HAL Portal Chu Clermont-Ferrand
Not a member yet
7589 research outputs found
Sort by
Évaluation périnatale des troubles mentaux paternels pendant la période prénatale
No full textNational audienc
Les motivations des étudiantes sages-femmes à intégrer la filière maïeutique : étude qualitative auprès d’étudiantes sages-femmes de deuxième année de la région Auvergne-Rhône-Alpes
No full textIntroduction: midwifery training is undergoing a period of transformation, marked by a decline in attractiveness and successive reforms, including the creation of the sixth year in 2023. Students’motivation is influenced by a variety of factors, including study conditions and career prospects, which partly explains the decline in enrolment. Understanding these dynamics is essential to adapt training and enhance the profession’s appeal, thereby ensuring its sustainable future.Method and population: this qualitative, descriptive and interpretative study was carried out with 6 students midwives in training in the Auvergne-Rhône-Alpes region interviewed during individual semi-directive interviews. The main objective was to explore the motivations and representatives of students in midwifery before entering training. Additionally, the study aimed to identify factors and barriers influencing entry into training and describe how motivation evolves after enrolling in the midwifery curriculum.Results: students expressed concerns about learning conditions and career opportunities, which significantly impact their motivation. These findings highlight the need to adapt training programs and improve recognition of the profession to attract and retain future midwives.Discussion: improvements are still needed in areas such as knowledge dissemination, communication, and pedagogical support for students.Conclusion: maintaining student motivation in midwifery relies on strengthened pedagogical and psychological support, along with providing accurate information about the realities of the profession. The implementation of reforms raises questions about its impact on the attractiveness and recognition of the profession, requiring a long-term evaluation.Introduction : la formation des sages-femmes traverse une période de transformation, marquée par une baisse d’attractivité et des réformes successives, dont la création de la sixième année en 2023. Les motivations des étudiants sont influencées par des facteurs variés, notamment les conditions d’études et les perspectives professionnelles. Comprendre ces dynamiques est essentiel pour adapter la formation et renforcer l’attractivité du métier, garantissant ainsi un avenir pérenne à la profession.Méthode et population : cette étude qualitative, descriptive et interprétative a été réalisée auprès de 6 étudiantes sages-femmes en formation dans la région Auvergne-Rhône-Alpes interrogées lors d’entretiens semi-directif individuels. L’objectif principal était d’explorer les motivations et les représentations des étudiant.e.s en maïeutique avant l’entrée en formation. Il s’agissait aussi de connaître les facteurs et les freins à l’entrée dans la formation et de décrire l’évolution de la motivation après l’entrée dans le cursus de maïeutique.Résultats : les étudiantes expriment des inquiétudes quant aux conditions d’apprentissage et aux débouchés professionnels, ce qui impacte leur motivation.Discussion : des améliorations restent à mettre en place sur les connaissances, la communication et l’accompagnement pédagogique des étudiants.Conclusion : le maintien de la motivation des étudiants en maïeutique repose sur un accompagnement pédagogique et psychologique renforcé, ainsi qu’une information sur la réalité du métier. La mise en place des réformes soulève des interrogations quant à son impact sur l’attractivité et la reconnaissance de la profession, nécessitant une évaluation à long terme
Patient satisfaction with radio-frequency identification (RFID) tag localization compared with wire localization for nonpalpable breast lesions: the RFID trial
No full textInternational audienceAbstract Background Most breast cancers are detected at an early stage in which case conservative surgery is indicated. An accurate preoperative localization technique is essential for conservative surgery of non-palpable breast lesions. Currently, the gold standard technique is wire localization (WL). However, this technique has well-known drawbacks. Several wire-free techniques have been developed to overcome these drawbacks; one technique is localisation by Radiofrequency Identification (RFID). The purpose of this clinical trial was to assess the superiority of RFID tags (HOLOGIC) in terms of patient satisfaction, over wire localization of non-palpable breast lesions. Methods This was a single-centre, prospective, controlled and non-interventional trial. Patients were followed from their inclusion at the time of the preoperative consultation to the postoperative consultation, one month after surgery. Data on anxiety and satisfaction was collected from patients and clinicians using questionnaires, and clinical data was collected from the medical files. The primary outcome was the patients’ satisfaction scores, assessed using a visual analogue scale. Results Eighty patients were