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Experiencing and enduring patient distress: The distress of palliative care patients and its emotional impact on physicians in training Authors
No full textInternational audienceAbstract Background The extreme vulnerability experienced by patients in palliative care may result in significant distress. These patients require appropriate care while not pathologizing their natural distress. Given the challenges of caring for people experiencing significant distress, it is important to understand what professionals in training may feel when caring for patients in palliative care. Therefore, the aim of this study was to explore how professionals in training feel when confronted with the distress of patients undergoing palliative care. Methods A qualitative study employing interpretative phenomenological analysis was conducted. In 2022, 11 physicians in training were interviewed about their experiences with distressed patients due to palliative care. The interviews were conducted via video conference. The students participated in the national palliative care cross-training and were in their final year of residency training. Results The interviews revealed the following five themes: feelings of powerlessness, duty to act, difficulty in building a relationship, feeling insecure about oneself, and creating a space for listening and relating. All participants felt powerless in front of their patient’s distress. Numerous defense mechanisms were identified that made the relationship with the patient difficult. Four participants described being able to create a space for listening and relating to their patients. Conclusions A minority of students could establish a quality relationship with their distressed patients. Two concepts, interprofessional education and the patient-centered approach, were identified and could be developed in training
CHKA, un « marqueur-cible » potentiel pour le CHC-MASLD à un stade précoce de fibrose : analyse par approche des « omiques »
No full textInternational audienceIntroduction : Récemment, l’ASSLD a défini une nouvelle nomenclature concernant la maladie stéatosique du foie. La « MASLD » (Metabolic Dysfonction Associated Steatotic Liver Disease) désigne les patients atteints de stéatose hépatique ayant au moins un facteur de risque cardio-métabolique. La MASLD est devenue la cause la plus fréquente de maladie chronique du foie en Europe avec une prévalence d’environ 23.7%. Trente à 40 % des CHC-MASLD surviennent en l’absence de fibrose ce qui pose un défi en terme de détection précoce. Précédemment, nous avons rapporté l'existence de 2 phénotypes de CHC-MASLD, par analyse de métabolomique, selon la sévérité de la fibrose (F0F1 vs. F3F4). L’objectif de cette étude est d'explorer d’une part les voies du métabolisme lipidique par les « omiques »et d’autre part d’identifier des biomarqueurs tissulaires du CHC-MASLD selon le degré de fibrose.Matériels et Méthodes : Notre cohorte comprend 56 paires de tissus hépatiques humains, tumoraux et non-tumoraux (F0F1 = 28, F3F4 = 28), ainsi que 5 tissus hépatiques sains utilisés comme control (CRB Liver). Une approche d'analyse métabolomique non ciblée par chromatographie liquide-spectrométrie de masse (LC-MS) a été réalisée. En parallèle, une analyse par qRT-PCR axée sur l'expression de 14 gènes impliqués dans les principales voies du métabolisme lipidique a été effectuée (Tableau 1). Pour chaque groupe, le CHC a été comparé à son propre NTT ainsi qu’aux tissus hépatiques sains.Résultats : Nous avons identifié 30 métabolites dans les extraits de tissu tumoral (TT) et non-tumoral (NTT) par LC-MS(Fig.1A). Dans le groupe CHC-MASLD- F0F1, les taux de sphingolipides tel que les céramides Cer(d18:1/22:0), les sphingomyélines SM(41:1) ainsi que le phosphatidyléthanolamine PE(O-16:1_20 :4) sont sous-exprimés. En revanche, les taux des SM (35:1), SM (40:2) et SM (42:3) ainsi que les contenus en glycérophospholipides, tels que les phosphatidylcholines PC (16:0_14:0), PC(16:0/16:0), PC(18:0_18:1), PC(40:8) et PE(18:0_18:1) sont sur-exprimés dans ce même groupe. Dans le CHC-MASLD-F3F4, le contenu en métabolites est diminué de 50% par rapport au tissu non tumoral. Cependant on note que les taux des métabolites tels que PC (18:0_18:1), PC(18:0_20:3) et phosphatidylinositol PI(16:0_18:1), sont sur-exprimés. Ce dernier métabolite est considéré comme un onco-métabolite.En parallèle, les résultats de l'analyse transcriptomique par qRT-PCR ont montré que parmi les 14 gènes