PubMed Health⌕ Search

Biomedical subjects

S Dubé

Publications and source records attributed to S Dubé.

At least 19 recordsLinked to original sources
PubMed2007

Non-patient factors related to rates of ruptured appendicitis.

BACKGROUND: Adult rates of ruptured appendicitis vary from 13.2 to 41.9 per cent in urban hospitals, despite controlling for individual factors. This suggests an effect of hospital organization. Surgeons report that appendicectomies may be delayed because of lack of access to operating rooms. METHODS: Combining interviews with hospital personnel and information from medical records for 1998-1999, a cross-sectional study using logistic regression, taking hospital clustering of patients into account, was conducted on 861 patients from 12 hospitals. Hospitals were grouped into organizational models. The diagnostic information was recoded to ensure interhospital validity. RESULTS: Hospitals with high activity and volumes of patients, but without an operating room designated for urgent surgery, were associated with a significantly higher risk of peritonitis (P<0.050). Time to surgery was very long in all hospitals, particularly time after departure from the emergency department and for elderly patients. CONCLUSION: Organizational characteristics, in unfavourable combinations, influence the course of time-dependent diseases such as appendicitis. Difficulties in gaining access to operating rooms, even for urgent operations, have emerged. Delays in treatment must be addressed when planning healthcare reforms.

Adolescent↗
PubMed2004

[Could we trust clinical statistics from data banks of the National Health Service (NHS)?].

Can we accept the statistics provided by the Ministry of Health, which uses large computerized databases? Through MEDECHO, the Ministry provides to hospital managers, reports cards on different interventions. These reports compare different hospitals performances. Surgeons involved in the process hesitate to accept this information. Using the results of the performance of cholecystectomy provided by this system (Gr: A), we compared the same cohort (1 April-31 December 1996 = 346 cholecystectomies) but using specific criteria determined as relevant to our surgeons (Gr: B). The rate of complication gives a crude aftermath and no attempt was used to adjust for severity. The MEDECHO data are adjusted for severity. The global rate of complications is similar Gr: A 11%, Gr: B 12%. Major complication rate for pulmonary embolism, hemorrhage and biliary duct trauma are identical. The rate of surgical site infection is higher in Gr: B (5% vs. 2%). The patients are seen in the outpatient clinic and these observations are not included by the analytical system unless the patient has been readmitted. For our hospital, the MEDECHO data are valid and reliable even though they underestimated the wound infection rate. These results could be explained by an appropriate interpretation of the code system by the archivist and by the surgeons' precision to complete the summary sheet of hospitalization. We can conclude that these data can be used as a means to evaluate the quality of outcome of a surgical service.

Canada↗
PubMed2004

The Quebec Association of Gastroenterology position paper on colorectal cancer screening - 2003.

Colorectal cancer is a leading cause of death and the third most common cancer in Canada. Evidence suggests that screening can reduce mortality rates and the cost effectiveness of a program compares favourably with initiatives for breast and cervical cancer. The objectives of the Association des gastro-entérologues du Québec Task Force were to determine the need for a policy on screening for colorectal cancer in Quebec, to evaluate the testing methods available and to propose one or more of these alternatives as part of a formal screening program, if indicated. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with five- to 10-yearly double contrast barium enema or 10-yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and cost-effectiveness studies in Quebec are now warranted.

Barium Sulfate↗
PubMed2001

Acquisition of lexical morphology in simple partial epilepsy.

In the study of language acquisition following early brain damage, results have been divergent. On one hand, some studies claim that language eventually resumes to normal, whereas, on the other hand, studies show lasting deficits throughout development. Discrepancies in the results could arise from different etiologies and tests used. This study attempts to determine the extent to which the development of verb production is affected in later development in children who had simple partial epilepsy (SPE). Measures of diversity and fluency of three verb types, namely main verbs, auxiliary and copula verbs, and nonfinite verbs were used on three children diagnosed as SPE and compared to control groups. Our main results show a limited production of auxiliary verbs. Further analysis of their productions suggest a telegraphic style of speech, as reflected by a superior production of nonfinite verb type compared with normal children. These findings are interpreted as reflecting long-lasting consequences of early brain damage with respect to language development.

