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Dans le cadre du développement de la classification internationale des maladies (CIM-11), les groupes de travail ont développé des propositions avec pour objectif d’améliorer l’utilité clinique de la classification. Ces propositions sont testées via la plateforme internet « Réseau Mondial de Pratique Clinique (RMPC) » permettant de conduire à des études cliniques électroniques dans les langues officielles de l’OMS, dont le français. Cette étude s’intéresse aux catégories diagnostiques des troubles de l’alimentation et des conduites alimentaires (TCA). Des nouveaux diagnostics ont été proposés tels que le trouble d’hyperphagie et le trouble d’évitement et de restriction de l’apport alimentaire.
– évaluer l’impact des changements spécifiques des TCA entre la CIM-10 et la CIM-11 auprès des membres francophones du RMPC ;
– évaluer la validité, l’utilité clinique des nouvelles propositions et l’accord inter-juges des participants.
Étude mixte, internationale, conduite par internet auprès des membres francophones du RMPC.
Membres du RMPC maîtrisant le français (environ 1000 professionnels) et exerçant une activité clinique.
La population cible recevra un email d’invitation. Les participants seront amenés à lire deux vignettes puis à poser des diagnostics et à répondre à des questions complémentaires, en se basant sur la CIM-10 ou la CIM-11 qu’ils auront reçu de façon aléatoire.
Les vignettes représenteront des cas cliniques réels et reflèteront les changements spécifiques entre la CIM-10 et la CIM-11. Elles seront ainsi présentées par pair (8 pairs possibles).
– interparticipants portant sur l’utilisation du système diagnostique (10 ou 11) et l’attribution du diagnostic en fonction des changements spécifiques ;
– intra-participant sur l’évaluation des pairs de vignettes.
Cette étude doit permettre d’évaluer les nouvelles propositions CIM en français, en tenant compte des spécificités culturelles et linguistiques de la francophonie.
The World Health Organization Department of Mental Health and Substance Abuse has been conducting an active program of field studies and international surveys as a part of developing the ICD-11 classification of mental and behavioural disorders.
A key priority for WHO is that the ICD-11 serve as a more effective tool for reducing the global disease burden of mental and behavioural disorders.
In support of this objective, a major goal of the revision is to improve the classification's clinical utility. To provide relevant information on clinical utility, WHO has worked to assess the perspectives of practicing clinicians throughout the world.
Two global field studies have been conducted regarding how clinicians conceptualize the relationships among mental disorders based on their clinical experience. The first study included 1371 psychiatrists and psychologists from 64 countries, and used a paired comparisons methodology. The second study used a ‘folk taxonomy’ method, and was administered with 480 psychiatrists and psychologists in Brazil, China, India, Japan, Mexico, Nigeria, Spain, and the USA.
Highly similar results were obtained across two large international studies using different methodologies. Clinicians’ conceptualizations are rational and highly stable, regardless of country, language, profession, and country income level. Differences between clinicians’ judgments and classification system are not due to idiosyncratic clinician error, but rather to systematic differences.
The presentation will discuss how empirical data on clinician judgments are contributing to the development of a new and more clinically useful classification of mental disorders, without sacrificing validity.
Schizophrenia and other serious mental illnesses (SMI) are most accurately conceptualized as chronic conditions, in which pattern of functioning rather than diagnosis is often most important in determining what services are needed at any given time. People with SMI have lost the ability to carry out daily tasks, live independently, work, have interpersonal relationships, and engage in leisure pursuits. Much of the focus of treatment is based on needs assessment in these areas rather than on the diagnostic category.
To demonstrate how WHO's International Classification of Functioning Disability and Health (ICF) can provide a framework for treatment planning, defining goals, assessing progress and outcomes, and allocating resources for people with SMI.
To analyze the ability of the ICF to reflect the functional problems, treatment goals and outcomes of major psychosocial rehabilitation approaches for people with schizophrenia and other forms of SMI.
Extended clinical examples will be provided to illustrate the potential application of the ICF in this context.
The goals and outcomes of psychosocial rehabilitation approaches including training related to social skills, independent living skills, occupational skills, and illness/wellness management and other approaches such as family-based treatment, neurocognitive therapy, and environmental engineering are a good fit with the conceptual structure, content and descriptive, individualized nature of the ICF.
The ICF provides an internationally recognized basis for the specification of treatment goals, evaluation parameters, and health care outcomes, including specific characteristics of mental disorders and broader functional issues likely to be treatment's most important goals.
One of the WHO's innovations for improving the ICD-11 chapter Mental and Behavioral Disorders was the creation of the Global Clinical Practice Network (GCPN), an international network of more than 12,000 mental health and primary care professionals from 144 countries.
Aims and objectives
In order to evaluate perceived clinical utility of the ICD-11 guidelines, the case-controlled field studies that involved the application of the proposed diagnostic guidelines to standardized case material were implemented via the Internet in different languages.
