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Geslain G, Cointe A, Naudin J, Dauger S, Poey N, Pages J, Le Roux E, Bonacorsi S. Diagnostic Accuracy of Blind Bronchial Sample Testing by BioFire Pneumonia plus Panel in Pediatric Intensive Care Unit Patients and Its Impact in Early Adaptation of Antimicrobial Therapy: A Prospective Observational Study. Pediatr Infect Dis J 2024:00006454-990000000-00827. [PMID: 38621162 DOI: 10.1097/inf.0000000000004349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Community-acquired and nosocomial lower-respiratory-tract infections in critically ill pediatric patients require early appropriate antibiotic therapy to optimize outcomes. Using blind bronchial samples, we assessed the diagnostic performance of the rapid-multiplex polymerase chain reaction (PCR) assay BioFire Pneumonia plus Panel vs. reference standard culturing with antimicrobial susceptibility testing. METHODS For this prospective observational study in a single pediatric intensive care unit, we included consecutive patients younger than 18 years admitted for suspected community-, hospital- or ventilator-associated pneumonia in 2021-2022. Sensitivity, specificity, positive predictive value and negative predictive value of the multiplex PCR assay were determined. The kappa coefficient was computed to assess agreement, and univariate analyses were done to identify factors associated with discrepancies between the 2 diagnostic methods. RESULTS Of the 36 included patients (median age, 1.4 years; interquartile range, 0.2-9.2), 41.7%, 27.8%, and 30.5% had community-, hospital- and ventilator-associated pneumonia, respectively. The overall κ was 0.74, indicating good agreement. Overall, the sensitivity of the multiplex PCR assay was 92% (95% CI: 77%-98%) and specificity 95% (95% CI: 92%-97%), with variations across microorganisms. The median time from sample collection to antimicrobial susceptibility test results was 3.9 (2.5-15) hours with the multiplex PCR assay and 60.5 (47.6-72.2) hours with the reference technique. CONCLUSION The BioFire Pneumonia plus Panel used to test blind bronchial samples had satisfactory diagnostic performance in critically ill pediatric patients. The rapid results provided by this test may improve the appropriateness of antimicrobial therapy and help minimize the use of antibiotics.
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Affiliation(s)
- Guillaume Geslain
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
| | - Aurélie Cointe
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
- Department of Microbiology, Escherichia coli National Reference Center, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérôme Naudin
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Dauger
- From the Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Paris Cité University, NeuroDiderot, INSERM UMR 1141, Paris, France
| | - Nora Poey
- Department of General Paediatrics, Paediatric Infectious Diseases and Internal Medicine, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; and
| | - Justine Pages
- Clinical Epidemiology Unit, INSERM CIC 1426, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Enora Le Roux
- Clinical Epidemiology Unit, INSERM CIC 1426, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Bonacorsi
- Paris Cité University, IAME, INSERM UMR 1137, Paris, France
- Department of Microbiology, Escherichia coli National Reference Center, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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Le Roux E, Meunier-Beillard N, Simonel C, Omorou A, Lejeune C. Spouses of patients treated for colon cancer: identification of key caregiver skills using the Delphi method. Support Care Cancer 2024; 32:263. [PMID: 38564042 DOI: 10.1007/s00520-024-08456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Spouses are often the front-line caregivers for colon cancer patients. Providing this support requires a particular set of coping skills. Our objective was to identify key skills that healthcare and medico-social sector professionals could assess in routine practice that would allow them to propose appropriate support to spouses who are accompanying colon cancer patients in their care pathway. METHODS An online two-round Delphi study was conducted among French colon cancer patients, spouses and professionals. The content of the Delphi study was developed from a previously published qualitative study. RESULTS In the first round of the study, 63% of the participants were professionals (n = 40), 19% spouses (n = 12) and 17% patients (n = 11). In the second round, they were respectively 55% (n = 22), 22% (n = 9) and 22% (n = 9). Twenty-seven of the 75 proposed skills were consensually identified as key skills. Nine were related to emotional and psychological well-being, six to social relations, four to organisation, five to health and three to domestic domains. The three most consensual skills (≥ 90% agreement) for spouses were (1) helping the tired patient in everyday life, (2) stimulating the patient to prevent him/her from giving up and (3) limiting one's amount of personal time to care for the patient. CONCLUSION The study identified the key skills needed by spouses of patients being treated for colon cancer. Better awareness of these skills among professionals would enable them to offer tailored support to help patients and spouses maintain their physical and emotional well-being.
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Affiliation(s)
- Enora Le Roux
- Université Paris Cité, Inserm, ECEVE, F-75010, Paris, France
- AP-HP Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | - Nicolas Meunier-Beillard
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l'Innovation, USMR, Dijon, France
| | - Caroline Simonel
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Abdou Omorou
- Université de Lorraine, CHRU Nancy, Inserm CIC 1433 Clinical Epidemiology, Nancy, France
- 1319 UMR INSPIIRE, Inserm, Université de Lorraine, Nancy, France
- The French National Platform Quality of Life and Cancer, Nancy, France
| | - Catherine Lejeune
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.
- Inserm, Université Bourgogne-Franche-Comté, UMR 1231, EPICAD, Dijon, France.
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Bayart J, Drouet J, Peycelon M, Mariani P, Le Roux E, Husain M, Agar J, Bonacorsi S, Caseris M. Temocillin for febrile urinary tract infections caused by ESBL-producing Enterobacteriaceae in children: a monocentric exposed/non-exposed study. J Antimicrob Chemother 2024; 79:918-922. [PMID: 38412330 DOI: 10.1093/jac/dkae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To compare the efficacy of temocillin with standard of care (SOC) for treatment of ESBL-producing Enterobacteriaceae (ESBL-E) febrile urinary tract infection (ESBL-E FUTI) in children. METHODS A monocentric retrospective study of children hospitalized with confirmed ESBL-E FUTI from January 2015 to May 2022 was conducted, comparing clinical cure and a 3 month relapse between two groups of patients: 'exposed' patients (EP) and 'non-exposed' patients (NEP) to temocillin. EP received temocillin for at least 3 days. They were matched (1:1 ratio) on age group, sex and presence of uropathy with NEP who received SOC antibiotic therapy. RESULTS Thirty-six temocillin-treated children (EP) were matched with 36 SOC children (NEP); 72.2% were under 2 years old (n = 52) and 75.0% had a congenital uropathy (n = 54). EPs had more FUTI history (97.2%, n = 35) than NEPs (61.1%, n = 22) (P < 0.01). Clinical cure rate was 98.6% overall, with no difference between the two groups, as for the FUTI relapse rate, which was 37.1% for EPs versus 27.8% for NEPs (P = 0.45). In bivariate analyses, factors associated with relapses were congenital uropathy (91.3% versus 66.7%, P = 0.04) and subtypes of uropathy, with refluxing uropathy and posterior urethral valves being the more prevalent. Median duration of hospitalization was longer in the EPs (8.0 versus 5.0 days) (P = 0.01). CONCLUSIONS The high clinical cure rate and comparable outcomes suggest that temocillin may be an effective therapeutic alternative to standard treatment for ESBL-E FUTI in children.
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Affiliation(s)
- Jules Bayart
- Service de Pédiatrie Générale, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Juliette Drouet
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, APHP North-Université Paris Cité. Robert-Debré University Hospital, Centre de Référence des Malformations Rares des Voies Urinaires (MARVU), ERN eUROGEN accredited center, Paris, France
| | - Patricia Mariani
- Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Enora Le Roux
- Unité de Recherche Clinique, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Maya Husain
- Service de Pédiatrie Générale, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Julien Agar
- Service de Pharmacie à Usage Intérieur, Hôpital Robert-Debré, AP-HP, Paris, France
| | | | - Marion Caseris
- Service de Pédiatrie Générale, Hôpital Robert-Debré, AP-HP, Paris, France
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Labouret M, Trebossen V, Ntorkou A, Bartoli S, Aubart M, Auvin S, Bader-Meunier B, Baudouin V, Corseri O, Dingulu G, Ducrocq C, Dumaine C, Elmaleh M, Fabien N, Faye A, Hau I, Hentgen V, Kwon T, Meinzer U, Ouldali N, Parmentier C, Pouletty M, Renaldo F, Savioz I, Benoist JF, Le Roux E, Ellul P, Melki I. Juvenile neuropsychiatric systemic lupus erythematosus: A specific clinical phenotype and proposal of a probability score. Lupus 2024; 33:328-339. [PMID: 38315109 DOI: 10.1177/09612033241229022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.
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Affiliation(s)
- Mathilde Labouret
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Alexandra Ntorkou
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Sophie Bartoli
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Mélodie Aubart
- Paediatric Neurology Department, Necker-Enfants Malades Hospital, University of Paris-Cité, AP-HP, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, French Institute of Health and Medical Research U1163, Imagine Institute, University of Paris-Cité, Paris, France
| | - Stéphane Auvin
- Department of Paediatric Neurology, Center for Rare Epilepsies & Epilepsy Unit, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
| | - Véronique Baudouin
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Cécile Dumaine
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Monique Elmaleh
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Nicole Fabien
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- UMR1123 Inserm, Université Paris Cité, Paris, France
| | - Isabelle Hau
- Department of General Paediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Véronique Hentgen
- Department of General Paediatrics, French Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Versailles Hospital, Le Chesnay, France
| | - Théresa Kwon
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Cyrielle Parmentier
- Department of Paediatric Nephrology, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Florence Renaldo
- Department of Paediatric Neurology, Center for Neurogenetic Diseases, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Isabelle Savioz
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Reference Centre for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Université Paris Saclay, UFR Pharmacie, France
| | - Enora Le Roux
- UMR1123 Inserm, Université Paris Cité, Paris, France
- Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Robert Debré Mother-Child University Hospital, Nord-Université Paris Cité, AP-HP, Paris, France
| | - Pierre Ellul
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163, Université Paris Cité, Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
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Pomey MP, Le Roux E, Nadon N, Perron J, Barry A, Bémeur C, Poder TG, Duford F, Laviolette L, Tétrault-Lassonde J, Vialaron C, Escalona MJ, Normandin L, Huard G, Girardin C, Rose C, Malas K, Ouellet D, Vincent C. Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e54440. [PMID: 38517464 PMCID: PMC10998179 DOI: 10.2196/54440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l'Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects. OBJECTIVE This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention's cost-effectiveness. METHODS Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study. RESULTS In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited. CONCLUSIONS The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54440.
