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Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials.

BackgroundAnxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress.Design/MethodThis is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files.DiscussionThis study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.

Ambient light artifacts can confound Raman spectroscopy measurements performed in a clinical setting such as during open surgery. However, requiring light sources to be turned off during intraoperative spectral acquisition can be impractical because it can slow down the procedure by requiring surgeons to acquire data under light conditions different from the routine clinical practice. Here a filter system is introduced allowing in vivo Raman spectroscopy measurements to be performed with the light source of a neurosurgical microscope turned on, without interfering with the standard procedure. Ex vivo and in vivo results on calf and human brain, respectively, show that when the new filter system is used there is no significant difference between Raman spectra acquired under pitch dark conditions or with the microscope light source turned on. This is important for the clinical translation of Raman spectroscopy because of the resulting decrease in total imaging time for each measurement and because the surgeon can now acquire spectroscopic data with no disruption of the surgical workflow.

Modern cancer diagnosis requires histological, molecular, and genomic tumor analyses. Tumor sampling is often achieved using a targeted needle biopsy approach. Targeting errors and cancer heterogeneity causing inaccurate sampling are important limitations of this blind technique leading to non-diagnostic or poor quality samples, and the need for repeated biopsies pose elevated patient risk. An optical technology that can analyze the molecular nature of the tissue prior to harvesting could improve cancer targeting and mitigate patient risk. Here we report on the design, development, and validation of an in situ intraoperative, label-free, cancer detection system based on high wavenumber Raman spectroscopy. This optical detection device was engineered into a commercially available biopsy system allowing tumor analysis prior to tissue harvesting without disrupting workflow. Using a dual validation approach we show that high wavenumber Raman spectroscopy can detect human dense cancer with >60% cancer cells in situ during surgery with a sensitivity and specificity of 80% and 90%, respectively. We also demonstrate for the first time the use of this system in a swine brain biopsy model. These studies set the stage for the clinical translation of this optical molecular imaging method for high yield and safe targeted biopsy.

Objectives This study aimed to estimate the incidence of medical consultations six months after an emergency department (ED) consultation for non-cardiac chest pain (NCCP). It also investigated the role of heart-focused anxiety (HFA) and other factors in predicting an increased healthcare utilization in these patients. Method This was a prospective study of 428 patients who came to an ED with NCCP. Patients completed an interview and questionnaires assessing HFA, psychological distress, the characteristics of NCCP, and comorbidities. Their medical consultations were assessed by telephone interview six months later. The contribution of each factor was assessed using a binomial negative regression. Results Eighty-three percent of patients reported at least one medical consultation (mean = 3.1, standard deviation = 3.9). HFA (incident rate ratio 1.01; 95% CI, 1.00–1.02), the presence of a medical condition (2.14; 1.51–3.03), NCCP frequency (1.49; 1.16–1.91) and NCCP-related interference (1.08; 1.04–1.13) were predictive of further medical consultations. Conclusions A significant proportion of patients with NCCP are at risk of multiple medical consultations following discharge from the ED. HFA appears as a determinant of medical consultations after controlling for multiple confounding factors.

Les valeurs, un outil d’appropriation par les soignants d’une demarche ethique en contexte des soins palliatifs – Cette recherche a voulu savoir comment, par les valeurs qu’ils privilegient, les soignants peuvent approfondir le sens qu’ils donnent a leur pratique et ameliorer leur approche du malade. Un questionnaire utilise comme guide d’entrevue de groupe, d’entrevue individuelle et d’auto-administration a permis de recueillir des donnees aupres des 83 soignants qui travaillent en soins palliatifs. Les resultats indiquent que, dans leur pratique, les soignants privilegient les valeurs de respect, de compassion, d’ecoute, d’ethique, de competence et d’authenticite. Ils indiquent aussi que quotidiennement les soignants sont confrontes a une grande souffrance, qu’ils vivent des conflits et des dilemmes, et que cet etat de fait les oblige, en l’absence d’espaces pour dialoguer avec d’autres personnes qui experimentent des situations semblables, a entreprendre une demarche en solitaire pour se sortir de cette impasse. Comme strategie de soutien aux soignants, il est propose de creer des espaces de dialogue, de leur apporter des connaissances theoriques, un savoir-faire, un savoir-etre et de les encourager a travailler en interdisciplinarite.

During the diagnosis and treatment process for brain cancer, clinicians often need to achieve a brain biopsy to get histological data. However there are risks associated with this procedure: 1) collected samples are not always representative of the tumor and 2) there is a risk of blood vessel rupture when the sample is taken. This type of bleeding occurs between 0.3 and 59.8% of the cases and the mortality rate can be as high as 3.9% (Dammers et al, Woodworth et al). Here we present a diffuse reflectance spectroscopy imaging system directly integrated on a brain biopsy needle to guide surgeon during needle biopsy procedures. To mitigate the risks associated with the procedure, our imaging system combines 18 optical fibers (9 used as white-light sources and 9 used as detectors) to acquire a total of 81 reflectance spectra per acquisition. A tomographic algorithm (Goyette et al) is used to reconstruct an image in the vicinity of the needle based on the optical contrast due to the optical absorption of hemoglobin (Hb) which is the main absorber in brain. The evaluation and characterization tests were first carried out in vitro using tissue-simulating phantoms reproducing human brain optical properties (absorption and scattering).

