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Home treatment for patients with cancer-associated venous thromboembolism
No full textInternational audiencePatients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients’ quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home
Tofacitinib for patients with anti-TNF refractory ulcerative proctitis: a multicenter cohort study from the GETAID
No full textInternational audienceBackground - Although ulcerative proctitis [UP] can dramatically impair quality of life, treatment efficacy has been poorly investigated in UP as it was historically excluded from phase 2/3 randomised controlled trials in ulcerative colitis. Our aim was to assess the effectiveness and safety of tofacitinib for the treatment of UP. Methods - We conducted a retrospective, multicentre study in 17 GETAID centres, including consecutive patients with UP treated with tofacitinib. The primary endpoint was steroid-free remission between Week 8 and Week 14, defined as a partial Mayo score of 2 [and no individual subscore above 1]. Secondary outcomes included clinical response and steroid-free remission after induction and at 1 year. Results - All the 35 enrolled patients previously received anti-tumour necrosis factor [TNF] therapy and 88.6% were exposed to at least two lines of biologics. At baseline, the median partial Mayo score was 7 (intequartile range [IQR] [5.5-7]). After induction [W8-W14], 42.9% and 60.0% of patients achieved steroid-free remission and clinical response, respectively. At 1 year, the steroid-free clinical remission and clinical response rates were 39.4% and 45.5%, respectively, and 51.2% [17/33] were still receiving tofacitinib treatment. Survival without tofacitinib withdrawal was estimated at 50.4% (95% confidence interval [CI] [35.5-71.6]) at 1 year. Only a lower partial Mayo at baseline was independently associated with remission at induction (0dds ratio [OR] = 0.56 for an increase of 1, (95% CI [0.33-0.95], p = 0.03). Five [14.3%] adverse events were reported, with one leading to treatment withdrawal [septic shock secondary to cholecystitis]. Conclusion - Tofacitinib may offer a therapeutic option for patients with refractory UP
A reproducible, self-reported, field-based tool for monitoring ovarian hormone status and body weight variations in female athletes: the Answ'Her questionnaire
No full textInternational audienceDepending on the nature of their sports, athletes may be engaged in successive weight loss (WL) and regain, conducing to “weight cycling.” The aims of this paper were to systematically (and meta‐analytically when possible) analyze the post‐WL recovery of (i) body weight and (ii) fat mass; fat‐free mass; and performance and metabolic responses in weight cycling athletes (18–55 years old, body mass index < 30 kg.m −2 ). MEDLINE, Embase, and SPORTDiscus databases were explored. The quality and risk of bias of the 74 included studies were assessed using the quality assessment tool for quantitative studies. Thirty‐two studies were eligible for meta‐analyses. Whatever the type of sports or methods used to lose weight, post‐WL body weight does not seem affected compared with pre‐WL. While similar results are observed for fat‐free mass, strength sports athletes (also having longer WL and regain periods) do not seem to fully recover their initial fat mass (ES: −0.39, 95% CI: [−0.77; −0.00], p = 0.048, I 2 = 0.0%). Although the methods used by athletes to achieve WL might prevent them from a potential post‐WL fat overshooting, further studies are needed to better understand WL episodes consequences on athletes' performance as well as short‐ and long‐term physical, metabolic, and mental health
Étude de la pratique des sages-femmes lors d'accouchement accompagné à domicile
No full textIntroduction: the current birth monitoring in France is based on the HAS recommendations (2017), not including the home birth while it represents 1503 births in 2021. We observe an increase of women’s request concerning the respect of physiologic birth, and an increase of alterative births.Methods and population: this qualitative, descriptive and interpretative study was conducted with six home birth midwives interviewed in a semi-structured individual interview to identify home birth midwives practices during birth monitoring compare to the HAS recommendations.Results and discussion: the practice of home birth midwives is usually different compare to the HAS recommendations because of a very good knowledge of the woman by the midwife and the fine analysis of a lot of indicators during birth. Her knowledge of physiology aim her to intervene wisely, limiting iatrogenic practices.Conclusion: homebirth is a marginal practice aiming a personalized and safe care for low obstetrical risk women. A better comprehension of this practice would facilitate the communication with hospital teams who are required to take care of parturient or women who have recently given birth due to an emergency transfer at hospital.Introduction : la surveillance du travail en France repose sur les recommandations de la HAS sur l’accouchement normal (2017). Ces recommandations n’abordent pas les accouchements accompagnés à domicile (AAD) qui ont représenté 1503 naissances en 2021. On observe une demande croissante de la part des femmes du respect du processus physiologique de l’accouchement, ainsi qu’un essor des naissances dites « alternatives ».Méthodes et population : une étude qualitative, descriptive et interprétative a été réalisée auprès de six sages-femmes pratiquant l’AAD lors d’un entretien semi-directif individuel afin d’identifier les pratiques des sages-femmes AAD lors de la surveillance du travail par rapport aux recommandations de la HAS.Résultats et discussion : la pratique des sages-femmes AAD est généralement différente des recommandations de la HAS du fait de la très bonne connaissance de la femme par la sagefemme et de l’analyse fine d’une multitude d’indicateurs durant le travail. Sa connaissance de la physiologie lui permet d’intervenir à bon escient, en limitant les pratiques iatrogènes.Conclusion : l’AAD est une pratique marginale qui vise une prise en charge personnalisée et sécuritaire pour les femmes à bas risque obstétrical. Une meilleure compréhension de cette pratique faciliterait la communication avec les équipes hospitalières qui sont amenées à prendre en charge des parturientes ou accouchées suite à un transfert en urgence du domicile à la maternité
Accouchement inopiné extra-hospitalier : vécu des femmes et des couples et répercussions dans le post-partum
No full textIntroduction: unplanned out-of-hospital deliveries constitute 0.5% of births in France. Multiparity, distance from the maternity and a history of fast childbirth are risk factors. Possible complications, the duty to give birth alone or with assistance are stressful factors, influencing the short- and long-term experience of couples.Method: a qualitative, descriptive and interpretative study was carried out using interviews of women and couples who had given birth unexpectedly. The main aim was to explore their experiences, to understand the knowledge they had and what was missing, and to investigate the consequences in the post-partum period.Results and discussion: couples do not consider themselves prepared for an unexpected birth. The women described the stress and intense pain but explained that they were able to cope by trusting their bodies and doing what their instincts told them. The births all went well, with no major maternal or neonatal complications. The transfer and stay in the maternity unit have an influence on their long-term experience. The birth strengthened intra-family ties, with mothers describing empowerment and fathers feeling proud.Conclusion: overall, this birth is symbolic and represents a good memory for all the participants. Better care by the emergency services and during the post-partum period would improve the experience.Introduction : les accouchements inopinés extra-hospitaliers (AIEH) représentent 0,5 % des naissances en France. La multiparité, l’éloignement de la maternité et un antécédent d’accouchement rapide sont des facteurs de risque. Les éventuelles complications, la nécessité de réaliser l’accouchement seuls ou en présence de secours sont des éléments de stress, influençant le vécu à court et long terme pour les couples.Méthode : une étude qualitative, descriptive et interprétative a été réalisée grâce à des entretiens auprès de couples