De Quebec Research Articles

Comparative accuracy of Mini-Linguistic State Examination, Addenbrooke's Cognitive Examination, and Depistage Cognitif de Quebec for the diagnosis of primary progressive aphasia.

Clinical diagnosis in primary progressive aphasia (PPA) is challenging. Recently, emphasis has been placed on the importance of screening evaluation. Three different screening tests that use different strategies based on the assessment of language (Mini-Linguistic State Examination, MLSE) or different cognitive domains (Addenbrooke's Cognitive Examination, ACE-III and Dépistage Cognitif de Québec, DCQ) have been proposed and independently validated. These tests aim to detect PPA and classify into the three main variants (non-fluent (nfvPPA), semantic (svPPA) and logopenic (lvPPA)). This study aims to evaluate and compare the diagnostic capacity of these three instruments in PPA. A cross-sectional study including 43 patients with PPA (nfvPPA (n = 19), svPPA (n = 8), and lvPPA (n = 16)) and 21 cognitively unimpaired controls was conducted. Clinical diagnoses were established based on an extensive multidisciplinary assessment including neuropsychological assessment, fluorodeoxyglucose-positron emission tomography, MRI, and cerebrospinal fluid biomarkers. Both PPA patients and controls completed the three tests (MLSE, ACE-III, and DCQ). Internal consistency was excellent for the three tests. The area under the curve for the diagnosis of PPA was 0.950 for MLSE, 0.953 for ACE-III, and 0.933 for DCQ. Correlations between the three tests were high. The MLSE, ACE-III, and DCQ tests obtained adequate levels of discrimination between the variants of PPA, with accuracies between 76-79%. This study confirms the validity of ACE-III, MLSE, and DCQ for the diagnosis of PPA and its variants. This suggests that detailed assessment of linguistic characteristics (MLSE) and non-linguistic features (DCQ, ACE-III) are relevant for the diagnosis and classification of PPA.

Galanin inhibition of wake-active histaminergic neurons

Histaminergic neurons are a population of wake-active neurons confined to the tuberomammillary nucleus (TMN) in the posterior hypothalamus. They form a crucial component of the ‘sleep switch’ in the brain and promote arousal when activated. The histaminergic neurons are strongly innervated by ventrolateral preoptic area (VLPO) neurons expressing galanin, a neuropeptide associated with sleep promotion. While recent studies have confirmed the importance of VLPO projections to the TMN in initiating and maintaining sleep, the ability of galanin to modulate the activity of the wake-promoting histaminergic neurons of the TMN has largely been overlooked. Therefore, we aimed to determine the mechanisms by which galanin alters the electrical excitability of genetically identified histaminergic neurons. We hypothesized that galanin inhibits histaminergic neuron activity via direct post-synaptic activation of galanin 1 receptors (GalR1). Whole-cell patch-clamp electrophysiology was performed on hypothalamic brain slices from mice expressing tdTomato fluorescence in cells expressing histidine decarboxylase (HDC), the sole enzyme required for histamine synthesis (HDCCre::tdTomato mice). RNAscope ® in situ hybridization was used to explore Gal1R mRNA expression in HDC expressing neurons. Whole-cell current-clamp recordings in male mice revealed that galanin (100nM) inhibits the majority of HDC neurons. The galanin-induced inhibition was associated with a hyperpolarization of the membrane potential and a decrease in firing frequency. Consistent with our hypothesis, a selective galanin 2 receptor (Gal2R) agonist (M1145 - 200nM) had no effect on male HDC neuron activity. RNAscope ® studies in male mice revealed co-expression of Gal1R mRNA in a large proportion of HDC-expressing neurons. Interestingly, the galanin-induced inhibition of HDC neuron electrical excitability was less pronounced in female mice. Overall, our data point to an important role of post-synaptic Gal1Rs expressed on histaminergic neurons in mediating galanin’s inhibitory effects in the TMN. Our data also suggest that sex differences exist in histaminergic neuron responsiveness to galanin. These findings are consistent with the idea that some of the sleep promoting effects of VLPO neuron activation occur through galanin’s ability to inhibit the wake-active histaminergic neurons. Sleep Research Society (SRS), Canada First Research Excellence Fund (Sentinel North Partnered Research Chair in Sleep Pharmacometabolism), Fondation Institut Universitaire de Cardiologie et de Pneumologie de Quebec (FIUCPQ), Fonds de recherche de Quebec - Sante (FRQS). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

First Report of Powdery Mildew Caused by Golovinomyces ambrosiae on Cannabis sativa L. (marijuana) in Quebec, Canada.

