Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.411
Filtrar
1.
Maturitas ; 141: 46-52, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036702

RESUMO

BACKGROUND/OBJECTIVE: The COVID-19 epidemic is particularly serious in older adults. The symptomatology and epidemic profile remain little known in this population, especially in disabled oldest-old people with chronic diseases living in nursing homes. The objective of the present study was to comprehensively describe symptoms and chronological aspects of the diffusion of the SARS-CoV-2 virus in a nursing home, among both residents and caregivers. DESIGN: Five-week retrospective cohort study. SETTING: A middle-sized nursing home in Maine-et-Loire, west of France. PARTICIPANTS: Eighty-seven frail older residents (87.9 ± 7.2years; 71 % female) and 92 staff members (38.3 ± 11.7years; 89 % female) were included. MEASUREMENTS: Mass screening for SARS-CoV-2 was performed in both residents and staff. Attack rate, mortality rate, and symptoms among residents and staff infected with SARS-CoV-2 were recorded. RESULTS: The attack rate of COVID-19 was 47 % in residents (case fatality rate, 27 %), and 24 % in staff. Epidemic curves revealed that the epidemic started in residents before spreading to caregivers. Residents exhibited both general and respiratory signs (59 % hyperthermia, 49 % cough, 42 % polypnea) together with geriatric syndromes (15 % falls, 10 % altered consciousness). The classification tree revealed 100 % COVID-19 probability in the following groups: i) residents younger than 90 with dyspnea and falls; ii) residents older than 90 with anorexia; iii) residents older than 90 without anorexia but with altered consciousness. Finally, 41 % of staff members diagnosed with COVID-19 were asymptomatic. CONCLUSIONS: The pauci-symptomatic expression of COVID-19 in older residents, together with the high prevalence of asymptomatic forms in caregivers, justifies mass screening in nursing homes, possibly prioritizing residents with suggestive combinations of clinical signs including dyspnea, falls, anorexia and/or altered consciousness.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Anorexia/virologia , Betacoronavirus , Cuidadores , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dispneia/virologia , Feminino , Idoso Fragilizado , França/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos
2.
Rev Med Suisse ; 16(710): 1926-1931, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058579

RESUMO

Listeria monocytogenes, a gram-positive bacterium, is the cause of Listeriosis. Its mortality is currently the highest for food borne diseases. Affected are mainly elderly or immunocompromised patients, as well as pregnant women. Despite food hygiene measures and surveillance, outbreaks are possible in developed countries. In the canton of Valais, six hospitalized cases including one death occurred between end of March and the beginning of May 2020. The typing of these strains of L. monocytogenes showed a link to a larger Swiss outbreak associated with contaminated soft cheese (Brie). The outbreak ended once the producer recalled the incriminated cheese. This article describes the outbreak with a review of other outbreaks' sources and a reminder of preventive measures.


Assuntos
Queijo/microbiologia , Surtos de Doenças , Contaminação de Alimentos/estatística & dados numéricos , Listeria monocytogenes , Listeriose/epidemiologia , Listeriose/microbiologia , França/epidemiologia , Humanos , Listeriose/prevenção & controle , Suíça/epidemiologia
3.
Crit Care ; 24(1): 610, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066801

RESUMO

BACKGROUND: Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. METHODS: We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms' onset and date of sampling. RESULTS: From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13-12.64, p = 0.03). CONCLUSIONS: The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/terapia , Síndrome do Desconforto Respiratório do Adulto/virologia , Sistema Respiratório/virologia , Idoso , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Estudos Prospectivos , Respiração Artificial , Suíça/epidemiologia , Carga Viral , Eliminação de Partículas Virais
4.
Rev Prat ; 70(6): 617-620, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058601

RESUMO

Prehospital management of acute stroke patients. In France, prehospital management of patients with suspected acute stroke relies on emergency medical communication centers (Samu), which provides first-line telephone assessment and dispatches the most appropriate emergency vehicle. Such tasks are not straightforward because many clinical symptoms may correspond to stroke and alternative diagnoses - stroke mimics - are common. It is crucial to reduce both prehospital and hospital delays in patients eligible for reperfusion therapies, namely intravenous thrombolysis and/or mechanical thrombectomy. Because mechanical thrombectomy only applies to patients with acute ischemic stroke and large-vessel occlusion, prehospital triage is important. However, clinical prediction of large-vessel occlusion is difficult and whether a specific patient should be sent to the nearest primary stroke center (drip and ship paradigm) or a comprehensive stroke center with thrombectomy capability (mothership paradigm) remains uncertain. Prehospital notification of the hospital-based stroke teams by the emergency medical system crews is crucial in reducing delays to achieve reperfusion.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , França/epidemiologia , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Trombectomia , Triagem
5.
Rev Prat ; 70(5): 502-506, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058634

