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We aimed to explore stroke rehabilitation professionals’ understanding and representations of peer support; the benefits they anticipated for patients; and the levers and barriers they perceived to implement the intervention in their practice. This qualitative study comprised four focus groups with 21 rehabilitation professionals and four semi-structured interviews. It was held in a French hospital. Interpretation was guided by the Consolidated Framework for Implementation Research. Although professionals had poor knowledge on peer support, they identified many unmet needs of stroke survivors that peer support could meet such as social, emotional and informational support. Main barriers were the lack of human and financial resources, and of linkage between hospital and community professionals, and the fear that peer support would give false hope to survivors if not delivered properly. They showed ambivalence towards patient engagement, acknowledging its importance, but demonstrating top-down attitudes. They also identified potential avenues for the implementation of peer support for stroke survivors. Our study supports the necessity to involve professionals in the construction of peer-support interventions and to sensitise them to provide patient-centred care. It delivers insights on effective implementation strategies to develop peer support interventions for stroke survivors reintegrating the community. Stroke survivors experience many difficulties especially when transitioning from hospital to home, in which peer-support could be helpful.Success of peer-support interventions rely on the collaboration of healthcare professionals with peer supporters.Individual peer-support might be useful for stroke survivors in the following key dimensions: healthcare pathway orientation, social/administrative procedures, emotional support, informational support, informal caregivers support.Rehabilitation departments planning to implement individual peer-support, should consider supporting and training both the team and the peer-supporters to work together and adopt partnership postures. Stroke survivors experience many difficulties especially when transitioning from hospital to home, in which peer-support could be helpful. Success of peer-support interventions rely on the collaboration of healthcare professionals with peer supporters. Individual peer-support might be useful for stroke survivors in the following key dimensions: healthcare pathway orientation, social/administrative procedures, emotional support, informational support, informal caregivers support. Rehabilitation departments planning to implement individual peer-support, should consider supporting and training both the team and the peer-supporters to work together and adopt partnership postures.

To assess the interrater reliability of the SOFMER Activity Score (SAS) (version 2 [v2], an 8-item [4 motor and 4 cognitive] and 5-level scale) and improve its scoring system before conducting further validation steps.Cross-sectional, prospective, observational, noninterventional, and multicentric study.The study was conducted between November 2018 and September 2019 in 4 French rehabilitation centers (2 public university hospitals for adults and 2 private not-for-profit rehabilitation centers for children).The study included 101 participants (N=101; mean age, 44.5±25.4 years; 28.7% younger than 18 and 18.8% older than 65 years). The female/male sex ratio was 0.6. The causes for admission to the center were mainly neurologic (65%) or orthopedic (24%).None.Activity limitation was rated with the SAS the same day by 2 independent multidisciplinary teams. The interrater reliabilities of the score items were assessed using weighted kappa coefficients.All weighted kappa coefficients ranged between 0.83 and 0.92, indicating "good" to "excellent" interrater reliability. Interteam score disagreements occurred in 227 of 808 scores (28%). The reason for most disagreements was unnoticed human or material aid during the observation period.The results demonstrate the high interrater reliability of the SASv2 and allow carrying out further validation steps after minor changes to item scoring instructions and clearer definitions of some items that help improving scoring standardization. The SASv2 may then become a consistent measure of activity level for clinical research or burden of care investigations.

ContextA previous study demonstrated a long-term functional improvement of spatial neglect after methylphenidate combined with prismatic adaptation in a group of patients suffering from left spatial neglect after a right stroke (RITAPRISM study).Objectivewe hypothesized that the functional improvement after MP combined with PA depends on striatal integrity in responders patients.MethodsWe conducted an MRI study in “MP+PA” program to identify lesional pattern in responders and non-responders patients in the RITAPRISM cohort. Using anatomical segmentation on morphological MRI, we compared lesional pattern in the striatum between responders and non-responders patients.ResultsThe beneficial effect of MP+PA co-administration should require striatal integrity in neglect patients. More specifically, our results suggest that the short-term effect is mediated by the ventral striatum whereas the long-term effect is mediated by the posterior putamen.ConclusionBenefical effet of MP+PA could rely on reinforcement processes at early stage of the MP+PA program and visuospatial substrates at long-term.

