Measuring the effectiveness of integrated vector management with targeted outdoor residual spraying and autodissemination devices on the incidence of dengue in urban Malaysia in the iDEM trial (intervention for Dengue Epidemiology in Malaysia): study protocol for a cluster randomized controlled trial

In common with many South East Asian countries, Malaysia is endemic for dengue. Dengue control in Malaysia is currently based on reactive vector management within 24 h of a dengue case being reported. Preventive rather than reactive vector control approaches, with combined interventions, are expected to improve the cost-effectiveness of dengue control programs. The principal objective of this cluster randomized controlled trial is to quantify the effectiveness of a preventive integrated vector management (IVM) strategy on the incidence of dengue as compared to routine vector control efforts

Targeted outdoor residual spraying, autodissemination devices and their combination against Aedes mosquitoes: field implementation in a Malaysian urban setting

Currently, dengue control relies largely on reactive vector control programmes. Proactive vector-control using a rational, well-balanced integrated vector management approach may prove more successful for dengue control. As part of the development of a cluster randomized controlled epidemiological trial, a study was conducted in Johor Bahru, Malaysia. The study included one control site (three buildings) and three intervention sites which were treated as follows: targeted outdoor residual spraying only (TORS site, two buildings); deployment of autodissemination devices only (ADD site, four buildings); and the previous two treatments combined (TORS + ADD site, three buildings). The primary entomological measurement was per cent of positive ovitraps—ovitrap index (OI). The effect of each intervention on OI was analyzed by a modified ordinary least squares regression model. Relative to the control site, the TORS and ADD sites showed a reduction in the Aedes OI (−6.5%, P = 0.04 and −8.3%, P = 0.10, respectively). Analysis by species showed that, relative to control, the Ae. aegypti OI was lower in ADD (−8.9%, P = 0.03) and in TORS (−10.4%, P = 0.02). No such effect was evident in the TORS + ADD site. The present study provides insights into the methods to be used for the main trial. The combination of multiple insecticides with different modes of action in one package is innovative, although we could not demonstrate the additive effect of TORS + ADD. Further work is required to strengthen our understanding of how these interventions impact dengue vector populations and dengue transmission

A Multicenter Cohort Study on 301 Tissue-Level Implants: Cumulative Implant Survival Rate and Marginal Bone Level Change Up to 4.5 Years

International audienc

Psychological effect of COVID-19 pandemic among women undergoing infertility care, a French cohort – PsyCovART Psychological effect of COVID-19: PsyCovART

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[Risk of second cancer after germinal cell testicular cancer: study from the data of Doubs cancer registry]

International audienceTesticular cancer, both seminoma and nonseminoma tumours, account for 1 to 1.5 % of male cancers. Many studies have shown that the risk of a second cancer after radiotherapy is dependent on the size of the exposure fields and the strength of delivered doses of radiotherapy. According to the literature, the relative risk of second cancer among patients treated by irradiation for seminoma limited to the testis varies from 1.5 to 1.9. We conducted a retrospective epidemiological study to measure the risk of second cancer in a population treated for both seminoma and nonseminoma tumours. The study period included patients who were diagnosed from 1978 to 2002. Data were provided by the Doubs cancer registry. Among these 291 cases of testicular cancer, we found 11 cases of second cancer after 157 seminomas (stomach, lungs, testis, ORL, kidney and oesophagus), and 3 cases after 134 nonseminomas (thyroid, kidney and testis). We found a high risk for second pulmonary and testicular cancers (standardised incidence ratio almost statistically significant). While our results are not conclusive regarding the etiology of these second cancers, they do form a useful, comparative basis for further study. They constitute the first step of a study that will be carried out on the risk related to radiation after orchidectomy

Facteurs prédictifs de grossesse spontanée chez les chez les femmes présentant une réserve ovarienne diminuée traitées par DHEA

