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Charmasson A, Ecollan M, Jaury P, Partouche H, Frachon A, Pinot J. Perceived impact of discussions with a healthcare professional on patients' decision regarding COVID-19 vaccine. Hum Vaccin Immunother 2024; 20:2307735. [PMID: 38346925 PMCID: PMC10863372 DOI: 10.1080/21645515.2024.2307735] [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: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
There is evidence that advice from Healthcare Professionals (HCPs) plays an important role in patients' decision to get vaccinated, but the extent to which patients perceive this impact is unclear. The aim of this study was to assess the perceived impact of a discussion with a HCP on participants' decision to be vaccinated against COVID-19. A cross-sectional survey was conducted among adults who consulted a general practitioner (GP) or a pharmacist in Ile-de-France, France, after COVID-19 vaccines became available (October-November 2021 period). A total of 344 participants were included, 65.2% of whom reported having had a discussion about COVID-19 vaccines with a HCP. Overall, 55% of participants were advised to be vaccinated by their HCP. Most of the discussions took place with a GP (n = 203, 48.9%). According to 52.5% of participants, the discussion had a positive impact, i.e. it was perceived as encouraging vaccination. The latter reported that, among HCPs, GPs had the greatest number of discussions with a positive impact on the decision to be vaccinated against COVID-19 (93.1%). In the study population, the COVID-19 vaccine hesitancy rate, according to the WHO definition, was high (38.1%), although the COVID-19 vaccine coverage rate was 87.1%. Vaccine hesitant participants were more likely to report a discussion that had a perceived negative impact on their decision to get vaccinated (20.0%) than non-hesitant participants (5.8%, p = .004).
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Affiliation(s)
- Alric Charmasson
- Department of General Practice, Université Paris Cité, Paris, France
| | - Marie Ecollan
- Department of General Practice, Université Paris Cité, Paris, France
| | - Philippe Jaury
- Department of General Practice, Université Paris Cité, Paris, France
| | - Henri Partouche
- Department of General Practice, Université Paris Cité, Paris, France
| | - Adèle Frachon
- Department of General Practice, Université Paris Cité, Paris, France
| | - Juliette Pinot
- Department of General Practice, Université Paris Cité, Paris, France
- INSERM, IAME, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
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2
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de Beaurepaire R, Jaury P. Baclofen in the treatment of alcohol use disorder: tailored doses matter. Alcohol Alcohol 2024; 59:agad090. [PMID: 38266071 PMCID: PMC10807704 DOI: 10.1093/alcalc/agad090] [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: 10/28/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses. METHODS A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature. RESULTS The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring. CONCLUSIONS The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.
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Affiliation(s)
- Renaud de Beaurepaire
- Renaud de Beaurepaire, GH Paul-Guiraud, 54 Avenue de La République, 94806 Villejuif, France
| | - Philippe Jaury
- Faculté de Médecine, Université Paris Cité, Paris, France
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Airagnes G, du Vaure CB, Galam E, Bunge L, Hoertel N, Limosin F, Jaury P, Lemogne C. Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it. J Psychosom Res 2021; 144:110410. [PMID: 33676151 DOI: 10.1016/j.jpsychores.2021.110410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/30/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined. METHODS The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S. RESULTS The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group. CONCLUSION Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.
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Affiliation(s)
- Guillaume Airagnes
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, UMS011, Population-based Epidemiological Cohorts, Villejuif, France.
| | - Céline Buffel du Vaure
- Université de Paris, Faculté de Médecine Paris Descartes, Département de Médecine Générale, Paris, France; Inserm, Epidemiology and Statistics Sorbonne Paris Cité, UMR 1153, METHODS Team, Paris, France
| | - Eric Galam
- Université de Paris, Faculté de Médecine Paris Diderot, Département de Médecine Générale, Paris, France
| | - Lucie Bunge
- Université de Paris, Faculté de Médecine Paris Diderot, Département de Médecine Générale, Paris, France
| | - Nicolas Hoertel
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Frédéric Limosin
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Médecine Paris Descartes, Département de Médecine Générale, Paris, France; Société Médicale Balint, Woippy, France
| | - Cédric Lemogne
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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4
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Lemogne C, Buffel du Vaure C, Hoertel N, Catu-Pinault A, Limosin F, Ghasarossian C, Le Jeunne C, Jaury P. Balint groups and narrative medicine compared to a control condition in promoting students' empathy. BMC Med Educ 2020; 20:412. [PMID: 33167952 PMCID: PMC7654605 DOI: 10.1186/s12909-020-02316-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/18/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND The perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students' empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS Students who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session. RESULTS Data from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): - 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants' characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (β = 2.673, P = 0.030). CONCLUSIONS Balint groups may promote clinical empathy to some extent among medical students, at least in the short run.
