-type ACC [False Discovery Rate (FDR) |1|]. EnrichR and Kegg Pathway analyses identified PI3K-Akt and focal adhesion signaling pathways as significantly overexpressed in conventional-type ACCs compared to solid-type ACCs which significantly overexpressed the nitrogen metabolism pathway. CREBBP mutations and NOTCH activating gene mutations were only present in solid-type ACCs, concerning 5/16 (31%) of cases for each gene. Tumors with NOTCH activating mutations displayed strong diffuse nuclear NICD1 staining, an established marker of Notch pathway activation, with a median H-score of 150 (110-280). Solid-type ACC also differed from basal-type TNBC, with fewer TP53 mutations and a more stable genomic profile on array comparative genomic hybridization (CGH). In summary, solid ACC of the breast is a distinct molecular entity within the ACC family and is different from common basal-type TNBC. A diagnostically useful biomarker of solid adenoid cystic carcinoma, NOTCH could also be a novel potential therapeutic target in 30% of cases

Light-sensitive brain pathways and aging

Notwithstanding its effects on the classical visual system allowing image formation, light acts upon several non-image-forming (NIF) functions including body temperature, hormonal secretions, sleep-wake cycle, alertness, and cognitive performance. Studies have shown that NIF functions are maximally sensitive to blue wavelengths (460–480 nm), in comparison to longer light wavelengths. Higher blue light sensitivity has been reported for melatonin suppression, pupillary constriction, vigilance, and performance improvement but also for modulation of cognitive brain functions. Studies investigating acute stimulating effects of light on brain activity during the execution of cognitive tasks have suggested that brain activations progress from subcortical regions involved in alertness, such as the thalamus, the hypothalamus, and the brainstem, before reaching cortical regions associated with the ongoing task. In the course of aging, lower blue light sensitivity of some NIF functions has been reported. Here, we first describe neural pathways underlying effects of light on NIF functions and we discuss eye and cerebral mechanisms associated with aging which may affect NIF light sensitivity. Thereafter, we report results of investigations on pupillary constriction and cognitive brain sensitivity to light in the course of aging. Whereas the impact of light on cognitive brain responses appears to decrease substantially, pupillary constriction seems to remain more intact over the lifespan. Altogether, these results demonstrate that aging research should take into account the diversity of the pathways underlying the effects of light on specific NIF functions which may explain their differences in light sensitivity