Vous êtes sur la page 1sur 14

PHAR 505 - Abilities Lab I (1.

5 credits) Fall 2012


Course Managers:
Katie Kiser, Pharm.D. , BCPS kkiser@rx.umaryland.edu Amy Ives, Pharm.D. aives@rx.umaryland.edu Assistant Professor 410-706-5821 Assistant Professor 301-738-6394 Pharmacy Hall S446 301-395-1824 (cell) SG Campus, I-107

Office Hours
Course faculty do not have specific office hours, therefore appointments may be scheduled through each individual faculty via email or phone. Maximum Enrollment: N/A Minimum Enrollment: N/A Eligible Class Standing: Year 1 Pathway: None Dual Degree Program: N/A Supported Campuses: Baltimore/Shady Grove

Prerequisite Courses: None Catalog Course Description:


The abilities lab is a series of courses that occur during the fall and spring terms during years one through three of the curriculum. The purpose of the abilities lab is to assist student pharmacists in achieving proficiency in professional abilities, through the integration of knowledge, skills, behaviors, and values in order to function as an independent pharmacy practitioner in a variety of health care environments. The sequence requires the integration of didactic and experiential content across the first three years of the curriculum.

Expanded Course Description:


This course is designed to assist student pharmacist in developing and achieving proficiency in professional abilities. Most of the course outcomes are designed to be ability outcomes, which include elements that require the integration of knowledge, skills, and attitudes. Students will achieve these outcomes in a variety of ways:

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Knowledge will be obtained through pre-lab readings and self-paced learning activities, attending lab sessions, participating in lab activities, and completing assignments; Skills will be practiced through pre-lab preparation and participation in lab activities and assessments; and Attitudes will be addressed and practiced in lab activities, discussions, assessments, and reflection.

Course Outcomes:
1. Given the name of up to 50 nonprescription and prescription medications that are used to treat infectious disorders or ailments related to the disorders, recall information regarding brand/generic name, therapeutic class, common indication(s), absolute contraindication(s), usual dosing, and major side effects. 2. Given a set of medical terms/abbreviations, correctly identify or define the terms/abbreviations. 3. Given a set of abbreviations, identify those that appear on The Joint Commissions Official Do Not Use List and recommend an appropriate alternative abbreviation or terminology. 4. Given a problem, correctly perform pharmaceutical calculations. 5. Given a set of written or verbal prescription/drug orders in a simulated community or inpatient setting, correctly transcribe (if applicable), interpret, process, fill, label, and verify the orders. 6. Given a question and access to resources, answer drug information queries accurately using appropriate resource(s). 7. Given a simulated or standardized patient encounter, practice environment, drug name, and access to drug information resources, provide patient counseling for drugs covered to date in the Abilities Lab Sequence. 8. Given a simulated or standardized patient encounter, collect a medication history, family history, social history, and patient demographics and record findings in a standardized manner. 9. Given physical examination equipment, accurately measure and document vital signs (including blood pressure, heart rate, respiratory rate, pain level, and smoking status). 10. Given patient specific information and data, correctly categorize that information and data as subjective, objective, an assessment, or a plan. 11. Given the expectations outlined in the course syllabus, demonstrate acceptable qualities and characteristics of professional behavior, including maintenance of professional competence.

