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La prise en charge de la grossesse chez les adolescentes par les sages-femmes
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 prise en charge des grossesses adolescentes par les sages-femmes représente un enjeu majeur de santé publique. Cette étude vise à explorer les perceptions et pratiques des sages-femmes face à cette population vulnérable.Méthode : une étude qualitative a été menée à travers des entretiens semi-directifs auprès de 9 sages-femmes exerçant en Protection Maternelle et Infantile (PMI) et en libéral. L’analyse des données s’est faite selon une approche thématique.Résultats : les adolescentes enceintes rencontrent de nombreuses difficultés, notamment un isolement social, des pressions familiales et des obstacles à l’accès aux soins. Les sages-femmes adoptent des approches adaptées, mettant l’accent sur une relation de confiance, un suivi médical personnalisé et un accompagnement psychosocial renforcé. Cependant, elles soulignent un manque de protocoles spécifiques et une coordination insuffisante entre les différents acteurs.Discussion : la prise en charge des adolescentes enceintes nécessite une approche holistique intégrant un suivi médical, un soutien psychologique et un accompagnement social. Un renforcement des formations des sages-femmes et l’amélioration des protocoles existants sont recommandés.Conclusion : l’implication des sages-femmes est essentielle pour garantir un accompagnement optimal des adolescentes enceintes. Une meilleure coordination interprofessionnelle et des ressources adaptées permettraient d’améliorer leur suivi et leur bien-être
Systematic review and network meta-analysis comparing the efficacy of conventional therapy and biologics to prevent endoscopic postoperative recurrence in patients with Crohn’s disease
No full textInternational audienceAs no direct comparison is available between drugs to prevent endoscopic postoperative recurrence (POR) in Crohn’s disease (CD), hierarchizing these therapeutic options remains challenging. Objectives: We aimed to compare the effectiveness of treatments to prevent CD endoscopic POR. Design: Systematic review and network meta-analysis using a random-effects model. Data sources and methods: We include studies comparing treatments to prevent CD POR according to PRISMA guidelines. The primary endpoint was endoscopic POR (Rutgeerts score ⩾i2). Surface under the cumulative ranking (SUCRA) was used to hierarchize the treatments. Results: Twenty studies were included (2414 patients). Overall heterogeneity was moderate (τ = 0.34). Ustekinumab (odds ratio (OR) = 0.23 (0.07–0.70); OR = 0.29 (0.08–0.99)), vedolizumab (OR = 0.17 (0.05–0.59); OR = 0.22 (0.06–0.85)), infliximab (OR = 0.18 (0.36–0.88); OR = 0.23 (0.09–0.54)), and adalimumab (OR = 0.17 (0.07–0.42); OR = 0.22 (0.08–0.59)) were more effective to prevent endoscopic POR than placebo or 5-ASA, respectively, contrary to thiopurines (OR = 0.52 (0.22–1.24); OR = 0.66 (0.25–1.76)). Adalimumab (OR = 0.33 (0.15–0.74)) and infliximab (OR = 0.34 (0.13–0.87)) were more effective than thiopurines. While no difference was observed between the four biologics, adalimumab (SUCRA = 0.81), infliximab (SUCRA = 0.80), vedolizumab (SUCRA = 0.79), and ustekinumab (SUCRA = 0.72) had the highest likelihood of being the most effective drug, contrary to thiopurines (SUCRA = 0.41), 5-ASA (SUCRA = 0.24), or placebo (SUCRA = 0.16). Conclusion: This network meta-analysis confirms the efficacy of anti-TNF agents, vedolizumab, and ustekinumab in preventing endoscopic CD POR without any difference between them. When a prophylactic therapy is needed, biologics should be preferred to 5-ASA or thiopurines. Trial registration: PROSPERO registration number CRD42024555528
Evolution and factors associated with presenteeism in severe asthma after treatment with biologics
No full textInternational audienceBackgroundWork productivity is impaired in severe asthma; however, its evolution under biologics is poorly known, particularly regarding presenteeism, fact of being present at work while ill.ObjectiveTo investigate the evolution and factors associated with presenteeism in severe asthma after treatment with biologics.MethodsWe conducted a national, multicentric, uncontrolled cohort study. Patients with severe asthma eligible for a biologic and having a professional activity were included. Patients were assessed at baseline and after six months of treatment. Outcomes (percentages of presenteeism, absenteeism and work productivity loss) were measured using the Work Productivity and Activity Impairment (WPAI):Asthma questionnaire.ResultsA total of 167 patients were included and 122 were analyzed (59.8% women, mean age at 45.7 years). At inclusion, median presenteeism was at 30%. Under biologic, we observed a significant decrease in mean