RESUMEN

PURPOSE: Acute cannabis use is associated with impaired driving performance and increased risk of motor vehicle crashes. Following the Canadian Cannabis Act's implementation, it is essential to understand how recreational cannabis legalization impacts traffic injuries, with a particular emphasis on Canadian emergency departments. This study aims to assess the impact of recreational cannabis legalization on traffic-related emergency department visits and hospitalizations in the broader context of North America. METHODS: A systematic review was conducted according to best practices and reported using PRISMA 2020 guidelines. The protocol was registered on July 5, 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), and Scopus were searched without language or date restrictions up to October 12, 2023. Studies were included if they examined cannabis-related traffic-injury emergency department visits and hospitalizations before and after recreational cannabis legalization. The risk of bias was assessed. Meta-analysis was not possible due to heterogeneity. RESULTS: Seven studies were eligible for the analysis. All studies were conducted between 2019 and 2023 in Canada and the United States. We found mixed results regarding the impact of recreational cannabis legalization on emergency department visits for traffic injuries. Four of the studies included reported increases in traffic injuries after legalization, while the remaining three studies found no significant change. There was a moderate overall risk of bias among the studies included. CONCLUSIONS: This systematic review highlights the complexity of assessing the impact of recreational cannabis legalization on traffic injuries. Our findings show a varied impact on emergency department visits and hospitalizations across North America. This underlines the importance of Canadian emergency physicians staying informed about regional cannabis policies. Training on identifying and treating cannabis-related impairments should be incorporated into standard protocols to enhance response effectiveness and patient safety in light of evolving cannabis legislation.

RéSUMé: OBJECTIF: La consommation aiguë de cannabis est associée à une conduite avec facultés affaiblies et à un risque accru d'accidents de la route. À la suite de la mise en œuvre de la Loi canadienne sur le cannabis, il est essentiel de comprendre l'incidence de la légalisation du cannabis à des fins récréatives sur les blessures de la route, en mettant l'accent sur les services d'urgence canadiens. Cette étude vise à évaluer l'impact de la légalisation du cannabis à des fins récréatives sur les visites et les hospitalisations aux urgences liées à la circulation dans le contexte plus large de l'Amérique du Nord. MéTHODES: Une revue systématique a été menée selon les meilleures pratiques et a été rapportée en utilisant les directives PRISMA 2020. Le protocole a été enregistré le 5 juillet 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost) et Scopus ont été fouillés sans restriction de langue ou de date jusqu'au 12 octobre 2023. Des études ont été incluses si elles examinaient les visites aux urgences et les hospitalisations avant et après la légalisation du cannabis à des fins récréatives. Le risque de biais a été évalué. La méta-analyse n'était pas possible en raison de l'hétérogénéité. RéSULTATS: Sept études étaient admissibles à l'analyse. Toutes les études ont été menées entre 2019 et 2023 au Canada et aux États-Unis. Nous avons trouvé des résultats mitigés concernant l'impact de la légalisation du cannabis récréatif sur les visites aux urgences pour les blessures de la route. Quatre des études incluaient une augmentation des accidents de la route après la légalisation, tandis que les trois autres études n'ont révélé aucun changement significatif. Le risque global de biais était modéré parmi les études incluses. CONCLUSIONS: Cet examen systématique met en évidence la complexité de l'évaluation de l'impact de la légalisation du cannabis récréatif sur les blessures de la route. Nos résultats montrent un impact varié sur les visites aux urgences et les hospitalisations en Amérique du Nord. Cela souligne l'importance pour les médecins d'urgence canadiens de se tenir informés des politiques régionales sur le cannabis. La formation sur l'identification et le traitement des déficiences liées au cannabis devrait être intégrée aux protocoles normalisés afin d'améliorer l'efficacité de l'intervention et la sécurité des patients à la lumière de l'évolution de la législation sur le cannabis.

Asunto(s)

RESUMEN

Background: Written feedback is essential in resident teaching, but preceptors are not always well equipped to provide relevant feedback. The purpose of this study was to evaluate the effectiveness of multi-episodic training and the use of a criterion-referenced guide for written feedback for family medicine preceptors in a French-language academic hospital. Method: Twenty-three (23) preceptors participated in the training and used the criterion-referenced guide to guide them during the written evaluation in an evaluation sheet named "Field Notes." The content of these Field Notes was analyzed according to completion, the rate of specific feedback, and the rate of feedback by CanMEDS-MF role before and after the training over a three-month period. Results: Based on the analysis of the Field Notes (n = 70 pre-test; n = 138 post-test), an increase in the percentage of completion (50% vs. 92%, z = 2.97, p = 0.0030) and specific feedback (59% vs. 92%, z = 2.47, p=0.0137) was noted. There was no significant increase in feedback by CanMEDS-MF role. Conclusions: The development of multi-episodic training and a criterion-referenced guide, created according to the CanMEDS-MF repository, suggests an improvement in comprehensive and specific written feedback in family medicine education.

