Centre Hospitalier Universitaire Sainte-Justine Research Articles

Risk factors for pre-term birth in a Canadian cohort of HIV-positive women: role of ritonavir boosting?

BackgroundThe risk of pre-term birth (PTB) associated with the use of protease inhibitors (PIs) during pregnancy remains a subject of debate. Recent data suggest that ritonavir boosting of PIs may play a specific role in the initiation of PTB, through an effect on the maternal–fetal adrenal axis. The primary objective of this study is to compare the risk of PTB among women treated with boosted PI versus non-boosted PIs during pregnancy.MethodsBetween 1988 and 2011, 705 HIV-positive women were enrolled into the Centre Maternel et Infantile sur le SIDA mother–infant cohort at Centre Hospitalier Universitaire Sainte-Justine in Montreal, Canada. Inclusion criteria for the study were: 1) attendance at a minimum of two antenatal obstetric visits and 2) singleton live birth, at 24 weeks gestational or older. The association between PTB (defined as delivery at <37 weeks gestational age), antiretroviral drug exposure and maternal risk factors was assessed retrospectively using logistic regression.ResultsA total of 525 mother–infant pairs were included in the analysis. Among them, PI-based combination anti-retroviral therapy was used in 37.4%, boosted PI based in 24.4%, non-nucleoside reverse transcriptase inhibitor (NNRTI) or nucleoside reverse transcriptase inhibitor based in 28.1%, and no treatment was given in 10.0% of cases. Overall, 13.5% of women experienced PTB. Among women treated with antiretroviral therapy, the risk of PTB was significantly higher among women who received boosted versus non-boosted PI (OR 2.01, 95% CI 1.02–3.97). This remained significant after adjusting for maternal age, delivery CD4 count, hepatitis C co-infection, history of previous PTB, and parity (aOR 2.17, 95% CI 1.05–4.51). There was no increased risk of PTB with the use of unboosted PIs as compared to NNRTI- or NRTI-based regimens.ConclusionWhile previous studies on the association between PTB and PI use have generally considered all PIs the same, our results would indicate a possible role of ritonavir boosting as a risk factor for PTB. Further work is needed to understand the pathophysiologic mechanisms involved, and to identify the safest ARV regimens to be used in pregnancy.

Partially involuting congenital hemangiomas: A report of 8 cases and review of the literature

Congenital hemangiomas have been divided into 2 major subtypes based on clinical behavior: rapidly involuting congenital hemangioma (RICH) and noninvoluting congenital hemangioma (NICH). We describe a clinical subtype of congenital hemangioma that begins as a RICH but fails to completely involute and persists as a NICH-like lesion. We propose the term "partially involuting congenital hemangioma" for this lesion with overlapping features. A review of the medical charts, serial clinical photographs, imaging, and biopsies performed on children with a diagnosis of partially involuting congenital hemangioma between 2001 and 2012 at Centre Hospitalier Universitaire Sainte-Justine pediatric dermatology/vascular anomalies clinic was performed. Eight full-term, healthy infants presented at birth with vascular lesions typical of RICH. Affected locations included the head and neck, trunk, or extremities. Size varied from 2.0 × 1.5 cm to 13.0 × 8.5 cm. All had rapid involution during the first 12 to 30 months of life before stabilizing in size and appearance. Only a small number of cases were identified. Partially involuting congenital hemangiomas are congenital hemangiomas with a distinct behavior, evolving from RICH to persistent NICH-like lesions. Their recognition and study will help us better understand whether RICH and NICH are indeed separate entities or simply part of a spectrum.

Long-term Visual Outcome of Methylmalonic Aciduria and Homocystinuria, Cobalamin C Type

