Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening condition with high mortality. Diagnosis is challenging due to variable clinical presentation and a protracted latency period following initiation of the offending drug. DRESS is a complex interplay that starts by introduction of the offending drug, reactivation of viruses and activation of the immune system. Herpes virus reactivation is considered a diagnostic marker and indicator of illness severity. Prompt recognition and the removal of offending agent remain the key to successful treatment. In cases of severe organ involvement, corticosteroids, immunoglobulins, antiviral and specialist consultation may be helpful. Here we present a case of a 36-year-old African-American male who presented with symptoms mimicking sepsis with an associated skin eruption that was diagnosed as DRESS.

Radiography is a constantly changing environment that is continuously evolving with new technology and new techniques on how to image human anatomy. This has led to cheaper and easier ways of imaging that present an opportunity for radiographers to practice independently from radiologists. The increase in the number of radiographers going into private practice since 2006 has led to a number of private radiography practices failing due to competition and other management and financial factors. This study seeks to provide insight into the changing environment of private radiographic practice and the level of success it can bring to radiographers. This will enable radiographers to better determine their personal and professional development needs, which will effectively improve their ability to manage and sustain private radiographic practices. This approach stems from the researcher’s belief that with the right skill and knowledge radiographers can run successful private practices and in so doing be able to empower others to do the same. The researcher has chosen to carry out a qualitative, exploratory, descriptive and contextual research design in order to explore and describe the detailed recommendations and views of private radiographic practice owners and how they manage their practices. The chosen method of data collection for this study is individual one-on-one interviews supported by a literature control. The one-on-one interview was used to collect the data from participants who meet the inclusion criteria. The researcher purposively selected participants to ensure that their ideas and opinions will benefit the study. The chosen method of data analysis is Tesch’s data analysis approach as it follows the qualitative way of data analysis which occurs in three phases: description, analysis, and interpretation. This research made use of Guba’s trustworthiness model to establish the validity and reliability of the qualitative research. The four criteria in this model for trustworthiness are truth-value by using the qualitative approach of credibility; applicability determined by using transferability; consistency determined by using the qualitative approach of dependability and, finally, neutrality determined by the qualitative approach to confirmability. The following six (6) ethical principles were followed to ensure no harm came to the participants: beneficence and non-maleficence, autonomy, justice, veracity, confidentiality and privacy. On completion of the study, the researcher made recommendations based on the findings for inclusion in basic radiographic training and continuous professional development. These recommendations are: Complete reviewing of the management training syllabus in radiography education. Compilation of literature that deals with private practice radiography. Inclusion of private practice radiographers in radiography societies. Further research into the subject of private practice radiography. This will allow for the knowledge contained in the study to be accessible to those who need it. It is also important to note that a study of this nature has never been conducted and therefore sharing of this information will allow for radiographers to know and understand what sustaining a private radiographic practice involves. The findings will be disseminated in seminars, conferences and publications.

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No description available.

No description available.

Purpose: This study assessed effectiveness of five tools recommended by the US Preventive Services Task Force (USPSTF), designed to help primary care clinicians determine which unaffected patients to refer to genetics specialists for breast cancer risk assessment based on concerning family history. Design: This descriptive secondary analysis included 85 women aged 40-74. All participants had a first-degree female relative previously diagnosed with breast cancer who also had uninformative negative BRCA1/2 tests. Methods: Each pedigree was evaluated using the five tools including the Family History Screen-7 (FHS-7), Pedigree Assessment Tool (PAT), Manchester Scoring System, Referral Screening Tool (RST), and Ontario-Family History Assessment Tool (Ontario-FHAT). All five tools were applied to each study participant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to describe each tool’s ability to identify women with elevated risk as calculated by the Claus model. Receiver operating curves (ROC) were also plotted. Differences between areas under the curve (AUCs) for all possible pairs of tools were estimated through logistic regression to assess for differences in tool performance. Results: Claus calculations identified 14 women out of 85 whose lifetime risk of breast cancer was elevated at > 15%. Only two tools, the Ontario-FHAT and FHS-7, identified all 14 women with elevated risk, a sensitivity of 100%. The FHS-7 tool flagged all 85 participants, meaning its specificity was zero. The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a negative predictive value (NPV) of 100%, indicating that if a woman was not found to need a referral to a genetics professional, it is likely she did not have an elevated lifetime risk of developing breast cancer. AUC values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools. Conclusion: In this population, the Ontario-FHAT out-performed other tools in terms of sensitivity and negative predictive value; however, low specificity and positive predictive value must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to a genetics specialist.