étudiés, l'expression d'ARN de 6 gènes, codant pour CHKA, DGAT1, MBOAT7, SPTLC2, SMPD1 et SGMS1 est exclusivement sur-exprimés dans MASLD-TT-F0F1 (Tableau 1, Fig. 1B). En revanche, l'expression d'ARN de ces mêmes 14 gènes reste inchangée dans le groupe MASLD-F3F4 (Tableau 1).L'ensemble de ces données permet d’appuyer l'existence de 2 phénotypes de CHC-MASLD selon la sévérité de fibrose.Par ailleurs, il ressort que l’augmentation de l’expression du gène codant pour CHKA est en accord avec nos précédentes données de métabolomique. En effet, nos résultats ont rapporté une accumulation importante des dérivés de la phosphocholine exclusivement dans les extraits de tissus tumoraux, avec ou sans fibrose minime. Ces observations suggèrent que la choline peut servir de marqueur en imagerie dans le CHC-MASLD chez les patients présentant une fibrose minime de stade F0 à F1.Conclusion : Les analyses par « omiques » permettent de : 1) discriminer CHC-MASLD en fonction de la sévérité de la fibrose ; 2) proposer un traceur pour le CHC-MASLD avec ou sans fibrose minimale. Cette observation pourrait conduire à une application clinique : la choline marquée pouvant être privilégiée en tant que traceur plus efficace pour le PET-scan chez les patients présentant un CHC développé sur MASLD à un stade précoce de fibrose
Motor disorders related to oxaliplatin-induced peripheral neuropathy: long-term severity and impact on quality of life
No full textInternational audiencePurpose: Sensory chemotherapy-induced peripheral neuropathy (CIPN) is well-recognized, but motor CIPN remains understudied. This secondary analysis focused on the long-term severity and impact of motor disorders, their relation to sensory CIPN, neuropathic pain, psychological distress, and health-related quality of life (HRQoL) after oxaliplatin-based chemotherapy in colorectal cancer (CRC) survivors.Methods: Data from a multicenter, cross-sectional study were re-analyzed to explore motor CIPN among CRC survivors up to 5 years post-chemotherapy, with no longitudinal follow-up. Questionnaires assessed sensory and motor CIPN (QLQ-CIPN20), neuropathic pain (DN4), anxiety and depression (HADS), and HRQoL (QLQ-C30).Results: Among 405 CRC survivors, 31.1% had sensory CIPN as previously described. When categorizing the 405 CRC survivors based on the years since their last oxaliplatin-based chemotherapy, the motor scores derived from the QLQ-CIPN20 showed no significant difference between years (p = 0.08). Motor CIPN scores correlated with female gender, higher oxaliplatin dose intensity, sensory CIPN, and neuropathic pain. Motor CIPN also linked to decreased HRQoL and increased psychological distress.Conclusion: The study underscores the detrimental impact of motor disorders on CRC survivors post-oxaliplatin-based chemotherapy. Oncologists should prioritize assessing and managing motor manifestations alongside sensory symptoms to enhance post-cancer quality of life
P857 Effectiveness and safety of subcutaneous infliximab in perianal Crohn's disease: a multicentre cohort study
No full textMeeting abstract du "19th Congress of ECCO", Stockholm, Suède, 21-24 février, 2024International audienceBackground Infliximab (IFX) demonstrated its effectiveness in perianal CD (pCD) and represents the first-line medical treatment. A subcutaneous (SC) formulation has recently been developed, however so far it has not been specifically investigated in pCD. The aim of our study was to evaluate the effectiveness and safety of SC IFX in pCD. Methods We conducted a multicentre retrospective cohort study in the French GETAID, in patients with either active (group 1) or inactive (group 2) pCD who received SC IFX. Inclusion criteria were, for group 1: active pCD in the 6 months prior to initiation of SC IFX; and for group 2: inactive pCD for > 6 months at the time of IV to SC switch, but with a history of seton drainage. The primary endpoint in group 1 was clinical remission at 6 months (absence of anal ulcers, and absence of draining fistula). Univariate and multivariable logistic regression analyses were performed to identify predictors of clinical remission. In group 2, the primary endpoint was perianal clinical recurrence during follow-up. Results A total of 192 patients were included in 24 centres. Mean age was 38.9 years, 43.2% were women, 25.1% were smokers. 