Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial

INTRODUCTION: This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria. METHODS AND ANALYSIS: This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for >6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks. ETHICS AND DISSEMINATION: The protocol has been approved by the and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03545464

Trials

BACKGROUND: Recent data suggest that 10-20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized control trial suggested that this condition may be induced by the stress experienced during the event or emergency room (ER) stay and can be prevented in up to 75% of patients with a single, early, short eye movement desensitization and reprocessing (EMDR) psychotherapeutic session delivered in the ER. The protocol of the SOFTER 3 study was designed to compare the impact on 3-month PCLS of early EMDR intervention and usual care in patients presenting at the ER. Secondary outcomes included 3-month post-traumatic stress disorder, 12-month PCLS, self-reported stress at the ER, self-assessed recovery expectation at discharge and 3 months, and self-reported chronic pain at discharge and 3 months. METHODS: This is a two-group, open-label, multicenter, comparative, randomized controlled trial with 3- and 12-month phone follow-up for reports of persisting symptoms (PCLS and post-traumatic stress disorder). Those eligible for inclusion were adults (>/=18 years old) presenting at the ER departments of the University Hospital of Bordeaux and University Hospital of Lyon, assessed as being at high risk of PCLS using a three-item scoring rule. The intervention groups were a (1) EMDR Recent Traumatic Episode Protocol intervention performed by a trained psychologist during ER stay or (2) usual care. The number of patients to be enrolled in each group was 223 to evidence a 15% decrease in PCLS prevalence in the EMDR group. DISCUSSION: In 2012, the year of the last national survey in France, 10.6 million people attended the ER, some of whom did so several times since 18 million visits were recorded in the same year. The SOFTER 3 study therefore addresses a major public health challenge. TRIAL REGISTRATION: Clinical Trials. NCT03400813 . Registered 17 January 2018 - retrospectively registered

Clin Toxicol (Phila)

Introduction: Button battery ingestion in children can be fatal if oesophageal perforation occurs. Such children require chest radiography in the emergency department to determine the button battery position and number. Current guidelines recommend that a button battery impacted in the oesophagus should be removed within two hours. We developed a clinical tool (the button battery impaction score) to estimate the risk of oesophageal impaction and help determine the most appropriate healthcare facility for initial assessment, either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval. Methods: A multicentre retrospective study was conducted over seven years in eight French poison centres. We included patients aged less than 12 years with radiography showing the button battery position and a symptom description before radiography. Button battery impaction scores were calculated using backward stepwise selection. Results and discussion: A total of 1,430 patients were included, of whom 86, 461, and 375 had a button battery in their oesophagus, stomach, and post-pyloric position, respectively. No button batteries were identified by radiography in 508 patients. Sixteen of thirty-five factors independently predicted oesophageal impaction before chest radiography (P = 15 mm. The button battery impaction score showed an area under the curve value of 0.87, a negative predictive value of 0.98, and a sensitivity of 0.86. No cases of death, stricture, or haemorrhage were observed in patients with negative scores, including those with oesophageal impaction. Conclusions: A button battery impaction score used readily available data to predict the risk of oesophageal impaction after button battery ingestion and before chest radiography. When further validated, this rapid tool may be widely applicable in determining an appropriate facility for patient transfer to either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval

J Psychiatr Res

Up to 20% of patients presenting at an emergency room (ER) after a stressful event will for several months suffer from very diverse long-lasting symptoms and a potentially significant decline in quality of life, often described as post concussion-like symptoms (PCLS). The objectives of our randomized open-label single-center study were to assess the feasibility of psychologist-led interventions in the context of the ER and to compare the effect of eye movement desensitization and reprocessing (EMDR) with reassurance and usual care. Conducted in the ER of Bordeaux University Hospital, the study included patients with a high risk of PCLS randomized in three groups: a 15-min reassurance session, a 60-min session of EMDR, and usual care. Main outcomes were the proportion of interventions that could be carried out and the prevalence of PCSL and post-traumatic stress disorder (PTSD) three months after the ER visit. One hundred and thirty patients with a high risk of PCLS were randomized. No logistic problem or patient refusal was observed. In the EMDR, reassurance and control groups, proportions of patients with PCLS at three months were 18%, 37% and 65% and those with PTSD were 3%, 16% and 19% respectively. The risk ratio for PCLS adjusted for the type of event (injury, non-injury) for the comparison between EMDR and control was 0.36 [95% CI 0.20-0.66]. This is the first randomized controlled trial that shows that a short EMDR intervention is feasible and potentially effective in the context of the ER. The study was registered at ClinicalTrials.gov (NCT03194386)

