60 research outputs found
To a consensus model of clinical validation and surveillance of non-pharmacological interventions (NPIs)
Introduction : De plus en plus de thĂ©rapeutiques non pharmacologiques aussi appelĂ©es interventions non mĂ©dicamenteuses (INM) sont prescrites par des mĂ©decins aux patients malades chroniques de maniĂšre complĂ©mentaire ou alternative aux traitements conventionnels. Leur usage est recommandĂ© par dâautres professionnels de santĂ© sans prescription. Leur offre sâĂ©tend chaque jour davantage notamment dans les domaines de la nutrition, de la e-santĂ© et de lâajustement psychologique Ă la maladie (ex. ETP). Lâobjectif de ce travail Ă©tait de vĂ©rifier sâil existait un modĂšle consensuel de validation clinique et de surveillance de ces thĂ©rapeutiques comme câest le cas pour le mĂ©dicament et les dispositifs mĂ©dicaux implantables. MĂ©thode : Nous avons procĂ©dĂ© Ă une revue de la littĂ©rature sur les modĂšles de validation et de surveillance des INM. Nous avons interrogĂ© les bases de donnĂ©es scientifiques et mĂ©dicales. RĂ©sultats : Nous avons identifiĂ© 17 modĂšles de la validation et de surveillance des INM. Des modĂšles sâinspirent du mĂ©dicament. Dâautres se fondent sur les interventions comportementales. Dâautres se basent sur le design et lâimplĂ©mentation. Dâautres enfin, sont hybrides. Aucun modĂšle nâest consensuel ou dominant actuellement. Conclusion : Lâusage croissant des INM encouragĂ©es par les mĂ©dias et lâarrivĂ©e dans le secteur de la santĂ© des industriels des nouvelles technologies et de la nutrition exige quâun modĂšle consensuel de validation clinique et de surveillance soit adoptĂ©. A ce jour, force est de constater que ce nâest pas le cas. Leur nombre augmente mĂȘme, nous en avons identifiĂ© 17. Cette diversitĂ© rĂ©duit la comparabilitĂ© des rĂ©sultats des Ă©tudes et risque de multiplier les erreurs de prescription et les mĂ©susages.Introduction: More and more non-pharmacological interventions (NPIs) are prescribed by doctors for patients with chronic disease, as additional or alternative paths to conventional treatments. Some are recommended by other professionals. The offer of NPIs extends every day especially in the areas of nutrition, e-health and psychological adjustment to the disease. The aim of this work was to verify if there was a consensus model or dominant clinical validation and surveillance of these solutions as is the case for the drug and medical devices. Material and method: We conducted a literature review on the validation and surveillance models of NPIs. Results: We identified three models of validation, one inspired by the drug, one by behavioral interventions, one by engineering and based on the design and implementation (e.g., Agile, model Fogg). We also identified hybrid models (e.g., MOST, SMART). To date, no model predominates. Conclusion: Patient expectations against NPIs reported by the media and the arrival in the health sector of industrial from new technologies and nutrition require the emergence of a consensus model of clinical validation and surveillance of NPIs. To date, no model predominates. This lack may multiply prescription errors and the risk of misuse
Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials
The aim of this study was to examine whether the efficacy of transtheoretical model (TTM)âbased interventions on physical activity (PA) varied according to the following criteria: (1) interventions targeted the actual stages of change (SOCs) or did not; (2) participants were selected according to their SOC or were not; and (3) its theoretical constructs (decisional balance, temptation, self-efficacy, processes of change). Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified. The between-group heterogeneity statistic (Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not (Qbâ=â1.28, pâ=â0.22) or in interventions selecting participants according to their SOC compared with those that did not (Qbâ=â0.01, pâ=â0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC (Cohen's dâ=â0.36; 95% confidence interval (CI): 0.22â0.49)) or not (dâ=â0.23; 95% CI: 0.09â0.38) and whether they selected their participants according to their SOC (dâ=â0.33; 95% CI: 0.13â0.53) or not (dâ=â0.32; 95% CI: 0.19â0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention (Qbâ=â8.82, pâ=â0.003), the use of self-efficacy (Qb =6.09, pâ=â0.01), and the processes of change (Qbâ=â3.51, pâ=â0.06). TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs
Motrial, first search engine in clinical trial on non pharmaceutical interventions (NPIs)
Le nombre de publications dâĂ©tudes cliniques Ă©valuant les interventions non mĂ©dicamenteuses (INM) augmente exponentiellement depuis 2000. Il encourage les chercheurs Ă rĂ©aliser les revues systĂ©matiques et les mĂ©ta-analyses attendues par les professionnels de santĂ©, les patients et les dĂ©cideurs pour connaĂźtre leur efficacitĂ© rĂ©elle et leur indication pertinente. Seulement, la diversification des supports de communication mĂ©dicale et scientifique, les stratĂ©gies opportunistes de publication, les informations manquantes dans les publications et la non exhaustivitĂ© des bases de donnĂ©es biomĂ©dicales rendent la recherche bibliographique complexe et Ă risque de biais. Pour rĂ©pondre Ă ce manque, la Plateforme CEPS propose un moteur de recherche, appelĂ© Motrial, qui permet de collecter, de trier et dâorganiser les publications dâĂ©tudes cliniques sur les INM.The number of clinical trial publications assessing non-pharmacological intervention (NPI) has been increasing exponentially since 2000. It encourages researchers to carry out the systematic reviews and meta-analyzes expected by health professionals, patients, and decision-makers to learn about their real effectiveness and their relevant indication. However, the diversification of medical and scientific communication media, opportunistic publishing strategies, missing data in publications and non-exhaustiveness of biomedical databases make bibliographic research complex and at risk of bias. To address this shortcoming, the academic Plateforme CEPS offers a search engine, called Motrial, that collects, sorts and organizes publications of NPI clinical trials
