Impact of an interactive web tool on patients' intention to receive COVID-19 vaccination: a before-and-after impact study among patients with chronic conditions in France.

OBJECTIVES: In France, about 30% of the population refuses COVID-19 vaccination outright, and 9 to 40% are hesitant. We developed and evaluated an interactive web tool providing transparent and reliable information on the benefits and risks of COVID-19 vaccination. METHODS: The most recent scientific data at the time of the study were implemented into an interactive web tool offering individualized information on the risks of COVID-19 infection-related events versus vaccination-related serious adverse events. The tool was evaluated during a before-and-after impact study nested in ComPaRe, a French e-cohort of adult patients with chronic conditions. Primary outcome was the proportion of patients intending to receive vaccination after using the tool, among those not intending to receive it at baseline. RESULTS: Between January 8 and 14, 2021, we enrolled 3152 patients in the study [mean age 55.2 (SD: 16.9), 52.9% women and 63% with ≥ 2 chronic conditions]. Before consulting the tool, 961 (30.5%) refused to be vaccinated until further data on efficacy/safety was obtained and 239 (7.5%) outright refused vaccination. Among these 1200 patients, 96 (8.0%, number needed to treat: 12.5) changed their mind after consulting the tool and would subsequently accept vaccination. CONCLUSIONS: Our interactive web tool represents a scalable method to help increase the intent to receive COVID-19 vaccination among patients with chronic conditions and address vaccine hesitancy. Since April 2021, our tool has been embedded on the official webpage of the French Government for COVID-19 information.

Confinement, Desolvation, And Electrosorption Effects on the Diffusion of Ions in Nanoporous Carbon Electrodes.

Supercapacitors are electrochemical devices which store energy by ion adsorption on the surface of a porous carbon. They are characterized by high power delivery. The use of nanoporous carbon to increase their energy density should not hinder their fast charging. However, the mechanisms for ion transport inside electrified nanopores remain largely unknown. Here we show that the diffusion is characterized by a hierarchy of time scales arising from ion confinement, solvation, and electrosorption effects. By combining electrochemistry experiments with molecular dynamics simulations, we determine the in-pore conductivities and diffusion coefficients and their variations with the applied potential. We show that the diffusion of the ions is slower by 1 order of magnitude compared to the bulk electrolyte. The desolvation of the ions occurs on much faster time scales than electrosorption.

Trends in the delivery of reimbursed nicotine replacement therapies between 2016 and 2019 in France.

OBJECTIVES: Describe the evolution of the expenses and the number of boxes of nicotine replacement therapy reimbursed by the French health insurance between 2016 (flat rate of €.150/year with advance payment) and 2019 (65% reimbursement without in advance payment and without a spending limit). SETTING AND PARTICIPANTS: Descriptive and analytical epidemiological study between January 1, 2016 and December 31, 2019 based on a retrospective collection of data from OpenMEDIC (the merged French health insurances drug claim database) on the number of reimbursed NRT boxes dispensed by community pharmacies and their annual cost. RESULTS: During 4 years, 7.4 million boxes of NRT were reimbursed (total cost of 148.4 million euros): approximately 300,000 in 2016, 650,000 in 2017, 1.9 million in 2018 and 4.6 million in 2019, namely a fifteen-fold increase between 2016 and 2019 (a geometric growth ratio of 2.5 each year). This increase was slightly more pronounced among men than among women, and concerned more NRT delivered from time to time (gums, tablets): transdermal devices proportion decreased from 79.7% of reimbursed NRT in 2016 to 52.9% in 2019, with an increase in gums (8% to 13.3%) and sublingual tablets (8.4% to 15.8%) over the same period. CONCLUSIONS: The evolution of NRT reimbursement comes with an increase in NRT deliveries. This suggests a real medical need rather than a short trend: therefore, this suggests a catch-up in the access to care.

Place of patient-reported outcomes & experiences measurements (PROMS/PREMS) in the assessment and pricing of Health technologies in France.

In the context of health technologies assessment, patient-reported outcome measures (PROMs) have become assessment criteria that are expected by evaluation agencies along with the other usual clinical criteria. PROMs instruments measure all aspects of patient experience in connection with their health: symptoms, activities of daily living (physical function, sleep, etc.), various aspects of health-related quality of life (QoL), compliance, global impression of change in wellbeing. PROMs are useful both as 1) a primary or secondary efficacy endpoints, and 2) a tolerability criterion to supplement vigilance data reported by clinicians. Measurement of PROMs must be subject to methodological rigor that is identical to that of other assessment criteria measured by an observer. Scales must be validated, suitable for the objective, and where possible specific to a disease. In addition to standard measures of quality of life, PROMs are taken into consideration in the assessments performed by the HAS, even if their impact on the conclusions is difficult to isolate, as assessments are multifactorial and take into account all data available with regard to the medical context. The CEPS will indirectly take into account PROMs in the fixing of the price or tariff only if they have contributed to the award of the ASA/ASMR by the ad hoc committee of the HAS. The working group has formulated three recommendations which aim to further the implementation of patient-reported outcome measures: (1) Better information for all parties involved in a dossier for technology assessment, (2) Systematization of the collection of PROMs for evaluation of health products, (3) Improved quality of dossiers thanks to the use of relevant and validated tools.