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Terminal Performance Outcomes (TPO) 1: Participate in the development of patient-specific therapeutic plans 1.1 Compile and evaluate patient-specific information 2: Select the appropriate dosage form, formulation, route of drug administration, and/or drug delivery system 3: Provide drug products to patients 3.1 Oversee a drug delivery system that provides drug products to patients in a timely, safe, and efficient manner 3.2 Ensure the security, integrity, and proper storage of drug products 4: Use technology effectively to carry out professional functions 4.1 Use technologies to safely and efficiently prepare and deliver drug products to patients 4.2 Use technologies to store and retrieve information 4.3 Use technologies to perform patient monitoring activities 5: Prepare medications for patient use 5.1 Ensure that drug products are labeled appropriately 5.2 Employ professional practice standards to compound the most commonly prescribed drug products in acute (e.g. IV admixtures, total parenteral nutrition) and chronic care (e.g. oral suspensions, topical preparations) settings 6: Educate patients regarding patient-specific therapeutic plans 6.1 Communicate with patients and caregivers to assure they understand the importance, nature, and scope of the therapeutic plan(s) being recommended 6.2 Communicate with patients and caregivers to inform them about the potential benefits and risks of the therapeutic plan(s) being recommended 6.3 Determine if patients and caregivers are able to appropriately use (including administration techniques) the drug regimen included in their therapeutic plan(s) 7: Administer drug products to patients 8: Perform basic life support measures and triage patients 8.2 Recognize situations which are beyond ones own scope of practice or professional competence 8.3 Refer patients to other health care professionals or institutions for advanced levels of care 9: Maximize appropriate drug use behaviors 9.1 Determine the extent to patients adhere with their therapeutic plan(s) including recommended drug regimens 9.2 Determine whether patients engage in and use appropriate techniques to perform self-monitoring activities as part of their therapeutic plan(s) 9.3 Identify the root cause(s) that prevent patients from engaging in optimal drug use behaviors 9.4 Influence patients to improve adherence to recommended lifestyle behaviors, drug regimens, and selfmonitoring 10 10.1.3 Evaluate the actual or potential impact of drug-drug and drug-food interactions on patient outcomes 10.2 Collaborate in the patient monitoring process via 10.2.1 Interviewing patients to determine if the therapeutic objectives are being achieved or if the patient is experiencing an adverse drug effect
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

10.2.2 Performing targeted physical examinations (e.g. vital signs, visual inspection) to determine if the therapeutic objectives are being achieved or if the patient is experiencing an adverse drug effect 10.2.3 Record patient-specific monitoring data in an organized manner using appropriate medical terminology 11: Answer patient-specific questions via 11.1 Identify appropriate sources of information and evaluate primary literature to synthesize answers to patient-specific questions 11.2 Communicate information to physicians, other prescribers, patients, and caregivers in a timely and effective manner 12: Identify payment sources and mechanisms for professional services and products via 12.1 Use electronic payment systems effectively to receive payment for professional services and products 12.2 Identify codes that describe the most common professional services provided by pharmacists 14: Participate in health education via 14.1 Respond to general drug information requests from patients, health professionals, and lay media 14.2 Prepare and deliver educational programs to lay audiences regarding health promotion and appropriate drug use 14.3 Prepare and deliver educational programs to health professionals regarding drug therapy 16: Maintain professional competence via 16.1 Identify and analyze emerging issues, products, and services related to drug therapy and health 16.2 Carry out responsibilities in accordance with legal, ethical, social, economic, and professional norms 16.3 Demonstrate self-awareness, identify self-learning needs, and engage in a process of continual professional development

Required Textbooks/Readings:
Medical Terminology: A Short Course, 5th Edition, Davi-Ellen Chabner, Elseveir, 2008 ISBN-10: 1-4160-5518-1 / ISBN-13: 978-1-4160-5518-1 Pharmaceutical Calculations, 13th Edition, Howard Ansel, Lippincott Williams & Wilkins, 2009 ISBN-10: 158255837X / ISBN-13: 9781582558370

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Online Resources:
http://blackboard.umaryland.edu This link will lead you to the course website. All information regarding the course, assignments, grades and weekly handouts can be found here. http://www.pharmacy.umaryland.edu This link will lead you to the main website for the The University of Maryland Baltimore School of Pharmacy. Information regarding upcoming events, course schedules (CelCat), directories and registration information can be found here. http://www.hshsl.umaryland.edu This link will lead you to The University of Maryland Baltimore library website. Access to online databases, journals and electronic books can be found here.

