How to treat venous thromboembolism (TVE) in cancer patients: ten years of multidisciplinary team meetings (MDTM) at Saint-Louis Hospital.

BACKGROUND: - The management of venous thromboembolism (VTE) is particularly challenging in patients with cancer who undergo complex treatment protocols. Cancer patients often have comorbidities which may affect the efficacy and safety of anticoagulant treatments. Coordinated multidisciplinary management of these complex cases can help optimize delivery of individualized anticoagulant treatment. AIMS: - To describe the multidisciplinary team meeting (MDTM) for the management of VTE in cancer patients at our institution and to document outcomes in these patients. METHODS: - Bi-monthly MDTMs attended by different physicians and nurses were established at Saint-Louis Hospital in 2008. We performed a retrospective analysis of all cases discussed between September 2008 and January 2018. RESULTS: - Over a 10-year period, 520 patients were discussed a total of 551 times. Their mean age was 63 years with 278 (53%) women. The most frequent primary cancer sites were breast (23%), genitourinary (21 %), hematological (20%), digestive (15%), and lung (9%). Fifty-two percent of patients had metastatic cancer, and 54% of them were receiving chemotherapy. The optimal treatment for pulmonary embolism (17%), deep vein thrombosis (16%), catheter-related thrombosis (20%) or combined events (46%) was discussed. Twenty-three patients (4.4%) were discussed for one VTE recurrence and 4 (0.8%) for 2 recurrences. CONCLUSIONS: - A dedicated MDTM for the management of VTE in cancer patients allows to discuss a wide range of clinical scenarios and contributes to optimal adherence to evidence-based clinical practices guidelines. The MDTM evaluation was successfully carried out within a short time-frame of VTE diagnosis and helped optimize individualized treatment plans.

Effet paradoxal du type d'excision sur la prise et le délai de cicatrisation des greffes expansées pour le traitement des brûlures aiguës: a propos de 1129 cas.

Split-thickness meshed skin graft is frequently used in the treatment of acute burns. We studied the effect of the type of basement preparation on graft intake and healing time. We retrospectively analysed 1,129 meshed grafts used in the treatment of acute burns between 1995 and 2005. Intake was significantly better after avulsion (82%) than after tangential excision (75%). Intake was better if avulsion was performed before day 7 (83% vs. 73%). A trend for better intake after tangential excision was seen when performed between day 7 and 21. Healing time was significantly shorter after tangential excision. These results show the paradox that avulsion favours graft intake but delays healing time, contrary to tangential excision.

[A cross-sectional study of trait-anxiety in a group of 111 intellectually gifted children]. / Étude transversale de l'anxiété trait dans un groupe de 111 enfants intellectuellement surdoués.

INTRODUCTION: Intellectually gifted children are often thought to display a high risk for psychopathology. However, this assertion has received only few direct arguments to date, and there is in fact a lack of knowledge on this subject. The aim of this study was to compare trait-anxiety - which is considered as a sensitive and early indicator of psychoaffective difficulties in children - in intellectually gifted children to the norm. METHODS: One hundred and eleven children aged 8 to 12 and with an intellectual quotient (IQ) higher than 129 participated in the study. They were recruited in a hospital department of child and adolescent psychiatry and through psychologists' private practice, where they attended consultation because of academic underachievement and/or social maladjustment. All the children were examined by trained psychiatrists and psychologists: none had a present or past medical or psychiatric condition and, additionally, none had an elevated score on the French version of the Children's Depressive Rating Scale Revised (Moor & Mack, 1982). Parents filled in a questionnaire for the collection of socio-demographic data and children answered the French version of the Revised-Children's Manifest Anxiety Scale (R-CMAS; Reynolds, 1999), a 37-items self-assessment of trait-anxiety, the psychometric properties of which have been validated in children with high IQ. DATA ANALYSIS: Mean scores and subscores on the R-CMAS in the whole studied group and as a function of gender and age were compared to French normative data (Reynolds, 1999) by calculation of 95% confidence intervals; subgroups were compared using Student's t-tests. Proportions of children who's score and subscores exceeded anxiety cut-off norms were compared to normative data using chi-square tests. Statistical significance was considered at the P<0.05 level. RESULTS: The studied group comprised mainly boys, and members of a sibling. Parents mainly lived as man and wife, had high academic levels, and had a professional activity. The confidence intervals of the R-CMAS scores and subscores all comprised their normative value, which denotes that no difference was statistically significant. Comparisons for age and gender showed no significant difference. Proportions of results exceeding the cut-off scores and subscores did not significantly differ from the norms. DISCUSSION: General and dimensional trait-anxiety levels in the studied group were comparable to normative data. These results are in accordance with previous studies of trait-anxiety in children and adolescents with high IQ, which all showed normal or decreased levels. These findings do not corroborate the hypothesis that intellectual giftedness constitutes a risk factor for psychopathology. LIMITS: The studied group was a clinical one, which could limit the generalisation of the results. However, mental disorders were ruled out, and the psychometric and socio-demographic characteristics of the group were in keeping with those described for the general population of gifted children. Moreover, considering that participant children displayed academic underachievement and/or social maladjustment, it can be supposed that their anxiety levels were not lower than those in the general population of gifted children. Secondly, the potentially confusing effect of socio-demographic variables (underrepresentation of low socio-economic levels and single-parent families) could not be statistically taken into account, due to the absence of a specific control group. CONCLUSION: Intellectually gifted children seem not to display increased trait-anxiety. However, further studies are necessary to investigate psychological functioning in gifted children and their risk for psychopathology.

Self-rated health and risk of incident dementia: a community-based elderly cohort, the 3C study.

OBJECTIVES: We examined the relationship between self-rated health and incident dementia, and investigated the impact of cognitive complaints, depressive symptoms, and functional status on this relationship. METHODS: Participants of the 3C Study, a prospective cohort study composed of 8,169 community-dwelling persons aged ≥65 years, were asked to rate their health at the baseline examination in 1999-2001. They were followed for a median of 6.7 years during which dementia was screened and diagnosed. Hazard ratios (HR) of dementia according to baseline self-rated health (good, fair, or poor) were estimated with a Cox model adjusted for potential confounders. RESULTS: During the 46,990 person-years of follow-up, 618 participants developed dementia. Risk of dementia was increased in participants with poor (adjusted HR 1.70, 95% confidence interval [CI] 1.22-2.37) or fair (adjusted HR 1.34, 95% CI 1.13-1.59) self-rated health compared to those with good self-rated health. Poor self-rated health was associated with both AD (1.48, 1.00-2.24) and vascular dementia (3.38, 1.25-9.17). Self-rated health was a stronger predictor of dementia in participants without cognitive complaints (risk of dementia in subjects without cognitive complaints rating their health as poor: 1.96 [1.24-3.09], p = 0.004) and in those without functional disability. CONCLUSIONS: Participants rating their health as poor or fair at baseline were at increased risk of incident dementia during follow-up. Self-rated health could help raise awareness of medical doctors about a patient's risk of dementia, especially in those without conditions indicative of potential cognitive impairment.