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Affiliation(s)
- Marie-Pascale Pomey
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département de gestion, évaluation et politique de santé, école de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre d'excellence sur le partenariat avec les patients et le public, Montreal, QC, Canada
| | - Enora Le Roux
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France
- AP-HP.Nord-Université Paris Cité, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | - Nathalie Nadon
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Jessie Perron
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Regroupement cardio-vasculaire, hépatologie et transplantation, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Angèle Barry
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Axe immunopathologie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Réseau transplantation et cliniques externes de transplantation et d'hépatologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Chantal Bémeur
- Axe Cardiométabolique, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Thomas G Poder
- Département de gestion, évaluation et politique de santé, école de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'IUSMM, CIUSSS de l'Est de l'Île de Montréal, Montreal, QC, Canada
| | - Fernand Duford
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Louise Laviolette
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Johanne Tétrault-Lassonde
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Cécile Vialaron
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Manuel J Escalona
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Louise Normandin
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Geneviève Huard
- Axe immunopathologie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Catherine Girardin
- Axe immunopathologie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Christopher Rose
- Axe Cardiométabolique, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Kathy Malas
- Carrefour de l'Innovation, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Denis Ouellet
- Direction de la biovigilance et de la biologie médicale, Ministère de la Santé et des Services sociaux du Québec, Montreal, QC, Canada
| | - Catherine Vincent
- Axe immunopathologie, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Département d'hépatologie, Centre hospitalier universitaire de Montréal (CHUM), Montreal, QC, Canada
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6
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Pitrat B, Turpin A, Peyret E, Hamonniere T, Drain A, Maatoug R, Le Roux E. Mobile app measuring sleep and behaviors: A trial in adolescents with addiction. Encephale 2024:S0013-7006(23)00214-2. [PMID: 38311486 DOI: 10.1016/j.encep.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/08/2023] [Accepted: 11/02/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The smartphones generalisation allows the development of attractive "real-life" monitoring tools for care and research enabling the measurement of addictive behaviours and comorbidities such as sleep disorders. The study objective was to assess the interest of a mobile app collecting such information among adolescents with addictive behaviours in order to enhance the availability of behavioural data in consultation. METHODS An open label randomised pilot study was held along two parallel arms. The patients randomised to the intervention group (n=18) used a mobile app to provide daily data for 15 days relating to their sleep and their behaviour (addictive behaviours with or without substances). The patients in the control group (n=18) used a paper diary allowing the collection of the same data, only the medium differed. RESULTS The patients' median age was 16 years [15.0-16.5]. A median of 67% and 10% of the expected information was completed respectively in the intervention and control groups during the 15 days of follow-up and could be used in consultation (P=0.08). The patient's knowledge, attitudes, intentions to change, behaviour change and seeking help related to the use of the diaries appeared higher in the intervention group (20.5/30) than in the control group (11/20). CONCLUSION This study described the high patient compliance with the data collection by means of the app. The diary app seems to have been more impactful for patients than the paper diary. This app could represent an important tool to improve the therapeutic alliance and care due to a better knowledge of the behaviours on the part of the clinician but also a better awareness of the patients themselves.
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Affiliation(s)
- Benjamin Pitrat
- Child and Adolescent Psychiatry Department, Robert-Debré Hospital, AP-HP Nord-université de Paris, 75019 Paris, France
| | - Agathe Turpin
- Clinical Epidemiology Unit, Robert-Debré Hospital, AP-HP Nord-université de Paris, Inserm, CIC 1426, Paris, France
| | - Emmanuelle Peyret
- Child and Adolescent Psychiatry Department, Robert-Debré Hospital, AP-HP Nord-université de Paris, 75019 Paris, France
| | - Tristan Hamonniere
- LPPS, université de Paris, 92100 Boulogne-Billancourt, France; Clinique médicale et pédagogique Dupré, Fondation santé des étudiants de France, Sceaux, France
| | | | - Redwan Maatoug
- Service de psychiatrie adulte de la Pitié-Salpêtrière, institut du cerveau (ICM), AP-HP, Sorbonne université, 75013 Paris, France
| | - Enora Le Roux
- Clinical Epidemiology Unit, Robert-Debré Hospital, AP-HP Nord-université de Paris, Inserm, CIC 1426, Paris, France; ECEVE UMR 1123, Inserm, université de Paris, Paris, France.
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Morsa M, Perrin A, David V, Rault G, Le Roux E, Alberti C, Gagnayre R, Pougheon Bertrand D. Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research. JMIR Form Res 2024; 8:e38064. [PMID: 38261372 PMCID: PMC10848132 DOI: 10.2196/38064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/01/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. OBJECTIVE This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users' point of view to detect PEx early and treat it. This study focused on the patients' experiences as the first and main users of home monitoring. METHODS A qualitative study was conducted to explore patients' and professionals' experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. RESULTS A total of 20 patients completed the study. Three main categories emerged from the patients' verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients' learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. CONCLUSIONS We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. TRIAL REGISTRATION ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028.
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Affiliation(s)
- Maxime Morsa
- Adaptation, Resilience and Change Research Unit, University of Liège, Liège, Belgium
- Laboratory Health Promotion and Education (UR3412), Sorbonne Paris North University, Bobigny, France
| | - Amélie Perrin
- Paediatrics CF Centre, Nantes University Hospital, Nantes, France
| | - Valérie David
- Paediatrics CF Centre, Nantes University Hospital, Nantes, France
| | - Gilles Rault
- Laboratoire Educations et Pormotion de la santé, Université Sorbonne Paris Nord, Bobigny, France
| | - Enora Le Roux
- Institut National de la Santé et de la Recherche Médicale (UMR 1123 ECEVE), Université de Paris, Paris, France
- Unit of Clinical Epidemiology (CIC-EC 1426), Hôpital Universitaire Robert Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Corinne Alberti
- Institut National de la Santé et de la Recherche Médicale (UMR 1123 ECEVE), Université de Paris, Paris, France
- Unit of Clinical Epidemiology (CIC-EC 1426), Hôpital Universitaire Robert Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Rémi Gagnayre
- Laboratory Health Promotion and Education (UR3412), Sorbonne Paris North University, Bobigny, France
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Ouldali N, Le Roux E, Faye A, Leblanc C, Angoulvant F, Korb D, Delcour C, Caula C, Wohrer D, Rybak A, Delafoy M, Carrié C, Strullu M, Oualha M, Levy R, Mimoun C, Griffon L, Nuzzo A, Eyraud C, Levy M, Ellul P. Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study. PLoS One 2023; 18:e0294022. [PMID: 38060541 PMCID: PMC10703252 DOI: 10.1371/journal.pone.0294022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE. METHODS We conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program. RESULTS Twenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (p<0.0001 for both skills). Students from the intervention group performed better in a summative OSCE that assessed the structuring of a medical history (median mark 16/20, IQR [15; 17] versus 14/20, [13; 16], respectively, p = 0.012). Adjusted analyses gave similar results. The students from the intervention group reported a feeling of improved competence and a reduced level of stress at the time of the evaluation, supported by the qualitative data showing the benefits of the formative sessions. CONCLUSION Our findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program.
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Affiliation(s)
- Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Paris Cité University, Paris, France
- Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, Quebec, Canada
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Paris Cité University, INSERM UMR 1137, IAME (Infection, Antimicrobials, Modelling, Evolution), Paris, France
| | - Enora Le Roux
- Paris Cité University, INSERM UMR 1137, IAME (Infection, Antimicrobials, Modelling, Evolution), Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Paris Cité University, Paris, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Claire Leblanc
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - François Angoulvant
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Paris Cité University, Paris, France
- INSERM, Cordeliers Research Center, UMRS 1138, Sorbonne Université, Université Paris Cité, Paris, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré University Hospital, Paris University, Paris, France
- Paris University, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Clémence Delcour
- Department of Obstetrics and Gynecology, Robert Debré University Hospital, Paris University, Paris, France
| | - Caroline Caula
- Pediatric Emergency Department, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Delphine Wohrer
- Pediatric Emergency Department, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Alexis Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Pediatric Emergency Department, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Manon Delafoy
- Department of Hematology, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Claire Carrié
- Department of Hematology, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Marion Strullu
- Department of Hematology, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker University Hospital, Paris Cité University, Paris, France
| | - Romain Levy
- Immunology-Hematology and Rheumatology Department, Necker University Hospital, Paris Cité University, Paris, France
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, Paris Cité University, Paris, France
| | - Lucie Griffon
- Pediatric Non-Invasive Ventilation and Sleep Unit, Necker Hospital, Paris Cité University, Paris, France
| | - Alexandre Nuzzo
- Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Paris Cité University, Paris, France
| | - Clara Eyraud
- Paris Cité University, INSERM UMR 1137, IAME (Infection, Antimicrobials, Modelling, Evolution), Paris, France
| | - Michael Levy
- Pediatric Intensive Care Unit, Robert Debré University Hospital, Paris Cité University, Paris, France
| | - Pierre Ellul
- Child and Adolescent Psychiatry Department, Robert Debré University Hospital, Paris Cité University, Paris, France
- INSERM, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne University, Paris, France
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Mechraoui A, Ithier G, Pages J, Haouari Z, Ali L, Bonnard A, Benkerrou M, Missud F, Koehl B, Holvoet L, Le Roux E, Brousse V. Early splenectomy in a large cohort of children with sickle cell anemia: risks and consequences. Haematologica 2023; 108:3409-3417. [PMID: 37226714 PMCID: PMC10690920 DOI: 10.3324/haematol.2022.282556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
In children with sickle cell anemia (SCA), early splenic complications can require splenectomy, but the benefit-to-risk ratio and the age at which splenectomy may be safely performed remain unclear. To address this question, we analyzed the rate of post-splenectomy events in children with SCA splenectomized between 2000-2018 at the Robert Debré University Hospital, Paris, France. A total of 188 children underwent splenectomy, including 101 (11.9%) from our newborn cohort and 87 referred to our center. Median (Q1-Q3) age at splenectomy was 4.1 years (range 2.5-7.3 years), with 123 (65.4%) and 65 (34.6%) children splenectomized at ≥3 years of age or <3 years of age, respectively. Median postsplenectomy follow-up was 5.9 years (range 2.7-9.2 years) yielding 1192.6 patient-years (PY) of observation. Indications for splenectomy were mainly acute splenic sequestration (101 [53.7%]) and hypersplenism (75 [39.9%]). All patients received penicillin prophylaxis; 98.3% received 23-valent polysaccharic pneumococcal (PPV-23) vaccination, and 91.9% a median number of 4 (range 3-4) pneumococcal conjugate vaccine shots prior to splenectomy. Overall incidence of invasive bacterial infection and thrombo-embolic events were 0.005 / PY (no pneumococcal infections) and 0.003 / PY, respectively, regardless of age at splenectomy. There was an increased proportion of children with cerebral vasculopathy in children splenectomized <3 years of age (0.037 / PY vs. 0.011 / PY; P<0.01). A significantly greater proportion of splenectomized than non-splenectomized children were treated with hydroxycarbamide (77.2% vs. 50.1%; P<0.01), suggesting a more severe phenotype in children who present spleen complications. If indicated, splenectomy should not be delayed in children, provided recommended pneumococcal prophylaxis is available. Spleen complications in childhood may serve as a marker of severity.
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Affiliation(s)
- Aimen Mechraoui
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris
| | - Ghislaine Ithier
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris
| | - Justine Pages
- Clinical Epidemiology Unit, Robert Debré University Hospital, Inserm, CIC 1426, F-75019, Paris
| | - Zinedine Haouari
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris
| | - Liza Ali
- Service de Chirurgie, APHP, Hôpital Universitaire Robert Debré, F-75019 Paris
| | - Arnaud Bonnard
- Service de Chirurgie, APHP, Hôpital Universitaire Robert Debré, F-75019 Paris
| | - Malika Benkerrou
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris, France; Inserm, UMR-1123 ECEVE, Université Paris Cité, Paris
| | - Florence Missud
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris
| | - Berengère Koehl
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris, France; Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris
| | - Laurent Holvoet
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris
| | - Enora Le Roux
- Clinical Epidemiology Unit, Robert Debré University Hospital, Inserm, CIC 1426, F-75019, Paris, France; Inserm, UMR-1123 ECEVE, Université Paris Cité, Paris
| | - Valentine Brousse
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, F-75019 Paris, France; Université Paris Cité and Université des Antilles, Inserm, BIGR, F-75015 Paris.
