11 research outputs found
Impact d'un parcours personnalisé de soins des patients sous thérapies anti cancéreuses orales : étude monocentrique et point de vue des médecins généralistes
No full textLe développement des thérapies anticancéreuses par voie orale nécessite une prise en charge ambulatoire précoce des patients. Ces procédures procurent des bénéfices sur le plan médical, social et familial. Cependant ces traitements utilisent des molécules complexes aux effets secondaires et interactions médicamenteuses avec lesquels il faut être très vigilant. La continuité des soins et le renforcement de la coordination ville-hôpital, avec un rôle central du médecin traitant, est primordiale dans cette nouvelle organisation.Dans ce cadre, le CH d’Avignon propose aux patients atteints de cancers traités par thérapie orale le parcours THEO pour les suivre et accompagner lors de leur retour au domicile. Un classeur PPS spécifique des thérapies orales leur est remis.Nous avons effectué une étude descriptive, transversale, rétrospective et monocentrique afin d’évaluer l’impact du parcours THEO sur les hospitalisations et durées moyennes de séjour des patients soignés pour une même pathologie (12 pathologies, 91% hématologiques).L’objectif secondaire était de connaître le point de vue des médecins généralistes sur ce nouveau parcours de soins et l’outil « classeur PPS THEO ».La population de l’étude comportait 195 patients, traités par 12 classes médicamenteuses, dont 143 inclus dans le parcours THEO et 52 non inclus.Les résultats ne mettent pas en évidence de différence significative en ce qui concerne les facteurs d’hospitalisation des patients traités en hématologie.Pour les patients traités en oncologie, l’examen des moyennes laisse apparaître des tendances dans lesquelles le parcours THEO diminue la durée moyenne d’hospitalisation [4,8 jours (+/-7,0) contre 10,6 jours (+/-11,1) pour les non THEO ; p=0,26] ainsi que la durée totale d’hospitalisation [12,6 jours (+/-17,2) contre 23,4 jours (+/-22,6) pour les non THEO ; p=0,2]. On parle ici de petites populations. Ces tendances sont donc à confirmer sur une plus large cohorte.Concernant l’évaluation du parcours THEO, les 107 médecins généralistes de ces patients ont été contactés. 29 d’entre eux ont répondu, soit un taux de réponse de 27,1%.Plus de 40% de ces médecins ne connaissaient pas les thérapies ciblées avant d’avoir un patient traité par ce type de molécule. Dans 62% des cas, le classeur PPS n’a pas été présenté par le patient mais 100% des médecins traitant confirment son utilité dans la prise en charge de celui-ci. Le contenu du classeur PPS est jugé pertinent pour 86,2% d’entre eux. Outre le dossier communicant de cancérologie proposé depuis le premier Plan Cancer, les médecins généralistes portent de l’intérêt au développement d’autres outils, la fiche thérapeutique, la permanence téléphonique ou les applications digitales sécurisées.L’évolution des thérapies orales et de la prise en charge ambulatoire du cancer s’inscrit dans une démarche de bénéfices attendus en termes de santé, bien-être du patient et maitrise des coûts
Correction: Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey (Infection, (2024), 52, 3, (1125-1141), 10.1007/s15010-023-02169-7)