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Affiliation(s)
- Cédric Lemogne
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Hôtel-Dieu, Service de Psychiatrie de l’adulte, 1 place du parvis Notre-Dame, 75004 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
| | - Céline Buffel du Vaure
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité, Research Center UMR 1153, Inserm, 1 place du parvis Notre-Dame, 75004 Paris, France
| | - Nicolas Hoertel
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Service de Psychiatrie et d’Addictologie de l’adulte et du sujet âgé, 4 parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - Annie Catu-Pinault
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- Société Médicale Balint, 10 Route de Thionville, 57140, Woippy, France
| | - Frédéric Limosin
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Service de Psychiatrie et d’Addictologie de l’adulte et du sujet âgé, 4 parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - Christian Ghasarossian
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Claire Le Jeunne
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Médecine Interne, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- Société Médicale Balint, 10 Route de Thionville, 57140, Woippy, France
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Rigal L, Sidorkiewicz S, Le Jeunne C, Porcher R, Jaury P. Reply to comments on the Rigal et al. (2019) Bacloville trial. Addiction 2020; 115:2186-2187. [PMID: 32364260 DOI: 10.1111/add.15104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Laurent Rigal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France.,Université Paris-Saclay, Département de Médecine Générale, Le Kremlin-Bicêtre, France.,Institut national d'études démographiques (INED), Paris, France
| | - Stéphanie Sidorkiewicz
- Université de Paris, Faculté de Santé, UFR de Médecine,Département de Médecine Générale, Paris, France.,Universitét de Paris, CRESS, INSERM, INRA, Paris, France
| | - Claire Le Jeunne
- Service de médecine interne APHP-Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Raphaël Porcher
- Universitét de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'épidémiologie clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Santé, UFR de Médecine,Département de Médecine Générale, Paris, France
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6
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Rigal L, Sidorkiewicz S, Tréluyer JM, Perrodeau E, Le Jeunne C, Porcher R, Jaury P. Titrated baclofen for high-risk alcohol consumption: a randomized placebo-controlled trial in out-patients with 1-year follow-up. Addiction 2020; 115:1265-1276. [PMID: 31833590 DOI: 10.1111/add.14927] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/14/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Laurent Rigal
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France.,Université Paris-Saclay, Département de Médecine Générale, Le Kremlin-Bicêtre, France.,Institut national d'études démographiques (INED), Paris, France
| | - Stéphanie Sidorkiewicz
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Jean-Marc Tréluyer
- Unité de recherche clinique, School of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Elodie Perrodeau
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'épidémiologie clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Claire Le Jeunne
- Service de médecine interne APHP-Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Raphaël Porcher
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'épidémiologie clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, Paris, France
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7
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Agabio R, Sinclair JM, Addolorato G, Aubin HJ, Beraha EM, Caputo F, Chick JD, de La Selle P, Franchitto N, Garbutt JC, Haber PS, Heydtmann M, Jaury P, Lingford-Hughes AR, Morley KC, Müller CA, Owens L, Pastor A, Paterson LM, Pélissier F, Rolland B, Stafford A, Thompson A, van den Brink W, de Beaurepaire R, Leggio L. Baclofen for the treatment of alcohol use disorder: the Cagliari Statement. Lancet Psychiatry 2018; 5:957-960. [PMID: 30413394 DOI: 10.1016/s2215-0366(18)30303-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cittadella Universitaria, I-09042 Monserrato, Italy.
