Information and Communication Technologies in Lung Transplantation: Perception of Patients and Medical Teams

Optimal therapeutic management is a major determinant of patient prognosis and healthcare costs. Information and communication technologies (ICTs) represent an opportunity to enhance therapeutic management in complex chronic diseases, such as lung transplantation (LT). The objective of this study was to assess the preferences of LT patients and healthcare professionals regarding ICTs in LT therapeutic management. A cross-sectional opinion survey was conducted among lung transplant patients and healthcare professionals from the French lung transplantation centers. Five ICTs were defined (SMS, email, phone, internet, and smartphone application) in addition to face-to-face communication. An unsupervised approach by Principal Component Analysis (PCA) identified lung transplant patient profiles according to their preferences for ICTs. Fifty-three lung transplant patients and 15 healthcare professionals of the French LT centers were included. Both expected ICTs for treatment management and communication. Phone call, face-to-face, and emails were the most preferred communication tools for treatment changes and initiation. PCA identified four ICTs-related profiles (“no ICT”, “email”, “SMS”, and “oral communication”). “Email” and “oral communication” profiles are mainly concerned with treatment changes and transmission of new prescriptions. The “SMS” profile expected reminders for healthcare appointments and optimizing therapeutic management. This study provides practical guidance to enhance LT therapeutic management by ICT intervention. The type of ICT used should take into account patient profiles to improve adherence and thereby the prognosis. A combination of strategies including information, education by a multidisciplinary team, and reminders is a promising approach to ensure an optimal management of our patients

Approche pharmaco-épidémiologique pour évaluer les bénéfices à long terme des corticoïdes inhalés dans l'asthme

LYON1-BU Santé (693882101) / SudocSudocFranceF

Comparison of seven comorbidity scores on four-month survival of lung cancer patients

Abstract Background The comorbidity burden has a negative impact on lung-cancer survival. Several comorbidity scores have been described and are currently used. The current challenge is to select the comorbidity score that best reflects their impact on survival. Here, we compared seven usable comorbidity scores (Charlson Comorbidity Index, Age adjusted Charlson Comorbidity Index, Charlson Comorbidity Index adapted to lung cancer, National Cancer Institute combined index, National Cancer Institute combined index adapted to lung cancer, Elixhauser score, and Elixhauser adapted to lung cancer) with coded administrative data according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems to select the best prognostic index for predicting four-month survival. Materials and methods This cohort included every patient with a diagnosis of lung cancer hospitalized for the first time in the thoracic oncology unit of our institution between 2011 and 2015. The seven scores were calculated and used in a Cox regression method to model their association with four-month survival. Then, parameters to compare the relative goodness-of-fit among different models (Akaike Information Criteria, Bayesian Information Criteria), and discrimination parameters (the C-statistic and Harrell’s c-statistic) were calculated. A sensitivity analysis of these parameters was finally performed using a bootstrap method based on 1,000 samples. Results In total, 633 patients were included. Male sex, histological type, metastatic status, CCI, CCI-lung, Elixhauser score, and Elixhauser-lung were associated with poorer four-month survival. The Elixhauser score had the lowest AIC and BIC and the highest c-statistic and Harrell’s c-statistic. These results were confirmed in the sensitivity analysis, in which these discrimination parameters for the Elixhauser score were significantly different from the other scores. Conclusions Based on this cohort, the Elixhauser score is the best prognostic comorbidity score for predicting four-month survival for hospitalized lung cancer patients

Impact of polypharmacy and comorbidity on survival and systemic parenteral treatment administration in a cohort of hospitalized lung-cancer patients