Contexte: La rétroaction écrite est primordiale dans l'enseignement aux résidents, mais les précepteurs ne sont pas toujours outillés pour offrir une rétroaction pertinente. Cette étude visait à évaluer l'efficacité de formations multiépisodiques et l'utilisation d'un guide critérié pour les rétroactions écrites des précepteurs en médecine familiale d'un centre hospitalier académique francophone. Méthode: Vingt-trois (23) précepteurs ont participé aux formations et ont utilisé le guide critérié pour les guider lors de l'évaluation écrite dans une fiche évaluative nommée «feuille de route¼. Le contenu de ces feuilles de route a été analysé selon la complétion, le taux de rétroactions spécifiques et le taux de rétroactions par rôle CanMEDS-MF avant et après les formations sur une période de trois mois. Résultats: Selon l'analyse des feuilles de route (n=70 prétest ; n=138 posttest), une augmentation du pourcentage de complétion (40% vs 92%, z=3.51, p=0.0005) et de rétroactions spécifiques (59% vs 92%, z=2.47, p=0.0137) fut notée. Il n'y avait aucune augmentation significative quant aux rétroactions par rôle CanMEDS-MF. Conclusions: L'élaboration de formations multiépisodiques et d'un guide critérié, créés selon le référentiel CanMEDS-MF, suggère une amélioration de rétroactions écrites complètes et spécifiques en éducation de la médecine familiale.

Asunto(s)

RESUMEN

Physician wellness is critical for patient safety and quality of care. Coaching has been successfully and widely applied across many industries to enhance well-being but has only recently been considered for physicians. This review aimed to summarize the existing evidence on the effect of coaching by trained coaches on physician well-being, distress and burnout. MEDLINE, Embase, ERIC, PsycINFO and Web of Science were searched without language restrictions to December 21, 2022. Studies of any design were included if they involved physicians of any specialty undergoing coaching by trained coaches and assessed at least one measure along the wellness continuum. Pairs of independent reviewers determined reference eligibility. Risk of bias was assessed using the Cochrane Risk of Bias Tools for Randomized Controlled Trials (RCTs) and for Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was not possible due to heterogeneity in study design and outcome measures as well as inconsistent reporting. The search retrieved 2531 references, of which 14 were included (5 RCTs, 2 non-randomized controlled studies, 4 before-and-after studies, 2 mixed-methods studies, 1 qualitative study). There were 1099 participants across all included studies. Risk of bias was moderate or serious for non-RCTs, while the 5 RCTs were of lower risk. All quantitative studies reported effectiveness of coaching for at least one outcome assessed. The included qualitative study reported a perceived positive impact of coaching by participants. Evidence from available RCTs suggests coaching for physicians can improve well-being and reduce distress/burnout. Non-randomized interventional studies have similar findings but face many limitations. Consistent reporting and standardized outcome measures are needed.

Asunto(s)

RESUMEN

Background: Good communication between healthcare professionals and their patients is essential to enlighten the benefits and risks of vaccination. Despite the availability of effective vaccines, reluctance prevails, sometimes fuelled by sub-optimal communication leading to a lack of trust. An evaluation of the effectiveness of a communication strategy for which healthcare professionals are trained has yet to be carried out. Objective: Systematic review of studies with a randomized controlled trial (RCT) to define and evaluate the impact of healthcare professionals' communication on patients' vaccine adherence. Methods: We performed a structured search on Medline, Embase, CENTRAL, PsycINFO and CINAHL. The studies selected include those involving healthcare professionals authorized to administer vaccines according to Canadian guidelines. Primary outcomes include vaccination rate or vaccine hesitancy rate. Results: Nine articles were included. Five studies (n=5) reported intervention effectiveness according to vaccine adherence. The results are largely represented by parental vaccine hesitancy for human papillomavirus (HPV) or childhood vaccination, while three studies (n=3) target the general population. The risk of bias relative to the studies is either low (n=7) or of some concern (n=2). Conclusion: The effectiveness of communication varies according to the studies and knowledge acquired through training. Future studies will need to examine communication with healthcare professionals in order to establish a consensus on optimal and appropriate training.

RESUMEN

Background: The coronavirus disease 2019 (COVID-19) vaccination campaign highlighted the requirement to better understand the needs of different populations. French-speaking minorities (FSMs) have greater difficulty accessing quality care in French, and this problem was exacerbated during the COVID-19 pandemic. Objective: The aim of this survey was to develop a descriptive portrait of the health needs of FSMs in relation to the COVID-19 vaccination campaign by describing their vaccination status, attitudes and beliefs compared with English-speaking majorities. Methods: A survey was conducted among eligible participants using convenience sampling. Data measurement includes a descriptive statistical comparison using analysis of the variance, univariate logistic regressions and a two-proportions z-test. Results: Of the 1,505 respondents (554 FSMs vs. 951 English speakers), the FSMs have an average age of 51.4 years and 89.2% are Canadian citizens. Vaccination of children was preponderant among English speakers (74.2% vs. 86.3%), including against COVID-19 (58.6% vs. 73.9%). A higher proportion of FSMs had gotten vaccinated in order to obtain a vaccine passport (39% vs. 29.3%). Among the unvaccinated, FSMs were more likely to question the efficacy of vaccines (60% vs. 36.4%). Canadian citizen FSMs with higher education could be divided in relation to the vaccine regimen. Conclusion: This survey revealed differences between FSMs and the English-speaking majority in their perceptions of vaccine efficacy, particularly vaccination of children, and a polarization of attitudes/beliefs among FSMs according to certain sociodemographic factors.

RESUMEN

Amplification of the CCNE1 locus on chromosome 19q12 is prevalent in multiple tumour types, particularly in high-grade serous ovarian cancer, uterine tumours and gastro-oesophageal cancers, where high cyclin E levels are associated with genome instability, whole-genome doubling and resistance to cytotoxic and targeted therapies1-4. To uncover therapeutic targets for tumours with CCNE1 amplification, we undertook genome-scale CRISPR-Cas9-based synthetic lethality screens in cellular models of CCNE1 amplification. Here we report that increasing CCNE1 dosage engenders a vulnerability to the inhibition of the PKMYT1 kinase, a negative regulator of CDK1. To inhibit PKMYT1, we developed RP-6306, an orally bioavailable and selective inhibitor that shows single-agent activity and durable tumour regressions when combined with gemcitabine in models of CCNE1 amplification. RP-6306 treatment causes unscheduled activation of CDK1 selectively in CCNE1-overexpressing cells, promoting early mitosis in cells undergoing DNA synthesis. CCNE1 overexpression disrupts CDK1 homeostasis at least in part through an early activation of the MMB-FOXM1 mitotic transcriptional program. We conclude that PKMYT1 inhibition is a promising therapeutic strategy for CCNE1-amplified cancers.

Asunto(s)

RESUMEN

Ataxia telangiectasia and Rad3-related (ATR) kinase protects genome integrity during DNA replication. RP-3500 is a novel, orally bioavailable clinical-stage ATR kinase inhibitor (NCT04497116). RP-3500 is highly potent with IC50 values of 1.0 and 0.33 nmol/L in biochemical and cell-based assays, respectively. RP-3500 is highly selective for ATR with 30-fold selectivity over mammalian target of rapamycin (mTOR) and more than 2,000-fold selectivity over ataxia telangiectasia mutated (ATM), DNA-dependent protein kinase (DNA-PK), and phosphatidylinositol 3-kinase alpha (PI3Kα) kinases. In vivo, RP-3500 treatment results in potent single-agent efficacy and/or tumor regression in multiple xenograft models at minimum effective doses (MED) of 5 to 7 mg/kg once daily. Pharmacodynamic assessments validate target engagement, with dose-proportional tumor inhibition of phosphorylated checkpoint kinase 1 (pCHK1) (IC80 = 18.6 nmol/L) and induction of phosphorylated H2A.X variant histone (γH2AX), phosphorylated DNA-PK catalytic subunit (pDNA-PKcs), and phosphorylated KRAB-associated protein 1 (pKAP1). RP-3500 exposure at MED indicates that circulating free plasma levels above the in vivo tumor IC80 for 10 to 12 hours are sufficient for efficacy on a continuous schedule. However, short-duration intermittent (weekly 3 days on/4 days off) dosing schedules as monotherapy or given concomitantly with reduced doses of olaparib or niraparib, maximize tumor growth inhibition while minimizing the impact on red blood cell depletion, emphasizing the reversible nature of erythroid toxicity with RP-3500 and demonstrating superior efficacy compared with sequential treatment. These results provide a strong preclinical rationale to support ongoing clinical investigation of the novel ATR inhibitor, RP-3500, on an intermittent schedule as a monotherapy and in combination with PARP inhibitors as a potential means of maximizing clinical benefit.

Asunto(s)

RESUMEN

Birds may act as biovectors of nutrients and contaminants at the regional scale and potentially increase the exposure to such substances in ecosystems frequented by these birds. However, no study has estimated biotransport of contaminants by individual birds through their feces (guano). Elevated concentrations of halogenated flame retardants (HFRs) have been reported in ring-billed gulls (Larus delawarensis) breeding near Montreal (QC, Canada)- a known hotspot for HFRs. The objective of the present study was to investigate the concentrations of polybrominated diphenyl ethers (PBDEs) and selected emerging HFRs (e.g., Dechlorane-related compounds) in guano of individual ring-billed gulls, and to assess the relative accumulation of these HFRs by comparing concentrations in plasma (absorbed) versus guano (excreted). A second objective was to determine the importance of one of the largest ring-billed gull colony (Deslauriers Island) in North America located near Montreal as a vector of HFR biotransport at the regional scale. Elevated concentrations of PBDEs and Dechlorane plus were determined in guano and plasma of ring-billed gulls, although in general no difference was found between males and females. However, plasma to guano concentration ratios were significantly greater in females for the highly hydrophobic BDE-209 and Dechlorane plus compared to males. Overall, for both sexes combined, the total amount of HFRs (sum of the 16 major PBDEs and five emerging HFRs) deposited by this entire colony (64,980 gulls) in the Montreal area through guano during the 28-days incubation period was estimated to 1 g. This study showed that urban-adapted ring-billed gulls from this large colony represent an underestimated biovector of HFRs, which may contribute to augment exposure to these toxic compounds in nearby ecosystems.

Asunto(s)