| | | | - Giovanni Addolorato
- AUD and Alcohol Related Diseases Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Henri-Jean Aubin
- Centre de Recherche en Epidémiologie et Santé des Populations, Faculté de Médecine, Université Paris-Sud, Paris, France; Faculté de Médecine, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Paris, France; Hôpitaux Universitaires Paris-Sud, Paris, France
| | - Esther M Beraha
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Fabio Caputo
- SS Annunziata Hospital, Department of Internal Medicine, Cento, Italy
| | - Jonathan D Chick
- Castle Craig Hospital, Blyth Bridge, UK; School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Nicolas Franchitto
- Department of Addiction Médicine, Poisons and Substance Abuse Treatment Centre, Toulouse-Purpan University Hospital, Toulouse, France
| | - James C Garbutt
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul S Haber
- National Health Medical Research Council, Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital Paisley, Paisley, UK
| | - Philippe Jaury
- Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Anne R Lingford-Hughes
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christian A Müller
- Department of Psychiatry, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Louise M Paterson
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
| | - Fanny Pélissier
- Poison Control Centre, Toulouse-Purpan University Hospital, Toulouse, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon, Lyon, France; University of Lyon, Lyon, France
| | | | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | | | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, USA; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA; Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, RI, USA
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8
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Jaury P, Buffel du Vaure C, Bunge L, Galam E, Vincens ME, Catu-Pinault A, Ghasarossian C, Lemogne C. Groupes Balint de Formation à la Relation Thérapeutique chez les étudiants en 4e année de médecine. Effets sur l’empathie clinique par un essai randomisé multicentrique contrôlé. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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de Beaurepaire R, Sinclair JMA, Heydtmann M, Addolorato G, Aubin HJ, Beraha EM, Caputo F, Chick JD, de La Selle P, Franchitto N, Garbutt JC, Haber PS, Jaury P, Lingford-Hughes AR, Morley KC, Müller CA, Owens L, Pastor A, Paterson LM, Pélissier F, Rolland B, Stafford A, Thompson A, van den Brink W, Leggio L, Agabio R. The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective. Front Psychiatry 2018; 9:708. [PMID: 30662411 PMCID: PMC6328471 DOI: 10.3389/fpsyt.2018.00708] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/03/2018] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30-80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30 to more than 300 mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an "off-label" prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD.
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Affiliation(s)
| | - Julia M A Sinclair
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital Paisley, Paisley, United Kingdom
| | - Giovanni Addolorato
- AUD and Alcohol Related Diseases Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Department of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Henri-Jean Aubin
- Faculté de Médecine, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Sud, Paris, France.,Faculté de Médecine, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Paris, France.,Hôpitaux Universitaires Paris-Sud, Paris, France
| | - Esther M Beraha
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Fabio Caputo
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, Italy
| | - Jonathan D Chick
- Castle Craig Hospital, Blyth Bridge, United Kingdom.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | | | - Nicolas Franchitto
- Department of Addiction Medicine, Poisons and Substance Abuse Treatment Centre, Toulouse-Purpan University Hospital, Toulouse, France
| | - James C Garbutt
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paul S Haber
- National Health Medical Research Council, Centre of Research Excellence in Mental Health and Substance Use, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Philippe Jaury
- Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Anne R Lingford-Hughes
- Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christian A Müller
- Department of Psychiatry, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn Owens
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Adam Pastor
- Department Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Louise M Paterson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Fanny Pélissier
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon, Lyon, France.,University of Lyon, Lyon, France
| | | | - Andrew Thompson
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam University, Amsterdam, Netherlands
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Division of Intramural Clinical and Basic Research, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, United States.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States.,Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Roberta Agabio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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Pinot J, Rigal L, Granger B, Sidorkiewicz S, Jaury P. Tailored-Dose Baclofen in the Management of Alcoholism: A Retrospective Study of 144 Outpatients Followed for 3 Years in a French General Practice. Front Psychiatry 2018; 9:486. [PMID: 30349490 PMCID: PMC6186794 DOI: 10.3389/fpsyt.2018.00486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/25/2018] [Accepted: 09/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background: More information is needed about the efficacy and safety of long-term baclofen in the treatment of alcohol use disorders. The objective of this study was to assess the effect of treatment with tailored-dose baclofen on alcohol consumption in patients with alcohol use disorders followed for 3 years after first initiating baclofen treatment. Methods: This retrospective descriptive cohort included outpatients followed in a French general practice clinic for 3 years and treated with tailored-dose baclofen to reduce or eliminate alcohol consumption. At 3 years, treatment was considered successful if alcohol consumption was at or below levels defined as low-risk by the WHO (≤ 40 g/d in men and ≤ 20 g/d in women). Results: The study population included 144 patients (88 men and 56 women). The participants' mean age was 46 ± 11 years and mean daily alcohol intake before treatment was 167 ± 77 grams. At the end of the study, treatment was successful for 91 (63.2%) patients. Participants' mean dose of baclofen at the end of study period was 100 ± 101 mg/d. We identified 75 (52.1%) patients for whom treatment was successful at each annual follow-up appointment: at 1, 2, and 3 years. The mean maximum dose of baclofen over follow-up of the 144 patients was 211 ± 99 mg/d (dose range: 40 mg/d to 520 mg/d). Conclusion: In this study, tailored-dose baclofen appears to be an effective treatment in patients with alcohol use disorders, with sustainable effect over time (3 years). There are many adverse effects but they are consistent with those already described in the literature.