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Le Roux E, Bourmaud A, Jacquin P, Mahlaoui N, Guffroy A, Belot A, Romier M, Sattoe J, Van Staa A, Alberti C, Mellerio H, Dumas A. Clinics dedicated to transition preparation for adolescents and young adults with chronic conditions: Factors influencing their use. Arch Pediatr 2023; 30:617-619. [PMID: 37704524 DOI: 10.1016/j.arcped.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023]
Abstract
To pool resources and reduce inequalities in access to transition preparation for patients, transition clinics were created in France. They are places in hospitals, independent of the usual care departments, offering multiple resources and services for adolescents and their parents. Of the 24 physicians from care departments who were surveyed, half of them do not use transition clinics. The implementation of transition clinics in hospitals did not lead to their adoption by the care departments that needed the most support for transition preparation of their patients. A strategy improving adoption is needed to allow transition clinics to reduce inequalities.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France; AP-HP. Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, F-75019 Paris, France; Groupe de Recherche en Médecine et Santé de l'Adolescent, 75014 Paris, France.
| | - Aurélie Bourmaud
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France; AP-HP. Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, F-75019 Paris, France
| | - Paul Jacquin
- Groupe de Recherche en Médecine et Santé de l'Adolescent, 75014 Paris, France; Plateforme de transition « Ad'venir », Unité de médecine d'adolescent, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nizar Mahlaoui
- Centre de Reference Déficits Immunitaires Héréditaires (CEREDIH), Unité d'Immunologie, Hématologie et Rhumatologie pédiatrique; Plateforme de Transition « La Suite », Hôpital universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Aurélien Guffroy
- Espace adolescents jeunes adultes, Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Mélanie Romier
- Espace « Pass'âge », Hospices Civils de Lyon, Lyon, France
| | - Jane Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands
| | - AnneLoes Van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands
| | - Corinne Alberti
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France; AP-HP. Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, F-75019 Paris, France
| | - Hélène Mellerio
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France; Groupe de Recherche en Médecine et Santé de l'Adolescent, 75014 Paris, France; Plateforme de transition « Ad'venir », Unité de médecine d'adolescent, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agnès Dumas
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
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Pasqualini C, Cohen L, Le Roux E, Caseris M, Faye A. Tuberculosis in 0-5-year-old children following TB contact investigations: a retrospective study in a low burden setting. Front Pediatr 2023; 11:1145191. [PMID: 37404556 PMCID: PMC10315530 DOI: 10.3389/fped.2023.1145191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction We assessed the risk of tuberculosis (TB), the management and the outcomes of 0-5-year-old children after TB contact investigations in a low-burden setting. Method All 0-5-year-old children who attended the TB clinic of Robert Debre Hospital, Paris, France, for a TB contact investigation between June 2016 and December 2019 were included in this retrospective study. The risk factors for TB were assessed using univariate and multivariate analyses. Results A total of 261 children were included. Forty-six (18%) had TB, including 37 latent tuberculosis infections (LTBIs) and 9 active TB diseases. The prevalence of TB was 21% among high-risk contacts, i.e., household or close contacts and regular or casual contacts. There was no TB among intermediate- or low-risk contacts (0/42). Living under the same roof with (OR: 19.8; 95% CI: 2.6-153), the BCG vaccine (OR: 3.2; 95% CI: 1.2-8.3), contact duration >40 h (OR: 7.6; 95% CI: 2.3-25.3) and sleeping in the room of the index case (OR: 3.9; 95% CI: 1.3-11.7) were independently associated with TB. The BCG vaccine was no longer associated when the analysis was restricted to interferon gamma release assay results. Among children without initial LTBI, antibiotic prophylaxis was not prescribed for 2-5-year-old children or for 32/36 (89%) of 0-2-year-old children who had intermediate- or low-risk contact. Overall, none of these children experienced TB. Conclusion In our low prevalence setting, the risk of TB in 0-5-year-old children following a household or close contact was high. Further studies are needed to better assess prophylaxis recommendations in intermediate or low risk contact.
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Affiliation(s)
- Cassandre Pasqualini
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Robert Debré, Paris, France
| | - Laure Cohen
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Robert Debré, Paris, France
| | - Enora Le Roux
- AP-HP, Nord-Université Paris Cité, Hôpital Universitaire Robert Debré, Unité d'Épidémiologie Clinique, Inserm, Paris, France
- ECEVE, Inserm, Paris, France
| | - Marion Caseris
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Robert Debré, Paris, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Robert Debré, Paris, France
- ECEVE, Inserm, Paris, France
- Université Paris Cité, Paris, France
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Pourdieu C, El Hoss S, Le Roux E, Pages J, Koehl B, Missud F, Holvoet L, Ithier G, Benkerrou M, Haouari Z, Da Costa L, El Nemer W, Laurance S, Aronovicz YC, Le Van Kim C, Fenneteau O, Lainey E, Brousse V. Relevance of Howell-Jolly body counts for measuring spleen function in sickle cell disease. Am J Hematol 2023; 98:E110-E112. [PMID: 36794434 DOI: 10.1002/ajh.26879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Charlotte Pourdieu
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France.,Faculté de Médecine, Site des Cordeliers, Sorbonne Université, Paris, France
| | - Sara El Hoss
- Red Cell Hematology Lab, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Enora Le Roux
- AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | - Justine Pages
- AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | - Bérengère Koehl
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France.,Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - Florence Missud
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France
| | - Laurent Holvoet
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France
| | - Ghislaine Ithier
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France
| | - Malika Benkerrou
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France
| | - Zinedine Haouari
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France
| | - Lydie Da Costa
- Hôpital Universitaire Robert Debré, AP-HP, Service Hématologie Biologique, Paris, France
| | - Wassim El Nemer
- Établissement Français du Sang PACA-Corse, Aix Marseille Univ, EFS, CNRS, ADES, 'Biologie des Groupes Sanguins', Marseille, France
| | - Sandrine Laurance
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | | | - Caroline Le Van Kim
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - Odile Fenneteau
- Hôpital Universitaire Robert Debré, AP-HP, Service Hématologie Biologique, Paris, France
| | - Elodie Lainey
- Hôpital Universitaire Robert Debré, AP-HP, Service Hématologie Biologique, Paris, France
| | - Valentine Brousse
- Centre de Référence MCGRE, Service d'Hématologie-Immunologie, AP-HP, Hôpital Robert Debré, Paris, France.,Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
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13
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Le Roux E, Martin P, Alberti C, Minary L, Kivits J, Chapoton B, Giraudeau B, Chauvin F, Dubois C, Amiel P, Dumas A, Bourmaud A. A Smoking Prevention Intervention Among Young People in an Online Community Game: Results from a Pilot Randomized Controlled Trial. Games Health J 2023; 12:140-149. [PMID: 36602510 DOI: 10.1089/g4h.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Innovative methods for smoking prevention interventions need to be investigated to increase attractiveness, access hard-to-reach populations, and increase effectiveness. We studied the feasibility and immediate effects of an intervention to reinforce norms and behaviors of young people related to antismoking, integrated into a popular online community game. Methods: A pilot randomized controlled trial was conducted through the HABBO online community. The intervention group was exposed to repeated discussion sessions with small groups of peer players and two facilitators once a week for 1 month (four sessions), inside the game. The control group had access to antismoking information websites. Process indicators (attractiveness, participation) and immediate outcomes (norms and intentions with regard to smoking) were assessed by questionnaire. Results: One hundred sixteen players were invited to participate in the intervention; 10 did not meet eligibility criteria, 30 were allocated to the intervention group, and 76 to the control group. Median age was 23. Twenty-four percent were not in education, employment, or training. A median of eight players attended each session and the median number of exchange chats by session was 399; 70% of chat time was occupied by the players. Twenty players attended all four sessions. Immediate norms, representations, and intentions were evaluated in 39 players and showed small differences between groups. Conclusion: Delivering and evaluating a smoking prevention intervention in an online game is feasible. In the targeted online community game, the intervention was attractive and allowed the delivery of innovative interventions to audiences with diverse social profiles. Long-term effects, sustainability, and evaluation methodology are discussed.
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Affiliation(s)
- Enora Le Roux
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France.,AP-HP.Nord-Université Paris Cité, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France.,Groupe de Recherche en Médecine et Santé de l'Adolescent, Paris, France
| | - Philippe Martin
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France.,Institut National d'Etudes Démographiques (INED), UR14-Sexual and Reproductive Health and Rights, Paris, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Kremlin-Bicêtre, France.,GDID Santé, Paris, France
| | - Corinne Alberti
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France.,AP-HP.Nord-Université Paris Cité, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | | | - Joëlle Kivits
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France.,Faculté de Médecine, Université Paris Cité, Paris, France.,Cité du genre, Université Paris Cité, Paris, France
| | - Boris Chapoton
- Université Jean Monnet, Saint Etienne, Coactis UR 4161, Paris, France
| | - Bruno Giraudeau
- Université de Tours, Nantes Université, INSERM, SPHERE U1246, Tours, France.,INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Chauvin
- Institut de Cancérologie de la Loire, Université Jean Monnet-UDL, St Etienne, France
| | - Capucine Dubois
- Fil Santé Jeune, Ecole des Parents et des Educateurs d'Ile de France, Paris, France
| | - Philippe Amiel
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France
| | - Agnès Dumas
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France
| | - Aurélie Bourmaud
- Université Paris Cité, ECEVE UMR 1123, Inserm, Faculté de Médecine, Paris, France.,AP-HP.Nord-Université Paris Cité, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
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14
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Rossi M, Pirenne F, Le Roux E, Smaïne D, Belloy M, Eyssette‐Guerreau S, Couque N, Holvoet L, Ithier G, Brousse V, Koehl B, Faye A, Benkerrou M, Missud F. Delayed haemolytic transfusion reaction in paediatric patients with sickle cell disease: A retrospective study in a French national reference centre. Br J Haematol 2022; 201:125-132. [PMID: 36541848 DOI: 10.1111/bjh.18605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Delayed haemolytic transfusion reaction (DHTR) is a life-threatening haemolytic anaemia following red blood cell transfusion in patients with sickle cell disease, with only scarce data in children. We retrospectively analysed 41 cases of DHTR in children treated between 2006 and 2020 in a French university hospital. DHTR manifested at a median age of 10.5 years, symptoms occurred a median of 8 days after transfusion performed for an acute event (63%), before surgery (20%) or in a chronic transfusion programme (17%). In all, 93% of patients had painful crisis. Profound anaemia (median 49 g/L), low reticulocyte count (median 140 ×109 /L) and increased lactate dehydrogenase (median 2239 IU/L) were observed. Antibody screening was positive in 51% of patients, and more frequent when there was a history of alloimmunisation. Although no deaths were reported, significant complications occurred in 51% of patients: acute chest syndrome (12 patients), cholestasis (five patients), stroke (two patients) and kidney failure (two patients). A further transfusion was required in 23 patients and corticosteroids were used in 21 to reduce the risk of additional haemolysis. In all, 13 patients subsequently received further transfusions with recurrence of DHTR in only two. The study affords a better overview of DHTR and highlights the need to establish guidelines for its management in children.
