The relationship between semantic and episodic memory: evidence from a case of severe anterograde amnesia

International audienceIt is increasingly being recognized that new declarative, consciously accessible information can be learned in anterograde amnesia, but it is not clear whether this learning is supported by episodic or semantic memory. We report a case of a 55-year-old man who experienced severe amnesia after limited damage to the medial temporal lobe following neurosurgical complications. His general cognitive performance and knowledge of new French words and public events that occurred before and after the onset of amnesia were assessed. Performance remained satisfactory on post-morbid vocabulary and public events, with a drop in performance observed for very recent public events only, while knowledge of very recent vocabulary was comparable to that of the control subjects. The implications of these findings for our understanding of the underlying learning mechanisms are discussed. This is the first report of acquisition of consciously accessible postmorbid knowledge of public events in a patient with severe anterograde amnesia

Les essais plateformes

International audienc

Platform trials

International audienceFor the past few years, platform trials have experienced a significant increase, recently amplified by the COVID-19 pandemic. The implementation of a platform trial is par-ticularly useful in certain pathologies, particularly when there is a significant number of drug candidates to be assessed, a rapid evolution of the standard of care or in situations of urgent need for evaluation, during which the pooling of protocols and infrastructure optimizes the number of patients to be enrolled, the costs, and the deadlines for carrying out the investiga-tion. However, the specificity of platform trials raises methodological, ethical, and regulatory issues, which have been the subject of the round table and which are presented in this article. The round table was also an opportunity to discuss the complexity of sponsorship and data management related to the multiplicity of partners, funding, and governance of these trials, and the level of acceptability of their findings by the competent authorities

Outpatient healthcare and clinical trials in the care pathway: Organisational and regulatory aspects and tools

International audienceClinical research in outpatient healthcare, particularly in general practice, which is the first line of contact with the population, is now a public health issue. However, this type of research has specific characteristics that differentiate it from clinical research conducted in a hospital setting and requires an adaptation of its conditions of practice: in terms of organisation, the development of research in outpatient healthcare relies on the appropriation of its fundamentals by the investigators, which implies their presentation, upstream, from the initial cycle, and the participation of practitioners in training modules adapted to research in primary care, such as those already organised by several GIRCI (Groupement Inter régional de la Recherche Clinique et de l’Innovation [French Interregional Clusters for Clinical Research and Innovation]). To compensate for the fragmented nature of their location, on the model of the EMRCs (équipes mobiles de recherche clinique [mobile clinical research teams]) in oncology, mobile research teams should enable general medical practices to participate in clinical trials. This presupposes, on the one hand, the allocation of earmarked funding to ensure the sustainability of a base of dedicated personnel and, on the other hand, the impetus of a national dynamic through the setting up of a multi-organisation thematic institute for "research in primary care" associated, at the operational level, with a national scale investigation network supported by a platform of excellence. The use of digital tools and innovations (telemedicine; data collection via connected tools; e-consent; electronic signature) which make it possible to digitise and relocate all or part of the research procedures for both the participant and the investigation teams. An adaptation of the legal framework in order to bring the place of research closer to the patient and not the other way round, which means moving the equipment and investigations closer to the patient. Taking into account the acceptability of the patient, thus limiting the disruption that may be caused by his or her participation in a research protocol and motivating the practitioner by valuing his or her contribution and providing all the guarantees of scientific relevance and independence of practice. In view of the contextual analysis, positive feedback and the availability of organisational and digital support points facilitating the delocalisation and digitisation of the conduct of research activity as close as possible to the patient and his or her doctor, the round table concluded that opportunities exist today which favour the development of clinical research in general practice. It is important to seize this opportunity and make the most of it without delay

« Médecine de ville et essai clinique dans le parcours de soins : aspects organisationnels, réglementaires, outils »

National audienceLa recherche clinique en médecine de ville, notamment en médecine générale, celle qui en 1re ligne de rencontre avec la population, est aujourd’hui un enjeu de santé publique. L’exercice de cette recherche a des spécificités qui la différencie de la recherche clinique conduite en milieu hospitalier ce qui nécessite une adaptation de ses conditions d’exercice : – le développement de la recherche en médecine de ville suppose la maîtrise de ses fondamentaux par les investigateurs, et donc leur présentation, en amont, dès le cycle initial de formation, suivi, puisqu'il s'agit d'un domaine de connaissance complexe et évolutif, d'une participation des praticiens à des modules de formation adaptées à la recherche en soins primaires à l’exemple de ce que plusieurs Groupement interrégional de recherche clinique et d’innovation (GIRCI) ont déjà organisés. Pour compenser le mode éclaté de leur localisation, sur le modèle des équipes mobiles de recherche clinique en cancérologie (EMRC) en cancérologie, des équipes mobiles de recherche doivent mettre les cabinets de médecine générale en capacité de participer aux essais cliniques. Ceci suppose, d’une part, l’allocation de financements fléchés permettant de pérenniser un socle de personnels dédiés, et, d’autre part, l’impulsion d’une dynamique nationale au travers de la mise en place d’un Institut thématique multi-organisme de « Recherche en soins primaires » associé, au plan opérationnel, à un réseau d’investigation d’envergure nationale porté par une plateforme d’excellence ; – le recours aux outils et innovations digitales (télémédecine ; recueil des données via des outils connectés ; e-consentement ; signature électronique) qui permettent de dématérialiser et délocaliser tout ou partie des actes de la recherche que ce soit pour le participant ou les équipes d’investigations ; – une adaptation du cadre juridique afin de rapprocher le lieu de recherche du patient et non l’inverse, ce qui revient à déplacer les matériels et les investigations au plus près du patient ; – la prise en compte de l’acceptabilité du patient, avec donc le souci de limiter la perturbation que peut représenter sa participation à un protocole de recherche et la motivation du praticien en valorisant sa contribution et en apportant toutes les garanties de pertinence scientifique et d’indépendance d’exercice. Au vu de l’analyse contextuelle, des retours d’expérience positifs et de la disponibilité de points d’appui organisationnels et digitaux facilitant la délocalisation et dématérialisation de la conduite de l’activité de recherche au plus près du patient et de son médecin, la table ronde a conclu que des opportunités existent aujourd’hui qui favorisent le développement de la recherche clinique en médecine générale. Il convient de s’en saisir et de profiter, sans tarder, de ce moment propice