7 research outputs found
âI Canât Go Farâ: Perceptions and Experiences of Heart Failure Patients Regarding Physical Activity: A Qualitative Study Using Semistructured Face-to-Face Interviews
International audienceBackground Participation in regular physical activity (RPA) is beneficial to the quality of life and life expectancy of patients with chronic heart failure (CHF). However, it is inadequate in many patients. Aims To determine the factors that influence the practice of RPA in patients with CHF managed in general practice. Method This was a qualitative study using semistructured, individual face-to-face interviews. Patients with CHF (New York Heart Association Stages 1â3) capable of participating in RPA were enrolled by their general practitioner. A longitudinal and transversal inductive thematic analysis was performed by two researchers. Results Five themes emerged from the 19 interviews that were conducted. Poor knowledge of the disease and the benefits of participating in RPA, as well as the lack of motivation or enjoyment, in particular due to the absence of previous participation, were considered significant obstacles. Fear associated with CHF or other comorbidities was also an obstacle. Attendance at a rehabilitation center, family and social circles, and having a pet all appeared to be beneficial. Family and friends were important for motivating the patient to participate in an activity but could also be an obstacle when they were overprotective. Conclusion This study helps highlight the difficulties for patients with CHF associated with participation in RPA. Despite the obstacles, there are enabling factors on which the general practitioner may rely to motivate their patients
Ătude comparative en soins primaires du taux d'INR dans la cible thĂ©rapeutique chez des patients traitĂ©s par warfarine ou fluindione pour une fibrillation atriale. LâĂ©tude FLOWER (FLuindione Or WarfarinE â Result INR)
International audienc
Benefits and adverse effects of sacubitril/valsartan in patients with chronic heart failure: A systematic review and metaâanalysis
International audienceThis review aims to assess the benefits and adverse effects of sacubitril/valsartan in heart failure, with a focus on important patient outcomes. A systematic review was conducted of double- blind randomized controlled trials (RCTs) comparing sacubi -tril/valsartan versus a reference drug, in heart failure patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction, published in French or English. Searches were undertaken of Medline, Cochrane Central, and Embase. The primary outcomes were all- cause mortality and adverse events. From 2 082 articles analyzed, 5 were included. For all- cause mortality, the absolute numbers for HFrEF (2 RCTs, 4627 pa -tients) were 16% on sacubitril/valsartan and 18% on enalapril, with a risk ratio (RR) of 0.85 [CI =0.78, 0.93], and 13% vs 14% in with HFpEF (2 RCTs, 5097 patients), with no statistical difference. Under the Grading of Recommendations Assessment,Development and Evaluation (GRADE) approach, the evidence for HFrEF patients was of moderate quality. For HFrEF patients, an increased risk of symptomatic hypo -tension and angioedema (low quality of evidence) was shown. There was no statisti -cal difference for the risk of hyperkalemia or worsening renal function. There was a protective RR (0.50 [0.34, 0.75]) for worsening renal function for patients with HFpEF, with a high quality of evidence despite similar absolute numbers (1.4% vs. 2.8%). To keep in mind for shared decision- making, sacubitril/valsartan reduces all- cause mor -tality in HFrEF patients but for HFpEF further data are needed. Take into considera-tion the small number of studies to date to assess the risks