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Affiliation(s)
- Marica Rossi
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
| | - France Pirenne
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Etablissement Français du Sang, Henri Mondor Hospital Créteil France
| | - Enora Le Roux
- CIC 1426, UEC, AP‐HP, Nord ‐ Université Paris Cité, Hôpital Universitaire Robert Debré, INSERM Paris France
| | - Djamel Smaïne
- Etablissement Français du Sang, Robert Debré Hospital, AP‐HP Paris France
| | - Marie Belloy
- General Pediatrics Unit, Robert Ballanger Hospital Aulnay‐sous‐Bois France
| | | | - Nathalie Couque
- Department of Molecular Genetics Robert Debré Hospital, AP‐HP Paris France
| | - Laurent Holvoet
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
| | - Ghislaine Ithier
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
| | - Valentine Brousse
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
- INSERM Unité mixte de recherche (UMR)_S1134 Paris France
| | - Bérengère Koehl
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
- INSERM Unité mixte de recherche (UMR)_S1134 Paris France
- Université Paris Cité Paris France
| | - Albert Faye
- Université Paris Cité Paris France
- General Pediatrics Unit, Robert Debré Hospital, AP‐HP Paris France
| | - Malika Benkerrou
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
- INSERM UMR_S1123 Paris France
| | - Florence Missud
- Sickle Cell Disease Center, Hematology Unit, Robert Debré Hospital, Assistance Publique–Hôpitaux de Paris (AP‐HP) Paris France
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15
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Mellerio H, Dumas A, Alberti C, Guilmin-Crépon S, Gastaldi M, Passini L, Gabarro C, Morsa M, Le Roux E, Jacquin P. Are transition preparation consultations for adolescents with chronic conditions valuable? A mixed-methods study. Eur J Pediatr 2022; 181:2849-2861. [PMID: 35536409 DOI: 10.1007/s00431-022-04473-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
Our objective was to assess the value of transition preparation consultations (TPC) offered by the AD'venir unit (R. Debré hospital, Paris) as a new service of transitional care, from the perspective of adolescents with chronic conditions (CCs) and their referring healthcare providers (RHCPs). TPCs included a face-to-face interview with pediatricians trained in adolescent medicine, exploring the adolescent's past (CC history), present (daily life, Treatment Burden Questionnaire, family/peer relationships, school, hobbies, sexuality, drugs), and future (global life project, transition, Good2Go questionnaire). The mixed-methods design included the following: a qualitative analysis within a multidisciplinary group (clinicians/sociologists/psychologist/public health researchers) of audio-recordings of TPCs (n = 27/girls = 56%/median age = 17.7 years) and phone interviews with adolescents 2 years post-TPC (n = 26); and a quantitative analysis of the Treatment Burden and Good2Go questionnaires and the benefits perceived by RHCPs (questionnaire 6 months post-TPC). TPCs were a form of training for adult care, adolescents meeting a practitioner alone often for the first time. Naming their CC was difficult. All complained of limitations experienced in social life (diet, fatigue, laboratory/medical appointments), but not the treatment itself; most adolescents willingly talked about sexuality. Adolescents' feelings about transition were various, with poor representations of adult healthcare. Transfer was frequently unplanned. After TPCs, RHCPs modified their practices. Transition in the 2 years post-TPC was usually successful. Conclusion What is Known: • In adolescents with chronic conditions, it is advocated to personalize transition care according to the clinical and social context, pointed out as potentially impacting. • Little is known about the most effective ways to prepare patients according to their needs. What is New: • Based on a global approach to adolescent health, transition preparation consultations are delivered by specially trained physicians. • They are a feasible and valuable way to highlight facilitators and barriers to successful transition and initiate the adolescents' own vision of their future.
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Affiliation(s)
- Hélène Mellerio
- AD'venir, Adolescent Medicine Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France. .,Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France. .,French Clinical Research Group in Adolescent Medicine and Health, 97 bd de Port-Royal, 75014, Paris, France.
| | - Agnès Dumas
- Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, 97 bd de Port-Royal, 75014, Paris, France
| | - Corinne Alberti
- Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France.,CIC 1426, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France
| | - Sophie Guilmin-Crépon
- Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France.,CIC 1426, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France
| | - Margaux Gastaldi
- AD'venir, Adolescent Medicine Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France
| | - Loïc Passini
- AD'venir, Adolescent Medicine Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France
| | - Céline Gabarro
- Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France
| | - Maxime Morsa
- Laboratory of Education and Health Practices (EA3412), University Paris 13, 1 rue de Chablis, 93017, Bobigny, France
| | - Enora Le Roux
- Université de Paris, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, 75010, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, 97 bd de Port-Royal, 75014, Paris, France.,CIC 1426, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France
| | - Paul Jacquin
- AD'venir, Adolescent Medicine Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48 bd Sérurier, 75019, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, 97 bd de Port-Royal, 75014, Paris, France
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16
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Truong J, Cointe A, Le Roux E, Bidet P, Michel M, Boize J, Mariani-Kurkdjian P, Caseris M, Hobson CA, Desmarest M, Titomanlio L, Faye A, Bonacorsi S. Clinical impact of a gastrointestinal PCR panel in children with infectious diarrhoea. Arch Dis Child 2022; 107:601-605. [PMID: 34921002 DOI: 10.1136/archdischild-2021-322465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/28/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Multiplex gastrointestinal PCR (GI-PCR) allows fast and simultaneous detection of 22 enteric pathogens (including Campylobacter, Salmonella, Shigella/enteroinvasive Escherichia coli (EIEC), among other bacteria, parasites and viruses). However, its impact on the management of children with infectious diarrhoea remains unknown. PATIENTS/DESIGN All children eligible for stool culture from May to October 2018 were prospectively included in a monocentric study at Robert-Debré University-Hospital. INTERVENTION A GI-PCR (BioFire FilmArray) was performed on each stool sample. MAIN MEASURES Data on the children's healthcare management before and after GI-PCR results were collected. Stool culture results were also reported. RESULTS 172 children were included. The main criteria for performing stool analysis were mucous/bloody diarrhoea and/or traveller's diarrhoea (n=130). GI-PCR's were positive for 120 patients (70%). The main pathogens were enteroaggregative E. coli (n=39; 23%), enteropathogenic E. coli (n=34; 20%), Shigella/EIEC (n=27; 16%) and Campylobacter (n=21; 12%). Compared with stool cultures, GI-PCR enabled the detection of 21 vs 19 Campylobacter, 12 vs 10 Salmonella, 27 Shigella/EIEC vs 13 Shigella, 2 vs 2 Yersinia enterocolitica, 1 vs 1 Plesiomonas shigelloides, respectively. Considering the GI-PCR results and before stool culture results, the medical management was revised for 40 patients (23%): 28 initiations, 2 changes and 1 discontinuation of antibiotics, 1 hospitalisation, 2 specific room isolations related to Clostridioides difficile infections, 4 additional test prescriptions and 2 test cancellations. CONCLUSION The GI-PCR's results impacted the medical management of gastroenteritis for almostone-fourth of the children, and especially the prescription of appropriate antibiotic treatment before stool culture results.
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Affiliation(s)
- Jeanne Truong
- General Paediatrics, Robert Debré University Hospital, AP-HP, Paris, France .,Université de Paris, UFR de médecine Paris-Nord, Paris, Île-de-France, France
| | - Aurélie Cointe
- Microbiology Laboratory, Robert-Debré University Hospital, AP-HP, Paris, Île-de-France, France.,IAME UMR 1137, INSERM, Paris, Île-de-France, France
| | - Enora Le Roux
- Unité d'Epidémiologie Clinique, Robert Debré University Hospital, AP-HP, Paris, France.,ECEVE UMR-1123, INSERM, Paris, Île-de-France, France
| | - Philippe Bidet
- Microbiology Laboratory, Robert-Debré University Hospital, AP-HP, Paris, Île-de-France, France.,IAME UMR 1137, INSERM, Paris, Île-de-France, France
| | - Morgane Michel
- ECEVE UMR-1123, INSERM, Paris, Île-de-France, France.,URC Eco, Hôtel-Dieu, AP-HP, Paris, France
| | - Julien Boize
- Department of Paediatric Emergency Care, Robert Debré University Hospital, AP-HP, Paris, Île-de-France, France
| | | | - Marion Caseris
- General Paediatrics, Robert Debré University Hospital, AP-HP, Paris, France
| | - Claire Amaris Hobson
- Université de Paris, UFR de médecine Paris-Nord, Paris, Île-de-France, France.,IAME UMR 1137, INSERM, Paris, Île-de-France, France
| | - Marie Desmarest
- Department of Paediatric Emergency Care, Robert Debré University Hospital, AP-HP, Paris, Île-de-France, France
| | - Luigi Titomanlio
- Université de Paris, UFR de médecine Paris-Nord, Paris, Île-de-France, France.,Department of Paediatric Emergency Care, Robert Debré University Hospital, AP-HP, Paris, Île-de-France, France.,U1141, INSERM, Paris, France
| | - Albert Faye
- General Paediatrics, Robert Debré University Hospital, AP-HP, Paris, France.,Université de Paris, UFR de médecine Paris-Nord, Paris, Île-de-France, France.,ECEVE UMR-1123, INSERM, Paris, Île-de-France, France
| | - Stéphane Bonacorsi
- Microbiology Laboratory, Robert-Debré University Hospital, AP-HP, Paris, Île-de-France, France.,IAME UMR 1137, INSERM, Paris, Île-de-France, France
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17
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Martin P, Chapoton B, Bourmaud A, Dumas A, Kivits J, Eyraud C, Dubois C, Alberti C, Le Roux E. Health Promotion in Popular Online Community Games among Young People: Proposals, Recommendations and Applications (Preprint). JMIR Serious Games 2022. [DOI: 10.2196/39465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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18
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Le Roux E, Turpin A, Michel M, Tejedor I, Menesguen F, Malivoir S, Bottius S, Mellerio H, Polak M, Touraine P. Evaluation of a new transition organization for young adults with endocrine or metabolic diseases. Eur J Endocrinol 2022; 186:379-387. [PMID: 35038310 DOI: 10.1530/eje-21-1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effect of a new care organization on multiple outcomes of transition success and its cost-effectiveness in patients with any endocrine or metabolic disease diagnosed during childhood and transferred to adult care. DESIGN Non-randomized controlled trial in a French university hospital. METHODS Patients transferred to adult care during the control period (04/2014-08/2016) and the intervention period (09/2016-06/2018) were included. The intervention is based on case management involving liaising with pediatric services, personalizing care pathways, and liaising with structures outside hospital (general practitioner, educational and social sector). The primary endpoint was the percentage of patients lost to follow-up at 24 months post transfer. Other outcomes were collected from medical files, consultation software, and questionnaires. A cost analysis was performed. RESULTS Two hundred two patients were included (101 per period), the most represented pathologies were congenital and non-congenital hypopituitarism (respectively n = 34 (17%) and n = 45 (22%)) and thyroid diseases (n = 21, 10%). Patients were aged 22.5 in median at 24 months post transfer where 12 were lost to follow-up in the control group vs 9 with the intervention (P = 0.49). The percentage of honored consultation among those planned during 24 months was higher with intervention (P = 0.0065). Patient satisfaction, physician trust, and transfer delay did not differ between the groups. The incremental cost-effectiveness ratio was €179 per patient not lost to follow-up. CONCLUSIONS At 24 months post transfer, the rate of lost to follow-up did not differ significantly, but indicators of a steadier follow-up were increased and the intervention appeared to be cost-effective.
