Description des interventions visant une perte de poids chez les femmes traitées pour un cancer du sein à l'aide de la Behaviour Change Technique Taxonomy version 1 (BCTTv1): travail de Bachelor

Introduction : La qualité des descriptions des études d’intervention visant un changement de comportement est très variable. Par conséquent, ces interventions sont difficilement implantables dans la pratique professionnelle. Dans le cadre du cancer du sein, les femmes ont une tendance à prendre du poids suite aux traitements. Il n’y pas de recommandation pour la prise en charge du poids de ces patientes. Cela est principalement dû à un manque de preuves solides, malgré qu’une perte de poids soit réalisable. Les composantes efficaces des interventions réalisées ne sont pas connues. Le but de ce travail est d’identifier les ingrédients actifs des interventions visant une perte de poids chez les femmes traitées pour un cancer du sein à l’aide de la taxonomie Behaviour Change Technique Taxonomy version 1 (BCTTv1). Méthodes : 24 études d’intervention visant une perte de poids chez les femmes traitées pour un cancer du sein ont été analysées. Une analyse descriptive des interventions menées a été effectuée sur la base du fondement de l’intervention, du type d’intervention auto-déclaré par les auteurs, de la description de l’intervention, du public cible de l’intervention, des modalités d’intervention et des ressources matérielles et humaines. Les 24 interventions ont également été codées à l’aide de la taxonomie BCTTv1 afin d’en dégager les ingrédients actifs. Résultats : Dix-huit études sur vingt-quatre ont une composante alimentaire ainsi qu’une composante d’activité physique. Six études ont également une composante de soutien social. Les descriptions des études inclues sont très variables dans la précision et dans le vocabulaire utilisé pour les qualifier, malgré que les interventions soient très similaires. Les modalités d’interventions ainsi que les ressources matérielles et humaines ne sont pas toujours explicitées de manière claire. Nous avons pu identifier 25% des labels BCT possibles. Les labels les plus fréquents sont Goal setting (behavior) (1.1), Social support (unspecified) (3.1), Instruction on how to perform the behavior (4.1) et Goal setting (outcome) (1.3) par ordre décroissant. Conclusion : Nos résultats ont montré la variabilité des descriptions pour des interventions qui sont finalement semblables. Le faible nombre de labels BCT trouvé montre le manque de précision dans les descriptions pour que l’ingrédient actif soit clairement identifié. Nos résultats montrent l’importance de l’utilisation d’un langage commun afin que ces interventions puissent être comparées beaucoup plus facilement et de ce fait, apporter encore plus de poids aux résultats de toutes les études portant sur le sujet des femmes atteintes d’un cancer du sein. Ce travail est une première étape vers la compréhension des mécanismes de perte de poids dans le cadre du cancer du sein. Il est important, dans les futures études, que les interventions soient décrites de manière structurée et avec un langage commun. Ceci dans le but de les rendre plus systématiques et d’augmenter les preuves quant au bénéfice d’une prise en charge du surpoids et de l’obésité chez les femmes traitées pour un cancer du sein, avec un objectif de changement de comportement à long terme

Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: A Literature Review

Medical nutrition therapy in critically ill patients remains challenging, not only because of the pronounced stress response with a higher risk for complications, but also due to their heterogeneity evolving from different phases of illness. The present review aims to address current knowledge and guidelines in order to summarize how they can be best implemented into daily clinical practice. Further studies are urgently needed to answer such important questions as best timing, route, dose, and composition of medical nutrition therapy for critically ill patients and to determine how to assess and to adapt to patients’ individual needs.</p

Usability study of a new tool for nutritional and glycemic management in adult intensive care:Glucosafe 2

The new decision support tool Glucosafe 2 (GS2) is based on a mathematical model of glucose and insulin dynamics, designed to assist caregivers in blood glucose control and nutrition. This study aims to assess end-user acceptance and usability of this bedside decision support tool in an adult intensive care setting. Caregivers were first trained and then invited to trial GS2 prototype on bedside computers. Data for qualitative analysis were collected through semi-structured interviews from twenty users after minimum three trial days. Most caregivers (70%) rated GS2 as convenient and believed it would help improving adherence to current guidelines (85%). Moreover, most nurses (80%) believed that GS2 would be timesaving. Nurses' risk perceptions and manual data entry emerged as central barriers to use GS2 in routine practice. Issues emerged from the caregivers were compiled into a list of 12 modifications of the GS2 prototype to increase end-user acceptance and usability. This usability study showed that GS2 was considered by ICU caregivers as helpful in daily clinical practice, allowing time-saving and better standardization of ICU patient's care. Important issues were raised by the users with implications for the development and deployment of GS2. Integrating the technology into existing IT infrastructure may facilitate caregivers' acceptance. Further clinical studies of the performance and potential health outcomes are warranted.</p

