L’amélioration de la prise en charge médicamenteuse est un objectif constant des équipes en charge de la qualité et de la gestion des risques liés aux soins 1,2 . En psychiatrie, le circuit du ...médicament concerne à la fois les secteurs intra et extrahospitaliers, pour lequel l’analyse des risques est parfois moins maîtrisée. L’objectif de ce travail est d’établir une cartographie des risques, a priori, du circuit du médicament du secteur extrahospitalier de notre établissement (800 lits) afin d’aboutir à l’élaboration de recommandations pour la sécurisation de ce circuit 3 . Un état des lieux du fonctionnement du circuit du médicament en secteur extrahospitalier a été réalisé en collaboration avec la cellule qualité de janvier à juin 2015 au sein de 11 centres médico-psychologiques et 10 centres et/ou hôpitaux de jour. Les données recueillies lors de cette étude observationnelle ont été analysées selon la méthode AMDEC (analyse des modes de défaillance, de leurs effets, et de leur criticité). Après pondération (construction d’une matrice), les divers circuits ont été modélisés en logigrammes intégrant différents points (conciliation médicamenteuse, conditions de prescriptions, de délivrance, et d’administration) et comportant sept issues potentielles allant de la situation la plus à risque vers la plus sécurisée (pondérée à 100 %). Les étapes du circuit les plus critiques sont l’absence de conciliation, la non-informatisation des prescriptions et l’administration médicamenteuse sans prescription. Dans seulement 2 situations sur 28 (7 %) le circuit extrahospitalier est sécurisé à 100 % et dans 13 cas sur 28 (46 %), un niveau de sécurisation supérieur à 50 % (seuil d’acceptabilité défini) est atteint. Si le choix de la valeur seuil (50 %) et la pertinence d’un tel outil restent critiquables, ce travail préliminaire a permis la mise en évidence des situations les plus à risque, la création d’un groupe de travail pluridisciplinaire et l’élaboration de mesures correctives.
ABSTRACT
In this chapter, we discuss two measures designed to assess executive function (EF) as part of the NIH Toolbox Cognition Battery (CB) and report pediatric data from the validation study. EF ...refers to the goal‐directed cognitive control of thought, action, and emotion. Two measures were adapted for standardized computer administration: the Dimensional Change Card Sort (a measure of cognitive flexibility) and a flanker task (a measure of inhibitory control in the context of selective visual attention). Results reveal excellent developmental sensitivity across childhood, excellent reliability, and (in most cases) excellent convergent validity. Correlations between the new NIH Toolbox measures and age were higher for younger children (3–6 years) than for older children (8–15 years), and evidence of increasing differentiation of EF from other aspects of cognition (indexed by receptive vocabulary) was obtained.
Aim
Quantifying a species' climate niche is often the first step to determining potential sensitivity to climate change. This process typically relies on native occurrence records, assuming that ...these reflect the breadth of a species' climatic requirements. Yet, many species survive in non‐native regions with climates beyond their native range. Identifying their characteristics could help to better elucidate responses to climate change. Here, we use an extensive data set of urban street tree and native range records for 566 tree species to assess differences between species native and urban climate niches and whether niche differences are predictable given characteristics of species native ranges.
Location
Global.
Time Period
1970–2020.
Major Taxa Studied
Tree species.
Methods
Multivariate niche estimations were undertaken using eight climate variables. Calculations included the size of species' urban and native niches, overlap and direction of shift. Relationships between niches and native range attributes (temperature and precipitation breadth, range size, Köppen Geiger subclasses occupied) were calculated using multiple linear regression.
Results
83% of tree species studied had significantly larger urban niches compared to native niches. Species with narrow geographic ranges demonstrated greater mismatch between their two niches, and the direction of niche shift was associated with their native range Köppen Geiger zone. For example, species native to the wet tropics tend to be planted in cooler, drier urban spaces; those native to cold regions are planted in warmer urban spaces.
Main Conclusion
Native range occurrences may poorly reflect the breadth of climatic conditions a species can tolerate—particularly for species with narrow geographic ranges. For some species, Köppen Geiger zones may be a useful proxy to help understand sensitivity to climate change. Accounting for possible plasticity in tree species to climate can improve our understanding of their sensitivity and adaptive capacity to climate change.