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Affiliation(s)
- Enora Le Roux
- INSERM, Université de Paris, ECEVE UMR 1123, Paris, France
- AP-HP, Hôpital Universitaire Robert Debré, Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Paris, France
- Groupe de Recherche en Médecine et Santé de l'Adolescent, GRMSA, Paris, France
| | - Agathe Turpin
- AP-HP, Hôpital Universitaire Robert Debré, Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Paris, France
| | - Morgane Michel
- INSERM, Université de Paris, ECEVE UMR 1123, Paris, France
| | - Isabelle Tejedor
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et Médecine de la Reproduction
- Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Centre de Pathologies Gynécologiques Rares, HCP-ENDO European Reference Network, Paris, France
| | - Florence Menesguen
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et Médecine de la Reproduction
- Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Centre de Pathologies Gynécologiques Rares, HCP-ENDO European Reference Network, Paris, France
| | - Sabine Malivoir
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et Médecine de la Reproduction
- Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Centre de Pathologies Gynécologiques Rares, HCP-ENDO European Reference Network, Paris, France
| | - Sandrine Bottius
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et Médecine de la Reproduction
- Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Centre de Pathologies Gynécologiques Rares, HCP-ENDO European Reference Network, Paris, France
| | - Hélène Mellerio
- INSERM, Université de Paris, ECEVE UMR 1123, Paris, France
- Groupe de Recherche en Médecine et Santé de l'Adolescent, GRMSA, Paris, France
- AP-HP Nord-Université de Paris, Hôpital Universitaire Robert Debré, Plateforme de Transition Ad'venir, Unité de Médecine d'Adolescent, Paris, France
| | - Michel Polak
- AP-HP Centre-Université de Paris, Hopital Universitaire Necker-Enfants Malades, Pediatric Endocrinology, Gynaecology and Diabetology, IMAGINE Institute, ENDO-European Reference Network Team, Paris, France
| | - Philippe Touraine
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et Médecine de la Reproduction
- Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Centre de Pathologies Gynécologiques Rares, HCP-ENDO European Reference Network, Paris, France
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19
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Pham A, Ecochard-Dugelay E, Bonnard A, Le Roux E, Gelas T, Rousseau V, Thomassin N, Cabon-Boudard I, Nicolas A, Guinot A, Rebeuh J, Le Mandat A, Djeddi DD, Fouquet V, Boucharny A, Irtan S, Lemale J, Comte A, Bridoux-Henno L, Dupont-Lucas C, Dimitrov G, Turquet A, Borderon C, Pelatan C, Chaillou Legault E, Jung C, Willot S, Montalva L, Mitanchez D, Gottrand F, Bellaiche M. Feeding disorders in children with oesophageal atresia: a cross-sectional study. Arch Dis Child 2022; 107:52-58. [PMID: 33863700 DOI: 10.1136/archdischild-2020-320609] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION With advances in surgical and neonatal care, the survival of patients with oesophageal atresia (OA) has improved over time. Whereas a number of OA-related conditions (delayed primary anastomosis, anastomotic stricture and oesophageal dysmotility) may have an impact on feeding development and although children with OA experience several oral aversive events, paediatric feeding disorders (PFD) remain poorly described in this population. The primary aim of our study was to describe PFD in children born with OA, using a standardised scale. The secondary aim was to determine conditions associated with PFD. METHODS The Feeding Disorders in Children with Oesophageal Atresia Study is a national cohort study based on the OA registry from the French National Network. Parents of children born with OA between 2013 and 2016 in one of the 22 participating centres were asked to complete the French version of the Montreal Children's Hospital Feeding Scale. RESULTS Of the 248 eligible children, 145 children, with a median age of 2.3 years (Q1-Q3 1.8-2.9, min-max 1.1-4.0 years), were included. Sixty-one children (42%) developed PFD; 13% were tube-fed (n=19). Almost 40% of children with PFD failed to thrive (n=23). The presence of chronic respiratory symptoms was associated with the development of PFD. Ten children with PFD (16%) had no other condition or OA-related complication. CONCLUSION PFD are common in children with OA, and there is no typical profile of patients at risk of PFD. Therefore, all children with OA require a systematic screening for PFD that could improve the care and outcomes of patients, especially in terms of growth.
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Affiliation(s)
- Aurélie Pham
- AP-HP, Department of Neonatology, Armand-Trousseau Childrens Hospital, Paris, France
| | - Emmanuelle Ecochard-Dugelay
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Enora Le Roux
- AP-HP, Paris, France, Nord-Université de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Robert-Debré Hospital, Paris, France
| | - Thomas Gelas
- Hôpital Femme-Mère-Enfant, Service de Chirurgie Pédiatrique, CHU Lyon, Lyon, France
| | - Véronique Rousseau
- Pediatric Surgery, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Nadège Thomassin
- Hépato-Gastroentérologie Pédiatrique, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Isabelle Cabon-Boudard
- AP-HM, Service de Pédiatrie, Hôpital de la Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Audrey Nicolas
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Audrey Guinot
- Service de Chirurgie Infantile, CHU de Nantes, Hôpital Mère-enfant, Nantes, France
| | - Julie Rebeuh
- Department of Pediatrics, University Hospital Centre Strasbourg, Strasbourg, France
| | - Aurélie Le Mandat
- Service de Chirurgie Viscérale Pédiatrique, CHU de Toulouse, France, Hôpital des Enfants, Toulouse, France
| | - Djamal-Dine Djeddi
- Service de Pédiatrie Médicale, CHU Amiens Picardie, France, Pôle Femme Couple Enfant, Amiens, France
| | - Virginie Fouquet
- Paediatric Surgery, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicetre, France
| | - Aurélie Boucharny
- Service de Pédiatrie, CHU Dijon, France, Hôpital d'Enfants, Dijon, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand-Trousseau Childrens Hospital, Paris, France
| | - Julie Lemale
- Department of Pediatric Gastroenterology, Armand-Trousseau Children's Hospital, Paris, France
| | - Aurélie Comte
- Service de Médecine Pédiatrique, CHU Besançon, Besançon, France
| | - Laure Bridoux-Henno
- Département de Médecine de l'Enfant et de l'Adolescent, CHU Rennes Unité de Nutrition, Rennes, France
| | - Claire Dupont-Lucas
- Pediatrics, Gastroenterology Unit, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Georges Dimitrov
- Service de Chirurgie Pédiatrique, CHR d'Orléans, Orléans, France
| | - Anne Turquet
- Service de Pédiatrie, CHU La Réunion, La Reunion, France
| | - Corinne Borderon
- Service de pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Pelatan
- service de pédiatrie, CH Le Mans, Le Mans, Pays de la Loire, France
| | | | - Camille Jung
- Service de Pédiatrie, CH Intercommunal de Créteil, Creteil, France
| | - Stéphanie Willot
- Service de Médecine Pédiatrique, CHRU de Tours, Hôpital Clocheville, Tours, France
| | - Louise Montalva
- Department of General Pediatric Surgery, Robert Debre Children University Hospital, APHP, Paris, France
| | - Delphine Mitanchez
- Service de Néonatologie, CHRU de Tours, France, Hôpital Bretonneau, Tours, France
| | - Frederic Gottrand
- Centre de Reference des Affections Chroniques et Malformatives de l'œsophage, CHU Lille, Lille, France
| | - Marc Bellaiche
- AP-HP, Service des Maladies Digestives de l'Enfant, Hôpital Universitaire Mère-enfant Robert-Debré, Paris, France
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20
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Mellerio H, Jacquin P, Le Roux E. [Supporting the adolescents with chronic condition during transition: Role of the transition units]. Med Sci (Paris) 2021; 37:888-894. [PMID: 34647877 DOI: 10.1051/medsci/2021114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The transition of care between pediatric and adult care is a key-period for adolescents with chronic disease, because of the high risk of follow-up loss and of short-term and long-term poorer health. To support transition, platforms of transition have been created in France since several years, implemented in pediatric or adult care structures. Their common objective is to provide a physical reception of adolescents and their parents to share about transition issues, and to inform them about resources to enhance the adolescent's global health. They tend to work closely with the referent health care providers and the patients' associations. A large heterogeneity of functioning and health care supply is still observed in these recent structures. Supporting these structures and reinforcing the partnerships between pediatric and adults care remain a challenge.
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Affiliation(s)
- Hélène Mellerio
- Plateforme de transition AD'venir, Service de médecine d'adolescent, Hôpital Robert Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France - Université Paris Diderot, Sorbonne Paris Cité, UMR Inserm 1123, Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), 10 avenue de Verdun, 75010 Paris, France - Groupe de recherche en médecine et santé de l'adolescent, 75014 Paris, France
| | - Paul Jacquin
- Plateforme de transition AD'venir, Service de médecine d'adolescent, Hôpital Robert Debré, AP-HP, 48 boulevard Sérurier, 75019 Paris, France - Groupe de recherche en médecine et santé de l'adolescent, 75014 Paris, France
| | - Enora Le Roux
- Université Paris Diderot, Sorbonne Paris Cité, UMR Inserm 1123, Épidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), 10 avenue de Verdun, 75010 Paris, France - Groupe de recherche en médecine et santé de l'adolescent, 75014 Paris, France - Centre d'investigation clinique Épidémiologie clinique (CIC-EC), CIC 1426, 75010 Paris ; Unité d'épidémiologie clinique, Hôpital Robert Debré, 75019 Paris, France
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21
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Courbiere B, Le Roux E, Mathieu d’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigné M, Chanavaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process. J Clin Med 2021; 10:jcm10173810. [PMID: 34501257 PMCID: PMC8432013 DOI: 10.3390/jcm10173810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 01/28/2023] Open
Abstract
International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP.
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Affiliation(s)
- Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, 13005 Marseille, France
- Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-38-37-11
| | - Enora Le Roux
- Unité d’Epidémiologie Clinique, Hôpital Universitaire Robert Debré, AP-HP Nord-Université de Paris, Inserm, CIC 1426, 75019 Paris, France;
- ECEVE UMR 1123, Université de Paris, Inserm, 75019 Paris, France
| | - Emmanuelle Mathieu d’Argent
- Department of Gynecology-Obstetric and Reproductive Medicine, GRC6-UPMC, Centre Expert en Endométriose (C3E), Université Pierre-et-Marie-Curie Paris 6, Hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France;
| | - Antoine Torre
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Rouen, 37 bd Gambetta, 76000 Rouen, France;
| | - Catherine Patrat
- Service de Biologie de la Reproduction—CECOS, APHP Centre—Université de Paris, Site Cochin, Inserm U1016, 75014 Paris, France;
| | - Christophe Poncelet
- Department of Gynecology-Obstetric, UFR SMBH Leonard de Vinci, CH René Dubos, 95000 Cergy-Pontoise, France;
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
| | - Jacques Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, 31000 Toulouse, France;
| | - Anne-Sophie Gremeau
- Department of Gynecologic Surgery and IVF, Clermont-Ferrand, University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Hélène Creux
- Clinique Saint Roch, Department of Gynecology-Obstetric and Reproductive Medicine, 34000 Montpellier, France;
| | - Maëliss Peigné
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
- Department of Reproductive Medicine and Fertility Preservation, AP-HP Hôpital Jean Verdier, 93143 Bondy, France
| | | | - Lara Dirian
- EndoFrance, Association Française de lutte contre l’Endométriose, 70190 Tresilley, France;
| | - Xavier Fritel
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Poitiers, 86000 Poitiers, France;
- Inserm CIC-P 1402, 86021 Poitiers, France
| | - Jean-Luc Pouly
- Department of Gynecology-Obstetric, CH Moulins Yzeure, 03000 Moulins, France;
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain-en Laye, 78300 Poissy, France;
- Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Paris-Saclay University, 78300 Poissy, France
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22
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Morsa M, Perrin A, David V, Rault G, Le Roux E, Alberti C, Gagnayre R, Pougheon Bertrand D. Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study. JMIR Res Protoc 2021; 10:e14552. [PMID: 34406124 PMCID: PMC8411325 DOI: 10.2196/14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. OBJECTIVE This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users' point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. METHODS We have been conducting a multicenter pilot study involving 36 patients with CF aged ≥12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a "React to PEx" educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients' personalized alert thresholds by reviewing the data collected during phase 1 and their patients' clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients' experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). RESULTS The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users' experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. CONCLUSIONS This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. TRIAL REGISTRATION ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14552.
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Affiliation(s)
- Maxime Morsa
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Amélie Perrin
- Pediatric Cystic Fibrosis Center, Nantes University Hospital, Nantes, France
| | - Valérie David
- Pediatric Cystic Fibrosis Center, Nantes University Hospital, Nantes, France
| | - Gilles Rault
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Enora Le Roux
- Unité Mixte de Recherche 1123 Epidémiologie Clinique et EValuation Economique appliquées aux populations vulnérables, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre d'Investigation Clinique 1426 Unit of Clinical Epidemiology, Hôpital Universitaire R Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Corinne Alberti
- Unité Mixte de Recherche 1123 Epidémiologie Clinique et EValuation Economique appliquées aux populations vulnérables, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre d'Investigation Clinique 1426 Unit of Clinical Epidemiology, Hôpital Universitaire R Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Rémi Gagnayre
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Dominique Pougheon Bertrand
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
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23
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Courbière B, Roux EL, Mathie. D’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigne M, Chavanaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. P–454 Oocyte vitrification for fertility preservation in women with benign gynecological disease: French national clinical guidelines with a modified Delphi consensus process. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there consensual clinical practices about fertility preservation (FP) for benign gynecological diseases BGD)?
Summary answer
A consensus study using the modified Delphi method identified 28 consensual practices concerning oocyte vitrification for fertility preservation in women with benign gynecological disease.
