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Author Correction: First external validity study of the Fagotti score in ovarian cancer
No full textInternational audienc
International Association of Oral and Maxillofacial Medicine (AIMOM) consensus on the management of osteochemonecrosis in 2024.
No full textInternational audienceDrug-related osteonecrosis of the jaws, more commonly called OsteoChemoNecrosis (OCN), is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS, 2014). Despite numerous studies on the subject, the International Association of Oral and Maxillofacial Medicine (AIMOM) deems it important to establish a consensus on the treatment of this maxillofacial bone condition.OCN is an oral complication in patients who meet the following criteria:-Ongoing or previous treatment with antiresorptive agents (bisphosphonates, anti-RANKL) or antiangiogenic agents.-Persistent bone exposure or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region for more than 8 weeks.-Absence of radiotherapy of the jaws or metastatic lesions.The staging of OCN incorporates patient-reported symptoms, clinical lesion assessment, and radiological imaging [1] (Fig. 1).-Stage 0: No clinical evidence of necrotic bone; non-specific clinical and/or radiological symptoms.-Stage 1 (Focal OCN) and Stage 2 (Diffuse OCN): patients may be asymptomatic (1a-2a) or symptomatic with pain/infection (1b-2b).-Stage 3: OCN is complicated by extra-oral fistula, spontaneous fractures, etc.The assessment of the risk of OCN as well as its treatment involve a multidisciplinary team including dentists, general practitioners, rheumatologists, oncologists, oral and maxillofacial surgeons, nurses, and the patient.Decisions regarding the cessation of antiresorptive treatment must balance the benefits and risks.Molecules at the origin of OCN are anti-RANKL (Denosumab) with 70.3% of cases reported in France between 2015 and 2020, amino-bisphosphonates (zoledronic acid (23%) and alendronate (8.7%)) especially when used in high doses for oncological treatment [2]. Whatever the molecules involved, the mandible is the most frequently affected area [2].Stopping Denosumab is often sufficient for spontaneous healing within 6 to 8 months due to its shorter half-life (28 days) compared to bisphosphonates (up to 10 years). Osteometabolic control, including the balance of biomarkers such as PTH, CTX, osteocalcin, vitamin D, and calcium, is recommended to optimize healing [3]. The use of PTH (Teriparatide) should be moderated or avoided in patients with active cancer [4]
Vécu des sages-femmes néo-diplomées sur leur première expérience d'une réanimation du nouveau-né en salle de naissance
No full textIntroduction: neonatal resuscitation is not a rare event and few students have been able to practice it. However, the midwife is most of the time the first person on site in case of resuscitation, she has the medico-legal responsibility for her actions. The main way to acquire a clinical look is frequent training in real life. New graduate midwives are therefore faced with this complex situation with little experience got on their work placement.Methods and population: this qualitative, descriptive and interpretative study was conducted with 12 midwives interviewed during semi-directed individual interviews. The main objective was to describe the decision-making process and the experience of a first neonatal resuscitation of new graduate midwives.Results and discussion: the study revealed that hands-on training, including high-fidelity simulation, is a real asset for understanding the real-life experience. New graduate midwives have a mixed opinion on their experience but the feeling of efficiency remains generally correct. The work environment is a determining factor, with the presence of colleagues that can create a balance within the team.Conclusion: the experience of a first neonatal resuscitation is associated with a multitude of components with the intervention of emotions on this subject. The new graduate midwife must therefore be effective in this emergency situation. A suggestion for improvement on the training field can be proposed by emphasizing the practice by checking the knowledge with the midwife.Introduction : la réanimation néonatale n’est pas un événement rare et peu d’étudiantes ont pu la pratiquer. Pourtant, la sage-femme est la plupart du temps la première personne sur place en cas de réanimation, elle a la responsabilité médico-légale de ses actes. Or, le moyen essentiel pour acquérir un regard clinique est la formation fréquente dans la vie réelle. Les sages-femmes néo-diplômées se retrouvent donc face à cette situation complexe avec peu d’expérience obtenue lors de leur stage.Méthode et population : cette étude qualitative, descriptive et interprétative a été réalisée auprès de 12 sages-femmes interrogées lors d’entretien individuel semi-dirigés. L’objectif principal était de décrire le processus de décision et le vécu d’une première réanimation néonatale des sages-femmes néo-diplômées.Résultats et discussion : l’étude a révélé que la formation pratique avec notamment la simulation haute-fidélité est un véritable atout pour appréhender le vécu. Les sages-femmes néo-diplômées ont un avis mitigé sur leur vécu mais le sentiment d’efficacité reste dans l’ensemble correct. L’environnement de travail est un facteur déterminant, entre autres avec la présence de collègues qui peut créer un équilibre au sein de l’équipe.Conclusion : le vécu d’une première réanimation néonatale est associé à une multitudes de composantes avec l’intervention des émotions sur ce sujet. La sage-femme néo-diplômée doit donc être efficace face à cette situation d’urgence. Une suggestion d’amélioration sur le terrain de stage lors de la formation peut être proposée en accentuant la pratique en vérifiant les acquis avec la sage-femme