Abstract Background Although polypharmacy has been described among cancer patients, very few studies have focused on those with lung cancer. We aimed to assess whether polypharmacy and comorbidity have an impact on systemic parenteral treatment administration and survival among lung-cancer patients. Methods In this retrospective monocenter cohort study, we included patients hospitalized in thoracic oncology for the first time between 2011 and 2015. The Elixhauser score was used to assess comorbidity and polypharmacy was estimated with a threshold of at least five prescribed medications. The Fine and Gray competitive risk model was used to estimate the impact of polypharmacy and comorbidity on systemic parenteral treatment administration within the first two months of hospitalization. The effect of comorbidity and polypharmacy on overall survival was evaluated by Cox proportional hazards analysis. Results In total, 633 patients were included (71% men), with a median age of 66 years. The median Elixhauser score was 6 and median overall survival was four months. Among the patients, 24.3% were considered to be receiving polypharmacy, with a median number of medications of 3, and 49.9% received systemic parenteral treatment within two months after hospitalization. Severe comorbidity (Elixhauser score > 11), but not polypharmacy, was independently associated with a lower rate of systemic parenteral treatment prescription (SdHR = 0.4 [0.3;0.6], p < 0.01) and polypharmacy, but not a high comorbidity score, was independently associated with poorer four-month survival (HR = 1.4 [1.1;1.9], p < 0.01) Conclusions This first study to evaluate the consequences of comorbidity and polypharmacy on the care of lung-cancer patients shows that a high comorbidity burden can delay systemic parenteral treatment administration, whereas polypharmacy has a negative impact on four-month survival

Lactic Acidosis in Diabetic Population: Is Metformin Implicated? Results of a Matched Case-Control Study Performed on the Type 2 Diabetes Population of Grenoble Hospital University

International audienc

Rejet aigu induit par la rifampicine chez un patient transplanté pulmonaire

RésuméObjectifs : Décrire un cas clinique d’interactions médicamenteuses en transplantation d’organe solide ayant conduit au rejet aigu. Discuter des modalités thérapeutiques disponibles pour prévenir et traiter le rejet aigu en transplantation pulmonaire.Résumé du cas : Le cas présenté concerne un homme âgé de 61 ans, traité avec une association rifampicine-isoniazide, bénéficiant d’une transplantation pulmonaire. Un rejet aigu a été mis en évidence quelques jours après l’intervention et a été traité par majoration de l’immunosuppression induite, avec une réponse partielle au traitement.Discussion : Le rejet aigu constitue une des complications majeures de la transplantation pulmonaire. La prévention du rejet aigu repose essentiellement sur l’immunosuppression, par l’association d’un traitement d’induction et d’une trithérapie de maintenance. Dans le cas présenté, aucune étiologie non iatrogène n’a pu être mise en évidence, et la causalité des interactions médicamenteuses entre la rifampicine, puissant inducteur enzymatique, et les médicaments immunosuppresseurs (tacrolimus, mofétil mycophénolate, prednisone) a rapidement été établie dans la survenue du rejet.Conclusion : La polymédication des patients transplantés conduit à de nombreuses interactions médicamenteuses potentielles qu’il est important de déceler et de prendre en charge afin de maintenir l’efficacité clinique des traitements immunosuppresseurs.AbstractObjectives: To describe a clinical case of drug interaction in a solid-organ transplant that resulted in acute lung transplant rejection. To discuss the available therapeutic modalities for preventing and treating acute rejection in lung transplantation.Case summary: A 61-year-old male treated for latent tuberculosis with an association of rifampicin-isoniazid underwent a lung transplantation for which he received immunosuppressant agents (tacrolimus, mofetil mycophenolate, and prednisone). Acute lung transplant rejection was observed a few days after the procedure. Doses of immunosuppression agents were increased with a partial response to the treatment.Discussion: Acute rejection is one of the main complications of lung transplantation. Its prevention is based mainly on immunosuppression with induction therapy followed by maintenance therapy. In this case, no noniatrogenic etiology could be identified. A drug interaction between rifampicin, a potent enzyme inducer, and immunosuppressant agents (tacrolimus, mofetil mycophenolate, and prednisone) was established in this occurrence of rejection.Conclusion: Polymedication in transplant patients leads to the potential for drug interactions that should be taken into consideration in order to maintain the clinical efficacy of the immunosuppressive therapy