What is known already
Clinical Practical international guidelines are still published in oncology for offering standardized information and care for adults and children with cancer. Recently, the ESHRE Female Fertility Preservation Guideline Development Group published recommendations for healthcare professionals involved in fertility preservation for post-pubertal women and transgender adolescents and young adults. However, benign gynecological indications weren’t distinctly individualized of malignant conditions. There’s a lack of large cohort studies assessing the risks and outcome of FP for benign gynecological diseases. Healthcare professionals need consensus for defining the “good” indications of FP for benign gynecological diseases that could impair fertility.
Study design, size, duration
A steering group composed by 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices concerning fertility preservation for benign gynecological disease. Then, 114 key stakeholders including various healthcare professionals (n = 108) and patient representatives(n = 6) were asked to answer at two rounds of a modified Delphi via an online survey from February to September 2020.
Participants/materials, setting, methods
Participants had to score 42 items for the first round and 31 for the second round using a nine-point Likert scale. These statements were distributed into five categories: Information to deliver to age-reproductive women with a BGD (n = 9), technical aspect of fertility preservation for BGD (n = 6), indications of FP for endometriosis (n = 13), indications of FP for none-endometriosis BGD (n = 10), idiopathic diminished ovarian reserve in the absence of gynecologic and endocrinologic diseases (n = 4).
Main results and the role of chance
Survey response of stakeholders was 75% (86 out of 114) for the round 1 and 87% (75 out of 86) for the round 2. Consensus recommendations were achieved for 28 items, and no consensus between stakeholders was achieved in the remaining items. Stakeholders rated the importance of an age-specific information concerning the risk of diminished ovarian reserve after surgery and the necessity to inform about the benefice/ risk balance of oocyte vitrification, in particular about the chance of live-birth according to the age at the time of oocyte vitrification. They endorsed oocyte vitrification as the reference FP technique for those benign indications. Experts rejected to determine lower and upper age limits in women for fertility preservation. FP shouldn’t be offered in rAFS stages I and II endometriosis without endometriomas.
Limitations, reasons for caution
Experts were only French native speakers from France, and Belgium. It would have been interesting to conduct this survey with experts from other continents.
Wider implications of the findings: At our knowledge, we present here the first guideline s focusing on FP in women with BGD, following a designed scientific Delphi procedure. These guidelines could be useful for gynecologists to better inform women with benign gynecological diseases about the indication or not to offer a FP procedure.
Trial registration number
Not applicable
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Affiliation(s)
- B Courbière
- APHM Hôpital de la Conception / Aix Marseille Univ, Gynecology- Obstetrics and reproductive Medicine, Marseille, France
| | - E L Roux
- Hôpital Universitaire Robert Debré- AP-HP/ Inserm- Université de Paris, Unité d’épidémiologie clinique Inserm- CIC 1426 / ECEVE UMR 1123, Paris, France
| | - E Mathie. D’Argent
- APHP Hôpital Tenon /Université Pierre-et-Marie-Curie Paris 6, Department of Gynecology-Obstetric and Reproductive Medicine- Centre expert en endométriose C3E, Paris, France
| | - A Torre
- CHU Rouen, Department of Gynecology - Obstetric and Reproductive Medicine, Rouen, France
| | - C Patrat
- APHP centre – Université de Paris- site Cochin- Inserm U1016, Service de Biologie de la Reproduction – CECOS, Paris, France
| | - C Poncelet
- CH rené Dubos / Université Sorbonne Paris Nord - Université Paris 13, Gynecology - Obstetrics / UFR SMBH leonard de Vinci, Cergy-Pontoise, France
| | - J Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, Toulouse, France
| | - A S Gremeau
- University Hospital Clermont-Ferrand, Gynecologic surgery and IVF, Clermont-Ferrand, France
| | - H Creux
- Clinique Saint Roch, Gynecology-Obstetric and Reproductive Medicine, Montpellier, France
| | - M Peigne
- AP-HP Hôpital Jean Verdier / Université Sorbonne Paris Nord- Paris 13, Reproductive Medicine and Fertility Preservation, Bondy, France
| | | | - L Dirian
- EndoFrance, Association Française de lutte contre l’endométriose, Paris, France
| | - X Fritel
- CHU Poitiers, Gynecology- Obstetric and Reproductive Medicine / Inserm CIC-P 1402, Poitiers, France
| | - J L Pouly
- CH Moulins Yzeure, Gynecology-Obstetric, Moulins, France
| | - A Fauconnier
- CHI Poissy-Saint-Germain-en Laye / Paris -Saclay University, Gynecology and Obstetrics / Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Poissy, France
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24
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Dufetelle E, Mulier G, Taytard J, Boizeau P, Le Roux E, Beydon N. Peripheral obstruction without airflow limitation is rare and not specific to asthma in children. Pediatr Pulmonol 2021; 56:858-865. [PMID: 33369239 DOI: 10.1002/ppul.25222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022]
Abstract
Peripheral (or small) airway obstruction (PAO) is considered a marker of childhood asthma but the techniques able to directly measure it are rarely used in routine. Usual spirometry and plethysmography can detect a certain degree of PAO when reduced forced vital capacity (FVC) is associated to normal forced expiratory volume in 1 s (FEV1 ) to FVC ratio, and normal total lung capacity (TLC). The frequency of this functional pattern has never been studied in different pediatric respiratory conditions. To assess the prevalence and outcome of PAO in children with different diseases or symptoms, we retrospectively extracted from our database all files of Caucasian subjects encompassing spirometry and plethysmography measurements. Spirometry patterns (normal, airflow limitation [AFL; low FEV1 /FVC], low FVC [with normal FEV1 /FVC]) and final functional patterns (normal, AFL, PAO, restrictive [low TLC], or mixed) were described. We included 4394 files recorded in 1794 children (median [IQR] age: 10.7 [9.2-12.9] years). At inclusion, 125 (7%) children had low FVC of which 56 (44.8%, and 3.1% [95% CI 2.3-3.9] of the whole population) had PAO. PAO prevalence increased with age (OR (95% CI) per 2-year-increase: 2.26 (1.59-3.23); p < .001), and was more frequent in chronic bronchial diseases other than asthma (1.6% vs. 8.0%). On repeated tests, PAO frequently normalized (26.1%) or persisted (43.5%), but it less often progressed into AFL (13%) or restrictive (13%) patterns. PAO is an infrequent nonspecific and persistent functional pattern. Its prevalence increases with age and in diagnosis of chronic respiratory diseases other than asthma.
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Affiliation(s)
- Edouard Dufetelle
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France
| | - Guillaume Mulier
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Jessica Taytard
- Service de Pneumologie pédiatrique, Centre National de Référence des Maladies Respiratoires Rares, AP-HP, Hôpital Trousseau, Paris, France.,INSERM, UMR-S 1158, Sorbonne Université, Paris, France
| | - Priscilla Boizeau
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Enora Le Roux
- Unité d'épidémiologie Clinique, AP-HP. Hôpital Universitaire Robert Debré, Paris, France.,Inserm CIC 1426, F-75019, Nord Université de Paris, Paris, France
| | - Nicole Beydon
- Unité d'Exploration Fonctionnelle Respiratoire, Service de Physiologie, APHP, Hôpital Armand-Trousseau, Paris, France.,INSERM U 938, Centre de Recherche Saint Antoine, Sorbonne Université, Paris, France
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25
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Sigalla J, Duparc Alegria N, Le Roux E, Toumazi A, Thiollier AF, Holvoet L, Benkerrou M, Dugue S, Koehl B. Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis. Children (Basel) 2021; 8:children8020084. [PMID: 33530318 PMCID: PMC7911240 DOI: 10.3390/children8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient's age, sex, and clinical presentation.
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Affiliation(s)
- Jeanne Sigalla
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Nathalie Duparc Alegria
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Enora Le Roux
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
| | - Artemis Toumazi
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
| | - Anne-Françoise Thiollier
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Laurent Holvoet
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Malika Benkerrou
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Sophie Dugue
- Pain Management Unit, Trousseau Hospital, AP-HP, Sorbonne Université, F-75012 Paris, France;
| | - Berengere Koehl
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
- INSERM UMRS 1134, Red Blood Cell Pathophysiology, F-75015 Paris, France
- Correspondence:
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Le Roux E, Mari Muro M, Mognon K, Saïd M, Caillavet V, Matheron S, Ledoux S, Decq P, Vorspan F, Le Strat Y, Delaugerre C, Le Bras M, Alberti C, Ruszniewski P, Zerr P, Faye A. A governmental program to encourage medical students to deliver primary prevention: experiment and evaluation in a French faculty of medicine. BMC Med Educ 2021; 21:47. [PMID: 33435980 PMCID: PMC7805043 DOI: 10.1186/s12909-020-02472-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/22/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders. METHODS A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries. RESULTS One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p < 0.01). Delivering actions in high schools and to a medium-sized number of beneficiaries per week was associated with students' satisfaction. No effect of gender or theme of prevention was observed. For 248/341 (72.7%) students, the public health service program prompts them to address prevention issues in the future. CONCLUSION The public health service undertaken by medical students through the program is a feasible and acceptable means of delivering preventive actions. Reinforcement of training and closer interaction with the host institutions would improve results.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France.
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France.