Required Equipment:
Calculator: basic, non-programmable (NO cell phones, Blackberries, iPhones, or TI-82) see calculator policy below Stethoscope (must have a diaphragm and a bell and must be separate from the blood pressure cuff) Blood pressure cuff (adult size) University of Maryland issued lab coat (required to be worn during lab after White Coat Ceremony) University of Maryland name badge Laptop computer with wireless access Watch with a second hand

School Calculator Policy:


Student Responsibilities: 1) Students are expected to bring a simple, non-programmable calculator to all in-class exams and other assessments. The calculator must have exponential, log, and power functions, but not be able to save equations or text. The school does not generally provide calculators for use during exams and quizzes. 2) If a student is in any doubt about the acceptability of the calculator they plan to use, it should be shown to the proctor as they enter the exam. All calculators are subject to inspection by proctors at any time during an exam. Proctors may grant exceptions to this requirement only when use of a more sophisticated calculator has been approved in advance of the exam by the course manager. 3) Any text or non-factory preprogrammed equations discovered on or used by a student during an exam will constitute grounds for an academic misconduct hearing. The student may also receive zero or reduced credit on the exam at the discretion of the course manager.
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

Students are strongly advised to purchase and have available during exams and quizzes one of the following recommended calculators: TI 30 Xa (battery powered) TI 36 Xa (solar powered)

Victor 930-2 (solar powered)

HP 10s (solar powered)

Proctor Responsibilities: Proctors may determine student compliance by inspecting calculators at any time before, during or after an exam. Proctors may grant exceptions to the requirement of non-programmable calculators only when use of a more sophisticated calculator has been approved in advance of the exam by the course manager. If a proctor identifies a student using a non-approved calculator, the calculator will be collected for inspection and the student will receive a zero on the quiz for ABL I.

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Course Website:
http://blackboard.umaryland.edu Students are expected to routinely access the course website and their umaryland.edu email account to view course announcements, obtain lab materials and assignments, complete pre-lab assignments, access grades, and to initiate and/or respond to any and all communication and correspondence.

Course Delivery:
Pre-lab sessions and materials will be provided via Blackboard in the format of online lectures, readings, assignments, and tutorials. It is the responsibility of the student to review all pre-lab materials, including self-paced study and assignments, and come to lab prepared for all scheduled activities and assessments. Laboratory and assessment activities will be conducted live on both the Baltimore and Shady Grove campuses respectively and will utilize the practice labs, classrooms, and exam room spaces. The course is designed to include weekly sessions comprised of either 3-hour workshops, to involve all course participants, or 3-hour lab sessions, with 6 groups per lab session. Attendance at all sessions is mandatory. Lab sessions will be assigned by group (groups will be comprised of 10 students each). The organization of the lab into groups will provide each student the opportunity to gain from the shared experiences and knowledge of others and to improve interpersonal and communication skills through small group discussion, interaction, activities, and presentations. Each lab session will be comprised of three abilities-based activities and assessments (as appropriate). There will be required calculation sessions to review calculations content throughout the semester and before an assessment on that content. Weekly lab quizzes will be taken by all students simultaneously at both campuses. There will be a midterm practical, a one-station teaching objective structured clinical exam (TOSCE), a final practical, and a final written exam.

Activities and Assessments:


Various active learning activities will be incorporated in this course to provide ample opportunities for students to acquire knowledge, practice the skills, and model attitudes needed to master the courses ability outcomes. Performance criteria will be provided during the semester for each activity and assessment. There will be both formative assessments (for educational, improvement purposes) such as weekly activities, sessions, and TOSCE and summative assessments (for grading purposes) such as weekly quizzes, midpoint and final practicum, and a final written exam. Self-paced Study: There are four areas of self-paced study in Abilities Lab I which include pharmaceutical calculations, medical abbreviations (including the official Do Not Use List), medical terminology, and drug knowledge. The details of the self-paced study are included at the end of this syllabus and will be available on Blackboard. There will be six required pharmaceutical calculations review sessions throughout the semester to review calculations content before each quiz assessment. Students who would like assistance with other self-paced material are encouraged to contact a course manager. It is expected that students will otherwise review these materials outside of their scheduled lab session and come to lab each week prepared for the scheduled weekly quiz on these areas. These areas will also be assessed on a written final exam.

