Barriers and facilitators to the involvement of general practitioners in the prescription of buprenorphine.

INTRODUCTION: France has one of the highest opioid agonist treatment (OAT) coverage rates in the world. French general practitioners (GPs) are providing the majority of prescriptions. However, a fall in the number of GPs initiating buprenorphine has been observed over the last decade. METHODS: The objective of this study was to explore the obstacles and facilitators to the involvement of GPs in the prescription of buprenorphine. A qualitative study comprising 14 individual interviews and a focus group bringing together 5 GPs was conducted among GPs based in France between June 2021 and March 2022. We performed data analysis using a grounded theory methodology. RESULTS: The interviews showed a great diversity in the level of involvement of GPs, depending on their experience, their representations of patients with OUD, their mode of exercise, and their personal preferences. The negative representations of the patients associated with the feeling of physical and ethical endangerment, the feeling of powerlessness, the fear of a disruption of the practice and the feeling of incompetence appeared at the forefront of the difficulties stated. Conversely, the strengthening of initial training and the facilitation of access to self-training tools and multidisciplinarity, the consideration of opioid use disorder (OUD) as a chronic illness with the application of a patient-centered motivational approach, as well as the defining and respecting one's own limits when prescribing buprenorphine seem to be the keys to a balanced and fulfilling practice. CONCLUSION: Raising awareness of the frequency of OUD appeared to be an additional lever to enhance the interest of the GPs concerned. Additional studies focusing on the evolution of professional practices would be necessary to extend these findings.

Suggestions for a Systematic Regulatory Approach to Ocean Plastics.

The research investigates the problems and maps the solutions to the serious threat that plastics pose to the oceans, food safety, and human health, with more than eight million tons of plastic debris dumped in the sea every year. The aim of this study is to explore how to better improve the regulatory process of ocean plastics by integrating scientific results, regulatory strategies and action plans so as to limit the impact of plastics at sea. Adopting a problem-solving approach and identifying four areas of intervention enable the establishment of a regulatory framework from a multi-actor, multi-issue, and multi-level perspective. The research methodology consists of a two-pronged approach: 1. An analysis of the state-of-the-art definition of plastics, micro-, and nanoplastics (respectively, MPs and NPs), and 2. The identification and discussion of loopholes in the current regulation, suggesting key actions to be taken at a global, regional and national level. In particular, the study proposes a systemic integration of scientific and regulatory advancements towards the construction of an interconnected multi-tiered (MT) plastic governance framework. The milestones reached by the project SECURE at UiT - The Arctic University of Norway provide evidence of the strength of the theory of integration and rights-based approaches. The suggested model holds substantial significance for the fields of environmental protection, food security, food safety, and human health. This proposed MT plastic governance framework allows for the holistic and effective organization of complex information and scenarios concerning plastics regulation. Containing a clear definition of plastics, grounded on the precautionary principle, the MT plastic framework should provide detailed mitigation measures, with a clear indication of rights and duties, and in coordination with an effective reparatory justice system.

Value of speckle tracking for the assessment of right ventricular function in patients operated on for tetralogy of fallot. Comparison with magnetic resonance imaging.

BACKGROUND: Right ventricular (RV) function is a major prognostic factor in patients (pts) with operated tetralogy of Fallot (TOF). We compared the results of RV speckle tracking (two-dimensional [2D] strain) with those of magnetic resonance imaging (MRI) in this setting. METHODS: At transthoracic echocardiogram (echo), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), velocity of S-wave at tricuspid annulus with tissue Doppler, and 2D strain (longitudinal maximal systolic strain) were recorded. Their results were compared to RV indexed end-diastolic volume (EDV), indexed end-systolic volume (ESV), and RV ejection fraction (EF) at MRI. RESULTS: Twenty-two pts (16 M) aged 11-62 years (mean 23.2 ± 10.8) were included. Parameters of RV systolic function were as follows: RVFAC = 40 ± 10%, TAPSE = 18 ± 4 mm, S-wave = 10 ± 0.2 cm/sec, and RV EF at MRI = 43 ± 11%. Global RV systolic strain was -15.5 ± 4.2%, free wall strain was -15.1 ± 6.3%, and septal strain was -15.8 ± 3.8% on average for the whole group. Echo indexed RV end-diastolic area correlated with EDV at MRI (r = 0.73), as well as echo indexed RV end-systolic area and ESV at MRI (r = 0.71). Global RV 2D strain correlated well with RV EF at MRI: r = 0.68; P < 0.05, and with ESV at MRI: r = 0.63. Feasibility, intra- and inter-observer reproducibility of 2D strain were adequate. CONCLUSIONS: Speckle tracking is a promising method to estimate RV systolic function in pts operated on for TOF.

Comparison of right ventricular systolic function in patients with low risk and intermediate-to-high risk pulmonary embolism: a two-dimensional strain imaging study.

AIM: Right ventricular (RV) dysfunction is key for risk stratification in pulmonary embolism (PE). The goal of this study was to compare RV strain values between low and intermediate-to-high risk PE patients assessed by two-dimensional (2D) strain imaging. METHODS: The inclusion criterion was a diagnosis of PE confirmed by thoracic computed tomography scan with contrast medium, or by scintigraphy perfusion lung scan. Risk stratification of PE was defined as high when there was hemodynamic instability; intermediate when there were signs of RV dysfunction on echocardiography; and/or elevated troponin I and/or brain natriuretic peptide and low when none of these criteria were present. All patients underwent echocardiography at admission. Apical four-chamber images were analyzed off line using both conventional and 2D strain imaging. RESULTS: Sixty-two patients (mean age 66 years) were prospectively recruited: 33 with low risk PE, 29 with intermediate-to-high risk PE. Global 2D RV strain differed significantly between groups (-13.1% vs. -18.7%, P < 0.01), as did free wall (-12.7% vs. -20.2%, P < 0.016) and septal wall (-13.5% vs. -17.2%, P < 0.01). When the RV was divided into segments, we observed a similar reduction in absolute strain value in the mid and apical free wall segments and in the apical septal wall (-20.3 ± -7.6 vs. -11.8 ± 8.9%; P < 0.01 and -19.6 ± 6.9 vs. -7.4 ± 9.1%; P < 0.01, and -17.7 ± 7.0 vs. 9.9 ± 8.0; P < 0.01, respectively). 2D strain and tricuspid annular plane systolic excursion were significantly related (r(2)  = 0.35, P < 0.01). CONCLUSIONS: Peak RV longitudinal 2D strain is reduced in patients with intermediate-to-high risk PE, especially in the apical and mid segments of the free wall. Global and regional RV longitudinal 2D strain is altered in patients with intermediate-to-high risk PE as compared with low risk PE.