Patients' perspective on how to improve the care of people with chronic conditions in France: a citizen science study within the ComPaRe e-cohort.

BACKGROUND: This study aimed to involve patients with chronic conditions in generating ideas for improving their care. METHODS: We performed a citizen science study. Participants were adult patients with chronic conditions recruited in Community of Patients for Research 'ComPaRe,' a French e-cohort of patients with chronic conditions. Participants generated ideas to improve their care in answer to the open-ended question, 'If you had a magic wand, what would you change in your healthcare?' Three researchers and two patients independently extracted ideas from open-ended answers by using thematic analysis. Ideas were grouped into areas for improvement at the consultation, hospital/clinic and health system levels. Findings were validated and enriched by a second sample of participants recruited in ComPaRe. RESULTS: Between May 2017 and April 2018, a total of 1636 patients provided 3613 ideas to improve consultations (1701 ideas related to 58 areas for improvement), hospitals/clinics (928 ideas related to 41 areas for improvement) and the health system (984 ideas related to 48 areas for improvement). At the consultation level, most ideas were related to improving physician-patient discussions, informing patients about their own care, and adapting treatment to patient preferences and context. At the hospital/clinic level, most ideas aimed at improving the coordination and collaboration in care. At the health system level, most ideas were related to decreasing the administrative burden imposed on patients, improving access to care and reducing the costs of care. CONCLUSION: Patients have many ideas to improve their care, from the content of consultations to the organisation of hospitals. Our study provides the proof of concept for a method to leverage patients' practical knowledge of the care system to improve it.

Chemisorption of Hydroxide on 2D Materials from DFT Calculations: Graphene versus Hexagonal Boron Nitride.

Recent nanofluidic experiments revealed strongly different surface charge measurements for boron-nitride (BN) and graphitic nanotubes when in contact with saline and alkaline water (Nature 2013, 494, 455-458; Phys. Rev. Lett. 2016, 116, 154501). These observations contrast with the similar reactivity of a graphene layer and its BN counterpart, using density functional theory (DFT) framework, for intact and dissociative adsorption of gaseous water molecules. Here we investigate, by DFT in implicit water, single and multiple adsorption of anionic hydroxide on single layers. A differential adsorption strength is found in vacuum for the first ionic adsorption on the two materials-chemisorbed on BN while physisorbed on graphene. The effect of implicit solvation reduces all adsorption values, resulting in a favorable (nonfavorable) adsorption on BN (graphene). We also calculate a pKa ≃ 6 for BN in water, in good agreement with experiments. Comparatively, the unfavorable results for graphene in water echo the weaker surface charge measurements but point to an alternative scenario.

On the dynamics of charging in nanoporous carbon-based supercapacitors.

Supercapacitors are electricity storage systems with high power performances. Their short charge/discharge times are due to fast adsorption/desorption rates for the ions of the electrolyte on the electrode surface. Nanoporous carbon electrodes, which give larger capacitances than simpler geometries, might be expected to show poorer power performances because of the longer times taken by the ions to access the electrode interior. Experiments do not show such trends, however, and this remains to be explained at the molecular scale. Here we show that carbide-derived carbons exhibit heterogeneous and fast charging dynamics. We perform molecular dynamics simulations, with realistically modeled nanoporous electrodes and an ionic liquid electrolyte, in which the system, originally at equilibrium in the uncharged state, is suddenly perturbed by the application of an electric potential difference between the electrodes. The electrodes respond by charging progressively from the interface to the bulk as ions are exchanged between the nanopores and the electrolyte region. The simulation results are then injected into an equivalent circuit model, which allows us to calculate charging times for macroscopic-scale devices.

Simulating Supercapacitors: Can We Model Electrodes As Constant Charge Surfaces?

Supercapacitors based on an ionic liquid electrolyte and graphite or nanoporous carbon electrodes are simulated using molecular dynamics. We compare a simplified electrode model in which a constant, uniform charge is assigned to each carbon atom with a realistic model in which a constant potential is applied between the electrodes (the carbon charges are allowed to fluctuate). We show that the simulations performed with the simplified model do not provide a correct description of the properties of the system. First, the structure of the adsorbed electrolyte is partly modified. Second, dramatic differences are observed for the dynamics of the system during transient regimes. In particular, upon application of a constant applied potential difference, the increase in the temperature, due to the Joule effect, associated with the creation of an electric current across the cell follows Ohm's law, while unphysically high temperatures are rapidly observed when constant charges are assigned to each carbon atom.