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

1. Pre-lab Preparation: Each lab week there are materials which may include readings, online presentations, tutorials, or assignments that are expected to be reviewed and completed prior to lab. Weekly quizzes and the final written exam will also assess concepts from pre-lab materials. 2. Workshops: The workshops will assist in the development of the knowledge and competency in all course outcomes. The sessions will be utilized to introduce and review concepts that will be practiced and assessed throughout laboratory activities. 3. Laboratory Activities: The activities during lab will assist in the development of competency in all course outcomes. Some examples of activities include community and hospital medication dispensing (including intravenous dosage forms), measuring vitals signs, collecting a medication, family, and social history, patient counseling on medications and/or devices, answering drug information questions, and medical documentation. These activities will be assessed both formatively and summatively throughout the course during lab sessions and during a midterm practical, a final practical, a written final, and TOSCE. 4. Midterm Practical: Community dispensing, hospital intravenous admixture, and patient counseling will be assessed on this practical. There will be at least four scheduled lab activities to review and practice these abilities before the midterm practical. This assessment is considered high stakes, which is defined for this assessment as filling one out of two community prescriptions correctly AND filling one out of two intravenous admixtures correctly. The patient counseling portion of this assessment is NOT a high stakes component. Please see Grading section for further explanation of high stakes. 5. Final Written Exam: The final written exam will assess knowledge retention of self-paced study (pharmaceutical calculations, medical abbreviations, medical terminology, and drug knowledge), pre-lab preparation, and lab activity materials. Three areas of the final written exam are high stakes, which is defined for this assessment as achieving at least an 80% on the pharmaceutical calculations, medical abbreviations (including the official Do Not Use list), AND medical terminology sections. 6. Final Practical: The ability to accurately measuring vital signs will be assessed on this practical. There will be at least three scheduled course activities to review and practice this ability before the final practical. None of the components of the final practical are high stakes. 7. TOSCE (Teaching Objective Structured Clinical Exam): Students will interact with a standardized patient (an actor who is trained to portray a specific patient or health care provider) in a simulated clinical environment. Any type of clinical skill learned to date, such as patient counseling or medication history collection, could be practiced during the TOSCE. Students will have 10 minutes to complete the encounter and then an additional 5 minutes with the standardized patient to receive formative feedback about their performance. Students will also write a reflective piece about the experience. 8. Curriculum Vitae (CV): Throughout the Abilities Lab Sequence and entire Pharm.D. curriculum you will be expected to maintain a curriculum vitae (CV). Please see CV orientation documents located on the courses Blackboard site for more information. 9. Professionalism and Participation: Refer to the Attendance and Other Course Policies sections of this syllabus for criteria that will assess appropriate professionalism and participation. An assessment of these criteria will be completed each week of lab. If it is assessed that a student does not meet the
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

professionalism and participation criteria for a given activity within any given week, five points will be deducted for each infraction from the total professionalism and participation points. A letter grade for the course will be earned based on the following activities and assessments: Weekly Quizzes (25 points per quiz x 8) 200 Midterm Practical (50 points per section [community, IV, patient counseling]) 150 1 Station TOSCE 50 TOSCE Video and Reflection 50 Written Final Exam 150 Final Practical 50 Drug Information Homework Sets (20 points each) 40 Calculations Homework Sets (10 points each) 60 Curriculum Vitae 50 Professionalism & Participation see Professionalism Section 200 _____________________________________________________________________________ Total Possible Points: 1000 points

Grading:
Many of the courses assessments and assignments are graded by teaching assistants and mistakes may occasionally occur. If a student feels a grade is incorrect or deserves reconsideration, he/she may request via email for any assignment be reviewed or re-graded by the course manager within seven days of the grade being posted to Blackboard. Requests for re-grading made after this seven day timeframe will not be honored. There will be components of assessments that will be considered high stakes. All high stakes assessment components must be completed successfully (as predefined for each assessment) or the student will not pass the course, regardless of the overall number of course points achieved. If a student does not pass a high-stakes assessment component, one remediation attempt will be offered during the semester; students who pass remediation will then be assigned the course grade that corresponds to their total points achieved. Students who fail the remediation attempt will receive a failing grade in the course and will be required to attend an academic hearing with the Student Affairs Committee as per school academic policies. Summary of possible infractions: Students with unexcused absences to any required lab activity will be penalized with loss of 20 professionalism points. If three professionalism infractions occur in the semester, the students final letter grade in the course will be lowered by one grade. If four professionalism infractions occur in the semester, the students final letter grade in the course will be lowered by two letter grades. If five professionalism infractions occur in the semester, the student will fail the course. If a student fails four out of five high stakes components during their first attempt, the students final letter grade in the course will be lowered by one grade.

