Determinants of the access to remote specialised services provided by national sarcoma reference centres

BACKGROUND: Spatial inequalities in cancer management have been evidenced by studies reporting lower quality of care or/and lower survival for patients living in remote or socially deprived areas. NETSARC+ is a national reference network implemented to improve the outcome of sarcoma patients in France since 2010, providing remote access to specialized diagnosis and Multidisciplinary Tumour Board (MTB). The IGéAS research program aims to assess the potential of this innovative organization, with remote management of cancers including rare tumours, to go through geographical barriers usually impeding the optimal management of cancer patients. METHODS: Using the nationwide NETSARC+ databases, the individual, clinical and geographical determinants of the access to sarcoma-specialized diagnosis and MTB were analysed. The IGéAS cohort (n = 20,590) includes all patients living in France with first sarcoma diagnosis between 2011 and 2014. Early access was defined as specialised review performed before 30 days of sampling and as first sarcoma MTB discussion performed before the first surgery. RESULTS: Some clinical populations are at highest risk of initial management without access to sarcoma specialized services, such as patients with non-GIST visceral sarcoma for diagnosis [OR 1.96, 95% CI 1.78 to 2.15] and MTB discussion [OR 3.56, 95% CI 3.16 to 4.01]. Social deprivation of the municipality is not associated with early access on NETSARC+ remote services. The quintile of patients furthest away from reference centres have lower chances of early access to specialized diagnosis [OR 1.18, 95% CI 1.06 to 1.31] and MTB discussion [OR 1.24, 95% CI 1.10 to 1.40] but this influence of the distance is slight in comparison with clinical factors and previous studies on the access to cancer-specialized facilities. CONCLUSIONS: In the context of national organization driven by reference network, distance to reference centres slightly alters the early access to sarcoma specialized services and social deprivation has no impact on it. The reference networks' organization, designed to improve the access to specialized services and the quality of cancer management, can be considered as an interesting device to reduce social and spatial inequalities in cancer management. The potential of this organization must be confirmed by further studies, including survival analysis

Bone sarcomas: ESMO–EURACAN–GENTURIS–ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up

Production costs have been covered by ESMO from central funds

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

5. 11 mars 1946. Décret n° 46-399 tendant à autoriser la nomination sans concours des membres du personnel enseignant de l'Institut national agronomique et des Écoles nationales d'agriculture

Gouin Félix, Tanguy-Prigent Francois, Philip André. 5. 11 mars 1946. Décret n° 46-399 tendant à autoriser la nomination sans concours des membres du personnel enseignant de l'Institut national agronomique et des Écoles nationales d'agriculture. In: L'enseignement agricole et vétérinaire de la Libération à nos jours. Textes officiels avec introduction, notes et annexes. Paris : Institut national de recherche pédagogique, 2005. p. 87. (Bibliothèque de l'Histoire de l'Education, 21

5. 11 mars 1946. Décret n° 46-399 tendant à autoriser la nomination sans concours des membres du personnel enseignant de l'Institut national agronomique et des Écoles nationales d'agriculture

Gouin Félix, Tanguy-Prigent Francois, Philip André. 5. 11 mars 1946. Décret n° 46-399 tendant à autoriser la nomination sans concours des membres du personnel enseignant de l'Institut national agronomique et des Écoles nationales d'agriculture. In: L'enseignement agricole et vétérinaire de la Libération à nos jours. Textes officiels avec introduction, notes et annexes. Paris : Institut national de recherche pédagogique, 2005. p. 87. (Bibliothèque de l'Histoire de l'Education, 21

9. 22 mai 1946. Loi n° 46-1148 assimilant l'Institut agricole d'Algérie aux Écoles nationales d'agriculture

Gouin Félix, Tanguy-Prigent Francois, Le Troquer André, Philip André. 9. 22 mai 1946. Loi n° 46-1148 assimilant l'Institut agricole d'Algérie aux Écoles nationales d'agriculture. In: L'enseignement agricole et vétérinaire de la Libération à nos jours. Textes officiels avec introduction, notes et annexes. Paris : Institut national de recherche pédagogique, 2005. pp. 100-101. (Bibliothèque de l'Histoire de l'Education, 21

9. 22 mai 1946. Loi n° 46-1148 assimilant l'Institut agricole d'Algérie aux Écoles nationales d'agriculture

Gouin Félix, Tanguy-Prigent Francois, Le Troquer André, Philip André. 9. 22 mai 1946. Loi n° 46-1148 assimilant l'Institut agricole d'Algérie aux Écoles nationales d'agriculture. In: L'enseignement agricole et vétérinaire de la Libération à nos jours. Textes officiels avec introduction, notes et annexes. Paris : Institut national de recherche pédagogique, 2005. pp. 100-101. (Bibliothèque de l'Histoire de l'Education, 21

Novel approach to bind and specifically detect FimH-expressing E. coli using heptylmannose-functionalized cellulose

International audienc

Isolated Rupture of the Teres Major Muscle When Water Skiing: A Case Report and Literature Review

Isolated lesions to the teres major muscle are rare. They generally occur in patients participating in sports such as baseball, tennis, or boxing. We report the case of a sports patient who suffered an isolated injury to the teres major while water skiing. The clinical presentation was confirmed by MRI. Conservative treatment was chosen and consisted of brief analgesic immobilization, followed by rehabilitative treatment. The rapid recovery of this patient with normal isokinetic strength evaluation at 6 months was interesting for objectifying full muscle recovery. Our results and the data from the literature suggest that functional rather than surgical treatment is preferable in isolated lesions to the teres major muscle