Development of Indirect Health Data Linkage on Health Product Use and Care Trajectories in France: Systematic Review

BackgroundEuropean national disparities in the integration of data linkage (ie, being able to match patient data between databases) into routine public health activities were recently highlighted. In France, the claims database covers almost the whole population from birth to death, offering a great research potential for data linkage. As the use of a common unique identifier to directly link personal data is often limited, linkage with a set of indirect key identifiers has been developed, which is associated with the linkage quality challenge to minimize errors in linked data. ObjectiveThe aim of this systematic review is to analyze the type and quality of research publications on indirect data linkage on health product use and care trajectories in France. MethodsA comprehensive search for all papers published in PubMed/Medline and Embase databases up to December 31, 2022, involving linked French database focusing on health products use or care trajectories was realized. Only studies based on the use of indirect identifiers were included (ie, without a unique personal identifier available to easily link the databases). A descriptive analysis of data linkage with quality indicators and adherence to the Bohensky framework for evaluating data linkage studies was also realized. ResultsIn total, 16 papers were selected. Data linkage was performed at the national level in 7 (43.8%) cases or at the local level in 9 (56.2%) studies. The number of patients included in the different databases and resulting from data linkage varied greatly, respectively, from 713 to 75,000 patients and from 210 to 31,000 linked patients. The diseases studied were mainly chronic diseases and infections. The objectives of the data linkage were multiple: to estimate the risk of adverse drug reactions (ADRs; n=6, 37.5%), to reconstruct the patient’s care trajectory (n=5, 31.3%), to describe therapeutic uses (n=2, 12.5%), to evaluate the benefits of treatments (n=2, 12.5%), and to evaluate treatment adherence (n=1, 6.3%). Registries are the most frequently linked databases with French claims data. No studies have looked at linking with a hospital data warehouse, a clinical trial database, or patient self-reported databases. The linkage approach was deterministic in 7 (43.8%) studies, probabilistic in 4 (25.0%) studies, and not specified in 5 (31.3%) studies. The linkage rate was mainly from 80% to 90% (reported in 11/15, 73.3%, studies). Adherence to the Bohensky framework for evaluating data linkage studies showed that the description of the source databases for the linkage was always performed but that the completion rate and accuracy of the variables to be linked were not systematically described. ConclusionsThis review highlights the growing interest in health data linkage in France. Nevertheless, regulatory, technical, and human constraints remain major obstacles to their deployment. The volume, variety, and validity of the data represent a real challenge, and advanced expertise and skills in statistical analysis and artificial intelligence are required to treat these big data

Traitement médicamenteux chez la femme transplantée avec un projet de grossesse : à propos de deux cas de transplantation pulmonaire et cardio-pulmonaire

International audienc

Traitement médicamenteux chez la femme transplantée avec un projet de grossesse : à propos de deux cas de transplantation pulmonaire et cardio-pulmonaire

International audienc

Traitement médicamenteux chez la femme transplantée avec un projet de grossesse : à propos de deux cas de transplantation pulmonaire et cardio-pulmonaire

Les progrès en transplantation pulmonaire permettent aux femmes en âge de procréer d’envisager de devenir mères. Lors d’un projet de grossesse, une adaptation des immunosuppresseurs et des thérapeutiques associées est nécessaire. Elle doit tenir compte des effets tératogènes et fœtotoxiques des médicaments, ainsi que des modifications pharmacocinétiques rencontrées au cours de la grossesse. De plus en plus de données sont actuellement disponibles sur la gestion des médicaments immunosuppresseurs et des traitements associés au cours de la grossesse chez les patientes transplantées. Nous rapportons ici deux cas d’adaptation de la prise en charge thérapeutique, avant et pendant la grossesse, pour deux patientes transplantées pulmonaire ou cardio-pulmonaire. Afin d’éviter la survenue de complications pour la mère et l’enfant, une analyse de la littérature a été nécessaire pour adapter la prise en charge de chaque patiente