BackgroundThe reproducible beneficial effect of constraint-induced movement therapy (CIMT) in hemiparetic stroke patients makes it a good model to study brain plasticity during rehabilitation procedures.ObjectiveAssess the functional brain reorganization induced by each of the two components of CIMT: (i) non-affected upper-limb constraint and (ii) intensive training of the paretic arm.MethodsBrain activity of a right hemiparetic chronic stroke patient and of 10 healthy controls was recorded with a functional magnetic resonance imaging (fMRI) during a finger opposition task. For the patient, a total of 8 assessments were performed, before and after each component of CIMT. At each time point, brain activity during movement was compared with rest. Patient’s results were first compared to the control group and then correlated to motor performance across sessions.ResultsConstraint-therapy-related improvement was correlated with a decrease of cerebral activity in sensory-motor regions of both the affected and the non-affected hemispheres. Intensive-therapy-related improvement was correlated with the recruitment of pre-motor cortices and cerebellum in both hemispheres.ConclusionsTwo different patterns of brain activity underlie the effects of intensive training and constraint which could account for the respective effect of each component of the therapy.

Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment.This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework.We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment).Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p = 0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p = 0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p 0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p = 0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p = 0.001) were associated with lower social participation.The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.

International audience; Background Stroke represents a major Public Health issue in industrialized countries because of its frequency and severity. In secondary stroke prevention, treatment efficacy is correlated to medication adherence. However, it remains suboptimal in stroke patients. Community pharmacists, in light of their positioning in the care pathway and proximity to patients, can play an essential role in patient support and improving treatment adherence. However, it is currently unknown whether pharmacists are ready to perform this task. Objective Evaluate knowledge, practices and training needs for community pharmacists in therapeutic stroke management to improve long term care for stroke patients. Setting Community pharmacies in the Rhone Alpes region (France). Method We conducted a cross sectional study via a standardized self-assessment questionnaire consisting of 40 questions divided into three parts. The latter was designed by a multidisciplinary team and distributed electronically to community pharmacists of the Rhône-Alpes region (France). Main outcome measure (a) global knowledge score on the pathology, risk factors and clinical care management, (b) description of the support practices for stroke patients, (c) training needs for pharmacists. Results The 104 participants presented a moderate level of knowledge (global score: 12/20 ± 3). Topics best mastered were: pathophysiology, target blood pressure and place of antiplatelets in the therapeutic strategy. Knowledge items that needed improvement were: warning signs correctly identified by 44% of participants, time delay for thrombolysis for which 14% answered correctly, target glycated hemoglobin levels were correct for 41%, and the 3 recommended antihypertensive drug classes were only identified by 5% of participants. Patient education received from pharmacists concerned dosage (89%), treatment adherence (88%), benefits (66%) and administration modalities of medicines (64%), management of risk factors (75% for diet, 73% for physical activity, 70% for smoking and 53% for alcohol). All pharmacists wanted additional training on risk factors and clinical management guidelines. Conclusion Based on this small study, the fragmented knowledge and varied practices promote the need for further training for pharmacists to optimize support of stroke patients. This study promotes the elaboration of training systems adapted to pharmacists' needs. This will help support the development of a targeted pharmaceutical care approach for stroke patients.

Unilateral spatial neglect has been extensively described for visual and representational manifestations but tactile and motor manifestations as well as body neglect point to bodily manifestations of this neurological condition. This chapter reviews the perceptual, motoric and high-level representational symptoms manifested in neglect patients and attempt to classify them according to the body image/schema framework. One puzzling aspect of the wide spectrum of body neglect symptoms is that physiological bottom-up maneuvers, such as prism adaptation, which act at the level of body schema, do also efficiently improve body image manifestations of neglect. This relationship allows us to elaborate on the dialectical relationships between body image and body schema. Thus, understanding body neglect in terms of diagnosis, evaluation, physiopathology and therapeutics through the dynamical interactions between body schema and body neglect, provide perspectives to manage other lateralized body troubles, neglect-like manifestations of bodily attention or distorted representations.