Marijuana (Cannabis sativa L.) is legal in Canada for medical and recreational purposes and is currently a multi-million-dollar industry. The province of Quebec follows British Columbia and Ontario in production acreage (Government of Canada 2018). During the growing season 2020-2021, five greenhouse growers throughout Quebec reported the presence of signs and symptoms reminiscent of powdery mildew including the presence of white powdery patches on the adaxial sides of leaves of several C. sativa cultivars. From one commercial facility, infected leaves of three cannabis cultivars (Sour Diesel, Orange Krush, and Lemon Sour) were photographed and the fungal mycelium was collected for identification in the laboratory. Fungal mycelium on leaf tissue was white and amphigenous and displayed unbranched hyaline conidiophores ranging from 130 to 275 μm in height (n = 50). Conidiophores arose from the upper surface of hyphal mother cells ranging from 35-70 × 8-13 μm in diameter (n = 25) and formed catenescent conidia. Conidia were broad ellipsoid-ovoid and measured, 24 to 35 × 12 to 19 μm (n = 50), and hyphae ranged from 3-8 μm in diameter (n = 30). Based on previous description (Qiu et al. 2020), the fungus was placed within the Golovinomyces genus. The species identification was confirmed through multi-locus phylogenetic using internal transcribed spacer (ITS), 28S large ribosomal subunit, and chitin synthase I (CHS1) genes amplified as recommended (Qiu et al. 2020), and directly sequenced with amplification primers (Centre Hospitalier de l'Université Laval de Quebec, CA). The three marker sequences shared 100% similarity for all the samples analyzed and were deposited in Genbank under accession numbers: OM131434 (28S), OM131448 (ITS), and OM141118 (CHS1). The phylogenetic analysis of the multi-locus sequences amplified grouped all three Quebec marijuana isolates in the G. ambrosiae accessions, confirming their identification. Pathogenicity was confirmed by transferring conidia onto detached healthy leaves of hop plants (Humulus lupulus) cultivar Northern Brewer kept under greenhouse conditions (28C, 50-60% relative humidity, and 14 h light) via paint brush inoculation. Hop leaves were used as surrogate due to the restricted availability of marijuana leaves. Inoculated leaves were placed in the growth chamber set at 20C, 50-60% relative humidity, and long days conditions as previously suggested (Weldon et al. 2020). The leaves developed powdery mildew colonies after 21 days, and the fungus was confirmed to be G. ambrosiae following morphological characterization and amplification of CHS1. Powdery mildew caused by G. ambrosiae (previous Golovinomyces cichoracearum) has been reported affecting hemp (Cannabis sativa) in New York and Oregon, United Sates (Weldon et al. 2020; Wiseman et al. 2021), and in British Columbia, Canada (Pépin et al. 2018; Punja et al. 2021), and this is the first report of G. ambrosiae causing powdery mildew on marijuana in Quebec. REFERENCES Government of Canada 2018. Online, retrieved January 7, 2021 https://www150.statcan.gc.ca/n1/daily-quotidien/180430/dq180430b-eng.htm Pépin N, Punja ZK, Joly DL. 2018. First report of powdery mildew caused by Golovinomyces cichoracearum sensu lato on Cannabis satia in Canada. Plant Disease. 102(12):2644. Doi: https://doi.org/10.1094/PDIS-04-18-0586-PDN Punja, Z. P. (2021). First report of the powdery mildew pathogen of hops, Podosphaeria macularis, naturally infecting cannabis (Cannabis sativa L., marijuana) plants under field conditions, Canadian Journal of Plant Pathology, Doi: https://doi.org/10.1080/07060661.2021.1960424. Qiu, P.-L., Liu, S.-Y., Bradshaw, M., Rooney-Latham, S., Takamatsu, S., Bulgakov, T. S., Tang, S.-R., Feng, J., Jin, D.-N., Aroge, T., Li, Y., Wang, L.-L., and Braun, U. 2020. Multi-locus phylogeny and taxonomy of an unresolved, heterogeneous species complex within the genus Golovinomyces (Ascomycota, Erysiphales), including G. ambrosiae, G. circumfusus and G. spadiceus. BMC Microbiology. 20:51. Doi : https://doi.org/10.1186/s12866-020-01731-9. Weldon WA, Ullrich MR, Smart LB, Smart CD, Gadoury DM. 2020. Cross-infectivity of powdery mildew isolates originating from hemp (Cannabis sativa) and Japanese hop (Humulus japonicus) in New York. Plant Health Progress. 21(1):47-53. Doi: https://doi.org/10.1094/PHP-09-19-0067-RS Wiseman, M. S., Bates, T. A., Garfinkel, A. R., Ocamb, C. M., and Gent, D. H. 2021. First Report of Powdery Mildew Caused by Golovinomyces ambrosiae on Cannabis sativa in Oregon. Plant Disease 105(9):2733. Doi: https://doi.org/10.1094/PDIS-11-20-2455-PDN.

First report of a ‘Candidatus Phytoplasma asteris’ strain affecting lingonberry (Vaccinium vitis‐idaea) and causing lingonberry stunt phytoplasma disease

