Lung damage in cystic fibrosis (CF) is strongly associated with lower airway infections. Early treatment of
is recommended. Pathogen detection requires sampling of lower airway secretions, which ...remains a challenge in nonexpectorating patients. Our hypothesis was that chest physiotherapy would improve the quality of airway secretion samples and increase the rates of pathogens detected in nonexpectorating patients. This prospective multicentre study compared three successive methods for sampling airway secretions applied through the same session: 1) an oropharyngeal swab (OP), 2) a chest physiotherapy session followed by a provoked cough to obtain sputum (CP-SP) and 3) a second oropharyngeal swab collected after chest physiotherapy (CP-OP).
,
and
growth cultures were assessed. Accuracy tests and an equivalence test were performed to compare the three successive methods of collection. 300 nonexpectorating children with CF were included.
was detected cumulatively in 56 (18.9%) children, and according to the different collection methods in 28 (9.8%), 37 (12.4%) and 44 (14.7%) children by using OP, CP-OP and CP-SP, respectively. Compared with OP, the increased detection rate was +22% for CP-OP (p=0.029) and +57% for CP-SP (p=0.003). CP-SP had the best positive predictive value (86.3%) and negative predictive value (96.0%) for
compared with the overall detection. The results of this adequately powered study show differences in the rates of pathogens detected according to the sampling method used. Chest physiotherapy enhanced detection of
in nonexpectorating children with CF.
Introduction
Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that has demonstrated clinical benefits in phase 3 trials. We report results from a real-world study ...(BRIO) to assess the effectiveness of ivacaftor in people with cystic fibrosis (pwCF) in France.
Methods
BRIO was an observational study conducted at 35 centers in France. Both pwCF initiating ivacaftor treatment and those already taking ivacaftor were included and prospectively followed for 24 months. The primary objective was to evaluate the effect of ivacaftor on percent predicted forced expiratory volume in 1 s (ppFEV
1
); secondary objectives were evaluating the effect of ivacaftor on clinical effectiveness, healthcare resource utilization (HCRU), and safety.
Results
A total of 129 pwCF were enrolled; 58.9% were aged < 18 years; 64.3% had a
G551D
-
CFTR
allele. Mean age at ivacaftor initiation was 19.1 years (range, 2–64 years); ppFEV
1
increased by a least squares mean of 8.49 percentage points in the first 6 months and was sustained through 36 months of ivacaftor use. Growth metrics increased during the first 12 months post-ivacaftor and remained stable. The rate of pulmonary exacerbations (PEx) decreased during the 12 months post-ivacaftor compared with the 12 months pre-ivacaftor; estimated rate ratios (95% CI) were 0.57 (0.43–0.75) for PEx events and 0.25 (0.13–0.48) for PEx requiring hospitalization. No new safety concerns were identified; no deaths occurred.
Conclusions
The results from this real-world study of ivacaftor usage in France were consistent with prior clinical trial outcomes, confirming the clinical effectiveness of ivacaftor, as well as an associated reduction in HCRU.
En 2016, les équipes et chercheurs du GDR NoST ont décidé de créer cinq ateliers qui rythment depuis la vie du groupe de recherche. Parmi ces ateliers, le Centre d’études et de recherches ...internationales et communautaires (CERIC-UMR DICE 7318) a initié l’atelier intitulé « Un concept : le consensus ». Dans le prolongement de cet atelier, un projet de recherche a été financé par l’Université de Strasbourg, dans le cadre des projets Idex Attractivité. Ce projet de recherche, intitulé « Le consensus en santé et environnement : Analyse de la construction d’une pratique en contexte d’incertitude scientifique » (CONSENS), s’est déroulé de 2018 à 2020. Les contributions réunies dans ce dossier spécial en sont le résultat. Le projet de recherche s’est intéressé spécifiquement au concept de « consensus », tel que mobilisé dans les processus décisionnels. L’approche casuistique retenue a permis d’identifier les différentes manifestations du consensus, de les cartographier et de saisir certaines des dynamiques qui les sous-tendent. L’approche pluridisciplinaire, et l’écriture à quatre ou six mains qui en a découlé, a, par ailleurs, conduit à mieux appréhender les interactions, pas toujours attendues, entre les différentes formes de consensus.
Ce numéro est le fruit d’une réflexion interdisciplinaire sur les défis sociétaux engendrés par les avancées biomédicales et technoscientifiques, qui tendent à transformer l’homme par les multiples ...dispositifs techniques susceptibles soit de le soigner (nanotechnologies), soit de suppléer certains de ses organes déficients (cœur Carmat, prothèses 3D, reproduction génétique des organes défectueux, corps régénérable par les techniques du clonage et de la thérapie cellulaire, utérus artificiel), soit de l’augmenter (lunettes 3D, œil bionique, implants cérébraux pour stimulation), soit de le transformer en fonction de ses souhaits et de ceux de la société (esthétique, sexe, mi-homme-mi-robot). Sans cesse interconnecté, il pourrait, grâce à l’intelligence artificielle et Big data, disposer de nouvelles capacités, mieux gérer son parcours de vie et de soins qui peu à peu seraient de plus en plus personnalisés et performés. La problématique centrale est de savoir si cette révolution humaine technoscientifique remet en cause l’humanité de la personne et est susceptible d’affecter son intériorité.
Revue des droits de l'homme - N° 17 Altwegg-Boussac, Manon; Arenas, Guillermo; Aubry, Régis ...
La Revue des droits de l’homme,
02/2020
Journal Article
PDF
