[CamiCon study: Evaluation of a new tool for automated and connected voiding calendar]. / Étude CamiCon : évaluation d'un nouvel outil pour la réalisation d'un calendrier mictionnel automatisé et connecté.

INTRODUCTION: A voiding diary (VD) is a key element in the evaluation of patients with overactive bladder (OAB) at initial presentation and during treatment to assess its effectiveness. In order to be clinically relevant, it must be performed over 3 days according to the International Continence Society (ICS). Unfortunately, some patients find it cumbersome. We aimed to evaluate the reliability and patient satisfaction when using a connected tank device. MATERIAL AND METHOD: We conducted a single-center prospective study including 41 patients. Each patient completed a paper voiding diary and then a diary with Diary Pod® (DP) or inversely depending on the study arm. Data from 34 patients were collected. After completion of both diaries, patients completed a satisfaction questionnaire sent by email via GoogleForm. Study statistics were performed with Jamovi® and Excel® software. RESULT: Data from 34 patients were analyzed. There was a statically significant difference (P=0.046) between the mean volume calculated from the paper VD and that calculated from the connected VD (DP). There was no statistically significant difference (P=0.112) between the mean number of daytime voids, mean number of nighttime voids (P=0.156), mean water intake (P=0.183) reported on the paper VD and the connected VD. Thirteen (42%) paper VD and 1 connected VD did not include documentation of the presence or absence of urine leakage or urgency. There was no statistically significant difference between the two calendars regarding the presence or absence of urine leakage (P=0.180) and urinary urgency (P=0.564). Eighty-four percent (26/31) preferred the connected tank to the usual method (paper/pen), while 55% (17/31) and 29% (9/31) of the participants respectively answered that the DP was "very definitely" or "definitely" an aid for performing VD. Nevertheless, 39% (12/31) and 55% (17/31) considered its price to be high or fair and only 22% (7/31) were inclined to buy it. CONCLUSION: This study showed that the Diary connected reservoir Pod® is a reliable and innovative tool for voiding schedules. It facilitates data collection for the majority of patients (83%) and could, through better patient compliance, provide better quality data and help their interpretation by the physician. These factors could encourage the implementation of the connected voiding diary as a diagnostic tool. It would also be used for the assessment of treatment effectiveness in daily clinical practice as well as in research. Its cost remains a major obstacle, judged by 39% of patients to be too high, and could therefore be proposed in specific situations requiring precise data.

[Organization of the health system in the region to meet the needs of patients Covid long]. / Organisation du système de santé en région pour répondre aux besoins des patients Covid long.

Under the impetus of the Regional Health Agencies, the organization of the health system was redeployed throughout the health crisis linked to Covid-19. Mostly supported by coordination support mechanisms, post-Covid coordination units were activated in 2021 in each region, at the departmental level, to meet the needs of professionals and users. This article reports on the deployment of the Covid long devices in the Occitanie region.

[Analysis of preferences and behaviors towards dosing devices of liquid oral forms and study of the impact of a pharmaceutical education on the safety of their use]. / Analyse des préférences et des comportements envers les dispositifs d'administration des formes orales liquides et étude de l'impact d'une éducation pharmaceutique sur la sécurité de leur utilisation.

OBJECTIVES: The aim of this study was to analyze patients' preferences and behaviors towards dosing devices of oral liquid medication and the impact of pharmaceutical education on their handling practices. METHODS: A cross-sectional study was carried out at a pharmacy. Participants were asked to answer a pre-established questionnaire about their preferences and behaviors towards oral liquid administration devices. The impact of pharmaceutical education was assessed by simulating filling a 5mL dose using a metering device of their choice. The data collected was analyzed by SPSS 20.0. RESULTS: Preferences and behaviors regarding dosing devices were variable according to the characteristics of the population. Of the 396 participants, one third continued to use household spoons and only 54% of them chose calibrated dosing devices. Pharmaceutical education had a positive impact on administration practices. CONCLUSIONS: Particular attention should be carried to dosing devices of oral liquid forms. An inventory should be drawn up to assess the quality and safety of the marketed specialties.

