Effects of backpacking holidays in Australia on alcohol, tobacco and drug use of UK residents

BACKGROUND: Whilst alcohol and drug use among young people is known to escalate during short holidays and working breaks in international nightlife resorts, little empirical data are available on the impact of longer backpacking holidays on substance use. Here we examine changes in alcohol, tobacco and drug use when UK residents go backpacking in Australia. METHODS: Matched information on alcohol and drug use in Australia and the UK was collected through a cross sectional cohort study of 1008 UK nationals aged 18–35 years, holidaying in Sydney or Cairns, Australia, during 2005. RESULTS: The use of alcohol and other drugs by UK backpackers visiting Australia was common with use of illicit drugs being substantially higher than in peers of the same age in their home country. Individuals showed a significant increase in frequency of alcohol consumption in Australia compared to their behaviour in the UK with the proportion drinking five or more times per week rising from 20.7% (UK) to 40.3% (Australia). Relatively few individuals were recruited into drug use in Australia (3.0%, cannabis; 2.7% ecstasy; 0.7%, methamphetamine). However, over half of the sample (55.0%) used at least one illicit drug when backpacking. Risk factors for illicit drug use while backpacking were being regular club goers, being male, Sydney based, travelling without a partner or spouse, having been in Australia more than four weeks, Australia being the only destination on their vacation and drinking or smoking five or more days a week. CONCLUSION: As countries actively seek to attract more international backpacker tourists, interventions must be developed that target this population's risk behaviours. Developing messages on drunkenness and other drug use specifically for backpackers could help minimise their health risks directly (e.g. adverse drug reactions) and indirectly (e.g. accidents and violence) as well as negative impacts on the host country

Parcours de santé du patient hémophile et évaluation de l'impact organisationnel d'une innovation

The organizational impact analysis provides complementary data to clinical and medico-economic health innovation’s assessment. Several innovative drugs liable to changes in healthcare organization are or soon will be available for the management of hemophilia. The aim of this work was to assess the organizational impact of innovation in health pathway. To this end, we have studied the evolution of the health pathway driven by innovative therapeutics, in the past. Then, a modelisation of the current pathway was completed, in order to analyze the impact of the innovations, upcoming, in hemophilia comprehensive care management. This work led to realize a schematic representation of a complex health pathway, and to implement a quantitative multiple criteria decision analysis for assessing an organizational impact. This data was completed by the implementation of a qualitative research in order to include the patient and their caregiver’s point of view, in this analysis.L’évaluation de l’impact organisationnel apporte des éléments complémentaires et éclairants aux évaluations cliniques et médico-économiques des innovations en santé. Des médicaments innovants, susceptibles d’induire un changement dans le parcours des patients sont ou vont être mis à disposition dans la prise en charge de l’hémophilie. L’objectif de ce travail de thèse était d’évaluer l’impact organisationnel d’une innovation sur le parcours de santé du patient hémophile. Pour cela, nous avons étudié l’évolution du parcours de santé du patient induite par les innovations thérapeutiques, par le passé. Puis, une modélisation du parcours actuel a été réalisée, afin d’évaluer l’impact des innovations, à venir, dans l’organisation de la prise en charge globale du patient. Ce travail a permis de réaliser une représentation schématique d’un parcours de santé complexe, et de mettre en œuvre une méthode quantitative d’analyse de décision multicritères pour évaluer un impact organisationnel. Ces données ont été complétées par la mise en place d’une étude qualitative pour intégrer le point de vue du patient et de leurs aidants à cette analyse

Haemophilia in France: Modelisation of the Clinical Pathway for Patients

Process-of-care studies participate in improving the efficiency of the care pathway for patient with haemophilia (CPPH) and rationalize the multidisciplinary management of patients. Our objective is to establish a current overview of the different actors involved in the management of patients with haemophilia and to provide an accurate description of the patient trajectory. This is a qualitative exploratory research based on interviews of the principal health professionals of four haemophilia services, between November 2019 and February 2020, in France. Mapping of the CPPH processes within the different institutions and/or services, as well as the rupture zones, were identified. Treatment delivery and biological analyses were carried out exclusively in healthcare institutions. The main liberal health professionals solicited were nurses, physiotherapists and general practitioner. Obstacles and barriers within the specialized service, with other hospital services and external hospital or private services, community health care providers et community environment and individual one was complex and multiples. Our research identified potential concerns that need to be addressed to improve future studies to identify influential elements. Similarly, other qualitative studies will have to be conducted on the perceptions and literacy of patients with haemophilia to develop a global interactive mapping of their trajectories

Health pathway of persons with hemophilia and evaluation of the organizational impact of innovation.

L’évaluation de l’impact organisationnel apporte des éléments complémentaires et éclairants aux évaluations cliniques et médico-économiques des innovations en santé. Des médicaments innovants, susceptibles d’induire un changement dans le parcours des patients sont ou vont être mis à disposition dans la prise en charge de l’hémophilie. L’objectif de ce travail de thèse était d’évaluer l’impact organisationnel d’une innovation sur le parcours de santé du patient hémophile. Pour cela, nous avons étudié l’évolution du parcours de santé du patient induite par les innovations thérapeutiques, par le passé. Puis, une modélisation du parcours actuel a été réalisée, afin d’évaluer l’impact des innovations, à venir, dans l’organisation de la prise en charge globale du patient. Ce travail a permis de réaliser une représentation schématique d’un parcours de santé complexe, et de mettre en œuvre une méthode quantitative d’analyse de décision multicritères pour évaluer un impact organisationnel. Ces données ont été complétées par la mise en place d’une étude qualitative pour intégrer le point de vue du patient et de leurs aidants à cette analyse.The organizational impact analysis provides complementary data to clinical and medico-economic health innovation’s assessment. Several innovative drugs liable to changes in healthcare organization are or soon will be available for the management of hemophilia. The aim of this work was to assess the organizational impact of innovation in health pathway. To this end, we have studied the evolution of the health pathway driven by innovative therapeutics, in the past. Then, a modelisation of the current pathway was completed, in order to analyze the impact of the innovations, upcoming, in hemophilia comprehensive care management. This work led to realize a schematic representation of a complex health pathway, and to implement a quantitative multiple criteria decision analysis for assessing an organizational impact. This data was completed by the implementation of a qualitative research in order to include the patient and their caregiver’s point of view, in this analysis

Intérêt du Sugammadex (Bridion ® ) dans la décurarisation en anesthésiologie (bilan de son utilisation et évaluation de son impact économique aux Hospices Civiles de Lyon)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Preparation and characterization of polyvinylidene fluoride nanofibrous membranes by forcespinning™

Nanofibers of polyvinylidene fluoride (PVDF) were prepared using solutions of PVDF with acetone and dimethylacetamide. The solutions were prepared at different concentrations (18, 21.5, and 25% wt) of PVDF. The nanofiber membranes were produced by using the Forcespinning™ method. Parameters such as the orifice size and spinneret angular velocity were varied. The produced membranes were characterized using scanning electron microscopy, differential scanning calorimetry, and X-ray diffraction to determine the effect of varying parameters in the Forcespinning™ process on fiber diameter, bead formation, thermal stability, polymorphism, and morphology of the fibers and overall structure of the membrane. It was observed that polymer concentration played a key role in fiber and bead formation; at higher concentrations (such as 25 wt%), the fiber diameter increased but the bead formation decreased. The prepared composite membranes have potential applications on separators for Li-ion batteries, ultra filtration membranes, and proton conductivity membranes for fuel cells applications. POLYM. ENG. SCI., 2012

Haemophilia in France: Modelisation of the Clinical Pathway for Patients

International audienceProcess-of-care studies participate in improving the efficiency of the care pathway for patient with haemophilia (CPPH) and rationalize the multidisciplinary management of patients. Our objective is to establish a current overview of the different actors involved in the management of patients with haemophilia and to provide an accurate description of the patient trajectory. This is a qualitative exploratory research based on interviews of the principal health professionals of four haemophilia services, between November 2019 and February 2020, in France. Mapping of the CPPH processes within the different institutions and/or services, as well as the rupture zones, were identified. Treatment delivery and biological analyses were carried out exclusively in healthcare institutions. The main liberal health professionals solicited were nurses, physiotherapists and general practitioner. Obstacles and barriers within the specialized service, with other hospital services and external hospital or private services, community health care providers et community environment and individual one was complex and multiples. Our research identified potential concerns that need to be addressed to improve future studies to identify influential elements. Similarly, other qualitative studies will have to be conducted on the perceptions and literacy of patients with haemophilia to develop a global interactive mapping of their trajectories