Recommandations de pratique clinique sur la prise en charge du patient adulte à présentation psychiatrique dans les structures d’urgences

De nombreux patients consultant aux urgences souffrent de pathologies psychiatriques préexistantes ou ont une symptomatologie évocatrice d’une pathologie psychiatrique. En effet, les troubles psychiatriques touchent un adulte sur quatre, et 75%des affections psychiatriques débutent avant l’âge de 25 ans. Le parcours de soins d’un patient adulte à présentation psychiatrique dans les structures d’urgences concerne de multiples intervenants. La complexité inhérente à ces patients complexes ainsi qu’à l’interdisciplinarité induite dans la prise en charge impose un cadre de prise en charge clair et consensuel. Des experts de la psychiatrie, de la gérontopsychiatrie et de la médecine d’urgence se sont réunis pour émettre ces recommandations de bonnes pratiques. Le choix de présenter des recommandations de bonnes pratiques et non des recommandations formalisées d’experts a été fait devant l’insuffisance de littérature de fort niveau de preuve dans certaines thématiques et de l’existence de controverses. À travers ces recommandations de bonnes pratiques cliniques, ils se sont attachés à décrire la prise en charge de ses patients aussi bien en préqu’en intrahospitalier. Les objectifs de ces recommandations sont de présenter les éléments indispensables à l’organisation du parcours de soins de ces patients, la gestion de l’agitation ainsi que la prise en charge pharmacologique ou non. Une partie spécifique est consacrée aux aspects réglementaires.Many patients who come to the emergency department suffer from pre-existing psychiatric pathologies, or have a symptomatology suggestive of a psychiatric pathology. Indeed, psychiatric disorders affect one adult in four and 75% of psychiatric disorders begin before the age of 25 years. The care pathway of an adult patient with a psychiatric presentation in emergency facilities involves multiple stakeholders. The inherent complexity of these complex patients, as well as the interdisciplinary nature of their care, requires a clear and consensual framework for care. Experts in psychiatry, geronto-psychiatry and emergency medicine have come together to produce these recommendations for good practice. The choice to present good practice recommendations rather than formalized expert recommendations was made in view of the lack of literature with a high level of evidence in certain areas and the existence of controversies. Through these recommendations of good clinical practice, they have endeavoured to describe the management of these patients both in the pre-hospital and in the in-hospital setting. The objectives of these recommendations are to present the essential elements for the organization of the care of these patients, the management of agitation as well as the pharmacological or non-pharmacological management. A specific part is devoted to the regulatory aspects