Project Rebuild the Evidence Base (REB): a method to interpret randomised clinical trials and their meta-analysis to present solid benefit-risk assessments to patients
International audienceEvidence-based medicine is the cornerstone of shared-decision making in healthcare today. The public deserves clear, transparent and trust-worthy information on drug efficacy. Yet today, many drugs are prescribed and used without solid evidence of efficacy. Clinical trials and randomized clinical trials (RCTs) are the best method to evaluate drug efficacy and side effects. In a shared medical decision-making approach, general practitioners need drug assessment to be based on patient-important outcomes. The aim of project Rebuild the Evidence Base (REB) is to bridge the gap between the data needed in clinical practice and the data available from clinical research. The drugs will be assessed on clinical patient important outcomes and for a population. Using the Cochrane tools, we propose to analyse for each population and outcome : 1) a meta-analysis based on RCTs with a low risk of bias overallâ; 2) an evaluate of results of confirmatory RCTs; 3) a statistical analysis of heterrogeneity between RCTs, and 4) an analysis of publication bias. Depending on the results of these analyses, the evidence will be categorised in 4 different levels: firm evidence, evidence (to be confirmed), signal or absence of evidence. Project REB proposes a method for reading and interpreting randomized clinical trials and their meta-analysis to produce quality data for general practitioners to focus on benefit-risk assessment in the interest of patients. If this data does not exist, it could enable clinical research to better its aim
Projet Rebuild the Evidence Base
National audienceIntroduction. La mĂ©decine fondĂ©e sur les preuves (EBM) est la pierre angulaire de la dĂ©cision mĂ©dicale partagĂ©e. Le public mĂ©rite des informations claires, transparentes et dignes de confiance sur lâefficacitĂ© des mĂ©dicaments. Pourtant, aujourdâhui, de nombreux mĂ©dicaments sont prescrits et utilisĂ©s sans preuve solide de leur efficacitĂ©. Les essais cliniques randomisĂ©s (ECR) et leurs mĂ©ta-analyses sont les meilleures Ă©tudes pour Ă©valuer lâefficacitĂ© des mĂ©dicaments et leurs effets indĂ©sirables, mais leurs rĂ©sultats ne sont pas facilement interprĂ©tables en pratique et sont mĂȘme parfois discutables par rapport aux donnĂ©es retenues. Dans une approche de dĂ©cision mĂ©dicale partagĂ©e, les mĂ©decins gĂ©nĂ©ralistes ont besoin que lâĂ©valuation des mĂ©dicaments soit fondĂ©e sur des rĂ©sultats importants et pertinents pour le patient. Lâobjectif du projet Rebuild the Evidence Base (REB) est de combler le fossĂ© entre les donnĂ©es nĂ©cessaires Ă la pratique clinique et les donnĂ©es disponibles de la recherche clinique.MĂ©thodes et analyses. Les mĂ©dicaments seront Ă©valuĂ©s selon des critĂšres cliniques importants pour les patients et dans une population donnĂ©e. En utilisant les outils Cochrane, pour chaque population et critĂšre dâĂ©valuation choisis, seront rĂ©alisĂ©es : 1. une mĂ©ta-analyse, fondĂ©e sur des essais contrĂŽlĂ©s randomisĂ©s (ECR) avec un faible risque global de biais ; 2. lâĂ©valuation des rĂ©sultats issus des ECR de confirmation ; 3. lâĂ©valuation de lâhĂ©tĂ©rogĂ©nĂ©itĂ© statistique entre essais (I2), et 4. lâĂ©valuation du risque de biais de publication. En fonction des rĂ©sultats de ces analyses, les preuves seront Ă©valuĂ©es selon quatre niveaux : preuve solide, rĂ©sultat probant mais Ă confirmer, signal Ă confirmer, ou absence de preuve.Conclusion. Le projet REB propose une mĂ©thode de lecture et dâinterprĂ©tation des essais cliniques randomisĂ©s et de leur mĂ©ta-analyse afin de produire des donnĂ©es de qualitĂ© permettant aux mĂ©decins gĂ©nĂ©ralistes de se centrer sur lâĂ©valuation du bĂ©nĂ©fice-risque dans lâintĂ©rĂȘt des patients. Si ces donnĂ©es nâexistent pas, cela permettra Ă la recherche clinique de mieux dĂ©finir ses objectifs