Resume Objectif Mettre en evidence, une anomalie de relaxation sphincterienne (pseudo-dyssynergie vesico-sphincterienne – DVS), dans la Maladie de Parkinson Idiopathique (MPI), qui constituerait un obstacle sous vesical. Materiel et methode Une etude retrospective a ete realisee en incluant des hommes dont le diagnostic de MPI etait certain et ayant participe au programme de reeducation SIROCCO. Les patients inclus ont presente une hyperactivite vesicale et une dysurie sans obstacle prostatique echographique. Ils ont ete evalues cliniquement par le score de symptomes urinaires Urinary Symptoms Profile (USP). L’obstruction sous vesicale a ete evaluee sur le plan urodynamique par l’etude pression-debit. L’obstruction urodynamique a ete evaluee par l’index d’obstruction vesicale (BOOI). Elle a ete definie par un BOOI > 40. Resultats Le nomogramme pression-debit a pu etre analyse chez cinq patients qui repondaient aux criteres d’inclusion. Chez ce groupe de 5 patients atteints de MPI, le diagnostic a ete porte en moyenne 10,6 ans (7–14) avant la realisation des etudes pression-debit. Nos resultats ont objective 4 patients obstructifs parmi 5 et un patient equivoque. Une pseudo-DVS striee a ete retrouvee chez les 3 patients obstructifs et associee a une probable pseudo-DVS lisse chez un patient. Conclusion Nous avons observe, dans cette courte serie, une anomalie de la relaxation sphincterienne chez les patients presentant une MPI. Niveau de preuve 3.

Resume Objectif Evaluer l’efficacite et la tolerance de la stimulation transcutanee du nerf tibial posterieur (SNT) chez des patients atteints de maladie de Parkinson idiopathique (MPI) ayant un syndrome clinique d’hyperactivite vesicale (SCHV) et mettre en evidence des criteres predictifs d’observance. Methode Nous avons mene une etude retrospective, monocentrique, d’une cohorte de 17 patients atteints de MPI ayant utilise la SNT pour un SCHV. L’efficacite du traitement etait evaluee sur l’amelioration clinique ressentie avec une note sur 10. Les patients ont ete classes comme « observants » s’ils continuaient a utiliser la SNT un an apres la prescription ou « non observants » s’ils avaient arrete. Nous avons compare differentes caracteristiques entre ces deux sous-groupes (âge, sexe, IMC, anciennete de la maladie, anciennete des symptomes, traitements associes, reeducation perineale associee, score USP, score Qualiveen, score HAD) afin de souligner des criteres predictifs d’observance a la SNT. Resultats Dix-sept patients ont ete etudies, 9 femmes et 8 hommes, d’âge median 66 ans (55–77), avec une duree mediane d’evolution de la maladie de 8 ans (1–22) et des symptomes urinaires de 3 ans (1–10). Une amelioration clinique a ete ressentie chez 10 patients sur 17 (59 %), sur la nycturie et/ou l’urgenturie pour 9 patients (mediane 6,5/10). Trois patients n’ont ressenti aucune efficacite, et quatre n’ont pas utilise assez longtemps le dispositif pour pouvoir l’evaluer. Deux patients ont eu des effets indesirables (decharges electriques et syndrome des jambes sans repos) obligeant l’arret. Sept patients ont ete classes comme « observants » et dix patients comme « non observants » a 1 an. La plupart des caracteristiques etudiees ne sont pas des criteres predictifs d’observance exceptees la nycturie et pollakiurie qui semblent etre predictifs de bonne observance (p = 0,03 et p = 0,05 respectivement). Conclusion Notre etude semble souligner une efficacite centree sur la nycturie et l’imperiosite. De plus la nycturie et la pollakiurie semblent etre des criteres predictifs d’observance de la SNT. La nycturie pourrait donc etre un symptome cle dans l’indication de prescription de SNT dans cette population. Mais d’autres etudes avec un plus grand effectif doivent etre menees pour obtenir une meilleure selection des patients. Niveau de preuve IV.

Background The French government has set up a community-based learning programme on health promotion for undergraduate health students to involve them in key public health objectives. At the University of Lyon, students first underwent formal instruction, including e-learning, lectures, and interactive seminars, and then became health educators for school pupils. The main objective of the present study was to assess the process of implementing this programme during the 2018–2019 academic year. Methods The satisfaction and perception of medical and midwife students with community-based learning experiences were assessed by a questionnaire, semi-directive interviews, and observations. Replies to the questionnaire were described by median and interquartile range or by proportion. A paired Wilcoxon-Mann–Whitney test was used to compare self-evaluated students’ competence scores before and after the seminars (alpha risk of 5%). Thematic analyses using grounded theory were performed on recorded and transcribed interviews, and on transcribed notes taken during the observations. Results Over time the students have evolved from a negative perception of the community-based learning to a positive one. The students were mostly satisfied by interactive seminars that allowed them to gain confidence and competencies in health education. Their involvement in the programme increased their self-esteem. They became more aware of their educative responsibilities regarding public health issues as future professionals. Conclusions The students had a positive perception of the implementation of a community-based learning programme in our University, as it appeared a pertinent strategy to raise their awareness of prevention and health education issues.

Background. The French government set up a community-based service learning programme on health promotion for undergraduate health students to involve them in key public health objectives. At the University of Lyon, students first underwent formal instruction, including e-learning, lectures, and interactive seminars, and then became health educators for school pupils. The main objective of the present study was to assess the process of implementing this programme during the 2018-2019 academic year.Methods. Satisfaction and perception of medical and midwife students with service learning experiences were assessed by a questionnaire, semi-directive interviews, and observations.Results. Over time the students evolved from a negative perception of service learning to a positive one. Students were mostly satisfied by interactive seminars that allowed them to gain confidence and competence in health education. They felt valued by taking part in this service learning. They became more aware of their educative responsibilities on public health issues as future professionals.Conclusions. Students had a positive perception of the implementation of a community-based service learning programme in our University, as it seems a good way to raise their awareness of prevention and health education issues.

Background and Purpose: We used differential actigraphy as a novel, objective method to quantify motor neglect (a clinical condition whereby patients mimic hemiplegia even in the absence of sensorimotor deficits), whose diagnosis is at present highly subjective, based on the clinical observation of patients’ spontaneous motor behavior. Methods: Patients wear wristwatch-like accelerometers, which record spontaneous motor activity of their upper limbs during 24 hours. Asymmetries of motor behavior are then automatically computed offline. On the basis of normal participants’ performance, we calculated cutoff scores of left/right motor asymmetry. Results: Differential actigraphy showed contralesional motor neglect in 9 of 35 patients with unilateral strokes, consistent with clinical assessment. An additional patient with clinical signs of motor neglect obtained a borderline asymmetry score. Lesion location in a subgroup of 25 patients was highly variable, suggesting that motor neglect is a heterogenous condition. Conclusions: Differential actigraphy provides an ecological measure of spontaneous motor behavior, and can assess upper limb motricity in an objective and quantitative manner. It thus offers a convenient, cost-effective, and relatively automatized procedure for following-up motor behavior in neurological patients and to assess the effects of rehabilitation.

International audience; This study integrated functional connectivity measures using resting-state fMRI and behavioral data from a single-case observation of patient (PER) one year after right-hemispheric hemorrhage in the intraparietal sulcus and superior parietal lobule (IPS/SPL). PER showed no sign of clinical neglect. Her behavioral performance in the visuo-manual pointing task and in the letter discrimination task under conditions of endogenous and exogenous attentional cueing was compared between the left (affected) and right (unaffected/control) peripheral visual fields. The resting-state fMRI demonstrated an imbalance between the right and left hemispheric frontoparietal functional connectivity within the dorsal attentional and motor networks. Although the frontal and occipital cortices were not structurally damaged, specific fronto-occipital functional connectivity was imbalanced, which was strongly associated with the behavioral changes. First, the activity in the right frontal eye field showed weaker correlations with the activity in the right inferior occipital area compared to the correlation with the activity in the left inferior occipital area. This imbalanced fronto-occipital functional connectivity was accompanied by a specific impairment in endogenous covert attention in the left visual field. Second, the activity within M1 in both hemispheres showed weaker correlations with the activity of the right cuneus compared to the correlation with the activity in the left cuneus. The imbalanced fronto-occipital functional connectivity was associated with the impairment of the reaching movement of the left and right hands towards the left visual field (optic ataxia). Altogether, our results showed that a lesion to the posterior parietal cortex affects the relationship between distal regions underlying the sensorimotor and attentional abilities

Up to 50% of patients with acquired brain damage due to vascular, traumatic, or degenerative origin show central visual processing deficits. Likewise, some 30–50% of right-hemisphere lesioned patients and 10% of left-hemisphere lesioned individuals post-stroke suffer from spatial neglect. The current chapter first describes the clinical problems for both diseases, followed by recommendations for their assessment and therapy. Recommendations for therapy are based on the GRADE system. For neurovisual disorders, saccadic compensation training is recommended for treating the visual scanning deficit associated with a homonymous field cut. Hemianopic alexia can be treated with reading therapy. Convergent fusional disorders and impaired stereopsis may be treated by fusional therapy with dichoptic devices. For spatial neglect, a dozen of different therapies are available, their effectiveness still being matter of scientific evaluations. Although no formal recommendation was given in the respective Cochrane analysis (Bowen et al., Cochrane Database Syst Rev 2013:CD003586, 2013), several well-controlled studies have appeared in the meanwhile, which allow some practical recommendations which are summarized in the chapter.

International audience; Purpose: From a patient’s perspective, participation is a major determinant of quality of life. We aimed to review contextual factors, both personal and environmental, potentially associated with post-stroke participation.Methods: PubMed, PsycINFO, and Web of Science were searched for original quantitative and qualitative studies that investigated contextual factors of post-stroke participation, measured participation as the primary outcome, and met inclusion criteria.Results: Socio-demographic determinants were mostly unrelated with participation or showed discordant and inconclusive results. Although less investigated, psychosocial/psychological factors, particularly self-esteem and acceptance, were associated with participation in most studies. Motivation was found in qualitative studies, but discordant in quantitative ones. Environmental factors were even less investigated and mainly in qualitative studies among patients with communication disabilities. Among these, social support and attitude of others appeared to be major determinants of participation as well as physical environment and societal environment (services and polices).Conclusions: Personal factors, particularly psychological and psychosocial factors, were identified as positively associated with post-stroke participation. Environmental factors such as support, relationships, and positive attitudes towards patients were major facilitators of participation as well as physical environment and accessibility to appropriate services. Most of these factors are modifiable and should be addressed to improve patient participation.Implications for RehabilitationPsychosocial factors (motivational aspects, acceptance of a new condition, self-esteem) and environmental factors (social support, attitudes towards the patient, physical environment, access to health, social services and policies) were identified as determinants of post-stroke participation.A structured evaluation of determinants of participation may be used in clinical practice to propose appropriate support and then improve patients’ recoveryPrograms to improve patients’ psychosocial skills such as self-esteem, acceptance, motivation should be tested and implemented, and policies to develop appropriate services accessibility should be encouraged.

International audience

Letter; International audience; No abstract available

Background Experts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. Method We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. Results Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. Conclusions Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-021-02517-x.

Neglect manifestations are typically explored in the visual modality. Although they are less commonly investigated tactile deficits also exist, and the aim of this study was to explore neglect in this modality. A haptic object discrimination task was designed to assess whether or not shape perception is impaired in seven right brain damaged patients with or without neglect. Each patient's performance on the object discrimination task was assessed before and after a brief period of prism adaptation, a bottom-up rehabilitation technique known to improve neglect symptoms. The results suggest that a haptic deficit - in the form of substantially more left errors - is present only in patients with neglect. Following prism adaptation, the left bias error rates in neglect patients were substantially reduced, and were similar to those observed in patients without neglect. Moreover, the haptic processing of the right side of objects also improved slightly. This finding suggests an expansion of the effects of prism adaptation to the unexposed, tactile modality supporting the cross-modal central effect hypothesis.

Background: Innovation in healthcare cannot be conceived without an interdisciplinary approach. Hackathons are an innovative approach to promote team working and demonstrated an interest in higher education through inquiry-based learning. An interdisciplinary team of students and young professionals organized the first hybrid presential and online neurorehabilitation hackathon, within the joined 2020 WCNR-SOFMER congress, adapting to the COVID-19 pandemic. Methods: Interdisciplinary teams worked during two days on concrete issues met by people with a disability and their caregivers, accompanied by multi-skilled mentors to create tangible solutions. An independent jury selected the winning project. Results: HRL met the expectations of 96% of the 31 participants. They reported better knowledge and ability about teamwork, ethics, and patient-centered approaches. Conclusions: HRL allowed the creation of a strong interdisciplinary and international network which will be valuable to foster innovation. It demonstrated its value in the junior and students’ training for teamwork, communication, creativity in innovation, and ethics in health.

International audience

Resume Introduction Les activites de pharmacie clinique, en plus de contribuer a la securite du patient, doivent permettre de maitriser les depenses de sante. L’objectif de cette etude est de mesurer l’impact economique des interventions pharmaceutiques (IP) realisees au cours de l’analyse des prescriptions en service de reeducation neurologique. Materiels et methode Pendant un an, les IP ont ete recueillies et codifiees. Ont ete selectionnees celles ayant potentiellement un impact direct sur les couts medicamenteux (ex : arrets, diminutions de posologie…). Les couts des IP ont ete evalues selon trois hypotheses (HYP) de jours impactes par l’IP : 1 (1 j) ; 2 (7 j) ; 3 (30 j). Les couts directs medicamenteux evites (CDME) grâce a l’IP ont ete calcules et compares a ceux induits par sa realisation. Resultats Ont ete selectionnees 516 IP pour les HYP 1 et 2 et 411 pour l’HYP 3. Le cout induit par IP est de 2317 € pour les HYP 1 et 2 et de 1888 € pour l’HYP 3. Pour les HYP 1, 2 et 3, les CDME sont de 490 €, 3432 € et 8107 € pour des ratios couts evites/induits de 0,21, 1,48 et 4,29. Discussion-conclusion Excepte l’HYP 1 peu probable, notre etude a montre que les IP permettaient de realiser des economies. Il faudrait maintenant envisager une etude integrant les couts d’iatrogenie evitee.

Visual mental imagery is a cognitive experience characterised by the activation of the mental representation of an object or scene in the absence of the corresponding stimulus. According to the analogical theory, mental representations have a pictorial nature that preserves the spatial characteristics of the environment that is mentally represented. This cognitive experience shares many similarities with the experience of visual perception, including eye movements. The mental visualisation of a scene is accompanied by eye movements that reflect the spatial content of the mental image, and which can mirror the deformations of this mental image with respect to the real image, such as asymmetries or size reduction. The present article offers a concise overview of the main theories explaining the interactions between eye movements and mental representations, with some examples of the studies supporting them. It also aims to explain how ocular-tracking could be a useful tool in exploring the dynamics of spatial mental representations, especially in pathological situations where these representations can be altered, for instance in unilateral spatial neglect.

Resume Objectif Le but de cette etude etait d’evaluer l’interet de la collaboration medico-pharmaceutique sur la qualite de l’antibiotherapie dans la prise en charge des infections urinaires (IU) au sein d’un etablissement de soins de suite et de readaptation. Patients et methodes Une analyse quotidienne des prescriptions d’antibiotiques a ete realisee par le pharmacien via le logiciel informatise de prescription. Tout patient ayant necessite une instauration de traitement pour la prise en charge d’une infection urinaire entre le 1 er janvier 2014 et le 31 decembre 2015 a ete inclus dans l’etude. En plus des actions regulieres de sensibilisation des prescripteurs sur le bon usage des antibiotiques, le pharmacien a emis des interventions pharmaceutiques afin d’optimiser les prescriptions d’antibiotiques. Parallelement, 3 indicateurs qualite de l’antibiotherapie ont ete suivis : la duree de l’antibiotherapie, la posologie et la conformite de l’antibiotique a l’antibiogramme. Le taux de conformite de ces 3 indicateurs a permis d’evaluer la qualite de l’antibiotherapie dans la prise en charge de l’infection urinaire. Resultat Cent cinquante-quatre patients ont ete inclus et 252 infections urinaires ont ete suivies. Le pharmacien a realise 68 interventions pharmaceutiques en lien avec les antibiotiques (posologies supra- ou infra-therapeutiques, durees de traitement non precisees ou inadaptees, voie d’administration non adequate…). L’evaluation du taux de conformite des 3 indicateurs qualite a montre de bons resultats, puisqu’ils etaient de 96,4 % pour la duree de traitement, 98,8 % pour la posologie de l’antibiotique et 99,2 % pour la conformite de l’antibiotique a l’antibiogramme. Conclusion Cette etude nous a permis de mettre en evidence l’impact de la collaboration medico-pharmaceutique sur la qualite de l’antibiotherapie dans la prise en charge de l’IU. La sensibilisation des prescripteurs, associee a un suivi quotidien par le pharmacien des instaurations de traitement antibiotique et de leur reevaluation permettent d’optimiser la prise en charge des infections urinaires des patients en service de reeducation. Niveau de preuve 4.

International audience; BACKGROUND:Findings regarding the impact of language bias on treatment effect estimates (TEE) are conflicting, and very few studies have assessed these impacts in rehabilitation. The purpose was to compare TEE between studies published in non-English language (SPNEL) and those published in English language (SPEL) included in a previously published meta-analysis assessing the effects of physical therapy on balance and postural control after stroke.METHODS:Six databases were searched until January 2019. Two independent reviewers selected randomised trials, extracted data, and assessed risk of bias. We conducted subgroup meta-analyses according to the language of study publication, then compared TEE between SPEL and SPNEL subgroups by using a random-effects meta-regression model.RESULTS:From 13,123 records, 132 SPEL (n = 5219) and 13 SPNEL (n = 693) were included. SPNEL had a weight in the pooled estimate (8.2%) significantly lower than SPEL (91.8%; p