66 patients were included in group 1, 117 in group 2. In 9 patients, pCD had > 6 months persistent activity on IV IFX when switched to SC. In group 1, median follow-up was 46 (26.6-64.6) weeks, 51/66(77.3%) patients received combination therapy, surgical drainage was performed in 40(60.6%) patients. One(1.5%), 1(1.5%), 32(48.5%), 20(30.3%) and 12(18.2%) patients received 0, 1, 2, 3 and ≥ 4 IV perfusions respectively before SC switch. At M6, 27/61(44.3%) patients were in clinical remission and 53/61(86.9%) in clinical response. MRI remission or response was achieved in 19/28(68%) patients. In univariate analysis, factors inversely associated with remission were BMI, previous pCD surgery, initial seton drainage, and SC dose optimization. In multivariable analysis, prior exposure to ≥1 biologic (OR 0.248;CI95% [0.071-0.861]p= 0.0243) was predictive of clinical remission. In group 2, median follow-up was 53.6(36.7-67) weeks. The pCD recurrence rate at 6 months was 3.1%. The recurrence-free survival curve is shown in Figure1. Overall, SC IFX was discontinued in 20(10.4%) patients, 8 switched back to IV. Two cases of immunization were observed. Median IFX serum concentration was > 20(17.1- > 20) µg/l. There were 16(8.3%) cases of adverse events related to pain/injection-site reaction: 4 switched back to IV, 1 stopped IFX. There were 5 cases of infection, no case of cancer. Conclusion Our results are in line with those reported in the literature on the effectiveness of IV IFX in pCD. The SC formulation appears to be effective and safe for active pCD, and for maintaining remission in inactive pC
Characteristics, management, and mid-term prognosis of older adults with cardiogenic shock admitted to intensive care units: Insights from the FRENSHOCK registry
No full textInternational audienceBackground: The incidence of heart failure and cardiogenic shock (CS) in older adults is continually increasing due to population aging. To date, prospective data detailing the specific characteristics, management and outcomes of CS in this population are scarce.Methods: FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. We studied 1-month and 1-year mortality among patients over 75-year-old, adjusted for independent predictors of 1-month and 1-year mortalities.Results: Out of 772 patients included, 236 (30.6%) were 75 years old or more (mean age 81.9 ± 4.7 years, 63.6% male). Compared to patients Conclusion: A third of patient with CS in critical care unit are older than 75 years and their risk of death at one month and one year is more than double compared to the younger ones. Further research is essential to identify best therapeutic strategy in this population. NCT02703038
Complications sérieuses et récidives après bandelette sous-urétrale par voie rétropubienne versus transobturatrice pour 2682 patientes participant au registre VIGI-MESH
No full textInternational audienceBackground: Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them.Objective(s): To compare serious complications and reoperations for recurrence after midurethral sling procedures by the retropubic and transobturator routes for female stress urinary incontinence.Study Design: This analysis covers patients included in the French multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence by the retropubic or transobturator route, excluding single-incision slings. Follow-up continued to October 2021. Serious complications (Clavien-Dindo classification ≥ Grade III) imputable to the midurethral sling and reoperations for recurrence were compared by Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery.Results: 1830 participants received a retropubic sling and 852 a transobturator sling in 134 French centers, placed by 167 surgeons. The cumulative two-year estimate of serious complications was 5.8% (95% CI 4.8-7.0%) in the retropubic group and 2.9% (95% CI 1.9–4.3%) in the transobturator group, that is, after adjustment, half that of the retropubic group (adjusted HR 0.41; 95% CI 0.3-0.6). The cumulative two-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% CI 2.0-3.6) in the retropubic group and 2.8% (95% CI 1.7-4.2) in the transobturator group, with risk of revision for recurrence higher in the transobturator group after adjustment (adjusted HR 1.9; 95% CI 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence.Conclusions: The transobturator route for midurethral slings is associated with a lower risk of serious complications but a higher risk of surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring
Liver disease in germline mutations of telomere-related genes: Prevalence, clinical, radiological, pathological features, outcome, and risk factors