et de femmes ayant accouché inopinément. L’objectif principal était d’explorer leur vécu, de comprendre leurs connaissances et ce qu’il leur a manqué, et de rechercher les conséquences dans le post-partum.Résultats et discussion : les couples ne se considèrent pas préparés à un accouchement inopiné. Le stress et la douleur intense sont décrits par les femmes, mais elles expliquent avoir réussi à faire face en ayant confiance en leur corps et en faisant ce que leur instinct leur dictait. Les naissances se sont toutes bien déroulées, sans complications maternelles ou néonatales majeures. Le transfert et l’accueil en maternité exercent une influence sur leur vécu à long terme. Cet accouchement renforce les liens intra-familiaux, les mères décrivent un empowerment et les pères une fierté.Conclusion: cette naissance est symbolique, et représente un bon souvenir pour l’ensemble des participants. Une meilleure prise en charge par les secours et lors du post-partum permettrait d’améliorer le vécu
Fertility preservation for patients with breast cancer: altered response to ovarian stimulation and loss of cholesterol homeostasis in ovarian follicles
No full textInternational audienceStudy question:Does the presence of breast cancer alter the ovarian response to hormonal stimulation and thecholesterol homeostasis in ovarian follicles?Summary answer:The deleterious impact of breast cancer on the ovarian response might be link to an alteration of thecholesterol biosynthesis in cumulus cells.What is known already:Breast cancer is the most frequent cancer in reproductive-aged women. The cancer itself seems to exerta deleterious impact on the ovarian functions. Indeed, cancer patients who undergo fertility preservationbefore cancer therapy initiation show a poorer response to ovarian stimulation than healthy women.Nevertheless, this impact remains controversial, and the mechanisms by which the cancer impairs theovarian functions are poorly understood. To our knowledge, no study has yet evaluated the impact ofbreast cancer on the cholesterol biosynthesis pathway in human cumulus cells, a pathway essential foroocyte competence to maturation and fertilization.Study design, size, duration:30 patients with breast cancer (10 triple negative (TNBC), 10 hormone-receptor positive (HR+) and 10HER2 positive (HER2+)) and 30 women oocytes donors undergoing oocyte cryopreservation will beincluded from January 2019. We assess ovarian response to stimulation (number, quality of retrievedoocytes; total FSH dose). We quantify the level of enzymes and regulators of the cholesterol biosynthesispathway in cumulus cells (CC) by RT-qPCR. We plan to quantify cholesterol levels in follicular fluids (FF).Participants/materials, setting, methods:Since January 2019, 25 breast cancer patients (9 TNBC, 8 HR+ and 8 HER2+) and 30 oocytes donors(control group) under 37 years old have been included. Ovarian stimulation was performed withantagonist protocol. Following ovarian pick up and denudation, CC and FF were collected. After totalRNAs extraction from CC, the expression levels of enzymes and regulators of the cholesterolbiosynthesis pathway were quantified by RT-qPCR. Cholesterol levels will be quantified in FF.Main results and the role of chance:The clinico-biological characteristics (age, BMI) are comparable between cancer patients and the controlgroup (p>0.05). Serum AMH levels are lower in the TNBC subgroup (2.3±1.6 ng/mL) than in the controlgroup (4.7±2.8 ng/mL, p=0.04). A poorer ovarian response to ovarian stimulation is observed in the breastcancer group compared with the control group (number of mature oocytes: 9.4±5.2 vs. 14.5±7.7, p=0.007).Among the cancer patients group, the TNBC subgroup shows the poorest ovarian response tostimulation (number of mature oocytes: 7.6±4.3 vs. 14.5±7.7 in control group, p=0.006) despite the highesttotal administered FSH dose (2480±880 IU vs. 1831±460 IU in control group, p=0.02).Dysregulation of the cholesterol biosynthesis pathway is observed in the breast cancer group. For TNBCand HR+ cancer patients, we observed an increase in the transcripts levels of CYP51 enzyme (respectively3.28±1.69 vs. 1.84±2.33, p=0.0098 and 1.77±1.78 vs. 1.84±2.33, p=0.03) and SREBP2 activator (respectively2.04±0.95 