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The organisation of the care pathway for patients receiving treatment with chimeric antigen receptor T cells meets strict standards. Here we describe the regulations in France, how this pathway can be enhanced and its current limitations. [ABSTRACT FROM AUTHOR]

Le nombre de médecin est aujourd'hui en France très insuffisant pour faire face à la demande croissante de soins des patients. Le vieillissement de la population, le nombre croissant de pathologies chroniques, les inégalités d'accès aux soins dans les territoires sont autant d'enjeux à considérer. En optimisant le parcours de soins, et en favorisant l'interdisciplinarité ; en intégrant les évolutions du numérique en santé, dossier médical partagé, nouveaux outils numériques, télésanté ; et en s'appuyant sur le maillage territorial des officines pharmaceutiques en misant sur le pharmacien d'officine comme acteur de santé publique de proximité, la France cherche à rendre plus efficient son système de santé dans les territoires, palliant ainsi au manque de médecins. The number of doctors in France today is far too low to meet the growing demand for patient care. An ageing population, a growing number of chronic pathologies and inequalities in access to care across the country are just some of the issues to be considered. By optimizing the care pathway, and promoting interdisciplinarity; by integrating digital health developments, such as shared medical records, new digital tools and telehealth; and by relying on the territorial network of pharmacies, banking on the dispensing pharmacist as a local public health player, France is seeking to make its healthcare system more efficient in the regions, thereby making up for the shortage of doctors. [ABSTRACT FROM AUTHOR]

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En lien avec la feuille de route interministérielle sur l'obésité (2019-2022), la Haute Autorité de Santé (HAS) a publié en 2022 un guide pour optimiser le parcours de soins de l'enfant et de l'adolescent en situation de surpoids ou d'obésité et ainsi accompagner les professionnels de santé dans sa mise en œuvre. Ce guide insiste tout particulièrement sur l'importance de la surveillance de l'indice de masse corporelle (IMC) tout au long de l'enfance à chaque occasion afin d'optimiser le dépistage du surpoids et de l'obésité. En cas d'excès pondéral avéré, il détaille l'importance de l'évaluation multidisciplinaire de chaque situation avec la prise en compte des différents aspects (contexte socioculturel, psychoaffectif entre autres) et les leviers que les professionnels peuvent utiliser tout au long du parcours de soins qui doit être coordonné, gradué et inscrit dans la durée pour espérer être efficace. In link with the interministerial plan for obesity (2019-2022), the French National Authority for Health (HAS) has published in 2022 a guide to optimize the care pathway for overweight and obese children and adolescents to support healthcare professionals in its implementation. The guide particularly emphases on the importance of calculating Body Mass Index (BMI) throughout childhood, at every opportunity, to optimize screening for overweight and obesity. In case where excess weight has been established, it details the importance of multidisciplinary assessment of each situation, with considering several important aspects (socio-cultural, psycho-affective, etc.) and detailing the levers that professionals can use throughout this care pathway that must be coordinated and graduated on the long-term manner if it is to be effective. [ABSTRACT FROM AUTHOR]

Copyright of Psycho-Oncologie is the property of PiscoMed Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

