[Analysis of the profile of employees declared unfit for the job : How do societal or extra-professional factors contribute, and what are the consequences for employment?] / Analyse du profil des salariés déclarés inaptes au poste de travail : quelle place pour les facteurs sociétaux ou extra-professionnels et quelles conséquences sur l'emploi ?

INTRODUCTION: Professional career can be modified by health problems. Professional impairment, certified by an occupational health physician, can be followed by a redeployment or occupational disintegration. OBJECTIVES: To describe the profiles of workers declared unfit for their workplace and the profiles of those who have no remaining work capacity (RWC). METHODS: The workers followed by an inter-enterprise occupational health service composed of 20 occupational physicians. The characteristics of workers declared unfit for work were extracted from the medical files: age, gender, activity sector (Naf), socioprofessional category (PCS), pathology leading to professional impairment (CIM10), status of obligation to employ disabled workers (BOETH). Factors associated with unfitness to work due to no remaining work capacity (RWC) were identified by logistic regression models. RESULTS: In 2019, 82678 workers in France were followed by the SPSTI and 554 (0.67%), of whom 162 had no RWC, were declared unfit to work by an occupational health physician. Professional impairment rates were highest for women and workers > 55 years old. Psychological (29%) and rheumatic (50%) pathologies were the most frequent causes of professional impairment. BOETH status was identified among 63%. Age > 45 and psychological pathology were significantly associated with absent RWC, whereas gender, activity sector and PCS were not. DISCUSSION: No comprehensive public administration records of professional impairment exist in France. While past studies have described the profiles of workers who were unfit for their workplace, none have characterized those without RWC, who are high risk of precarity. CONCLUSIONS: Psychological pathologies generate the most professional impairment in persons without RWC. Prevention of these pathologies is essential. While rheumatic disease is the first cause of professional impairment, the proportion of workers with these diseases who have no remaining work capacity is relatively low; this may be due to the efforts made to facilitate their return to work.

Caregiver-infant and toddler interactions during diapering: Caregiver responsiveness and child well-being and involvement.

The findings of this empirical research provide new information about the importance of caregiver interactions during care routines, specifically diaper changing, in supporting infant and toddler involvement and well-being. This correlational study involved observations of 144 separate diapering cycles by 31 caregivers with 74 infants and toddlers in 30 infant and toddler classrooms in a U.S. Midwest city. Based on these observations, caregiver responsiveness was found to be significantly related to both child involvement and child well-being. Another feature of caregivers' behavior, caregiver encouragement, was significantly associated with child well-being, but not child involvement. The study results suggest that caregivers' behaviors, specifically responsiveness and encouragement, during diapering are vital proximal processes in the moment-to-moment interactions between a caregiver and child. Thus, responsiveness and encouragement in care routines should be emphasized in infant care settings and be a focus for caregiver professional development, including pre- and in-service training. Although training related to diapering is often restricted to health concerns, the findings suggest that specific caregiver-child interactions during this care routine may support or hinder children's well-being and involvement in the moment. Caregiver responsiveness to children's cues in this context may enhance children's opportunities to practice involvement in bidirectional relationships and support children's well-being.

Los resultados de esta investigación empírica aportan información acerca de la importancia de las interacciones del cuidador durante las rutinas de prestar el cuidado, específicamente el cambio de los pañales, en cuanto a apoyar la participación y el bienestar del infante y el niño pequeñito. Este estudio correlativo incluyó las observaciones de 144 ciclos separados de cambios de pañales por parte de 31 cuidadores con 74 infantes y niños pequeñitos en 30 salas para infantes y niños pequeñitos en una ciudad del medio oeste de los Estados Unidos. Con base en estas observaciones, se encontró que la sensibilidad del cuidador estaba significativamente relacionada con la participación y el bienestar del niño. Otra característica del comportamiento del cuidador, la motivación del cuidador, se asoció significativamente con el bienestar del niño, pero no con la participación del niño. Los resultados del estudio sugieren que los comportamientos de los cuidadores, específicamente la sensibilidad y la motivación, durante el cambio de pañales son procesos vitales proximales en las interacciones de momento a momento entre un cuidador y el niño. Por tanto, la sensibilidad y la motivación en las rutinas de prestar cuidado deben enfatizarse en escenarios de cuidados a infantes y deben ser el enfoque para el desarrollo profesional del cuidador, incluyendo el entrenamiento previo y durante el servicio. Mientras que el entrenamiento relacionado con el cambio de pañales es a menudo restringido a las preocupaciones de salud, los resultados sugieren que interacciones específicas entre cuidador y niño durante la rutina de este cuidado pudieran apoyar o impedir el bienestar y la participación del niño en este momento. La sensibilidad del cuidador a las señales del niño en este contexto pudiera mejorar las oportunidades del niño para practicar la participación en relaciones bidireccionales y apoyar el bienestar de los niños.

Les résultats de ces recherches empiriques offrent de nouvelles données sur l'important des interactions de la personne prenant soin de l'enfant durant les routines de soin, plus particulièrement le changement de couche, dans le soutien à l'implication et au bien-être du nourrisson et du petit enfant. Cette étude corrélationnelle a compris des observations de 144 cycles de changement de couche séparés, faits par 31 personnes prenant soin de 74 nourrissons et petits enfants dans 30 crèches dans une ville américaine du centre-nord des Etats-Unis. Basé sur ces observations on a établi que la réaction des personnes prenant soin des enfants était liée de manière importante à l'implication de l'enfant et au bien-être de l'enfant. Un autre trait du comportement des personnes prenant soin de l'enfant, leurs encouragements, était lié de manière important au bien-être de l'enfant, mais pas à l'implication de l'enfant. Les résultats de l'étude suggèrent que les comportements des personnes prenant soin de l'enfant, plus spécifiquement la réaction et l'encouragement, durant le changement de couche sont des processus de proximité essentiels dans les interactions moment-à-moment entre la personne prenant soin de l'enfant et l'enfant. Donc la réaction et l'encouragement dans les routines de soin devraient être soulignés dans les contextes de soin au nourrisson et leur nécessitée accentuée dans la formation professionnelle des personnes prenant soin d'enfant, y compris durant la formation pré-emploi et la formation continue. Bien que la formation au changement de couches soit souvent confinée aux préoccupations en matière de santé les résultats suggèrent que les interactions spécifiques personne prenant soin de l'enfant-enfant durant cette routine de soin peut soutenir ou entraver le bien-être et l'implication des enfants dans le moment. La réaction des personnes prenant soin de l'enfant aux signaux des enfants dans ce contexte peut accroître les opportunités qu'ont les enfants de s'impliquer dans des relations bidirectionnelles et soutenir le bien-être des enfants.

Entry characteristics and performance in a Masters module in Tropical Medicine: a 5-year analysis.

OBJECTIVES: Postgraduate courses can contribute to better-qualified personnel in resource-limited settings. We aimed to identify how entry characteristics of applicants predict performance in order to provide support measures early. METHODS: We describe demographic data and end-of-module examination marks of medical doctors who enrolled in a first semester module of two one-year MSc programmes between 2010 and 2014. We used t-tests and one-way anova to compare, and post hoc tests to locate differences of mean marks between categories of entry characteristics in univariate analysis. After exclusion of collinear variables, multiple regression examined the effect of several characteristics in multivariable analysis. RESULTS: Eighty-nine students (47% male) with a mean age of 32 (SD 6.4) years who received their medical degree in the UK (19%), other European (22%), African (35%) or other countries (24%) attended the 3-months module. Their mean mark was 69.1% (SD 10.9). Medical graduates from UK universities achieved significantly higher mean marks than graduates from other countries. Students' age was significantly negatively correlated with the module mark. In multiple linear regression, place of medical degree (ß = -0.44, P < 0.001) and time since graduation (ß = -0.28, P = 0.007) were strongest predictors of performance, explaining 32% of the variation of mean marks. CONCLUSION: Students' performance substantially differs based on their entry criteria in this 1st semester module. Non-UK graduates and mature students might benefit from early support.

Evaluating the Effectiveness of a Nurse Practitioner-Led Outreach Program for Long-Term-Care Homes.

An observational prospective cohort study was conducted on 1,353 observations from a convenience sample of 311 long-term-care (LTC) residents to evaluate the effectiveness of a nurse practitioner-led outreach program on the health outcomes, emergency department (ED) transfers, and hospital admissions of LTC residents. The results show that ED transfers by the NPs were 27% less likely to be non-urgent than transfers made by MDs (OR = .73; 95% CI .54-.97) and that ED transfers by the NPs were 3.23 times more likely to be admitted to hospital than transfers by MDs (OR = 3.23; 95% CI 1.17-8.90). These findings highlight the potential benefits of the NP-led outreach program for LTC residents and for the health-care system.