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Affiliation(s)
- Juliette Pinot
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Laurent Rigal
- Département de Médecine Générale, Université Paris Sud, Paris Saclay, Faculté de Médecine, Paris, France
| | - Bernard Granger
- Faculté de Médecine, Service de Psychiatrie et d'Addictologie Hôpital Tarnier, Hôpitaux Universitaire Paris Centre, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Stéphanie Sidorkiewicz
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Philippe Jaury
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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11
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Buffel du Vaure C, Lemogne C, Bunge L, Catu-Pinault A, Hoertel N, Ghasarossian C, Vincens ME, Galam E, Jaury P. Promoting empathy among medical students: A two-site randomized controlled study. J Psychosom Res 2017; 103:102-107. [PMID: 29167035 DOI: 10.1016/j.jpsychores.2017.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Received: 06/12/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the effects of Balint groups on empathy measured by the Consultation And Relational Empathy Measure (CARE) scale rated by standardized patients during objective structured clinical examination and self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS A two-site randomized controlled trial were planned, from October 2015 to December 2015 at Paris Diderot and Paris Descartes University, France. Eligible students were fourth-year students who gave their consent to participate. Participants were allocated in equal proportion to the intervention group or to the control group. Participants in the intervention group received a training of 7 sessions of 1.5-hour Balint groups, over 3months. The main outcomes were CARE and the JSPE-MS© scores at follow-up. RESULTS Data from 299 out of 352 randomized participants were analyzed: 155 in the intervention group and 144 in the control group, with no differences in baseline measures. There was no significant difference in CARE score at follow-up between the two groups (P=0.49). The intervention group displayed significantly higher JSPE-MS© score at follow-up than the control group [Mean (SD): 111.9 (10.6) versus 107.7 (12.7), P=0.002]. The JSPE-MS© score increased from baseline to follow-up in the intervention group, whereas it decreased in the control group [1.5 (9.1) versus -1.8 (10.8), P=0.006]. CONCLUSIONS Balint groups may contribute to promote clinical empathy among medical students. TRIAL REGISTRATION NCT02681380.
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Affiliation(s)
- Céline Buffel du Vaure
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France; METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité, Research Center UMR 1153, Inserm, 1 place du parvis de Notre Dame, 75004 Paris, France.
| | - Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 20 Rue Leblanc, 75015 Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, 2 ter, rue d'Alésia, 75014 Paris, France
| | - Lucie Bunge
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 16 rue Henri Huchard, 75018 Paris, France
| | - Annie Catu-Pinault
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France; Société Médicale Balint, 10 Route de Thionville, 57140 Woippy, France
| | - Nicolas Hoertel
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 20 Rue Leblanc, 75015 Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, 2 ter, rue d'Alésia, 75014 Paris, France
| | - Christian Ghasarossian
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Marie-Eve Vincens
- Société Médicale Balint, 10 Route de Thionville, 57140 Woippy, France; Université Paris 13, Sorbonne Paris Cité, Département de Médecine Générale, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France
| | - Eric Galam
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 16 rue Henri Huchard, 75018 Paris, France
| | - Philippe Jaury
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France; Société Médicale Balint, 10 Route de Thionville, 57140 Woippy, France
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12
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Le Lous M, De Chanaud N, Bourret A, Senat MV, Colmant C, Jaury P, Tesnière A, Tsatsaris V. Improving the quality of transvaginal ultrasound scan by simulation training for general practice residents. Adv Simul (Lond) 2017; 2:24. [PMID: 29450025 PMCID: PMC5806366 DOI: 10.1186/s41077-017-0056-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 06/15/2017] [Accepted: 11/01/2017] [Indexed: 01/08/2023] Open
Abstract