Letter grades will be assigned based on cumulative course performance as follows: A: 899.5-1000 B: 799.5-899.4
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

C: 699.5-799.4 F: 699.4

Course Schedule:
The Abilities Lab I course schedule can be found at the end of the syllabus and on: Abilities Lab I Blackboard site: (Under My Courses select Fall 2012 PHAR 505 - Abilities Lab I) http://blackboard.umaryland.edu University of Maryland School of Pharmacy Web site (Celcat): (select under Fall 2012: PHAR 505) https://rxsecure.umaryland.edu/apps/schedules/list/courses.cfm It is the students responsibility to check the course schedule for posted changes during the semester.

Inclement Weather/Emergency Closures:


Students should refer to this courses Blackboard site, Course Information page, for school policies. Students will be notified of rescheduled activities/examinations impacted by their respective campus closures.

Attendance:
Attendance is expected for all course activities. For each activity, attendance will be tracked by student roll call. Students who are late will have 5 points deducted from their total professionalism points. Students who have an unexcused absence will have 20 points deducted from their total professionalism points and lose any associated assessments points for that lab day as previously described. Students who show up after the beginning of a required activity (including examinations) or who leave before the end of a required activity are considered absent unless the absence is excused by the course master. All absences must be excused and pre-approved by the respective campus course manager. It is the students responsibility to arrange to switch lab sessions with another student for an excused and pre-approved absence. In the case of a true emergency which prevents the prior notification of the respective campus course manager (e.g. car accident), it will be at the course managers discretion if the absence is excused and documentation of the absence may be required. Of note, work, vacation, and personal leave are not considered acceptable reasons for an absence. Students who think they may arrive late for unforeseen circumstances must immediately contact the respective campus course manager and leave a message on their cell phone if no answer. It is at the course managers discretion if the late arrival will be excused or unexcused. Please refer to this courses Blackboard site, Course Information page, for school policies on attendance. Please refer to the Exam Admittance section for activity and assessment specific policies.

Other Course Policies:


Course Questions: All questions concerning materials, activities, assessments, etc should be directed toward both course managers. Dress Policy:
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

As consistent with the expectations of the practice environment, professional dress and attention to personal hygiene are mandatory. Personal grooming and attire are expected such that they do not compromise the professional integrity of the School of Pharmacy nor the profession of pharmacy. If a student presents to lab unprofessionally dressed, it will result in loss of all related assessment and professionalism and participation points for that lab session. The following is considered appropriate attire: ALL: once the White Coat Ceremony has taken place, students are to wear their clean, pressed, waist-length, long-sleeved lab coat provided by the School of Pharmacy with their University of Maryland name badge. Men: Slacks, collared shirt with tie or sweaters, socks, closed-toe shoes, and modest, professionally appropriate jewelry. Women: Slacks, skirts or dresses (no more than 1 inch above the knee), blouses or sweaters, closed-toe shoes and modest, professionally appropriate jewelry.

Please note: Flip-flops, sandals, Crocs, open-toed shoes, sneakers, Uggs, baseball caps, cargo pants, jeans, colored jeans, yoga pants, leggings, t-shirts, mini-skirts, low-cut blouses, sweaters with hoods are NOT permissible attire. Laboratory Rules: The use of cell phones and pagers during laboratory activities is unacceptable. The use of laptop computers is limited to the completion of laboratory activities. Surfing the web or checking email during laboratory activities is unacceptable. Food and beverage in the laboratory is prohibited

Assessment/Examination Policies: Professional dress is required for all laboratory activities, including practicals and the TOSCE. Professional dress is not required for orientation, workshops, open labs for extra practice, quizzes or the final written exam. No hats, hooded sweatshirts, programmable calculators, cell phones, or PDAs allowed during examinations or assessments. Challenges for exam questions or practical components must be filled out during the exam or practical. The course manager will review, decide on the outcome, and correspond with the student via email with the final decision on the challenge. Due dates for assignments are included in the course schedule in Celcat. Assignments that are turned in late, without prior approval of the course manager, with receive a five point deduction for each day late. An automatic zero will be given if the assignment is not handed in as of 5PM on Friday of the given week the assignment is due. All written assignments and assessments must be written in a professional manner. All submissions should contain appropriate use of grammar and punctuation and contain no spelling errors. Failure to meet this standard will result in an automatic zero for the assignment as determined by the grading rubric for that assignment.

