Québec, Canada
Québec, Canada

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Defay F.,CHUQ | De Serres G.,CHUQ | De Serres G.,Institute National Of Sante Publique Du Quebec 2400 Destimauville | De Serres G.,Laval University | And 7 more authors.
Pediatrics | Year: 2013

OBJECTIVE: A previous measles outbreak investigation in a high school in Quebec, Canada identified 2-dose vaccine effectiveness of 94%. The risk of measles in 2-dose recipients was significantly higher (2-4 times) when measles vaccine was first administered at 12 versus $15 months of age, with no significant effect of the age at second dose. Generalizability of this association was also assessed in the expanded provincial data set of notified cases. METHODS: This matched case-control study included only 2-dose recipients. All confirmed (laboratory or epidemiologically linked) cases in patients aged 5 to 17 years were included. Each case was matched to 5 controls. RESULTS: A total of 102 cases and 510 controls were included; 89% of cases were in patients 13 to 17 years old. When the first dose was administered at 12 to 13 months compared with $15 months of age, the risk of measles in participants outside the outbreak school was 6 times higher (95% confidence interval, 1.33-29.3) and was 5.2 times higher (95% confidence interval, 1.91-14.3) in the pooled estimate (participants from the outbreak school + outside that school). CONCLUSIONS: A significantly greater risk of measles among 2-dose recipients whose first dose was given at 12 to 13 months rather than $15 months of age is confirmed in the larger Quebec data set. The mechanism remains unknown, but vaccine failures in 2-dose recipients could have substantial implications for measles elimination efforts through 2-dose vaccination. The optimal age at first dose may warrant additional evaluation. Copyright © 2013 by the American Academy of Pediatrics.


PubMed | Canadian Association of Pathologists, Saskatoon Health Region, The Ottawa Hospital, Trillium Health Partners and 5 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

73 Background: Robust quality assurance (QA) programs incorporating both technical and interpretive aspects of QA are integral to accurate pathology diagnosis and quality of care a cancer patient receives. Programs and governance addressing technical pathology quality have been well developed in Canada and internationally. The extent of interpretive pathology QA implementation across Canada remains unknown. The objective of this study was to document the current landscape for pathology QA in Canada.An environmental scan was conducted to determine the types and extent of current large institution and provincial-level pathology QA programs in place across Canada. An electronic survey was administered to key stakeholders and senior decision makers in cancer pathology. Targeted interviews were conducted with pathology leaders in each province to verify survey results, deliberate and resolve ambiguous responses. Results were presented to all survey respondents as a feedback mechanism.9/10 provinces currently have a professional group representing pathologists. 10/10 provinces currently have a technical QA program. Of these, 2/10 provinces are governed through Accreditation Canada, 3/10 provinces are governed through the Ontario Laboratory Accreditation Program and the remaining 5/10 provinces are governed by separate provincially-led programs. For interpretive pathology QA, 2/10 provinces have a coordinated provincial interpretive QA program, 5/10 provinces do not have provincial coordination, and have plans to implement one, and 3/10 provinces do not have a provincially coordinated interpretive QA program in place, nor are they planning to develop one.This is the first study to document the provincial landscape for pathology QA in Canada. Large pan-Canadian variations remain for level of integration and future plans to develop and integrate interpretive pathology QA programs within provinces. Next steps should include the development of a pan-Canadian recommendations framework for interpretive pathology QA to help guide senior decision-makers in implementing such quality programs provincially.


Hurd T.,Nursing Practice Solutions | Chadwick P.,Salford Primary Care Trust | Cote J.,CHUQ | Cockwill J.,Smith and Nephew Wound Management Inc | And 2 more authors.
International Wound Journal | Year: 2010

Negative pressure wound therapy is widely used in the treatment of hard-to-heal wounds; however, pain during dressing changes, which is often associated with pain on the commencement and cessation of pressure application and because of in-growth of new granulation tissue into interstices of foam dressings, is often experienced. Anecdotal reports have suggested that choice of gauze as the negative pressure wound therapy dressing may reduce the pain associated with dressing changes. A prospective, multi-center, non-comparative clinical investigation was carried out using gauze-based negative pressure wound therapy in chronic and acute wounds. Over 152 patients were evaluated. Median duration of therapy was 18 days with 91% of patients progressing towards healing at the end of therapy. Wound pain and odour were significantly reduced (P < 0·001) over the course of therapy. Wound pain during dressing changes was reported to be absent in 80% of dressing removals. No damage to the wound bed following dressing removal was observed in 96% of dressing changes. Dressing applications were considered easy in 79% of assessments and took a median of 20 min to complete. In patients susceptible to pain, gauze-based negative pressure therapy may be a viable option to maximise patient comfort. © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.