Mechanical circulatory support with the Impella® LP5.0 pump and an intra-aortic balloon pump for cardiogenic shock in acute myocardial infarction: The IMPELLA-STIC randomized study.

BACKGROUND: Percutaneous assist devices may be used as a bridge to recovery in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI). AIM: To test the hypothesis that the Impella® LP5.0 pump (Abiomed Europe GmbH, Aachen, Germany) provides haemodynamic benefits and improves left ventricular ejection fraction (LVEF) in patients with CS-AMI already managed with an intra-aortic balloon pump (IABP). METHODS: This was a prospective randomized study. The primary endpoint was change in cardiac power index (CPI) from baseline to 12hours after implantation, measured with a Swan-Ganz catheter. Secondary endpoints included LVEF at 30 days. RESULTS: Fifteen patients with CS-AMI were randomized; 12 were available for primary endpoint analysis (IABP group, n=6; Impella LP5.0+IABP group, n=6). Baseline characteristics were similar in both groups. Change in CPI after 12hours was not significantly different between the two groups (IABP group: ΔCPI=0.08±0.08W/m2; Impella LP5.0+IABP group: ΔCPI=-0.02±0.25W/m2; P=0.4). There was no significant change from baseline CPI in either group over 96hours, and no difference in CPI between groups at each timepoint. In the Impella LP5.0+IABP group, the part of the CPI provided by the native heart decreased from 0.37±0.10 to 0.10±0.20 (P=0.01). LVEF was similar at baseline (29.7%±8.4% and 29.3%±6.7%) and 1 month (40.6%±12.5% and 38.6%±14.4%) in the IABP and Impella LP5.0+IABP groups, respectively. Adverse events, especially major bleeding, were common, and occurred mainly in the Impella LP5.0+IABP group. CONCLUSIONS: In patients with CS-AMI stabilized by initial treatment with inotropes and an IABP, the Impella LP5.0 did not provide additional haemodynamic support or improvement in LVEF at 1 month; its use in this setting might be futile and possibly harmful.

[Diagnosis disclosure in geriatric oncology]. / L'annonce diagnostique en oncogériatrie.

The disclosure of a cancer diagnosis in an elderly person is often difficult. It can be impacted by sensory or cognitive disorders, a depressive condition, or by the presence of family members. It is important to take account of a disease which is sometimes at an advanced stage, reduced life expectancy and obvious frailty. The disclosure should always be made whatever the clinical situation, but always with an adapted, honest and step-by-step process.

[Adapting the care pathway]. / Adapter le parcours de soins.

The implementation of cross-functional measures along the care pathway of cancer patients in France is globally lower in the elderly. However, age is not a criterion for excluding curative treatment, and the evaluation of physical, psychological and social resources and comorbidities is particularly significant in this population. Identifying needs in terms of support care which influences the patient's quality of life as well as the efficacy of treatments is also essential. The objective of geriatric oncology coordination is to offer elderly cancer patients global treatment, curative or otherwise, through the putting in place of a personalised care programme.

[An interview guide for screening for psychological pain in oncology]. / Un guide d'entretien pour le dépistage de la souffrance psychologique en cancérologie.

An interview guide has been introduced with patients treated in oncology in order to assess their psychological pain. It helps to structure the nurse interview. It also combines the identification of the patient's psychological needs with the creation of an opportunity to talk, thereby initiating a help relationship.

[Cancer diagnosis disclosure and supportive care seen from the patient side. A cross sectional multicentre survey]. / Étude transversale, multicentrique, sur le ressenti des patients concernant le dispositif d'annonce du diagnostic de cancer.