Vaccinium vitis-idaea is a red berry-producing woody shrub, native to North America, Europe, and Scandinavia, known commonly as lingonberry (Hendrickson, 1997). During the spring/summer seasons of 2019 and 2020, producers from Quebec, Canada, have noticed symptoms of yellowing leaves and stunted growth, resembling symptoms caused by phytoplasma. To confirm whether phytoplasmas were indeed associated with these reported symptoms, fifteen lingonberry plants from different producers from the region of Chaudière-Appalaches were analysed (Table 1). Of these, nine had symptoms of stunting, little leaves and yellowing, while the rest showed no visible symptoms when collected (Figure 1). For each plant, total DNA was extracted from leaves and stem tissue using a CTAB-based method. The DNA was used as a template for a cpn60UT PCR with primers H279p/H280p (Dumonceaux et al., 2014), and the positive samples were subjected to direct PCR with phytoplasma 16S primers R16F2n/R16R2 as previously described (Perez-Lopez et al., 2019). Amplicons of the expected size (∼600 bp for cpn60UT) were obtained for 9/15 samples, while those for R16F2n/R2 sequences were obtained for 8/9 samples positives using the cpn60UT assay (Table 1). The cpn60UT and R16F2n/R2 amplicons obtained from two symptomatic samples (named LbSP14 and LbSP16 for lingonberry stunt phytoplasma) were purified and sequenced directly with the amplification primers (Centre Hospitalier de l'Université Laval de Quebec, Canada). The R16F2n/R2 sequence from LbSP14 was cloned into the pGEMT-Easy Vector (Promega, USA), and two clones were sequenced. Sequences were deposited in GenBank with Accession Nos OL739234 and OL739235 for LbSP14 and LbSP16 cpn60UT, respectively, and OL773369 and OL773370 for LbSP14 and LbSP16 R16F2n/R2 sequences. Accession Nos. OL773367 and OL773368 were used to register the sequences obtained from clone 1 (LbSP14c1) and clone 2 (LbSP14c2), respectively. A group/subgroup classification was performed on the LbSP cpn60UT sequences using CpnClassiPhyR (Muirhead et al., 2019) and R16F2n/R2 sequences with iPhyClassifier (Zhao et al., 2009). Phylogenetic relationships were determined using cpn60UT and R16F2n/R2 sequences of the LbSP phytoplasma and those from GenBank with the MEGA program version X (Kumar et al., 2018) and the neighbour-joining method with 1000 bootstraps. The CpnClassiPhyR classification suggested that the LbSP phytoplasma strain is a ‘Candidatus Phytoplasma asteris’-related strain and a member of the cpn60UT I-I(E/AI)AI subgroup (Figure 2a), with a similarity coefficient of 1.00 compared with blueberry stunt phytoplasma (BbSP; MH279496). The phylogenetic tree showed that LbSP strains branches with cpn60UT I, closely related to BbSP isolates from Quebec, Nova Scotia and New Brunswick (Figure 3). The 16S classification linked to the cpn60UT identified is 16SrI- (E/AI)AI (Perez-Lopez et al., 2019). We also found that LbSP displays 16S rRNA-encoding gene sequence heterogeneity with two distinct rrn operons, rrnE (OL773367) and rrnAI (OL773368), as previously reported for BbSP (Figure 2b and Figure 4). To our knowledge, this is the first report of lingonberry as a possible phytoplasma host. Other Vaccinium species, for example blueberry (Vaccinium corymbosum), are known to be affected by phytoplasmas in the same 16SrI- (E/AI)AI subgroup in Quebec (Perez-Lopez et al., 2019), and by 16SrI-E phytoplasmas in Canada and the USA (Lee et al., 2004; Arocha-Rosete et al. 2019). The fact that blueberries and lingonberries can be affected by phytoplasma strains in the same phytoplasma subgroup may suggest a common insect vector with variable feeding habits. Our findings are the basis for the understanding of the colonisation of a new plant host in the family Ericaceae by phytoplasmas. We would like to thank the MAPAQ and Les Airelles des Frères, specially to F. Philippe Roy for the support and collaboration, and to Prof. Jean Collin who through the class PLG-3305 supported the completion of the research.

Evaluation of predictor factors of psychological distress in women with unexplained infertility.

Objective:The objective of this study was to establish the frequency of anxiety and depressive symptoms among women diagnosed with unexplained infertility and to identify risk factors.Methods:We conducted a descriptive cross-sectional study. Forty-two women from the CHU de Quebec fertility clinic were recruited. Women completed the ‘Hospital Anxiety and Depression Scale’ (HADS) self-administered questionnaire, used to estimate prevalence of anxiety and depressive symptoms (score ≥ 8).Results:Overall, 55% (n = 23) of participants were identified with anxiety or depressive symptoms according to the HADS questionnaire. Anxiety symptoms were more frequent (55%) compared with depressive symptoms (10%). According to a logistic regression model, being under 35 years old [odds ratio (OR) = 16.6, confidence interval (CI): 1.9–25.0], never had a previous spontaneous abortion (OR = 5.6, CI: 1.1–43.5) and never sought fertility treatment (OR = 5.5, CI: 1.1–45.4) were associated with a higher risk of anxiety and depressive symptoms.Conclusion:Anxiety and depressive symptoms are common among women with unexplained infertility, and strategies should be developed to better support and treat this high-risk population.