Two hundred and seventy-eight Russian mental health care professionals, the GCPN members, have participated in case controlled Internet study for the chapter “Schizophrenia and Other Primary Psychotic Disorders”. Russian participants were represented by psychiatrists mostly (89%) and much less by psychologists (8%) which corresponds with the general situation in the Russian mental health care system.
Russian clinicians have used the proposed ICD-11 diagnostic guidelines successfully to assess delusional disorder as well as schizophrenia. But there were certain categories (schizoaffective disorder, subthreshold delusions) with which the participants seemed to struggle. The critical comments were focused on opposing so called syndrome-based assessment and nosological diagnostics. Most concerns were about elimination of Schizophrenia subtypes.
Russian mental health care professionals proved to be interested in ICD revision process and demonstrated their special diagnostics opinion based on rich clinical traditions and psychopathological approach. In order to use ICD-11 guidelines in clinical practice more efficiently supplementary appropriate training would be needed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In this article, I explore the ways territorial authority or sovereignty emerges from within a particular mode of Indigenous creativity—the creation and performance of Hopi taatawi (traditional songs)—despite the appropriation of Hopi traditional lands by the American settler-state. Hopi territories within Öngtupqa (Grand Canyon) are just a sample of the many places where Indigenous authority, as expressed through sound-based performances, continues to resonate despite the imposition of settler-colonial structures that have either silenced Indigenous performances of authority or severed these places from Indigenous territories. Drawing on the work of Hopi composers and intellectuals, I explore how Hopi musical composition and performance are deeply intertwined with Hopi political philosophy and governance, resulting in a form of sovereignty that is inherently sonic rather than strictly literary or textual in nature. Recognizing that this interconnection between territorial authority and sound production is common across many Indigenous communities, I propose listening to contemporary Indigenous creativity not just as an aesthetic form but as a source of sonic sovereignty.
We evaluated provider adherence to practice guidelines for inpatients diagnosed with Clostridoides difficile infection (CDI) before and after implementation of a best practice alert (BPA) linking a positive test result to guideline-based orders. After implementation of the BPA, guideline-based prescribing increased from 39.4% in 2013 to 67.7% in 2016 (P = .014).
Secondary plant compounds have shown bioactivity against multi-drug resistant Haemonchus contortus in small ruminants. This study screened 51 strains of birdsfoot trefoil (BFT, Lotus corniculatus) crude aqueous extracts (BFT-AqE) for anti-parasitic activity in vitro against egg hatching, and of those 51 strains, 13 were selected for further testing of motility of first (L1) and third stage (L3) larvae, and exsheathment of L3. Proanthocyanidin content ranged between 1.4 and 63.8 mg PAC g−1 powder across the 51 BFT strains. When tested against egg hatching, 21 of the 51 aqueous extracts had an EC50 of 1–2 mg powder mL−1, 70% of the strains were >90% efficacious at 6 mg powder mL−1 and 11 of the strains were 100% efficacious at 3 mg powder mL−1 BFT-AqE. Across the 13 strains tested against L3, efficacy ranged from 0 to 75% exsheathment inhibition, and 17 to 92% L3 motility inhibition at a concentration of 25 mg powder mL−1 BFT-AqE. There was no correlation between the PAC content of BFT powders and the anti-parasitic activity of aqueous extracts, therefore other secondary compounds may have contributed to the observed anti-parasitic effects. Further testing of BFT using bioactivity-driven fractionation and screening of BFT populations for the identified anti-parasitic compounds is needed.
The use of psychoactive, potentially dependence-producing substances is highly prevalent around the world, and contributes substantially to global disease burden. There is a major gap between the need for treatment for substance use disorders. Changes proposed for the classification of substance use disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems, based on a public health approach, have important implications for the conceptualisation, structure and availability of services. These include: (1) an updated and expanded range of substance classes; (2) greater specification of different harmful patterns of substance use, which may be continuous or episodic and recurrent; (3) a new category to denote single episodes of harmful use; (4) a category describing hazardous use of substances; and (5) simplification of diagnostic guidelines for substance dependence. This paper describes these changes and the opportunities they present for improved prevention, treatment, monitoring and health policy.
The study aimed to examine variations in the use of International Classification of Diseases, Tenth Edition (ICD-10) diagnostic categories for mental and behavioural disorders across countries, regions and income levels using data from the online World Psychiatric Association (WPA)-World Health Organization (WHO) Global Survey that examined the attitudes of psychiatrists towards the classification of mental disorders.
A survey was sent to 46 psychiatric societies which are members of WPA. A total of 4887 psychiatrists participated in the survey, which asked about their use of classification, their preferred system and the categories that were used most frequently.
