Reflections on teaching mindfulness to teenagers: from research to clinic

Increased stress reactivity during adolescence has been associated with vulnerability for psychiatric disorders in adulthood and mindfulness-based interventions (MBI) seem to be an option to stress. However, there is still debate on how to best teach MBI to teenagers. For the last 6 years, authors have been proposing the “Mindfulteen” (MT) to teenagers between 12 and 19 years in Geneva. The MT was first applied in different clinical trials and in a qualitative study and, as the results were encouraging, is now proposed in a clinical context at the University Hospital. Authors aim to share here some lessons learned from this experience: 1. Motivation and curiosity are key to engagement, and this is particularly important in school settings; 2. Even if adaptation is needed for different age groups, the program’s core remains easily the same; 3. Short formal practices with not much silence are needed, and metaphors can help; 4. Clarifying the intention of each practice can improve engagement, and the same explicit attitude can be brought into inquiry; 5. A trauma-sensitive approach is crucial, especially in clinical settings; 7. Proposing different versions of the same practice facilitates home practice; 8. Even if participants are not practicing between sessions, it doesn’t mean that they are not integrating mindfulness into their lives; 9. Creative and playful activities can provide rich mindful moments. In conclusion, there are open questions about teaching mindfulness to adolescents and authors believe that sharing and exchanging experiences is important to find some of the answers.&nbsp

Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study

Introduction: This population-based study aims to assess prognosis of prostate cancer diagnosed with prostate-specific antigen (PSA) levels <4 ng/ml in routine care. Materials and methods: We compared prostate cancer patients with low PSA values (n=59) with other prostate cancer patients (n=1330) by logistic regression and the Cox model using data from the Geneva Cancer Registry. Results: Patients with low PSA values more frequently had early-stage and well differentiated tumours. Nevertheless, 35% presented with aggressive tumour characteristics or metastases. After adjustment for other prognostic factors, prostate cancer-specific mortality was similar for both groups (hazard ratio: 1.1; 95%CI: 0.6-2.2). Conclusion: We conclude that cancer with low PSA values at diagnosis is not indolen

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Background: Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care. &nbsp; &nbsp; Methods: We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication. &nbsp; &nbsp; Results: Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences. &nbsp; &nbsp; Conclusions: Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes

Applying the GRADE framework for clinical guidelines in pediatrics: challenges and opportunities

Clinicians need recommendations for their daily practice. They also need to be able to appraise the trustworthiness of these recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework has been a major advance in this field. In this thesis, I discuss the specific challenges and potential solutions in applying GRADE to pediatric populations. In particular, I outline issues about (1) clarifying the target population in the presence of numerous age-groups; (2) the choice of patient-important outcomes for young children and their parents; (3) the limitations resulting from the evidence available in pediatrics, (4) the difficulty in finding trustworthy baseline risks for all relevant age-group; (5) the dynamics of values and preferences in pediatrics. Finally, since weak recommendations are preference-sensitive, I also discuss potential challenges of shared-decision making with pediatric patients who gradually express their autonomy and capacity of decision

Etude de la sensibilité au glucose et du couplage métabolisme-sécrétion dans les cellules d'insulinome INS-1E durant deux années de culture continue

Provenant d'insulinome de rat, les cellules INS-1 sont largement utilisées comme substituts de cellules beta. Elles sont hétérogènes et peu stables sur de longues périodes de cultures. Sur la base du contenu en insuline et de la réponse au glucose, nous avons isolé de manière clonale les cellules INS-1E. Nous décrivons la stabilité du phénotype de cellules beta différenciées, durant 116 passages (27-142), soit 2.2 ans de suivi continu. Les cellules INS-1E peuvent être utilisées avec fiabilité entre les passages 40 et 100, montrant un contenu moyen d'insuline de 2.3±0.11ug par million de cellules. Les cellules INS-1E présentent des réponses sécrétoires dans la gamme physiologique de concentrations en glucose ainsi que l'expression de la voie d'amplification. Nous avons mesuré plusieurs paramètres métaboliques. Les amas sphéroïdes ont aussi été testés quant à leurs réponses aux sécrétagogues. Ces données confirment la valeur de la lignée cellulaire INS-1E