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/)

Altération des protéines spécifiques du surfactant pulmonaire au cours de l'hypoxie et l'avitaminose (rôle dans le développement de Pneumocystis carinii)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Mise en évidence et localisation de phospholipases A2 et d'une phospholipase B dans l'épiderme humain

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Intéractions entre Pneumocystis et son biotope (rôle des phospholipides du surfactant pulmonaire)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy – a cohort study

Background and objective Appendectomy may modulate the risk of inflammatory bowel disease through an effect on the gut microbiota. This study investigated the associations between appendectomy and incidence of Crohn’s disease (CD) or ulcerative colitis (UC), with an emphasis on the influence of age and time post appendectomy.Methods This cohort study included 400 520 subjects born in Québec in 1970–1974 and followed until 2014. Administrative health data were used to ascertain appendectomy and cases of CD and UC. Cox proportional hazards models with time-dependent variables (appendectomy and time elapsed post appendectomy) allowed for the estimation of HRs and 95% CIs.Results A total of 2545 (0.6%) CD cases and 1134 (0.3%) UC cases were identified during follow-up. Appendectomy increased the risk of CD (HR=2.02; 95% CI: 1.66 to 2.44), especially when performed at 18–29 years of age. The risk of CD was increased in the first 2 years, and decreased significantly after ≥15 years post appendectomy. Appendectomy appeared to protect against UC (HR=0.39; 95% CI: 0.22 to 0.71). The risk of UC was not associated with age at appendectomy, but decreased with time elapsed post appendectomy (HR=0.21; 95% CI: 0.06 to 0.72, comparing ≥5 with 0–4 years after appendectomy).Conclusions The increased risk of CD related to appendectomy in young adults may result from detection bias, but physicians should have a low threshold for suspicion of CD in young symptomatic adults with a history of appendectomy. A strong protective effect of appendectomy against UC was observed after 5 years

Regulation of immune response in post-operative endophthalmitis

Regulation of immune response in post-operative endophthalmitis. annual meeting of the association-for-research-in-vision-and-ophthalmology (ARVO

Construction et évaluation d’un programme d’éducation thérapeutique du patient dans le domaine de la douleur liée au cancer

International audiencePain, one of the most feared symptoms for patients with cancer, remains insufficiently alleviated and impairs quality of life. Therapeutic patient education (TPE) is a relevant approach to this problem while allowing patients to develop skills to better manage their pain. In the "Basse-Normandie" French region, the management of pain relies on two organized networks, thus allowing proximity and accessibility for all concerned. In this context, our team has begun a broad five-step research program that is part of a regional health policy: (1) training in TPE of 10 doctor/nurse pairs; (2) identification of educational expectations of patients and their relatives in the field of cancer pain; (3) design and optimization of a TPE program dedicated to cancer pain; (4) regional pilot study aiming to assess the feasibility, quality and transferability of the program; (5) evaluation of the TPE program by interventional comparative randomization at the national level. This article aims to present the program which originality and strengths are based on collaborative work between health stakeholders. Objectives, methodology and expected results of the research phase (stages 2, 4, 5) are notably developed. The main expected outcomes are to prove the effectiveness of the program in improving the knowledge and skills of patients in the field of pain cancer in order to promote their adherence to treatment and, consequently, to enable them to better manage it. The long-term objective is to disseminate the educational approach by modifying practices that provide a mutual benefit for caregivers and patients.La douleur est l'un des symptômes les plus redoutés par les patients atteints de cancer. Elle reste insuffisamment soulagée et retentit sur leur qualité de vie. L'éducation thérapeutique du patient (ETP) constitue une approche pertinente pour répondre à cette problématique en permettant au patient de développer des compétences pour mieux gérer sa douleur. En Basse-Normandie, la prise en charge de la douleur liée au cancer s'appuie notamment sur deux réseaux structurés permettant ainsi la proximité et l'accessibilité pour tous. Dans ce contexte, nous avons construit un large programme de recherche s'inscrivant dans une politique régionale de santé, en cinq étapes : (1) formation à l'ETP de 10 binômes médecins/infirmières ; (2) identification des attentes éducatives des patients et des proches dans le domaine de la douleur ; (3) conception et optimisation d'un programme ETP ; (4) étude pilote régionale permettant d'évaluer la faisabilité, la qualité et la transférabilité du programme ; (5) évaluation du programme d'ETP par randomisation comparative interventionnelle menée à l'échelle nationale. L'objectif de cet article est de présenter la stratégie de notre approche et plus particulièrement les objectifs, la méthodologie et les résultats attendus des phases de recherche (étapes 2, 4, 5). À l'issue des cinq étapes, notre ambition est de démontrer l'efficacité du programme éducatif pour améliorer les compétences des patients leur permettant de mieux gérer leur douleur. La finalité à long terme est de diffuser la démarche éducative avec une modification des pratiques apportant un bénéfice réciproque pour les soignants et les patients

Therapeutic Patient Education in Cancer Pain Management: from Practice to Research: Proposals and Strategy of the French EFFADOL Program

International audienceIn the field of cancer pain, therapeutic patient education (TPE) allows patients to develop skills to better manage their pain. In the Lower Normandy region of France, the management of pain is based on networking, thus allowing proximity and accessibility for all concerned. We have thus designed and initiated a broad five-stage research program that includes the following: (1) training for caregivers in TPE; (2) identifying the educational expectations of patients and their relatives with regard to cancer pain; (3) the design of a TPE program; (4) the evaluation of its quality; and (5) the evaluation of its effectiveness by comparative randomization. This article presents this approach and more particularly the research phases (stages 2, 4, 5) for which the objectives, the methodology, and the expected results are justified. Among the key points, particular attention is paid to the evaluation of the educational dimension that provides patients with self-efficacy to participate actively in the management of their pain, their perception of changes in relation to it and its impact. The choice of a specific assessment criterion (subscale 9 of the Brief Pain Inventory) and of the step-wedge design are thus argued. This approach, which is based on a partnership between health care professionals and researchers, aims to demonstrate the benefits provided by TPE to patients in order to enable them to better manage their pain on a daily basis