Grey and harbour seals in France : distribution at sea, connectivity and trends in abundance at haulout sites

Grey (Halichoerus grypus) and harbour seals (Phoca vitulina) are sympatric seal species, but they display distinct strategies of habitat use and connectivity between haulout sites. The distribution patterns and variations in relative abundance of both species were investigated along the French coast of the English Channel, at the southern limit of their range where seal numbers are increasing. Regular censuses conducted at all main haulout sites in mainland France showed significant seasonal variations at most sites, with more harbour seals counted during summer (breeding and moulting seasons), and more grey seals during summer only in the eastern English Channel. Trends in maximum haulout numbers at haulout sites showed a significant increase over the last five years, ranging from 9.7 to 30.9% per year for harbour seals, and from 5.8% (in the western English Channel) to 49.2% (in the eastern English Channel) per year for grey seals. These rates of increase in grey seal numbers are not linked to local pup production and most probably result from seal movements from the southwest British Isles and the North Sea, respectively. Aerial surveys conducted across the English Channel showed that most seal observations at sea were concentrated in the north-eastern English Channel. Telemetry showed that the 28 harbour seals tracked remained highly coastal, within a radius of 100 km from their haulout sites, and did not move to other known colonies. Grey seals moved much greater distances, reaching up to 1200 km from their capture site. More than half of the 45 grey seals tracked crossed the English Channel, especially during the breeding season, moving to known colonies in the southwest British Isles and the North Sea. Combining individual tracks and long-term surveys of the seal populations allowed a better understanding of the dynamics of these populations and their connectivity at a larger regional scale. The findings provide direct information for the management of grey and harbour seals within the frame of the Marine Strategy Framework Directive, and highlight focus areas where potential interactions between the two species should be monitored.PostprintPeer reviewe

Tectonic evolution of the Rehamna metamorphic dome (Morocco) in the context of the Alleghanian-Variscan orogeny

Structural and 40Ar/39Ar geochronological investigations of the Rehamna Massif (Meseta, Moroccan Variscan belt) provide new constraints on the tectonic evolution of the Alleghanian-Variscan orogen during the Upper Paleozoic. Three main tectonic events have been recognized: (1) Southward thrusting of an Ordovician sequence over the Proterozoic basement, its Cambrian sedimentary cover, and the overlying Devono-Carboniferous basin. This event caused subhorizontal shearing and prograde Barrovian metamorphism of the buried rocks. (2) Continuous shortening resulting in the development of a synconvergent extrusion of metamorphosed units to form a dome elongated E-W. This was responsible for synconvergent detachment of the Ordovician upper crustal sequence. The timing of these two episodes is constrained to 310–295 Ma by cooling and metamorphic amphibole and mica ages (3) A NW-WNW convergence in a direction orthogonal to the previous one and characterized by the accretion of the Rehamna dome to the continental basement in the east. Based on 40Ar/39Ar cooling ages from a syntectonic granitoid and its host rocks and metamorphic 40Ar/39Ar ages from greenschist facies mylonite, the timing of this event falls between 295 and 280 Ma. The end of the Variscan orogeny in the Moroccan Meseta is constrained by the 40Ar/39Ar cooling age of a posttectonic pluton dated at ~275 Ma. The tectonic events highlighted in Morocco coincide with the late Variscan-Alleghanian tectonic evolution of southern Europe and North America and can be correlated with the global reorganization of plates that accompanied suturing of Pangaea at around 295 Ma.Peer reviewe

Médicaments et personnes agées en France (quelle consommation en 2011 ?)

PARIS-BIUP (751062107) / SudocSudocFranceF

Physicians' views on pharmacists' involvement in hospital deprescribing: A qualitative study on proton pump inhibitors

International audienceBackground: Clinical pharmacists have a pivotal role in the management of the patient's medication. However, it is necessary to know how pharmacistmediated deprescribing could be implemented in a hospital setting according to hospital physicians. Objective: To explore physicians' views on the involvement of hospital pharmacists in the deprescribing process using the example of PPIs. Methods: A qualitative study using two focus groups with hospital physicians was conducted to determine their attitudes regarding deprescribing initiated by the hospital pharmacist. The interviews were recorded and transcribed using the NVivo analysis software. A thematic analysis led to a categorization of all the verbatims. Results: Hospital doctors are reluctant to deprescribe drugs initiated by a colleague and feel that it is the responsibility of the general practitioner (GP), who fails to do so due to lack of time. In this situation, the hospital pharmacist is in the best position to deprescribe because of his/her expertise in drug therapy. This should be a discussion between the hospital pharmacist, the hospital doctor, the GP and the patient. Deprescribing should always be adapted to the patient's context. Conclusion: Hospital physicians are open to a pharmacist-mediated, patientcentred approach to deprescribing as long as the GP is involved

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on benzodiazepines deprescription in the elderly (BESTOPH-MG trail): a research protocol in primary care

International audienceEvaluation of the effectiveness of a joint general practitionerpharmacist intervention on benzodiazepine deprescription in theelderly (BESTOPH-MG trial) : a research protocol in primary careNizet P (1), Fournier JP (2), Caillet P (3), Lebeaupin M (3), Vigneau C (1), Huon JF (1)(1) Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes andHEalth Research, SPHERE, F-44000 Nantes, France (2) Nantes Université, Univ Tours, Département de MédecineGénérale de Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes,France (3) Nantes Université, CHU Nantes, Unité Santé Publique Interventionnelle, F-44000, FranceBackground: In France, numerous actions have been taken by the health authorities toreduce the use of benzodiazepines (BZDs): information, recommendations, healthsurveillance. However, no patient-centred public health action has been taken.Objective: Evaluate the effectiveness of a joint general practitioner (GP)-pharmacist (P)intervention on BZD deprescription at 12 months.Methods: This is a pragmatic, multi-centre, cluster-randomised, controlled, generalpopulation trial, funded by the Ministry of Health to the tune of 570,000€. The studypopulation will be: patients aged 65 years and over, monthly users of at least one BZDrecruited from the MG-P clusters. The intervention will consist of two steps: delivery ofa kit of documents addressing the risks of BZDs by the GP, followed by 3 motivationalinterviews with the P carried out within 3 months of the deprescription.Results: The primary endpoint will be cessation or reduction of BZD use at 12 monthsfrom inclusion. The secondary endpoints will be assessment of the incremental costutility ratio of the intervention, the proportion of resumption of BZDs afterdiscontinuation, assessment of quality of life (EQ5D-5L), anxiety (GAD-7), insomniaseverity (ISI), BZD dependence (ECAB), autonomy (ADL), number of falls, as well as aqualitative analysis by semi-structured interviews with P and GP in the interventiongroup. The number of subjects required is 400 (200 per arm) based on the inclusion of10 patients per pair and allowing for 20 pairs per arm during the 12 months of inclusion.Conclusion: This study will provide evidence to assist with deprescribing through ajoint GP-P intervention. We expect an improvement in deprescribing of at least 10points following the intervention

(De)Prescribing of proton pump inhibitors: what has changed in recent years? an observational regional study from the French health insurance database

Abstract Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. Methods This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded. Results The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020. Conclusions This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project

Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review

International audienceAbstract Background In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. Methods We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. Results Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)—including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. Conclusions Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

International audienceBackground Deprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians’ part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults. Methods This is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires. Discussion This study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults. This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers. The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways. Clinical trial registration ClinicalTrials.gov , identifier, NCT05765656