| | - Marta Mari Muro
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | - Kore Mognon
- General Medecine department, Université de Paris, F-75018, Paris, France
| | - Mélèa Saïd
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | | | - Sophie Matheron
- Unité UMR 1137 IAME, Université de Paris, Inserm, F-75010, Paris, France
- AP-HP, Nord-Université de Paris, Hôpital Universitaire Bichat-Claude Bernard, Service de maladies infectieuses et tropicale, F-75018, Paris, France
| | - Séverine Ledoux
- AP-HP, Nord-Université de Paris, Hôpital Louis Mourier, Service des explorations fonctionnelles, F-92700, Colombes, France
| | - Philippe Decq
- AP-HP, Nord-Université de Paris, Hôpital Beaujon, Service de neurochirurgie, F-92110, Clichy, France
| | - Florence Vorspan
- AP-HP, Nord-Université de Paris, Hôpital Lariboisière, Service de psychiatrie, F-75010, Paris, France
| | - Yann Le Strat
- AP-HP, Nord-Université de Paris, Hôpital Louis Mourier, Service de psychiatrie, F-92700, Colombes, France
- INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), F-75014, Paris, France
| | - Constance Delaugerre
- AP-HP, Nord-Université de Paris, Hôpital Saint Louis, Service de virologie, INSERM U944, F-75010, Paris, France
| | - Morgane Le Bras
- Université de Paris, UMR_S 976, Inserm, Institut de Recherche Saint Louis, F-75010, Paris, France
| | - Corinne Alberti
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France
- Service de Santé Publique, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, 48 boulevard Serurier, CIC 1426, F-75019, Paris, France
| | | | - Philippe Zerr
- General Medecine department, Université de Paris, F-75018, Paris, France
| | - Albert Faye
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France
- Service de Pédiatrie Générale, AP-HP, Nord-Université de Paris, Hôpital Universitaire Robert Debré, F-75019, Paris, France
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Le Roux E, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Pinto G, Léger J, Hatem S, Polak M, Poitou C, Touraine P. Transition of young adults with endocrine and metabolic diseases: the 'TRANSEND' cohort. Endocr Connect 2021; 10:21-28. [PMID: 33263561 PMCID: PMC7923139 DOI: 10.1530/ec-20-0520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The transition from paediatric to adult medicine involves risks of poor patient outcomes and of significant losses of patients to follow up. The research aimed to analyse the implementation in an initial cohort of patients of a new programme of transition to adult care based on a case management approach. DESIGN A longitudinal study of the case management approach to transition, initiated in a university hospital in France in September 2016. METHODS Patients with the endocrine or metabolic disease diagnosed during childhood and transferred to adult care were included. The transition programme includes three steps based on case management: liaising with paediatric services, personalising care pathways, and liaising with structures outside the hospital (general practitioners, agencies in the educational and social sector). RESULTS The cohort included 500 patients, with malignant brain tumour (n = 56 (11%)), obesity (n = 55 (11%)), type 1 diabetes (n = 54 (11%)), or other disease (n = 335 (67%)). Their median age at transfer was 19, and the sex ratio was 0.5. At median 21 months of follow-up, 439 (88%) had a regular follow-up in or outside the hospital, 47 (9%) had irregular follow-up (absence at the last appointment or no appointment scheduled within the time recommended), 4 had stopped care on doctor's advice, 4 had died, 3 had moved, and 3 had refused care. The programme involved 9615 case management actions; 7% of patients required more than 50 actions. Patients requiring most support were usually those affected by a rare genetic form of obesity. CONCLUSIONS Case managers successfully addressed the complex needs of patients. Over time, the cohort will provide unprecedented long-term outcome results for patients with various conditions who experienced this form of transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d’Épidémiologie Clinique, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Graziella Pinto
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Juliane Léger
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du Développement, Paris, France
| | | | - Michel Polak
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
- Correspondence should be addressed to P Touraine:
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Le Roux E, Mellerio H, Jacquin P, Bourmaud A, Guilmin-Crépon S, Faye A, Matheron S, Boulkedid R, Alberti C. Practical generic guidelines for paediatric-to-adult transition for adolescents with chronic disease. Eur J Public Health 2020; 29:442-448. [PMID: 30535247 DOI: 10.1093/eurpub/cky258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The last 20 years have seen many attempts to improve transition to adult healthcare for adolescents with chronic disease, but there is currently no established consensus on generic practices. Our goal was to identify relevant and pragmatic guidelines for transition practice for each step of this process (before, during and after transfer), applicable to a wide range of chronic illnesses and health services, via a participatory approach involving all the key stakeholders. METHODS We conducted interviews and a literature review to elaborate a questionnaire for use in an online 2-round Delphi survey. The survey panel included 36 French health and social professionals from different care settings, and young adults and parents with an experience of healthcare transition related to all types of chronic disease. RESULTS The survey consensus identified 19 items on feasibility and relevance criteria, which form the guidelines. It is composed of five practices to be adopted during preparation in paediatrics, seven practices in the active phase of transition and seven in adult care. Two guidelines achieved complete consensus: having a longer consultation for the first appointment with the adult doctor, and keeping the same adult doctor throughout follow-up. A further 36 items met the criterion of relevance, but were deemed unfeasible. CONCLUSIONS Taking into account all stakeholder views and the real-world applicability of care practices enabled us to elaborate consensual guidelines whose implementation requires no additional health service resources.
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Affiliation(s)
- Enora Le Roux
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France
| | - Hélène Mellerio
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France
| | - Paul Jacquin
- Service de Médecine de l'Adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Aurélie Bourmaud
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Sophie Guilmin-Crépon
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Albert Faye
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,Service de Pédiatrie Générale, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Sophie Matheron
- Unité IAME UMR 1137, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,Service des Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Rym Boulkedid
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Corinne Alberti
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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Sadozai L, Sable S, Le Roux E, Coste P, Guillot C, Boizeau P, Berthe-Aucejo A, Angoulvant F, Lorrot M, Bourdon O, Prot-Labarthe S. International consensus validation of the POPI tool (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions) to identify inappropriate prescribing in pediatrics. PLoS One 2020; 15:e0240105. [PMID: 33017423 PMCID: PMC7535059 DOI: 10.1371/journal.pone.0240105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/19/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION While drug prescription should be based on established recommendations stemming from clinical trials but in pediatrics, many drugs are used without marketing authorization. Consequently recommendations are often based on clinical experience and the risk of inappropriate prescription (IP) is high. A tool for detecting IP in pediatrics-called POPI (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions)-has been developed in France. However the relevance of its use at an international level is not known. Our aim has been to adapt POPI for a worldwide use. MATERIAL AND METHOD A two-round Delphi online questionnaire was completed and validated by international experts to identify consensual items. They were asked to rate the validity of each items taking into account the recommendations and practices in their countries. Only propositions obtaining a median score in the upper tertile with an agreement of more than 75% of the panel-for the first round-and 85%-for the second round-were retained. RESULTS Our panel included 11 pharmacists (55%) and 9 physicians (45%). The panelists came from 12 different countries: England, Belgium, Brazil, Canada, China, Ivory Coast, Ireland, Malaysia, Portugal, Switzerland, Turkey and Vietnam. At the end of the first round, of the 105 items of the original POPI tool, 80 items were retained including 16 items reworded and 25 items were deleted. In the second round, 14 experts participated in the study. This final international POPI tool is composed of 73 IP and omissions of prescriptions in the fields of neuropsychiatry, dermatology, infectiology, pneumology, gastroenterology, pain and fever. DISCUSSION AND CONCLUSION This study highlights international consensus on prescription practice in pediatrics. The use of this tool in everyday practice could reduce the risk of inappropriate prescription. The impact of the diffusion of POPI tool will be assessed in a prospective multicentric study.
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Affiliation(s)
- Laily Sadozai
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
| | - Shaya Sable
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
| | - Enora Le Roux
- Unité d’épidémiologie clinique, Hôpital Universitaire Robert Debré, AP-HP.Nord-Université de Paris, Inserm, CIC 1426, Paris, France
- ECEVE UMR 1123, Université de Paris, Inserm, Paris, France
| | - Pierre Coste
- Unité d’épidémiologie clinique, Hôpital Universitaire Robert Debré, AP-HP.Nord-Université de Paris, Inserm, CIC 1426, Paris, France
- ECEVE UMR 1123, Université de Paris, Inserm, Paris, France
| | - Clémence Guillot
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
| | - Priscilla Boizeau
- Unité d’épidémiologie clinique, Hôpital Universitaire Robert Debré, AP-HP.Nord-Université de Paris, Inserm, CIC 1426, Paris, France
- ECEVE UMR 1123, Université de Paris, Inserm, Paris, France
| | - Aurore Berthe-Aucejo
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
- ECEVE UMR 1123, Université de Paris, Inserm, Paris, France
| | | | | | - Olivier Bourdon
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
- Clinical Pharmacy, Paris Descartes University, Paris, France
- Education and Health Practices, Paris XIII University, Bobigny, France
| | - Sonia Prot-Labarthe
- Pharmacy Department, Robert-Debré Hospital, AP-HP, Paris, France
- ECEVE UMR 1123, Université de Paris, Inserm, Paris, France
- Pediatric Group, Société Française de Pharmacie Clinique, Paris, France
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Ploton MC, Sommet J, Koehl B, Gaschignard J, Holvoet L, Mariani-Kurkdjian P, Benkerrou M, Le Roux E, Bonacorsi S, Faye A. Respiratory pathogens and acute chest syndrome in children with sickle cell disease. Arch Dis Child 2020; 105:891-895. [PMID: 32269038 DOI: 10.1136/archdischild-2019-317315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute chest syndromes (ACS) may be associated with upper respiratory tract infections, but the epidemiology of viral and intracellular respiratory pathogens in children with sickle cell disease (SCD) is not precisely known. The aim of this study was to describe the epidemiology of viral and intracellular respiratory pathogens in children with SCD presenting with fever and/or ACS. MATERIALS AND METHODS An observational, prospective, single-centre cohort study with nested case-control analysis was conducted on children with SCD admitted from October 2016 to October 2017 for fever and/or ACS to the paediatric department of Robert Debré university hospital, Paris, France. They were screened for 20 respiratory pathogens by a multiplex PCR in the nasopharynx (FilmArray). RESULTS We included 101 children. M/F sex ratio of 0.45. The median age was 3.2 years (IQR: 1.4-8.2). At least one pathogen was isolated in 67 patients (67%). The most frequent viruses were as follows: rhinovirus (n=33), adenovirus (n=14), respiratory syncytial virus (n=13) and parainfluenza viruses (n=11). Mycoplasma pneumoniae was detected in one case. Twenty-three (23%) presented with or developed ACS. A nested case-control analysis was performed, after pairing ACS with non-ACS children for age and inclusion period. There was no statistical association between any viral detection or multiple viral infection, and ACS (p=0.51) even though parainfluenza viruses were twice as common in ACS. CONCLUSIONS Viral detection in febrile children with SCD is frequent, but its association with ACS was not demonstrated. In this study, M. pneumoniae was rare in young children with SCD experiencing ACS.
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Affiliation(s)
- Marie-Caroline Ploton
- Department of General Pediatrics and infectious diseases, Hôpital Universitaire Robert-Debré, Paris, France.,Department of General Pediatrics, Hôpital Nord Ouest, Villefranche, France
| | - Julie Sommet
- Department of Pediatric Intensive Care, Hôpital Universitaire Robert Debré, Paris, France
| | - Bérengère Koehl
- Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert-Debré, Paris, France
| | - Jean Gaschignard
- Department of General Pediatrics and infectious diseases, Hôpital Universitaire Robert-Debré, Paris, France
| | - Laurent Holvoet
- Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert-Debré, Paris, France
| | | | - Malika Benkerrou
- Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert-Debré, Paris, France
| | - Enora Le Roux
- Clinical Research Unit, Hôpital Universitaire Robert Debré, Paris, France.,ECEVE INSERM 1123, Université de Paris, Paris, France
| | - Stephane Bonacorsi
- Laboratory of Microbiology, Hôpital Universitaire Robert Debré, Paris, France.,Université de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics and infectious diseases, Hôpital Universitaire Robert-Debré, Paris, France .,Université de Paris, Paris, France
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Roux EL, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Polak M, Poitou C, Touraine P. MON-LB308 Studying the Care and Social Pathway of Young Adults With Endocrine and Metabolic Diseases During Transition: The “Transend” Cohort. J Endocr Soc 2020. [PMCID: PMC7208793 DOI: 10.1210/jendso/bvaa046.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context. The transition period between pediatric and adult medicine is associated with poor patient outcomes and an important number of patients lost to follow up. Intervention exist but the few published randomized trials do not allow to study long-term patient outcomes nor intervention sustainability in time. Objective. Describe the cohort of patients in adult care who benefit from a new transition program based on case management approach, its activity and follow-up outcomes. Methods. A longitudinal study was led since September 2016 in adult services of endocrinology, nutrition and diabetology of a French University Hospital. Patients with any endocrine disease diagnosed during childhood and transferred to adult care were included. The care pathway for these patients was built in three steps. Step 1 is dedicated in liaising with pediatric services and patient to facilitate its first visit in adult care. Step 2 defines the care pathway in adult service based on the needs assessment realized by the coordinator upon the patient’s arrival in adult service. Step 3 focuses in liaising with structures outside hospital (GP, educational and social sector). Thorough the follow-up, the coordinator is identified as the key contact by the patients. Attendance to medical appointments, clinical, and social data are collected throughout patient follow-up. Results. Since 3 years, 500 patients benefited from the case management mainly for their obesity (n=91, 18%), type 1 diabetes (n=54, 11%), malignant brain tumor (n=68, 14%) or congenital hypopituitarism (n=42, 8%). They were aged 19 in median at transfer in adult care, sex ratio: 0,5, A large majority live in the parental home (409, 82%), 169 (34%) are university students, 130 (26%) are in high school, 90 (18%) are in medico-social institution. Patients who required most of support from the coordinator usually combine one (or more) somatic disease and either a neuro-cognitive disorder or a psychiatric disorder, they all have social difficulties. In patients with more than 3 months of follow-up (median: 18 months), 22/418 (5%) are out of follow-up. Concerning the patients for whom the follow-up is 36 months or more, the percentage of out of lollow-up is the same: 5% Conclusions. The case manager addresses the complex needs of diverse patients. With time, the cohort will provide unprecedented long-term results of patients with various conditions who went through transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de nutrition, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Michel Polak
- AP-HP.Centre-Université de Paris, Hôpital Universitaire Necker enfants malades, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de nutrition, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
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Mellerio H, Jacquin P, Trelles N, Le Roux E, Belanger R, Alberti C, Tubiana-Rufi N, Stheneur C, Guilmin-Crépon S, Devilliers H. Validation of the "Good2Go": the first French-language transition readiness questionnaire. Eur J Pediatr 2020; 179:61-71. [PMID: 31515671 DOI: 10.1007/s00431-019-03450-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
The use of transition readiness questionnaires is strongly recommended in adolescents with chronic conditions. The aim of our study was to validate "Good2Go," the first French-language transition readiness questionnaire. We analyzed the data from 2 multicentric studies (Canada and France) involving adolescents with chronic conditions (type 1 diabetes, inflammatory bowel disease, cystic fibrosis, epilepsy, juvenile idiopathic arthritis). Content and construct validity were examined using factorial and Rasch analysis (structural validity), Spearman's correlation, and Mann-Whitney test (external validity). Cronbach's α and intra-class correlation coefficients explored reliability. Cognitive interviews assessed wording comprehension and item appropriateness. Good2Go was completed by 321 participants (boys = 51%; mean age = 16.4 years (standard deviation = 1.5; min = 14.0; max = 18.0); Canada = 51.1%). Factor analysis identified 3 domains: "health self-advocacy," "knowledge about chronic conditions," and "self-management skills." The 3-domain structure showed a satisfying Rasch fit, internal consistency, and test-retest reliability. Good2Go domain scores were significantly higher in participants over 17 years of age, indicating satisfactory external validity.Conclusion: Good2Go is a valid 20-item questionnaire to assess transition readiness in adolescents with chronic conditions and may be useful in routine care to propose individually tailored preparation for their transfer to adult healthcare. Further research is now needed to analyze correlation between domain scores and success of transition.What is Known:• In adolescents with chronic conditions, the use of transition readiness questionnaires is recommended to propose individually tailored preparation for their transfer to adult healthcare.• However, no French-language questionnaire has been so far validated.What is New:• Based on a complete validation methodology, this study highlights that the French-language 20-items Good2Go questionnaire has good psychometric properties.• It explores all transition key points though 3 scored domains: "health self-advocacy", "knowledge about chronic disease" and "self-management skills".