To describe the long-term ophthalmologic outcomes of patients with methylmalonic aciduria and homocystinuria, cobalamin C type (cblC). Retrospective case series. All patients with cblC referred to the Department of Ophthalmology of the Centre Hospitalier Universitaire Sainte-Justine from 1984 through 2012 were studied. Twelve such patients were identified. Clinical ophthalmic examinations, neuroimaging, electroretinography, and the results of MMACHC mutation analysis were reviewed retrospectively. We examined visual acuity, ocular alignment, presence of maculopathy and peripheral retinopathy, optic atrophy, and nystagmus. Photopic and scotopic electroretinograms were reviewed. We examined and compared mutations in the MMACHC gene. Neuroimaging abnormalities were compiled when available. Twelve cblC patients were followed up from 2 to 23 years (average, 10 years). Eleven of 12 patients were diagnosed before the age of 1 year (range, birth-2 years). An initial ophthalmic examination was performed within the first year of age in 9 of 12 patients. Visual acuity at the time of presentation was variable, ranging from light perception to 20/20. Visual acuity was worse than 20/100 in 75% (9/12) of patients at last follow-up. Eight patients (67%) had obvious maculopathy on fundus examination. Other findings included peripheral retinopathy (8/12 [67%]), nystagmus (8/12 [67%]), strabismus (5/12 [42%]), and optic atrophy (6/12 [50%]). Funduscopic deterioration was documented in 1 patient, whereas electrophysiologic changes occurred in 4 patients. Neuroimaging results were available in 7 of the patients, revealing corpus callosum atrophy (7/7 [100%]) and periventricular white matter loss (6/7 [85%]). Most children in our series had early-onset disease with neurologic manifestations and abnormal ophthalmologic examination results. Despite early treatment, many early-onset cblC patients have poor visual function.

Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers

Few options, apart from the buttock area, are available for autologous breast reconstruction in thin teenagers. The aim of the present study was to objectively evaluate and compare donor-site morbidity of the inferior gluteal artery perforator (IGAP) flap with that of the previously described inferior gluteal musculocutaneous flap. A retrospective review of all IGAP flaps for breast reconstruction performed in teenagers between June 2006 and April 2011 at the Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, was performed. Patients were invited to undergo a specific physical evaluation and complete a questionnaire on aesthetic and functional outcomes. Thirteen records and 11 photographic charts were reviewed. Lateral buttock flattening was noticeable in nine of 11 cases. Three patients experienced some degree of inferior displacement of the gluteal crease. All six patients available for the appointment presented with a zone of dysesthesia or hypoesthesia in the territory of the operated buttock and/or posterior thigh. No motor impairment was found. The questionnaire, completed by eight patients, revealed that six were satisfied or very satisfied with the surgery. Appearance of the operated buttock was rated 3.4 on a scale from 1 to 5 (5 = normal) compared with the normal side. The IGAP flap remains a suitable option for breast reconstruction in slim teenagers. Similar to the myocutaneous flap, the major donor-site morbidity of the IGAP flap remains sensory impairment involving the posterior femoral cutaneous nerve. There is, however, less visible lateral depression when it is harvested as a perforator flap.

Pregnancy Outcomes in Women With and Without Gestational Diabetes Mellitus According to The International Association of the Diabetes and Pregnancy Study Groups Criteria

To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (α level of 0.05; two-tailed). The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92-29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79-3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95-1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92-6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53-2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84-2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42-1.26; P=.29) compared with group 2. Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. II.

The AMÉLIE project: failure mode, effects and criticality analysis: a model to evaluate the nurse medication administration process on the floor

The objective of this article was to critically evaluate the causes of adverse drug events during the nurse medication administration process in paediatric care units in order to identify and prioritize interventions that need to be implemented. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary committee composed of nurses, pharmacists, physicians and risk managers evaluated through consensus the process of administering medications at the Centre hospitalier universitaire de Sainte-Justine. By mapping the process, all the failure modes were identified and associated with at least one cause each. Using a summary grid, each failure mode was evaluated by rating frequency (from 1 to 9), likelihood of failure detection (from 0 to 100%) and severity (from 1 to 9) using adapted versions of already published scales. A 10-member committee was set up, and it met eight times between January and April 2010. In the two specialized paediatric units selected (n = 38 beds), an average number of approximately 20 000 drug doses was administered monthly from about 400 non-proprietary names. Through consensus, the committee identified 16 processes and 53 failure modes. While frequency and severity were based on perceptions that could be objectivized with local data and scientific documentation, the likelihood of detection was mainly based on individual perception. FMECA is a useful approach to improve the medication process.