Brain needle biopsy (BNB) is performed to collect tissue when precise neuropathological diagnosis is required to provide information about tumor type, grade, and growth patterns. The principal risks associated with this procedure are intracranial hemorrhage (due to clipping blood vessels during tissue extraction), incorrect tumor typing/grading due to non-representative or non-diagnostic samples (e.g. necrotic tissue), and missing the lesion. We present an innovative device using sub-diffuse optical tomography to detect blood vessels and Raman spectroscopy to detect molecular differences between tissue types, in order to reduce the risks of misdiagnosis, incorrect tumour grading, and non-diagnostic samples. The needle probe integrates optical fibers directly onto the external cannula of a commercial BNB needle, and can perform measurements for both optical techniques through the same fibers. This integrated optical spectroscopy system uses diffuse reflectance signals to perform a 360-degree reconstruction of the tissue adjacent to the biopsy needle, based on the optical contrast associated with hemoglobin light absorption, thereby localizing blood vessels. Raman spectra measurements are also performed interstitially for tissue characterization. A detailed sensitivity of the system is presented to demonstrate that it can detect absorbers with diameters

Invasive brain cancer cells cannot be visualized during surgery and so they are often not removed. These residual cancer cells give rise to recurrences.

« La mort n'est ni deprimante ni seduisante, elle est tout simplement une realite de la vie ». Sogyal Rinpoche, grand Maitre bouddhiste. La mort est un mystere. Pour la science, elle constitue un probleme. Pour les humains, elle represente la fin de la vie. Elle est une source de peur, d'angoisse et de souffrance. En milieux cliniques, les soignants en soins palliatifs font face quotidiennement a cette dure realite qu'est la mort. Inevitablement, ils sont vite amenes a reflechir sur leurs valeurs profondes, a se questionner sur la vie et la mort. Ils font aussi face a des dilemmes personnels et professionnels au cours de leurs interventions aupres des mourants. C'est par une demarche praxeologique lors de mes rencontres avec des soignants sur le terrain que j'ai cherche a connaitre leurs valeurs personnelles et que je me suis rendu compte des preoccupations qu'ils avaient et des dilemmes ethiques auxquels ils faisaient face dans leur pratique.A partir des resultats de l'etude et en tenant compte de la philosophie bouddhiste de la souffrance, j'ai tente de repondre a la question suivante : Par les valeurs qu'il privilegie, comment le soignant peut-il approfondir davantage le sens qu'il donne a sa pratique et, de ce fait, assurer un meilleur accompagnement des patients en soins palliatifs? En repondant a cette question, je visais a proposer un mode d'accompagnement qui consisterait pour le soignant a adopter une demarche de reflexion susceptible de donner un sens a sa pratique et d'ameliorer ainsi son approche du patient en soins palliatifs. Un questionnaire utilise, a la fois, comme guide en entrevues de groupe, en entrevues individuelles face a face et en auto-administration a permis de recueillir des donnees sur la perception que des soignants avaient de leur relation avec un malade en fin de vie. Differents cadres theoriques ont guide l'analyse des donnees, la discussion des resultats et, de facon generale, l'orientation de la conduite de l'etude. Cette etude montre que les participants jugent importantes dans leur pratique en soins palliatifs les valeurs suivantes : le respect, la compassion, l'ecoute, l'ethique, la competence et l'authenticite. Pour certains d'entre eux, la compassion est consideree comme etant plus qu'une valeur, elle est une dimension essentielle dans la relation soignant-patient. De plus, les participants ont avoue etre quotidiennement confrontes a une grande souffrance. Ils ont dit vivre des conflits et des dilemmes lorsque les valeurs des uns ne correspondaient pas a celles des autres. Cet etat de fait les a obliges a une reflexion et a un engagement, et les a invites a entreprendre une demarche personnelle afin de reussir a gerer ce genre de problemes. Aussi, les organisations de sante devraient-elles encourager une culture ethique chez les soignants et leur fournir les moyens de creer des espaces de dialogue qui permettraient la progression vers une humanisation des soins par le respect des diverses valeurs en jeu. Enfin, des connaissances techniques, un savoir-faire, un savoir-etre et un travail en interdisciplinarite conditionneraient leur competence, leur efficacite, leur equilibre et leur constance.

A brain needle biopsy procedure is performed for suspected brain lesions in order to sample tissue that is subsequently analysed using standard histopathology techniques. A common complication resulting from this procedure is brain hemorrhaging from blood vessels clipped off during tissue extraction. Interstitial optical tomography (iOT) has recently been introduced by our group as a mean to assess the presence of blood vessels in the vicinity of the needle. The clinical need to improve safety requires the detection of blood vessels within 2 mm from the outer surface of the needle, since this distance is representative of the volume of tissue that is aspirated durirng tissue extraction. Here, a sensitivity analysis is presented to establish the intrinsic detection limits of iOT based on simulations and experiments using brain tissue phantoms. It is demonstrated that absorbers can be detected with diameters >300 μm located up to >2 mm from the biopsy needle core for bulk optical properties consistent with brain tissue.

The extraction of tissue samples during brain needle biopsy can cause life-threatening hemorrhage because of significant blood vessel injury during the procedure. Vessel rupture can have significant consequences for patient health, ranging from transient neurological deficits to death. Here, we present a sub-diffuse optical tomography technique that can be integrated into neurosurgical workflow to detect the presence of blood vessels. A proof-of-concept study performed on a realistic brain tissue phantom is presented and demonstrates that interstitial optical tomography (iOT) can detect several 1 mm diameter high-contrast absorbing objects located