Brain↗
PubMed2000

Clinimetric scale to measure surgeons' satisfaction with anesthesia services.

PURPOSE: Continuous quality improvement is of increasing interest to anesthesiologists. Since surgeons are coworkers and important clients of anesthesiologists, the level of satisfaction of surgeons with anesthesia services should be explored to optimize quality. The purpose of this study was, first, to introduce the concept of surgeons as clients of anesthesiologists and second, to develop and test an instrument to measure surgeons' satisfaction, the Surgeon Satisfaction with Anesthesia Services (SSAS) scale. METHODS: A conceptual model of surgeon satisfaction with anesthesia services was created before the development of the SSAS scale. The scale, composed of socio-demographic, Likert-type and open-ended questions was sent to a sample of 250 surgeons selected randomly by the Collège des Médecins du Québec. Exploratory factorial analysis were performed on the results. RESULTS: A Cronbach's alpha of 0.84 was obtained for internal consistency. Exploratory factorial analysis yielded two subscale factors: a) clinical expertise and b) attitudes and behaviour Global mean of surgeons'satisfaction was moderately high (3.11/4.0). Satisfaction was not related to sociodemographic variables. Very high scores were obtained for items related to clinical expertise. Items related to attitudes and behaviour obtained lower scores. A significant difference was obtained between both factors (t = -5.732, P = 0.0001). CONCLUSION: The SSAS scale is a new instrument to evaluate surgeon satisfaction. Overall, surgeons seem satisfied with anesthesia services, but many areas of dissatisfaction persist. Further discussions with surgeons should be encouraged, in view of improving the perceptions of the quality of anesthesia services and interprofessional relationships.

Anesthesiology↗
PubMed2000

The safe use of epidural anesthesia after subcutaneous injection of low-dose heparin in general abdominal surgery.

OBJECTIVE: To determine if epidural anesthesia after the subcutaneous injection of low-dose unfractionated heparin (LDUH) in patients who undergo elective bowel surgery is safe with respect to hemorrhagic complications. DESIGN: A prospective cohort study. SETTING: Two hospitals affiliated with the Université de Montréal. PATIENTS: Fifty patients scheduled for elective bowel surgery. INTERVENTION: Subcutaneous injection of 5000 units of LDUH and elective surgery for colonic carcinoma, chronic diverticulosis or inflammatory bowel disease. MAIN OUTCOME MEASURES: Activated partial thromboplastin time (APTT), anti-IIa and anti-Xa heparin levels measured before and 2 and 4 hours after injection of LDUH. RESULTS: In no case was the heparin anti-IIa or anti-Xa level higher than 0.20 U/mL, which is considered a significant detectable level of heparin. CONCLUSION: LDUH given subcutaneously is not associated with significant detectable heparin levels, so epidural anesthesia should be safe when performed 2 hours after LDUH injection in patients who undergo general abdominal surgery in the absence of any other impairment of hemostasis.

Anesthesia, Epidural↗
PubMed1999

[Recurrence and satisfaction levels following onysectomy with or without phenolization].

OBJECTIVE: To compare recurrence and satisfaction levels among patients undergoing onysectomy with phenolization (OP) and without phenolization (OS). DESIGN: Retrospective cohort study. SETTING: Family practice unit. PARTICIPANTS: All patients (N = 35) undergoing onysectomy between September 1992 and May 1993, and between January 1996 and February 1997. MAIN OUTCOME MEASURES: Type of onysectomy (OP or OS) was taken from the patient's medical record. A telephone interview was used to determine whether patients had experienced recurrence; satisfaction was measured retrospectively at diagnosis, at time of surgery, and after surgery using a five-point scale (very unsatisfied to very satisfied). RESULTS: Among the 30 patients interviewed by telephone, four of the six patients in the OS group experienced recurrence, and four of the 24 patients in the OP group experienced recurrence. (Fisher's exact test, P = .007). In the OS group, satisfaction levels at diagnosis, during surgery, and after surgery were 4.7, 4.5, and 4.2, respectively. In the OP group, satisfaction levels at these three points were 4.3, 4.2, and 4.4, respectively. Notwithstanding technique used, a connection was noted between recurrence and satisfaction level at the time of the telephone interview (repeated measures test, P = .036). CONCLUSION: In general medicine, onysectomy with phenolization could be the treatment of choice for ingrown toenails.