Démarche pour la mise à niveau d’un secteur de soins pharmaceutiques : le cas de la néonatologie

While the concept of clinical pharmacy was developed in the 1960s, clinical outpatient and inpatient programs are characterized by their great variety and disparity when it comes to the presence of pharmacists in healthcare sectors. This article aims to describe a method in which pharmaceutical care sectors in healthcare facilities can be upgraded. This is a descriptive study supporting the upgrade of pharmaceutical care practiced in the neonatology sector of a 500-bed mother-child university hospital center, the centre hospitalier universitaire Sainte-Justine (CHUSJ). The CHUSJ's Pharmacy Department employs more than 70 healthcare professionals. The study involved the following upgrading steps: (1) a review of the literature, (2) a description of the profile of the sector and (3) a description of the upgrading of pharmacist practice in neonatology. A total of 121 articles were compiled, 16 of which were selected to evaluate the impact and 54 a description of the pharmacist's role in neonatology. The authors did not identify any particular pharmaceutical activity based on very good quality data (A). However, six of them were based on good quality data (B) and eight lacked adequate proof (C, D) in relation to the practice of neonatology. Nevertheless, a number of other authors described the development of the pharmacist's clinical role in neonatology. This study described the sector profile and upgrading of pharmaceutical practice that resulted from the literature review and a subsequent discussion among pharmacists. There are few data on the impact of pharmacists in neonatology. This descriptive study proposes a number of steps aimed at upgrading pharmaceutical care within a Quebec university hospital center.

Re: S Ratnapalan, MS Rayar, M Crawley. Educational services for hospitalized children. Paediatr Child Health 2009;14(7):433-6

To the Editor: I would like to bring to the attention of the editorial board and readers of Paediatrics & Child Health, the article intitled “Educational services for hospitalized children”, published in a past issue of Paediatrics & Child Health. Although the authors of this article were well intentioned, and their subject of query valuable, their methodology seemed to lack depth, their Web site review and telephone calls seemed incomplete, and their review of Quebec paediatric hospitals contained a few notable inaccuracies. Let me quote parts of the article: “The Montreal Children’s Hospital and the Centre hospitalier universitaire Sainte-Justine are under the McGill University Health Centre umbrella...” (page 433, last paragraph). “There are no other children’s hospitals in the province of Quebec” (other than the Montreal Children’s Hospital, the Centre hospitalier universitaire Sainte-Justine, and the Shriners Hospital for Children – page 436, first paragraph). The Centre hospitalier universitaire Sainte-Justine is one of the largest children’s hospitals in Canada, and its clinical, academic and research achievements are wellknown throughout North America, Europe and many other countries. To mistake its academic affiliation (it is affiliated with the University of Montreal) denotes a lack of rigueur in the authors’ fact-checking process. Furthermore, the authors write that there are no other children’s hospitals in the province, while there are two other major children’s hospitals. The Centre mere-enfant du Centre hospitalier universitaire de Quebec (CHUQ), in Quebec City, affiliated with the Universite Laval, boasts 51 neonatal intensive care unit beds, eight paediatric intensive care unit beds and 81 paediatric beds; the teaching staff comprises approximately 50 paediatricians, specialists and subspecialists. The Centre hospitalier universitaire de Sherbrooke (CHUS), affiliated with the Universite de Sherbrooke, has approximately 25 neonatal intensive care unit beds, six paediatric intensive care unit beds and 40 paediatric beds, and has a teaching staff of approximately 40. Both of these centres offer educational services to their patients via the help of one bilingual teacher at each centre, who works full time in the case of the CHUQ, and three days per week in that of the CHUS. The services are offered to children who are hospitalized for more than three days, and for grade levels from the first year of primary school to the last year of secondary school. The teachers are provided by the respective local school boards. Please note that there are also rehabilitation or psychiatric facilities that have been overlooked. As a board representative from Quebec, let me express to the authors my regrets that their research process was not more thorough. The Caring for Kids Web site provides functioning links to the CHUQ, CHUS and Centre hospitalier universitaire Sainte-Justine Web sites, with contact information for queries, and should members experience much difficulty with the French language, Canadian Paediatric Society board representatives can provide easy assistance. The information above was a 10 min phone call away, and was not at all “difficult” to obtain.

Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity

BackgroundStudies that contributed to the epidemiology of nausea and vomiting of pregnancy have reported conflicting findings, and often failed to account for all possible co-variables necessary to evaluate the multidimensional associations. The objectives of this study were to: 1) Estimate the prevalence and the severity of nausea and vomiting of pregnancy during the 1st and the 2nd trimester of pregnancy, and 2) Identify determinants of presence and severity of nausea and vomiting of pregnancy during the 1st and 2nd trimesters separately, with a special emphasis on the impact of race/ethnicity.MethodsA prospective study including pregnant women attending the Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics for their prenatal care was conducted from 2004 to 2006. Women were eligible if they were ≥ 18 years of age, and ≤ 16 weeks of gestation. Women were asked to fill out a 1st trimester self-administered questionnaire and were interviewed over the telephone during their 2nd trimester of pregnancy. Presence of nausea and vomiting of pregnancy was based on the reporting of pregnant women (yes/no); severity of symptoms was measured by the validated modified-PUQE index.ResultsOf the 367 women included in the study, 81.2% were Caucasians, 10.1% Blacks, 4.6% Hispanics, and 4.1% Asians. Multivariate analyses showed that race/ethnicity was significantly associated with a decreased likelihood of reporting nausea and vomiting of pregnancy (Asians vs. Caucasians OR: 0.13; 95%CI 0.02–0.73; and Blacks vs. Caucasians OR: 0.29; 95%CI 0.09–0.99).ConclusionOur study showed that race/ethnicity was associated with the reporting of nausea and vomiting of pregnancy in the 1st trimester of pregnancy.

Retrospective cohort study of 163 pediatric glaucoma patients

Objective: The aim of our study was to describe a cohort of pediatric glaucoma patients in Quebec. Design: This study was a retrospective medical record review. Participants: The study included patients younger than 18 years who were diagnosed with glaucoma between 1980 and 2000 and monitored at the Ophthalmology Clinic of the Sainte-Justine University Hospital Centre (Centre Hospitalier Universitaire Sainte-Justine) and had ocular hypertension or glaucoma in at least 1 eye. Methods: The data gathered concerned patients' information, the surgical procedures performed post diagnosis associated with the glaucoma diagnosis, and the drugs prescribed. Results: The study included 163 patients (254 eyes), a total of 374 surgical procedures, and the use of 2885 antiglaucoma drug therapies. For the 4 most frequent pathologies, patients were monitored for 8.4 (SD 4.2) years for aphakic glaucoma/pseudophakic glaucoma, 10.0 (SD 5.5) years for congenital glaucoma, 9.0 (SD 5.2) years for Axenfeld-Rieger syndrome, and 7.5 (SD 3.4) years for uveitic glaucoma. In total, 113 patients had at least 1 surgical procedure (69.3%). Before 1985, only timolol, pilocarpine, epinephrine, acetazolamide, and dipivefrin were used. Other beta blockers then appeared (betaxolol, levobunolol between 1985 and 1990, and the timolol-pilocarpine association between 1990 and 1995). After 1995, we saw the arrival of a new class of prostaglandin F2 alpha analogues, with latanoprost and other carbonic acid anhydrase inhibitors such as dorzolamide and brinzolamide. Conclusions: This study illustrates the great variety of glaucoma diagnostic subgroups and the use of surgery and drug therapies.

Yu-Ray Chen, M.D., and Léonard Bergeron, M.D., C.M., M.Sc., F.R.C.S.(C)

I want to thank Professor Chen and Dr. Bergeron for guest editing this issue of Seminars in Plastic Surgery on the topic of “Aesthetic Surgery in Asians” as well as the authors for their contributions. Professor Yu-Ray Chen is currently the chairman of the Chang Gung Steering Committee and professor of surgery at the Chang Gung University. He graduated from the National Taiwan University Medical School in 1972 and did his general surgery residency at the National Taiwan University Hospital and plastic surgery training at the Chang Gung Memorial Hospital under the tutelage of Dr. M. Samuel Noordhoff. He was a clinical and research fellow of craniofacial and plastic surgery from March 1979 to June 1980 with Dr. Ken Salyer at the Southwestern Medical School in Dallas and with Dr. Ian Munro at the Hospital for Sick Children of the Toronto University. He returned to Taiwan in 1980 and started his practice as a plastic surgeon at the Chang Gung Memorial Hospital. He became the director of the Craniofacial Center of that hospital and held this position until 1997. Professor Chen also became chairman of the Department of Plastic Surgery, as well as chief of the Department of Surgery from 1992 to 1995. He then assumed the office of the superintendent of Chang Gung Memorial Hospital from 1997 to 2003. In September 2006, he became the chairman of the Chang Gung Steering Committee, where he is in charge of six teaching hospitals and institutes. Since 1980, Professor Chen has performed more than 2000 midfacial and mandibular osteotomies and numerous cleft and intracranial reconstructions. Professor Chen also has developed several modifications of osteotomies in the maxillofacial region. He has a keen interest in craniofacial fibrous dysplasia. He has authored more than 180 publications and often presents at local and international scientific meetings. Despite his busy surgical practice, Professor Chen is a dynamic member of many professional societies and is a staunch advocate of education and research. Dr. Bergeron obtained his medical degree from McGill University Faculty of Medicine in Montreal in 2002. He completed his plastic surgery residency at the Universite de Montreal, Quebec, Canada, and is currently completing a craniofacial surgery fellowship at Chang Gung Memorial Hospital in Taipei, Taiwan, with Dr. Philip Kuo-Ting Chen. At this early stage of his career, he has already received several honors and awards for best papers and scientific presentations and has written several publications. Dr. Bergeron is pursuing a career in academics and research. He is particularly interested in all aspects of craniofacial surgery from reconstruction to aesthetic refinements. Upon completion of his fellowship, Dr. Bergeron will be an attending staff at Hospital du Sacre-Coeur de Montreal and Centre Hospitalier Universitaire Sainte-Justine. Both are teaching hospitals of the Universite de Montreal, Montreal, Quebec, Canada.