Background Ultrasonography (US) is an essential tool for the diagnosis of acute gynecological conditions. General practice (GP) residents are involved in the first-line management of gynecologic emergencies. They are not familiar with US equipment. Initial training on simulators was conducted. The aim of this study was to evaluate the impact of simulation-based training on the quality of the sonographic images achieved by GP residents 2 months after the simulation training versus clinical training alone. Methods Young GP residents assigned to emergency gynecology departments were invited to a one-day simulation-based US training session. A prospective controlled trial aiming to assess the impact of such training on TVS (transvaginal ultrasound scan) image quality was conducted. The first group included GP residents who attended the simulation training course. The second group included GP residents who did not attend the course. Written consent to participate was obtained from all participants. Images achieved 2 months after the training were scored using standardized quality criteria and compared in both groups. The stress generated by this examination was also assessed with a simple numeric scale. Results A total of 137 residents attended the simulation training, 26 consented to participate in the controlled trial. Sonographic image quality was significantly better in the simulation group for the sagittal view of the uterus (3.6 vs 2.7, p = 0.01), for the longitudinal view of the right ovary (2.8 vs 1.4, p = 0.027), and for the Morrison space (1.7 vs 0.4, p = 0.034), but the difference was not significant for the left ovary (2.9 vs 1.7, p = 0.189). The stress generated by TVS after 2 months was not different between the groups (6.0 vs 4.8, p = 0.4). Conclusion Simulation-based training improved the quality of pelvic US images in GP residents assessed after 2 months of experience in gynecology compared to clinical training alone.
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Affiliation(s)
- M Le Lous
- 1Department of Gynecology Obstetrics and Reproductive Medicine, AP-HP, Cochin Port Royal Hospital, University of Sorbonne Paris Cité, Paris, France.,2Simulation Department iLumens, Sorbonne Paris Cité University, Paris, France.,3Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - N De Chanaud
- 2Simulation Department iLumens, Sorbonne Paris Cité University, Paris, France.,4General Practice Department, Paris Descartes University, Paris, France
| | - A Bourret
- 1Department of Gynecology Obstetrics and Reproductive Medicine, AP-HP, Cochin Port Royal Hospital, University of Sorbonne Paris Cité, Paris, France
| | - M V Senat
- 5Department of Obstetrics and Gynecology, AP-HP, Bicêtre Hospital, University of Paris-Sud, Orsay, France
| | - C Colmant
- 5Department of Obstetrics and Gynecology, AP-HP, Bicêtre Hospital, University of Paris-Sud, Orsay, France
| | - P Jaury
- 4General Practice Department, Paris Descartes University, Paris, France
| | - A Tesnière
- 2Simulation Department iLumens, Sorbonne Paris Cité University, Paris, France.,6Department of Anesthesia, AP-HP, Cochin Port Royal Hospital, University of Sorbonne Paris Cité, Paris, France
| | - V Tsatsaris
- 1Department of Gynecology Obstetrics and Reproductive Medicine, AP-HP, Cochin Port Royal Hospital, University of Sorbonne Paris Cité, Paris, France.,2Simulation Department iLumens, Sorbonne Paris Cité University, Paris, France
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13
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Myszkowski N, Villoing B, Zenasni F, Jaury P, Boujut E. Monitoring stress among internal medicine residents: an experience-driven, practical and short measure. PSYCHOL HEALTH MED 2016; 22:719-726. [PMID: 27687606 DOI: 10.1080/13548506.2016.1220599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 10/21/2022]
Abstract
Residents experience severely high levels of stress, depression and burnout, leading to perceived medical errors, as well as to symptoms of impairment, such as chronic anger, cognitive impairment, suicidal behavior and substance abuse. Because research has not yet provided a psychometrically robust population-specific tool to measure the level of stress of medicine residents, we aimed at building and validating such a measure. Using an inductive scale development approach, a short, pragmatic measure was built, based on the interviews of 17 medicine residents. The Internal Medicine Residency Stress Scale (IMRSS) was then administered in a sample of 259 internal medicine residents (199 females, 60 males, MAge = 25.6) along with the Hospital Anxiety and Depression Scale, Maslach Burnout Inventory, Satisfaction With Life Scale and Ways of Coping Checklist. The IMRSS showed satisfactory internal reliability (Cronbach's α = .86), adequate structural validity - studied through Confirmatory Factor Analysis (χ2/df = 2.51, CFI = .94; SRMR = .037, RMSEA = .076) - and good criterion validity - the IMRSS was notably strongly correlated with emotional exhaustion (r = .64; p < .001) and anxiety (r = .57; p < .001). Because of its short length and robust psychometric qualities, the use of the IMRSS is recommended to quickly and frequently assess and monitor stress among internal medicine residents.