Adult↗
PubMed1998

[Assessment of the quality of life during adjuvant chemotherapy of colorectal cancer].

Enhanced 5 year survival rates with adjuvant chemotherapy for colon and rectal cancers are 5% and 9% respectively, according to recent meta-analysis. Despite the NIH consensus statement endorsing adjuvant chemotherapy, many clinicians regard such a seemingly small benefit not justworthy of the expense, inconvenience, discomfort and risk of treatment for their individual patient with colorectal carcinoma. The aim of this study is to evaluate these quality of life issues. The seven criteria considered most important were determined by interviews of treated patients, who emphasized the following quality of life parameters: nausea and vomiting, diarrhea, perineal dermatitis, asthenia, impairment of daily activity, family support, and difficulties of daily transportation to hospital. A numeric scale (1-5) was used to measure their answers (0 = hospitalization, 5 = no modification), and the nonparametric rank coefficient of Kendall was used to compare them. Twenty patients with colon cancer treated with Moertel's protocol and 5 patients with rectal cancer treated with Krook's protocol were evaluated. The study revealed a diminished quality of life for both patients with colon cancer (7 on a scale of 10) and those with rectal cancer (6 on the same scale). By using the same questionnaire at one week interval, the responses remained unchanged (p < 0.001). The effect of radiotherapy seems to be responsible for this difference. This study is one of the first to approach the quality of life from the real interested party's point of view: the patient.

Activities of Daily Living↗
PubMed1997

Acute colonic surgery and unrecognized hypothyroidism: a warning. Report of six cases.

PURPOSE: This study was designed to highlight the significant morbidity related to undetected hypothyroidism in the elderly who are undergoing emergency surgery. METHOD: Case reports of six patients who presented with acute colonic surgical conditions are reviewed. RESULTS: Six cases of undetected hypothyroidism in a group of elderly patients was unmasked at the time of surgery for acute colonic conditions or in the perioperative period. These patients experienced increased morbidity, but once detected and treated, all but one had an uneventful recovery. CONCLUSION: Unrecognized hypothyroidism may lead to unnecessary surgery or even a potentially fatal outcome. A heightened awareness of this not so uncommon entity is mandatory.

Aged↗
PubMed1997

Adjuvant chemotherapy in colorectal carcinoma: results of a meta-analysis.

UNLABELLED: Despite the National Institutes of Health consensus regarding use of adjuvant chemotherapy in colorectal carcinoma, many general surgeons question the efficacy of this approach when considering costs involved for both the individual patient and society at large. PURPOSE: This study was designed to determine the real impact of adjuvant chemotherapy on five-year survival rates of patients. METHOD: A qualitative and quantitative meta-analysis of results from 39 randomized clinical trials published from 1959 to 1993 is described. RESULTS: Design quality of clinical trials had a mean score of 48.6 percent (+/-6.2 standard deviation). A small benefit of therapy in terms of overall survival was noted, with a mortality odds ratio (OR) of 0.91 (confidence interval (CI) 95 percent, 0.83-0.99). For the group of colon carcinomas, the OR was 0.81 (CI 95 percent, 0.69-0.94) with an OR of 0.64 (CI 95 percent, 0.48-0.85) for the group of rectal carcinomas. The effect size was 0.09 for the colon group and 0.20 for the rectal group. For those patients who receive chemotherapy, this effect size implies that we can expect an increase of 5 percent in the survival rate in the group with colon carcinoma and a 9 percent increase in the survival rate in the group with rectal carcinoma. CONCLUSION: Given the high incidence of colorectal carcinoma, the small benefit observed for those patients receiving chemotherapy is far from negligible. However, indications for adjuvant chemotherapy warrant further discussion.

Antineoplastic Agents↗
PubMed1997

Bowel preparation with polyethylene glycol electrolyte lavage solution is potentially hazardous in patients with carcinoma of the cardia: a case report.

