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Effect of the score predicting imminent delivery on the management of unexpected out-of-hospital obstetrical deliveries: a cluster randomized clinical trial
No full textInternational audienceBackground and importance Early identification of imminent deliveries is crucial for guiding the decision to dispatch emergency medical team to the prehospital setting. Objective To study whether the use of the score predicting imminent delivery (SPID) at the emergency call center reduces the risk of prehospital delivery occurring without the presence of a physician-staffed mobile ICU team. Design, setting, and participants Prospective multicenter cluster randomized controlled trial in 19 call centers in France. Calls from pregnant woman in labor with at least 33 weeks of amenorrhea were eligible. The emergency call center responses included medical advice, transport to the hospital by personal means or ambulance, or dispatch of the mobile ICU team. Intervention In the intervention group, the use of the SPID was mandatory to guide decision-making. Outcomes measures and analysis The primary outcome was the rate of prehospital deliveries occurring without the initial dispatch of a mobile ICU team. The secondary endpoints included the prehospital deliveries rate without the presence of a mobile ICU team on site, call duration, satisfaction score, and maternal and neonatal mortality. Main results A total of 7782 pregnant women were included in the intention-to-treat analysis (3773 control and 4009 intervention), including 523 (7.0%) prehospital deliveries (6.3% intervention and 7.6% control) and a 22.3% rate of mobile ICU dispatch decision (20.8% intervention group and 23.8% control). Prehospital delivery without initial dispatch of a mobile ICU was less frequent in the intervention group compared to control: 0.95 vs. 2.01% [odds ratio (OR) 0.46; 95% confidence interval (CI), 0.31–0.70]. There was also a lower rate of prehospital delivery without the presence of a mobile ICU team on site in the intervention group: 1.92 vs. 3.34% (OR = 0.58; 95% CI, 0.42–0.82). There was no significant difference in the other secondary endpoints. Conclusion In this multicenter randomized controlled trial, the systematic use of the SPID was associated with a reduction of prehospital deliveries occurring without the presence of a mobile ICU team
Severe Parvovirus B19 Infection in Patients with Sickle Cell Disease Hospitalized in Intensive Care Unit
No full textInternational audienceParvovirus B19 infection can lead to severe complications in patients with chronic haemolysis. The aim of this study was to describe severe Parvovirus B19 infections in adult patients with sickle cell disease (SCD). In this multicentre, retrospective, observational cohort study, adult patients with SCD admitted to intensive care units (ICUs) between 2011 and 2024 with acute Parvovirus B19 infection were included. Unsupervised analysis was performed including clinical and biological characteristics to identify clusters of patients with different outcomes. Clinical phenotypes were defined based on patient clustering. Parvovirus B19 genomes from ICU (n=15) and non-ICU control patients (n=15) admitted to the hospital during the same period were sequenced and compared. Sixty-one patients (52% female, median age: 29 years [IQR: 24;38]) from eight ICUs in France were included. Three clusters of patients were identified. From these clusters, three groups of patients with distinct clinical phenotype were identified: erythroblastopenia (n=26), bone marrow necrosis (BMN) and fat cerebral embolism syndrome (CFE) (n=17), and other vaso-occlusive manifestations (n=18). Length of stay in the ICU and hospital was longer in patients with BMN/CFE. There was no difference in Parvovirus B19 genotype or NS1 or VP1/2 amino-acid diversity between the groups. Similar results were observed between patients who were admitted to the ICU and those who were not. ICU patients with SCD and acute Parvovirus B19 infection presented three clinical phenotypes associated with different initial severity and outcome, but with similar Parvovirus B19 clades and amino-acid diversity
Evaluation of the anti-C-C chemokine receptor type 4 monoclonal antibody mogamulizumab in patients with advanced cutaneous T-cell lymphomas and with large cell transformation