RESUMO

Review of the prescription of antipsychotics in children. In France, as in the rest of the world, prescribing of antipsychotic drugs increases in children and adolescentsIndeed, antipsychotics are frequently prescribed in children and adolescents for both psychotic and non-psychotic disorders, with 36 to 93%o fprescriptionsbeingoff-label in this population. In addition, a high number of adverse events have been reported in the literature under antipsychotic treatment. The consequences of these adverse events are still poorly documented. In France, a 12-months national prospective study (ETAPE) observed a high incidence rate, severity and persistence of adverse events during first-time antipsychotic treatment in pediatric patients. Therefore, a careful and continuous clinical and biological monitoring all over the treatment period is required to adapt treatment decisions based on benefice-risk-analysis.


Assuntos
Antipsicóticos , Transtornos Mentais , Adolescente , Antipsicóticos/efeitos adversos , Criança , França/epidemiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Prescrições , Estudos Prospectivos
6.
Rev Prat ; 70(5): 509-513, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058636

RESUMO

What prescription for psychostimulants in children? The Attention Deficit and Hyperactivity Disorder (ADHD) is a frequent disorder in children and adolescents. The diagnosis is clinical with the input of several informants (child, family, teachers…). ADHD is a risk factor for academic difficulties, school dropout, social isolation, injury, oppositional behaviour. In school-age children and adolescents having moderate to high or persistent impairment despite psycho-educational support and environmental modification, the first-line treatment is methylphenidate. Group or individual cognitive behavioural therapy for parents and/or children and adolescents is recommended for co-occurring disorders and persistent impairment. In France, the initiation of methylphenidate requires an annual hospital prescription by a paediatrician or psychiatrist, and a regular medical supervision (weight, heart rate, blood pressure…). At least once a year, the indication of methyphenidate needs to be re-evaluated and confirmed at the hospital. In case of lack of efficiency and/or poor tolerance, therapeutic alternatives including non-psychostimulants should be considered.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Terapia Cognitivo-Comportamental , França/epidemiologia , Humanos , Pais
7.
Rev Prat ; 70(6): 657-659, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058613

RESUMO

Epidemiology of illicit substances use in france The landscape of illicit substances use is evolving in France, with dealers going digital. Cannabis and cocaine are consumed by 44% and 5% of French subjects, respectively, and are the most frequent motive for care. Other illicit substances such as ecstasy (MDMA), amphetamines, LSD and other hallucinogenic products are used by 2-3% of French subjects. Heroin and other opiates, although regularly used by less than 1% of French subjects, are provoking both a severe dependence and medical complications that require a specific treatment.


Assuntos
Cannabis , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Anfetaminas , França/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
9.
Medicine (Baltimore) ; 99(40): e22623, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019485

RESUMO

PURPOSE: To identify the 100 most cited research articles on cervical cancer radiotherapy. METHODS: The Web of Science and Scopus databases were searched to identify the 100 most cited articles on cervical cancer radiotherapy as of September 29, 2019. Articles were ranked based on the total citations received from 2 databases. One hundred articles about radiotherapy for cervical cancer were identified. The following important information was extracted: author, journal, year and month of publication, country or region, and radiotherapy technologies. RESULTS: The 100 most cited articles on cervical cancer radiotherapy were published between 1964 and 2016, and the total citations from 2 databases ranged from 3478 to 211, including a total of 49,262 citations as of September 29, 2019. The index of citations per year ranged from 170.4 to 13.1. These articles were from 16 countries or regions, with most publications being from the United States (n = 38), followed by Austria (n = 15), Canada (n = 8), France (n = 8) and the United Kingdom (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 42), followed by Radiotherapy and Oncology (n = 13), Cancer (n = 8) and Journal of Clinical Oncology (n = 7). These articles were categorized as original studies (n = 86), recommendations (n = 5), guidelines (n = 5) and reviews (n = 4). Of the 100 most cited articles, intracavitary brachytherapy (n = 50) and 3-dimensional conformal radiotherapy (n = 34) were the most commonly used treatment techniques. CONCLUSION: To the best of our knowledge, this is the first report and analysis of the most cited articles on cervical cancer radiotherapy. This bibliographic study presents the history of technological development in external radiation therapy and brachytherapy. Brachytherapy is an indispensable part of radiotherapy for cervical cancer. The International Journal of Radiation Oncology Biology Physics is the journal with the most publications related to cervical cancer radiotherapy.