Satisfaction with Facial Appearance following Bimaxillary Orthognathic Surgery

Patient-reported outcomes (PRO) questionnaires allow clinicians to collect data reflecting the healthcare experience directly from the patient's perspective. PRO can be used to collect information about outcomes that matter to patients such as quality of life or satisfaction with appearance after a cosmetic procedure. That information is relevant to patients with dentofacial deformities treated with orthognathic surgery because primary outcomes for such procedures include improved occlusion and facial harmony. However, the literature is scarce regarding patient-reported cosmetic outcomes after orthognathic surgery. The aim of this study was to assess satisfaction with facial appearance following bimaxillary orthognathic surgery using the FACE-Q, a PRO instrument developed for patients undergoing facial esthetic surgery. Thirty patients presenting with Class II skeletal deformities were recruited at CHU de Quebec - Université Laval and asked to answer a French version of the FACE-Q questionnaire focusing on orthognathic surgery relevant scales including “Satisfaction with Facial Appearance,” “Satisfaction with Lower Face and Jawline,” and “Satisfaction with Chin." Statistical analysis included Bowker's test of symmetry for the evolution of individual items and a mixed linear regression adjusting for the following covariates: difference between pre- and postoperative FACE-Q scores for each scale, age, sex, procedure, and vertical diagnosis. Results showed significantly improved FACE-Q scores for satisfaction with facial appearance (+17.42, P < .0001), nose (+6.13, P < .017), lower face and jawline (+34.58, P < .0001), and chin (+27.94, P < .0001) after surgery. Scores for satisfaction with cheekbones (+4.26, P = .1868) and nostrils (+6.25, P = .248) did not differ significantly. Patients were divided in 2 groups according to the procedure performed (bimaxillary surgery only or bimaxillary surgery in combination with genioplasty), but this did not significantly influence patient's satisfaction for facial appearance, lower face and jawline, or chin. Patients with hyperdivergent profiles were less satisfied with their chin appearance than normodivergent patients both before and after surgery (P = .024). Covariates such as age and sex did not have a significant effect on satisfaction scores. Overall, 86% of patients reported an improvement regarding their facial profile. Alar base widening was not an issue after Le Fort I osteotomies, as postoperative scores for alar base width were not statistically significant (P = .8312). A majority of patients (64%) thought their jawline was more defined after surgery, and most (81%) considered their chin suited their face better. In conclusion, bimaxillary orthognathic surgery for Class II positively affected patient satisfaction with facial appearance as demonstrated with higher postoperative FACE-Q scores. Patient-reported outcome measures such as the FACE-Q offer valuable information to the clinician wishing to have a better outlook from the patient's perspective in order to offer more patient-centered care. This type of tool can facilitate communication with the patient and help increase the surgeon's understanding of the impact of bimaxillary surgery on the patient's life.

Abstract PS10-37: Real-world experience of patients treated for HER2-positive metastatic breast cancer at the centre hospitalier universitaire de Quebec: A retrospective cohort study

Abstract Introduction: Multiple HER2-targeted therapies are now available and have significantly altered the natural course of HER2-positive metastatic breast cancer (mBC), with overall survival (OS) now exceeding 4 years. However, patients with HER2-positive mBC represent a heterogeneous population with some patients presenting with a history of a localized cancer and some with de novo metastatic disease. Our aim was to study the outcomes of HER-positive mBC in a real-life setting and compare the evolution between patients with “recurrent” breast cancer compared to those with “de novo” disease. Methods: In this single-center, retrospective study, we included patients with HER2-positive mBC treated at the Centre hospitalier universitaire (CHU) de Quebec using the local cancer registry and patients’ medical charts. We included all female patients &amp;gt; 18 years of age who received one or more anti-HER2 therapy for mBC. Patients whose follow-up at our center was incomplete were excluded. We identified patients who developed mBC after the occurrence of a localised disease (“Recurrent” group) and patients diagnosed with metastatic disease upon first presentation (“De novo” group). Primary outcome was OS. Secondary outcomes were progression-free survival (PFS) for each line of treatment and for each type of treatment (trastuzumab [T], pertuzumab [P], lapatinib [L] and trastuzumab emtansine [T-DM1]). We performed survival analysis using the Kaplan-Meier method and the log rank test. Results: A total of 106 patients in the Recurrent group and 58 patients in the De novo group were identified between May 2002 and December 2018 and data were collected between March and June 2019, by which time 97 (59.1%) had died. There were differences in baseline characteristics between the Recurrent and the De novo groups regarding age at first metastasis (50.7 vs 57.4 years, p=0.001). A total of 44.3 % vs 32.8 % of patients developed brain metastasis respectively (p=0.15). There was no statistical difference between the two groups regarding OS (3.8 years for Recurrent vs 4.2 years for De novo, p=0.17). PFS were also similar between the 2 groups for every anti-HER2 treatment available during the study period (Table 1). Median PFS could not be established for P in the De novo group since 80 % of patients were censured at the time of data collection. In the Recurrent group, P, L and T-DM1 had median PFS at least as long as those reported in landmark clinical trials. PFS were also similar between groups when comparing treatment lines (Table 2). Conclusion: In this retrospective study of patients from a real-world setting, anti-HER2 therapies offered similar OS between HER2-positive mBC patients with recurrent disease and with de novo metastatic disease. Median PFS are also equivalent between groups, with durations in the range of the PFS reported in major RCTs. Table 1TreatmentRecurrent groupRecurrent groupDe novo groupDe novo groupP valuenMedian PFS (years)nMedian PFS (years)Trastuzumab741.7441.90.14Pertuzumab333.115-0.15Lapatinib290.7110.60.17T-DM1310.7120.70.52 Table 2LineRecurrent groupRecurrent groupDe novo groupDe novo groupP valuenMedian PFS (years)nMedian PFS (years)1sd1061.6582.00.142nd490.7200.60.273rd230.990.70.794th100.430.80.53 Citation Format: Vincent Douville, Christine Desbiens, Valérie Théberge, Caty Blanchette, Julie Lemieux. Real-world experience of patients treated for HER2-positive metastatic breast cancer at the centre hospitalier universitaire de Quebec: A retrospective cohort study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-37.

The Clinical Significance of Bone Mineral Density Changes Following Long-Term Androgen Deprivation Therapy in Localized Prostate Cancer Patients.