The main objective of this research program was to assess the status of clinical knowledge and evidence-based practice in the medical management of mass casualties, contaminated by exposure to a chemical weapon, during a medical evacuation, which is defined as from the incident site of a contaminated environment up-to a clean zone. First, in our published systematic review, we assessed past medical responses during a chemical attack. The lack of clinical data and intervention-related information, such as protection and decontamination capabilities, stresses not only the need to study acute or prehospital settings, but also a set of integrated competences in the contaminated environment (i.e.: protection, decontamination and clinical interventions) (Prospero registered CRD42019104473). Second, a method paper which presents an ongoing international retro-prospective observational study on the medical responses during a chemical attack has been submitted for publication. The goal of this study is to describe the acute clinical management of patients in the contaminated zone (1970-2036; US Clinical trial registered NCT05026645). Data gathering is currently ongoing with the use of a comprehensive online registry programmed by the Quebec Respiratory Health Research Network. In the third and fourth, we started the development of two technological innovations to improve the medical management of mass casualties, caused by a chemical weapon, in contaminated environments. The first is the creation of a mobile laboratory for the continuity of our work in both indoor and outdoor settings. The other is the launch of a research program, named VIMY Multi-System, which includes: (1) An electronic casualty card system integrating the United Kingdom National Early Warning System; (2) a forward-deployable telemedicine capability prototype – currently undergoing integration testing – that incorporates drone technology to monitor patients being clinically managed in a simulated chemically contaminated environment. Our fifth published paper, on the methods of oxygen conservation with an automated titration system (n= 60; US Clinical trial registered NCT02782936 and NCT02809807), showed that such an automated system may constitute a viable medical solution for interventions in a contaminated environment and also constitutes one of the possible solutions to improve therapeutic interventions. The system studied allows the maintenance of adequate oxygenation while reducing the use of oxygen in patients, making it possible to extend their treatment duration even under conditions of limited logistical resources in oxygen. The oxygen flow provided by the automated system allows a mean reduction in administered oxygen quantities of more than six-fold when decreasing the prescribed SpO2 target from 98 to 90% (5 L/min to1 L/min, p <0.001) in hospitalized patients with respiratory disorders. The comparison was conducted on the basis of conservative flow rate targets reported in the literature (2.5, 5.0, 10.0 and 15.0 l/min). When it comes to the automated correction of a hypoxemic condition in sick patients and healthy subjects wearing a gas mask, the prescribed SpO2 target resulted in maximum administered oxygen flow rates of 0.2 L/min and 2.9 L/min respectively. These results show a possible logistic and therapeutic optimization in the use of oxygen. Finally, these initial advances will be integrated as our research work progresses in order to improve clinical evidence-based practices in contaminated environments due to the use of chemical weapons. / L’objectif principal de cette recherche était d’évaluer l’état des connaissances et le savoir-faire de la pratique clinique dans la gestion d’un grand nombre de blessés, contaminés des suites d’une exposition à l’arme chimique, pendant leur évacuation médicale depuis le site de l’incident dans un environnement contaminé jusqu’à la zone propre. Premièrement, dans une revue systématique que nous avons publiée, nous avons évalué les réponses médicales passées lors d’attaques chimiques. Le manque de données cliniques et d’autres informations liées à l’intervention, tel que les capacités de protection et de décontamination, souligne non seulement la nécessité d’étudier l’environnement préhospitalier, mais aussi la gamme de compétences interdépendantes en milieu contaminé (c.-à-d. : protection, décontamination et interventions cliniques) (Prospero CRD42019104473). Deuxièmement, nous avons soumis pour publication la méthodologie d’une étude rétroprospective observationnelle internationale s’intéressant aux réponses médicales lors d’une attaque chimique. Le but consiste à décrire la gestion clinique en soins aigus des blessés dans la zone contaminée (1970-2036) (ClinicalTrials.gov NCT05026645). L’acquisition de données est en cours à l’aide d’un registre de données intégral en ligne qui a été programmé par le Réseau de recherche en santé respiratoire du Québec. En troisième et quatrième lieu, nous avons entrepris le développement de deux innovations technologiques afin d’améliorer la prise en charge médicale des patients en milieu contaminé à la suite de l’utilisation de l’arme chimique. L’un est la création d’un laboratoire mobile pour poursuivre nos travaux tant à l’intérieur qu’à l’extérieur. L’autre est la mise sur pied d’un programme de recherche, nommé VIMY Multi-Systèmes, qui inclut : (1) un système de carte de blessés électronique intégrant le système national d’alerte précoce du Royaume-Uni, (2) les premiers tests d’intégration d’un prototype d’une capacité de télémédecine de déploiement avancé, incluant la technologie du drone, pour une surveillance clinique globale des patients pris en charge en milieu contaminé chimique simulé. Notre cinquième publication, qui porte sur les méthodes de maintien de l’oxygénation par titrage automatisée (n=60 ; ClinicalTrials.gov NCT02782936 et NCT02809807), nous a permis de démontrer qu’un système automatisé peut constituer une solution médicale intéressante qui serait applicable dans les interventions en milieu contaminé et de surcroît comme une solution pour améliorer les actions thérapeutiques. Le système que nous avons étudié permet de maintenir une oxygénation adéquate tout en limitant la consommation d’oxygène des patients, prolongeant ainsi leur durée de traitement, notamment en cas de ressources en oxygène limitées. D’une part, le débit de l’oxygène fourni par le système automatisé a permis une réduction moyenne des quantités administrées de l’ordre de plus de six fois lors de la diminution de la cible de saturation en oxygène (SpO2) prescrite de 98 à 90 % (5 L/min à 1 L/min, p < 0,001) chez les patients hospitalisés atteints de maladies respiratoires. La comparaison s’est faite par rapport à des débits conservateurs rapportés dans la littérature (2,5, 5,0, 10,0 et 15,0 L/min). D’autre part, la correction automatisée d’une condition hypoxémique chez les patients malades et les sujets sains portant le masque à gaz, la cible SpO2 a engendré des débits maximaux d’oxygènes administrés de 2,5 et 2,9 L/min respectivement. Ainsi, nous avons démontré une optimalisation logistique et thérapeutique de la consommation de l’oxygène. Finalement, ces premières avancées seront intégrées au fur et à mesure de l’avancement de nos recherches afin d’améliorer le processus de soins en milieu contaminé issu de l’utilisation de l’arme chimique.