[Display omitted] La survenue de fractures osseuses est fréquente dans la population âgée et chez les patients atteints d'un cancer, en particulier ceux qui présentent des métastases osseuses. L'incidence croissante du cancer liée au vieillissement de la population constitue un enjeu sanitaire majeur, y compris pour la santé osseuse. La prise en charge des patients âgés atteints d'un cancer doit prendre en compte l'hétérogénéité et les spécificités de cette population. Les outils de dépistage disponibles tels que le G8 et le VES13 tout comme l'évaluation gériatrique approfondie (EGA) ne couvrent pas les informations liées à la santé osseuse. Une évaluation des complications osseuses sera indiquée en fonction des syndromes gériatriques identifiés comme les chutes, les antécédents du patient et le plan de traitement oncologique. Certaines thérapies anticancéreuses ont un impact délétère sur le remodelage osseux et exposent au risque d'ostéoporose. L'hypogonadisme, induit par l'hormonothérapie et certaines chimiothérapies, est le principal facteur à l'origine d'une diminution de la densité minérale osseuse. Les thérapies oncologiques présentent également un risque de toxicité directe (chimiothérapie, radiothérapie ou corticostéroïdes) ou indirecte via les troubles électrolytiques (certaines chimiothérapies ou inhibiteurs de tyrosine-kinase) sur le remodelage osseux. La prévention des complications osseuses relève d'une prise en charge pluridisciplinaire. Certaines interventions proposées dans le cadre de l'EGA visent à améliorer la santé osseuse et réduire le risque de chute. Cette démarche est également fondée sur le traitement de l'ostéoporose et la prévention des complications associées aux métastases osseuses. La prise en charge des fractures, qu'elles soient liées ou non aux métastases osseuses, fait référence au concept d'orthogériatrie. Le rapport bénéfices-risques de l'opération, l'accès aux techniques mini-invasives, la pré-habilitation ou réhabilitation ainsi que le pronostic lié au cancer et aux syndromes gériatriques sont également pris en compte. La santé osseuse est une dimension essentielle en oncogériatrie. L'évaluation du risque osseux devrait faire partie intégrante de l'EGA en routine clinique et des outils spécifiques d'aide à la décision thérapeutique devront être développés. La prise en charge des complications osseuses doit être assimilée au parcours de soins du patient et l'approche oncogériatrique pluridisciplinaire se doit de prévoir une expertise rhumatologique. The occurrence of bone fractures is frequent in the elderly population, and in cancer patients, especially with bone metastases. The growing incidence of cancer associated with an aging population implies important health challenges, including bone health. Decisions on cancer care in older adults have to take into account older adults' specificities. Screening tools as G8 or VES 13 and evaluating tools as comprehensive geriatric assessment (CGA) do not include bone-related items. Bone risk assessment is indicated according to identification of geriatric syndromes such as falls, history, and the oncology treatment plan. Some cancer treatments disrupt bone turnover and decrease bone mineral density. This is mainly caused by hypogonadism, induced by hormonal treatments and some chemotherapies. Treatments can also cause direct (i.e. chemotherapy, radiotherapy or glucocorticoids) or indirect toxicity through electrolyte disorders (i. e. some chemotherapies or tyrosine kinase inhibitors) on bone turnover. Bone risk prevention is multidisciplinary. Certain interventions proposed in the CGA aim to improve bone health and reduce the risk of falling. It is also based on the drug management of osteoporosis, and the prevention of complications from bone metastases. Management of fractures, related or not to bone metastases, relates to the concept of orthogeriatrics. It is also based on the benefit-risk ratio of the operation, access to minimally invasive techniques, prehabilitation or rehabilitation, but also the prognosis related to cancer and geriatric syndromes. Bone health is essential in older cancer patient's care. Bone risk assessment should be part of CGA in routine use and specific decision-making tools should be developed. Bone event management must be integrated throughout the patient's care pathway and onco-geriatrics multidisciplinarity should include rheumatological expertise. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

These proposed recommendations have been issued as part of an innovative approach based on an individualised, structured and coordinated patient pathway to engage patients in specific implanted neurostimulation (NSI) management for pain relief in the context of certain chronic pain conditions. This pathway necessarily involves chronic pain structures (SDC) and implantation centres (CI). This work takes the form of recommendations at several levels. We will distinguish between what is required, what is expected and what is desired in terms of good practice, depending on local and regional resources, in order to ensure optimal quality of care. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psycho-Oncologie is the property of PiscoMed Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le Centre Psychiatrique d'Orientation et d'Accueil, est le plus grand centre d'urgences psychiatriques français, avec plus de 10 000 consultations par an. L'objectif de notre étude observationnelle rétrospective est de décrire la population des patients de 15 à 18 ans (18 ans exclus) consultant dans notre centre (motifs de consultation, diagnostics psychiatriques, décision d'orientation en précisant vers quelles structures ces mineurs sont orientés) et de proposer un modèle prédictif de décision d'hospitalisation. Tous les patients consécutifs âgés de plus de 15 ans et de moins de 18 ans consultant au CPOA entre le 1er janvier 2017 et le 31 décembre 2021 ont été inclus dans l'étude. Les caractéristiques de notre échantillon sont décrites en termes de proportions pour les variables qualitatives et de moyennes et d'écarts types, pour les variables quantitatives. La probabilité d'être hospitalisé a été modélisée sur l'ensemble de l'échantillon à l'aide d'un modèle Probit multivarié, pour lequel ont été vérifiées les hypothèses de validité. Nous avons répertorié 2712 passages correspondant à 1873 patients inclus dans notre étude (âge moyen = 16,2 ± 0,72, 54 % de filles) soit à 5,2 % en moyenne de la file active totale. Les principaux motifs de consultation ont été les idéations dépressives (22 %), les angoisses (19 %), et les idées suicidaires (18 %). Les troubles psychiatriques les plus fréquemment diagnostiqués selon la 10e révision de la Classification Internationale des Maladies ont été F30–39 (troubles de l'humeur) (34 %), F40–48 (troubles névrotiques, troubles liés à des facteurs de stress et troubles somatoformes) (24 %) et F60–69 (trouble de la personnalité et du comportement) (11 %). Parmi les patients relevant d'une indication d'hospitalisation, soit 27 % au total, 85 % ont été orientés sur des structures pour adultes et moins de 12 % sur des structures d'hospitalisation dédiées à l'adolescent, alors que parmi les patients orientés en ambulatoire, soit 65 % au total, seulement 11 % ont été dirigés sur des consultations pédopsychiatriques. Un âge plus élevé, une tentative de suicide la semaine précédant le passage aux urgences psychiatriques, des conduites et idées suicidaires, des comportements hétéro-agressifs, d'agitation ou d'excitation psychomotrice, des idées délirantes, une errance, une fugue ou un voyage pathologique ainsi qu'un diagnostic de type F20–F29 (Schizophrénie, trouble schizotypique et troubles délirants) et F30–F39 sont des facteurs significativement prédictifs d'une indication d'hospitalisation. L'hospitalisation en psychiatrie des adolescents consultant aux urgences psychiatriques est un problème majeur. Les facteurs prédictifs sont des indicateurs d'une nécessité absolue de soins immédiats renforcés avec hospitalisation. Malheureusement le manque de structures dédiées aux adolescents sont tels que trois quarts des adolescents se retrouvent hospitalisés en structures pour adultes, et ce qui n'est pas adapté ni acceptable. The CPOA (Centre Psychiatrique d'Orientation et d'Accueil) is the largest psychiatric emergency center in France, with more than 10,000 consultations per year. The aim of our retrospective observational study is to describe the population of patients aged 15 to 18 years (18 years old not included) consulting our center (reasons for consultation, psychiatric diagnoses, referral decision by specifying the structures to which these minors are referred) and to describe a predictive model for the decision to hospitalize. All consecutive patients aged over 15 and under 18 consulting in the CPOA between January 1, 2017 and December 31, 2021 were included in the study. The characteristics of our study sample are described in terms of proportions for qualitative variables and with means and standard deviations for quantitative variables. The probability of being hospitalized was modeled on the entire sample using a multivariate Probit model for which the hypotheses of validity were tested. We have recorded 2712 visits, corresponding to 1873 patients included in our study (mean age = 16.2 ± 0.72, 54% girls), i.e. an average of 5.2% of the total patients. The main reasons for consultation were depressive ideations (22%), anxiety (19%), and suicidal thoughts (18%). The most frequently diagnosed psychiatric disorders according to the 10th revision of the International Classification of Diseases were F30-39 (mood disorders) (34%), F40-48 (neurotic, stress-related and somatoform disorders) (24%) and F60–69 (personality and behavioral disorders) (11%). Among the patients with an indication for hospitalization, i.e. 27%, 85% were admitted in adult units and fewer than 12% in adolescent specific units, while among the patients with an outpatient care, i.e. 65% in total, only 11% were referred to child psychiatry consultations. An older age, a suicide attempt in the week preceding the visit to the psychiatric emergency department, suicidal behaviour and suicidal ideations, hetero-aggressive behaviour, psychomotor agitation or excitement, delusions, wandering, running away or pathological travel, and a diagnosis of type F20–F29 (Schizophrenia, schizotypal disorder and delusional disorders) and F30–F39 were significantly predictive of a decision to hospitalize. Psychiatric hospitalization of adolescents consulting due to psychiatric emergencies is a major problem. The predictive factors for hospitalization reflect an absolute need for immediate care. Unfortunately the lack of structures dedicated to adolescents is such that three quarters of adolescents end up hospitalized in adult structures, which is neither appropriate nor acceptable. [ABSTRACT FROM AUTHOR]

Deafness is the most common sensory disability: it primarily causes language delay, as well as communication and cognitive disorders. In France, it has been subject to systematic neonatal screening since 2014. Cochlear implants have revolutionized its management by providing access to spoken language for severe to profound hearing impairments - however, the benefits are inversely proportional to the age of implantation. The objective of this article was to demonstrate the difficulty of reconciling the theoretical healthcare journey of a deaf child in a cochlear implant project before the age of 1, which involves numerous consultations, the implementation of hearing aid, and speech therapy rehabilitation, with the actual experiences of families (acceptance of the diagnosis, completion of various assessments, administrative difficulties, etc.). Therefore, it is essential to offer psychological and speech therapy support to the family and assist them in social procedures. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During several decades, patients with haemophilia have been treated using FVIII and FIX concentrates by haematologists working in specialized comprehensive haemophilia care centres. In the last fifteen years haemophilia treatments have been tremendously improved and novel treatment options have been developed. Gene therapy is one of these innovative approaches and will soon be available on the market. The European Association for Haemophilia and Allied Disorders and the European Haemophilia Consortium recently described a new healthcare setting for the management of patients who will receive gene therapy. This hub-and-spoke model aims to ensure the safe administration and monitoring of gene therapy by expert comprehensive haemophilia care centres, in close collaboration with the proximity haemophilia treatment centres where the patient is followed up. Any adverse events should be managed by both the expert "hubs" in collaboration with the spoke centre to provide the timeliest state-of-the-art treatment and management options to patients receiving gene therapy. All adverse events and efficacy data should be reported lifelong to a centralised registry. French reference centre for haemophilia and the patient's organization AFH worked together to adapt the European Hub and spoke model to the existing infrastructures and organization for rare bleeding disorders in France. This review describes the haemophilia patient's journey for gene therapy in France. [ABSTRACT FROM AUTHOR]