No full textInternational audienceBackground and aim: Germline mutations of telomere-related genes (TRG) induce multiorgan dysfunction, and liver-specific manifestations have not been clearly outlined. We aimed to describe TRG mutations-associated liver diseases. Approach and results: Retrospective multicentre analysis of liver disease (transaminases>30 IU/L and/or abnormal liver imaging) in patients with TRG mutations. Main measurements were characteristics, outcomes, and risk factors of liver disease in a TRG mutations cohort. The prevalence of liver disease was compared to a community-based control group (n=1190) stratified for age and matched 1:3 for known risk factors of liver disease. Among 132 patients with TRG mutations, 95 (72%) had liver disease, with associated lung, blood, skin, rheumatological and ophthalmological TRG diseases in 82%, 77%, 55%, 39%, and 30% of cases, respectively. Liver biopsy was performed in 52/95 patients, identifying porto-sinusoidal vascular disease (PSVD) in 48%, and advanced fibrosis/cirrhosis in 15%. After a follow-up of 21 months (12-54), ascites, hepato-pulmonary syndrome, variceal bleeding, and hepatocellular carcinoma occurred in 14%, 13%, 13%, and 2% of cases, respectively. Five-year liver transplantation-free survival was 69%. A FIB-4 score ≥3·25 and ≥1 risk factor for cirrhosis were associated with poor liver transplantation-free survival. Liver disease was more frequent in patients with TRG mutations than in the paired control group (80/396, (20%)), OR 12.9 (CI95% 7.8-21.3, p <0.001). Conclusions: TRG mutations significantly increase the risk of developing liver disease. Although symptoms may be mild they may be associated with severe disease. PSVD and cirrhosis were the most frequent lesions suggesting that the mechanism of action is multifactorial
Référentiel national de traitement des carcinomes épidermoïdes des voies aérodigestives supérieures – Principes généraux de traitement
No full textInternational audienceObjectives: The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations.Methodology: To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS).Results: The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey.Conclusion: All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.Objectifs : La prise en charge des cancers des voies aérodigestives supérieures est une spécialité complexe. Il est indispensable de proposer une actualisation pour instaurer une prise en charge optimale. À l’initiative de l’INCa et sous l’égide de la SFORL, le comité scientifique, piloté par le professeur Béatrix Barry, le docteur Gilles Dolivet et le docteur Dominique De Raucourt, a décidé d’élaborer un référentiel visant à définir de façon scientifique et consensuelle les principes généraux des traitements des cancers des voies aérodigestives supérieures applicables à toutes les sous-localisations.Méthodologie : Pour élaborer ce référentiel, une équipe pluridisciplinaire de praticiens a été constituée. Une analyse systématique de la littérature a été réalisée pour produire des recommandations classées par grades, conformément aux normes de la Haute Autorité de santé (HAS).Résultats : La gradation des recommandations selon les normes de la HAS a permis d’établir la référence en matière de prise en charge des patients, en fonction de plusieurs critères. Dans ce référentiel, les patients bénéficient d’une prise en charge différenciée en fonction des facteurs pronostiques qu’ils présentent (âge, comorbidités, statut TNM, statut HPV, etc.), des conditions de réalisation et des critères de qualité de la chirurgie indiquée (opérabilité, résécabilité, qualité des marges, mutilation, chirurgie de rattrapage), ainsi que des critères de qualité de la radiothérapie (volume cible, délai de mise en œuvre…). La place des traitements médicaux et postopératoires a également été évaluée en fonction de critères précis. Enfin, les soins de support doivent être organisés dès le début et tout au long du parcours de soins des patients.Conclusion : L’ensemble des données recueillies a permis d’élaborer un référentiel complet visant à harmoniser les pratiques au niveau national, à faciliter la prise de décision en réunion de concertation pluridisciplinaire, à promouvoir l’égalité des pratiques et, enfin, à mettre disposition un état de l’art et des pratiques de références pour évaluer la qualité des soins. Ce nouveau référentiel a pour vocation d’être mis à jour tous les cinq ans afin de refléter au mieux les dernières avancées dans le domaine
