[Management of child and adolescent depression in primary care: A systematic meta-review]. / Prise en charge de la dépression de l'enfant et l'adolescent en soins premiers : une métarevue systématique de la littérature.

OBJECTIVE: To develop a practical guide for the management of child and adolescent depression for general practitioners (GPs), suited to their practice frame, that can be implemented on a website aimed to help GPs to manage the main mental disorders encountered in primary care. METHOD: A systematic meta-review was performed as recommended by the PRISMA statement. Each step, articles' selection, inclusion, methodological assessment and data extraction for the narrative synthesis was independently performed by two researchers. A study protocol was registered on PROSPERO (number CRD42016042710). The databases Pubmed, Cochrane and Web of Science were explored. Each step was performed independently by two researchers following PRISMA. Meta-analyses and systematic reviews (including guidelines based on a systematic review), published between 2002 and 2015, in English or French, dealing with the therapeutic management, in primary care, of patients aged 6 to 18 years old with a major depressive disorder (MDD) were included. Grey literature was explored searching the websites of national and international health agencies, learned societies, and article references. The methodological and report qualities were assessed using the AGREE II, PRISMA checklist and R-AMSTAR grid. A narrative synthesis was performed to produce the practical guide, prioritizing data from the best evaluated articles. An expert group of GPs' and one child psychiatrist validated the guide in its final form. RESULTS: Thirty-eight studies were included: 12 recommendations, 5 systematic reviews and 21 meta-analyses. The best evaluated guideline had an AGREE-II assessment of 81%, and the best evaluated meta-analysis had an assessment of 86% for R-AMSTAR and 96% for PRISMA. The average scores of the R-AMSTAR and PRISMA assessments were 65% and 72% respectively. The average score of the AGREE II grid assessment was 57%. The data were synthesized into a practical guide for the GPs' practice, corresponding to the different consultation times. MDD diagnosis should be done on the DSM or ICD basis. The Childrens' Depression Rating Scale-revised or the Revised Beck Depression Inventory are useful in primary care for MDD appraisal in children and adolescents. For mild MDD a supportive psychotherapy and surveillance for 4 to 6 weeks is preconized in primary care. In the absence of improvement, a specific and structured psychotherapy is recommended, and the patient should be addressed to a child psychiatrist. For moderate to severe MDD, the young patient should be addressed to a specialist in child psychiatry. A psychotherapy, which can be associated with fluoxetine, especially in adolescents, is indicated with a revaluation of the pharmacological treatment between 4 to 8 weeks. A weekly follow-up by the GP is recommended during the first month, especially after the initiation of an antidepressant to assess the suicidal risk. Beyond the first month, a consultation should be scheduled every two weeks. CONCLUSION: A clinical guide was created from the best evidence-based data to help GPs in the management of child and adolescent MDD. A French-language website, aimed to assist GPs in mental disease management and available during their consultation, will be created based on the compilation of this meta-review with other similar meta-reviews.

Comparative experimental and theoretical study of the rotational excitation of CO by collision with ortho- and para-D2 molecules.

A joint crossed beam and quantum mechanical investigation of the rotationally inelastic collisions of CO with ortho- and para-D2 molecules is reported. A new 4D potential energy surface (PES) averaged over the ground vibrational states of D2 and CO is used to calculate the rovibrational bound states of the ortho-D2-CO complexes. Close coupling calculations are then performed in the rigid rotor approximation for ortho- and para-D2 colliding with CO for the experimentally investigated transition of CO (j = 0 → 1) and for collision energies ranging from 0.1 to 25 cm-1. The agreement between theory and experiment is found to be very good for both the bound state energies of the ortho-D2-CO complexes and for the inelastic scattering cross-sections showing that the free rotation of two rigid rotors is a very good model of the D2-CO system in this low collision energy domain.

[Ophthalmology telemedicine at Rennes University Medical Center: Evaluation of the secure platform OMNIDOC during its first year of use]. / Télé-expertise en ophtalmologie au centre hospitalier universitaire de Rennes : évaluation de la plateforme sécurisée OMNIDOC au cours de sa première année d'utilisation.

INTRODUCTION: Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. MATERIALS AND METHODS: Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. RESULTS: Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. DISCUSSION: The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.

Exploring Memory Systems After Pediatric Posterior Fossa Tumor: From Memory Profile Comparisons in Nonirradiated Versus Irradiated Patients to Episodic Memory Tests Capable of Detecting Radiation-induced Hippocampal Damage.