Polyethylene glycol (PEG) electrolyte solution can induce potentially fatal complications when used as a lavage in preoperative bowel preparation. A 60-year-old man with carcinoma of the esophagogastric junction had a Mallory-Weiss tear after bowel preparation with PEG. He was successfully resuscitated, first with balanced salt solution then by transfusion. The literature on the subject is reviewed and recommendations are made, which include consideration of alternative methods of bowel preparation (e.g., sodium phosphate solution) in patients with esophageal obstruction.

Adenocarcinoma↗
PubMed1996

Two contributions of motion induction: a preattentive effect and facilitation due to attentional capture.

By combining the paradigms of motion induction (presentation of an inducing stimulus, followed after a short delay by the presentation of an elongated bar next to it) and visual search (many-item displays with or without a pop-out target), it was possible to demonstrate the existence of two separate contributions to the motion induction effect. Illusory motion in the test bar could be produced either preattentively or by facilitation due to attentional capture. The former effect is fast, independent of the delay between the inducers and the test bar and operating simultaneously at all locations across the visual display, the latter is slower (full strength in 200-300 msec) and confined to the vicinity of the pop-out inducer. The two possibly also differ in their spatial extent, the attentional capture effect extending over a larger area around the inducer. We conclude that the motion induction effect can be used to show the existence of several effects due to the sudden presentation of a visual stimulus.

Attention↗
PubMed1996

Hypothalamic-pituitary-adrenocortical activity and response to cognitive behavior therapy in unmedicated, hospitalized depressed patients.

OBJECTIVE: Surprisingly little research supports the hypothesis that depressions characterized by objective measures of neurobiological dysregulation respond poorly to psychotherapy. Moreover, relevant studies testing this hypothesis have been compromised by low rates of neurobiological abnormality in outpatient samples. The authors therefore investigated response to cognitive behavior therapy in relation to pretreatment measures of hypothalamic-pituitary-adrenocortical (HPA) activity in hospitalized, yet unmedicated, patients. METHOD: The subjects were 29 unmedicated, hospitalized patients with major depression (DSM-III-R and Schedule for Affective Disorders and Schizophrenia/Research Diagnostic Criteria), nonpsychotic/nonbipolar subtype. After a 7- to 14-day evaluation, urinary free cortisol levels and dexamethasone suppression tests (DSTs) were obtained. Patients were treated for an average of 3 weeks with intensive individual cognitive behavior therapy. Response was assessed in relation to clinical severity of illness and pretreatment HPA parameters. RESULTS: Response to inpatient cognitive behavior therapy was inversely associated with pretreatment urinary free cortisol concentrations, although not strongly correlated with DST results. Overall, 12 (92%) of 13 cortisol suppressors on the DST who had normal urinary free cortisol concentrations responded to treatment, compared with only seven (44%) of the 16 patients characterized by nonsuppression of cortisol and/or elevated urinary free cortisol excretion. The relation between response to cognitive behavior therapy and HPA activity was not explained by clinical measures of symptom severity. CONCLUSIONS: Results are consistent with the hypothesis that patients with increased HPA function are less responsive to psychotherapy and, hence, might require somatic interventions. It is proposed that the negative impact of hypercortisolism on neurocognitive function mediates this relationship.

Adolescent↗
PubMed1995

Sertraline safety and efficacy in major depression: a double-blind fixed-dose comparison with placebo.

In a 6-week, randomized, double-blind, multicenter trial, sertraline 50 mg, 100 mg, or 200 mg, or placebo, was administered once daily to 369 patients with DSM-III-defined major depression. Efficacy variables included changes from baseline scores for total Hamilton Rating Scale for Depression (HAMD), HAMD Bech Depression Cluster, Clinical Global Impressions (CGI) Severity, CGI Improvement, and Profile of Mood States Depression/Dejection Factor. For the evaluable-patients analysis, all sertraline groups showed significantly (p < 0.05 or better) greater improvements in all efficacy variables except one when compared with the placebo group. For the all-patients analysis, all efficacy variables in the 50 mg group were statistically significantly (p < 0.05) better than placebo. Side effects increased with increasing dosage but were usually mild and well tolerated. The results of this study show that sertraline 50 mg once daily is as effective as higher dosages for the treatment of major depression with fewer side effects and therapy discontinuations.