Copyright of Psycho-Oncologie is the property of PiscoMed Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients. From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge. The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients. This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations. [ABSTRACT FROM AUTHOR]

La maladie du foie gras non-alcoolique (en anglais, Non-Alcoholic Fatty Liver Disease , NAFLD) toucherait 26 % des hommes et 11 % des femmes, en France. La NAFLD est un continuum de lésions hépatiques allant de la stéatose simple à la stéatohépatite non-alcoolique (NASH), la NASH avec fibrose hépatique et parfois la cirrhose post NASH. La NAFLD est favorisée par un excès de poids (surpoids ou obésité) associé à des anomalies métaboliques systémiques touchant notamment le tissu adipeux et les muscles striés. Le traitement préventif et curatif de la NAFLD repose sur les mesures hygiéno-diététiques. Ces mesures ont prouvé leur efficacité en termes de résolution de la NASH et de stabilisation, voire de régression de la fibrose hépatique. La mise en place d'un programme d'activité physique adaptée (APA), par un professionnel compétent, contribue significativement à l'amélioration de l'état clinique indépendamment de la perte de poids. Au niveau moléculaire, la littérature actuelle souligne l'effet pléiotropique de cette prise en charge notamment par son action directe ou indirecte sur le métabolisme local (e.g. hépatique) et systémique, l'état inflammatoire systémique et l'activité rhéologique. Au-delà de ces répercussions physiopathologiques, le professionnel en APA accompagne le patient présentant une maladie chronique, ici la NAFLD, à induire un changement de mode de vie durable en s'axant sur son état motivationnel. Ces mesures sont bénéfiques tant chez l'adulte que chez l'enfant. Non-Alcoholic Fatty Liver Disease (NAFLD) is estimated to affect 26% of men and 11% of women in France. NAFLD is a continuum of liver damage ranging from, simple steatosis, to non-alcoholic steatohepatitis (NASH), NASH with liver fibrosis and sometimes post-NASH cirrhosis. NAFLD is favored by excess weight (overweight or obesity) associated with systemic metabolic abnormalities affecting particularly, adipose tissue and striated muscles. The preventive and curative treatment of NAFLD is based on hygienic and dietary measures. These measures have proven to be effective in terms of resolution of NASH and stabilization or even regression of liver fibrosis. The implementation of a program of adapted physical activity (APA), by a competent professional, contributes significantly to the improvement of the clinical state independently of weight loss. At the molecular level, the current literature emphazises the pleiotropic effect of this management, particularly through its direct or indirect action on local (e.g. hepatic) and systemic metabolism, the systemic inflammatory state and rheological activity. Beyond these pathophysiological repercussions, the APA professional accompanies the patient with a chronic disease, in this case NAFLD, to induce a sustainable lifestyle change by focusing on his or her motivational state. These measures appear to be beneficial for both adults and children. [ABSTRACT FROM AUTHOR]

Since 2009, the law has reinforced the role of the general practitioner in coordinating care in France. Various structures, such as coordination support systems and specific regional systems, have been set up to improve the efficiency of care pathways. Primary care teams and specialized care teams organize care around patients. Multi-professional health centers and health centers facilitate local collaboration between professionals., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Telecare is a telehealth practice open to medical auxiliaries and pharmacists. In semi-structured interviews, nurses shared their experiences. The results show that new skills are being mobilized to meet the needs of diabetic patients. However, there are still obstacles to be overcome, such as a lack of digital skills and organizational and technical difficulties, which need to be taken into account if we are to continue deploying this practice., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Ten advanced practice nurses are already working at the Guillaume-Régnier hospital in Rennes. As part of an internship at this facility, students in the second year of the IPA master's degree in psychiatry and mental health at the University of Rennes were interested in the dynamics surrounding this still recent profession, the diversity of the missions performed, and inter-professional collaboration. An online survey was distributed to IPAs, and four interviews were conducted with healthcare professionals working with them., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Résumé: Les médecins généralistes ont des difficultés dans le suivi des patients âgés atteints de cancer, faute de communication avec l'hôpital. Le point de vue des infirmier(e)s diplômé(e)s d'État libéraux(les) (IDEL) n'a, quant à lui, pas été étudié dans la littérature alors qu'ils font partie des professionnels de soins primaires. Cette étude a donc pour objectif principal d'identifier les éléments qui influencent la continuité informationnelle entre l'hôpital et la ville du point de vue des IDEL à travers une méthodologie qualitative. Au total, 14 IDEL ont participé à cette étude. Il en ressort que le manque de support de transmission à destination des professionnels engendre une rupture dans la continuité des informations. Le patient âgé devient alors le vecteur d'informations. Les IDEL manquent de formation en oncogériatrie. Une clarification des rôles de chaque professionnel est nécessaire afin d'améliorer la continuité des soins en oncogériatrie. [ABSTRACT FROM AUTHOR]