No full textInternational audienceWe aimed to compare the response to mogamulizumab in cutaneous T-cell lymphomas between patients with tumour status and/or large cell transformation and those without, and to investigate treatment effectiveness, depending on expression levels of C-C chemokine receptor type 4 (CCR4). We found that response to mogamulizumab at 8 weeks (primary endpoint) was significantly higher in patients without tumour status and/or large cell transformation. Conversely, no significant difference was found regarding CCR4 expression levels between mogamulizumab responders and nonresponders
Characteristics and outcomes of ICU patients with sepsis transmitted by cats and dogs: the PETSEPSIS multicentre retrospective observational cohort study
No full textInternational audienceBackgroundMillions of households have cats or dogs as pets, and infections due to bites or scratches are increasing, with the most common pathogens being Pasteurella spp., Bartonella spp., Capnocytophaga spp, and Francisella tularensis. The objective of this study was to describe patients admitted to the intensive care unit (ICU) for infection transmitted by cats or dogs, as well as their outcomes.MethodsThe retrospective multicentre observational cohort study PETSEPSIS included consecutive adults admitted to 46 ICUs in France between 2009 and 2019 for sepsis due to cat or dog bites and/or caused by any of the four above-listed bacteria. We described their features and outcomes and performed univariate and multivariate analyses to identify factors associated with death.ResultsWe included 174 patients with a median age of 64 [50–74] years; 58.1% were male. The median SAPS II score was 42 [28–58]. Mechanical ventilation was required in 51.2% of patients, for a median duration of 7 [4–13] days. Vasopressor support was used in 53.5%, renal replacement therapy in 19%, and limb amputation in 3.6% of the patients. The median ICU length of stay was 7 [4–16] days. Hospital mortality was 24.1%. The clinical presentation and severity of sepsis were similar across bacteria, although patients with Pasteurella spp. were older and had more comorbidities. Contact with cats were more often reported for Pasteurella spp. and Bartonella spp. infections and contact with dogs for Capnocytophaga spp. infections. Risk factors for hospital mortality present on ICU admission were older age, smoking, preexisting liver disease, high serum creatinine, and anaemia. Neither the type of micro-organism nor the initial antimicrobial treatment was associated with mortality.ConclusionsThis large multicentre study shows that infections transmitted by cats and dogs are infrequent reasons for ICU admission but are associated with substantial morbidity and mortality. Mortality was associated with older age and comorbidities but not with the type of microorganism or initial antibiotic treatment
Soft skills in dental student curricula: an evidence and gap map
No full textInternational audienceBackground Soft skills are recognised as essential for dental practitioners, but their integration into dental education is inconsistent. The aim of this evidence and gap map was to explore the use of soft skills teaching initiatives in undergraduate dental education and to clarify the key domains in this research field. Methods An extensive search of studies from 2014 to 2024 on the PubMed database was carried out by four researchers. Inclusion criteria covered articles, including both advocacy or position papers, and studies reporting on implemented and evaluated educational interventions in soft skills in undergraduate dental education. The search is aligned with Joanna Briggs Institute and PRISMA-ScR guidelines and based on predefined coding frameworks from the literature. ResultsFrom the 1,449 records initially identified, 317 were included after rigorous examination. There were generally more educational programme description or evaluation papers compared to advocacy articles. More than two-thirds of the included articles were published in pedagogy-focused journals. The papers were classified into four domains (i.e. dentist-patient relationship, cooperation, life balance and clinical reasoning), with most studies falling into the dentist-patient relationship and cooperation domains. Various graphic formats present the results (i.e. a visual map, radar charts, and a geographical map), which provides a comprehensive and accessible representation, thus aiding in the exploration of the identified themes, connections, and key domains in this research field.Conclusions This evidence and gap map represents an attempt to capture a picture of existing educational practises relating to soft skills in dentistry teaching and, thus, raise broader questions regarding how soft skills should contribute to redefining the role of dentistry for dentists, patients and society. However, integrating soft skills comes with various challenges, such as the training of educators, the standardisation of content and evaluations, and the development of research evaluating the impacts of soft skills teaching on dentists and patients. Ultimately, it would be beneficial to engage patients in defining the various curriculum items and prioritising the most relevant ones concerning soft skills. This collaborative approach would ensure that the educational content aligns with the needs of patients and helps address larger public health challenges.</div