No full textAcknowledgements Members of the EPICOVIDEHA registry: Joseph Meletiadis, Florian Reizine, Jan Novák, Summiya Nizamuddin, Roberta Di Blasi, Alexandra Serris, Pavel Jindra, Sylvain Lamure, François Danion, Maria Chiara Tisi, Mario Virgilio Papa, Nurettin Erben, ľuboš DrgoňA, Nathan C. Bahr, Murtadha Al-Khabori, Ayten Shirinova, Jörg Schubert, Lisset Lorenzo De La Peña, José-Ángel Hernández-Rivas, Elena Busch, Josip Batinić, Giuseppe Sapienza, Mohammad Reza Salehi, Reham Abdelaziz Khedr, Nina Khanna, Baerbel Hoell-Neugebauer, Ana Groh, Eleni Gavriilaki, Rita Fazzi, Rémy Duléry, Roberta Della Pepa, Mario Delia, Nicola Coppola, Maria Calbacho, Darko Antić, Hossein Zarrinfer, Ayel Yahia, Vivien Wai-Man, Ana Torres-TIenza, Alina Daniela Tanasa, Andrés Soto-Silva, Laura Serrano, Enrico Schalk, Ikhwan Rinaldi, Gaëtan Plantefeve, Monica Piedimonte, Maria Enza Mitra, Carolina Miranda-Castillo, Jorge Loureiro-Amigo, Ira Lacej, Martin Kolditz, María-Josefa Jiménez-Lorenzo, Guillemette Fouquet, Omar-Francisco Coronel-Ayala, Mathias Brehon, Panagiotis Tsirigotis, Anastasia Antoniadou, Gina Varricchio, Maria Vehreschild, Agostino Tafuri, José-María Ribera-Santa Susana, Joyce Marques De Almeida, María Fernández-Galán, Avinash Aujayeb, Athanasios Tragiannidis, Malgorzata Mikulska, Sein Win, Elizabeth De Kort, Hans-Beier Ommen, Donald C. Vinh, Hans Martin Orth, Sandra Malak, Przemyslaw Zdziarski, Modar Saleh, Chi Shan Kho, Fabio Guolo, M. Mansour Ceesay, Christopher H. Heath, Sergey Gerasymchuk, Monica Fung, Maximilian Desole, Erik De Cabo, Tania Cushion, Fazle Rabbi Chowdhury, Louis Yi Ann Chai, Fevzi Altuntaş, Charlotte Flasshove. The original article has been updated
Correction: Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey (Infection, (2024), 52, 3, (1125-1141), 10.1007/s15010-023-02169-7)
No full textAcknowledgements Members of the EPICOVIDEHA registry: Joseph Meletiadis, Florian Reizine, Jan Novák, Summiya Nizamuddin, Roberta Di Blasi, Alexandra Serris, Pavel Jindra, Sylvain Lamure, François Danion, Maria Chiara Tisi, Mario Virgilio Papa, Nurettin Erben, ľuboš DrgoňA, Nathan C. Bahr, Murtadha Al-Khabori, Ayten Shirinova, Jörg Schubert, Lisset Lorenzo De La Peña, José-Ángel Hernández-Rivas, Elena Busch, Josip Batinić, Giuseppe Sapienza, Mohammad Reza Salehi, Reham Abdelaziz Khedr, Nina Khanna, Baerbel Hoell-Neugebauer, Ana Groh, Eleni Gavriilaki, Rita Fazzi, Rémy Duléry, Roberta Della Pepa, Mario Delia, Nicola Coppola, Maria Calbacho, Darko Antić, Hossein Zarrinfer, Ayel Yahia, Vivien Wai-Man, Ana Torres-TIenza, Alina Daniela Tanasa, Andrés Soto-Silva, Laura Serrano, Enrico Schalk, Ikhwan Rinaldi, Gaëtan Plantefeve, Monica Piedimonte, Maria Enza Mitra, Carolina Miranda-Castillo, Jorge Loureiro-Amigo, Ira Lacej, Martin Kolditz, María-Josefa Jiménez-Lorenzo, Guillemette Fouquet, Omar-Francisco Coronel-Ayala, Mathias Brehon, Panagiotis Tsirigotis, Anastasia Antoniadou, Gina Varricchio, Maria Vehreschild, Agostino Tafuri, José-María Ribera-Santa Susana, Joyce Marques De Almeida, María Fernández-Galán, Avinash Aujayeb, Athanasios Tragiannidis, Malgorzata Mikulska, Sein Win, Elizabeth De Kort, Hans-Beier Ommen, Donald C. Vinh, Hans Martin Orth, Sandra Malak, Przemyslaw Zdziarski, Modar Saleh, Chi Shan Kho, Fabio Guolo, M. Mansour Ceesay, Christopher H. Heath, Sergey Gerasymchuk, Monica Fung, Maximilian Desole, Erik De Cabo, Tania Cushion, Fazle Rabbi Chowdhury, Louis Yi Ann Chai, Fevzi Altuntaş, Charlotte Flasshove. The original article has been updated.</p
Law in a Gaelic Utopia: Perceptions of Brehon Law in Nineteenth and Early Twentieth Century Ireland
No full textIt is well known that the term “utopia” was invented by a lawyer. The word was used by Sir Thomas More as the title of his famous work describing an ideal commonwealth situated on a fictitious island in the New World. “Utopia” literally means “nowhere” or “no place” in Latin but since the publication of More’s book in 1516 the word has acquired a different meaning in the English language. It is now generally understood to mean “good place” or “ideal place” with connotations of impracticality and unattainability.