PubMed | BC Childrens Hospital, University of Toronto, CHU Sainte Justine, Health Science Center and CHUQ
Type: | Journal: Pediatric cardiology | Year: 2016

Coronary artery (CA) aneurysms are serious complications of Kawasaki disease (KD) responsible for ischemic events. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are reported with limited data on indications and comparative efficacy. Retrospective multicenter comparison of CA intervention following KD is performed in this study. Twenty two cases were available from 5 centers, of whom 11 underwent CABG, 10 PCI and 1 systemic thrombolysis. Age at intervention (8.33.9 vs 11.34.9 years, p=0.14) and interval from diagnosis (5.64.1 vs 6.54.7years, p=0.64) were similar between CABG and PCI. Interventions were based on angiography in 15 patients or cardiac event in 7, with no difference between CABG and PCI (p=0.24). Patients with CABG were more likely to undergo multivessel intervention (73 vs 10%, p=0.006). None of the patients needed reintervention after CABG, compared to 6 after PCI and 1 after systemic thrombolysis (p=0.004). Signs of ischemia on stress testing or MIBI were present in 15 patients before intervention and persisted in 9 patients following last intervention, in a significantly higher proportion after CABG than PCI (80 vs 17%, p=0.01). In this series, CABG, which mostly involved multivessel intervention, was superior to PCI. Nevertheless, larger-scale studies may help define patient selection criteria for a beneficial PCI approach.


Dessery Y.,Laval University | Dessery Y.,University of Québec | Belzile E.L.,CHUQ | Belzile E.L.,Laval University | And 3 more authors.
Knee | Year: 2014

Background: Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA. Methods: Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace. Results: Knee pain was alleviated with all three braces (p < 0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/Bw*Ht (p < 0.001) and 0.293 to 0.268 (p < 0.05), respectively, while no significant reduction was observed with the V3P-brace (p = 0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics. Conclusions: No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term. © 2014 Elsevier B.V. All rights reserved.


Hindlimb unloading and reloading are characterized by a major loss of muscle force and are associated with classic leukocyte infiltration during recovery from muscle atrophy. Macrophages act as a cellular cornerstone by playing both pro- and anti-inflammatory roles during muscle recovery from atrophy. In the present study, we investigated the role of macrophages in muscle atrophy and regrowth using in vivo and in vitro models. Mice depleted in monocytes/macrophages and submitted to a hindlimb unloading and reloading protocol experienced a significant delay in muscle force recovery compared with matched placebo mice at 7 and 14 days after reloading. Furthermore, an in vitro myotube/macrophage coculture showed that anti-inflammatory macrophages, which contain apoptotic neutrophils and express low levels of cyclooxygenase-2, completely prevented the loss of protein content and the myotube atrophy observed after 2 days in low serum medium. The presence of macrophages also protected against the decrease in myosin heavy chain content in myotubes exposed to low serum medium for 1 day. Interestingly, the addition of an anti-IGF-1 antibody to the coculture significantly decreased the ability of macrophages to protect against myotube atrophy and myosin heavy chain loss after 2 days in low serum medium. These results clearly indicate that macrophages and, more precisely, the release of IGF-1 by macrophages, play an important role in recovery from muscle atrophy. Copyright © American Society for Investigative Pathology.


PubMed | Laval University and CHUQ
Type: Comparative Study | Journal: The Knee | Year: 2014

Conservative orthotic treatments rely on different mechanisms, such as three-point bending systems or hinges forcing external rotation of the leg and knee stabilization, to alter the biomechanics of the lower limbs and thus reduce knee loading on the affected compartment in patients with knee osteoarthritis (KOA). No previous study had compared the effects of these mechanisms on external loading and leg kinematics in patients with KOA.Twenty-four patients with medial KOA (Kellgren-Lawrence grade II or III) wore three custom knee braces: a valgus brace with a three-point bending system (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a functional knee brace used in ligament injuries (ACL-brace). Pain relief, comfort, lower extremity kinematics and kinetics during walking were compared with and without each knee brace.Knee pain was alleviated with all three braces (p<0.01). The VER- and ACL-braces allowed a significant reduction in peak knee adduction moment (KAM) during terminal stance from 0.313 to 0.280 Nm/BwHt (p<0.001) and 0.293 to 0.268 (p<0.05), respectively, while no significant reduction was observed with the V3P-brace (p=0.52). Reduced knee adduction and lower ankle and knee external rotation were observed with the V3P-brace but not with the VER-brace. The ACL-brace did not modify lower limb kinematics.No difference between the knee braces was found for pain reduction, discomfort or KAM. The VER-brace was slightly more comfortable, which could ensure better compliance with treatment over the long term.


Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients.Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks.From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively.The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879.


Halperin S.A.,Dalhousie University | Tapiero B.,University of Montréal | Dionne M.,CHUQ | Meekison W.,Westcoast Clinical Research | And 8 more authors.
Pediatric Infectious Disease Journal | Year: 2014

BACKGROUND: Combination diphtheria-tetanus-5 component acellular pertussis-inactivated poliovirus-Haemophilus influenzae b conjugate-hepatitis B vaccine (DTaP5-IPV-Hib-HepB) administered either concurrently with 7-valent pneumococcal conjugate vaccine (PCV7) or 1 month apart was generally safe and immunogenic at 2, 4 and 6 months of age. This study examined the effects of a booster dose at age 15 months. METHODS: Participants were randomized to DTaP5-IPV-Hib-HepB plus PCV7, DTaP5-IPV-Hib-HepB with PCV7 administered 1 month later or a pentavalent DTaP5-IPV/Hib plus HepB plus PCV7 at 15 months of age in a randomized, open-label, phase IIb clinical trial. Immunogenicity endpoints were rates of seroresponse to pertussis toxoid, filamentous hemagglutinin, pertactin and fimbriae types 2 and 3; rates of seroprotection against (Hib) polyribosylribitol phosphate capsular polysaccharide, hepatitis B surface antigen, diphtheria toxoid, tetanus toxoid and poliovirus types 1, 2 and 3; and geometric mean titers to all vaccine antigens. Safety endpoints included solicited injection-site reactions and systemic and serious adverse events. RESULTS: Seroresponse/seroprotection rates for all antigens exceeded prespecified criteria in both groups that received the hexavalent DTaP5-IPV-Hib-HepB; in the group that received the currently licensed pentavalent vaccine, seroresponse/seroprotection rates exceeded the criteria for all antigens except filamentous hemagglutinin. Seroresponse rates were ≥88.9% for pertussis antigens and seroprotection rates against polyribosylribitol phosphate capsular polysaccharide, hepatitis B surface antigen, diphtheria toxoid, tetanus toxoid and poliovirus antigens were ≥95.1% in recipients of DTaP5-IPV-Hib-HepB. CONCLUSIONS: DTaP5-IPV-Hib-HepB administered concomitantly with PCV7 or 1 month apart at 15 months of age following the infant series was well-tolerated and elicited antibody responses to all vaccine antigens, with no significant interference from concomitant PCV7 administration (clinicaltrials.gov registration number NCT00362427). Copyright © 2013 by Lippincott Williams & Wilkins.


Froment M.-A.,CHUQ | Frechette E.,University of Québec | Dagnault A.,CHUQ
Radiotherapy and Oncology | Year: 2011

Background and purpose: To assess the effectiveness of prophylactic irradiation of intervention track (PIT) to prevent tumor seeding in patients with malignant pleural mesothelioma. Materials and methods: A retrospective review was conducted of 171 patients with a histological diagnosis of pleural mesothelioma with some undergoing prophylactic irradiation of intervention sites. Results: Forty-eight patients (28%) received PIT. A majority of patients were followed until death. Thoracoscopy (88%) was the procedure most often performed. Thirty-three percent of patients received chemotherapy. The median dose of PIT was 21 Gy in 3 fractions with electrons or 6 MV photons. The local progression free survival (LPFS) at the intervention site was significantly higher in the PIT group and was not influenced by chemotherapy. At 6 months, LPFS for the intervention sites was 91% with PIT and 74% without PIT (p = 0.002). During the follow-up, 6 patients (13%) in the PIT group had tumor invasion of the subcutaneous tissue compared to 40 patients (33%) in the group without PIT (p = 0.008). Conclusions: This study suggests that PIT in mesothelioma reduces the incidence of procedure tract metastasis. Finally, chemotherapy does not seem to have an influence on the incidence of tract metastasis. © 2011 Elsevier Ireland Ltd. All rights reserved.

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