Long-term androgen deprivation therapy has been associated with decreased bone mineral density in men with prostate cancer. Some evidence suggests that there is no impact on fracture risk despite this bone mineral density loss. Our study aimed to quantify changes in bone mineral density in men with high risk prostate cancer on long-term androgen deprivation therapy and calcium and vitamin D supplementation. Bone mineral density analysis was conducted for localized high risk prostate cancer patients enrolled in the phase III randomized trial PCS-V (Prostate Cancer Study 5), comparing conventional and hypofractionated radiation therapy. Patients received 28 months of luteinizing hormone-releasing hormone agonist and calcium and vitamin D supplementation (500 mg calcium BID+400 IU vitamin D3 BID). The areal density and T-scores (spine, femoral neck and total femur) at baseline and 30 months of followup were extracted, and the absolute change was calculated. Clinical bone density status (normal, osteopenia, osteoporosis) was monitored. The lumbar spine, femoral neck and total femoral bone mineral density were measured for 226, 231, and 173 patients, respectively. The mean percent change in bone mineral density was -2.65%, -2.76% and -4.27% for these respective sites (p <0.001 for all). The average decrease in bone mineral density across all sites was -3.2%, with no decline in bone mineral density category in most patients (83%). Eight patients (4%) became osteoporotic. Despite a mild decline in bone mineral density, the change in clinical bone mineral density category remained low with long-term androgen deprivation therapy. Consequently, calcium and vitamin D supplementation alone may suffice for most localized prostate cancer patients on long-term androgen deprivation therapy.

A two-week interprofessional teamwork simulation with real cardiac patients

To review a collaborative Lean methodology involving various health professionals for the improvement of interprofessional work and the coordination of care during patient hospitalization to reduce length of stay.Two similar Lean projects were carried out in the geriatric care unit of two hospitals of the Centre Hospitalier Universitaire de Québec (CHU de Quebec). The projects focused on interprofessional collaboration through Lean activities for improving the geriatric patient trajectory and discharge processes. The mean length of stay in the geriatric care unit was measured before and after the project. Secondary outcomes were the length of stay in the emergency room (ER) and the number of medical consultations realized by a geriatric physician in the ER.Projects led to a new shared vision of interprofessional approach in both geriatric care units. The mean length of stay for the first geriatric care unit was reduced by 3 days and by 7 days for the second unit. Optimization in ER flow also been observed for both projects.These interprofessional Lean projects described how a group of various professionals could change their vision from a shared decision making of patient discharge to a collaborative workflow of cares by designing together the process and not focussing on individuals. This collaborative workflow is possible by implementing an interprofessional focus on communication, role clarification and the autonomy of all healthcare professional as soon as the patient is admitted to the ER and during the whole hospitalization period.

Development and evaluation of a patient-centred program for low anterior resection syndrome: protocol for a randomized controlled trial

IntroductionLow anterior resection syndrome (LARS) is described as disordered bowel function after rectal resection that leads to a detriment in quality of life, and affects the majority of individuals following restorative proctectomy for rectal cancer. The management of LARS includes personalised troubleshooting and effective self-management behaviours. Thus, affected individuals need to be well informed and appropriately engaged in their own LARS management. This manuscript describes the development of a LARS patient-centred programme (LPCP) and the study protocol for its evaluation in a randomised controlled trial.Methods and analysisThis will be a multicentre, randomised, assessor-blind, parallel-groups, pragmatic trial evaluating the impact of an LPCP, consisting of an informational booklet, patient diaries and nurse support, on patient-reported outcomes after restorative proctectomy for rectal cancer. The informational booklet was developed by a multidisciplinary LARS team, and was vetted in a focus group and semistructured interviews involving patients, caregivers, and healthcare professionals. The primary outcome will be global quality of life (QoL), as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (QLQ-C30), at 6 months after surgery. The treatment effect on global QoL will be modelled using generalised estimating equations. Secondary outcomes include symptom change, patient activation, bowel function measures, emotional distress, knowledge about LARS and satisfaction with the LPCP.Ethics and disseminationThe Research Ethics Committee (REC) at the Integrated Health and Social Services Network for West-Central Montreal (health network responsible for the Jewish General Hospital) is the overseeing REC for all Quebec sites. They have granted ethical approval (MP-05-2019-1628) for all Quebec hospitals (Jewish General Hospital, McGill University Health Center, CHU de Quebec) and have granted full authorisation to begin research at the Jewish General Hospital. Patient recruitment will not begin at the other Quebec sites until inter-institutional contracts are finalised and feasibility/authorisation for research is granted by their respective REC. The results of this study will be presented at national and international conferences, and a manuscript with results will be submitted for publication in a high-impact peer-reviewed journal.Trial registration numberNCT03828318; Pre-results.