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Affiliation(s)
- Nils Myszkowski
- a Department of Psychology , Dyson College of Arts and Sciences, Pace University , New York , NY , USA
| | - Barbara Villoing
- b Faculté de Médecine, Département de Médecine Générale , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Franck Zenasni
- c Laboratoire Adaptations Travail-Individu , IUPDP, Université Paris Descartes, Sorbonne Paris Cité , Boulogne-Billancourt , France
| | - Philippe Jaury
- b Faculté de Médecine, Département de Médecine Générale , Université Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Emilie Boujut
- d Laboratoire de Psychopathologie et Processus de Santé , IUPDP, Université Paris Descartes, Sorbonne Paris Cité , Boulogne-Billancourt , France
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14
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Picard J, Catu-Pinault A, Boujut E, Botella M, Jaury P, Zenasni F. Burnout, empathy and their relationships: a qualitative study with residents in General Medicine. PSYCHOL HEALTH MED 2015; 21:354-61. [DOI: 10.1080/13548506.2015.1054407] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rigal L, Legay Hoang L, Alexandre-Dubroeucq C, Pinot J, Le Jeunne C, Jaury P. Tolerability of High-dose Baclofen in the Treatment of Patients with Alcohol Disorders: A Retrospective Study. Alcohol Alcohol 2015; 50:551-7. [PMID: 26037372 DOI: 10.1093/alcalc/agv052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 05/06/2015] [Indexed: 01/31/2023] Open
Abstract
AIMS The aim of this study was to describe the tolerability of high-dose baclofen taken by patients with alcohol disorders during their first year of treatment. METHODS The medical records of all patients prescribed baclofen by one general practitioner were examined and all patients who could be contacted were retrospectively interviewed about adverse effects. RESULTS Of the 146 eligible patients, 116 (79%) could be interviewed. Ninety (78%) reported at least one adverse effect (mean number per patient: 2.8 ± 2.7). The mean dosage of baclofen at the onset of the first adverse effect was 83 ± 57 mg/day. The most frequent group of adverse effects involved disruption of the wake-sleep cycle and affected 73 patients (63%). Persistent adverse effects occurred in 62 patients (53%). Eight patients (7%) had adverse effects that led them to stop taking baclofen. Their dosages were <90 mg/day at that time. Alertness disorders and depression were the adverse effects that most frequently led to stopping baclofen. Bouts of somnolence and hypomanic episodes were the most potentially dangerous adverse effects. Women reported significantly more adverse effects than men. CONCLUSION High-dose baclofen exposes patients with alcohol disorders to many adverse effects. Generally persistent, some adverse effects appear at low doses and may be dangerous.
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Affiliation(s)
- Laurent Rigal
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Léa Legay Hoang
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Constance Alexandre-Dubroeucq
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Juliette Pinot
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Claire Le Jeunne
- Service de Médecine Interne Cochin, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Jaury
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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16
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Untas A, Boujut E, Corpechot C, Zenasni F, Chazouillères O, Jaury P, Poupon R, Buffel du Vaure C, Sultan S. Quality of life and illness perception in primary biliary cirrhosis: a controlled cross-sectional study. Clin Res Hepatol Gastroenterol 2015; 39:52-8. [PMID: 25132012 DOI: 10.1016/j.clinre.2014.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 05/14/2014] [Revised: 06/28/2014] [Accepted: 07/08/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to understand better the quality of life (QOL) and illness perception in women with primary biliary cirrhosis (PBC) through a comparison with women having diabetes. METHODS One hundred and ninety-four women took part in this study: 130 with PBC, 64 with type 2 diabetes. They were administered the SF-12 to measure QOL and the Brief Illness Perception Questionnaire to assess representations of their illness. Analysis of covariance with bootstrapping was used to compare QOL and illness perception scores by controlling age and mean disease duration. RESULTS Physical QOL was significantly worse for women with PBC than for women with diabetes. Women with PBC felt their disease would last longer and reported more symptoms and concerns related to their disease than women with diabetes. Significant differences were also observed for causes: women with PBC mainly reported autoimmune, emotional, unknown/unlucky and medical causes whereas women with diabetes reported mostly lifestyle and hereditary causes. Marginally significant differences were observed regarding consequences on daily life, feeling of control over the disease and emotional responses, which were shown to be worse in PBC. Mental QOL, treatment control and overall understanding of the disease was similar in both groups. CONCLUSIONS This study shows that women with PBC have a worse QOL and somewhat different illness perception than women with diabetes. Further research could help understand PBC specificities better in order to improve patient care, especially if factors such as fatigue or rarity of the disease explain these results.
