[Development of a targeted educational activity in addictology: From design to use in specialized structures in the Normandy region]

OBJECTIVE

Risk and damage reduction is a public health issue and allows to consider addiction as a chronic pathology in which patients have the opportunity to become actors of their own care, a philosophy shared with Therapeutic Education. In this context, our objective is to develop a tool adapted to the populations of patients/users in specialized structures, meeting the criteria of a Targeted Educational Activity, to allow them a better understanding and management of their addiction to opiates on a daily basis.

METHOD

In a multi-professional setting, involving pharmacists, doctors and nurses, an exploratory phase was conducted in order to identify the theme, the target population and the tool format. Then, the tool was built and validated with the ambition of responding pedagogically to the problems encountered daily by patients/users.

RESULTS

The pedagogical tool, called "Le QUIZZ à moindre risque", contains 51 questions categorized in 2 structured parts on the reduction of risks related to opiate consumption and substitution drugs. Focused on the problems of patients/users, it helps them achieve greater autonomy in their health and a better quality of life, with and despite the illness. The proposed format makes it a tool that can be freely consulted by patients/users according to their practices and needs; it can also be used in group workshops conducted with the caregivers.

CONCLUSION

The tool developed aims to (i) enable opiate users to acquire skills to improve the management of their consumption and the risks involved and (ii) strengthen communication between patients/users and caregivers by offering them the opportunity to be actors of their care. The tool is currently being tested and evaluated in many cities in Normandy and its optimization will allow for an improvement in care that meets the challenges and needs.

Engraftment of unrelated cord blood after reduced-intensity conditioning regimen in children with refractory neuroblastoma: a feasibility trial

Relapsed or refractory neuroblastoma is uniformly fatal. We hypothesized that allogeneic response could provide a platform for immunotherapy in neuroblastoma. We therefore undertook a pilot trial of unrelated cord blood transplantation after reduced intensity conditioning regimen (RIC) in children with relapsed neuroblastoma to assess engraftment and tolerability in this heavily pretreated population. The RIC included CY (50 mg/kg, day -6), fludarabine (40 mg/m(2), days -6 to -2), total body irradiation (200 cGy, day -1), and rabbit anti-thymocyte globulin (2.5 mg/kg, days -3 to -1). Six patients were enrolled: four were in partial responsive relapse, one with a mixed response and one in refractory relapse. All patients tolerated the regimen well and had donor engraftment with full neutrophil and plt recovery (median time 12 and 35 days, respectively). One patient never experienced neutropenia and another did not need plt transfusions. All patients progressed after transplant (median time 55 days, 26-180 days). Natural killer (NK) cell counts were normal within 2 months, whereas T-cell recovery was slower. In conclusion, unrelated cord blood engrafts after RIC in children with refractory neuroblastoma. Future research should be aimed at transplanting patients with minimal residual disease, using less intensive immunosuppression and adding NK-cell based post transplant immunotherapy.