Assuntos
Braquiterapia/métodos , Publicações/estatística & dados numéricos , Neoplasias do Colo do Útero/radioterapia , Áustria/epidemiologia , Bibliometria , Biologia/estatística & dados numéricos , Canadá/epidemiologia , Bases de Dados Factuais , Feminino , França/epidemiologia , Humanos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Física/estatística & dados numéricos , Publicações/tendências , Radioterapia (Especialidade)/estatística & dados numéricos , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
10.
Ann Biol Clin (Paris) ; 78(5): 499-518, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026346

RESUMO

The French society of clinical biology "Biochemical markers of COVID-19" has set up a working group with the primary aim of reviewing, analyzing and monitoring the evolution of biological prescriptions according to the patient's care path and to look for markers of progression and severity of the disease. This study covers all public and private sectors of medical biology located in metropolitan and overseas France and also extends to the French-speaking world. This article presents the testimonies and data obtained for the "Overseas and French-speaking countries" sub-working group made up of 45 volunteer correspondents, located in 20 regions of the world. In view of the delayed spread of the SARS-CoV-2 virus, the overseas regions and the French-speaking regions have benefited from feedback from the first territories confronted with COVID-19. Thus, the entry of the virus or its spread in epidemic form could be avoided, thanks to the rapid closure of borders. The overseas territories depend very strongly on air and/or sea links with the metropolis or with the neighboring continent. The isolation of these countries is responsible for reagent supply difficulties and has necessitated emergency orders and the establishment of stocks lasting several months, in order to avoid shortages and maintain adequate patient care. In addition, in countries located in tropical or intertropical zones, the diagnosis of COVID-19 is complicated by the presence of various zoonoses (dengue, Zika, malaria, leptospirosis, etc.).


Assuntos
Serviços de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Saúde Global/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Medicina de Viagem/organização & administração , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Betacoronavirus/fisiologia , Biomarcadores/análise , Biomarcadores/sangue , Camboja/epidemiologia , Criança , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/estatística & dados numéricos , Busca de Comunicante/métodos , Busca de Comunicante/estatística & dados numéricos , Infecções por Coronavirus/transmissão , Diagnóstico Diferencial , Feminino , França/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Ilhas/epidemiologia , Idioma , Laos/epidemiologia , Louisiana/epidemiologia , Masculino , Pessoal de Laboratório Médico/organização & administração , Pessoal de Laboratório Médico/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Estudos Retrospectivos , Inquéritos e Questionários , Análise de Sobrevida , Medicina de Viagem/métodos , Medicina de Viagem/estatística & dados numéricos , Doença Relacionada a Viagens , Clima Tropical , Medicina Tropical/métodos , Medicina Tropical/organização & administração , Medicina Tropical/estatística & dados numéricos , Vietnã/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-33007976

RESUMO

BACKGROUND: Understanding SARS-CoV-2 dynamics and transmission is a serious issue. Its propagation needs to be modeled and controlled. The Alsace region in the East of France has been among the first French COVID-19 clusters in 2020. METHODS: We confront evidence from three independent and retrospective sources: a population-based survey through internet, an analysis of the medical records from hospital emergency care services, and a review of medical biology laboratory data. We also check the role played in virus propagation by a large religious meeting that gathered over 2000 participants from all over France mid-February in Mulhouse. RESULTS: Our results suggest that SARS-CoV-2 was circulating several weeks before the first officially recognized case in Alsace on 26 February 2020 and the sanitary alert on 3 March 2020. The religious gathering seems to have played a role for secondary dissemination of the epidemic in France, but not in creating the local outbreak. CONCLUSIONS: Our results illustrate how the integration of data coming from multiple sources could help trigger an early alarm in the context of an emerging disease. Good information data systems, able to produce earlier alerts, could have avoided a general lockdown in France.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Betacoronavirus , Monitoramento Epidemiológico , França/epidemiologia , Humanos , Comportamento de Massa , Pandemias , Estudos Retrospectivos
12.
J Med Vasc ; 45(5): 288-293, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862987

RESUMO

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.