Patients’ Perception of the Impact of Innovation on Hemophilia Care Management Organization: A Qualitative Study Protocol (INNOVHEMO Study)

International audienc

Immunomodulatory drugs in multiple myeloma: Impact of the SCARMET (Self CARe and MEdication Toxicity) educational intervention on outpatients' knowledge to manage adverse effects.

Long-term multiple myeloma therapy by immunomodulatory drugs (IMiDs) raises the question of management of adverse effects. The aim of this study is to assess the impact of an educational session for patients on the acquisition of knowledge to manage hematologic and thromboembolic adverse effects of IMiDs. In this prospective single-center study, patients attended an educational session with a hospital clinical pharmacist and a nurse. The primary endpoint was the patient's level of knowledge for the management of IMiDs adverse effects, assess with a dedicated questionnaire administered before the session then 1 and 6 months after. Assessment of knowledge was combined with self-assessment of certainty. The secondary endpoints were adherence and IMiD treatment satisfaction. 50 patients were included. Patient knowledge increased at 1 month (p<0.001) despite a loss of knowledge at 6 months (p<0.05). Six months after the educational intervention, the number of patients with skills considered satisfactory by the pharmacist and nurse increased (p<0.01). Most patients showed satisfactory adherence, with medication possession ratio ≥ 80%. The Self CARe and MEdication Toxicity (SCARMET) study highlighted the impact of multidisciplinary follow-up in multiple myeloma patients to improve knowledge of toxicity self-management

Medical device assessment: scientific evidence examined by the French national agency for health – a descriptive study

<p>Abstract</p> <p>Background</p> <p>Scientific evidence supports decision-making on the use of implantable medical devices (IMDs) in clinical practice, but IMDs are thought to be far less investigated than drugs. In the USA, studies have shown that approval process of high-risk medical devices was often based on insufficiently robust studies, suggesting that evidence prior to marketing may not be adequate. This study aimed to ascertain level of evidence available for IMDs access to reimbursement in France.</p> <p>Methods</p> <p>The objective was to examine the scientific evidence used for IMDs assessment by the French National Authority for Health. We collected all public documents summarising supportive clinical data and opinions concerning IMDs issued in 2008. An opinion qualifies the expected benefit (EB) of the IMD assessed as sufficient or insufficient, and if sufficient, the level of improvement of the expected benefit (IEB) on a scale from major (level I) to no improvement (level V). For each opinion, the study with the highest level of evidence of efficacy data, and its design were collected, or, where no studies were available, any other data sources used to establish the opinion.</p> <p>Results</p> <p>One hundred and two opinions were analysed, with 72 reporting at least one study used for assessment (70.6%). When considering the study with the highest level of evidence: 34 were clinical non-comparative studies (47.2%); 29 were clinical comparative studies of which 25 randomised controlled trials (40.3%); 5 were meta-analyses of randomised controlled trials (6.9%); and 4 were systematic literature reviews (5.6%). The opinions were significantly different according to the study design (p < 0.001). The most frequent design for insufficient EB, IEB level V and IEB level IV was a non-comparative study (10/19, 52.6%; 15/24, 62.5%; and 8/15, 53.3%; respectively). For the 30 opinions with no supporting clinical study, 16 (53.3%) were based on an expert-based process, 9 (30.0%) were based on the conclusions of a previous opinion (all concluding IEB level V), and 5 (16.7%) reported no data (concluding insufficient EB for 4 and IEB level V for 1).</p> <p>Conclusions</p> <p>This study confirmed that level of evidence of clinical evaluation of IMDs is low and needs to be improved.</p