Exam Admittance:
Abilities Lab I: PHAR 505 Last Updated: 8.7.12

Weekly Quizzes: Unexcused tardiness for weekly lab quizzes will result in an automatic zero. Midpoint and Final Practical: An unexcused tardiness for a practical will result in an automatic zero for the practical and loss of all professionalism points (20 points) for that day, however the student will be allowed to participate in that assessment for formative feedback AND to demonstrate minimal competence in high stakes components as applicable. Written Final Exam: If more than 15 minutes late OR someone has already finished the Written Final Exam and left the examination room, the student will NOT be allowed to take the exam and an automatic zero will be assigned. TOSCE: If late to the TOSCE orientation, but prior to the actual start of the exam, the student will lose all professionalism points (20 points) for the day. Students who arrive after the actual start of the exam and/or who no-show to the exam will receive zero points for the activity. These students will still be required to complete the experience and will be rescheduled by OSCE faculty as able.

Exam Return: Students will be allowed to review their exams and practical assessments within 1 week of notification of posting of grades on Blackboard. Students will not be allowed to keep or take notes from the exam or assessment. The student must contact the course manager to discuss any questions or concerns about exam items. No answer key will be provided.

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Possession of Prior Examinations: It is a breach of the honor code to view or possess prior examinations or reconstructed examinations or to participate in an attempt to reconstruct an examination. Make-up Exams: Make-up exams will be at the discretion of the course manager. Homework/Exam/Assessment Collaboration: There will be no collaboration on homework, exams or formal assessments unless otherwise specified in the syllabus or assessment description. Professionalism: Professional behavior and attitudes are expected for all students enrolled in the Doctor of Pharmacy program at the University of Maryland School of Pharmacy. Professionalism will be evaluated throughout the curriculum, including didactic courses, laboratory sessions and experiential rotations. Throughout the Abilities Lab Sequence, professionalism will be evaluated using the Tenets of Professionalism for Pharmacy Students as described by the American College of Clinical Pharmacy (Pharmacotherapy 2009;29(6):757-759): Altruism: Make an unselfish commitment to serve the best interests of the patient about your own. Includes attendance and participation in all course related activities. Honesty and Integrity: Display honesty and integrity in all that you do, including protection ofpatient and peer confidentiality. Respect for Others: Treat others as you would want to be treated. Be willing to solicit constructive feedback. Professional Presence: Instill trust through professional presence, including maintaining professional attire and appearance. Professional Stewardship: Actively participate and engage in the profession of pharmacy. Dedication and Commitment to Excellence: Strive for excellence and assume responsibility for your learning and professional development.

(* For complete definitions of these attributes, please refer to the Professionalism Policy on Blackboard) Academic Integrity: Please refer to this courses Blackboard site, Course Information page, for school policies on the Student Honor Code and Guidelines for policies on cheating, plagiarism, facilitating academic dishonesty, abuse of academic materials, stealing, and lying.

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Recording: TOSCE encounters will be digitally recorded with video access only available to the student and course faculty. No live in lab activities or assessments will be recorded unless otherwise specified by the course managers. Class preparation: All lab materials will be posted to Blackboard for review. Students will be expected to review pre-lab materials and sessions, complete assignments, and be prepared for quizzes and other assessments that will be conducted throughout course activities. ADA Accommodations: Students who have been approved to receive ADA accommodations by the university and wish to receive accommodation should make arrangements with course managers, if possible, at least 2 business days before an exam or activity. Other assessment criteria in which students have approved ADA accommodations are at the discretion of the course managers. Further information about ADA accommodations and student procedures for seeking accommodations is available on the schools Student Affairs web site at: http://www2.pharmacy.umaryland.edu/administration/studentaffairs/ada/

Abilities Lab I: PHAR 505

Last Updated: 8.7.12

Vous aimerez peut-être aussi