Analyse de situation et évaluation de la faisabilité d'un programme éducatif individuel, auprès de patients sous thérapie anticancéreuse par voie orale

La prise en charge des patients atteints de cancer a été radicalement modifiée durant les dernières années par le développement des thérapies anticancéreuses orales. Elle nécessite une excellente coordination ville-hôpital. L objectif de cette étude est d identifier les freins et les leviers de l adhésion thérapeutique des patients atteints de cancer sous traitement par voie orale, afin de proposer un programme éducatif adapté. Une revue de la littérature et une analyse thématique du contenu de 21 entretiens semi-directifs avec des patients et des soignants ont été réalisées. Des éléments de non-adhésion sont rapportés dont la complexité du schéma de traitement, les effets indésirables et le sentiment d abandon par l équipe hospitalière. La conscience de la gravité de la maladie et de la nécessité du traitement favorise l adhésion médicamenteuse. La sur-adhésion est un élément particulier retrouvé chez certains de ces patients. Un programme d Education Thérapeutique du Patient (ETP) collaboratif entre le centre hospitalier et une plateforme de santé a alors été imaginé. Ce programme d ETP s inscrit dans la prise en charge des patients, pour améliorer l adhésion thérapeutique mais aussi la qualité, l efficacité, la sécurité et la continuité des soins, grâce à la collaboration ville-hôpital. Une étude de faisabilité a été initiée pour évaluer les moyens nécessaires pour garantir la pérennité du suivi de ces patients et résoudre les difficultés organisationnelles. Une étude médico-économique sera nécessaire pour vérifier l impact du programme.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design

Abstract Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV

Comparison between two generic questionnaires to assess satisfaction with medication in chronic diseases.

OBJECTIVE: The objective of this work was to compare two generic questionnaires assessing patients' satisfaction with medication. In addition we tested whether satisfaction can predict adherence to medication regimens in patients with chronic diseases, and which dimensions of satisfaction are most involved. METHODS: This prospective, observational study was conducted over one year in a heterogeneous population of patients with various chronic diseases. Satisfaction with medication was assessed by using the TSQM® vII and the SatMed-Q® questionnaires, and adherence to treatment was assessed with the Morisky-Green questionnaire. Clinical pharmacists interviewed patients to collect clinical, demographic and therapeutic data. RESULTS: 190 patients were enrolled. Both questionnaires showed excellent reliability and correlation was high (R=0.70; p<0.001). Adherence was correlated with satisfaction with medication whether assessed with the SatMed-Q® (R=0.23; p=0.002) or the TSQM® (R=0.17; p=0.02). Among different dimensions of satisfaction, convenience of use and side effects are prominent predictors of adherence. CONCLUSION: Adherence is related to the patient's satisfaction with medication whether assessed with the TSQM® vII or the SatMed-Q®. Therefore, these simple questionnaires could be used as predictive tools to identify patients whos' adherence needs to be improved

Implementing sustainable agriculture and rural development in the European Alps. Assets and limitations of local projects based on multi-stakeholder participation

In current scientific and political discourses there is common agreement that the future of alpine agriculture is not only a challenge for farmers, but also for the whole society. What remains unclear is the question of how to adapt agriculture towards sustainable development of the alpine territory in a manner that takes sufficient account of local diversity. We propose to treat agriculture and rural development as a matter of local concern starting with a definition of sustainable agriculture drawn up by local stakeholders. Based on a three-year experiment, we examine the capacity of local people to take joint action to contribute in a consistent way to rural development and to sustainable agriculture. We discuss the assets and limits of local projects based on multi-stakeholder participation to initiate closer links between farmers and other stakeholders and to renew the contribution of agriculture to rural development. Our paper highlights two main points. Firstly, how a social dynamics is initiated and how farmers and other actors take joint action towards sustainable development. Secondly we analyse the impact of such local projects on agriculture and rural development and the counterbalancing effects of global factors, including market trends and related policies. Finally, we discuss the consequences of our results for policies targeting rural sustainable development

Implementing sustainable agriculture and rural development in the European Alps. Assets and limitations of local projects based on multi-stakeholder participation

SAD CT4International audienceIn current scientific and political discourses there is common agreement that the future of alpine agriculture is not only a challenge for farmers, but also for the whole society. What remains unclear is the question of how to adapt agriculture towards sustainable development of the alpine territory in a manner that takes sufficient account of local diversity. We propose to treat agriculture and rural development as a matter of local concern starting with a definition of sustainable agriculture drawn up by local stakeholders. Based on a three-year experiment, we examine the capacity of local people to take joint action to contribute in a consistent way to rural development and to sustainable agriculture. We discuss the assets and limits of local projects based on multi-stakeholder participation to initiate closer links between farmers and other stakeholders and to renew the contribution of agriculture to rural development. Our paper highlights two main points. Firstly, how a social dynamics is initiated and how farmers and other actors take joint action towards sustainable development. Secondly we analyse the impact of such local projects on agriculture and rural development and the counterbalancing effects of global factors, including market trends and related policies. Finally, we discuss the consequences of our results for policies targeting rural sustainable development

Relationship between satisfaction with medication and quality of life.

<p>Relationship between satisfaction with medication and quality of life.</p

Relationship between dimensions of satisfaction with medication and adherence.

<p>Relationship between dimensions of satisfaction with medication and adherence.</p

Relationship between satisfaction with medication and levels of adherence.

*<p>P<0.017 <i>vs</i> “Goodg001 adherence”.</p

Correlation between scores of satisfaction for each dimension of the questionnaires.

<p>Data are expressed as mean (SD). R: Pearson correlation coefficient (Pearson correlation test).</p>*<p>(of 8).</p>**<p>Refers to the correlation between the composite score of the SatMed-Q® and the overall satisfaction score obtained with the TSQM® vII.</p><p>NA: not applicable.</p

Characteristics of the population (N = 172).

<p>Age is expressed as mean (standard deviation). All other variables are expressed as numbers (percentage). MD: Missing Data.</p