Engaging patients and families to transform heart failure care.

For patients with advanced heart failure involvement as a member of the healthcare team is critical to safe, high-quality and goal-directed care. While recognized as an important aspect of care, patient engagement is not yet a standard practice. This presents an opportunity for professional education and development in team-based care. This short report describes the development of a Community and Patient Advisory Team (CPAT) formed to support patient involvement in interprofessional collaborative practice. The CPAT, composed of patient and family advisors, researchers, care team members, and grant operations staff, served as a core team within the structure of a project to shape a new vision of care delivery. This was accomplished through participation in quarterly leadership workshops and facilitation of team training focused on patient-provider communication strategies to improve patient safety. The advisory team led the co-development of patient materials to support patient engagement during the new implementation of structured interprofessional bedside rounds. Involving community members as partners helped shape our work to more effectively and directly address gaps in current patient care.

[Cutaneous adverse reactions to chemotherapy and their management]. / Réactions cutanées indésirables à la chimiothérapie et leurs traitements.

Chemotherapy is an essential component in the multidisciplinary management of many cancers. Skin reactions to chemotherapeutics are rather frequent, and their morbidity may be significant. It is wise to identify them with precision in order to chose the most adequate preventive and therapeutic measures. The dermatopathology assessment is helpful for the diagnostic.

[Mental health policy: regional activities. Considerations by someone involved]. / La politique de santé mentale: l'action en région. Réflexion d'un acteur.

Based on experiences at the local, regional and central level, the author provides a number of personal observations concerning regional initiatives brought on by Québec's mental health policy.

[Cataract surgery and implantation in diabetics. Apropos of 92 eyes]. / Chirurgie de la cataracte et implantation chez le diabétique. A propos de 92 yeux.

We examined 92 eyes (63 patients) who underwent extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. Visual acuity improved by two lines or more in 65% of cases. Follow-up examination (6 months and 2 years) showed posterior capsule opacification in 30% of cases. Progression of diabetic retinopathy was mild but cystoid macular edema was present in 70% of cases with non proliferative retinopathy. Proliferative retinopathy was treated postoperative by pan retinal photocoagulation. One neovascular glaucoma occurred, secondary to a ruptured capsule.

[Bouchut's tubercles. A clinical and angiographic study]. / Tubercules de Bouchut. Etude clinique et angiographique.

Four patients (3 young adults and 1 child) with disseminated tuberculosis had choroidal tubercles; none of them was immunodepressed. The clinical and angiographic aspects of these nodules and their evolution are described. Their clinical interest is discussed: fundus examination is always indicated in cases of disseminated tuberculosis and, more generally, in cases of systemic granulomatosis.

[Retinopathy in pancreatitis]. / Rétinopathie des pancréatites.

Three patients with retinopathy associated with acute pancreatitis were observed. Each of them had a long history of alcohol abuse. The first patient was asymptomatic. Second one developed moderate visual loss in one eye (visual acuity 20/40), with a fascicular defect on Goldmann visual field registration. Third patient complained with bilateral and severe visual loss, with a large central scotoma. Cotton-wool patches and hemorrhages were present in the mild types of retinopathy. These cases had a good prognosis. An ischemic edema of posterior pole was associated in severe type of retinopathy. In this case, fluorescein angiography showed occluded macular retinal arterioles. Visual prognosis was poor. Pathogenesis of the lesions is still discussed. The main hypothesis are fat emboli or activated complement-induced granulocyte embolus formation. Efficacity of corticosteroids is not known.

[Hypertensive retinopathy and papilledema. Apropos of a case of glycyrrhizin poisoning]. / Rétinopathie hypertensive et oedème papillaire. A propos d'un cas d'intoxication par la glycyrrhizine.

We present a case report of a patient suffering of severe hypertension and grade IV hypertensive retinopathy according to the Keith-Wagener classification. Simultaneously hypertensive encephalopathy was present confirming the poor prognosis of discoedema occurring in the course of hypertension when left untreated. Hypertension was related to chronic poisoning with glycyrrhiza, and its hyperaldosteronism like effect. Pathogenesis of discoedema in malignant hypertension is discussed.

Specificity of commercially available antibodies used for gastrin measurement.

We examined the specificity of commercially available antibodies used in measurement of serum gastrin. Antibodies were obtained from five commercial laboratories, and antibody immunoreactivity with gastrin and cross-reactivity with cholecystokinin (CCK) were determined. All antibodies were equally immunoreactive with gastrin, and cross-reactivity of three antibodies with CCK was minimal (less than 5%). In contrast, substantial cross-reactivity with CCK was found with two antibodies. To determine the clinical significance of cross-reactivity with CCK, secretin injection tests were performed in 24 individuals: seven in normal health, four with Zollinger-Ellison syndrome, three with antral gastrin cell hyperfunction, six with ordinary duodenal ulcer disease, and four with atrophic gastritis. Serum gastrin levels were measured with all five gastrin antibodies. The response to secretin was negative in all normal subjects and in those with duodenal ulcer and antral gastrin cell hyperfunction. The response to secretin was positive in all four patients with gastrinoma with use of the five antisera. All four patients with atrophic gastritis had normal responses to secretin when antibodies with minimal CCK cross-reactivity were used; however, two of four had false positive secretin test results when serum gastrin levels were measured with the two antibodies with a high degree of cross-reactivity with CCK. These studies indicate that significant cross-reactivity of gastrin antibodies with CCK can result in false positive secretin injection test results and can lead potentially to the erroneous diagnosis of Zollinger-Ellison syndrome.