Jacinthe Leclerc

Université Laval / Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval · Pharmacy

Background An adverse event (AE) is any undesirable medical manifestation in an individual who has received pharmacological treatment. To be considered serious (SAE), it needs to meet minimally one of the severity criteria by Health Canada. The most recent data (2006) suggested that AEs were underreported (<6%) to health authorities. In Canada, sin...

Background Polypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems. Objective Characterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge. Design and setting Mul...

Background Following a diagnosis of diabetes, specialist physicians may be solicited regarding the prevention of major cardiovascular events (MACE) (stroke, myocardial infarction, cardiovascular death). Patients with established coronary heart disease (CHD) are more susceptible to MACE and may require distinct attention. However, trajectories of vi...

Background: After a diagnosis of diabetes, specialist physicians may play a key role in the secondary prevention of major cardiovascular events (MACE). Yet, trajectories of visits to specialists are heterogenous and their efficacy in the prevention of MACE remains unexplored. Goal: To assess whether trajectories of visits to specialists are associa...

Objetivou-se mapear as externalidades provocadas pelas recentes epidemias de dengue nas contas da Prefeitura Municipal de Ribeirão Preto e estimar os custos parciais relacionados a doença sob a perspectiva do SUS. Trata-se de um estudo retrospectivo, com análise dos custos relacionados a epidemias de dengue por meio dos componentes: recursos humano...

Background While significant gains were made in the management of heart failure (HF), most patients are still diagnosed when they are acutely ill in hospital, often with advanced disease. Earlier diagnosis in the community could lead to improved outcomes. Whether a partnership and an educational program for primary care providers (PCP) increase HF...

Background In metabolic syndrome (MetS), cardiovascular disease (CVD) risk reduction relies on the complementary use of diet and lipid-lowering medication. Evidence suggests that initiating such medication may impede diet quality. The objective of this study was to evaluate the relationship between diet quality and statin use among adults with MetS...

Background In real-world settings, whether diet and medication are used as complements for glycemic management in type 2 diabetes (T2D) remains unclear. This study assessed the relationship between diet quality and intensity of glucose-lowering medication among adults with T2D. Methods This cross-sectional study included 352 adults with T2D from t...

Schizophrenia, a serious psychiatric disorder, is among the top 10 global causes of disability and affects nearly 1% of the world population. Antipsychotics constitute the best treatment for patients with schizophrenia, however, this treatment class carries a high risk of metabolic syndrome, including lipid abnormalities. Indeed, the risk of metabo...

Background: The core motive of pharmacovigilance is the detection and prevention of adverse drug reactions (ADRs), to improve the risk-benefit balance of the drug. However, the causality assessment of ADRs remains a major challenge among clinicians, and none of the available tools of causality assessment used for assessing ADRs have been universal...

In cardiovascular disease (CVD) prevention, whether antihypertensive and lipid-lowering medications are used as complements to heart-healthy diets has not been thoroughly assessed. This scoping review aimed to 1- synthesize observational studies that assessed the relationship between diet and antihypertensive/lipid-lowering medication use, and 2- e...

Complementary and alternative medicines (CAM) are commonly used across the world by diverse populations and ethnicities but remain largely unregulated. Although many CAM agents are purported to be efficacious and safe by the public, clinical evidence supporting the use of CAM in heart failure remains limited and controversial. Furthermore, health c...

Background Given the importance in prevention of lower extremity amputations (LEA) associated with diabetes or peripheral artery disease (PAD), we sought to document the trends of primary LEA in Quebec, Canada, from years 2006 to 2019. Methods Using the Quebec Integrated Chronic Disease Surveillance System, we calculated crude and age-standardized...

Introduction The use of weapons of mass destruction against civilian populations is of serious concern to public health authorities. Chemical weapons are of particular concern. A few studies have investigated medical responses in prehospital settings in the immediate aftermath of a chemical attack, and they were limited by the paucity of clinical d...

Introduction The progression of complications of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent growth modeling approaches (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in a priori non-observed...

Background In heart failure, specific target doses for each drug are recommended, but some patients receive suboptimal dosing, others are undertreated or remain chronically in a titration phase, despite having no apparent contraindication or intolerance. We assessed the association of different levels of adherence to guidelines with outcomes in pat...

Contexte Les amputations des membres inférieurs (ADMI) représentent une complication du diabète et/ou de la maladie artérielle périphérique (MAP) pouvant être prévenues. En raison des changements de pratique et démographiques au Québec et des changements observés dans l'incidence des ADMI dans d'autres provinces canadiennes, notre objectif était de...

Introduction Antidepressant drugs are the most frequently prescribed medication for mental disorders. They are also used off-label and for non-psychiatric indications. Prescriptions of antidepressants have increased in the last decades, but no systematic review exists on the extent of their use in the community. Methods and analysis We will conduc...

