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La durée des formations en surspécialité a augmenté de manière concomitante et a plus que doublé après 2014. Ces données entraient en contradiction avec les commentaires de la plupart des CP (57 %) et des chefs de division (86 %) qui, disaient manquer de personnel et avoir un nombre anticipé plus de postes vacants plus élevés que le nombre de résidents disponibles. Les chefs de division qui rapportaient manquer de personnel attribuaient principalement cela à des contraintes gouvernementales ou budgétaires. Nous avons observé des contradictions entre les besoins perçus pour des CP additionnels et la difficulté croissante que rapportent les diplômés actuels à trouver de l’emploi. Ceci coïncide avec un nombre croissant d’années supplémentaires de formation en surspécialisation. Des contraintes institutionnelles ou gouvernementales contribuent possiblement à cette situation.in English, French E ngaging P atients i n C are (EPIC) est une initiative locale de participation des patients du University Health Network pour les patients et les familles qui ont reçu des soins en lien avec l’insuffisance cardiaque, la transplantation du cœur ou l’assistance circulatoire mécanique (dispositif d’assistance ventriculaire gauche). Les patients et les soignants peuvent participer à 4 niveaux différents, à savoir le partage, la consultation, la délibération et la collaboration, selon leurs connaissances, leur expérience et leur disponibilité. Le cadre EPIC comporte 4 volets prioritaires la prestation de soins et les politiques, la défense des droits des patients, le soutien aux pairs et la recherche. Nous avons déterminé les principaux obstacles à la participation par un échange sur les solutions possibles. Nous espérons que ce cadre peut servir de référence en matière de preuves à d’autres établissements offrant des soins aux patients atteints d’insuffisance cardiaque et la transplantation du Canada.Protein conformational changes are frequently essential for enzyme catalysis, and in several cases, shown to be the limiting factor for overall catalytic speed. However, a structural understanding of corresponding transition states, needed to rationalize the kinetics, remains obscure due to their fleeting nature. Here, we determine the transition-state ensemble of the rate-limiting conformational transition in the enzyme adenylate kinase, by a synergistic approach between experimental high-pressure NMR relaxation during catalysis and molecular dynamics simulations. By comparing homologous kinases evolved under ambient or high pressure in the deep-sea, we detail transition state ensembles that differ in solvation as directly measured by the pressure dependence of catalysis. Capturing transition-state ensembles begins to complete the catalytic energy landscape that is generally characterized by structures of all intermediates and frequencies of transitions among them.Background Symptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI). Methods AS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as “failing” if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was “unstable/deteriorating”, physicians were dissatisfied with disease control and/or did not consider treatment a “success”. Results The analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently “failing” who, compared to those with treatment success, reported poorer HRQoL 5-dimension EuroQoL (EQ-5D-3 L) 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS) 41.8 vs. 46.3; physical component summary (PCS) 40.2 vs. 45.1; impaired work productivity 46.4% vs. 25.0%; and activity 44.5% vs. 29.6%; all P  less then  0.001. Conclusions Among AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity. © The Author(s) 2020.Background Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. We asked primary care physicians (PCPs) and rheumatologists to identify barriers to screening and treatment for hyperlipidemia among patients with RA. Methods We recruited rheumatologists and PCPs nationally to participate in separate moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of barriers to screening and treatment for hyperlipidemia in patients with RA, then each selected the three most important barriers from this list. The resulting barriers were organized into physician-, patient- and system-level barriers, informed by the socioecological framework. Results Twenty-seven rheumatologists participated in a total of 3 groups (group size ranged from 7 to 11) and twenty PCPs participated in a total of 3 groups (group size ranged from 4 to 9). learn more Rheumatologists prioritized physician level barriers (e.g. ‘ownership’ of hyperlipidemia screening and treatment), whereas PCPs prioritized patient-level barriers (e.g. complexity of RA and its treatments). Conclusion Rheumatologists were conflicted about whether treatment of CVD risk among patients with RA should fall within the role of the rheumatologist or the PCP. All participating PCPs agreed that CVD risk reduction was within their role. Factors that influenced PCPs’ decisions for screening and treatment for CVD risk in patients with RA were mainly related to their concern about how treatment for CVD risk could influence RA symptomatology (myalgia from statins) or how inflammation from RA and RA medications influences lipid profiles. © The Author(s) 2020.