In the context of lung transplant (LT), because of diagnostic difficulties, antibody‐mediated rejection (AMR) remains a matter of debate. We retrospectively analyzed an LT cohort at Foch Hospital to ...demonstrate the impact of AMR on LT prognosis. AMR diagnosis requires association of clinical symptoms, donor‐specific antibodies (DSAs), and C4d+ staining and/or histological patterns consistent with AMR. Prospective categorization split patients into four groups: (i) DSA positive, AMR positive (DSAposAMRpos); (ii) DSA positive, AMR negative (DSAposAMRneg); (iii) DSA limited, AMR negative (DSALim; equal to one specificity, with mean fluorescence intensity of 500–1000 once); and (iv) DSA negative, AMR negative (DSAneg). AMR treatment consisted of a combination of plasmapheresis, intravenous immunoglobulin and rituximab. Among 206 transplanted patients, 10.7% were DSAposAMRpos (n = 22), 40.3% were DSAposAMRneg (n = 84), 6% were DSALim (n = 13) and 43% were DSAneg (n = 88). Analysis of acute cellular rejection at month 12 showed higher cumulative numbers (mean plus or minus standard deviation) in the DSAposAMRpos group (2.1 ± 1.7) compared with DSAposAMRneg (1 ± 1.2), DSALim (0.75 ± 1), and DSAneg (0.7 ± 1.23) groups. Multivariate analysis demonstrated AMR as a risk factor for chronic lung allograft dysfunction (hazard ratio HR 8.7) and graft loss (HR 7.56) for DSAposAMRpos patients. Our results show a negative impact of AMR on LT clinical course and advocate for an early active diagnostic approach and evaluation of therapeutic strategies to improve prognosis.
The authors find an association between antibody‐mediated rejection in lung transplantation and chronic lung allograft dysfunction and graft loss.
Purpose
This case-control study was designed to assess the efficacy of cryotherapy to prevent paclitaxel-induced painful peripheral neuropathy in women with breast cancer.
Methods
Participants served ...as their own paired control, with randomization of the cooled glove/sock to either the dominant or the non-dominant hand/foot, worn for 15 min prior to, during, and 15 min after completion of the paclitaxel infusion. Outcome measures included the Neuropathic Pain Symptom Inventory, the Brief Pain Inventory, and quantitative sensory testing. Data were measured at each of six time points—baseline, post-treatment (approximately 2 weeks after the last paclitaxel infusion), and at the first, fifth, ninth, and final weekly paclitaxel treatments.
Results
Of 29 randomized participants, 20 (69%) received at least one cryotherapy treatment, and 11 (38%) received all four cryotherapy treatments. Ten (34%) participants could not tolerate the cryotherapy, and six (21%) declined further participation at some point during the trial. Only seven participants (24%) were available for the final post-chemotherapy QST and questionnaires. There were no significant differences in measures of neuropathy or pain between treated and untreated hands or feet.
Conclusions
Strategies to prevent painful peripheral neuropathy are urgently needed. In this current trial, dropout due to discomfort precluded adequate power to fully understand the potential benefits of cryotherapy. Much more research is needed to discover safe and effective preventive strategies that can be easily implemented within busy infusion centers.
Our ability to fight COVID-19 demonstrates that where there’s a will, there’s a way. Yet proactive action will not be the single driving force behind us winning a stable and benign environment for ...our children. This article focuses on the not so obvious yet impactful trends affecting our ability to stave off the worst of climate change. These trends include carbon taxation, climate litigation, AI, space exploration, Direct Air Capture and an ever younger, more motivated demographic. Some trends will affect our efforts in unknown and unpredictable ways, while others will drive them with ever more force over the years to come. Carbon taxation requires a proactive change in government policy, but that change will place implementation in the hands of the free market. As we face an existential crisis never before seen by humanity, perhaps the largest driving force affecting our ability to ensure a healthy planet will be a more engaged public.
Several retrospective epidemiological studies report that utilization of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) inhibitors called statins at mid-life can reduce the risk of developing ...sporadic Alzheimer's disease (AD) by as much as 70%. Conversely, the administration of these inhibitors in clinically diagnosed subjects with AD confers little or no benefits over time. Here, we investigated the association between AD and HMGCR rs3846662, a polymorphism known to be involved in the regulation of HMGCR exon 13 skipping, in a founder population and in two distinct mixed North American populations of converting mild cognitively impaired (MCI) subjects (Alzheimer's disease Cooperative study (ADCS) and Alzheimer's disease Neuroimaging Initiative (ADNI) cohorts). Targeting more specifically women, the G allele negative (G-) AD subjects exhibit delayed age of onset of AD (P=0.017) and significantly reduced risk of AD (OR: 0.521; P=0.0028), matching the effect size reported by the apolipoprotein E type 2 variant. Stratification for APOE4 in a large sample of MCI patients from the ADCS cohort revealed a significant protective effect of G negative carriers on AD conversion 3 years after MCI diagnosis (odds ratio (OR): 0.554; P=0.041). Conversion rate among APOE4 carriers with the HMGCR's G negative allele was markedly reduced (from 76% to 27%) to levels similar to APOE4 non-carriers (27.14%), which strongly indicate protection. Conversion data from the independent ADNI cohort also showed significantly reduced MCI or AD conversion among APOE4 carriers with the protective A allele (P=0.005). In conclusion, HMGCR rs3846662 acts as a potent genetic modifier for AD risk, age of onset and conversion.
Health-related quality-of-life (HRQOL) assessments in research and clinical oncology settings are increasingly important. HRQOL instruments need to be rapid and still maintain the ability to capture ...the most relevant patient issues in a valid and reliable manner. The current study develops and validates the FACT-G7, a rapid version of the Functional Assessment of Cancer Therapy-General (FACT-G).
Oncology patients with advanced cancer (N = 533) from 11 diseases sites ranked the symptoms and concerns they viewed as ‘the very most important’ when undergoing cancer treatment, completed the FACT-G, and additional HRQOL measures. Oncology patients' scores were referenced across a general US population sample (N = 2000).
We selected the highest priority cancer-related symptoms and concerns endorsed by patients for inclusion in the FACT-G7. Fatigue and ability to enjoy life were ranked the most highly. The results provide preliminary support for the FACT-G7's internal consistency reliability (α = 0.74) and validity as evidenced by moderate-to-strong relationships with expected criteria. The references for the general population are summarized.
The FACT-G7 can be used to assess top-rated symptoms and concerns for a broad spectrum of advanced cancers in clinical practice and research.
The ITR serves as an international database for centers around the world to contribute to current knowledge about intestinal transplant outcomes. Led by the IRTA and managed by the Terasaki Research ...Institute, the ITR collects data annually and uses these data to generate reports that guide management strategies and policy statements. The aim of this manuscript was to analyze outcomes specific to pediatric intestinal transplantation. Outcome data for children transplanted from 1985 to 2017 were analyzed and predictive factors assessed. A total of 2010 children received 2080 intestine containing allografts during this period. Overall, 1‐year and 5‐year patient and graft survival were 72.7%/66.1% and 57.2/48.8%, respectively. One‐year conditional survival was most strongly associated with being a first‐time transplant recipient and liver‐inclusive grafts. Patient survival was most strongly associated with elective status of transplantation as compared with hospitalized status. Enteral autonomy following transplantation has continued to improve by era with colonic inclusion demonstrating additional incremental improvement in enteral autonomy and freedom from intravenous fluid. While PTLD and technical complications contribute less to graft loss than in earlier eras, rejection remains the largest contributor to long‐term graft loss. Re‐transplantation is linked with significantly worse conditional graft survival, and sepsis remains the largest contributor to patient death. Newer data elements are focusing on impact of donor variables, donor and recipient tissue typing, and impact of the development of de novo antibodies.
There has been increasing awareness that glioblastoma, which may seem histopathologically similar across many tumors, actually represents a group of molecularly distinct tumors. Emerging evidence ...suggests that cells even within the same tumor exhibit wide-ranging molecular diversity. Parallel to the discoveries of molecular heterogeneity among tumors and their individual cells, intense investigation of the cellular biology of glioblastoma has revealed that not all cancer cells within a given tumor behave the same. The identification of a subpopulation of brain tumor cells termed "glioblastoma cancer stem cells" or "tumor-initiating cells" has implications for the management of glioblastoma. This focused review will therefore summarize emerging concepts on the molecular and cellular heterogeneity of glioblastoma and emphasize that we should begin to consider each individual glioblastoma to be an ensemble of molecularly distinct subclones that reflect a spectrum of dynamic cell states.
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