Suivi et applicabilité des recommandations de l'évaluation onco-gériatrique standardisée par les médecins généraliste

L évaluation gériatrique standardisée est utile dans la prise en charge des patients âgés atteints de cancer mais son intérêt est probablement mal connu des médecins généralistes. L objectif de notre étude est d évaluer le suivi et l applicabilité des recommandations de l évaluation onco-gériatrique standardisée au cours du suivi en ville des patients âgés cancéreux. Il s agit d une étude descriptive et analytique, dont le recueil des données a été réalisé de manière prospective. Un questionnarie comprenant 20 questions a été adressé à une liste de médecins traitants après avoir obtenu leur accord de participation. Quatre-vingt-cinq médecins ont été joints ; cinq ont refusé d emblée de participer à l étude. Au sein des 80 medecins restants, 45 questionnaires étaient exploitables pour l analyse statistique. Les médecins interrogés ont été 93% à recevoir les comptes rendus de consultation d onco-gériatrie. Ils ont trouvé les recommandations de l évaluation utiles pour la prise en charge de leurs patients âgés cancéreux dans 78% des cas. Ils ont estimé dans 44% des cas qu elles avaient amélioré leur pratique.Cependant, 60% des médecins ont jugé que certaines recommandations étaient difficilement applicables en ville, plus particulièrement celles concernant la prise en charge nutritionnelle et sociale (53% pour la prise en charge nutritionnelle et 47% pour la prise en charge sociale). Les recommandations de l évaluation sont apparues utiles à la prise en charge des sujets âgés cancéreux en ville, dans notre travail. Cependant, une réflexion doit être engagée à propos des difficultés rencontrées lors de leur mise en oeuvre en ville. Deux pistes semblent envisageables : renforcer le lien ville-hôpital et ptoposer des sessions de formation en onco-gériatrie aux médecins de ville.Comprehensive geriatric assessment is useful in the care of elderly patient who have cancer, but is interest is probably not well-know from general practioners. The main goal of this study is to assess the follow-up and the application of the assessment recommandations during the care of elderly patients by these general practitioners . This is a descriptive and analytic study, based on general practtioners interviews. A questionnaire of 20 questions has been sent to a group of general practitioners with their approval. Eighty-five general practitioners have been successfully contacted; five immediately refused to participate in the study. In the 80 practitioners left, 45 questionnaires were relevant for an analytic study. 93% of the practitioners admitted to receive the report from the comprehensive geriatric assessment . they found the recommandations useful in 78% of their cases. They estimated that these recommandations improved significantly their work in 44% of their cases. 60% of the practitioners did however judge that some of the recommandations were hardly applicable out of the hospital, especially the ones about nutrition (53%) and social (47%) care. The recommandations of the assessment are useful to the care of elderly patient out of the hospital, but they could be more effective, by being more applicable by general practitioners . Two main improvements could be to reinforce the link between the hospital and general practitioners and to propose training session to these practitioners about oncology for elderly patients. The interest of these two propositions should be analyzed by other prospective studies.PARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Effect of intravenous immunoglobulins to postpone the gestational age of first intrauterine transfusion in very severe red blood cell alloimmunization: A case-control study

Background: Early intrauterine transfusion (IUT) is associated with a higher risk of fetal loss. Our objective was to evaluate the efficiciency of intravenous immunoglobulins (IVIG) to postpone the gestational age at first IUT beyond 20 weeks of gestation (WG) compared to the previous pregnancy in case of very severe red blood cell (RBC) alloimmunization. Study design and methods: Very severe RBC alloimmunization was defined by a high titer of antibodies and a previous pregnancy complicated by a first IUT before 24 WG and/or perinatal death directly related to alloimmunization. We performed a single-center case-control study. Cases and controls were patients respectively treated with weekly IVIG infusions started before 13 WG, and without. Results: Twenty cases and 21 controls were included. Gestational age (GA) at first IUT was postponed after 20 WG in 18/20 (90 %) of patients treated with IVIG and in 15/21 (71 %) in the control group (p = 0.24). Compared to the previous pregnancy, the GA at first IUT was postponed by a median of 22 [+11; +49] days in the IVIG group and occurred in average 2 days earlier [-17 ; +12] in the non-treated group (p = 0.02). There was no difference between number of IUT and need for exchange-transfusion. IVIG treatment was associated with a significant decrease of antibodies' quantitation. Conclusion: In our series, IVIG tends to differ first IUT beyond 20 WG and have a significant effect in postponing the gestational age of the first IUT in patients with very severe RBC alloimmunization

Plasma amyloid levels within the Alzheimer's process and correlations with central biomarkers

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