Sequential versus combination chemotherapy for the treatment of advanced colorectal cancer (FFCD 2000-05): an open-label, randomised, phase 3 trial

BACKGROUND: The optimum use of cytotoxic drugs for advanced colorectal cancer has not been defined. Our aim was to investigate whether combination treatment is better than the sequential administration of the same drugs in patients with advanced colorectal cancer. METHODS: In this open-label, randomised, phase 3 trial, we randomly assigned patients (1:1 ratio) with advanced, measurable, non-resectable colorectal cancer and WHO performance status 0-2 to receive either first-line treatment with bolus (400 mg/m(2)) and infusional (2400 mg/m(2)) fluorouracil plus leucovorin (400 mg/m(2)) (simplified LV5FU2 regimen), second-line LV5FU2 plus oxaliplatin (100 mg/m(2)) (FOLFOX6), and third-line LV5FU2 plus irinotecan (180 mg/m(2)) (FOLFIRI) or first-line FOLFOX6 and second-line FOLFIRI. Chemotherapy was administered every 2 weeks. Randomisation was done centrally using minimisation (minimisation factors were WHO performance status, previous adjuvant chemotherapy, number of disease sites, and centre). The primary endpoint was progression-free survival after two lines of treatment. Analyses were by intention-to-treat. This trial is registered at ClinicalTrials.gov, NCT00126256. FINDINGS: 205 patients were randomly assigned to the sequential group and 205 to the combination group. 161 (79%) patients in the sequential group and 161 (79%) in the combination group died during the study. Median progression-free survival after two lines was 10·5 months (95% CI 9·6-11·5) in the sequential group and 10·3 months (9·0-11·9) in the combination group (hazard ratio 0·95, 95% CI 0·77-1·16; p=0·61). All six deaths caused by toxic effects of treatment occurred in the combination group. During first-line chemotherapy, significantly fewer severe (grade 3-4) haematological adverse events (12 events in 203 patients in sequential group vs 83 events in 203 patients in combination group; p<0·0001) and non-haematological adverse events (26 events vs 186 events; p<0·0001) occurred in the sequential group than in the combination group. INTERPRETATION: Upfront combination chemotherapy is more toxic and is not more effective than the sequential use of the same cytotoxic drugs in patients with advanced, non-resectable colorectal cancer. FUNDING: Sanofi-Aventis France

To which countries do European psychiatric trainees want to move to and why?

publisher: Elsevier articletitle: To which countries do European psychiatric trainees want to move to and why? journaltitle: European Psychiatry articlelink: http://dx.doi.org/10.1016/j.eurpsy.2017.06.010 content_type: article copyright: © 2017 Elsevier Masson SAS. All rights reserved.publisher: Elsevier articletitle: To which countries do European psychiatric trainees want to move to and why? journaltitle: European Psychiatry articlelink: http://dx.doi.org/10.1016/j.eurpsy.2017.06.010 content_type: article copyright: © 2017 Elsevier Masson SAS. All rights reserved.BACKGROUND: There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country. METHODS: Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration. RESULTS: A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have 'ever' considered to move to a different country in their future, 53.5% were considering it 'now', at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (2500€) incomes, personal reasons were paramount (44.5%). CONCLUSIONS: A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities

Les algorithmes et la robotique permettent de décrire comment nous apprenons l'écriture manuscrite, et comment mieux aider les enfants avec des difficultés dans ce domaine

Les difficultés d'écriture sont fréquentes et handicapantes. Cependant, les difficultés d'apprentissage moteur sont dans leur ensemble difficiles à évaluer, ce qui limite par conséquent une rééducation, nécessaire le plus précocement possible. Des capteurs électroniques et des algorithmes peuvent aider à mesurer ces difficultés motrices plus facilement et plus objectivement. Les tablettes électroniques par exemple donnent accès à des caractéristiques qui ne sont pas utilisées dans les évaluations classiques. Nous décrivons comment ces caractéristiques (dans les domaines statiques, dynamique, de pression et d'inclinaison) permettent un diagnostic de dysgraphie et comment elles évoluent au cours du développement de l'enfant. Grâce à une analyse plus fine, trois différents clusters de dysgraphie émergent. Des études longitudinales, dans le futur, devraient permettre de mettre en évidence différents profils de développement, qui devraient nécessiter des prises en charges plus personnalisées. Cependant, ces caractéristiques ne sont pas utilisées dans le contexte de la rééducation conventionnelle papier-crayon. Il est possible d'augmenter ma motivation des enfants ayant un développement typique en leur demandant d'enseigner l'écriture à un robot. Nous avons enrichi cette preuve de concept avec des activités permettant des boucles de rétrocontrôle en direct (inclinaison, pression, dynamique, pauses), et mis en place une étude de cas à long terme (20 sessions, 500 minutes au total) avec un enfant avec un trouble du développement de la coordination qui ne progressait plus avec une rééducation classique papier-crayon. Nous montrons comment cette nouvelle méthode permet de diminuer les comportements d'évitement de l'enfant, améliore sa motivation et ses compétences de motricité fine et d'écriture. Cette thèse décrit comment de nouvelles caractéristiques numériques permettent d'implémenter des interventions de rééducation de l'écriture, qui se basent sur une adaptation plus personnalisée aux caractéristiques de l'enfant.Handwriting difficulties are frequent and impairing. However, the assessment of motor learning skills is difficult and limits early stage rehabilitation. Electronic sensors and algorithms can help to measure motor difficulties more easily and objectively. Electronic tablets, for instance, give access to handwriting features that are not usually evaluated in classical assessments. We describe how such digital features (in static, dynamic, pressure, and tilt domains) allow diagnosing dysgraphia and how they evolve during children development. From a finer analysis, three different clusters of dysgraphia emerge, longitudinal studies will allow to underline different patterns of development that seemingly require tailored remediation strategies. However, those digital features are not used in the context of conventional pen and paper therapies. It is possible to engage children with typical development in handwrit- ing exercises by asking them to teach a robot to write. We implemented a long-term case study (20 sessions, 500 minutes in total) observing a child with severe Developmental Co- ordination Disorder who did not progress anymore with a classic pen and paper approach by enriching this setup with various training activities using real-time feedback loops (on tilt, pressure, dynamic, pauses). We show how this new method tackles previous child’s behavior avoidances, boosting his motivation, and improving his motor and writing skills. This thesis demonstrates how new writing digital features allow the implementation of innovative handwriting remediation interventions, which rely on fostering children’s personal characteristics and adaptation skills

Épidémiologie des troubles de l'adaptation déclenchés par un facteur de stress professionnel en médecine générale

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La relation médecin-patient (enquête sur la demande jugée abusive dans la région Poitou-Charentes)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Psychotherapy within psychiatric training: Are we improving?

WOS: 00046125610311

La prise en charge de la douleur de la colique néphrétique non compliquée de l'adulte en médecine de ville

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude des facteurs influençant la demande des patients en consultation de médecine générale

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF