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The roles of French community pharmacists in palliative home care
No full textInternational audienceAbstract Background The World Health Organization identifies pharmacists as a key resource in palliative care. However, the roles of these professionals in end-of-life care at home remain poorly understood, and community pharmacists themselves sometimes struggle to recognize their true role in this care. The aim of our study was to analyze community pharmacists’ representations of their roles in palliative care at home in France. Methods The methodology was qualitative and based on semi-structured interviews with community pharmacists ( n = 26). The analysis of the interviews was carried out using a qualitative content approach with thematic and lexical analysis. Results Three main elements of the community pharmacist’s role were identified: drug expertise, care management, and psychosocial support for patients and their families. Conclusions This study highlights a wide variety of roles adopted by French community pharmacists in palliative care at home. Some of these roles, which are in line with WHO recommendations on palliative care, have been little described to date. These roles of community pharmacists in home-based palliative care could be better recognized, and the players better integrated into end-of-life care systems at home, in order to improve such care. Trial registration This work was carried out within the framework of a call for projects from the Fondation de France and has received the approval of the University Clermont Auvergne Research Ethics Committee (no. IRB00011540-2021-60)
Identification of primary mediastinal B-cell lymphomas with higher clonal dominance and poorer outcome using 5' RACE
No full textInternational audienceFew data exist regarding the tumor B-cell receptor (BCR) repertoire and lymphoid microenvironment in primary mediastinal B-cell lymphoma (PMBL). We applied 5' rapid amplification of cDNA ends (5'RACE) to tumor RNA samples from 137 PMBL patients with available gene expression profiling and next-generation sequencing data. We obtained 5'RACE results for 75/137 (54.7%) patients, with clinical characteristics as follows: median [min-max] age, 33 [18-64] years; female, 53.3%; ECOG score 0-1, 86.7%; stage I-II, 57.3%; 1st-line treatment with anti-CD20 plus ACVBP, 72%; CHOP14, 14.7%; CHOP21, 13.3%. Among the 60 biopsies that expressed a productive BCR, we highlighted a strong somatic hypermutation profile with 58 (96.7%) patients carrying mutated IgVH, defined as <98% identity to the germline sequence. We then identified a subgroup of 12/75 patients (16%) with a worse prognosis (progression-free survival (PFS): HR [95% CI]=17 [3.2-88]; overall survival (OS): HR=21 [2.1-210]) associated with the highest clonal dominance status (HCD), defined by the dominant clonotype representing >81.1% and >78.6% of all CDR3 sequences for IgVH and IgVL, respectively. Compared to other patients, this subgroup had similar clinical characteristics but a greater median allele frequency for all somatic variants, decreased BCR diversity, and greater expression of PDL1/PDL2 and MS4A1 genes, suggesting a greater tumoral infiltration. According to a multivariate model integrating AID expression and BCR diversity, only HCD status was associated with outcome (PFS: HR=14.6 [2.46-86.8]; OS: HR=11.4 [1-128.8]). We confirmed this poorer prognosis in an independent cohort, in which 6/37 (16%) patients exhibited HCD (PFS: HR=12 [3-46]; OS: HR=17 [1.8-170])
Estrous cycle regulates cephalic mechanical sensitivity and sensitization of the trigemino-cervical complex in a female rat model of chronic migraine
No full textInternational audienceAbstract The higher incidence of migraines in women compared with men has led to the inclusion of female animals in pain research models. However, the critical role of the hormonal cycle is frequently overlooked, despite its clear correlation with migraine occurrences. In this study, we show in a rat model of migraine induced by repeated dural infusions of an inflammatory soup (IS) that a second IS (IS2) injection performed in proestrus/estrus (PE, high estrogen) female rats evokes higher cephalic mechanical hypersensitivities than when performed in metestrus/diestrus (MD, low estrogen) or ovariectomized (OV) rats. This hypersensitivity induced by IS2 correlates with increased c-Fos expression in outer lamina II (IIo) neurons located in the periorbital projection area of the trigemino-cervical complex (TCC), in PE only. Four IS (IS4) repetition induced an enlargement of c-Fos expression in adjacent territories areas in PE, but not MD or OV animals. Unexpectedly, c-Fos expression in locus coeruleus neurons does not potentiate after IS2 or IS4 injections. To examine the impacts of the hormonal cycle on the physiology of lamina II o TCC neurons, we performed whole-cell patch-clamp recordings. Second inflammatory soup depolarizes neurons in PE and MD but not in OV rats and enhances excitatory synaptic inputs in PE animals to a greater extent compared with MD and OV rats. These findings show that central TCC sensitization triggered by meningeal nociceptor activation and the resulting cephalic hypersensitivity are modulated by the estrous cycle. This highlights the crucial need to account for not just sex, but also the female estrous cycle in pain research
Flecainide to Prevent Atrial Arrhythmia after Patent Foramen Ovale Closure, the AFLOAT Study: A Randomized Clinical Trial
No full textInternational audienceBackground: The real incidence of atrial arrhythmia (AA) after patent foramen ovale (PFO) closure and whether this complication can be prevented remain unknown. This study assessed if flecainide is effective to prevent AA during the first 3 months after PFO closure, and if 6 months treatment by flecainide is more effective than 3 months to prevent AA after PFO closure.Methods: AFLOAT is a prospective, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). Patients were randomized in a 1:1:1 ratio after PFO closure to receive flecainide (150 mg once a day in a sustained-release (SR) dose) for 3 months, flecainide (150 mg od SR dose) for 6 months, or no additional treatment (standard-of-care) for 6 months. The primary endpoint was the percentage of patients with at least one episode AA (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor (ICM). The secondary endpoint was the percentage of patients with at least one episode of AA (≥30s) recorded with ICM during the 3-6 months period after PFO closure.Results: 186 patients were included (mean age 54 years, male 68.8%) and AA (≥30s) occurred in 53 (28.5%) patients during the 6-month follow-up; 86.8% of these AA events occurred in the first month after PFO closure. The primary outcome occurred in 33/123 (26.8%) and 16/63 (25.4%) patients receiving flecainide for at least 3 months or standard of care, respectively [Risk Difference (RD) 1.4%; 95% confidence interval (CI) -12.9% to 13.8%, NS]. The secondary endpoint occurred in 3/60 (5.0%), 4/63 (6.3%), and 5/63 (7.9%) patients receiving flecainide 6 months, 3 months or standard of care, respectively [RD -2.9%; 95% CI -12.7% to 6.9%, and RD -1.6%; 95% CI -11.8% to 8.6%, respectively].Conclusions: In the first 6 months following successful PFO closure, AA (≥30s) occurred in 28.5% of cases, mostly in the first month after the procedure. Flecainide did not prevent AA after PFO closure
Explorer la variabilité interindividuelle de la réponse à l'alimentation dans une population âgée non fragile vivant à domicile : les projets DBSage et MétabotypAGE
No full textInternational audienceCe projet intitulé « Explorer la variabilité individuelle de la réponse à l’alimentation dans une population âgée non fragile vivant à domicile est la fusion de deux projets, d’une part le projet DBS age, qui a obtenu un financement Emergence, iSITE, et le projet métabotypage, qui a obtenu un financement INRAE. Ce projet trouve son origine dans la constatation que la variabilité individuelle à l’alimentation est plus élevée que ce que l’on pensait initialement. Ainsi, les recommandations nutritionnelles génériques (par âge et / ou par sexe) seraient peut-être moins efficaces que des recommandations plus personnalisées, basée sur un phénotypage poussé des personnes. Le projet DBSage avait comme critère principal plutôt le métabolisme protéique, avec la mesure des teneurs en aa dans des prélèvements de sang obtenus au bout du doigt par les volontaires eux-mêmes, et le projet Métabotypage se focalisait sur la glycémie mesurée en continu pendant 15 jours grâce à un capteur posé sur le bras.Nous avons tout d’abord profité de ce projet pour réaliser une base de données rassemblant toutes les méthodes appropriées pour phénotyper les individus sur le plan de leur alimentation, activité physique, santé clinique, sur les aspects psycho-socio-économiques, la cognition, et la physiologie. Nous avons alors pris une sélection de toutes ces méthodes pour les appliquer à notre protocole.Nous sommes ainsi en train de recruter 150 personnes âgées autonomes, en veillant à recruter une part équilibrée d’hommes et de femmes, et de personnes urbaines et rurales. Pour cela nous nous aidons d’un réseau local, RéseautAGE, que nous avons créé avec une trentaine de structures intéressées par la nutrition des personnes âgées.Le protocole en lui-même alterne des visites au Centre d’Investigation Clinique, des périodes à domicile, et une évaluation de la santé orale au CROC, et de la capacité physique sur la plateforme mobilité du CHU. Nous analyserons de nombreux paramètres dans des échantillons de sang, d’urine, ou de selles. Les volontaires rempliront des questionnaires variés, et nous réaliserons également des tests cognitifs, olfactifs et gustatifs. Le but est donc de voir si nous pouvons établir des métabotypes, c’est-à-dire des groupes de sujets dont les réponses aux repas tests sont similaires, et qui peuvent s’expliquer par les données phénotypiques obtenues.Grâce aux résultats obtenus, nous espérons réussir à réaliser une étude similaire, plus participative, sur 1000 sujets, en travaillant uniquement par correspondance (projet Part’AGE)
Predictors of abstinence maintenance after cocaine inpatient detoxification: A prospective study
No full textInternational audienceBackground and Objectives Cocaine is a highly addictive substance, and with no approved medication for cocaine use disorder (CUD), leading to a heavy burden. Despite validated psychosocial treatments, relapse rates after detoxification are very high in CUD. Few consistent factors can predict abstinence after detoxification. Our study, therefore, aimed at identifying factors predicting abstinence among CUD patients after inpatient detoxification.Methods Eighty‐one CUD inpatients were included during detoxification and characterized for clinical and sociodemographic data at baseline and at a follow‐up of 3 months after discharge, including a standard measure of their abstinence duration from cocaine. We performed Cox univariate analyzes to determine the factors associated with abstinence maintenance, followed by a multivariate Cox regression to identify independent predictors.Results Abstinence maintenance was shorter in patients injecting cocaine (hazard ratio [HR] = 5.16, 95% confidence interval [CI]: 2.01–13.27, p < .001) and using cocaine heavily in the month before inclusion (HR = 1.03, 95% CI: 1.00–1.06, p = .046). Conversely, abstinence maintenance was longer in patients with longer inpatient detoxification stays (HR = 0.96, 95% CI: 0.94–0.99, p = .015) and prescribed with selective serotonin reuptake inhibitors (SSRIs) (HR = 0.30, 95% CI: 0.16–0.56, p < .001). Discussion and Conclusions Patients with severe CUD may require longer inpatient stays to achieve abstinence. Regarding SSRI prescription, more specific studies are needed to provide stronger recommendations about their use in clinical practice.Scientific Significance Our findings suggest several modifiable factors to improve inpatient treatment response in CUD. As there are no specific recommendations about the optimal duration of inpatient stay, our results could pave the way for evidence‐based guidelines
Left atrial appendage closure in very elderly patients in the French National Registry
No full textInternational audienceOBJECTIVE: Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients. METHODS: A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups \textless80 years and ≥80 years. RESULTS: Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged \textless80 years, respectively; p=0.07). Despite a higher mean CHA(2)DS(2)-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p\textless0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19). CONCLUSION: Despite a higher mean CHA(2)DS(2)-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged \textless80 years. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03434015)
Comparison of clinical characteristics between responders and non-responders to hamstring stretching in individuals with chronic low back pain
No full textInternational audienceBackground/Objectives: Hamstring muscle (HM) flexibility is frequently compromised in people with chronic low back pain (CLBP), contributing to disability and leading to a less favorable recovery. In a previous article, we presented the results of a study on the immediate effect of passive HM stretching on flexibility in 90 people with CLBP. There was considerable variability in the changes after stretching. The objective of this supplementary analysis was to compare the clinical characteristics of individuals who experienced a significant improvement in flexibility with those who did not. Methods: We fixed a threshold of 7 • to indicate an improvement in passive Straight Leg Raise (SLR) angle and differentiate between 'Responders' and 'Non-responders' regarding passive HM stretching. Results: Only body mass index differed between groups; it was significantly smaller in Responders (p = 0.007). The majority of Non-responders experienced workplace accidents, but this was of marginal difference compared to Responders (p = 0.056). Conclusions: Further studies should consider a broader clinical analysis with a larger sample size to understand which factors influence the HM stretching response in CLBP patients
New ICD-11 diagnostic criteria for chronic secondary musculoskeletal pain associated with Parkinson disease
No full textInternational audienceBackground: Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk. Objective: To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS). Methods: The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal. Results: Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations. Conclusion: These recommendations propose a strategic approach to managing cancer risk in PwMS