Yet, in a broad sense the word “utopia” can mean much more than an imaginary idyllic land. In many ways a utopia represents an expression of desire on the part of its author. Following this reasoning, one might say that utopia is little more than a means of expressing ideal dreams of human happiness. Taken in this context, a utopia need not be a place at all. Alternatively, a utopia can be defined in terms of time. For many people this means an ideal future. Much of the genre of science fiction is dependent on utopias of this sort. For other people utopia lies in the past, in the idea of the Golden Age, a concept that is probably common to most cultures
The Colonization and Representation of Gaelic Culture: Elizabethans in Sixteenth Century Ireland
No full textabstract: Culture played an intrinsic role in the conquest of Ireland in the sixteenth century, and the English colonial project, so often described in political and military terms, must be reexamined in this context. By examining sixteenth century spatial and literary representations of Ireland and Irish culture it becomes evident that the process described by Timothy Mitchell, called enframement, was being imposed upon the Irish. Enframement is the convergence of two aspects of power, the metaphysical and the microphysical. Metaphysical power worked through maps and literature to bring order in the conceptual realm, allowing the English to imagine Ireland as they wished it to be. Microphysical power created order in the material world, by physically changing the appearance of the landscape and people to conform to England's laws and norms. The English justified their policy of colonization by representing Ireland and Gaelic culture as wild or barbarous, and hoped to achieve their colonial ambition by physically coercing the Irish into adopting the "superior" English culture.
When the Irish continued to rebel against English rule, the colonizers began employing methods of extreme violence to subdue the Gaelic people. At the same time, they began to practice more extreme forms of cultural colonization by attacking those aspects of Gaelic culture which most resisted conformity to English standards of civility. The Gaelic legal system, called Brehon law, redistributive inheritance, cattle herding and traditional forms of Irish dress were denigrated to assert English authority over the Irish people. English fear of the negative effects of Gaelic culture were exemplified by the Anglo-Irish lords, who were originally of English descent, but had "degenerated" into Irish barbarians through the use of Gaelic culture. This retrograde process could also occurred when an English person practiced marriage, childbirth, wet-nursing or fosterage with Irish persons. These interactions, and the consequences which came from them, were often described in terms of infection and disease. Thus culture, operating on multiple levels, and how that culture was represented, became a powerful site for colonial power to operate.Dissertation/ThesisMasters Thesis History 201
A machine learning approach to identify patients at risk for long-term consequences after pulmonary embolism
No full textPulmonary embolism (PE) can result in long-term sequelae, such as post-PE syndrome, including persistent dyspnea and chronic thromboembolic pulmonary hypertension (CTEPH). Existing prediction tools for severe post-PE complications lack sensitivity and specificity. This study aimed to develop a machine learning model to identify patients at risk for long-term consequences after PE. Using data from the RIETE registry, the largest prospective international PE registry, we developed supervised machine learning models to identify patients at increased risk of CTEPH and post-PE syndrome. Our approach involved data preprocessing, model training via random forest algorithm, and validation through Monte-Carlo cross-validation. The performance of the CTEPH prediction model was benchmarked against an existing score. Of the 57,981 PE patients in the RIETE registry, 5,217 were eligible for inclusion. Median age was 68 years, with 50.6% men. Machine learning was based on 111 predictor variables, with 171 patients (3.3%) developing CTEPH. The CTEPH model demonstrated good performance with an AUC of 0.74 (95%CI: 0.73-0.75), significantly outperforming the existing CTEPH prediction score (0.57; 0.54-0.61). Additionally, 1,310 (25.1%) patients were defined as having post-PE syndrome six months after index PE. The post-PE syndrome model showed poorer performance with an AUC of 0.62 (0.61-0.62). Key predictor variables across both models included chest pain at presentation, PE location, troponin, side of clot, and dyspnea at presentation. Machine learning models show promise in predicting CTEPH but are less effective for post-PE syndrome. Future refinement, including integrating imaging data, is necessary to improve predictive performance and clinical utility.
© 2025. The Author(s)
Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022
No full textBackground: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable. © 2024 The Author(s
Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022
No full textBackground: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable
Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings
No full textObjectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. Results: The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusion: These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts
Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey
No full textInternational audienc