Nausea and vomiting of pregnancy: what about quality of life?

The objective of this study was to determine the impact of nausea and vomiting of pregnancy (NVP) and other determinants on generic and NVP-specific health-related quality of life (QOL) in the first trimester of pregnancy. Prospective study. Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics, Montreal, Quebec, Canada. Pregnant women attending the clinics for their prenatal care from 2004 to 2006. Women were eligible if they were > or =18 years of age and < or =16 weeks of gestation at the time of their first prenatal visit. After their first prenatal visit, women were asked to fill out a questionnaire covering maternal characteristics, presence and severity of NVP, and health-related QOL. QOL was measured by the generic 12-item Short Form Health Survey v.1 (SF-12) and the NVP-specific Quality of Life for Nausea and Vomiting during Pregnancy. Of the 367 pregnant women included in the study, 78.5% of women reported NVP in the first trimester of pregnancy. Multivariable linear models showed that presence of NVP in the first trimester of pregnancy was significantly associated with a lower physical component summary scale (P < 0.0001) and mental component summary scale (P = 0.0066) of the SF-12 scores. More severe NVP (moderate versus mild: P = 0.0002; severe versus mild: P = 0.0177 as measured by the validated modified Pregnancy-Unique Quantification of Emesis and Nausea index), intensity of nausea symptoms reported on a visual analogue scale (P < 0.0001), and nonpharmacological methods used to ease NVP symptoms in the first trimester of pregnancy (P = 0.0059) were significantly associated with poorer NVP-specific QOL among women suffering from NVP. These findings show that presence and severity of NVP have a negative impact on health-related QOL, which emphasises the importance of an optimal management of NVP.

Validity of a Modified Pregnancy–Unique Quantification of Emesis and Nausea (PUQE) Scoring Index to Assess Severity of Nausea and Vomiting of Pregnancy

Objective The only validated nausea and vomiting of pregnancy (NVP) severity index is the Motherisk Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index that covers symptoms in the previous 12 hours. We sought to assess the validity of a modified-PUQE index that covers the entire first trimester of pregnancy by comparing NVP severity scores between the 12-hour PUQE index and our modified-PUQE index and by measuring the extent of the association between the modified-PUQE score and quality-of-life (QOL) score during the first trimester of pregnancy. Study Design A prospective study that included women who attended the Centre Hospitalier Universitaire Sainte-Justine or Rene-Laennec clinic for their prenatal visits was conducted from 2004-2006. Women were eligible if they were ≥18 years old and ≤16 weeks of gestation at the time of their first prenatal visit. Women who reported NVP were asked to fill out the 12-hour PUQE, the modified PUQE index, and the Short-Form Health Survey QOL index simultaneously. Intraclass correlation coefficients were calculated to determine concordance between the 2 scores. Linear regression models were built to measure the association between the modified-PUQE score and Short-Form Health Survey QOL scores. Results Among participants (n = 287), the mean NVP severity score was 5.7 vs 6.7 on the 12-hour PUQE and modified PUQE, respectively ( P Conclusion We are confident that, on the basis of the modified-PUQE, the relationship between QOL and severity of NVP justify the use of this new index.

Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service

Hematopoietic stem cell transplant patients represent a population at high risk for drug-related problems. Our objective is to describe pharmacist interventions in a hematopoietic stem cell transplant pediatric unit. METHODS AND PATIENTS. The Hematopoietic Stem Cell Transplant Unit of the Centre Hospitalier Universitaire Sainte-Justine performs around 50 hematopoietic stem cell transplants per year. During a pharmaceutical care specialized residency program, a French pharmacist participated in certain clinical activities. Drug-related problems and clinical interventions were compiled over 31 nonconsecutive days using a tool developed by the Société Française de Pharmacie Clinique. Data concerning patients, drugs, intervention, documentation, approval (if needed), and estimated impact were compiled. During the 31-day period, 525 interventions were collected (16.9 +/- 3.7 per day), targeting 29 patients. The main drug-related problems were adverse drug reactions (N = 125, 23.8%), untreated indication (N = 92, 17.5%) and failure to receive drug (N = 89, 17.0%). The pharmacist's interventions concerned mainly dose adjustment (N = 174, 33.1%) and drug monitoring (N = 132, 25.1%). Among the 324 (61.7%) interventions requiring a physician's approval, 302 (93.2%) were accepted without any change. A pharmacist is able to perform clinically relevant interventions in a hematopoietic stem cell transplant unit, given the complexity of the pharmacotherapy. Our description of drug-related problems and interventions may help other pharmacists already working or developing pharmaceutical care in a hematopoietic stem cell transplant unit to compare their practice and it is one of the few reported in the literature.

Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy

The only validated nausea and vomiting of pregnancy (NVP) severity index is the Motherisk Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index that covers symptoms in the previous 12 hours. We sought to assess the validity of a modified-PUQE index that covers the entire first trimester of pregnancy by comparing NVP severity scores between the 12-hour PUQE index and our modified-PUQE index and by measuring the extent of the association between the modified-PUQE score and quality-of-life (QOL) score during the first trimester of pregnancy. A prospective study that included women who attended the Centre Hospitalier Universitaire Sainte-Justine or René-Laennec clinic for their prenatal visits was conducted from 2004-2006. Women were eligible if they were > or = 18 years old and < or = 16 weeks of gestation at the time of their first prenatal visit. Women who reported NVP were asked to fill out the 12-hour PUQE, the modified PUQE index, and the Short-Form Health Survey QOL index simultaneously. Intraclass correlation coefficients were calculated to determine concordance between the 2 scores. Linear regression models were built to measure the association between the modified-PUQE score and Short-Form Health Survey QOL scores. Among participants (n = 287), the mean NVP severity score was 5.7 vs 6.7 on the 12-hour PUQE and modified PUQE, respectively (P < .05). There was substantial concordance between the indices (intraclass correlation coefficient, 0.71). Severity of NVP that was measured by the new modified index was associated with QOL. We are confident that, on the basis of the modified-PUQE, the relationship between QOL and severity of NVP justify the use of this new index.

Comparison of hospital pharmacy practice in France and Canada: can different practice perspectives complement each other?

To compare hospital pharmacy practice in France and Canada by identifying similarities and differences in the two institution's pharmacy activities, resources, drug dispensing processes and responsibilities. Centre hospitalier universitaire Sainte-Justine (SJ), Montréal, Québec, Canada and Hôpital Robert Debré (RD), Paris, France, are two maternal-child teaching hospitals. They share a similar mission focused on patient care, teaching and research. The data were gathered from annual reports, department strategic plans and by direct observation. The description and comparison of the legal environment, hospital demographics, pharmacy department data, drug dispensing processes and pharmacist activities in the two institutions. The Centre hospitalier universitaire Sainte-Justine and Hôpital Robert Debré are similar with respect to their mission and general demographics; number of beds, annual hospital expenditures, number of admissions, visits and childbirths. The respective pharmacy departments differ in allocated resources. The main operational differences concern compounding, quality control programs and clinical activities. The French department also manages medical devices, medical gases, blood derivatives and the sterilisation unit. These comparisons highlight the more patient-oriented Canadian hospital pharmacy practice against the more product-oriented French hospital practice Factors contributing to these differences include academic curriculum, the attention paid to the legal environment by professional bodies, staffing patterns and culture. There are differences between the hospital pharmacy practice in the studied hospitals in Canada and France. Hospital pharmacy practice in France seems to be more product oriented, and the practice in Canada seems more patient oriented.

Chronic Inflammatory Polyneuropathy

Thirteen children with chronic inflammatory demyelinating polyneuropathy monitored between 1975 and 2005 are reported from Centre hospitalier universitaire Sainte-Justine, Montreal, Canada.