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Affiliation(s)
- Aurélie Untas
- Laboratoire de Psychopathologie et Processus de Santé EA 4057, Institut Universitaire Paris Descartes de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
| | - Emilie Boujut
- Laboratoire de Psychopathologie et Processus de Santé EA 4057, Institut Universitaire Paris Descartes de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France
| | - Christophe Corpechot
- Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Inserm UMR_S938, AP-HP, Université Pierre-et-Marie-Curie Paris 6, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Franck Zenasni
- Laboratoire Adaptation Travail Individu EA 4469, Institut Universitaire Paris Descartes de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France
| | - Olivier Chazouillères
- Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Inserm UMR_S938, AP-HP, Université Pierre-et-Marie-Curie Paris 6, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Philippe Jaury
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Cochin-Port Royal, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Raoul Poupon
- Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Inserm UMR_S938, AP-HP, Université Pierre-et-Marie-Curie Paris 6, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Céline Buffel du Vaure
- Département de Médecine Générale, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Cochin-Port Royal, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Serge Sultan
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine, Montréal, Québec, Canada
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Mellon G, Rigal L, Partouche H, Aoun O, Jaury P, Joannard N, Guthmann JP, Cochereau D, Caumes E, Bricaire F, Salmon-Céron D. Vaccine knowledge in students in Paris, France, and surrounding regions. Can J Infect Dis Med Microbiol 2014; 25:141-6. [PMID: 25285109 PMCID: PMC4173975 DOI: 10.1155/2014/102747] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In France, young adults are legally freed from parental authority at the age of 18 years and are, thus, responsible for their own vaccine record. This young adult population is more frequently exposed to vaccine-preventable infectious diseases. OBJECTIVE To determine the factors associated with students' knowledge of the interval between two antitetanus boosters and their report of having up-to-date vaccinations. METHODS In April 2009, a survey was conducted involving a random sample of students between 18 and 25 years of age eating lunch at university dining facilities in Paris and its suburbs (Ile de France). RESULTS Among the 677 students approached, 583 agreed to participate. Only 207 (36%) of respondents knew the recommended dosing interval between two doses of tetanus vaccine booster (10 years). The majority of students (69%) reported having up-to-date vaccinations. Declaring having up-to-date vaccinations was significantly associated with having a general practitioner (OR 3.03 [95% CI 1.69 to 5.55]). Health care students were significantly more likely to know the decennial interval between two antitetanus boosters (OR 2 [95% CI 1.28 to 3.25]). Most of responding students (n=519 [89%]) believed that vaccines were very useful. CONCLUSIONS An overall lack of knowledge of vaccines was observed among this student population. Health care providers, such as GPs and university medical practice staff, who interact with these young individuals have an essential role to promote better vaccination coverage in this population.