Introduction The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure...

Introduction: The progression of type 2 diabetes (T2D) is unique to each patient and can be depicted through individual temporal trajectories. Latent group trajectory methods (latent growth mixture models [LGMM] or latent class growth analysis [LCGA]) can be used to classify similar individual trajectories in a priori non-observed groups (latent gr...

Introduction: Non-traumatic lower limb amputations (LLA) represent an important complication of diabetes (DM) and peripheral arterial disease (PAD). In Quebec, Canada, the latest data between 1996 to 2004 suggested a reduction in the incidence of LLA while other Canadian provinces observed a recent increase between 2010 and 2016. Our objective was...

Background Antidepressant drugs are the most frequently prescribed medication for mental disorders. They are also used off-label and for non-psychiatric indications. Prescriptions of antidepressants have increased in the last decades, but no systematic review exists on the extent of their use in the community. Methods and analysis We will conduct...

Background Cost studies appear sporadically in the scientific literature and are rarely revised unless drastic technological advancements occur. However, health technologies and medical guidelines evolve over time. It is unclear if these changes render obsolete prior estimates. We examined this issue in a cost study in the context of patients’ firs...

Objetivou-se delinear o protocolo da realização da revisão sistemática que terá o objetivo de avaliar o impacto da pandemia COVID-19 nas notificações de eventos adversos a medicamentos às autoridades sanitárias em todo o mundo. Trata-se de um protocolo de revisão sistemática consistente com as normativas e checklist PRISMA 2020, será conduzido de a...

Background: Patients with chronic or acute/postoperative pain frequently use opioids. However, opioids may cause considerable adverse reactions (ARs), such as respiratory depression, which could be lethal. Unfortunately, only 5% of drug-related ARs (including those to opioids) are reported to health authorities. Therefore, little is known regarding...

Introduction: In the last decade, an increase in the prevalence and a reduction in the incidence of diabetes have been observed in many countries including Canada. Yet, some Canadian provinces depicted an elevation in incidence rates among younger age groups. Our objective was to document these trends in the province of Quebec from fiscal years 200...

Background: Exaggerated blood pressure response to exercise is a cardiovascular risk factor associated to higher morbidity and mortality. Severely obese patients have an increased risk of exercise-induced hypertension (EIH). We aimed to assess the blood pressure response to exercise in patients with severe obesity who underwent bariatric surgery a...

Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de p...

IntroductionPost-marketing studies involve the detection and interpretation of potential problems associated with the use of a given drug. Post-marketing spontaneous pharmacovigilance systems, such as the Canada Vigilance program, may constitute a gold mine of free data for drug safety research. However, the quantity and the quality of data remain...

Background It is unclear whether generics are as safe as brand-name drugs in cardiology. For public health surveillance purposes, we evaluated if switching from the brand-name losartan, valsartan, or candesartan impacted the occurrence of the following outcomes: emergency room (ER) consultations, hospitalizations, or death.Study DesignThis was a re...

Background Previous systematic reviews (2008; 2016) concluded similarity in outcomes between brand-name and generic drugs in cardiology, but they included ≥ 50% comparative bioavailability studies, not designed or powered to detect a difference in efficacy or safety between drug types. We aimed to summarise best-evidence regarding the effectiveness...

Background: Generic drugs constitute lower cost alternatives when the original drug patent expires. Two large systematic reviews and meta-analyses (2008; 2016) concluded to similarity in outcomes between brand-name and generic drugs in cardiology. These meta-analyses were possibly biased by the inclusion of ≥ 50% comparative bioavailability studies...

Background Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, however the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training prog...

Background: The prevalence of mood disorders was estimated at 5.4% according to the latest Canadian survey. It has been suggested to use administrative data and self-reported data to optimize the estimation for mental health care in the population. Using administrative data, algorithms (combination of codes from the International Classification of...

Full-text here: https://rdcu.be/bA3UL Background: Clopidogrel has been widely used to prevent atherothrombotic events. Since 2011, pharmacists offer their patients the opportunity to switch to generic clopidogrel, an economical alternative. Whether bioequivalence of generic cardiovascular drugs translates into clinical equivalence at a population...

To assess a potential nocebo effect of generic substitution by comparing adverse events in patients switched to pseudogenerics or continuing brand-name valsartan in the population. Circulation (Vol 138, Suppl 1): https://www.ahajournals.org/doi/10.1161/circ.138.suppl_1.10772

We found some differences in time to adverse event between patients who switched to generics compared to those who remained on the brand-name. This uncertainty regarding generic substitution merits in-depth clinical investigation to delineate causality. Circulation (Vol 138, Suppl 1): https://www.ahajournals.org/doi/10.1161/circ.138.suppl_1.10777

Background: Blood pressure measurement in severe obesity may be technically challenging as the cuff of the device may not fit adequately around the upper arm. The aim of the study was to assess the agreement between intra-arterial blood pressure values (gold standard) compared with forearm blood pressure measurements in severely obese patients in...