The objective of this study was to describe patients' experience during cancer disclosure and initial carers' support phase, in three healthcare facilities in Haute-Savoie District, France. METHODOLOGY: We conducted a multicentric, cross-sectional telephone survey. Patients registered on the multidisciplinary cancer consultation platform lists were randomised. Practitioners validated the inclusion criteria of their patients, i.e. age over 18, patient fully informed of his/her diagnosis and able to answer a telephone interview. RESULTS: Two hundred thirty-six patients have been included. Outcome indicators reported as satisfactory were: the general setting of the disclosure consultation, the patient-doctor relationship, the coordination between the different carers and the patient carer relationship. The overall duration of the medical disclosure consultation and the time dedicated to explain the treatment and its adverse effects have been considered as insufficient. DISCUSSION: The measured indicators, which were by essence subjective, convey useful information on the quality of care in cancer treatment in the initial disclosure phase, as experienced by patients. This study has in particular allowed carers to start exploring ways to improve the experience of care of their patients.

[Non-tuberculous mycobacterial infection of a totally implanted perfusion device]. / Infection à mycobactérie non tuberculeuse d'une chambre implantable pour perfusion.

INTRODUCTION: Catheter-related infection by non-tuberculous mycobacteria is rare but difficult to diagnose and the treatment is not standardized. CASE REPORT: A 64-year-old woman treated for lung cancer with intravenous chemotherapy developed an infection of her totally implanted perfusion device with Mycobacterium chelonae. The infection was cured after surgical removal of the device and treatment with oral clarithromycin. CONCLUSION: Mycobacteria may infect vascular access devices. Rapid diagnosis of such infections allows early treatment.

[The choice of inhalation device: A medical act]. / Le choix du dispositif d'inhalation (hors nébulisation) : un acte médical.

Inhaled treatments are essential for respiratory diseases management, including COPD and asthma. Optimal control of the disease largely depends on patient's compliance and proper use of these treatments. Different types of ready-to-use inhaler devices are available: metered dose inhaler, dry powder inhaler or soft mist inhaler. Each of these devices presents specific characteristics and constraints that have to be evaluated and taken into account before prescription. In order to optimize adherence and treatment efficacy, the choice of inhaler device should depend on the specific needs, abilities and preferences of each patient and a specific education to treatment should be provided. Inhaled treatments, even containing the same drug, have different technical constraints and are thus not easily interchangeable. Their substitution without prior medical consent and without proper training can lead to errors in taking treatment, treatment failures and increased health care consumption. In France, substitution by the pharmacist is not authorized. While patient education must be carried out in collaboration with all health professionals, it is preferable that the choice of inhaler device remains the responsibility of the physician.

[Inhaled treatments in cystic fibrosis: what's new in 2013?]. / Mucoviscidose et traitements inhalés: quoi de neuf en 2013?

In the past few years some new inhaled drugs and inhalation devices have been proposed for the treatment of cystic fibrosis. Breath-controlled nebulizers allow increased pulmonary deposition, with a lower variability and a shorter delivery time. The new dry powder formulations of tobramycin, colistine and mannitol require a change in the inhalation technique which must be slow and deep. In the field of the inhaled mucolytic drugs, hypertonic saline and mannitol have an indication in some patients. With regard to antibiotics, dry-powder tobramycin and colistine can be substituted for the same drug delivered by nebulization. Nebulized aztreonam needs more studies to determine its place. These new treatments represent a definite advance for cystic fibrosis patients and need to be known by all practitioners. Their position in our therapeutic arsenal remains to be accurately defined.

[Inhaled medication in pediatrics]. / Traitements inhalés en pédiatrie.

Three different devices are available for inhaled medications in children: the pressurized metered dose inhalers (pMDIs, breath-actuator synchronized pMDI, and valved holding spacers), the dry powder inhalers, and the nebulizers. To choose the better device for a particular patient, a perfect knowledge of the available devices, of their mode of use, of their advantages and inconvenient is required. The use of a pMDI coupled to a valved holding spacer is the first mode of delivery to propose in children aged less than 6 years. After 6 years old, the DPIs may be proposed depending on the child's competences. At last, the nebulizations are indicated in some particular and severe indications, but new indications are appearing because of recent progresses.