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Affiliation(s)
- Guillaume Mellon
- Tropical and Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris
- General Medicine Department, Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris
| | - Laurent Rigal
- General Medicine Department, Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris
| | - Henri Partouche
- General Medicine Department, Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris
| | | | - Philippe Jaury
- General Medicine Department, Paris Descartes University, Sorbonne Paris Cité, Medical School, Paris
| | - Nathalie Joannard
- Direction régionale des affaires sanitaires et sociales île de France, Paris
| | - Jean Paul Guthmann
- Infectious Disease Department, Institut Nationale de Veille Sanitaire, Saint-Maurice
| | | | - Eric Caumes
- Tropical and Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris
| | - Francois Bricaire
- Tropical and Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris
| | - Dominique Salmon-Céron
- Infectious Diseases Department, Cochin Saint Vincent de Paul Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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18
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Airagnes G, Consoli SM, De Morlhon O, Galliot AM, Lemogne C, Jaury P. Appropriate training based on Balint groups can improve the empathic abilities of medical students: a preliminary study. J Psychosom Res 2014; 76:426-9. [PMID: 24745786 DOI: 10.1016/j.jpsychores.2014.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 02/06/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although empathy is critical in a doctor-patient relationship, empathic abilities seem to decline throughout medical school. This study aimed at examining changes in empathic abilities of fourth-year medical students who participated in an optional certificate based on Balint groups. METHODS Thirty-four students were included in the "Balint group" certificate and compared with 129 participating in other certificates. Before the training sessions and 4 months later, they filled up the interpersonal reactivity index (IRI) and were asked to rate their emotional reactions in response to two case-reports: the first described a woman with diabetes, borderline- personality traits and a history of childhood trauma; the second, a woman with histrionic traits suffering from multiple sclerosis and hospitalized for functional symptoms. A principal component analysis extracted four factors from the 8 questions asked: empathic-approach (e.g. finding the patient touching), rejecting-attitude, intellectual-interest and fear of emotion contagion. RESULTS At baseline, there were no socio-demographic or psychological differences between groups. At follow-up, an increase of IRI fantasy-scale (p=0.02) and a decrease of IRI empathic-concern (p=0.006) were observed, regardless of the group. Empathic-approach only increased in the "Balint group" and for the first case-report (p=0.023), with a difference between the groups at follow-up (p=0.003). CONCLUSION Results suggest that Balint groups may enable medical students to better handle difficult clinical situations such as those presented by borderline personalities. Our findings encourage assessing training initiatives designed at helping young medical students to take into account the emotional component of a doctor-patient relationship.
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Affiliation(s)
- Guillaume Airagnes
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France
| | - Silla M Consoli
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France.
| | | | - Anne-Marie Galliot
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France
| | - Cédric Lemogne
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Philippe Jaury
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Lelorain S, Sultan S, Zenasni F, Catu-Pinault A, Jaury P, Boujut E, Rigal L. Empathic concern and professional characteristics associated with clinical empathy in French general practitioners. Eur J Gen Pract 2012; 19:23-8. [PMID: 22908989 DOI: 10.3109/13814788.2012.709842] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Clinical empathy, i.e. the ability of physicians to adopt patient perspective, is an essential component of care, which depends in part on empathic concern, i.e. compassionate emotions felt for others. However, too much empathic concern can be challenging for physicians. Aim of this study was to examine physician practice characteristics that could explain clinical empathy beyond empathic concern. We were also interested in testing whether professional reflective activities, such as Balint group attendance or clinical supervision, might make clinical empathy less dependent on empathic concern. METHODS A total of 295 French general practitioners (response rate of 37%) completed self-reported questionnaires on empathic concern and clinical empathy, using the Toronto empathy questionnaire (TEQ) and the Jefferson scale of physician empathy (JSPE), respectively. We also recorded information on their professional practice: professional experience, duration of consultations, and participation in Balint groups or being a clinical supervisor. Hierarchical regression analyses were carried out with clinical empathy as dependent variable. RESULTS Empathic concern was an important component of clinical empathy variance. The physician practice characteristics 'consultation length' and 'being a Balint attendee or a supervisor,' but not 'clinical experience' made a significant and unique contribution to clinical empathy beyond that of empathic concern. Participating to one reflective activity (either Balint group attendance or clinical supervision) made clinical empathy less dependent on empathic concern. CONCLUSION Working conditions such as having enough consultation time and having the opportunity to attend a professional reflective activity support the maintenance of clinical empathy without the burden of too much empathic concern.
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Rigal L, de Beaurepaire R, Le Jeunne C, Jaury P. Patient Protection: from Compassion and Pragmatism to Research: Reponse to Dr Braillon's Comments. Alcohol Alcohol 2012. [DOI: 10.1093/alcalc/ags079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rigal L, Alexandre-Dubroeucq C, de Beaurepaire R, Le Jeunne C, Jaury P. Abstinence and ‘Low-Risk’ Consumption 1 Year after the Initiation of High-Dose Baclofen: A Retrospective Study among ‘High-Risk’ Drinkers. Alcohol Alcohol 2012; 47:439-42. [DOI: 10.1093/alcalc/ags028] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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