Recommandations de bonne pratique — Manager en structure de médecine d’urgences

International audienceManagement involves organizing, planning, coordinating, and/or scheduling a task. Emergency medical services (EMS) are subject to organizational challenges due to their specific activity, interprofessional relations within the team and with partners inside and outside the hospital. To help meet these challenges, the French Society of Emergency Medicine (SFMU) wanted to bring together experts practicing in EMS and teaching, and research experts to propose a set of guidelines for EMS management based on data from the literature. While managers must be recognized for their medical skills, they must also develop their leadership skills through specific training. These skills will enable them to adapt their leadership style to situations and teams in order to encourage team motivation and commitment. As the interface between teams in the field, management, and institutional partners, their role should be to encourage dialogue and reassure teams. The manager’s role and resources need to be formalized with management, in particular access to information so that the manager can convey a strategic vision to teams and partners. The implementation of a project and the holding of meetings must be organized with an effective strategy. To achieve this, setting out and sharing clear objectives, operating rules, and involving staff in decision making are effective tools for limiting resistance to change and encouraging the co-construction of transformations. The development of skills through individual and group training provides the time for exchanges necessary for professionals to flourish, for motivation to be strengthened, and for shared values to be built. Certain factors are directly associated with the attractiveness of an EMS, such as the working environment, diversification of activities, and individualized career management. The organizations that put in place must ensure psychological safety and effective interprofessional collaboration to improve the quality of working life and the quality of care. Communication and crisis management must be carefully thought out and methodically organized to build an EMS in which every employee can invest and feel at home. The experts agree that managing an EMS must be an organized activity with its own tools and skills. This role must be recognized by the teams, management, and partners.Le management consiste à organiser, à coordonner et/ou à planifier une tâche. Les structures de médecine d’urgences (SMU) sont soumises à des défis organisationnels du fait de l’activité qui leur est propre, de l’interprofessionnalité au sein de l’équipe et avec les partenaires intra- et extrahospitaliers. Pour aider à relever ces défis, la Société française de médecine d’urgence (SFMU) a souhaité réunir des experts exerçant en SMU et des experts enseignantschercheurs pour proposer un référentiel de management en SMU à partir des données de la littérature. Si le manager doit être reconnu pour ses compétences médicales, il doit également développer ses compétences de leader grâce à des formations spécifiques. Ces compétences lui permettront d’adapter son style de leadership aux situations et aux équipes pour favoriser la motivation et l’engagement des équipes. Son rôle, à l’interface entre les équipes de terrain, la direction et les partenaires institutionnels, doit permettre de favoriser le dialogue et de sécuriser les équipes. Le rôle et les moyens du manager doivent être formalisés avec la direction, en particulier l’accès à l’information pour que le manager puisse porter une vision stratégique auprès des équipes et des partenaires. La mise en place d’un projet et la tenue de réunions doivent être organisées avec une stratégie efficace. Pour cela, l’énonciation et le partage d’objectifs clairs, les règles de fonctionnement, l’implication des agents dans les décisions sont des outils efficaces pour limiter la résistance au changement et favoriser la coconstruction des transformations. Le développement des compétences par le biais de formations individuelles et collectives permet les temps d’échanges nécessaires à l’épanouissement des professionnels, au renforcement de la motivation et à la construction de valeurs communes. Certains facteurs sont directement associés à l’attractivité d’une SMU comme l’ambiance de travail, la diversification de l’activité et la gestion individualisée des carrières. Les organisations mises en place doivent permettre d’assurer une sécurité psychologique et une collaboration interprofessionnelle effective pour améliorer la qualité de vie au travail et la qualité des soins. La communication et la gestion de crise doivent être réfléchies et organisées avec méthode pour construire une SMU où chaque collaborateur pourra s’investir et se reconnaître. Les experts s’accordent à penser que manager une SMU doit être une activité organisée avec des outils et des compétences qui lui sont propres. Ce rôle doit être reconnu par les équipes, la direction et les partenaires

Valuing universities’ heritage assets in light of the third mission of universities

© Springer Nature Switzerland AG 2020. The chapter contributes to the current debate on universities’ heritage assets (UHA) value measurement by shedding light on the potential role that accounting, and reporting can play in this context. This study provides an in-depth discussion on the existing taxonomies of values for heritage assets and focuses on economic and monetary values. An original vision is used to critically observe the accounting for UHA in light of the third mission of universities. The chapter explores the measurement of such values, under an accrual accounting mandatory transition, recently adopted by Italian universities, demonstrating how values have been distorted to match the accounting practice. Several accounting behaviours are discussed in the light of Shapiro’s (Objectivity, relativism, and truth in external financial reporting: What’s really at stake in the disputes? Accounting, Organizations and Society, 22(2), 165-185, 1997) theory of social constructivism in financial reporting to offer a critique that can be useful to financial statement preparers to reflect on their decision