1-Naphthylamine↗
PubMed1995

[Dilatation enteroplasty for obstructive Crohn disease. Experience of the University of Montreal].

Multiple small bowel resections for obstructive symptoms caused by Crohn's disease can lead to a short bowel and malabsorption. Preservation of intestinal length is possible by the use of strictureplasty. Between August 1983 and March 1993, ninety strictureplasties were performed in 25 patients. They were 13 males and 12 females with a mean age of 37 years. Fourteen (56%) previously had small bowel resection for Crohn's disease. A mean number of 4.3 strictureplasties per patient were performed. Concomitant resection of bowel with active disease was performed in 18 patients (72%). In this series, no perioperative death occurred and one patient developed an enterocutaneous fistula. The overall complication rate was 8%. Postoperatively, 18 patients (72%) were completely relieved of symptoms, 6 were improved (24%) and one became worst (4%). After a 27 month follow-up period, the symptoms recurred in 13 patients (52%); three had no treatment, 7 had medical treatment and 3 required reoperation (12%). Our results support the safety and the use of strictureplasty for stenotic bowel lesions associated with Crohn's disease.

Adult↗
PubMed1994

The interaction of depth parameters in motion integration with polar plaids.

Many parameters have been investigated as to their effect on the way in which the visual system is able to integrate different motion directions at the same visual location. Of special interest have been parameters that determine the depth relationship between surfaces, such as disparity, relative contrast, and occlusion versus transparency. The preferred stimulus for this research has been the 'plaid', usually constructed from two linear gratings. The present study concentrated not on these Cartesian plaids, but on polar plaids, made from a combination of concentric circles and radial gratings. These kinds of plaids also have a special theoretical significance: within the Lie Transformation Group approach to visual pattern processing, Cartesian and polar stimuli represent different invariances in the visual world. This study compared Cartesian, polar and hybrid plaids as to their propensity to be perceived as coherently moving stimuli. Cartesian and polar plaids were similar in terms of the effects of intersection luminance and relative contrast on coherence, polar plaids being consistently less coherent. Hybrid plaids did not usually cohere at all. Adaptation to an unambiguously coherent plaid decreased perceived coherence when tested with a bistable plaid from the same, and not from the other Lie group, i.e. there was within-group adaptation but no between-group adaptation. Polar plaids also offer the possibility of studying the influence of another depth parameter on motion integration: expansion or contraction of circular gratings, which represent motion-in-depth toward or away from the observer. This motion-in-depth was tested for interaction with disparity or relative contrast in the determination of motion integration. The results were negative under the present conditions. Thus not all depth parameters contribute equally to the determination of the stimulus depth relations affecting the motion integration process.

Depth Perception↗
PubMed1994

Local and global factors of similarity in visual search.

Effects of the similarity between target and distractors in a visual search task were investigated in several experiments. Both familiar (numerals and letters) and unfamiliar (connected figures in a 5 x 5 matrix) stimuli were used. The observer had to report on the presence or absence of a target among a variable number of homogeneous distractors as fast and as accurately as possible. It was found that physical difference had the same clear effect on processing time for familiar and for unfamiliar stimuli: processing time decreased monotonically with increasing physical difference. Distractors unrelated to the target and those related to the target by a simple transformation (180 degrees rotation, horizontal or vertical reflection) were also compared, while the physical difference was kept constant. For familiar stimuli, transformational relatedness increased processing time in comparison with that for unrelated stimulus pairs. It was further shown in a scaling experiment that this effect could be accounted for by the amount of perceived similarity of the target-distractor pairs. For unfamiliar stimuli, transformational relatedness did have a smaller and less pronounced effect. Various comparable unrelated distractors resulted in a full range of processing times. Results from a similarity scaling experiment correlated well with the outcome of the experiments with unfamiliar stimuli. These results are interpreted in terms of an underlying continuum of perceived similarity as the basis of the speed of visual search, rather than a dichotomy of parallel versus serial processing.

Adult↗