Changes in weight-bearing are partly associated with the frontal trunk position, and foot placement manipulations can be used to modify weight-bearing distribution. Inference on weight-bearing is possible by observing the trunk position during the sit-to-stand task in persons with hemiparesis.

In hemiparetic individuals, improving STS symmetry by positioning the affected foot behind the nonaffected one did not decrease medio-lateral stability, which was associated with the level of stroke-related motor impairments.

Contexte : Développer le raisonnement est une nécessité dans la formation des professionnels de la santé. La formation par concordance (FpC) est une approche pédagogique qui place les apprenants dans des situations authentiques. Les questions posées sont celles que se posent les professionnels dans leur pratique et les réponses sont comparées à celles qu’ont données les membres d’un panel de référence. But : Décrire les variables dont il est nécessaire de tenir compte pour concevoir une FpC. Méthodes : Ces variables sont au nombre de six : 1) les buts de l’activité pédagogique ; 2) la nature de la tâche ; 3) le contenu et le niveau de complexité ; 4) le panel de référence ; 5) les rétroactions ; 6) l’environnement numérique d’apprentissage. Résultats : Les exemples illustrés dans cet article permettent de constater la versatilité de cette approche pour mettre l’accent sur les divers éléments critiques au raisonnement de diverses professions. Conclusion : Les exemples présentés illustrent comment il est possible de mettre au point des outils de FpC qui se prêtent à l’amélioration à chaque itération. Il est désormais possible d’imaginer qu’un jour cette approche à la formation fera partie importante de toute formation professionnelle.

Introduction Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous drug eruptions characterized by epidermal detachment. Pembrolizumab is a monoclonal antibody that binds to the programmed death-1 receptor, and it has been associated with numerous cutaneous adverse side-effects, including Stevens-Johnson syndrome. Case report We describe a 63-year-old male with metastatic lung adenocarcinoma who developed a rapidly progressing maculopapular rash three days after a first dose of pembrolizumab. On day 16, the rash affected more than 80% of body surface area with detachment of large sheets of necrolytic epidermis in 30–40% of body surface area. However, the patient only presented with mild mucosal involvement. Histopathologic examination of a skin biopsy showed a subepidermal blister with overlying prominent full thickness epidermal keratinocytic necrosis and a superficial perivascular infiltrate of lymphocytes. A toxic epidermal necrolysis secondary to pembrolizumab was then diagnosed. Management and outcome: In addition to supportive cares, the patient received corticosteroids and cyclosporine. The patient responded rapidly to the immunosuppressant therapy, and nearly complete re-epithelialization was achieved 24 days after the start of the reaction. Discussion In our review of the literature, 15 other cases of Stevens-Johnson syndrome/toxic epidermal necrolysis were reported with programmed death-1/programmed cell death ligand-1 inhibitors. To our knowledge, this is the first case of toxic epidermal necrolysis secondary to pembrolizumab published in the literature. The American Society of Clinical Oncology guidelines suggest that cyclosporine, in addition to corticosteroids, be initiated when toxic epidermal necrolysis is suspected. Clinicians should be aware of this rare dermatological emergency with the increasing use of pembrolizumab in oncology.