Projet Rebuild the Evidence Base
National audienceIntroduction. La mĂ©decine fondĂ©e sur les preuves (EBM) est la pierre angulaire de la dĂ©cision mĂ©dicale partagĂ©e. Le public mĂ©rite des informations claires, transparentes et dignes de confiance sur lâefficacitĂ© des mĂ©dicaments. Pourtant, aujourdâhui, de nombreux mĂ©dicaments sont prescrits et utilisĂ©s sans preuve solide de leur efficacitĂ©. Les essais cliniques randomisĂ©s (ECR) et leurs mĂ©ta-analyses sont les meilleures Ă©tudes pour Ă©valuer lâefficacitĂ© des mĂ©dicaments et leurs effets indĂ©sirables, mais leurs rĂ©sultats ne sont pas facilement interprĂ©tables en pratique et sont mĂȘme parfois discutables par rapport aux donnĂ©es retenues. Dans une approche de dĂ©cision mĂ©dicale partagĂ©e, les mĂ©decins gĂ©nĂ©ralistes ont besoin que lâĂ©valuation des mĂ©dicaments soit fondĂ©e sur des rĂ©sultats importants et pertinents pour le patient. Lâobjectif du projet Rebuild the Evidence Base (REB) est de combler le fossĂ© entre les donnĂ©es nĂ©cessaires Ă la pratique clinique et les donnĂ©es disponibles de la recherche clinique.MĂ©thodes et analyses. Les mĂ©dicaments seront Ă©valuĂ©s selon des critĂšres cliniques importants pour les patients et dans une population donnĂ©e. En utilisant les outils Cochrane, pour chaque population et critĂšre dâĂ©valuation choisis, seront rĂ©alisĂ©es : 1. une mĂ©ta-analyse, fondĂ©e sur des essais contrĂŽlĂ©s randomisĂ©s (ECR) avec un faible risque global de biais ; 2. lâĂ©valuation des rĂ©sultats issus des ECR de confirmation ; 3. lâĂ©valuation de lâhĂ©tĂ©rogĂ©nĂ©itĂ© statistique entre essais (I2), et 4. lâĂ©valuation du risque de biais de publication. En fonction des rĂ©sultats de ces analyses, les preuves seront Ă©valuĂ©es selon quatre niveaux : preuve solide, rĂ©sultat probant mais Ă confirmer, signal Ă confirmer, ou absence de preuve.Conclusion. Le projet REB propose une mĂ©thode de lecture et dâinterprĂ©tation des essais cliniques randomisĂ©s et de leur mĂ©ta-analyse afin de produire des donnĂ©es de qualitĂ© permettant aux mĂ©decins gĂ©nĂ©ralistes de se centrer sur lâĂ©valuation du bĂ©nĂ©fice-risque dans lâintĂ©rĂȘt des patients. Si ces donnĂ©es nâexistent pas, cela permettra Ă la recherche clinique de mieux dĂ©finir ses objectifs
Implementation of shared decision-making and patient-centered care in France: Towards a wider uptake in 2022
International audienceWe present the evolution of patient-centered care (PCC) and shared decision-making (SDM) in France since 2017, highlighting advantages and drawbacks of their implementation at the macro level. We then focus on several key policy and legislative milestones that are aimed to develop PCC and SDM. These milestones underline the importance of patient movements to support and fund the development of research and practice in the field. We shall conclude by presenting the growing research agenda and selected key topics. These key topics notably include the increase in both patient and healthcare professional trainings on PCC and SDM provided by healthcare users' and patients' representatives. PCC and SDM continue to be central preoccupations at the macro level, supported by public health policies and patients/healthcare users' actions. This overview, however, suggests that although implementation initiatives have increased since 2017, implementation remains scarce in routine clinical practice. Funding, not only for research projects, but for the implementation of PCC and SDM in real-life settings (e-decision aids, clinical guidelines integrating PCC/SDM, human resources dedicated to PCC/SDM, etc.) are needed to promote sustained adoption. More systematic training for both healthcare professionals and patients is also warranted for a true acculturation to occur