The majority (70.1%) of participating psychiatrists (out of 4887 psychiatrists) reported using the ICD-10 the most and using at least one diagnostic category once a week. Nine out of 44 diagnostic categories were considerably variable in terms of frequency of use across countries. These were: emotionally unstable personality disorder, borderline type; dissociative (conversion) disorder; somatoform disorders; obsessive–compulsive disorder (OCD); mental and behavioural disorders due to the use of alcohol; adjustment disorder; mental and behavioural disorders due to the use of cannabinoids; dementia in Alzheimer's disease; and acute and transient psychotic disorder. The frequency of use for these nine categories was examined across WHO regions and income levels. The most striking differences across WHO regions were found for five out of these nine categories. For dissociative (conversion) disorder, use was highest for the WHO Eastern Mediterranean Region (EMRO) and non-existent for the WHO African Region. For mental and behavioural disorders due to the use of alcohol, use was lowest for EMRO. For mental and behavioural disorders due to the use of cannabinoids, use was lowest for the WHO European Region and the WHO Western Pacific Region. For OCD and somatoform disorders, use was lowest for EMRO and the WHO Southeast Asian Region. Differences in the frequency of use across income levels were statistically significant for all categories except for mental and behavioural disorders due to the use of alcohol. The most striking variations were found for acute and transient psychotic disorder, which was reported to be more commonly used among psychiatrists from countries with lower income levels.
The differences in frequency of use reported in the current study show that cross-cultural variations in psychiatric practice exist. However, whether these differences are due to the variations in prevalence, treatment-seeking behaviour and other factors, such as psychiatrist and patient characteristics as a result of culture, cannot be determined based on the findings of the study. Further research is needed to examine whether these variations are culturally determined and how that would affect the cross-cultural applicability of ICD-10 diagnostic categories.
Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.
Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.
This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.
Of 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).
The modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.
ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med. 2017;32(6):625–630.
Let ℱ be a family of graphs and let d be large enough. For every d-regular graph G, we study the existence of a spanning ℱ-free subgraph of G with large minimum degree. This problem is well understood if ℱ does not contain bipartite graphs. Here we provide asymptotically tight results for many families of bipartite graphs such as cycles or complete bipartite graphs. To prove these results, we study a locally injective analogue of the question.
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
A retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
A range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
Neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments. Prehosp Disaster Med. 2016;31(6):675–679.
Aberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task.
Participants (N = 271, BDI = 206, BDII = 121) completed an ‘emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication.
Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance.
Emotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
Investigations on the relationship between sweet taste perception and body mass index (BMI) have been inconclusive. Here, we report a longitudinal analysis using a genetically informative sample of 1,576 adolescent Australian twins to explore the relationship between BMI and sweet taste. First, we estimated the phenotypic correlations between perception scores for four different sweet compounds (glucose, fructose, neohesperidine dihydrochalcone (NHDC), and aspartame) and BMI. Then, we computed the association between adolescent taste perception and BMI in early adulthood (reported 9 years later). Finally, we used twin modeling and polygenic risk prediction analysis to investigate the genetic overlap between BMI and sweet taste perception. Our findings revealed that BMI in early adulthood was significantly associated with each of the sweet perception scores, with the strongest correlation observed in aspartame with r = 0.09 (p = .007). However, only limited evidence of association was observed between sweet taste perception and BMI that was measured at the same time (in adolescence), with the strongest evidence of association observed for glucose with a correlation coefficient of r = 0.06 (p = .029) and for aspartame with r = 0.06 (p = .035). We found a significant (p < .05) genetic correlation between glucose and NHDC perception and BMI. Our analyses suggest that sweet taste perception in adolescence can be a potential indicator of BMI in early adulthood. This association is further supported by evidence of genetic overlap between the traits, suggesting that some BMI genes may be acting through biological pathways of taste perception.
The perception of sweetness varies among individuals but the sources of this variation are not fully understood. Here, in a sample of 1,901 adolescent and young adults (53.8% female; 243 MZ and 452 DZ twin pairs, 511 unpaired individuals; mean age 16.2 ± 2.8, range 12–26 years), we studied the variation in the perception of sweetness intensity of two monosaccharides and two high-potency sweeteners: glucose, fructose, neohesperidine dihydrochalcone (NHDC), and aspartame. Perceived intensity for all sweeteners decreased with age (2–5% per year) and increased with the history of otitis media (6–9%). Males rated aspartame slightly stronger than females (7%). We found similar heritabilities for sugars (glucose: h2 = 0.31, fructose: h2 = 0.34) and high-potency sweeteners (NHDC: h2 = 0.31, aspartame: h2 = 0.30); all were in the modest range. Multivariate modeling showed that a common genetic factor accounted for >75% of the genetic variance in the four sweeteners, suggesting that individual differences in perceived sweet intensity, which are partly due to genetic factors, may be attributed to a single set of genes. This study provided evidence of the shared genetic pathways between the perception of sugars and high-potency sweeteners.