vs. 1.27±1.13, p=0.003 and 1.12±0.47 vs. 1.27±1.13, p=0.02) of the cholesterol biosynthesis pathwaycompared to the control group. In HER2+ cancer patients, a significant decrease in the expression levelsof SQLE (0.39±0.34 vs 1.81±3.99, p = 0.001) and DHRC7 enzymes (0.33±0.32 vs 1.21±0.88, p= 0.0002) isobserved compared to the control group.Limitations, reasons for caution:Our preliminary results should be confirmed with the analysis of a larger number of participants.We should confirm that the observed modulations in the expression levels of enzymes and regulators ofthe cholesterol biosynthesis pathway led to a loss of cholesterol homeostasis by quantifying cholesterolin FF.Wider implications of the findings:Our findings strengthen the hypothesis that cancer exerts a deleterious impact on the ovarian functions,as we observed a lower ovarian response in patients with breast cancer. This project will have clinicalimplications, such as to adapt the fertility preservation approach according to the breast cancer subtype
The association between obesity severity and food reward in adolescents with obesity: a one-stage individual participant data meta-analysis
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L’accompagnement de l’ergothérapeute auprès de patients atteints de schizophrénie dans leur santé sexuelle
No full textIntroduction: sexual health is one of the major issues for people with schizophrenia due to their treatments. The professional of daily living activity is the occupational therapist. The aim of this dissertation was to know: how can the occupational therapist support people with shizopherenia struggle with their sexual health? Methods: five occupational therapists working with people suffering from schizophrenia and struggling with sexual health problems responded to a semi-structured interview conducted over the phone. The aim of this interview was to understand their intervention with this population and the impact on the professional but also the difficulties they met during the care.The interviews were qualitatively analysed in a longitudinal and cross-sectional way. Results: in the care sector, many professionals choose not to talk about sexual health because they are not comfortable with this topic. Others are surprised to exchange on this but they agreed to talk. All the occupational therapists interviewed didn’t have any training about sexual health. Conclusion: this study highlighted the importance of the collaboration between the occupationnal therapist and the pluridisciplinary team. It can identified differents approaches to talked about this subject and their difficulties before and after the care.Introduction : la santé sexuelle est l’une des problématiques majeures des personnes atteintes de schizophrénie à cause de leurs traitements. Le professionnel des activités de vie quotidienne est l’ergothérapeute. Le but de ce mémoire est de savoir : comment l’ergothérapeute peut accompagner des personnes atteintes de schizophrénie qui ont des problèmes dans leur santé sexuelle ?Méthode : cinq ergothérapeutes travaillant auprès de personnes atteintes de troubles schizophréniques et qui ont des problèmes dans leur santé sexuelle ont répondu à un entretien semi-directif par téléphone. L’objectif de cet entretien est de comprendre leur intervention auprès de cette population et l’impact sur le professionnel mais aussi les difficultés rencontrées durant la prise en soin. Ils ont fait l’objet d’une analyse qualitative longitudinale et transversale.Résultats : dans le milieu de la santé, beaucoup de professionnel choisissent de ne pas parler de la santé sexuelle car ils ne sont pas à l’aise avec cette thématique. D’autres sont surpris d’échanger sur ce sujet mais ils sont d’accord pour en parler. Tous les ergothérapeutes interrogés n’ont pas été formé à la santé sexuelle.Conclusion : ce mémoire met en évidence l’importance de la collaboration entre l’ergothérapeute et l’équipe pluridisciplinaire. Il a permis d’identifier les différentes approches pour parler de ce sujet et les difficultés avant et après la prise en soin
IELSG38: phase II trial of front-line chlorambucil plus subcutaneous rituximab induction and maintenance in mucosa-associated lymphoid tissue lymphoma.