presenteeism (-14.9%, p<0.001) and work productivity loss (-15.4%, p<0.001) but no difference in absenteeism (-1.8%, p=0.41). In the multivariate logistic model, high presenteeism (WPAI:Asthma-Q5 ≥4) at inclusion was associated with uncontrolled asthma (ACQ-6 ≥1.5) (OR=18.9 [2.7; 403]) and hyperventilation symptoms (Nijmegen >17) (OR=4.6 [1.3; 19.8]). In the multivariate linear regression model, we found an association between presenteeism evolution, ACQ-6 score at inclusion (Beta=15.9 [8.6; 23.2], per 1-point increase) and ACQ-6 score evolution (Beta=17.1 [9.9; 24.2], per 1-point increase).ConclusionAlthough limited by the lack of a control group, our results suggest that biologics can reduce presenteeism and work impairment in severe asthma, and that asthma control is the main factor associated with presenteeism
Prediction of Late Ventricular Arrhythmias in Patients with Left Ventricular Assist Device: Insights from the VT-LVAD Consortium
No full textInternational audienceNo abstract availabl
What is the optimal approach to analyse ventilator-free days? A simulation study
No full textInternational audienceBackgroundVentilator-free days (VFDs) are a composite outcome in critical care research, reflecting both survival and mechanical ventilation duration. However, analysis methods for VFDs are inconsistent, with some focusing on counts and others on time-to-event outcomes, while other approaches such as the multistate model and the win ratio have emerged. We aimed to evaluate various statistical models through simulations to identify the optimal approach for analysing VFDs.Methods First, 16 datasets of 300 individuals were simulated, comparing a control group to an intervention with varying survival rates and ventilation durations. Various statistical models were evaluated for statistical power and Type I error rate. Four clinical trial datasets (LIVE study, NCT02149589; ARMA study, NCT00000579; ACURASYS study, NCT00299650; COVIDICUS study, NCT04344730) were then used to apply the same statistical models to analyse VFDs. Twelve statistical methods were evaluated, including count-based, time-to-event approaches, and the win-ratio. Additionally, sensitivity analyses were conducted. ResultsMost statistical methods effectively controlled Type I error rate, except for the zero-inflated and hurdle Poisson/negative binomial count submodels, as well as the cause-specific Cox regression model for death. The power to detect survival benefit and ventilation duration effects varied, with time-to-event approaches, the Mann-Whitney test, the proportional odds model and the win ratio generally performing best. Similar results were observed in sensitivity analyses. In the real datasets, the multistate model, the Mann-Whitney test, the proportional odds model and the win ratio generally showed a significant association between VFDs and randomisation groups. ConclusionsThe multistate model could be recommended as the optimal approach for analysing VFDs, as it outperformed the other methods and offers a more interpretable effect size than the proportional odds model and the win ratio.</div
Smartphone-related pain and discomfort in hand osteoarthritis, rheumatoid arthritis, and psoriatic arthritis: results from the monocentric cross-sectional PHONERIC study
No full textInternational audienc
Sperm Telomere Interactions Are Impaired in Testicular Cancer Before and After Adjuvant Therapy
No full textInternational audienceABSTRACT Background No study has yet explored telomere length or interaction in sperm nuclei of testicular cancer (TC) patients exposed to chemotherapy or radiotherapy. However, sperm telomere dynamics have emerged as a potential marker in male infertility. Objectives We aimed to investigate in a pilot and exploratory study whether TC and its adjuvant treatments alter sperm telomeres and DNA integrity during a 2‐year follow‐up after treatment. Materials and methods This ancillary study is part of the multicentric prospective and longitudinal French GAMATOX study. Twenty‐nine TC patients treated with orchiectomy and either adjuvant chemotherapy ( n = 14) or radiotherapy ( n = 15) were included, alongside ten fertile donors. Semen samples were collected before orchiectomy and adjuvant therapy, and at 3, 6, 12, and 24 months after treatment. Sperm telomere length (STL) and telomere interactions were assessed by quantitative fluorescent in situ hybridisation (FISH). Sperm DNA fragmentation (SDF) was measured using the TUNEL assay, aneuploidy by FISH, and chromatin condensation defects by aniline blue staining. Results Before adjuvant therapy, patients presented a higher number of sperm telomere signals compared with controls ( p = 0.004), persisting 2 years after treatment ( p = 0.001). STL was not affected by tumour histology. Extremely short telomeres and the highest number of telomere