Dans le cadre d'une étude de cohorte prospective observationnelle, 1 353 observations provenant d'un échantillon de commodité composé de 311 bénéficiaires de soins de longue durée ont été soumises à un examen visant à évaluer l'efficacité d'un programme d'extension des services dirigé par des infirmières praticiennes en ce qui a trait aux résultats sur la santé, aux transferts vers le service des urgences et à l'hospitalisation des bénéficiaires de soins de longue durée. Les résultats indiquent que les patients transférés au service des urgences par des infirmières praticiennes étaient dans une proportion de 27 % moins susceptibles d'être non urgents que ceux transférés par des médecins (rapport de cotes = 0,73; intervalle de confiance à 95 % de 0,54 à 0,97), et 3,23 fois plus susceptibles d'être admis à l'hôpital que ceux transférés par des médecins (rapport de cotes = 3,23; intervalle de confiance à 95 % de 1,17 à 8,90). Ces constatations ont permis de mettre en évidence les avantages possibles d'un programme d'extension des services dirigé par des infirmières praticiennes pour les bénéficiaires de soins de longue durée et le système de soins de santé.

Developing a Web Site: A Strategy for Employment Integration of Internationally Educated Nurses.

In Canada and elsewhere, the case for hiring internationally educated nurses (IENs) has not been adequately made and guidance for employers is lacking. The Web site Internationally Educated Nurses: An Employer's Guide, launched in 2012, is intended to provide healthcare employers in Ontario with comprehensive information on the hiring and integration of IENs. An evaluation framework and mixed methods design were used to determine the usability of the site in relation to its goal. Convenience sampling was employed to select participants representing specified users (i.e., healthcare employers). Overall evaluation of usability was positive. Participants indicated that it raised their awareness of the advantages of hiring and integrating IENs to address shortages, increase workforce diversity, and provide culturally competent care. Future projects should focus on collaboration with employers to increase the uptake of IENs.

Au Canada et ailleurs, les avantages de l'embauche des infirmières et infirmiers diplômés à l'étranger (IIDE) n'ont pas été expliqués adéquatement et les employeurs manquent d'orientation à ce propos. Le site Web Internationally Educated Nurses: An Employer's Guide (Infirmières et infirmiers diplômés à l'étranger: Un guide destiné aux employeurs, en anglais seulement), lancé en juin 2012, vise à fournir aux employeurs dans le domaine des soins de santé de l'Ontario des renseignements complets sur l'embauche et l'intégration des IIDE. À partir d'un cadre d'évaluation et de diverses méthodes, le site Web a été soumis à une analyse afin de déterminer sa facilité d'utilisation en fonction de son objectif. Un groupe de participants représentant des utilisateurs précis (les employeurs dans le domaine de la santé) a été constitué au moyen d'un échantillonnage de commodité. Globalement, le résultat de l'évaluation de la facilité d'utilisation du site Web s'est révélé positif. Les participants ont indiqué que le site avait contribué à mieux les sensibiliser aux avantages et à l'importance de l'embauche des IIDE pour résoudre les problèmes de pénurie, pour accroître la diversité de l'effectif et pour offrir des soins adaptés sur le plan culturel. Les projets futurs devraient être axés sur une collaboration avec les employeurs afin d'accroître l'intégration des IIDE.

A Precarious Journey: Nurses from the Philippines Seeking RN Licensure and Employment in Canada.

Increasingly, internationally educated nurses (IENs) from developing countries are seeking RN licensure and employment in Canada. Despite efforts to support their integration into the nursing workforce, a significant number never achieve integration. To explore this phenomenon, the authors use ethnographic methods informed by postcolonial feminism and relational ethical theory to examine the experiences of nurses educated in the Philippines as they seek Canadian RN licensure and employment. The study's focus on a journey that begins in the Philippines and continues in Canada adds an important temporal dimension located in tensions within and between the contexts of regulatory and immigration policies. The findings illuminate the dual challenge of being a new arrival in the country and being an IEN pursuing the Canadian RN credential. Additionally, the findings deepen our understanding of the dominant political, ideological, and social values, both in the Philippines and in Canada, that shape this experience.

De plus en plus, des infirmières et infirmiers diplômés à l'étranger (IIDE) provenant de pays en développement cherchent à obtenir une accréditation d'infirmière ou infirmier autorisé (IA) afin de pouvoir se trouver un emploi au Canada. Malgré les efforts déployés pour soutenir leur intégration au sein de la profession infirmière, un nombre important d'entre elles et d'entre eux ne réussissent pas à s'intégrer. Dans le but d'étudier ce phénomène, les auteures de la présente étude ont utilisé les méthodes de l'ethnographie adaptées au point de vue du féminisme postcolonial et de la théorie de l'éthique relationnelle afin d'analyser l'expérience que vivent les IIDE des Philippines dans le cadre de leurs démarches pour l'obtention d'une accréditation d'IA et d'un emploi au Canada. Mettant l'accent sur un parcours qui commence aux Philippines et se poursuit au Canada, l'étude ajoute une importante dimension temporelle aux tensions qui existent à l'intérieur des différents contextes réglementaires et des politiques d'immigration, de même qu'entre ceux-ci. Les constatations des auteures mettent en lumière le double défi que doivent relever les IIDE, soit celui d'être des nouveaux arrivants et celui de devoir obtenir une accréditation d'IA canadienne. L'étude contribue également à approfondir notre compréhension des valeurs sociales, idéologiques et politiques dominantes aux Philippines et au Canada, lesquelles ont façonné les expériences étudiées.

A Scoping Review of the Literature on Internationally Educated Nurses in Canada: Mapping a Research Agenda.

The purpose of this scoping review was to map key themes in the Canadian literature on the professional integration of internationally educated nurses (IENs), identify the types and sources of and gaps in evidence, and offer recommendations for research. The work was guided by a 6-step methodological framework for scoping reviews. The search and selection of academic and grey literature for the period 2000-13 resulted in a sample of 157 papers for full-text screening. Themes derived from the literature reflect stages of IENs' professional integration: pre-immigration and early arrival, professional recertification, workforce integration, and workplace integration. Data were extracted, coded, and collated using electronic charts. Numerical and qualitative thematic summaries were used to analyze the data. Recommendations for research are as follows: create data systems to track IEN immigration and integration; determine the effectiveness of programs and policies for IENs; and examine the influence of language proficiency on professional recertification, workplace integration, and patient safety.

La présente analyse exhaustive a pour objectif de recenser les thèmes clés traités dans la documentation canadienne portant sur l'intégration professionnelle du personnel infirmier formé à l'étranger (PIFÉ), de déterminer les types et les sources des données probantes ainsi que les lacunes, et d'émettre des recommandations en matière de recherche. Dans le cadre de cette analyse, les auteures ont utilisé un cadre méthodologique comportant six étapes. Le recensement et la sélection d'une littérature didactique et d'une documentation parallèle couvrant la période de 2000 et 2013 a mené à un examen des textes intégraux de 157 documents de recherche. Les thèmes extraits de la littérature reflètent les étapes de l'intégration professionnelle des PIFÉ: la pré-immigration et l'arrivée au Canada; le recertification professionnelle; l'intégration au marché du travail; et l'intégration au travail. Des données ont été extraites, codées et rassemblées en utilisant des tableaux électroniques. Des résumés thématiques numériques et qualitatifs ont été utilisés pour analyser les données. Les recommandations en matière de recherche sont les suivantes: créer des systèmes de données pour suivre la démarche d'immigration et d'intégration du PIFÉ; déterminer l'efficacité des programmes et des politiques à l'intention des PIFÉ; et examiner l'influence de la maîtrise de la langue sur la recertification professionnelle, l'intégration au travail et la sécurité des patients.

Workforce Integration of Philippine-Educated Nurses who Migrate to Canada through the Live-in Caregiver Program.

Nurses who migrate through the Canadian Live-in Caregiver Program face significant barriers to their subsequent workforce integration as registered nurses in Canada. This study applies the concept of global care chains and uses single case study methodology to explore the experiences of 15 Philippine-educated nurses who migrated to Ontario, Canada, through the Live-in Caregiver Program. The focus is the various challenges they encountered with nursing workforce integration and how they negotiated their contradictory class status. Due to their initial legal status in Canada and working conditions as migrant workers, they were challenged by credential assessment, the registration examination, access to bridging programs, high financial costs, and ambivalent employer support. The results of the study are pertinent for nursing policymakers and educators aiming to facilitate the integration of internationally educated nurses in Canada.

Les infirmières qui migrent par l'intermédiaire du programme canadien des aides familiaux résidants font face à des obstacles importants après leur intégration à la population active en tant qu'infirmières au Canada. Cette étude applique le concept de chaînes mondiales des soins et utilise une méthodologie fondée sur l'étude de cas unique pour explorer le vécu de 15 infirmières formées aux Philippines et qui ont migré en Ontario, au Canada, par l'intermédiaire du programme des aides familiaux résidants. L'étude se penche notamment sur les divers défis qu'elles ont dû relever dans le cadre de leur intégration en milieu de travail infirmier ainsi que sur la façon dont elles ont composé avec leur niveau de classe contradictoire. En raison de leur statut juridique au Canada et de leurs conditions de travail en tant que travailleuses migrantes, elles ont dû surmonter les obstacles que représentaient l'évaluation de leurs titres de compétences, l'examen d'accréditation, l'accès aux programmes de transition, les coûts financiers élevés et le soutien ambivalent d'employeurs. Les résultats de l'étude offrent de l'information pertinente aux décideurs et aux éducateurs qui œuvrent pour la profession infirmière et pour l'intégration des infirmières formées à l'étranger au Canada.