Assuntos
Anticoagulantes/administração & dosagem , Bandagens Compressivas/tendências , Heparina de Baixo Peso Molecular/administração & dosagem , Padrões de Prática Médica/tendências , Trombose Venosa Profunda de Membros Superiores/terapia , Procedimentos Cirúrgicos Vasculares/tendências , Administração Oral , Adulto , Esquema de Medicação , Inibidores do Fator Xa/administração & dosagem , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/epidemiologia
13.
Rev Prat ; 70(3): 318-325, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32877069

RESUMO

Dengue fever: an emerging infectious disease. Dengue fever is caused by an arbovirus of the family Flaviviridae and the genus Flavivirus, of which there are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). It is transmitted by the bite of a diurnal mosquito of the genus Aedes, mainly A. aegypti and A. albopictus. An increasing cause of acute fever in travellers, it threatens to emerge in temperate regions where competent mosquitoes (Aedes) are established. Dengue fever is characterized by its clinical polymorphism ranging from asymptomatic to severe forms, which are rare in travellers. Its definite diagnosis is based on virological tests selected according to the stage of the disease and the kinetics of the virus. Its treatment is only symptomatic. It is a notifiable disease in mainland France and is subject to a plan to combat its spread and to specific surveillance in the overseas departments. Dengue prevention is based on the application of personal anti-vectorial protection measures among travellers, awareness-raising among health professionals and social mobilization to combat larval gites in endemic regions or regions colonized by Aedes. In France, the tetravalent vaccine Dengvaxia, which is licensed in France, is not recommended for people residing in overseas departments and for travelers to endemic areas.


Assuntos
Aedes , Doenças Transmissíveis Emergentes , Vírus da Dengue , Dengue , Animais , Dengue/epidemiologia , Dengue/transmissão , França/epidemiologia , Medicina de Viagem
14.
Rev Prat ; 70(3): 333-335, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32877072

RESUMO

West nile virus infection: an emerging arbovirosis in france and europe. West Nile virus is a mosquito-borne flavivirus, transmitted to humans by mosquitoes of the genus Culex, from an avian reservoir. Humans are accidental hosts and there is no report of human-to-human transmission, except via blood transfusion or organ transplantation. In 2018, Europe experienced the largest outbreak of West Nile virus infection ever. In France, 27 cases were identified including 7 neuro invasive forms. This infection is asymptomatic in most cases but may also manifest as an isolated fever or flu-like syndrome. In about 1% of cases, neuro-invasive forms with meningitis, meningoencephalitis or flaccid paralysis can be observed. There is no specific treatment for this viral infection. Prevention is based on the prevention of mosquito bites, but also on enhanced epidemiological surveillance during the period of circulation of the virus in Europe (from spring to autumn).


Assuntos
Culex , Febre do Nilo Ocidental , Vírus do Nilo Ocidental , Animais , Doenças Transmissíveis Emergentes , Europa (Continente)/epidemiologia , França/epidemiologia , Humanos , Febre do Nilo Ocidental/epidemiologia
15.
Sante Publique ; 32(2): 247-251, 2020 09 15.
Artigo em Francês | MEDLINE | ID: mdl-32989954

RESUMO

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência Odontológica/organização & administração , Epidemias , Pneumonia Viral/epidemiologia , França/epidemiologia , Humanos , Pandemias
17.
Sante Publique ; 32(2): 247-251, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985841

RESUMO

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência Odontológica/organização & administração , Epidemias , Pneumonia Viral/epidemiologia , França/epidemiologia , Humanos , Pandemias
18.
Rev Infirm ; 69(263): 43-45, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32993907

RESUMO

Student nurses at the heart of the Covid-19 crisis. Many student nurses were involved in dealing with the Covid-19 health crisis. As a consequence, the block release training programme was completely overturned in order to meet the urgent requirements of health and medical-social institutions. Two student nurses from Île-de-France, in their third year of training, share anonymously their experience on the ground during the health crisis. Their experiences, which required polyvalence, adaptability, stress management and autonomy on their part, have considerably enriched their portfolio of competencies.