signals per nucleus were more frequently observed after chemotherapy. SDF and chromatin condensation defects were transient and paralleled the recovery of conventional semen parameters, regardless of treatment type. A moderate increase in sperm aneuploidy was observed 6 months after chemotherapy ( p = 0.03). Conclusion TC patients presented impaired sperm telomere interactions before and after adjuvant therapy, as reflected by a persistently elevated number of telomere signals per nucleus, and a higher prevalence of extremely short sperm telomeres, especially after chemotherapy. While relative STL remained comparable to controls, these findings raise questions about the impact of telomere architecture on germ cell tumour biology and post‐treatment fertility
The Arrival of Exome Sequencing in French Prenatal Diagnosis: An Exploratory Qualitative Study Among Professionals in Prenatal Diagnosis Centers: Prenatome-SHS
No full textInternational audienceOBJECTIVE: Following the first French multicenter pilot study (AnDDI-Prenatome) focused on the implementation of prenatal exome sequencing (pES), this ancillary study aims to explore the ethical and clinical issues raised by pES within multidisciplinary prenatal diagnosis centers. METHODS: 33 healthcare professionals involved in the management of couples undergoing prenatal diagnosis (PND) took part in focus groups (2 with clinical geneticists, 3 with professionals from multidisciplinary prenatal diagnosis centers (MPDC), 1 with biologists). Each focus group was analyzed using the thematic analysis method. RESULTS: Professionals emphasized the importance of having a clear understanding of pES and the criteria for its prescription. Geneticists highlighted the need for a framework to clarify the implications of consent for patients and stressed the importance of offering structured support to assist couples in their decision-making process. Biologists and geneticists expressed a desire for effective multidisciplinary coordination of the care pathway, particularly in situations where the results were uncertain. CONCLUSION: These results will help to establish French recommendations for the prescription of pES
Epidemiology of pain, delirium, psychiatric disorders, discomfort and sedation-analgesia management in the intensive care unit: a one-day nationwide study
No full textInternational audienceBackgroundThe administration of sedatives and analgesics in intensive care units (ICUs) has evolved significantly over the past 20 years, shifting from deep to light sedation strategies to minimize adverse effects. Despite this shift, substantial variability persists in sedation-analgesia practices. This study aimed to provide an updated national overview of sedation-analgesia management with a focus on discomfort assessment practices, including pain, delirium, anxiety, thirst, mood, and sleep disorders.MethodsThis was a one-day, multicenter, cross-sectional study conducted in French ICUs. Data were collected from all adult patients hospitalized in the ICU on the study day. A Unit-level survey documented ICU characteristics and sedation-analgesia protocols. Patient-level data included sedation levels, pain scores, and assessments of discomfort conditions. Statistical analyses were performed using descriptive methods and multilevel logistic regression.ResultsAmong 258 French ICUs contacted, 128 units (50%) participated, enrolling 2,063 patients. Most ICUs were university-affiliated (54%) and mixed medical-surgical (58%); 63% had a written protocol for sedation-analgesia. Sedation and pain were assessed in 96% and 91% of ICUs, respectively. Light or no sedation was observed in 84% of patients, while 15% were deeply sedated – 63% of whom were misaligned with usual indications. Pain assessment was performed at rest in 90% of patients and during care in 62%. Pain prevalence increased with lighter sedation levels and during care. Hypnotics were used in 31% of patients, Mainly propofol and midazolam. Discomfort was reported in 44% of patients, mainly anxiety, sleep disorders, and thirst. Written protocols for sedation and analgesia were not associated with sedation depth, drug use, or delirium screening, but were linked to more frequent pain assessment at rest. Multivariable analyses showed that higher SOFA scores were associated with deep or misaligned deep sedation. The presence of a written protocol for sedation and analgesia reduced the risk of unassessed pain but was not associated with deep or misaligned deep sedation.ConclusionThe shift toward lighter sedation has been successfully achieved; however, a broad spectrum of stressful symptoms persists, including pain, anxiety, thirst, and sleep disruption. These findings underscore the need for more effective strategies to optimize pain and overall patient comfort in non-deeply sedated ICU patients