Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol

IntroductionBreast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program.Methods and analysisDesign and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care).ParticipantsWomen aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment.InterventionIn the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women.Primary endpointBC screening participation rates will be assessed after an 18-month follow-up period.Statistical analysisIn this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model.DiscussionThe research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future.Ethics and disseminationOn 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings

Formation of new phosphates from aldehydes by a DBU-catalysed Phospha-Brook rearrangement in a polar solvent

International audienc

Évaluation de l’apprentissage de la dermoscopie après une journée de formation auprès de médecins généralistes français sur le dépistage des tumeurs cutanées

International audienceIntroduction En raison de la disparité démographique des dermatologues et de la mise en place du parcours de soin, le médecin généraliste se retrouve de plus en plus souvent en première ligne pour le dépistage des tumeurs cutanées. Cependant, la formation à la dermoscopie n’est pas au programme de leur formation initiale comme leurs collègues dermatologues. Des journées de formation à la dermoscopie sont néanmoins proposées dans le cadre de la formation médicale continue des médecins généralistes. Notre étude avait pour objectif l’évaluation de l’impact d’une journée de formation à la dermoscopie auprès de médecins généralistes sur leur précision diagnostique dans le dépistage des tumeurs cutanées. Matériel et méthodes Nous avons réalisé une étude interventionnelle évaluant 4 journées de formation à la dermoscopie auprès de médecins généralistes. La formation a touché 60 médecins généralistes français exerçant dans la région Grand Ouest. L’impact de l’intervention a été évalué à l’aide de trois questionnaires dont les réponses avant/après (n = 59) ont été comparées afin d’établir des scores diagnostiques, histologiques et d’orientation. Résultats Trente-huit médecins généralistes ont répondu au pré-test et au post-test immédiat, nous permettant de constater une amélioration significative de leur score diagnostique moyen immédiatement après la formation (3,55 sur 10 au pré-test contre 6,16 sur 10 au post-test immédiat ; p < 0,001). Trente-sept médecins généralistes ont répondu à la fois au pré-test et au post-test différé, démontrant une amélioration significativement persistante du score diagnostique moyen deux mois après la formation (3,86 sur 10 au pré-test contre 5,35 sur 10 au post-test différé ; p = 0,002). Notre étude suggère également que la formation à la dermoscopie améliore la stratégie thérapeutique des médecins généralistes et diminue significativement le nombre d’orientations inutiles chez le dermatologue. Discussion Cette étude montre qu’une journée de formation à la dermoscopie auprès de médecins généralistes, permet d’améliorer leur précision diagnostique en dermoscopie, ainsi que leur stratégie thérapeutique. Il serait donc intéressant de continuer à former les médecins généralistes à la dermoscopie en élargissant l’offre de formation, car il est très probable que les médecins généralistes seront de plus en plus souvent sollicités pour le dépistage des cancers cutanés dans les années à venir en France

Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: an observational: cross-sectional study

International audienceObjectivesThe prevalence of ESBL-producing Escherichia coli (ESBL-E. coli) in community-acquired urinary tract infections (UTI) has been increasing worldwide since 2000, but with large geographical variations. The aim of this study was to determine whether the ESBL-E. coli rate in urine samples from individuals with community-acquired UTI was associated with the local socio-economic, environmental, agricultural and healthcare characteristics.MethodsThis was a cross-sectional study in western France using data on antibiotic susceptibility of E. coli isolated from urine samples of individuals with community-acquired UTI analysed in non-hospital laboratories from 2015 to 2017. The ESBL-E. coli rate was calculated for each laboratory. Data on socio-economic characteristics, human antibiotic consumption, hospital bed density, animal farming density and percentage of agricultural land and surface water were retrieved at the municipality level and aggregated by study area. Their association with ESBL-E. coli prevalence was quantified using multivariate linear regression models with a backward selection.ResultsFrom 358 291 E. coli isolates from urine samples tested in 92 laboratories, the mean ESBL-E. coli prevalence for the study period was 3.30%. In an adjusted model, the ESBL-E. coli rate was significantly (P 65 years old, third-generation cephalosporin use (DDD/1000 inhabitants), number of hospital beds/km2, poultry density, pig density and percentage of agricultural land. Lower deprivation was associated with a higher ESBL-E. coli rate.ConclusionsSeveral anthropogenic factors (primary care, hospitals and animal farming) are associated with the local ESBL-E. coli rate in community-acquired UTI. These results could contribute to improve risk management, including identification of at-risk patient groups

Cervical cancer screening uptake: A randomized controlled trial assessing the effect of sending invitation letters to non-adherent women combined with sending their general practitioners a list of their non-adherent patients (study protocol)

International audienceIntroduction Cervical cancer (CC) is the fourth most common cancer among women. It can be cured if diagnosed at an early stage and treated promptly. The World Health Organization suggests that 70% of women should be screened with a high-performance test by the age of 35. This paper reports a protocol to assess the effect of two modalities of organized CC screening programmes on CC screening uptake. Methods and analysis Design and setting: The design involves a 3-arm randomized controlled study performed in a French geographic area on the west coast. A total of 1,395 general practitioners will be randomized, depending on their general practice surgeries. Participants: The design is based on a total of 94,393 women aged 40 to 65 years who are eligible for CC screening. Intervention: In the “optimized cancer screening” group, the intervention will combine sending invitation letters to non-adherent women with sending general practitioners (GPs) a list of their non-adherent patients. In the “standard cancer screening” group, the intervention will be limited to sending invitation letters to non-adherent women. In the “usual care” group, no letter will be sent either to women or to their GPs. Primary endpoint: CC screening test uptake will be assessed after a 6-month follow-up period. Statistical analysis: The percentage of women who are up-to-date with their screening at 6 months after the intervention will be compared across arms using a generalized mixed linear model. Discussion A large-scale randomized trial of this nature is unprecedented. The study will enable us to assess a strategy relying on GPs, identified as the coordinators in this screening strategy. The study results should help policy makers to implement organized CC screening programs in the future. Ethics and dissemination The study was approved was approved by the Ethics Committee of the National College of Teaching General practitioners (IRB00010804). It was recorded in ClinicalTrials.gov on the number NCT04689178 (28 December 2020). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings

A face-to-face national congress experience during the COVID-19 pandemic: A report focussing on the risk of COVID-19 contamination

Background: The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination. Objectives: The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination. Methods: We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants. Results: A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 (SD 10) years, 96.2% had been vaccinated against SARS-CoV-2, and 11.4% considered themselves at risk for a severe form of COVID-19 for medical reasons. Concerning the interest in attending the congress face-to-face, mean score was 9 over 10 (SD 1.5). No case of COVID-19 was reported among participants according to the second questionnaire (449 respondents). Conclusion: During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress

A face-to-face national congress experience during the COVID-19 pandemic: A report focussing on the risk of COVID-19 contamination

Background: The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination. Objectives: The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination. Methods: We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants. Results: A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 (SD 10) years, 96.2% had been vaccinated against SARS-CoV-2, and 11.4% considered themselves at risk for a severe form of COVID-19 for medical reasons. Concerning the interest in attending the congress face-to-face, mean score was 9 over 10 (SD 1.5). No case of COVID-19 was reported among participants according to the second questionnaire (449 respondents). Conclusion: During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress

Incidence, criticité et typologie des évènements indésirables en Ehpad : premières caractéristiques épidémiologiques françaises et perspectives de prévention

International audienceKnowledge in France on the subject of care-related adverse events in the nursing home sector is sparse. An observational descriptive study was conducted in 25 nursing homes over a period of 2 weeks over periods of two weeks between 2016 and 2017. It aimed to describe the types of care-related adverse event, and to assess their seriousness, frequency of occurrence, and criticality. Eighty-six types of care-related adverse event belonging to 13 risk domains were identified (31 by the investigating physician). Among these types of event, 11 corresponded to an unacceptable level of criticality, and 13 were categorised as warranting surveillance. Efforts in nursing homes should focus on the various types of care-related adverse event: loss of or damage to a medical device; failure to administer a medication; failure to coordinate between structures; shortfalls in planning and care continuity; shortfalls in the information system; loss of or damage to laundry items; unplanned escapade. Recommendations on the main lines of prevention and improvement in nursing homes should be the subject of future study

Incidence of Adverse Events Associated with Technical Care and Support in French Nursing Homes: The EHPAGE Project

International audienceA rise in the number of dependent elderly people has made nursing homes an important part of the French health system. Through the struggle against adverse events associated with treatments, the question of the residents' safety and wellbeing has been paramount. To get an estimation of the highest incidence rates of adverse events in nursing homes, we carried out a follow-up study on 536 residents over 15-day periods between November 2016 and May 2017 in 8 French nursing homes. Notifications by professionals coupled with explorations by an investigating physician helped evidence the different typologies and degrees of seriousness of treatment-related adverse events. The 149 treatment-related adverse events that were identified belonged to 13 risk domains. Four of these domains accounted for 60% of treatment-related adverse events: 'medication and medical provision', 'living environment', 'technical care and accompaniment', 'care organization and coordination'. Four treatment-related adverse events out of the 149 (2.7%) had a level of seriousness rated as 4; 16 (10.7%) had a seriousness level rated as 3. Finally, particular attention should be paid to suicide risk. These first results need to be corroborated, but they will help develop messages of prevention aimed at professionals

Targeted screening for melanoma after a 5-year follow-up: Comparison of melanoma incidence and lesion thickness at diagnosis in screened (versus unscreened) patients

Melanoma incidence and mortality rates are increasing worldwide. While screening appears to be inefficient, targeted screening might be effective. Objective: To assess the relative risk of developing a melanoma in a population that participated in targeted screening program compared with the general population. The secondary objective was to identify the factors related to melanoma thickness at the time of diagnosis. Design, setting, and participants: We assessed the incidence of melanoma from 2011 to 2015 in a cohort of 3832 patients at elevated risk of melanoma living on the west coast of France. The patients were older than 20 years, selected using the Self-Assessment of Melanoma risk score, and invited each spring to undergo a complete skin examination as part of a pilot targeted screening program for melanoma. Main outcome, measures: We calculated the relative risk of developing a melanoma, based on the comparison of melanoma incidence in patients who participated in the targeted screening and in the general population in the geographic area. Data collection was performed by the regional cancer registry, in accordance with international standards. Demographical variables and histological variables related to the identification of a thick melanoma (stage 2 and higher) were also analyzed. Results: 3 169 patients developed melanomas between April 2011 and December 2015. The relative risk of developing a melanoma during the five years of follow-up was 4.33 [4.17;4.50] in patients who participated in the pilot targeted screening program compared with the general population. The following factors were associated with the identification of thick melanomas: male gender (OR = 1.40; 95% CI [1.18−1.66]), age older than 75 years (OR = 1.72; 95% CI [1.38−2.14]), and residence in a rural area (OR = 1.48; 95% CI [1.21−1.80]). The targeted screening program did not lead to a lower proportion of thick melanomas at the time of diagnosis (OR=0.48 [0.11−1.40]). Conclusions and relevance: Targeted screening for melanoma allows general practitioners to focus their attention, energy, and time on at-risk populations with greater efficiency. However, participation in the pilot screening program was not associated with the identification of thinner melanomas at the time of diagnosis. Trial registration: This trial was registered in the Clinical Trials database before study enrollment commenced (ClinicalTrials.gov; Registration number: NCT01610531)