Comparative Analysis of Three Workload Measurement Methodologies in Surgical Pathology: Conclusions and Implications on Public Health Care and Costing of Pathology Services.

OBJECTIVES: To carry out a comparative analysis between 3 different workload measurement systems in surgical pathology: the Resource-Based Relative Value Scale (RBRVS), the Level 4 Equivalent (L4E), and the Automatable Activity-Based Approach to Complexity Unit Scoring (AABACUS). The RBRVS is one of the most widely used systems in terms of attempting to measure workload, whereas it has been proposed as a means of costing (and thus setting reimbursement rates) of surgical pathology services in Greece, despite being widely criticized for its inaccurate design. METHODS: Surgical pathology workload for 1 representative month at Evaggelismos General Hospital was assessed using both the RBRVS and the 2 newer methods. RESULTS: Pearson correlation showed a high level of correlation (0.902, P < .01) between the L4E and AABACUS but less so between either of those and the RBRVS (0.712 and 0.626, respectively; P < .01). The highest level of discrepancy was observed in the subspecialties of genitourinary, breast, dermatopathology, and gastrointestinal pathology. In addition, total and average working hours as calculated by the RBRVS were significantly lower compared with the other 2 systems. CONCLUSIONS: The RBRVS tends to underestimate actual workload as a result of its inability to take specific workload parameters into account, such as slide count or the need for intradepartmental consultation.

PD-L1 testing in advanced gastric cancer-what physicians who treat this disease must know-a literature review.

Background and Objective: Immune checkpoint inhibition has shed light on a new era in cancer therapy, and randomized clinical trials have demonstrated that a meaningful portion of the overall population of metastatic gastric cancer (GC) patients may derive clinical benefit from immunotherapy, which raises the relevance in identifying predictive biomarkers. Programmed cell death-ligand 1 (PD-L1) expression has demonstrated a significant association between level of expression and the magnitude of benefit derived from immune checkpoint inhibition in GC. Nevertheless, this biomarker shows several pitfalls that must be considered in the therapeutic decision to incorporate immune checkpoint inhibition as the standard of care of GC, such as spatial and temporal heterogeneity, interobserver variability, immunohistochemistry (IHC) assay, and influence by chemotherapy or radiation therapy. Methods: In the present comprehensive review, we revised the main studies regarding PD-L1 evaluation in GC. Key Content and Findings: Here we describe the molecular characteristics of the tumor microenvironment in GC, the obstacles in the interpretation of PD-L1 expression and present the data of the clinical trials that have evaluated the efficacy and safety of immune checkpoint inhibition and the association with the biomarker expression, both in first-line and later lines of therapy. Conclusions: From the emerging predictive biomarkers for immune checkpoint inhibition, PD-L1 has demonstrated a meaningful association between level of expression in tumor microenvironment and the magnitude of benefit derived from immune checkpoint inhibition in GC.

Factors associated with the quality of life and persistent dyspnea severity in COVID-19 survivors: A cross-sectional study among healthcare workers.

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on global health. The alterations in quality of life (QoL) and the persistent symptoms of dyspnea have been the healthcare workers' challenges during and after the pandemic. The aim of this study was to assess factors associated with the QoL and persistent dyspnea experienced by COVID-19 survivors, particularly among healthcare workers. A cross-sectional study was conducted among healthcare workers at H. Adam Malik General Hospital, Medan, Indonesia, using direct interviews to collect the data. The EuroQol 5-dimensional 5-level (EQ-5D-5L) and the self-assessment EuroQol-visual analog scale (EQ-VAS) were employed to assess the QoL of the healthcare workers; and persistent dyspnea was evaluated using the modified Medical Research Council (mMRC) scale. Several possible risk factors such as demographic characteristics (gender and age), clinical characteristics (comorbidities, history of hospitalization, oxygen usage, history of COVID-19 vaccination, the severity of previous COVID-19, existence of post-COVID syndrome) and the symptoms of the post-COVID syndrome were collected. Chi-squared test or Fisher's exact test was used to identify the risk factors associated with the QoL and persistent dyspnea. A total of 100 healthcare workers were included in the study. The EQ-5D-5L assessment found that 2% of healthcare workers experienced pain/discomfort and 4% experienced anxiety/depression. The average healthcare worker's EQ-VAS score was 87.6±8.1. There was no significant association between studied demographics and clinical characteristics with QoL dimensions. However, post-COVID symptoms of activity limitation (p=0.004), sore throat (p=0.026), headache (p=0.012), myalgia (p=0.006), and arthralgia (p=0.001) were associated with pain/discomfort dimension of QoL. In addition, there was a significant association between activity limitation (p=0.012), headache (p=0.020), myalgia (p=0.015) and arthralgia (p=0.032) with anxiety/depression dimension of QoL. Our data suggested that the presence of post-COVID syndrome (p=0.006) and the presence of post-COVID syndrome symptoms of cough (p=0.021) and fatigue (p=0.015) were associated with persistent dyspnea. In conclusion, this study suggests that the presence of post-COVID syndrome and its symptoms are associated with low quality of health-related QoL and persistent dyspnea. Therefore, cautions are needed for such patients to prevent low QoL in the future.

Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life.

Healthcare workers play a critical role in the health of a nation, yet rates of healthcare worker stress are disproportionately high. We evaluated whether mindfulness-based cognitive therapy for life (MBCT-L), could reduce stress in healthcare workers and target a range of secondary outcomes. Method: This is the first parallel randomised controlled trial of MBCT-L. Participants were NHS workers, who were randomly assigned (1:1) to receive either MBCT-L or wait-list. The primary outcome was self-reported stress at post-intervention. Secondary variables were well-being, depression, anxiety, and work-related outcomes. Mixed regressions were used. Mindfulness and self/other-compassion were explored as potential mechanisms of effects on stress and wellbeing. Results: We assigned 234 participants to MBCT-L (n = 115) or to wait-list (n = 119). 168 (72%) participants completed the primary outcome and of those who started the MBCT-L 73.40% (n = 69) attended the majority of the sessions. MBCT-L ameliorated stress compared with controls (B = 2.60, 95% CI = 1.63‒3.56; d = -0.72; p < .0001). Effects were also found for well-being, depression and anxiety, but not for work-related outcomes. Mindfulness and self-compassion mediated effects on stress and wellbeing. Conclusions: MBCT-L could be an effective and acceptable part of a wider healthcare workers well-being and mental health strategy.

Los trabajadores sanitarios juegan un papel fundamental en la salud de una nación, pero sus tasas de estrés son desproporcionadamente altas. Se evaluó si la terapia cognitiva basada en mindfulness para la vida (MBCT-L) podría reducir el estrés y otras variables secundarias en trabajadores sanitarios. Método: Primer ensayo controlado aleatorizado de MBCT-L. Los participantes fueron asignados aleatoriamente (1:1) a un grupo MBCT-L o a una lista de espera. La variable principal fue estrés percibido (post-intervención), y las variables secundarias bienestar, depresión, ansiedad, y otras relativas al trabajo. Se utilizaron regresiones mixtas. Mindfulness y autocompasión fueron explorados como potenciales mediadores del estrés y bienestar. Resultados: 234 participantes fueron asignados a MBCT-L (n = 115) o grupo control (n = 119) y 168 (72%) participantes completaron la variable principal. Un 74% (n = 69) de quienes empezaron MBCT-L atendieron la mayoría de las sesiones. MBCT-L mejoró el estrés comparado con lista de espera (B = 2,60; 95% CI = 1,63‒3,56; d =-0,57; p <  0,0001). También se encontraron efectos en bienestar, depresión y ansiedad, pero no en variables del trabajo. Mindfulness y autocompasión mediaron efectos sobre estrés y bienestar. Conclusiones: MBCT-L podría ser una pieza eficaz y aceptable dentro de una estrategia más amplia de bienestar y salud mental para trabajadores sanitarios.

[The surgical patient self-check list, a new tool for safety before an operation]. / La fiche d'autocontrôle de l'opéré, un nouvel outil pour la sécurité avant l'intervention.

In surgery and anaesthesia safety rules and criteria must be respected. Checks need to be made by caregivers at certain stages. The patient should also be involved in these checks. The surgical patient self-check list is the tool used in this approach.

The novel 19G endobronchial USS (EBUS) needle samples processed as tissue "core biopsies" facilitate PD-L1 and other biomarker testing in lung cancer specimens: case report and the view point from the Respiratory Physician and the Pathologist.

The immunohistochemical expression of Programmed Death Ligand (PD-L1) predicts responses to PD-1/PD-L1 inhibitors in non-small cell lung cancer (NSCLC). PD-L1 testing is currently only recommended on tissue specimens; however, in many patients, cytology samples are the only specimens available. The introduction of the novel 19G "core-biopsy" needle has revolutionized the utility of endobronchial USS-guided biopsy (EBUS) by providing solid tissue "microbiopsies" rather than traditional liquid cytology samples. We report a case of metastatic adenocarcinoma with the only accessible site of biopsy being a hilar lymph node. Using the 19G core-biopsy needle and processing the microbiopsy samples in formalin provided more material for predictive biomarker testing, including PD-L1 immunohistochemistry, when traditional processing was inadequate. This case highlights the need for close multidisciplinary discussions between the pathologist and the respiratory physician regarding emerging biomarkers and novel biopsy techniques to obtain maximum utility of the tools and avoid repeated procedures for the patient.

The Most Recent Oncologic Emergency: What Emergency Physicians Need to Know About the Potential Complications of Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors targeting cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmable cell death protein 1 (PD-1)/PD-L1 have shown antitumor activity in cancers such as melanoma, non-small cell lung cancer, renal cell carcinoma, and urothelial cancer. Certain checkpoint inhibitors have been approved for use in Canada, and are becoming a mainstay in the treatment of melanoma and other malignancies. These drugs have a unique side effect profile and are known to cause immune-related adverse events (irAEs). These adverse events often appear to originate from an infectious etiology, when in fact they result from the enhanced immune response caused by immune checkpoint therapy. IrAEs are primarily treated with corticosteroids, which suppress the overactive immune response that is secondary to the treatment. IrAEs can occur in any organ system, but adverse events in the skin, gastrointestinal, endocrine, and pulmonary systems are among the most common. As an emergency physician, one must be familiar with these drugs and their adverse events in order to identify patients presenting with irAE and treat them accordingly. This paper provides a brief introduction to immune checkpoint inhibitors, discusses the most common irAEs relevant to emergency physicians, and gives suggestions on how to manage patients presenting to the emergency department (ED) suffering from irAEs.

Considerações sobre a comunicação do diagnóstico de câncer infantil: posição da criança, lugar dos pais, efeitos do discurso médico e possibilidades de intervenção do discurso do psicanalista / Considerations on communicating the diagnosis of childhood cancer: the child's position, the parent's place, effects of the medical discourse, and the intervention possibilities of the discourse of the psychoanalyst / Considérations à propos de la communication de la diagnose de cancer de l'enfant: la position de l'enfant, la place des parents, les effets du discours médical et le possibilités d'intervention du discours de l'analyste / Consideraciones sobre la comunicación del diagnóstico de cáncer infantil: posición del niño, el lugar de los padres, los efectos del discurso médico y las posibilidades de intervención del discurso del analista

O presente trabalho tem como objetivo investigar o processo de comunicação do diagnóstico de câncer infantil, levando em consideração a posição da criança, o lugar dos pais, os efeitos do discurso médico e as possibilidades de intervenção do discurso do analista. A partir da discussão de três casos clínicos, percebeu-se que a escuta analítica pôde auxiliar a equipe diante do conflito bioético cada vez mais presente na oncopediatria: deve a criança saber a verdade ou deve ser ela protegida da verdade? O discurso do psicanalista, estando advertido da impossibilidade de tudo dizer a respeito da verdade, consegue de antemão se desvencilhar desses imperativos e operar proporcionando um giro discursivo que produz como efeito a entrada em cena do saber singular do sujeito- -criança em detrimento de um saber universitário de ordem protocolar.

This paper investigates the process of communicating the diagnosis of childhood cancer considering the child's position, the parents' place, the effects of the medical discourse, and the intervention possibilities of the discourse of the psychoanalyst. Based on three clinical cases, the discussion points out how the analytic listening helped the team faced with a bioethical conflict increasingly present in pediatric oncology: should the child know the truth, or should they be protected from it? Being aware of the impossibility of telling the whole truth, the analyst can disentangle themself in advance from these imperatives and provide a discursive turn which highlights the child subject's singular knowledge in detriment of the formal academic knowledge.

La présente recherche vise à enquêter sur le processus de communication du diagnostic de cancer de l'enfant, tenant compte de la position de l'enfant, de la place des parents, des effets du discours médical et des possibilités d'intervention du discours de l'analyste. À partir de la discussion de trois cas cliniques, il a été possible de percevoir que l'écoute analytique a pu aider l'équipe face au conflit bioéthique de plus en plus présent en oncologie pédiatrique: l'enfant doit-il savoir la vérité ou doit-il être protégé de la vérité? Le discours du psychanalyste, prévenu de l'impossibilité de tout dire la vérité, parvient d'avance à se débarrasser de ces impératifs et à opérer en pourvoyant une tournure discursive qui produit l'effet de mise en scène du savoir singulier du sujet enfant au détriment du savoir de l'université de l'ordre protocolaire.

Este trabajo tiene como objetivo investigar el proceso de comunicación del diagnóstico de cáncer infantil, teniendo en cuenta la posición del niño, el lugar de los padres, los efectos del discurso médico y las posibilidades de intervención del discurso del analista. A partir de la discusión de tres casos clínicos, se constató que la escucha analítica ha podido ayudar al equipo ante el conflicto bioético cada vez más presente en la oncología pediátrica: ¿El niño debe conocer la verdad o debe estar protegido de la verdad? El discurso del analista, advertido de la imposibilidad de decir toda la verdad, logra de antemano deshacerse de estos imperativos y proporcionar un giro discursivo que produce el efecto de la entrada en escena del saber singular del sujeto infantil en detrimento del saber de la universidad de orden protocolario.

Current considerations related to physiological differences between the sexes and physical employment standards.

The use of physical employment standards (PES) has helped ensure that workers have the physical attributes necessary to complete their jobs in a safe and efficient manner. However, PES used in the selection processes have not always reflected the critical physical requirements of the job tasks. Women generally have smaller anthropometric stature than men, less muscle mass, and therefore less strength, power, and endurance, particularly in the upper body. Nonetheless, these attributes in themselves are not valid grounds for exclusion from employment in physically demanding occupations. Selection standards based upon size or strength, irrespective of the job requirements, have resulted in the barring of capable women from physically demanding jobs, claims of gender bias, and costly litigations. To ensure all individuals are provided with equal access to employment, accurate characterization of the critical physical requirements of the job is paramount. This paper summarizes the existing research related to disparities between the sexes that contribute to sex differences in job performance in physically demanding occupations including physical and legal factors. Strategies for mitigating these differences in the setting of PES and the meeting of minimum employment standards are discussed. Where available, injury rates for women and men in physically demanding occupations are presented and the etiology considered. Finally, areas for further research are identified.

The diagnostic journey of patients with mucopolysaccharidosis I: A real-world survey of patient and physician experiences.

UNLABELLED: Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disease. Affected individuals have disease ranging from attenuated to severe with significant disease burden, disability, and premature death. Early treatment with enzyme replacement therapy and/or stem cell transplantation can reduce disease progression and improve outcomes. However, diagnosis is often delayed, particularly for patients with attenuated phenotypes. We conducted a survey of 168 patients and 582 physicians to explore health care seeking patterns and familiarity of physicians with MPS I symptoms. Patients with attenuated MPS I typically first presented with stiff joints or hernia/bulging abdomen, and patients with severe disease with noisy/difficult breathing, or hernia/bulging abdomen. There was a mean delay from time of symptom presentation to diagnosis of 2.7 years for patients with attenuated disease, with a mean of 5 physicians consulted before receiving a correct diagnosis. MPS I was most commonly misidentified by physicians as rheumatoid arthritis (48-72%), with a wide variety of suspected diseases, including lupus. CONCLUSION: Patient and physician real-world surveys show that MPS I is under-recognized and diagnosis of MPS I remains delayed, particularly in patients with attenuated disease. Across regions and specialties, physicians require differential diagnosis education in order to improve early detection and early treatment initiation of MPS I.

Dosing irregularities and self-treated hypoglycemia in type 2 diabetes: results from the Canadian Cohort of an International Survey of Patients and Healthcare Professionals.

OBJECTIVE: Despite their importance in achieving good glycemic control, few real-world data on insulin dosing irregularities and hypoglycemia are available. The multinational, online Global Attitude of Patients and Physicians (GAPP2) survey was conducted to address this situation. METHODS: Insulin-treated patients with type 2 diabetes and healthcare professionals (HCPs) who treat such patients were surveyed in an online cross-sectional study. This article summarizes findings from a sample of the online population in a Canadian cohort of 156 patients and 202 HCPs. RESULTS: A total of 156 patients completed the questionnaires; 26% reported experiencing a dosing irregularity (missed, mistimed or reduced a basal insulin dose) in the previous 30 days. Up to 60% reported risk for hypoglycemia as the reason for intentional dosing irregularities. Of all patients, 80% reported experiencing a self-treated hypoglycemic event, and 33% recalled having at least 1 event in the previous month. HCPs recorded similar levels of patient-reported dosing irregularities. Over 90% indicated they recommended patients to temporarily reduce their insulin doses to deal with hypoglycemia. CONCLUSIONS: A sizeable minority of patients experienced dosing irregularities and self-treated hypoglycemia in this Canadian cohort. The data suggest that HCPs who completed the survey are aware of this and of the need to provide education and support for patients who regularly miss, mistime or reduce insulin doses. Although the desire to prevent hypoglycemic events is understandable and important, HCPs need to ensure fear of hypoglycemia does not compromise optimal diabetes management.

24/7 Registered Nurse Staffing Coverage in Saskatchewan Nursing Homes and Acute Hospital Use.

RÉSUMÉ La législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.