Maladie d’Alzheimer et appropriation de la durée d’action

International audienceLes perturbations de la temporalité habituellement objectivées dans la maladie d’Alzheimer (MA) à partir de stimuli élémentaires brefs, non écologiques, méritent d’être approfondies à partir d’activités courantes, familières, contextualisées. Au cours d’entretiens centrés sur les activités quotidiennes, les réponses portant sur la temporalité de six patients atteints de MA sont comparées aux autres thèmes exprimés, selon leur pertinence et leur caractère direct ou sollicité. Les altérations prédominent sur l’estimation de durée, comparée aux repères chronologiques, et autorisent à imaginer des intersections entre les processus mnésiques de la temporalité. Nos résultats ouvrent la perspective d’une interaction entre la voie automatique de la temporalité, mieux préservée et la voie contrôlée. L’entretien clinique, par la mise en scène conversationnelle de la cognition et de ses altérations, apparaît comme une méthode de choix pour explorer la temporalité vécue au cours de la maladie d’Alzheimer

Maladie d’Alzheimer et évaluation de la temporalité de la vie quotidienne : l’estimation de durée est-elle mieux préservée en mémoire située ou déclarative ?

National audienceAu cours de la maladie d’Alzheimer (MA), l’incapacité à maîtriser la dimension temporelle de la vie quotidienne est une source majeure de handicap. En l’absence d’outil validé existant, la présente recherche vise à contribuer à la compréhension des troubles de l’appropriation de la temporalité de la vie quotidienne chez une population de patients aux stades légers à modérés de la MA. Pour ce faire, nous avons élaboré puis administré une batterie de 12 estimations de durée de tâches quotidiennes à 440 témoins et 22 patients. Cette tâche apparaît préservée et indépendante chez les patients des processus cognitifs évalués, dont ceux impliqués par le test de l’horloge. La dépression n’influence pas cette estimation de durée. Ce type d’estimation de durée met en jeu des processus cognitifs préservés liés à la mémoire procédurale des scripts sur lesquels une approche de réhabilitation ultérieure pourrait se fonder

Evaluation des connaissances sémantiques de la temporalité au cours du vieillissement normal et de la maladie d’Alzheimer aux stades légers à modérés.

International audienc

Implementation of JACIE accreditation results in the establishment of new indicators that unevenly monitor processes contributing to the delivery of hematopoietic SCT

International audienceMore than 145 European hematopoietic SCT programs have received JACIE (Joint Accreditation Committee for ISCT Europe and EBMT) accreditation since 2000, demonstrating compliance with FACT (Foundation for the Accreditation of Cell Therapy)-JACIE international standards. The association of JACIE with improved patient outcome was recently documented. However, conditions in which quality management systems were introduced and the actual benefits remain to be fully evaluated. Our study focuses on one aspect of quality management: introduction and use of indicators. Through a questionnaire sent to JACIE-accredited centers and responses from 32 programs (or 40%), we identified 293 indicators, including 224 (76%) that were introduced during the preparatory phase of JACIE accreditation. Indicators were associated with the following processes: measurement, analysis and improvement (54/293 or 18%); donor collection (49/293 or 16%); processing and storage of cell therapy products (37/293 or 12.5%); and administration of hematopoietic progenitor cells (67/293 or 23%). Mapping revealed an uneven distribution of indicators across the different subprocesses that contribute to this highly specialized medical procedure. Moreover, we found that only 101/293 indicators (34%) complied with the rules for implementation of a quality indicator, as defined by the FDX 50-171 standard. This suggests that risks to donors/recipients are unevenly monitored, leaving critical medical steps with low levels of monitoring

Evaluation des connaissances sémantiques de la temporalité au cours du vieillissement normal et de la maladie d’Alzheimer aux stades légers à modérés.

International audienc

Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France

International audienceAbstract Background With the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists. Methods Firstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3). Discussion We expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability. Trial registration Registry: ClinicalTrials.gov. Trial registration number: NCT05989776. Date of registration: 7 th September 2023. URL: https://classic.clinicaltrials.gov/ct2/show/NCT05989776 . Protocol version Manuscript based on study protocol version 2.0, 21st may 2023

Additional file 1 of Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France

Supplementary Material 1: SPIRIT checklis

Intervention dose estimation in health promotion programmes: a framework and a tool. Application to the diet and physical activity promotion PRALIMAP trial

<p>Abstract</p> <p>Background</p> <p>Although the outcomes of health promotion and prevention programmes may depend on the level of intervention, studies and trials often fail to take it into account. The objective of this work was to develop a framework within which to consider the implementation of interventions, and to propose a tool with which to measure the quantity and the quality of activities, whether planned or not, relevant to the intervention under investigation. The framework and the tool were applied to data from the diet and physical activity promotion PRALIMAP trial.</p> <p>Methods</p> <p>A framework allowing for calculation of an intervention dose in any health promotion programme was developed. A literature reviews revealed several relevant concepts that were considered in greater detail by a multidisciplinary working group. A method was devised with which to calculate the dose of intervention planned and that is actually received (programme-driven activities dose), as well as the amount of non-planned intervention (non-programme-driven activities dose).</p> <p>Results</p> <p>Indicators cover the roles of all those involved (supervisors, anchor personnel as receivers and providers, targets), in each intervention-related groups (IRG: basic setting in which a given intervention is planned by the programme and may differ in implementation level) and for every intervention period. All indicators are described according to two domains (delivery, participation) in two declensions (quantity and quality). Application to PRALIMAP data revealed important inter- and intra-IRG variability in intervention dose.</p> <p>Conclusions</p> <p>A literature analysis shows that the terminology in this area is not yet consolidated and that research is ongoing. The present work provides a methodological framework by specifying concepts, by defining new constructs and by developing multiple information synthesis methods which must be introduced from the programme's conception. Application to PRALIMAP underlined the feasibility of measuring the implementation level. The framework and the tool can be used in any complex programme evaluation. The intervention doses obtained could be particularly useful in comparative trials.</p> <p>Trial registration</p> <p>PRALIMAP is registered at ClinicalTrials.gov under NCT00814554</p