International audienc

A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial

International audienceAbstract Background While patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities. Methods A nation-wide cluster-randomised controlled trial was performed in France, with each cluster defined as a primary care facility. The intervention included professional e-learning training, identification of a risk management advisor, and multidisciplinary meetings to address incident analysis. In the first observational period, a patient safety incident reporting system for professionals was implemented in all facilities. Then, facilities were randomised, and the program was implemented. Incidents were reported over the 15-month study period. Quasi-Poisson models were used to compare reporting rates. Results Thirty-five facilities (intervention, n = 17; control, n = 18) were included, with 169 and 232 healthcare professionals, respectively, involved. Overall, 7 out of 17 facilities carried out the entire program (41.2%), while 6 did not hold meetings (35.3%); 48.5% of professionals logged on to the e-learning website. The relative rate of incidents reported was 2.7 (95% CI = [0.84–11.0]; p = 0.12). However, a statistically significant decrease in the incident rate between the pre-intervention and post-intervention periods was observed for the control arm (HR = 0.2; 95% CI = [0.05–0.54]; p = 0.02), but not for the intervention arm (HR = 0.54; 95% CI = [0.2–1.54]; p = 0.23). Conclusion This program didn’t lead to a significant improvement in the patient safety incident reporting rate by professionals but seemed to sustain reporting over time. Considering that the program was fully implemented in only 41% of facilities, this highlights the difficulty of implementing such multidisciplinary programs in primary care despite its adaptation to the setting. A better understanding of how risk management is currently organized in these multiprofessional facilities is of key importance to improve patient safety in primary care. Trial registrations The study has been registered at clinicaltrials.gov (NCT02403388) on 30 March 2015

Anesthesia practices for management of labor pain and cesarean delivery in France (EPIDOL): A cross-sectional survey

International audienc

COMPARISON OF PRIMARY AND SECONDARY FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME

International audiencePurpose: The aim of this study was to compare primary versus secondary forms of multiple evanescent white dot syndrome (MEWDS) at T0 (baseline) and T1 (1–4 months after the onset of symptoms). Methods: A total of 101 eyes in 100 patients were included in a multicentric retrospective study. Results: Secondary MEWDS was defined as MEWDS associated with underlying chorioretinal inflammatory pathologies, mainly multifocal choroiditis and punctuate inner choroidopathy. Patients with secondary MEWDS were older ( P = 0.011). The proportion of women ( P = 0.8), spherical equivalent ( P = 0.3), and best-corrected visual acuity at T0 ( P = 0.2) were not significantly different between the two groups. The area of MEWDS lesions on late-phase indocyanine green angiography was significantly smaller in secondary MEWDS ( P = 0.001) and less symmetrical with respect to both horizontal ( P = 0.003) and vertical ( P = 0.004) axis. At T0, neither the clinical ( P = 0.5) nor the multimodal imaging ( P = 0.2) inflammation scores were significantly different between the groups. At T1, the multimodal imaging inflammation score was higher in secondary MEWDS ( P = 0.021). Conclusion: In secondary MEWDS, outer retinal lesions are less extensive and located close to preexisting chorioretinal lesions. Mild signs of intraocular inflammation on multimodal imaging are more frequent in secondary MEWDS during recovery. These findings suggest that chorioretinal inflammation may trigger secondary MEWDS

Polycystic liver: automatic segmentation using deep learning on CT is faster and as accurate compared to manual segmentation

Item does not contain fulltextOBJECTIVE: This study aimed to develop and investigate the performance of a deep learning model based on a convolutional neural network (CNN) for the automatic segmentation of polycystic livers at CT imaging. METHOD: This retrospective study used CT images of polycystic livers. To develop the CNN, supervised training and validation phases were performed using 190 CT series. To assess performance, the test phase was performed using 41 CT series. Manual segmentation by an expert radiologist (Rad1a) served as reference for all comparisons. Intra-observer variability was determined by the same reader after 12 weeks (Rad1b), and inter-observer variability by a second reader (Rad2). The Dice similarity coefficient (DSC) evaluated overlap between segmentations. CNN performance was assessed using the concordance correlation coefficient (CCC) and the two-by-two difference between the CCCs; their confidence interval was estimated with bootstrap and Bland-Altman analyses. Liver segmentation time was automatically recorded for each method. RESULTS: A total of 231 series from 129 CT examinations on 88 consecutive patients were collected. For the CNN, the DSC was 0.95 ± 0.03 and volume analyses yielded a CCC of 0.995 compared with reference. No statistical difference was observed in the CCC between CNN automatic segmentation and manual segmentations performed to evaluate inter-observer and intra-observer variability. While manual segmentation required 22.4 ± 10.4 min, central and graphics processing units took an average of 5.0 ± 2.1 s and 2.0 ± 1.4 s, respectively. CONCLUSION: Compared with manual segmentation, automated segmentation of polycystic livers using a deep learning method achieved much faster segmentation with similar performance. KEY POINTS: • Automatic volumetry of polycystic livers using artificial intelligence method allows much faster segmentation than expert manual segmentation with similar performance. • No statistical difference was observed between automatic segmentation, inter-observer variability, or intra-observer variability