La place de l’ergothérapeute dans l’accessibilité des lieux culturels
No full textIntroduction: the right to access culture is a fundamental right. Moreover, it is a meaningful activity for the overall population. In France, despite texts legislating an accessibility obligation for public-receiving establishments, in practice, they are few means of making them fully accessible and those that are, are often only partially accessible. The aim of this study was to answer the following questions: what is the role and impact of the occupational therapist in multidisciplinary projects to make cultural places accessible?Methods: three participants, including an occupational therapist, an occupational therapy student and an architecture student, participated in the Focus Group. The professional must have been involved in accessibility projects, of cultural places if possible and have received user feedback, while the students had to be interested by the accessibility and cultural places subjects. The Focus Group was organized around three topics by videoconferencing, over two hours. Each participant gave their free and informed consent to participate to the study and to be registered.Results: the association of skills and experiences specific to each professional facilitated a better integration of disabled people into so-called accessible establishments. Combined with a multidisciplinary approach, Universal Design is a good tool to improve the integration of everyone in society, particularly in cultural places. The occupational therapist is also a good asset for these accessibility projects thanks to his holistic, user centred approach, to his skills in environmental adaptation, and the models he can use.Discussion: this study enlightened us on the contribution of occupational therapists in a multidisciplinary team and on the ways they can intervene in an accessibility project in cultural places. For future studies, it could be interesting to do a comparative study between an accessibility project in a cultural place that received the intervention of an occupation therapist and another project that didn’t,to study its real added value.Introduction : le droit d’accès à la culture est un droit fondamental. De plus, il s’agit d’une activité significative pour la population générale. En France, malgré des textes légiférant une obligation d’accessibilité des établissements recevant du public, dans les faits, il y a peu de moyens pour les rendre entièrement accessibles et ceux qui le sont, ne le sont souvent que partiellement. Le but de cette étude était de répondre à la question suivante : quel est le rôle et l'impact de l'ergothérapeute dans les projets pluridisciplinaires visant à rendre les lieux culturels accessibles ?Méthodes : trois participants, dont un ergothérapeute, un étudiant en ergothérapie et un étudiant en architecture, ont participé au Focus Group. Les professionnels devaient avoir été impliqués dans des projets de mise en accessibilité, de lieu culturel si possible et avoir eu un retour d’expérience usager, tandis que les étudiants devaient être intéressés par les sujets de l’accessibilité et des lieux culturels. Le Focus Group s’est organisé autour de trois thématiques par visioconférence, sur une durée de 2h. Chaque participant a donné son accord libre et éclairé pour participer à l’étude et être enregistré.Résultats : l’association des compétences et expériences spécifiques à chaque professionnel a favorisé une meilleure intégration des personnes en situation de handicap dans les établissements dits accessibles. Associé à la pluridisciplinarité, le Design Universel est un bon outil pour favoriser l’intégration de tous dans la société, notamment dans les lieux culturels. L’ergothérapeute est aussi un atout dans ces projets d’accessibilité grâce à son approche holistique, centrée sur les usagers, ses compétences d’adaptation de l’environnement et aux modèles qu’il peut utiliser.Discussion : cette étude nous éclaire sur l’apport des ergothérapeutes dans une équipe pluridisciplinaire ainsi que sur les manières dont ils peuvent intervenir dans un projet de mise en accessibilité des lieux culturels. Pour de futures études, il pourrait être intéressant de faire une étude comparative entre un projet d’accessibilité de lieu culturel ayant reçu l’intervention d’un ergothérapeute et un autre projet n’en ayant pas reçu, afin d’en étudier sa réelle plus-value
Collaboration entre ergothérapeute et aides-soignants : maintien de l’autonomie et de l’indépendance des résidents en EHPAD
