Former les professionnels à l’alimentation des personnes âgées : revue critique des formations en France

International audienceSummary In a plea to improve the nutritional status of older people, Dorothee Volkert (2013) insisted on the need to train healthcare professionals. In line with these recommendations, our objective was to identify and analyze the training courses offered in France on older people's diet for both ?cure? providers, in charge of seniors? health (physician, nurse, dietician?), and ?care? providers, in charge of assisting seniors in their daily activities (caregiver, cook, manager of nursing homes?). Fifty-eight courses were identified. These were mainly short courses (62% lasted 2 days or less) provided as part of continuing education (76%). Most of the training courses present the nutritional needs of the older people and/or the undernutrition issue, thus constituting an important lever for raising the awareness of professionals on these important topics. However, the semantic analysis of programs raised proposals to enhance the training offer: increasing targeting of professionals working with older people living at home, taking greater account of the heterogeneity in the aged population and being more focused on the sensory and psychosocial aspects of meals and not only on nutritional aspects.Dans un plaidoyer pour améliorer le statut nutritionnel des seniors, Dorothée Volkert en 2013 insistait sur la nécessité de former les professionnels médico-sociaux. Dans la lignée de ces recommandations, notre objectif est d?inventorier et d?analyser les formations proposées en France sur l?alimentation des personnes âgées à destination des professionnels du «�cure�», en charge de la santé des seniors (médecin, infirmier, diététicien?) et du «�care�», en charge de l?accompagnement des seniors dans leur vie quotidienne (auxiliaire de vie, aide-ménagère, cuisinier et directeur d?institution?). Cinquante-huit formations ont été identifiées. Il s?agit essentiellement de formations courtes (62�% durent 2jours ou moins) dispensées dans le cadre de la formation continue (76�%). La plupart des formations abordent les besoins nutritionnels des seniors et/ou la dénutrition, constituant ainsi un levier important pour sensibiliser les professionnels à ces thématiques. L?analyse sémantique du contenu des programmes a néanmoins permis d?identifier des pistes pour enrichir l?offre de formation�: cibler davantage les professionnels accompagnant les seniors à domicile, prendre davantage en compte l?hétérogénéité de la population âgée et aborder davantage les aspects sensoriels et psychosociaux des repas

Former les professionnels à l'alimentation des personnes âgées : revue critique des formations disponibles en France

National audienc

Mod Pathol

Borderline hepatocellular adenomas (BL-HCA) are characterized by focal architectural/cytologic atypia and reticulin loss, features that are insufficient for a definitive diagnosis of hepatocellular carcinoma (HCC). The diagnosis and management of BL-HCA are challenging as their biological behavior, especially in terms of malignant potential, is still debated. We aimed to compare the clinicopathologic and molecular features of BL-HCA with those of typical HCA (T-HCA), HCA with malignant transformation (HCC on HCA), and HCC to assess the risk of malignancy. One hundred six liver resection specimens were retrospectively selected from 2 reference centers, including 39 BL-HCA, 42 T-HCA, 12 HCC on HCA, and 13 HCC specimens. Somatic mutations, including TERT promoter mutations associated with HCA malignant transformation and the gene expression levels of 96 genes, were investigated in 93 frozen samples. Additionally, TERT promoter mutations were investigated in 44 formalin-fixed, paraffin-embedded samples. The clinical features of patients with BL-HCA were similar to those of patients with T-HCA, patients being mainly women (69%) with a median age of 37 years. The median tumor size was 7.5 cm, 64% of patients had a single nodule, and no recurrence was observed. Compared with T-HCA, BL-HCA was significantly enriched in β-catenin-mutated HCA in exon 3 (41% vs 6%; P < .001). Unsupervised statistical analysis based on gene expression showed that BL-HCA overlapped with T-HCA and HCC on HCA, favoring a molecular continuum of the tumors. TERT promoter mutations were observed only in HCC on HCA (42%) and in HCC (38%). In conclusion, these results suggest that despite their worrisome morphologic features, the clinicopathologic and molecular features of BL-HCA are much closer to those of T-HCA than those of HCC on HCA or HCC. This strongly supports the usefulness of combining morphologic and molecular analyses in a practical diagnostic approach for guiding the management of BL-HCA