Easy-to-prescribe nutrition support in the intensive care in the era of COVID-19

Background & aims: COVID-19 pandemic had resulted in a massive increase in the number of patients admitted to intensive care units (ICUs). This created significant organizational challenges including numerous non-specialist ICU caregivers who came to work in the ICU. In this context, pragmatic protocols were essential to simplify nutritional care. We aimed at providing a simple and easy-to-prescribe nutritional protocol and evaluated its usefulness with questionnaires sent to physicians involved in the care of ICU COVID-19 patients.Methods: A simplified nutrition protocol was distributed to all physicians (n = 122) of the ICU medical team during COVID-19 pandemic. Clinical dieticians estimated energy targets for acute and post-acute phases at patient's admission and suggested adaptations of nutrition therapy. More complex situations were discussed with clinical nutrition doctors and, if required, a clinical evaluation was performed. To further facilitate the procedure, a chart with prescription aids was also distributed to the whole medical ICU team. At the end of the current pandemic wave, a 13-item questionnaire was emailed to the ICU medical team to obtain their opinion on the suggested nutritional therapy.Results: Answers were received from 81/122 medical doctors (MDs) (66% response rate), from intensive care physicians (41%), anaesthesiologists (53%) and MDs from other specialties (6%). Thirty-two percent of MDs felt that their knowledge of nutrition management was insufficient and 45% of the physicians surveyed did not face nutrition management in their daily practice prior to the pandemic. The initially proposed nutritional protocol, the chart with prescription aids and the suggested nutritional proposals were considered as useful to very useful by the majority of physicians surveyed (89.9, 90.7 and 92.1% respectively). The protocol was followed by 92% of MDs, and almost all participants (95%) were convinced that adaptations of nutritional therapy had beneficial effects on patients' outcomes.Conclusions: Nutritional therapy in critically ill COVID-19 patients is a challenge and the implementation of this specific pandemic simplified nutritional protocol was assessed as useful by a great majority of physicians. Pragmatic and simplified protocols are useful for ensuring the quality of nutritional therapy and could be used in future studies to assess its actual impact on the clinical outcomes of COVID-19 patients.</p

The central and biodynamic role of gut microbiota in critically ill patients

Gut microbiota plays an essential role in health and disease. It is constantly evolving and in permanent communication with its host. The gut microbiota is increasingly seen as an organ, and its failure, reflected by dysbiosis, is seen as an organ failure associated with poor outcomes. Critically ill patients may have an altered gut microbiota, namely dysbiosis, with a severe reduction in “health-promoting” commensal intestinal bacteria (such as Firmicutes or Bacteroidetes) and an increase in potentially pathogenic bacteria (e.g. Proteobacteria). Many factors that occur in critically ill patients favour dysbiosis, such as medications or changes in nutrition patterns. Dysbiosis leads to several important effects, including changes in gut integrity and in the production of metabolites such as short-chain fatty acids and trimethylamine N-oxide. There is increasing evidence that gut microbiota and its alteration interact with other organs, highlighting the concept of the gut–organ axis. Thus, dysbiosis will affect other organs and could have an impact on the progression of critical diseases. Current knowledge is only a small part of what remains to be discovered. The precise role and contribution of the gut microbiota and its interactions with various organs is an intense and challenging research area that offers exciting opportunities for disease prevention, management and therapy, particularly in critical care where multi-organ failure is often the focus. This narrative review provides an overview of the normal composition of the gut microbiota, its functions, the mechanisms leading to dysbiosis, its consequences in an intensive care setting, and highlights the concept of the gut–organ axis

Impact of nutritional therapy during the first wave of the COVID-19 pandemic in intensive care patients: A retrospective observational study

The COVID-19 pandemic has caused major organizational challenges to healthcare systems concerning staff, material and bed availability. Nutrition was not a priority in the intensive care unit (ICU) at the beginning of the pandemic with the need for simplified protocols. We aimed to assess the impact of a simplified nutritional protocol for critically ill COVID-19 patients during the pandemic first wave