Background
With the growing rate of childhood cancer cure and the risks of sequelae, long‐term follow‐up (FU) of survivors is a central issue. Several models have been proven far from satisfactory. ...Shared care FU is the result of collaboration between general practitioners (GPs) and cancer centers. We sought to demonstrate the feasibility of setting up a shared care program based on the patient‐centered education of GPs and to evaluate the impact of this model in an intervention study.
Methods
We compared the FU care achievement in two childhood cancer survivor cohorts in the same pediatric oncology center, (i) control group (n = 134) and (ii) intervention study cohort (n = 137), after setting up the program.
Results
The rate of survivors answering the survey and the rate of patients involved in FU by their GPs were higher in intervention study cohort than in baseline one (132/137 vs. 72/134 and 110/132 vs. 13/72; P ≤ 0.0001). The lack of any FU was definitely lower (10/132 vs. 18/72; P = 0.001) in the intervention study cohort.
Conclusion
In this shared care program, survivors overcame distrust in their GP's knowledge and entered the FU program after their GPs had been involved in patient‐centered education. Personalized and incentive‐based guidance was very useful in helping survivors to adhere to FU. Support of a dedicated long‐term FU team was very useful. A nationwide organization, consideration of special needs in subgroups of survivors and sustained funding are needed to adjust the program in the very long term.
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Determining bacterial aetiology of acute sinusitis is difficult without employing invasive procedures.
• Most episodes of acute sinusitis resolve ...spontaneously.
• Antibiotics have demonstrated efficacy for the treatment of acute bacterial sinusitis in clinical trials yet little is known of their effectiveness in real‐life treatment settings.
WHAT THIS STUDY ADDS
• Most cases of untreated acute sinusitis resolved spontaneously. Antibiotics were more effective when given within the first 10 days of treatment. This had no effect on later recurrence.
• Patients with poor oro‐dental condition or recent antibiotic use may derive the most benefit from an antibiotic prescription and this should be considered by prescribers.
• The antibiotics used were found to be equally effective.
• Existing recommendations to identify acute sinusitis with high probability of bacterial origin, such as the French recommendations, fever or duration of symptoms fail to identify patients in whom antibiotics are more effective.
AIMS
To assess the effectiveness of antibiotics in acute bacterial sinusitis.
METHODS
This was a prospective cohort study with 2 months follow‐up of 5640 patients with acute sinusitis included by a random sample from 1174 GPs and 120 ENT specialists. Main outcomes were short‐term initial success, defined as the absence of prescription of (another) antibiotic or sinus lavage within 10 days, and lack of recurrence between the 11th and 60th day, after initial success.
RESULTS
Initial success was found in 88.7% (95% CI 85.1, 91.4%) of patients without antibiotic prescription at inclusion and 96.2% (95% CI 95.7, 96.7%) of patients prescribed antibiotics. The 10 day adjusted hazard ratio (HR) for treatment failure (new antibiotic prescription or sinus drainage) with initial antibiotics compared with no antibiotics was 0.30 (95% CI 0.21, 0.42) with no difference between antibiotics. Antibiotics were more effective in patients with poor oro‐dental condition (HR 0.04, 95% CI 0.01, 0.20) and in patients who had already used antibiotics during the previous 2 months (HR 0.09, 95% CI 0.03, 0.28). For patients without failure at 10 days, recurrence between the 11th and 60th day was similar whether or not they had initially been prescribed an antibiotic, 94.1% (95% CI 93.4, 94.7%) and 93.4% (95%CI 90.3, 95.5%), respectively.
CONCLUSION
Most acute sinusitis cases not prescribed antibiotics resolve spontaneously. Antibiotics reduced by 3.3‐fold the risk of failure within 10 days, without impact on later recurrence. The greatest benefit of antibiotics was found for patients with poor oro‐dental condition or with antibiotic use within the previous 2 months.
Estimate the effect of lifestyle adjustment activities in patients with metabolic syndrome treated by prescribed balneotherapy.
Observational pilot cohort study with 12-month follow-up after ...multidimensional lifestyle training (physical, dietary, educational) during 3-week standard stay in the spa town of Eugénie-les-Bains.
Of 145 eligible patients, 97 were included; 63 were followed and analysable. At inclusion all had ≥3 National cholesterol education program-Adult treatment panel III (NCEP-ATPIII) criteria defining metabolic syndrome, 76.2% were female, mean age was 61.2 years. At the end of follow-up (median:10.4 months, Inter-Quartile Range: 6.7;11.4), 48 of these 63 patients (76.2%) no longer had metabolic syndrome (95%CI 65.7;86.7). These 48 patients without metabolic syndrome at the end of follow-up represented 49.5% of the 97 included (95%CI 39.5;59.4).
Future studies of lifestyle interventions taking advantage of the spa environment can be expected to find least one third of patients free of metabolic syndrome at the end of 12-month follow-up in the intervention group.
Contexte : Le portfolio est utilisé dans la formation et la validation du diplôme d’études spécialisées de médecine générale à l’Université de Bordeaux depuis 2004. L’appropriation de cet outil ...restait difficile pour les étudiants, ce qui a conduit le Département de médecine générale (DMG) à proposer une aide individuelle à l’écriture du premier script du portfolio en 2010. Objectif : Analyser l’usage de l’aide individuelle à l’écriture du premier script auprès des étudiants de première année de troisième cycle et des enseignants impliqués dans le dispositif. Méthode : enquête déclarative par questionnaires à l’attention des étudiants et des enseignants en 2012. Résultats : Le taux de réponse a été de 70 % chez les étudiants et de 44 % chez les enseignants. Soixante-douze pour cent des étudiants étaient intéressés par cette aide et 86 % d’entre eux avaient envoyé leur premier script à un enseignant désigné. Le temps de rétroaction avec les enseignants a été jugé insuffisant par 74 % des étudiants et 81 % souhaiteraient une aide complémentaire. Plus de 65 % trouvaient un intérêt à l’aide apportée mais 31 % se sentaient encore en difficulté au décours. Chez les enseignants, 88 % estimaient que l’aide était partiellement suffisante et que 12 % des étudiants étaient motivés. Conclusion : Le dispositif était perçu comme une bonne initiative mais l’adhésion restait dépendante du lien tissé entre l’étudiant et l’enseignant. Des modifications ont été apportées au dispositif. Le DMG a notamment mis en place un e-portfolio qui fera l’objet de prochaines études.
Background: The portfolio used at the University of Bordeaux since 2004 has a double purpose: the learning and the assessment of the postgraduate general medicine degree. Postgraduate students found it hard to suit the portfolio to their needs, which is why the teachers of the general practice department set up individual mentoring to help students draft the first script. Goal: To analyze the individual mentoring process among first-year postgraduate students and teachers involved in the project. Method: Declarative survey questionnaires filled in by the involved students and teachers. Results: The response rate for students was 70% and for teachers 44%. Some 72% of students were interested in the mentoring and 86% returned their first script to their appointed teacher. Some 74% of students felt that the time spent with teachers was inadequate and 81% would have liked further assistance. Over 65% found the assistance helpful, but 31% still felt uncomfortable with script writing after the mentoring. Some 88% of teachers felt that the one-time mentoring had been partly satisfactory and that 12% of students were motivated. Conclusion: The process was considered helpful but adherence depended on teacher-student relationship. The department has made some changes in the process and set up the ePortfolio, which will be the subject of future studies.
Cutaneous wound healing requires keratinocyte proliferation, migration and differentiation to restore the barrier function of the skin. The calcineurin/nuclear factor of activated-T-cell (NFAT) ...signaling pathway has been recently shown to be involved in keratinocyte growth, differentiation and migration. It is induced by an increased intracellular calcium rate and its inhibition results in decreased capacities of keratinocytes to migrate. Nevertheless, the link between calcineurin activation and keratinocyte migration remains unknown. Recently, Orai1, a pore subunit of a store-operated calcium channel that favors calcium influx, was shown to play a critical role to control proliferation and migration of basal keratinocytes. Of interest, the actin-bundling T-plastin is crucial in cell motility through cross-linking to actin filament and its synthesis was shown to be induced by calcium influx and regulated by the calcineurin/NFAT pathway in tumor Sezary cells. We investigated herein the role of the calcineurin/NFAT pathway-dependent T-plastin in keratinocyte migration, by quantifying T-plastin expression in keratinocytes and by analyzing their migration under calcineurin inhibition or knockdown of NFAT2 or T-plastin. We did confirm the role of the calcineurin/NFAT pathway in keratinocyte migration as shown by their decreased capacities to migrate after FK506 treatment or siNFAT2 transfection in both scratching and Boyden assays. The expression of NFAT2 and T-plastin in keratinocytes was decreased under FK506 treatment, suggesting that T-plastin plays a role in keratinocyte migration downstream to the calcineurin/NFAT pathway. Accordingly, siRNA knockdown of T-plastin expression also decreased their migration capacities. Actin lamellipodia formation as well as FAK and β6-integrin expression were also significantly decreased after treatment with FK506 or siRNA, reinforcing that NFAT2-dependent T-plastin expression plays a role in keratinocyte migration. These results indicate that T-plastin might be considered as a major actor in the mechanisms underlying calcineurin/NFAT-dependent keratinocyte migration and may explain wound-healing defects observed in patients under calcineurin inhibitor long-term treatment.
Prostate carcinoma in the elderly Ravaud, Alain; Pasticier, Gilles; Davin, Jean-Louis ...
Bulletin du cancer,
2008-May-28, Letnik:
95 FMC Onco
Journal Article
Recenzirano
Prostate carcinoma is the most frequent cancer in French men. Prostate carcinoma in elderly is the topic of this review. The review included chapters on age as the main factor for prostate carcinoma, ...the modification of disease presentation or PSA level depending on age, and then the challenge of age in therapeutic decisions. Finally, we evaluate the place of elderly patients in prospective trials and in adjustable therapies.
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