Automatic Generation of 3D Cellular Geometries by Deep Learning for Monte Carlo Simulations
No full textIndustry Day LABEX PRIME
Severe Paediatric Asthma Collaborative in Europe: real-world data on children on biologics
No full textInternational audienceIntroduction Real-world data on children with severe asthma is scarce. We report characteristics of children with severe asthma already on biologics, enrolled in the Severe Paediatric Asthma Collaborative in Europe, a clinical research collaboration of the European Respiratory Society. Methods We describe patient's characteristics including asthma control assessed with Global Initiative for Asthma (GINA) criteria, composite asthma severity index (CASI), exacerbations, unscheduled medical attendances, lung function and quality of life in children on biologic treatment because of severe asthma. We also assessed previous biologics use. Forced expiratory volume in 1 s, CASI, GINA, Paediatric Asthma Quality of Life Questionnaire score, exacerbations, unscheduled medical attendance and hospital admission comparisons in patients treated with different biologics were adjusted by age, sex and biologic therapy duration. Results Among the 250 children (median age 13.2 years) recruited, 56.8% used omalizumab, 21.6% mepolizumab and 21.6% dupilumab. At enrolment, the dupilumab group was older (median 15.0 years), while the omalizumab group had been on biologic treatment the longest (median 622 days). Overall, 27% and 8% had partly controlled and uncontrolled asthma respectively, according to GINA. In the last 12 months, 52% and 29% had at least one and two exacerbations, respectively; airflow obstruction was found in 33%. 10% were admitted to hospital due to exacerbation. A previous switch from another biologic was recorded in 16%, predominantly due to nonresponse. Conclusions Most children on biologics obtained good symptom control, but many still experienced asthma attacks. Switching between biologics was substantial. There is still an unmet need in severe paediatric asthma
Transmission et pérennisation des échanges patients-pairs aidants : impact des savoirs expérienciels sur la pratique
No full textNational audienceLe dispositif PEPS (Partenariat et expérience patient en santé) des Hospices Civils de Lyon (HCL) valorise l’intégration de l’expérience des patients dans la prise en charge médicale, grâce au rôle des patients-partenaires ou pair-aidants. Cependant, des enjeux persistent concernant la transmission des savoirs issus des échanges entre patients-partenaires et patients, leur pérennisation et leur valorisation. L’absence d’évaluation approfondie de l’impact des pair-aidants sur les équipes soignantes et sur la conservation des savoirs partagés soulève plusieurs questions : que reste-t-il des échanges après le passage des patients ou le départ des pair-aidants ? Comment ces savoirs peuvent-ils être transmis de manière efficace, notamment aux professionnels de santé ? Ce projet explore ces aspects en s’appuyant sur des travaux sur le transfert des savoirs expérientiels [1] et la transmission d’expériences entre pairs [2]. Cette étude adoptera une approche qualitative en combinant des entretiens semi-directifs avec des patients-partenaires et blessés médullaires (n ≈ 15-20), l’analyse de supports de communication (écrits, SMS) et des observations lors des interactions. Les données seront analysées via une méthode thématique inductive pour identifier les mécanismes de transmission et leurs implications. Les résultats devraient mettre en évidence les thématiques clés liées à la transmission des échanges et des savoirs expérientiels, ainsi que les stratégies pour les conserver et les pérenniser. Ils permettront également d’évaluer leur impact sur les pratiques des professionnels de santé et sur la collaboration pluridisciplinaire. Les conclusions fourniront des recommandations pour structurer et pérenniser ces savoirs, renforçant ainsi la prise en charge médicale et favorisant une collaboration enrichie et durable
Pourquoi une Société française du TDAH ?