P059: Characteristics of older adults attending the emergency department for suicidal thoughts or voluntary intoxication: a multicenter retrospective cohort study

Introduction: Suicidal thoughts and self-harm are disproportionately prevalent among older adults but are frequently overlooked by emergency physicians. Objective: This study aims to explore the characteristics of older adults visiting the ED for suicidal thoughts or voluntary intoxications. Methods: All older adults (□ 65 years old) who visited one of the five CHU de Quebec’ EDs in 2016 were eligible. The medical charts of patients who reported suicidal thoughts or intoxication in triage or received a relevant discharge diagnosis were reviewed. Involuntary intoxications were excluded. Descriptive statistics were used to present the results. Results: Results: A total of 478 ED visits were identified, of which 332 ED visits (n= 279 patients) were included. The mean age of the ED cohort was 72.6 (standard deviation 6.8) years old and 41.6% were female. Mood disorders (41.2%) and alcoholism (40.5%) were common. Most included patients had a diagnosis of voluntary intoxication (73.2%), including two suicides (0.6%). Following 109 ED visits (30.0%), patients were referred for a mental health assessment. Half of all ED visits resulted in a discharge by the emergency physician (50.0%), while 27.4% were admitted for in-patient care. In the subsequent year (2017), 38.4% returned to the ED for suicidal ideations or self-harm of which 7.9% attended the ED □ 5 times. Conclusion: ED visits for suicidal thoughts and voluntary intoxication in older adults are more common among men with known mood disorders or alcoholism. Referral for a mental health assessment is inconsistent. ED-initiated interventions designed for this population are needed.

P058: Accuracy of the trauma triage protocol Échelle québécoise de triage préhospitalier en traumatologie (EQTPT) in selecting patients requiring specialized trauma care

Introduction: This study aims to evaluate the accuracy of the Échelle québécoise de triage préhospitalier en traumatologie (EQTPT) to identify patients who will need urgent and specialized trauma care in the La Capitale-Nationale region, province of Quebec. Methods: A detailed review of prehospital and in-hospital medical charts was conducted for a sample of patients transported following a trauma by ambulance to one of the five CHU de Quebec's emergency departments (ED) between November 2016 and March 2017. Data related to the trauma mechanism, population, injuries sustained, diagnosis, intervention and patient outcomes were extracted. The study primary outcome was the use of at least one urgent and specialized trauma care defined as: admission to the intensive care unit (ICU), urgent surgery within less than 24 hours after arrival (excluding orthopedic surgery for one limb only), intubation in ED, angioembolization within 24 hours after ED arrival, activation of a massive transfusion protocol in the ED. Also, patients who died secondary to their trauma were also considered as requiring urgent care. Results: 902 patients were included. The mean age (SD) was 59 (28.5) years old, 494 (54.8%) were female. The main trauma mechanisms were falls (592 (65.6%)) followed by motor vehicle accident (201 (22%)). 367 (40.7%) patients were transported directly to the tertiary trauma centre from the field. 231 (25.6%) patients had at least one criteria included in the steps 1, 2 or 3 of the EQTPT. Subsequently, most patients (649 (71.9%) were discharged home from the ED while 177 (19.6%) patients were admitted to the hospital. 82 (9.1%) patients required urgent and specialized trauma care. Of these 82 patients, 27 patients (32%) were identified in step 1 of the protocol, 12 patients (14.6%) in step 2, 5 patients (6.1%) in step 3, 13 patients (15.9%) in step 4 and 2 patients (2.4%) in step 5 while 23 (28.0%) patients were not identified by any steps of the EQTPT protocol. Therefore, 44 (53.6%) of the patients requiring urgent and specialized trauma care were identified by the criteria proposed in the steps 1, 2 or 3. Conclusion: In this retrospective cohort study, the EQTPT was insensitive to identify trauma patients who will need prompt and complex trauma management. Studies are required to determine the factors that could help improve its accuracy.

Plasma Extracellular Vesicle Subtypes as Potential Biomarkers of Immune Activation in HIV-Infected Patients

Chronic immune activation and systemic inflammation during HIV infection despite effective antiretroviral therapy (ART) is associate with non-AIDS co-morbidities in people living with HIV (PLWH). Previous studies have shown that plasma levels of extracellular vesicles (EVs) may be used as immune activation or inflammatory biomarkers of HIV disease progression. Several studies have focused on microRNA and mitochondrial DNA (mtDNA) levels reached concomitantly in immune cells and EVs. We hypothesized that large and small EVs could contain different amounts of microRNA and mtDNA and that could reflect immune activation associated with elevated CD8 T cell count or low CD4/CD8 ratio in PLWH receiving ART. Plasma EVs obtained from PLWH and uninfected control were sized using dynamic light scattering and quantified using flow cytometry. Expression of mature miR-92, miR-155, miR-223 and mtDNA was measured by qRT-PCR. Positive correlation have been observed between CD8+ T cell count and large EV abundance, AChE activity in small EVs and negative correlation with miR-155 levels in small EVs. CD4/CD8 ratio was positively correlated with large EVs abundance and negatively with AChE activity in small EVs and PMN-associated copies of miR-92. MicroRNA-155 level in small EVs were positively correlated with monocyte counts. MiR-155 and mtDNA contents of large EVs were increased more than miR-92 and miR-223 contents in small EVs. A positive correlation was observed between large EVs mtDNA content and CD4 T cell count. These findings suggest that profiling the microRNA and mtDNA contents of EV might provide new functional biomarkers of immune activation and inflammation. Funding Statement: This study was funded through Canadian Institutes of Health Research (CIHR) grants MOP 188726; MOP-267056 (HIV/AIDS initiative) to C.G., MOP-03230 to J.P.R. and to C.T. for the cohort establishment and CIHR Foundation Grant FDN-143218 to M.A. for the studentship awarded to W.W.B., as well as by the Fonds de recherche du Quebec – Sante (FRQ-S) AIDS and infectious diseases network. C.T. is an FRQ-S scholar and holder of the Pfizer/Universite de Montreal chair on HIV translational Research. J-P.R. holds the Louis Lowenstein chair in Hematology & Oncology at McGill University. M-A.J. holds a CIHR Canada Research Chair tier 2 in Immuno-Virology. The infrastructure of the Centre de recherche du CHU de Quebec – Universite Laval is supportes by the FRQ-S. Declaration of Interests: The authors declare that no competing interests exist. Ethics Approval Statement: This study received approval from the ethics review boards of Centre de recherche du CHU de Quebec, Quebec, Canada and the McGill University Health Centre, Montreal, Quebec, Canada. All subjects were anonymous volunteers and provided written informed consent to participate in the study.

Commentary: Confronting Ideology: Islamophobia vs. Islamist Fundamentalism

On January 29th, 2017, Alexandre Bissonnette, a 27-year-old far-right anti-immigrant and anti-Islam Quebecois, entered into a mosque, killed six Muslims and injured dozens as they prayed at the Centre Culturel Islamique de Quebec. While the incident shocked the Quebecois and Canadian public, it was a proof that Islamophobes are as prone to killing innocent civilians as are militant Islamists.

Improving interprofessional approach using a collaborative lean methodology in two geriatric care units for a better patient flow

Abstract Objective To review a collaborative Lean methodology involving various health professionals for the improvement of interprofessional work and the coordination of care during patient hospitalization to reduce length of stay. Design/methodology/approach Two similar Lean projects were carried out in the geriatric care unit of two hospitals of the Centre Hospitalier Universitaire de Quebec (CHU de Quebec). The projects focused on interprofessional collaboration through Lean activities for improving the geriatric patient trajectory and discharge processes. The mean length of stay in the geriatric care unit was measured before and after the project. Secondary outcomes were the length of stay in the emergency room (ER) and the number of medical consultations realized by a geriatric physician in the ER. Findings Projects led to a new shared vision of interprofessional approach in both geriatric care units. The mean length of stay for the first geriatric care unit was reduced by 3 days and by 7 days for the second unit. Optimization in ER flow also been observed for both projects. Originality/value These interprofessional Lean projects described how a group of various professionals could change their vision from a shared decision making of patient discharge to a collaborative workflow of cares by designing together the process and not focussing on individuals. This collaborative workflow is possible by implementing an interprofessional focus on communication, role clarification and the autonomy of all healthcare professional as soon as the patient is admitted to the ER and during the whole hospitalization period.

Using Machine Learning to Predict Nosocomial Infections and Medical Accidents in a Nicu

Background: Adult studies have shown that nursing overtime and unit overcrowding is associated with increased adverse patient events but there exists little evidence for the Neonatal Intensive Care Unit (NICU). Objectives: To predict the onset on nosocomial infections and medical accidents in a NICU using machine learning models. Subjects: Retrospective study on the 7,438 neonates admitted in the CHU de Quebec NICU (capacity of 51 beds) from 10 April 2008 to 28 March 2013. Daily administrative data on nursing overtime hours, total regular hours, number of admissions, patient characteristics, as well as information on nosocomial infections and on the timing and type of medical errors were retrieved from various hospital-level datasets.

Evaluation of the Role of Plerixafor in Peripheral Blood Progenitor Cell Mobilization and Collection in Autologous Donors with Multiple Myeloma and Non-Hodgkin Lymphoma

Purpose Autologous hematopoietic stem cell transplantation is commonly used as treatment for patients with Multiple Myeloma (MM) or Non-Hodgkin Lymphoma (NHL). The mobilization and collection of peripheral blood progenitor cells (PBPC) to reach the required cell dose for transplantation is problematic for some patients when standard mobilization agents such as G-CSF, alone or combined with chemotherapy, are used. These patients are considered poor mobilizers with &lt; 20 CD34+ cells /μl on the planned day of collection and the optimal strategy to collect a sufficient number of PBPC in poor mobilizers is still not fully known. Plerixafor, a CXCR4 inhibitor, when added to the standard mobilization regimen, has been shown to improve mobilization and increase the probability of collecting a PBPC graft &gt; 2 X106CD34 /kg in standard mobilizers. In our center, Plerixafor became available in October 2012. However, how best to use plerixafor to improve care for poor mobilizers while ensuring the most cost-effective use of health care resources for this patient population remains an important question. To begin answering this question, we evaluated the impact of plerixafor usage in our population of poor mobilizers in our institution using a historical cohort for comparison. Material and method The population of poor mobilizers in the setting of MM or NHL (defined as &lt; 20 CD34 / μl on the planned day of collection) between January 2009 and December 2017 at Hôpital de l'Enfant Jesus (HEJ) du CHU de Québec was retrospectively studied and analyzed. To ensure that all poor mobilizers were included, we screened all flow cytometry CD34+ cell count results &lt; 50 /μl on the planned day of collection and reviewed all the charts of patients with &lt; 20 CD34 / μl regardless of whether they were collected or not. This chart review allowed a comprehensive description of the characteristics of our poor mobilizers, a comparison of the capacity to collect an adequate PBPC with or without plerixafor and to evaluate its impact on different variable with regard to PBPC collection and subsequent engraftment. The data were compiled in an ACCESS database using a retrospective review of digital patient charts. The data was analyzed by the Centre de Recherche du CHU de Quebec (CRCHUQ). Data were stratified by disease type and CD34 level on the planned day of PBPC collection. Results 207 patient charts were reviewed; 70 poor mobilizers with 95 mobilizations attempts, 30 of them using plerixafor, were included. The baseline characteristics of both groups were similar as well as the length of hospitalization for transplant and relapse free survival at one year. The addition of Plerixafor to our management of poor mobilizers did not significantly increase the proportion of patients proceeding to autologous PBPC transplant (80,4 vs 75% p=0,7599). During the mobilization attempts, the maximal CD34 /μl reached was similar in both groups (18,86 vs 15,4 p=0,1541). Plerixafor was associated with a superior collection efficiency (% of CD34 collected) (40,85 vs 60,91% p=0,007), but this can be explained by a greater use of central venous catheters for collection in this group (70 vs 95,1% p = 0,0275). Data stratified by initial diagnosis and CD34 level on the planned day of PBPC collection (&lt;10 c/μl versus [10c/μl - 20c /μl [) showed the same tendency. The collection duration was not significantly reduced in the plerixafor group, but there was a trend for a shorter mean duration of 22 minutes also explained by a greater use of central venous catheters in this group. The preplanned subgroups analyses have shown the same trend when stratified by diagnosis, with a reduction of 53 minutes in the multiple myeloma subgroup with a greater total CFU-GEM / kg per collect (46,35 vs 70,55 p=0,0163). Conclusion The use of plerixafor at HEJ did not improve significantly the proportion of poor mobilizers reaching an adequate PBPC graft and did not improve transplant outcomes compared to a historical control. Better strategies are needed to improve care for true poor mobilizers. The optimal use of plerixafor needs to be further studied. Table. Disclosures Blais-Normandin: Sanofi: Other: unrestricted research grant. Laroche:Sanofi: Other: unrestricted research grant.

MP51: Assessment of predictors of deterioration in mild traumatic brain injury with intracranial hemorrhage at emergency department

Introduction: Mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH) is a common cause of Emergency Department (ED) visits. Over the past years, several authors have debated the relevance of radiological and clinical follow-up of these patients, as the main challenge is to identify patients at risk of clinical deterioration. Objectives: To determine whether demographic, clinical or radiological variables can predict patient deterioration. Methods: Design: An historical cohort was constituted in two level-1 trauma centers (Chu de Quebec - Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal)). Participants: Medical records of mTBI patients aged ⩾16 with an ICH were reviewed using a standardized data collection tool. Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation. Measures: Deterioration was defined as either death, deterioration of the control CT scan according to the radiologist, clinical deterioration or neurosurgical intervention. Analyses: Logistic regression analyses were performed to ascertain predictors of deterioration. Interobserver agreement was calculated. Results: A total of 274 patients were included in our analyses. Mean age was 60.8 and 68.9% (n = 188) were men. Four variables were found to be associated with all outcomes: radiological deterioration, clinical deterioration, death, and neurosurgical intervention. Diabetes (odds ratio (OR) = 2.6, 95% CI [0.97-6.94]), confusion as an initial symptom (OR = 2.8, 95% CI [1.42-5.61]), anticoagulation (OR = 2.8, 95% CI [1.01-7.84]) and significant subdural hemorrhage (≥4 mm) (OR = 3.4, 95% CI [1.42-5.61]) seen on the first computed tomography scan were strongly associated with these outcomes. Age had a neutral effect (OR = 1.01, 95% CI [0.99-1.03]) while high initial Glasgow Coma score seemed to have a protective effect (OR = 0.4, 95% CI [0.24-0.69]). Radiological deterioration was not systematically associated with clinical deterioration. As for the 46 patients with a deterioration of CT scan, only 30.4% vs. 69.5% without deterioration (p = 0.0035) showed a clinical deterioration. Conclusion: Diabetes, anticoagulation, significant subdural hemorrhage and confusion as an initial symptom seem to be predictors of deterioration following a mild traumatic brain injury with positive CT scan.

Use of a magnetic double J stent in pediatric patients: A case–control study at two Canadian pediatric centers

BackgroundUreteral stents with magnetic tips (Blackstar©) were recently approved for use in Canada. To our knowledge this is the first published evidence of their use in pediatric patients. Traditionally, pediatric stent insertion and removal are performed under general anesthetic. Magnetic stents have three main benefits in pediatric patients; cost savings, decreased OR time and reduced general anesthetic exposure. MethodsThis study was a proof of concept pilot, ran from May 2017–May 2018 to demonstrate the safety and efficacy of magnetic stents in pediatric patients. Patients undergoing ureteroscopy, ureteric re-implantation, and pyeloplasty with simultaneous magnetic stent insertion. Forty (40) patients had regular double J stents removed under anesthesia and served as control cases, and 40 patients had a magnetic double J at initial surgery at two different sites, CHU de Quebec and Alberta Children's Hospital. ResultsOverall, 39 magnetic stents were successfully retrieved without general anesthetic, representing a retrieval failure rate of only 2.5%. ConclusionAs demonstrated in our research, magnetic stents represent a safe and equally effective alternative to traditional stents, especially in a pediatric patient. This is because, at worst, if retrieval of the magnetic stent fails, traditional cystoscopic removal can be performed, so nothing is lost. Study TypeCase–control study. Level of evidenceLevel III.

Improving flow in the OR

PurposeThe purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward.Design/methodology/approachTwo similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project.FindingsFor the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction).Originality/valueThese projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.