AIMS: Pediatric posterior fossa tumor (PFT) survivors experience long-term cognitive sequelae, including memory disorders, for which irradiation is one of the main risk factors. The aims of the present study were to (1) explore the profile of impairment in episodic, semantic, working and procedural memory systems in irradiated versus nonirradiated PFT survivors, and (2) test whether an autobiographical questionnaire and a two-phase ecological test (Epireal) assessing episodic memory are more sensitive to radiation-induced hippocampal damage than commonly used tests. MATERIALS AND METHODS: A total of 60 participants (22 irradiated PFT survivors, 17 nonirradiated PFT survivors, and 21 controls) were included in the prospective IMPALA study. They all underwent a broad battery of tests assessing the different memory systems in two 2-day sessions 3 weeks apart. We performed between-groups comparisons and analyzed impairment profiles, using -1.65 SDs as a cut-off. For irradiated patients, correlations were calculated between mean radiation doses to key brain structures involved in memory (hippocampus, cerebellum, and striatum) and corresponding memory scores. RESULTS: PBT survivors performed significantly more poorly than controls (p < 0.001) on conventional tests of episodic, semantic and working memory: 64% of irradiated patients and 35% of nonirradiated patients had a deficit in at least two memory systems, with episodic memory impairment being more specific to the irradiated group. Epireal had a larger effect size than the other episodic memory tests, allowing us to detect deficits in a further 18% of irradiated patients. These deficits were correlated with the mean radiation dose to the left hippocampus. CONCLUSION: Memory impairment is a frequent long-term cognitive sequela in PFT survivors, especially after radiation therapy. New ecological tests of episodic memory that are more sensitive to radiation-induced deficits than conventional tests could yield specific markers of the toxicity of medial temporal lobe irradiation.

[Validation of an ophtalmology tele-expertise protocol in nursing homes]. / Validation d'un protocole de téléexpertise d'ophtalmologie en EHPAD.

INTRODUCTION: Assisted living residents are a fragile population with limited access to health care. In recent years, telemedicine has developed in several specialties, including ophthalmology. The main objective of our study is the validation of an ophthalmology telemedicine protocol in assisted living facilities. MATERIALS AND METHODS: This is a retrospective, multicentric, descriptive study including 4 assisted living facilities in the Rennes area. An ophthalmic technician examined residents for one half-day per week. The examination was performed directly in the patient's room, in bed or in a chair, with portable equipment. An ophthalmologist from our service interpreted the results remotely on a deferred basis within 7 days. Appropriate medical or surgical care was then offered to the patient depending on the diagnosis. RESULTS: We included 113 residents. A complete, interpretable examination was achieved in 84.1% of cases. One or more ophthalmic conditions were diagnosed in 57.5% of the residents. Of the residents who were then seen at the university medical center, 65% underwent a scheduled surgical procedure or laser. Visual acuity was significantly improved subsequent to the telemedicine encounter. DISCUSSION: The success rate of a complete, interpretable examination allows us to now validate our nursing home examination procedure. In addition to bringing a large amount of initially unknown information to the medical and paramedical staff of the structure, ophthalmology telemedicine allows for a significant improvement in visual acuity. CONCLUSION: This project validated the feasibility of ophthalmology telemedicine in an assisted living setting. This protocol may also be applicable to other health care settings (penitentiaries, mental health institutions, etc.).

[Positioning in the oropharyngeal dysphagia]. / Positionnement dans les dysphagies oropharyngées.

Sitting body posture and the movements for the feeding gesture are interdependent and can worsen an oropharyngeal dysphagia. Their management will have a direct impact on the patient's handicap and will be able to decrease the complications. Clinical process aiming at placing a person having postural disorders, positioning will ensure a base adapted to the person, comfortable, allowing mobility and independence. It requires a methodical accompaniment: evaluation, test, validation, control of adapted equipment for the patient and gesture readjustment.

[Occupational therapy in the adaptation of food gesture]. / Place de l'ergothérapie dans l'adaptation du geste alimentaire.

A seated position and feeding movements are interdependent and can worsen an existing dysphagia. Their management can directly influence a patient's handicap and will decrease complications. Positioning is a clinical process aiming at placing a person having postural disorders, and will ensure a seating adapted to that person, comfortable and functional, authorizing mobility and independence. It requires a concomitant methodology: Evaluation, test, validation, control, for a material adapted to the person and a readjustment of the gesture.

[Echographic study in the exploration of supra-aortic trunks. Comparative study with doppler velocimetry and their respective roles in functional vascular explorations]. / Examen échographique dans l'exploration des troncs supra-aortiques. Etude comparée à l'examen vélocimétrique doppler et leur place respective dans les explorations fonctionnelles vasculaires.

Over the last six months, 1,311 doppler examinations of the supra-aortic trunks have been performed with confrontation doppler, ultrasound, arteriography and intra-operative examination according to the cases. We studied these cases with the following questions in mind: Does real time ultrasound of the supra-aortic trunks give more valuable information than the classical doppler examination? Is the diagnosis simplified? Is the therapeutic management altered? We are able to conclude: 1. In the case of a mildly stenotic plaque (less than 50%), the doppler examination gives an acoustic and graphic representation which is rich and not differentiated for stenoses of between 10% and 50%, which corresponds to an ultrasound plaque of 1 mm to 4-5 mm: the ultrasound supports the diagnosis. 2. However, in stenoses greater than 50%, there is good correlation between the doppler examination, ultrasound and arteriography. Ultrasound enables the exact extent of the plaque to be visualised in sagittal and transverse planes. It can diagnose aneurysmal lesions and suggest ulcerated lesions. 3. Finally, the doppler examination seems to be indispensable in cases of pre-thrombosis or fresh thrombosis of the carotid. Ultrasound can be negative at this early stage.