No full textInternational audienceThis document provides an overview of the establishment, objectives, and early activities of the first professional ADHD society in France, the “Société française du TDAH (SF-TDAH)”. The SF-TDAH aims to improve coordination among professionals involved in ADHD treatment and care throughout all ages. There are still significant issues in France for people with ADHD and families, including difficult access to care, a lack of trained healthcare professionals, and long waiting times for diagnosis and treatment. Additionally, concerns were raised about the effectiveness of generic medications and the variability of access to psychoeducation, psychological treatments, and school accommodations. The situation was particularly dire for adults, with limited treatment options and no authorization for ADHD medications. Since then, the French National Authority for Health (HAS) has started developing recommendations for diagnosing and treating ADHD in children and adolescents, expected to be published in 2024. A working group for adult ADHD recommendations will follow. In 2023, the national health authorities formed a group of experts and patient representatives to address ADHD-related issues, including prevalence, care pathways, professional training, and treatment access. The creation of the SF-TDAH is an output of this group with the objective to form a collective of professionals to promote best practices, collaboration, and research. The society's members include recognized professionals in child and adult ADHD from clinical and research backgrounds and representatives from scientific societies, public organizations, and ADHD associations. The SF-TDAH aims to: • Improve care quality through evidence-based and personalized medicine for ADHD and comorbidities. • Disseminate scientifically supported information to healthcare professionals and those involved in ADHD diagnosis and treatment. • Engage in initial and ongoing training for healthcare professionals across various sectors. • Combat stigma and exclusion through scientifically supported information. • Promote interdisciplinary scientific research on ADHD. • Collaborate with national and international scientific societies and research organizations. • Advocate for healthcare system improvements to enhance care accessibility and coordination. • Ensure better recognition and reimbursement for ADHD care in the healthcare system. SF-TDAH plans to achieve its objectives through: • Organizing training sessions, public meetings, conferences, and congresses for healthcare professionals and the public. • Publishing in various media, both print and electronic. • Engaging with the public, healthcare professionals, and authorities to advocate for ADHD-related issues. • Developing a national network of healthcare professionals, psychologists, and patient experts. • Participating in national and international professional associations and user organizations. • Maintaining an informative website for ADHD-affected individuals and their families. The SF-TDAH has contributed to the development of a charter for ADHD resource centers, which aims to enhance regional professional networks and skills. It also produced a report on methylphenidate generics, addressing concerns about supply disruptions and proposing solutions to ensure medication availability. The SF-TDAH has participated in several ADHD-related events and organized its own, including a scientific day in Lyon and a conference with the Société Médico-Psychologique. Internationally, SF-TDAH has been active in events such as the World Congress of Child and Adolescent Psychiatry organized by ICAPAP. The SF-TDAH supports research by responding to calls for proposals from national research institutions. The SF-TDAH aims to continue collaborating with ADHD associations and public authorities to enhance care and research networks. Establishing ADHD resource centres and developing a network of professionals is crucial for achieving these goals. The society seeks to increase its visibility and influence to better advocate for ADHD-affected individuals at national and international levels.Cet article décrit le contexte de la création de la Société française du TDAH (SF-TDAH), une association pour les professionnels intéressés et impliqués dans le parcours de soin des personnes concernées par ce trouble. Ses objectifs sont multiples mais ont comme ligne directrice essentielle la diffusion des connaissances et pratiques basées sur des données probantes. Nous reviendrons ici sur les missions que se donne la SF-TDAH et sur ses premiers travaux. Ceux-ci ont débuté par la collaboration avec les pouvoirs publics dans le cadre de la stratégie nationale en faveur des troubles du neurodéveloppement et sur des points d’actualité comme l’accessibilité des traitements et la communication scientifique. Les chantiers sont nombreux et nous souhaitons que la SF-TDAH y apportera une contribution dynamique et efficace