Reduced Production of Pro-Inflammatory and Pro-Catabolic Factors by Human Serum Metabolites Derived from a Patented Saffron Extract Intake
No full textInternational audienceSafe and anti-inflammatory plant-based natural products present an increasing focus in the treatment of chronic inflammatory diseases such as osteoarthritis or inflammatory bowel diseases. Among them, saffron, a spice derived from the stigma of Crocus sativus, could have anti-inflammatory properties and would be therefore a promising therapeutic agent for the treatment of such conditions. However, the anti-inflammatory molecular mechanisms of saffron in humans are still understudied and unclear. In this study, combining human serum metabolites and cell cultures, we evaluated the effect of circulating metabolites from the consumption of a patented saffron extract (Safr’InsideTM) on the chondrocytes and colon epithelial cell responses to inflammatory stress. Parametric or non-parametric Analysis of Variance with post hoc tests was performed. We demonstrated that human serum containing metabolites from saffron intake attenuated IL-1β-stimulated production of PGE2 and MMP-13 in chondrocyte cells and limited the increase in ICAM-1, MCP-1, iNOS, and MMP-3 in human epithelial cells following combined IL-1β and TNF-α inflammatory stimulation. Altogether, these data provide new findings into the mechanisms underlying the beneficial effects of saffron on chondrocytes and enterocyte cells at the cellular level and in the context of chronic inflammatory disorders
Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year
No full textInternational audienceBackground: Chronic pain affects approximately 30% of the general population, severely degrades quality of life and professional life, and leads to additional health care costs. Moreover, the medical follow-up of patients with chronic pain remains complex and provides only fragmentary data on painful daily experiences. This situation makes the management of patients with chronic pain less than optimal and may partly explain the lack of effectiveness of current therapies. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs could better characterize patients, chronic pain, pain medications, and daily impact to help medical management.Objective: This cohort study aimed to assess the ability of our mHealth tool (eDOL) to collect extensive real-life medical data from chronic pain patients after 1 year of use. The data collected in this way would provide new epidemiological and pathophysiological data on chronic pain.Methods: A French national cohort of patients with chronic pain treated at 18 pain clinics has been established and followed up using mHealth tools. This cohort makes it possible to collect the determinants and repercussions of chronic pain and their evolutions in a real-life context, taking into account all environmental events likely to influence chronic pain. The patients were asked to complete several questionnaires, body schemes, and weekly meters, and were able to interact with a chatbot and use educational modules on chronic pain. Physicians could monitor their patients' progress in real time via an online platform.Results: The cohort study included 1427 patients and analyzed 1178 patients. The eDOL tool was able to collect various sociodemographic data; specific data for characterizing pain disorders, including body scheme; data on comorbidities related to chronic pain and its psychological and overall impact on patients' quality of life; data on drug and nondrug therapeutics and their benefit-to-risk ratio; and medical or treatment history. Among the patients completing weekly meters, 49.4% (497/1007) continued to complete them after 3 months of follow-up, and the proportion stabilized at 39.3% (108/275) after 12 months of follow-up. Overall, despite a fairly high attrition rate over the follow-up period, the eDOL tool collected extensive data. This amount of data will increase over time and provide a significant volume of health data of interest for future research involving the epidemiology, care pathways, trajectories, medical management, sociodemographic characteristics, and other aspects of patients with chronic pain.Conclusions: This work demonstrates that the mHealth tool eDOL is able to generate a considerable volume of data concerning the determinants and repercussions of chronic pain and their evolutions in a real-life context. The eDOL tool can incorporate numerous parameters to ensure the detailed characterization of patients with chronic pain for future research and pain management