Plaisir et handicap physique
Associer plaisir et handicap physique, malgrĂ© l'apparente contradiction de ces deux termes, a Ă©tĂ© le point de dĂ©part de cette recherche. Dans une perspective exploratoire, nous avons menĂ©s des entretiens semi-directifs auprĂšs d'adultes prĂ©sentant un handicap physique, certains Ă©tant des sportifs, d'autres non. Les rĂ©sultats mettent en Ă©vidence l'existence tic, plaisirs spĂ©cifiques chez ce public, plaisirs qui reposent sur le dĂ©passement d'interdits sociaux ou personnels. Cette Ă©tude a, en outre, soulignĂ© la fonction du sport comme « passeport » au plaisir pour ce public, dans la mesure oĂč il se constitue en espace de dĂ©passement des limites et oĂč il permet Ă©galement l'accĂšs Ă une communautĂ© de plaisir avec les « valides ». Il reprĂ©sente alors une possibilitĂ© d'entrer dans un processus qui a pour but de « gagner en validité», situation qui gĂ©nĂšre un plaisir particulier pour ces personnes,Associating pleasure and physical deficiency has been the start point of this research, despite the apparent contradiction between these two terms. In an exploratory perspective, we've led semi-directive interviews next Io physically disabled adults, some of them practising sport, others don't. Results display the existence of specific pleasures among ibis group, pleasures which are associated with the surpassing of social or personnel interdictions. Furthermore, the study underlines a specific function of sport practise as « passport » to pleasure for these persons, insofar as sport practise is a situation of limits overstepping and because it allows an access to a community of pleasure with « the valids ». Sport is pointing out to this group a Possibility of entering in a specific processus leading to « win in validity ». This situation is engendering a specific pleasure among physically disabled people
Plaisir et handicap physique
Associer plaisir et handicap physique, malgrĂ© l'apparente contradiction de ces deux termes, a Ă©tĂ© le point de dĂ©part de cette recherche. Dans une perspective exploratoire, nous avons menĂ©s des entretiens semi-directifs auprĂšs d'adultes prĂ©sentant un handicap physique, certains Ă©tant des sportifs, d'autres non. Les rĂ©sultats mettent en Ă©vidence l'existence tic, plaisirs spĂ©cifiques chez ce public, plaisirs qui reposent sur le dĂ©passement d'interdits sociaux ou personnels. Cette Ă©tude a, en outre, soulignĂ© la fonction du sport comme « passeport » au plaisir pour ce public, dans la mesure oĂč il se constitue en espace de dĂ©passement des limites et oĂč il permet Ă©galement l'accĂšs Ă une communautĂ© de plaisir avec les « valides ». Il reprĂ©sente alors une possibilitĂ© d'entrer dans un processus qui a pour but de « gagner en validité», situation qui gĂ©nĂšre un plaisir particulier pour ces personnes,Associating pleasure and physical deficiency has been the start point of this research, despite the apparent contradiction between these two terms. In an exploratory perspective, we've led semi-directive interviews next Io physically disabled adults, some of them practising sport, others don't. Results display the existence of specific pleasures among ibis group, pleasures which are associated with the surpassing of social or personnel interdictions. Furthermore, the study underlines a specific function of sport practise as « passport » to pleasure for these persons, insofar as sport practise is a situation of limits overstepping and because it allows an access to a community of pleasure with « the valids ». Sport is pointing out to this group a Possibility of entering in a specific processus leading to « win in validity ». This situation is engendering a specific pleasure among physically disabled people
Systems medicine and integrated care to combat chronic noncommunicable diseases
We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems
De la nécessité de penser la post-réhabilitation: le rÎle déterminant des réseaux
National audienc
Dynamique des construits psychologiques et maladie chronique
MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocMONTPELLIER-BU STAPS (341722109) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocSudocFranceF
Etudier la dynamique des construits en psychologie sociale
National audienceCet article prĂ©cise les intĂ©rĂȘts et les limites de la perspective dynamique initiĂ©e par Nowak et Vallacher en 1998 dans le domaine de la psychologie sociale. Cette perspective a fourni des avancĂ©es majeures en Ă©conomie, en biologie et dans le contrĂŽle moteur. Les modĂšles thĂ©oriques, les mĂ©thodes, les instruments de recueil de donnĂ©es et les techniques dâanalyse sont dĂ©sormais au point afin dâune part de fournir une vĂ©rification des hypothĂšses de fonctionnement psychologique laissĂ©es en suspens par les travaux nomothĂ©tiques classiques et dâautre part dâidentifier lâinfluence des Ă©vĂ©nements de vie quotidiens sur le vĂ©cu psychologique. Une illustration sera donnĂ©e avec lâestime de soi. Cette nouvelle voie scientifique exige dâautant plus de rigueur pour ne pas ĂȘtre perçue comme un effet de mode ou hermĂ©tique Ă toute critique. Les piĂšges Ă©pistĂ©mologiques tels que lâanalogie, les bonds conceptuels, les leurres technologiques ou lâexploitation de mĂ©thodes inappropriĂ©es sont lĂ©gions. Les chercheurs en STAPS qui sâillustrent aux confins des interactions entre comportements moteurs, Ă©motions et pensĂ©es en situation Ă©cologique possĂšdent une longueur dâavance pour explorer ce nouveau champ. Ils utilisent en effet des concepts comme lâestime de soi, lâefficacitĂ© perçue, la motivation et lâanxiĂ©tĂ© qui se prĂȘtent formidablement Ă cette aventure scientifique. Reste Ă eux de ne pas tomber dans les piĂšges que cet article tente de souligner
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