No full textIntroduction: as the population ages, the number of people entering in nursing homes is increasing. Maintaining the autonomy and independence of these people is therefore important. The aim of this dissertation is to highlight the importance of the collaboration between occupational therapists and caregivers in maintaining the independence and autonomy of frail elderly people in nursing home during transfers (getting up, sitting down, etc.).Method: a qualitative study was conducted through semi-structured interviews. 4 occupational therapists agreed to answer the questions. The interview was carried out by telephone.Results: the results show that the collaboration between occupational therapists and caregivers is not negligible to maintain the autonomy and independence of elderly people living in nursing homes. This is a common goal even if several constraints surely exist.Conclusion: maintaining the autonomy and independence of frail elderly living in nursing homes is a goal for all. Collaboration between occupational therapists and caregivers cannot but help maintain or improve the autonomy and independence of these people.Introduction : à mesure que la population vieillit, le nombre de personnes entrant en EHPAD augmente. Il est donc important de maintenir l’autonomie et l’indépendance de ces personnes. L’objectif de ce mémoire est de mettre en évidence l’importance de la collaboration entre les ergothérapeutes et les aides-soignants dans le maintien de l’indépendance et de l’autonomie des personnes âgées fragiles en EHPAD pendant les transferts (se lever, s’asseoir, etc.).Méthode : une étude qualitative a été menée au moyen d’entretiens semi-structurés. 3 ergothérapeutes ont accepté de répondre aux questions. L’entretien a été effectué par téléphone.Résultats : les résultats montrent que la collaboration entre les ergothérapeutes et les aides-soignants n’est pas négligeable pour maintenir l’autonomie et l’indépendance des personnes âgées qui vivent dans les EHPAD. C’est un objectif qu’ils ont tous en commun, même si plusieurs contraintes existent.Conclusion : le maintien de l’autonomie et de l’indépendance des personnes âgées fragiles vivant en EHPAD est un objectif pour tous. La collaboration entre les ergothérapeutes et les aides-soignants ne peut qu’aider à maintenir ou à améliorer l’autonomie et l’indépendance de ces personnes
Value of combining biological age with assessment of individual frailty to optimize management of cancer treated with targeted therapies: model of chronic myeloid leukemia treated with tyrosine kinase inhibitors (BIO-TIMER trial)
No full textInternational audienceAbstract Background In the era of targeted therapies, the influence of aging on cancer management varies from one patient to another. Assessing individual frailty using geriatric tools has its limitations, and is not appropriate for all patients especially the youngest one. Thus, assessing the complementary value of a potential biomarker of individual aging is a promising field of investigation. The chronic myeloid leukemia model allows us to address this question with obvious advantages: longest experience in the use of tyrosine kinase inhibitors, standardization of therapeutic management and response with minimal residual disease and no effect on age-related diseases. Therefore, the aim of the BIO-TIMER study is to assess the biological age of chronic myeloid leukemia or non-malignant cells in patients treated with tyrosine kinase inhibitors and to determine its relevance, in association or not with individual frailty to optimize the personalised management of each patient. Methods The BIO-TIMER study is a multi-center, prospective, longitudinal study aiming to evaluate the value of combining biological age determination by DNA methylation profile with individual frailty assessment to personalize the management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors. Blood samples will be collected at diagnosis, 3 months and 12 months after treatment initiation. Individual frailty and quality of life will be assess at diagnosis, 6 months after treatment initiation, and then annually for 3 years. Tolerance to tyrosine kinase inhibitors will also be assessed during the 3-year follow-up. The study plans to recruit 321 patients and recruitment started in November 2023. Discussion The assessment of individual frailty should make it possible to personalize the treatment and care of patients. The BIO-TIMER study will provide new data on the role of aging in the management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors, which could influence clinical decision-making. Trial registration ClinicalTrials.gov , ID NCT06130787; registered on November 14, 2023
DRAMES and DTA databases: Complementary tools to monitor drug-related deaths in France
No full textInternational audienceIntroductionThe DRAMES (décès en relation avec l’abus de médicaments et de substances) registry is a French database of drug-related deaths (medications or illicit drugs) among drug users. The DTA (décès toxiques par antalgiques) registry is a French database of analgesic-related deaths among people without a history of drug abuse. Both registries are based on the collection of data on deaths for which forensic toxicology experts have performed analyses.Material and methodsIn the present study, we included drug- and analgesic-related deaths occurring from January 2013 to December 2022 in France. Subject demographic characteristics and medical history, forensic autopsy findings and toxicology reports were evaluated.ResultsAmong drug users (DRAMES registry), opioids used alone or in combination were the main contributor to drug-related deaths in France, as they are in most countries. However, licit methadone was the leading cause of opioid-related deaths (ahead of heroin) during the study period. The main trend was the dramatic increase in cocaine-related mortality. Among medical users of analgesics (DTA registry), tramadol was the leading cause of deaths throughout this period.ConclusionA large-scale naloxone distribution program is urgently needed in France to prevent opioid overdoses, including among licit methadone users. However, our data do not support the hypothesis of an opioid crisis in France, although close monitoring is still required, particularly for oxycodone