sequentially enrolled in two groups: the wire group ( n = 40) and the RFID group ( n = 40). One patient from the RFID group was excluded from the analysis because of a substantial migration during deployment. On a 10-point Visual Analogue Scale, the patients’ median satisfaction score was 9.8 (IQR = 1.32) for the wire group and 10 (IQR = 0.07) for the RFID group ( p < 0.001). A reduction in pain between device insertion and surgery was observed in the RFID group ( p = 0.009). The median placement time was shorter in the RFID group (15 min, IQR = 6) than in the wire group (20 min, IQR = 30) ( p = 0.01). Conclusion Our results show a statistically significant difference in median patient satisfaction score with the localization of non-palpable breast cancer lesions using RFID tags compared to the use of the WL. Although our results did not show clinically significant outcomes in terms of satisfaction, RFID tags are a reliable alternative to WL and simplify the organization of patients’ healthcare trajectories. Trial registration ClinicalTrials.gov ID; NCT04750889 registered on February 11, 2021. https://clinicaltrials.gov/ct2/show/NCT04750889?term=rfid&draw=2&rank=
Effectiveness and Safety of a Second JAK Inhibitor in Ulcerative Colitis: The J2J Multicentre Study
No full textInternational audienceBackground While three Janus kinase inhibitors (JAKi) have demonstrated efficacy in ulcerative colitis (UC), scarce data exist regarding JAKi intraclass switching. Aim To evaluate the effectiveness and safety of a second JAK inhibitor in UC. Methods This was a multicentre, retrospective, observational cohort including patients with moderate to severe UC who received a second‐line of JAKi after failure or intolerance of a first. The primary outcome was steroid‐free clinical remission (SFCR) at Weeks 8–14, defined as a partial Mayo score of 2 or less with no individual sub‐score above 1. Results Among the 169 patients from 28 participating centres, 105 received upadacitinib, 54 filgotinib and 10 tofacitinib as a second‐line of JAKi. Overall, 81/169 achieved SFCR at Weeks 8–14: 58/105 with upadacitinib, 18/54 with filgotinib and 5/10 with tofacitinib ( p = 0.03). In the multivariate analysis, upadacitinib was independently associated with higher odds of SFCR than filgotinib (OR = 3.15, 95% CI [1.52–6.79]). With a median follow‐up duration of 96 days, drug persistence at 6 months was 72.8% with upadacitinib, 57.2% with filgotinib and 66.7% with tofacitinib ( p = 0.099). 24.3% of patients (41/169) experienced at least one adverse event leading to treatment withdrawal in 9 patients (5%). No cases of death, cancer, or major acute cardiovascular events were reported. Conclusion A second‐line of JAKi provided clinical remission in about half of patients after induction, and was well tolerated
Simultaneous Activation of Beta‐Oxidation and De Novo Lipogenesis in MASLD ‐ HCC : A New Paradigm
No full textInternational audienceBackground and Aims : Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common cause of hepatocellular carcinoma (HCC). In this study, we combine metabolomic and gene expression analysis to compare HCC tissues with non‐tumoural tissues (NTT). Methods : A non‐targeted metabolomic strategy LC–MS was applied to 52 pairs of human MASLD‐HCC and NTT separated into 2 groups according to fibrosis severity F0F1‐F2 versus F3F4. The expression of genes related to de Novo lipogenesis (DNL) and fatty acid oxidation (FAO) has been analysed by quantitative RT‐PCR and/or interrogation of RNA‐seq datasets in 259 pairs of tissues (MASLD‐HCC vs. VIRUS‐HCC). Results : Metabolomic analysis revealed that acylcarnitines were the main discriminating metabolites according to fibrosis severity when we compared MASLD‐HCC‐F0F1‐F2 versus NTT and MASLD‐HCC‐F3F4 versus NTT. Based on these metabolomic data, the analysis of a panel of 15 selected genes related to DNL and FAO indicated that there is no difference between the 2 groups of MASLD‐HCC. In contrast the same comparative gene analysis according to the aetiology of HCC: MASLD‐HCC versus VIRUS‐HCC showed that both aetiologies shared the same upregulation of genes involved in DNL. However, five genes involved in FAO (HADHA, CRAT, CPT1, CPT2 and PPARA) are upregulated exclusively in MASLD‐HCC. This result indicates that FAO and DNL pathways are simultaneously activated in MASLD‐HCC in contrast to VIRUS‐HCC. Conclusions : These results suggest that, the involvement of adaptive metabolic pathways is different depending on the aetiology of HCC. Moreover, the dogma that simultaneous activation of FAO and DNL is incompatible in cancer would not apply to MASLD‐HCC
Efficacy of different modalities of faecal microbiota transplantation in ulcerative colitis: systematic review and network meta-analysis