Résumé: Les maladies inflammatoires chroniques de l'intestin (MICI) ont un pic d'incidence entre 20 et 30 ans, au moment où les personnes commencent à construire leur vie (vie de couple, travail, grossesse, acquisition d'un logement, etc.). Ces pathologies chroniques, autant handicapantes que tabou entraînent de réelles difficultés dans la vie quotidienne des patients. Les patients peuvent être amenés à démarrer des traitements nécessitant un apprentissage particulier afin de gagner en autonomie et certains vont avoir besoin d'un recours à des interventions chirurgicales. Les progrès de la médecine ainsi que les innovations thérapeutiques rendent la prise en charge des patients toujours plus complexe. De plus, ils doivent harmoniser la maladie et les soins avec leur vie familiale et professionnelle. Le parcours de soin correspond au juste enchainement, au bon moment des différentes compétences professionnelles, liées directement ou indirectement aux soins. Ce processus a pour objectif de répondre de la meilleure façon possible aux problèmes que rencontrent les patients ou les soignants au cours du processus de soins : il s'agit donc de l'orientation vers la solution thérapeutique jugée optimale lors de cette étape de vie, en prenant en compte le passé du patient et ses projets futurs. Les intervenants dans le processus de soin sont multiples mais comment faire en sorte que tous soient informés de la juste situation d'un patient à un moment donné et que leurs actions se coordonnent ? Le niveau de connaissance, d'implication des intervenants et d'accès à des nouvelles thérapeutiques des patients est variable ; comment agir pour donner à tous les patients les moyens d'avoir une prise en charge optimale ? Chronic Inflammatory Bowel Diseases have a peak incidence between 20 and 30 years old, when people begin to build their lives (married life, work, pregnancy, house acquisition, etc.). These chronic pathologies, as disabling as they are taboo, cause real difficulties in the daily lives of patients. Patients may have to start treatments requiring special training in order to gain autonomy and some will need to surgical interventions. Advances in medicine and therapeutic innovations make patient care ever more complex. In addition, they must harmonize their care with their family and professional life. The pathway care corresponds to the right sequence, at the right time, of the various professional skills, directly or indirectly linked to care. The objective of this process is to respond in the best way to a problem encountered by the patient or the caregivers during their care: it is therefore a question of orientation towards the therapeutic solution deemed optimal during this stage of life, taking into account its past and future plans. There are many people involved in the care process, but how can we ensure that everyone is informed of the reel situation of a patient at a moment and that their actions are coordinated? The level of knowledge, involvement of stakeholders and access to new therapies is variable; how to act to give all patients the means to have optimal care? [ABSTRACT FROM AUTHOR]

Copyright of Revue d'Économie Régionale & urbaine is the property of Librairie Armand Colin and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Développer et valider des recommandations françaises à destination des professionnels de santé prenant en charge les patients présentant une lombalgie commune avec ou sans radiculalgie. Afin de synthétiser la littérature existante, un rapport d'élaboration a été créé à partir d'une revue systématique des méta-analyses publiées sur la lombalgie entre 2015 et 2018 ainsi que des recommandations internationales publiées entre 2013 et 2018, pour synthétiser l'état des connaissances scientifiques. Un groupe d'experts multidisciplinaire comprenant 17 professionnels de santé impliqués dans la prise en charge de la lombalgie et 2 représentants des patients a été constitué. Ce groupe a élaboré des recommandations préliminaires ainsi qu'un parcours de soins. Après consultation de 25 institutions académiques, une version définitive des recommandations et de l'arbre décisionnel a été validée. Pour chaque recommandation, un accord entre experts a été évalué par la méthode RAND/UCLA. Le groupe d'experts a rédigé 32 recommandations préliminaires, dont un parcours de soins, qui a été modifié après consultation des institutions académiques. Le consensus du groupe d'experts multidisciplinaire a été évalué pour chaque recommandation finale : 32 recommandations ont été évaluées comme appropriées ; aucune n'a été évaluée comme incertaine ou inappropriée. Une approbation forte a été obtenue pour 27 recommandations et faible pour 5. Ces nouvelles recommandations introduisent plusieurs concepts dans la prise en charge de la lombalgie, notamment la nécessité d'identifier précocement les lombalgies à risque de chronicité afin de permettre une prise en charge accélérée et si nécessaire pluridisciplinaire. [ABSTRACT FROM AUTHOR]

Pour être plus efficient, le système de soins doit dépasser le travail en silo. L'émergence des maisons ou pôles de santé et des communautés professionnelles territoriales de santé favorise un fonctionnement basé sur la synergie, où chaque acteur apporte ses compétences. La réussite tient en la capacité à mettre en œuvre un projet au bénéfice des patients. To be more efficient, the healthcare system must move beyond working in silos. The emergence of health centers or clusters and territorial professional health communities favors an approach based on synergy, where each player contributes his or her skills. Success lies in the ability to implement a project for the benefit of patients. [ABSTRACT FROM AUTHOR]

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L'objectif de cette étude était de décrire le parcours de soins des enfants de 18 à 30 mois à risque élevé de troubles du spectre de l'autisme (TSA) suivis en protection maternelle et infantile (PMI) dans les Bouches du-Rhône. L'objectif secondaire était d'évaluer la faisabilité du dépistage systématique des TSA en consultation de PMI. Les enfants inclus dans l'étude descriptive du parcours de soins avaient 18 à 30 mois et un risque élevé de TSA au M-CHAT-R. Les données de la consultation de dépistage, 6, 12 et 24 mois après leur consultation ont été recueillies rétrospectivement. Pour l'étude qualitative transversale, des entretiens ont été menés auprès de médecins de PMI. Parmi les 2458 enfants dépistés entre septembre 2015 et décembre 2018, 76 enfants (3,1 %) avaient un risque élevé de TSA (M-CHAT-R ≥ 8). Ils ont bénéficié rapidement de mesures de socialisation, pour atteindre une importante intégration en école ordinaire. Le délai médian de consultation d'un médecin spécialiste à partir du dépistage était de 81 jours [40 ; 145]. Les principaux freins au dépistage systématique des TSA exprimés par les médecins de PMI étaient : le temps nécessaire au dépistage, la barrière de la langue, les difficultés de compréhension, l'offre de diagnostic et de soins limitée. Des leviers spécifiques au contexte de consultation de PMI ont été rapportés. De nombreuses actions peuvent être entreprises entre les âges de deux et trois ans pour ces enfants dépistés à risque élevé de TSA en PMI. The objective of this study was to describe the care pathway, socialization, and the modalities of scholarization of children aged 18 to 30 months at high risk of Autism Spectrum Disorders (ASD) followed in Maternal-Child Health Services (PMI) in the Bouches du-Rhône area in France. The secondary objective was to evaluate the feasibility of systematic screening for ASDs in PMI consultations. A mixed observational (quantitative-qualitative) study was carried out in the Bouches-du-Rhône department in France. The children included in the care pathway descriptive study were 18 to 30 months of age and at high risk for ASD at the M-CHAT-R (M-CHAT-R ≥ 8). Data from the screening visit, and 6, 12 and 24 months thereafter were collected retrospectively. For the cross-sectional qualitative study, interviews were conducted with PMI medical practitioners. From September 2015 to December 2018, of the 2458 children screened, 76 children (3.1%) were at high risk for ASD (M-CHAT-R ≥ 8) and the socialization of these children was initially poor since it was done only within the family (69% at the time of screening). These children quickly benefited from socialization measures, achieving a significant integration into regular school. Indeed, the schooling rate was very high at 24 months after the screening since 89% of the children were enrolled in school, most in regular schools, with human support. The care provided by a speech therapist, a psychomotrician or a psychologist increased over time. However, the speech therapist's follow-up was a little later than that of the psychomotrician. The median time to see a child psychiatrist or neuropaediatrician or pediatrician from screening was 81 days [40; 145]. Nine interviews were conducted with the referring PMI medical practitioners in the Bouches-du-Rhône department. The main barriers to routine screening for ASDs expressed by PMI medical practitioners were: the time required for screening, language and comprehension barriers, and limited diagnostic and care options. Levers specific to the PMI consultation setting were reported. This study provides a glimpse of certain characteristics of the care, socialization and schooling pathway of these very young children, which is little documented to date in France. In view of the elements resulting from the interviews, as well as the large number of children having been screened over three years (n = 2458), the feasibility of systematic screening for ASD at 18–30 months in the context of consultations with PMIs in the department seems to be established. Although specialized care management is confronted with structures, and the time frames described and studied were long, many actions can be undertaken between the ages of two and three years for these children. [ABSTRACT FROM AUTHOR]

Introduction: Emergency Department (ED) overcrowding is a major healthcare issue. The purpose of this study is to determine the causes of emergency department overcrowding and to evaluate intra-hospital transfer after initial treatment. Methods: we conducted a 1-year prospective study at the Emergency Reception Service of the Gabriel Touré University Hospital. All patients admitted to the Emergency Reception Service and belonging to classes 3, 4, 5 of the Clinical Classification of Emergency patients (CCEP) and whose length of stay in the department was greater than or equal to 24 hours were included in the study. Patients consulting the Emergency Department and classified as CCMU classes 1, 2, patients without a well-established medical record and patients who died before treatment were excluded by the study. Results: we recorded 19.571 calls to the emergency service, including massive influxes (a remarkable 44 times, 570 patients). Bed occupancy rate was 108.03% in our department; at the same time, the average bed occupancy in the Hospital was 56%. According to the CCEP classification, 83.75% of patients were CCEP3. Patients with neurological disorders were 557. Patients with a trauma accounted for 56.7%, compared with 49.2% of medical disorders encountered. Conclusion: the average length of stay was 63.59 hours, with a maximum length of 45 days. More than a quarter of the reasons for delayed intra-hospital transfers were due to the need for specific surveillance or specific treatments that were not feasible in conventional hospitalization. [ABSTRACT FROM AUTHOR]

The increase of chronic and complex medical disorders challenges actors in the health care system and affects the entire health care system in Switzerland. Through an interprofessional exchange between medical and health care professionals, the individual needs of patients can be better addressed, which has a positive impact on patients' treatments. To prepare students of the Bachelor of Medicine at ETH Zurich for these challenges, the ETH has designed a specific course together with four educational institutions, which is oriented towards the interprofessional, patient-centred supply chain. The aim of this interprofessional module is, that Bachelor of Medicine students, as well as Pharmacy and Nursing students, acquire knowledge about the other areas of responsibility and competences, and at the same time get to know the interfaces of interprofessional cooperations. [ABSTRACT FROM AUTHOR]

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Résumé: Fortement encouragée par les arrêtés de 2018 qui définissent les actes de télémédecine pris en charge par l'Assurance Maladie, la téléconsultation médicale s'est ancrée dans la pratique des médecins généralistes notamment à la faveur du confinement et de l'état d'urgence sanitaire. La téléconsultation a été utile pour éviter des prises de risque vis-à-vis de la COVID-19, pour assurer la surveillance des patients atteints de maladies chroniques ou pour améliorer l'accès aux soins. Au quotidien, à côté de ces avantages, il existe aussi des aléas de fonctionnement et des inconvénients qui méritent d'être évalués. Il faut s'interroger sur les conséquences de « cette autre façon de pratiquer la médecine » avec l'absence de l'examen clinique et la modification de la relation médecin-malade. Strongly encouraged by the health law of 2018th which determined the acts of Teleconsultation assumed by Assurance Maladie, the medical consultation has been implemented in practice of general medicine during home confinement and state of health emergencies. The teleconsultation has been useful to avoid any excessive risk taking with COVID-19, to provide monitoring of chronic diseases or to improve accessibility to health services. Day to day, beside these advantages, there are also some hazards of operating mode and inconvenience which must be evaluated. It is important to think about the consequences about the other way to practice medicine with the absence of physical examination and with the modification of the relationship between doctor and patient. [ABSTRACT FROM AUTHOR]

L'état des lieux de la prise en charge de la maladie rénale chronique avant le déploiement du forfait-parcours des patients est important à connaître pour permettre d'en mesurer l'impact à terme. Nous avons décrit la prise en charge en néphrologie sur 3 ans de 2835 patients ayant une maladie rénale chronique modérée à sévère, suivis dans la cohorte CKD-REIN entre 2013 et 2019, et son adéquation au référentiel de la Haute Autorité de Santé en vigueur sur la période. Le nombre moyen de consultations néphrologiques des patients (âge moyen 67 ans ; 65 % d'hommes ; 43 % de MRC stade 4 ou 5) augmentait de 1,1 à 2,7 par an, du stade 3A au stade 5 de la maladie rénale chronique. Aux stades 3B, 4 et 5, respectivement 84, 63 et 33 % des patients avaient le nombre minimum de consultations de néphrologie recommandé par la Haute Autorité de Santé. Au stade 4 ou 5 de la maladie rénale chronique, seuls 34 et 40 % des patients, respectivement, avaient bénéficié de consultation diététique, et 33 et 54 % avaient reçu des informations sur les options de traitement. Le délai moyen d'attente pour une première consultation de néphrologie était plus long (60 vs 45 jours), et leur durée moyenne plus courte (30 vs 38 à 40 minutes) en CHU comparé aux centres hospitaliers et aux établissements privés. L'écart important constaté entre les pratiques réelles et les recommandations témoigne des limites des ressources humaines et des organisations dans la prise en charge de la maladie rénale chronique en néphrologie, pour lesquelles des avancées sont attendues avec le financement au forfait. To be able to assess the impact of the bundled payment system on real-life management of patients with chronic kidney disease, an overview of patient-care management before its implementation is needed. We describe patterns of nephrology care over 3 years in 2835 patients with moderate to severe chronic kidney disease, who were followed-up from 2013 to 2019 in the CKD-REIN cohort study. Compliance with health authority guidelines during this period is also studied. At baseline, patients' mean age was 67 years, 65% were men, and 43% had chronic kidney disease stage 4 or 5. The mean number of nephrology visits increased from 1.1 to 2.7 per year, from chronic kidney disease stage 3A to stage 5. The minimum number of nephrology visits as recommended by health authorities was achieved in 84%, 63%, and 33% of patients with chronic kidney disease stages 3B, 4, and 5, respectively. In chronic kidney disease stages 4 and 5, only 34% and 40% of patients had seen a dietitian, and 33% and 54% had received information about treatment options, respectively. The average waiting time for a first appointment with a nephrologist was longer, 60 days and its duration shorter, 30 vs 38 to 40 minutes, in university hospitals compared with non-university hospitals and private clinics. The significant gap between received and recommended care reflects human resources and organizational limits in chronic kidney disease management in the nephrology setting. Improvements with bundled payment are expected. [ABSTRACT FROM AUTHOR]