No full textInternational audienceThe IELSG38 trial was conducted to investigate the effects of subcutaneous (SC) rituximab on the complete remission (CR) rate and the benefits of SC maintenance in patients with extranodal marginal zone lymphoma (MZL) who received frontline treatment with chlorambucil plus rituximab.Study treatment comprised an induction phase with chlorambucil 6 mg/m2/day orally on weeks 1-6, 9-10, 13-14, 17-18, and 21-22, and rituximab 375 mg/m2 intravenously on day 1 of weeks 1-4, and 1400 mg SC on weeks 9, 13, 17, and 21. Then, a maintenance phase followed with rituximab administered at 1400 mg SC every two months for two years.Of the 112 patients enrolled, 109 were evaluated for efficacy. The CR rates increased from 52% at the end of the induction phase to 70% upon completion of the maintenance phase. With a median follow-up of 5.8 years, the 5-year event-free, progression-free, and overall survival rates were 87% (95% CI, 78-92), 84% (95% CI, 75-89), and 93% (95% CI, 86-96), respectively. The most common grade ≥3 toxicities were neutropenia (33%) and lymphocytopenia (16%). Six patients experienced treatment-related serious adverse events, including fever of unknown origin, sepsis, pneumonia, respiratory failure, severe cerebellar ataxia, and fatal acute myeloid leukemia.The trial showed that subcutaneous rituximab did not improve the complete remission rate at the conclusion of the induction phase, which was the main endpoint. Nevertheless, SC maintenance might have facilitated long-term disease control, potentially contributing to enhanced event-free and progression-free survival
Étude des attentes et de l’impact d’une action de prévention auprès de futurs parents à propos du développement du langage des jeunes enfants
No full textIntroduction: prevention is a key word in the definition of speech therapy. Several interventions are lead in maternities in order to raise awareness among parents about their child’s language and communication’s development. What are the parents expecting when they sign up for the “language intervention” at the Châtaigneraie maternity? Is an ad hoc action of prevention enough to allow the parents to feel more prepared to help their child?Methods: the participants of this study are the parents who have participated in the “language intervention”. Two questionnaires have been created for this study. A first one is given at the beginning of the intervention et the second one is distributed at the end. A brochure based on the information delivered during the intervention is also distributed at the parents. A qualitive analysis has been conducted. 13 questionnaires have been analysed. Results: the parents are asking for information about the language development of their child, and they are feeling a fear of “doing it wrong”. They know that speaking to their child as soon as the pregnancy begins is important, but they are less aware of the positive effects of early daily reading. Most of the questioned parents are leaving the intervention feeling reassured and more confident.Discussion: this type of interventions is a necessity to allow the parents to have access at verified information. They increase the feeling of parental competency and concretely advice the parents on how to support their child’s language development.Introduction : la prévention est au cœur de la définition de l’orthophonie. Des ateliers sont menés en maternité afin de sensibiliser les parents autour du développement du langage et de la communication chez leurs enfants. Quelles sont les attentes des parents qui s’inscrivent à « l’atelier langage » dispensé au sein de la maternité de la Châtaigneraie ? Une action ponctuelle de prévention permet-elle aux parents de se sentir plus armés pour aider leurs enfants ?Matériel et méthodes : la population de ce mémoire est constituée des parents ayant assisté aux « ateliers langage ». Deux questionnaires ont été conçus pour cette étude. Un premier questionnaire est présenté au début de l’atelier et le second est distribué à la fin. Une plaquette d’informations basée sur les données fournies pendant l’intervention est également donnée aux participants. Une analyse qualitative a été réalisée. Les questionnaires de 13 participants ont été traités.Résultats : les parents sont demandeurs d’informations sur le développement langagier de leur nouveau-né et ils ressentent une appréhension de « mal faire ». S’ils sont conscients de l’importance de parler à leur enfant dès la grossesse, les bienfaits de la lecture quotidienne dès le plus jeune âge sont sous-estimés. La grande majorité des parents interrogés ressort de cette intervention rassurée et plus confiante.Discussion : les actions de prévention sont essentielles pour permettre aux parents d’avoir accès à des informations divulguées par des professionnels. Elles renforcent le sentiment de compétence parentale et divulguent des conseils concrets sur lesquels les parents peuvent s’appuyer pour favoriser le développement langagier de leur enfant