Assuntos
Infecções por Coronavirus/enfermagem , Educação em Enfermagem/organização & administração , Pandemias , Pneumonia Viral/enfermagem , Estudantes de Enfermagem/psicologia , Infecções por Coronavirus/epidemiologia , França/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
19.
Lancet Oncol ; 21(9): 1224-1233, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888454

RESUMO

BACKGROUND: Topotecan is currently the only drug approved in Europe in a second-line setting for the treatment of small-cell lung cancer. This study investigated whether the doublet of carboplatin plus etoposide was superior to topotecan as a second-line treatment in patients with sensitive relapsed small-cell lung cancer. METHODS: In this open-label, randomised, phase 3 trial done in 38 hospitals in France, we enrolled patients with histologically or cytologically confirmed advanced stage IV or locally relapsed small-cell lung cancer, who responded to first-line platinum plus etoposide treatment, but who had disease relapse or progression at least 90 days after completion of first-line treatment. Eligible patients were aged 18 years or older and had an Eastern Cooperative Oncology Group performance status 0-2. Enrolled patients were randomly assigned (1:1) to receive combination carboplatin plus etoposide (six cycles of intravenous carboplatin [area under the curve 5 mg/mL per min] on day 1 plus intravenous etoposide [100 mg/m2 from day 1 to day 3]) or oral topotecan (2·3 mg/m2 from day 1 to day 5, for six cycles). Randomisation was done using the minimisation method with biased-coin balancing for ECOG performance status, response to the first-line chemotherapy, and treatment centre. The primary endpoint was progression-free survival, which was centrally reviewed and analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02738346. FINDINGS: Between July 18, 2013, and July 2, 2018, we enrolled and randomly assigned 164 patients (82 in each study group). One patient from each group withdrew consent, therefore 162 patients (81 in each group) were included in the intention-to-treat population. With a median follow-up of 22·7 months (IQR 20·0-37·3), median progression-free survival was significantly longer in the combination chemotherapy group than in the topotecan group (4·7 months, 90% CI 3·9-5·5 vs 2·7 months, 2·3-3·2; stratified hazard ratio 0·57, 90% CI 0·41-0·73; p=0·0041). The most frequent grade 3-4 adverse events were neutropenia (18 [22%] of 81 patients in the topotecan group vs 11 [14%] of 81 patients in the combination chemotherapy group), thrombocytopenia (29 [36%] vs 25 [31%]), anaemia (17 [21%] vs 20 [25%]), febrile neutropenia (nine [11%] vs five [6%]), and asthenia (eight [10%] vs seven [9%]). Two treatment-related deaths occurred in the topotecan group (both were febrile neutropenia with sepsis) and no treatment-related deaths occurred in the combination group. INTERPRETATION: Our results suggest that carboplatin plus etoposide rechallenge can be considered as a reasonable second-line chemotherapy option for patients with sensitive relapsed small-cell lung cancer. FUNDING: Amgen and the French Lung Cancer Group (Groupe Français de Pneumo-Cancérologie).


Assuntos
Carboplatina/administração & dosagem , Etoposídeo/administração & dosagem , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Topotecan/administração & dosagem , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/efeitos adversos , Intervalo Livre de Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Etoposídeo/efeitos adversos , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Carcinoma de Pequenas Células do Pulmão/epidemiologia , Carcinoma de Pequenas Células do Pulmão/patologia , Topotecan/efeitos adversos
20.
Rev Infirm ; 69(263): 37-39, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32993905

RESUMO

Covid-19: psychological support programmes. The spread of Covid-19 in France, the confinement of the population and the changes to our way of life as a result of the health crisis have caused psychological distress to many people of all ages and conditions. In response to these problems, numerous remote psychological support programmes have been set up through teleconsultations. PsyCovid-19, created at Cadillac psychiatric hospital, is one such example.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Angústia Psicológica , Sistemas de Apoio Psicossocial , Telemedicina , Betacoronavirus , França/epidemiologia , Humanos , Pandemias
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA