Gyllingfrederiksen7249
in English, French Des études ont montré que la cardiologie pédiatrique est un domaine de plus en plus concurrentiel. Conséquemment, les diplômés actuels ont du mal à trouver de l’emploi. Au Canada, des observations empiriques sont cohérentes avec ces conclusions, mais aucune évaluation formelle n’a été réalisée. L’objectif de la présente étude était de mener une enquête auprès des cardiologues pédiatres (CP) sur leur perception de la main-d’œuvre actuelle au Canada. En novembre 2017, nous avons envoyé un sondage aux CP et aux résidents membres de l’Association canadienne de cardiologie pédiatrique. Nous sommes également entrés en contact avec les non-membres admissibles de l’Association canadienne de cardiologie pédiatrique par l’intermédiaire des directeurs de programmes et des chefs de division. Soixante-huit des quatre-vingt-trois CP ont rempli l’enquête (82 %). Le pourcentage des répondants qui ont rapporté avoir des difficultés à trouver un poste stable en cardiologie pédiatrique était de 83 % chez ceux ayant terminé leur formation après 2014, alors que le pourcentage était de 33 % chez ceux ayant terminé leur formation entre 2010 et 2014. La durée des formations en surspécialité a augmenté de manière concomitante et a plus que doublé après 2014. Ces données entraient en contradiction avec les commentaires de la plupart des CP (57 %) et des chefs de division (86 %) qui, disaient manquer de personnel et avoir un nombre anticipé plus de postes vacants plus élevés que le nombre de résidents disponibles. Les chefs de division qui rapportaient manquer de personnel attribuaient principalement cela à des contraintes gouvernementales ou budgétaires. Nous avons observé des contradictions entre les besoins perçus pour des CP additionnels et la difficulté croissante que rapportent les diplômés actuels à trouver de l’emploi. Ceci coïncide avec un nombre croissant d’années supplémentaires de formation en surspécialisation. Des contraintes institutionnelles ou gouvernementales contribuent possiblement à cette situation.in English, French E ngaging P atients i n C are (EPIC) est une initiative locale de participation des patients du University Health Network pour les patients et les familles qui ont reçu des soins en lien avec l’insuffisance cardiaque, la transplantation du cœur ou l’assistance circulatoire mécanique (dispositif d’assistance ventriculaire gauche). Les patients et les soignants peuvent participer à 4 niveaux différents, à savoir le partage, la consultation, la délibération et la collaboration, selon leurs connaissances, leur expérience et leur disponibilité. Le cadre EPIC comporte 4 volets prioritaires la prestation de soins et les politiques, la défense des droits des patients, le soutien aux pairs et la recherche. Nous avons déterminé les principaux obstacles à la participation par un échange sur les solutions possibles. Nous espérons que ce cadre peut servir de référence en matière de preuves à d’autres établissements offrant des soins aux patients atteints d’insuffisance cardiaque et la transplantation du Canada.Protein conformational changes are frequently essential for enzyme catalysis, and in several cases, shown to be the limiting factor for overall catalytic speed. However, a structural understanding of corresponding transition states, needed to rationalize the kinetics, remains obscure due to their fleeting nature. Here, we determine the transition-state ensemble of the rate-limiting conformational transition in the enzyme adenylate kinase, by a synergistic approach between experimental high-pressure NMR relaxation during catalysis and molecular dynamics simulations. By comparing homologous kinases evolved under ambient or high pressure in the deep-sea, we detail transition state ensembles that differ in solvation as directly measured by the pressure dependence of catalysis. Capturing transition-state ensembles begins to complete the catalytic energy landscape that is generally characterized by structures of all intermediates and frequencies of transitions among them.Background Symptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI). Methods AS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as "failing" if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was "unstable/deteriorating", physicians were dissatisfied with disease control and/or did not consider treatment a "success". Results The analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently "failing" who, compared to those with treatment success, reported poorer HRQoL 5-dimension EuroQoL (EQ-5D-3 L) 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS) 41.8 vs. 46.3; physical component summary (PCS) 40.2 vs. 45.1; impaired work productivity 46.4% vs. 25.0%; and activity 44.5% vs. 29.6%; all P less then 0.001. Conclusions Among AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity. © The Author(s) 2020.Background Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. We asked primary care physicians (PCPs) and rheumatologists to identify barriers to screening and treatment for hyperlipidemia among patients with RA. Methods We recruited rheumatologists and PCPs nationally to participate in separate moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of barriers to screening and treatment for hyperlipidemia in patients with RA, then each selected the three most important barriers from this list. The resulting barriers were organized into physician-, patient- and system-level barriers, informed by the socioecological framework. Results Twenty-seven rheumatologists participated in a total of 3 groups (group size ranged from 7 to 11) and twenty PCPs participated in a total of 3 groups (group size ranged from 4 to 9). Rheumatologists prioritized physician level barriers (e.g. 'ownership' of hyperlipidemia screening and treatment), whereas PCPs prioritized patient-level barriers (e.g. complexity of RA and its treatments). Conclusion Rheumatologists were conflicted about whether treatment of CVD risk among patients with RA should fall within the role of the rheumatologist or the PCP. All participating PCPs agreed that CVD risk reduction was within their role. Factors that influenced PCPs' decisions for screening and treatment for CVD risk in patients with RA were mainly related to their concern about how treatment for CVD risk could influence RA symptomatology (myalgia from statins) or how inflammation from RA and RA medications influences lipid profiles. © The Author(s) 2020.Background As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS. © The Author(s) 2020.Lupus anticoagulant is a misnomer as it is commonly associated with thromboembolic events. In few cases, the name retains its literal meaning when it characterizes patients with a bleeding disorder. We describe a patient with lupus anticoagulant, hypoprothrombinemia, and major bleeding (lupus anticoagulant/hypoprothrombinemia syndrome). Immunological studies revealed a huge amount of circulating monoclonal immunoglobulin M lambda (IgMλ) antiphosphatidylserine/prothrombin antibodies (14,400 U/mL). Affinity purified monoclonal antibodies (440 U/mL) prolonged the coagulation time of normal plasma by 12.2 seconds (diluted Russell viper venom time) and 25.5 seconds (silica clotting time). The original patient's plasma mixed 11 with normal plasma showed a marked prolongation of coagulation times (lupus cofactor) from a ratio of 2.94 to 5.23 in diluted Russel viper venom time and from 2.30 to 3.00 using the silica clotting time. Human prothrombin added to original patient's plasma caused a marked prolongation of coagulation times in diluted Russell viper venom test thus unequivocally explaining the lupus cofactor phenomenon. In conclusion, we have shown that lupus anticoagulant/hypoprothrombinemia syndrome is attributable to monoclonal IgMλ antibodies directed to phosphatidylserine/prothrombin and that prothrombin is the protein responsible for the observed lupus cofactor phenomenon.Objective To investigate the clinical relevance of an isolated echogenic cardiac focus (iECF) as a marker for trisomy 21 using a large second-trimester collective including a low-risk subgroup. Materials and Methods We retrospectively evaluated 1 25 211 pregnancies from 2000-2016 and analyzed all iECF cases with regard to chromosomal anomalies. It consisted of an early second-trimester collective from 14+0-17+6 weeks (n=34 791) and a second-trimester anomaly scan collective from 18+0-21+6 weeks. Two a priori risk subgroups (high and low risk) of the latter were built based on maternal age and previous screening test results using a cut-off of 1300. Likelihood ratios (LR) of iECF for the detection of trisomy 21, trisomy 13, trisomy 18 and structural chromosomal anomalies were estimated. Results In total, 1 04 001 patients were included. An iECF was found in 4416 of 1 02 847 euploid fetuses (4.29%) and in 64 of 557 cases with trisomy 21 (11.49%) giving a positive LR of 2.68 (CI 2.12-3.2). The sensitivity was 11.