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Affiliation(s)
- Hélène Mellerio
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France. .,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France. .,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France. .,French Clinical Research Group in Adolescent Medicine and Health, 75014, Paris, France. .,RECaP Network-Perceived health measurement Working Group, Paris, France.
| | - Paul Jacquin
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, 75014, Paris, France
| | - Nelson Trelles
- Service de chirurgie viscérale et digestive, Centre Hospitalier René Dubos, 95303, Pontoise, France
| | - Enora Le Roux
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,RECaP Network-Perceived health measurement Working Group, Paris, France
| | - Richard Belanger
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec, Québec, QC, G1E 6W2, Canada.,Département de pédiatrie, Centre mère-enfant Soleil du CHU de Québec, Université Laval, Quebec, Canada
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,RECaP Network-Perceived health measurement Working Group, Paris, France
| | - Nadia Tubiana-Rufi
- Service d'Endocrinologie et de Diabétologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France
| | - Chantal Stheneur
- Département de pédiatrie, CHU Saint Justine, Montréal, QC, Canada.,Faculté de médecine, Université de Montréal, Quebec, Canada
| | - Sophie Guilmin-Crépon
- Plateforme de transition Ad'venir, Unité de médecine d'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, 75010, Paris, France.,INSERM, ECEVE U1123 and CIC-EC, CIC 1426, 75010, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France.,Service d'Endocrinologie et de Diabétologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019, Paris, France
| | - Hervé Devilliers
- RECaP Network-Perceived health measurement Working Group, Paris, France.,Service de Médecine interne et Maladies systémiques (Médecine interne 2), Hôpital François-Mitterrand, 21079, Dijon cedex, France
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Le Roux E, Mari Muro M, Novic M, Chauvin F, Zerr P, Alberti C, Faye A. Health students to relaunch health prevention in France: gamble of the health service. J Epidemiol Community Health 2019; 74:305-306. [PMID: 31594787 DOI: 10.1136/jech-2019-212802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Enora Le Roux
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hopitaux de Paris, Paris, France .,Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
| | - Marta Mari Muro
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Martine Novic
- Département Universitaire des Sciences Infirmières et de Rééducation, Université Paris Diderot, Paris, France
| | - Franck Chauvin
- HESPER EA7425, Université Claude Bernard Lyon 1, Villeurbanne, France.,UFR de médecine, Université Jean Monnet Saint-Etienne, Saint-Etienne, France
| | - Philippe Zerr
- Département de Médecine Générale, Université Paris Diderot, Paris, France
| | - Corinne Alberti
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hopitaux de Paris, Paris, France.,Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
| | - Albert Faye
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France.,Hôpital Robert Debré, Service de Pédiatrie Générale, Assistance Publique-Hopitaux de Paris, Paris, France
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Kaguelidou F, Le Roux E, Mangiarini L, Lundin R, de Leeuw TG, Della Pasqua O, Felisi M, Bonifazi D, Tibboel D, Ceci A, de Wildt SN, Alberti C. Non-inferiority double-blind randomised controlled trial comparing gabapentin versus tramadol for the treatment of chronic neuropathic or mixed pain in children and adolescents: the GABA-1 trial-a study protocol. BMJ Open 2019; 9:e023296. [PMID: 30787078 PMCID: PMC6398794 DOI: 10.1136/bmjopen-2018-023296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Gabapentin is currently used 'off-label' in children and adolescents with chronic neuropathic pain, and reliable evidence of its effects and optimal dosing are lacking. OBJECTIVES The GABA-1 trial aims to compare the efficacy and safety of gabapentin liquid formulation relative to tramadol and to explore the pharmacokinetics of both drugs in the treatment of chronic, neuropathic or mixed pain in the paediatric population. METHODS AND ANALYSIS The trial is a multicentre, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial. Participants aged from 3 months to <18 years of age with moderate to severe (≥4/10 in age-appropriate pain scales) chronic neuropathic or mixed pain will be recruited in 14 clinical sites in eight European countries. A total of 94 subjects will be randomised to receive gabapentin and tramadol placebo or tramadol and gabapentin placebo throughout 16-19 weeks (including 3 weeks of titration [optimisation period], 12 weeks of treatment at a stable dose [maintenance period] and 1-4 weeks of tapering [discontinuation period]). The primary objective is to assess the efficacy of gabapentin relative to tramadol for the treatment of moderate to severe chronic neuropathic or mixed pain by comparing the difference in average pain scores (assessed by age-appropriate pain scales) between intervention arms after 15 weeks of treatment. Secondary objectives include the assessment of the safety, quality of life and global satisfaction with treatment and the description of the pharmacokinetic-pharmacodynamic relationship of gabapentin liquid formulation and tramadol oral drops to validate the recommended paediatric doses. Only rescue pain medication by paracetamol and/or ibuprofen is allowed during the trial. ETHICS AND DISSEMINATION Ethic approval was obtained in the eight participating countries. Results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. TRIAL REGISTRATION NUMBERS 2014-004851-30 and NCT02722603. TRIAL STATUS Ongoing research study, currently recruiting.
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Affiliation(s)
- Florentia Kaguelidou
- Department of Paediatric Pharmacology and Pharmacogenetics, AP-HP, Hôpital Robert Debré, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, CIC 1426, F-75019, Paris, France
| | - Enora Le Roux
- AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, Paris, France
- UMR-1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | | | - Thomas G de Leeuw
- Department of Anaesthesia, Erasmus MC Sophia Children’s Hospital & Center for Pain Medicine Rotterdam, Rotterdam, The Netherlands
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | - Mariagrazia Felisi
- PHARM – Pharmaceutical Research Management SRL, Lodi, Italy
- CVBF–Consorzio per le Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Donato Bonifazi
- PHARM – Pharmaceutical Research Management SRL, Lodi, Italy
- CVBF–Consorzio per le Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pharmacology and Toxicology, Radboud Universiteit Faculteit der Rechtsgeleerdheid, Nijmegen, The Netherlands
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, Paris, France
- Inserm, U1123 and CICEC 1426, F-75019, Paris, France
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Aupiais C, Zohar S, Taverny G, Le Roux E, Boulkedid R, Alberti C. Exploring how non-inferiority and equivalence are assessed in paediatrics: a systematic review. Arch Dis Child 2018; 103:1067-1075. [PMID: 29794107 DOI: 10.1136/archdischild-2018-314874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review characteristics, methodology and reporting of non-inferiority and equivalence trials in the specific context of paediatrics. DESIGN PubMed and Cochrane databases were searched (up to September 2016) for non-inferiority/equivalence randomised controlled trials conducted in children published in high-impact-factor journals (>5.0 for general/specialist medical journals; >2.2 for paediatric journals). RESULTS We found that the statistical hypothesis was inconsistent with the objective in 12 (10%) of the 125 reports included. Non-inferiority (n=98) and equivalence trials (n=27) were mostly used to evaluate interventions with easier administration (45%, n=54/120) and/or better safety profile (34%, n=41/120). All the data needed for targeted sample size recalculation were available for 39 reports (31%). The margin-representing the largest difference between arms that would be clinically acceptable-was reported in 119 (95%), and 44/119 (37%) reported the method used for margin determination. The median sample size was 268 (IQR 125-531). Margins were wider in smaller trials (<125 randomised patients) than in larger trials (p=0.04/p<0.01 for binary/continuous outcomes, respectively). We did not agree with the authors' conclusions in 11% (11/103) of the reports that provided sufficient information. CONCLUSIONS There is still a need to improve the quality of methodology, reporting and interpretation of non-inferiority/equivalence trials in paediatrics. In particular, the margins were often not justified and the conclusion was often not supported by the design and/or the results. As researchers have to cope with small sample size and with lack of evidence, methods for non-inferiority/equivalence trials need to be used and/or developed in this vulnerable population.
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Affiliation(s)
- Camille Aupiais
- Inserm UMR 1123-ECEVE, UMRS 1138, Team 22, CRC; APHP, Hôpital Robert Debré, University Paris Diderot, Paris, France
| | - Sarah Zohar
- Inserm, UMRS 1138, Team 22, CRC, University Paris Descartes, Sorbonne University, Paris, France
| | - Garry Taverny
- Inserm UMR 1123-ECEVE, University Paris Diderot, Paris, France
| | - Enora Le Roux
- Inserm UMR 1123-ECEVE and CIC-EC 1426, APHP, Hôpital Robert Debré, University Paris Diderot, Paris, France
| | - Rym Boulkedid
- Inserm UMR 1123-ECEVE and CIC-EC 1426, APHP, Hôpital Robert Debré, University Paris Diderot, Paris, France
| | - Corinne Alberti
- Inserm UMR 1123-ECEVE and CIC-EC 1426, APHP, Hôpital Robert Debré, University Paris Diderot, Paris, France
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Le Roux E, Gottot S, Aupiais C, Girard T, Teixeira M, Alberti C. Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting. PLoS One 2017; 12:e0169782. [PMID: 28114376 PMCID: PMC5256933 DOI: 10.1371/journal.pone.0169782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022] Open
Abstract
Background Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition. Methods Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted. Results Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams’ experience, a simplified categorization of these young people into four levels can be used: those “who have everything good”; those who have some deficiencies that must be addressed; those “who have everything bad”; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment. Conclusions Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated structure for transition care is not appropriate for all young people.
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Affiliation(s)
- Enora Le Roux
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- * E-mail:
| | - Serge Gottot
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Camille Aupiais
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Thomas Girard
- Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel-Dieu, Unité Guy Mocquet, Paris, France
| | - Maria Teixeira
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
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