No full textInternational audienceWhile several small sample size randomized controlled trials suggested the superiority of faecal microbiota transplantation (FMT) over placebo in ulcerative colitis (UC), the most effective modality to perform FMT remains unknown. Objectives: To compare the efficacy of different modalities of FMT to induce clinical remission in patients with UC. Data sources and methods: We performed a systematic review and network analysis (sources: MEDLINE, Embase, Cochrane CENTRAL; random effects model) of randomized controlled trials including at least one arm of FMT in adult patients with active UC. The primary endpoint, that is, clinical remission (total Mayo score ⩽2 with Mayo endoscopic score ⩽1), was assessed between weeks 6 and 12. Results are expressed as relative risks with 95% confidence intervals, adjusted for bowel cleansing and pre-FMT antibiotics. Ranking of FMT modalities was calculated as their surface under the cumulative ranking (SUCRA). Results: Among the 12 selected studies, patients were exclusively bio-naïve in 4 studies (4/12), while between 9% and 32% had prior biologics exposure in the other trials. The risk of bias was low across all domains in seven studies. Contrary to upper gastrointestinal tract (GI) FMT (Relative risk (RR) = 1.1 (0.2–7.7)), oral capsule (RR = 7.1 (1.8–33.3)), lower GI FMT (RR = 4.5 (1.7–12.5) and combination of both (RR = 12.5 (2.1–100)) are more effective than placebo to induce clinical remission. The combination of lower GI FMT and oral capsule was significantly more effective than upper GI FMT to induce clinical remission (RR = 10.7 (1.1–104.2)). Combination of lower GI FMT and oral capsule ranked the highest for the induction of clinical remission (SUCRA = 0.93). Multidonor FMT did not perform better than single donor FMT. Autologous FMT ranked lower than placebo (SUCRA = 0.12 vs 0.22). Conclusion: The combination of lower GI and oral capsule FMT seems to be the best modality of FMT for patients with UC. In clinical trials, autologous FMT should be avoided due to a potential detrimental effect. Trial registration: PROSPERO registration number: CRD42023385511
Acute metabolic responses to high‐intensity interval training in men with overweight or obesity: Does the exercise modality matter?
No full textInternational audienceThis study investigated the acute effects of two isoenergetic high-intensity interval exercise (HIIE) sessions, running (HIIE-RUN) and cycling (HIIE-BIKE), on post-exercise oxygen consumption ( VO 2 ), carbon dioxide production ( VCO 2 ), substrate oxidation and 24-h energy intake (EI) in men with overweight or obesity. Twelve fasted men (44.4 ± 14.5 years; body mass index: 28.3 ± 1.9 kg m -2 ) completed both HIIE sessions. VO 2 and VCO 2 were measured before, during and after exercise, while substrate oxidation was calculated before and after exercise. The rate of perceived exertion was recorded during each exercise. Appetite was assessed throughout each session using a visual analogue scale (VAS) and EI was recorded via a 24-h dietary questionnaire.Both exercise modalities resulted in similar energy expenditure (EE), but HIIE-BIKE elicited a significantly higher respiratory exchange ratio (P = 0.002). No significant effect of exercise modality or time × modality interaction was observed for VO 2 and EE during the post-exercise period. Fat oxidation was significantly increased during recovery compared with the pre-exercise levels (P < 0.001), but did not differ between modalities. Appetite and 24-h EI were unaffected by the exercise modality. In men with overweight or obesity, isoenergetic HIIE-RUN and HIIE-BIKE seem to induce comparable post-exercise VO 2 , EE and substrate oxidation during the 2-h recovery period. Both modalities similarly promoted fat oxidation without specific dietary compensation observed
Ruxolitinib stopped before transplantation does not induce cytokine release in myelofibrosis
No full textInternational audienceMyelofibrosis (MF) is a myeloproliferative neoplasm characterized by marrow fibrosis, splenomegaly, constitutional symptoms and cytopenia with a proinflammatory and profibrotic cytokine phenotype involving the JAK-STAT pathway. Ruxolitinib is a JAK 1/2 inhibitor with proven efficacy on splenomegaly and constitutional symptoms, but it does not reverse fibrosis or the risk of leukemic transformation. While hematopoietic stem cell transplantation remains the only curative approach, it is still associated with a relatively high non-relapse mortality (NRM) rate, partly due to GVHD. The potential role of ruxolitinib or its withdrawal on NRM remains to be elucidated, and inflammatory cytokines might be implicated. In this report, we compared cytokine profiles in patients with myelofibrosis not treated with ruxolitinib (n = 18) or who received ruxolitinib and stopped it at conditioning regimen initiation (n = 53), at three different time points. At baseline, MF patients without ruxolitinib had increased inflammatory cytokine levels (CD25, REG3A, IL18 and ST2) as compared to MF patients on ruxolitinib. On day 0 and week 1 post-transplantation, levels of these cytokines were similar with and without ruxolitinib. On the other hand, cytokine levels at baseline did not predict grades 2-4 acute GVHD or hyperacute GVHD. These findings suggest that baseline cytokine profile in MF patients does not impact the risk of GVHD. Stopping ruxolitinib just before conditioning regimen may not influence GVHD risk more than in MF patients who have not received ruxolitinib. The potential benefit of a later ruxolitinib discontinuation on D0 or after transplantation ruxolitinib requires further investigation