Much has been said and written over recent years about Attention-Deficit/Hyperactivity Disorder. There is a certain amount of confusion as to what exactly the condition constitutes and controversy continues to rage regarding treatment. A significant number of children appear to be affected. Previously, parents and teachers ·were blamed for failing to discipline effectively. Often, the difficulties remained undiagnosed and untreated. Thanks to the wisdom of so many experts who have generously shared their knowledge and considerable expertise, there is an increased awareness of ADHD. Although there is no cure, there are ways to manage the difficulties. However, early diagnosis and intervention is critical. Since many different symptoms are associated with the disorder, a multi-modal treatment plan has been found to lead to a better outcome. For the purpose of this study, a multi-modal programme was planned to address the needs of a small group of children with ADHD and their parents. The intention was to empower the parents, within a supportive group environment, by providing them with knowledge about the disorder and guidelines for managing the difficult behaviour. In addition, an attempt was made to change the negative behaviour patterns of the children through the medium of story-telling. It was hoped that by reducing the levels of parental stress, parents would be more competent to cope with their educational demands, so that their children could be guided more positively towards adulthood. The results of the programme were positive. Teachers and parents reported better behaviour by the children. The parents' stress levels were reduced. The parents expressed greater understanding about the disorder and a hopefulness that they could better manage their children. They felt they had benefitted from the advice given by other parents who were facing similar challenges. However, they felt that a short-term programme was insufficient to address all their needs and they expressed a need for ongoing support. In view of the chronicity of the disorder and the constantly changing needs of the child on his journey towards adulthood, cognisance was taken of the fact that longterm intervention is essential. / Psychology of Education / D.Ed. (Psychology of Education)

Much has been said and written over recent years about Attention-Deficit/Hyperactivity Disorder. There is a certain amount of confusion as to what exactly the condition constitutes and controversy continues to rage regarding treatment. A significant number of children appear to be affected. Previously, parents and teachers ·were blamed for failing to discipline effectively. Often, the difficulties remained undiagnosed and untreated. Thanks to the wisdom of so many experts who have generously shared their knowledge and considerable expertise, there is an increased awareness of ADHD. Although there is no cure, there are ways to manage the difficulties. However, early diagnosis and intervention is critical. Since many different symptoms are associated with the disorder, a multi-modal treatment plan has been found to lead to a better outcome. For the purpose of this study, a multi-modal programme was planned to address the needs of a small group of children with ADHD and their parents. The intention was to empower the parents, within a supportive group environment, by providing them with knowledge about the disorder and guidelines for managing the difficult behaviour. In addition, an attempt was made to change the negative behaviour patterns of the children through the medium of story-telling. It was hoped that by reducing the levels of parental stress, parents would be more competent to cope with their educational demands, so that their children could be guided more positively towards adulthood. The results of the programme were positive. Teachers and parents reported better behaviour by the children. The parents' stress levels were reduced. The parents expressed greater understanding about the disorder and a hopefulness that they could better manage their children. They felt they had benefitted from the advice given by other parents who were facing similar challenges. However, they felt that a short-term programme was insufficient to address all their needs and they expressed a need for ongoing support. In view of the chronicity of the disorder and the constantly changing needs of the child on his journey towards adulthood, cognisance was taken of the fact that longterm intervention is essential. / Psychology of Education / D.Ed. (Psychology of Education)