Parenthood is always demanding, but dealing with children during postgraduate training is a special kind of challenge. Is it really feasible to combine responsible parenting with academic success while you are a postgraduate trainee? In this short paper, we speak to trainees who have to manage this reality.

A comprehensive review of direct oral anticoagulants.

L’infirmière administre des médicaments par voie intraveineuse (IV) périphérique au quotidien : « NaCl 0,9 % à 100 mL/h », « D5 % 1/2S à 80 mL/h », « culot globulaire de 100 à 140 mL/h en moins de 4 heures », « TVO », « Bolus », etc. À chaque patient, son ordonnance et à chaque ordonnance, sa vitesse de perfusion! Cette dernière se définit comme le...

La dysfonction diastolique ventriculaire gauche (DDVG) représente l’anomalie cardiaque la plus fréquente. Cet article porte sur les principes de base de la diastologie, les déterminants et les caractéristiques de la DDVG, de même que sur les moyens diagnostiques et les traitements en prévention primaire.

L’Institut national de santé publique du Québec (INSPQ) effectue la surveillance des maladies chroniques de l’ensemble des Québécoises et Québécois dans le cadre d’un mandat ministériel de surveillance octroyé par le ministère de la Santé et des Services sociaux (MSSS). Cette surveillance s’effectue grâce aux fichiers médico-administratifs jumelés...

Background: Even with many direct oral anticoagulant options, brand-name or generic warfarin is still widely used to prevent atherothrombotic events in cardiology. Federal standards regulate bioequivalence of generic vs. brand-name drugs through comparative bioavailability studies but does not regulate clinical equivalence nor tolerability in a “re...

Deux médicaments visant à soutenir la perte pondérale sont approuvés au Canada : l'orlistat (Xenical MD) et le liraglutide (Saxenda MD). Cet article propose un tour d'horizon des indications, des effets indésirables et des mises en garde de ces deux molécules pharmacologiques indiquées dans le traitement de l'obésité.

Background—Once the patent of a brand-name drug expires, generic drugs are commercialized, and substitution from brand-name to generics may occur. Generic drug equivalence is evaluated through comparative bioavailability studies. Few studies have assessed outcomes after generic drug commercialization at a population level. We evaluated the impact o...

Les nausées et vomissements de la grossesse (NVG) peuvent entraîner des conséquences importantes sur la qualité de vie des futures mères, et parfois nuire à leur santé. Lors du suivi prénatal, ou de tout autre contact avec la femme enceinte, comment l’infirmière peut-elle aider sa patiente touchée par ces symptômes et quels sont les éléments de sur...

Background: Substitution from brand-name to generic drugs is one way to reduce costs of pharmacological treatments. Generic drugs licensing is obtained through comparative bioavailability studies for which a variation of up to 20% is generally accepted. However, “real-life” efficacy and tolerance of generic drugs are not studied prior to commercial...

Background: Clopidogrel is widely used to prevent atherothrombotic events. Federal standards regulate bioequivalence of generic and brand-name drugs through comparative bioavailability studies but does not regulate clinical equivalence nor tolerability in “real-life” settings. We evaluated the impact of the generic clopidogrel commercialization on...

Background: Substitution from brand-name to generic drugs is one way to reduce costs of pharmacological treatments. Generic drugs licensing is obtained through comparative bioavailability studies for which a variation of up to 20% is generally accepted. However, “real-life” efficacy and tolerance of generic drugs are not studied prior to commercial...

Introduction: Once patent of a brand-name drug expires, generic drugs are commercialized and substitution may occur. Few studies have assessed clinical impacts of generic drugs commercialization at a population level. Objective: We evaluated the impact for three generic versions of antihypertensive drugs on adverse events: hospitalizations and emer...

Quelles sont les différences entre médicaments originaux et médicaments génériques. Qu'en est-il de leur biodisponibilité? Sont-ils vraiment bioéquivalents? Cet article contribue à améliorer la pharmacovigilance infirmière en comparant les processus d'homologation des médicaments originaux et génériques tout en expliquant les concepts de base de la...

Background: Abdominal obesity and presence of the metabolic syndrome (MetS) are associated with cardiac abnormalities. Among those, left ventricular diastolic dysfunction (LVDD) is the most frequently encountered in clinical practice. Few studies evaluated the reversibility of LVDD by an approach promoting lifestyle modifications in abdominally ob...

Abstract Weight loss is a popular topic and may be of serious concern for many patients. Even with the abundant literature on obesity and cardiometabolic risk, it is always challenging to demystify and reinforce the determinants of safe approaches to lose weight. Measures of central obesity are essential to characterize the patient's adiposity dist...