While the needs of dependent seniors needs are important in Nursing Home (NH), the medical resources are low in residences located in a medical desert. Access to care in these NH is very unequal and can result in a loss of chance for residents who are immediately transferred to emergency with a risk of iatrogeny or inappropriate hospitalization. Objective: We aim to find new models of care organization to optimize management of elderly in NH thanks to new technologies Artificial Intelligence (AI) associated to telemedicine. Method: Intel@Care is a 3 steps program planned over 5 years : 1- faisability study : Intel@Med-Faisa (2019-2020); 2- proof of concept : Intel@Med-POC with socio-environmental study (2020-2022); 3- efficiency study with medico-economic assessment Intel@Med-Efficiency (2022-2024). Results: Intel@Med-Faisa : 18 residents were included in 2 NHs; 20 additional diagnoses were created to adapt the Artificial Intelligence algorithm to the clinical characteristics of the elderly. Intel@Med-POC: (study in progress): 306 residents to be included to validate development of evidence-based decision tool to help physician to make decisions to manage healthcare interventions, verify the acceptability of the new care organization. A medico-economic study is also conducted. Perspectives : This program aims to secure the use of this tool by professionals and to identify the obstacles and levers about use, perception and find an economic model for the deployment on the territory. In parallel, a clinical research will be conducted in order to adapt this organization to elderly people living at home in medical desert areas.

This article aims to describe, on a historical basis, the evolution of the concept of "health care pathway" for chronic patients in France, and to explore new possible horizons in the context of the recent public policies. [ABSTRACT FROM AUTHOR]

Copyright of Revue d'Économie Régionale & urbaine is the property of Librairie Armand Colin and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le suivi des patients transplantés d'organe solide repose sur la collaboration de tous les professionnels participant à leur prise en charge. La coordination et la communication entre ces acteurs de santé, de ville ou hospitaliers, sont des enjeux importants dans la construction d'un parcours de soins cohérent, structuré et individualisé. Les nombreuses missions du pharmacien d'officine lui confèrent une place importante dans cet accompagnement. The follow-up of solid organ transplant patients relies on the collaboration of all the professionals involved in their care. Coordination and communication between these healthcare actors, whether they are city or hospital staff, are important issues in the construction of a coherent, structured and individualised care pathway. The numerous missions of the dispensing pharmacist give him an important place in this support. [ABSTRACT FROM AUTHOR]

L'institution militaire a développé une politique d'accompagnement des blessés à travers la mise en place d'un parcours de soins et d'un parcours administratif balisés, allant du dépistage du trouble stress post-traumatique (TSPT) ou des problématiques de harcèlement et de souffrance au travail (numéro vert Écoute Défense) à la reconnaissance de l'imputabilité de la blessure en service conduisant à des indemnisations (pension militaire d'invalidité, jurisprudence Brugnot, fonds de prévoyance, garanties des assurances privées), en passant par la réhabilitation du blessé avec le soutien des cellules blessés des différentes armées (stages de réhabilitation par le sport), jusqu'à la réintégration professionnelle (stages d'immersion en entreprise, congés de reconversion, création d'entreprises) avec le dispositif Défense Mobilité pour la reconversion professionnelle. Dans cette seconde partie d'entretien, le PSYHC Laurent Brulin et l'assistante de service sociale Delphine Breuil évoquent le parcours administratif des blessés, les différents stages de réhabilitation par le sport et la question de la réinsertion professionnelle des militaires blessés. The military institution has developed a policy of supporting the wounded through the establishment of a care plan and a marked administrative path, ranging from screening for PTSD or problems of harassment and suffering at work (tall free call Écoute Défense) to the recognition of the imputability of the injury in service leading to compensation (military invalidity pension, Brugnot case law, contingency funds, private insurance guarantees, through the rehabilitation of the injured with support from injured cells of the various military Armies branches (rehabilitation training through sport) up to professional reintegration (company immersion courses, retraining leave, business creation) with the defense mobility system for professional retraining. In this second part of the interview, the PSYHC Laurent Brulin and social service assistant Delphine Breuil evoke the administrative path of the wounded, the various rehabilitation courses through sport and the question of the professional reintegration of injured soldiers. [ABSTRACT FROM AUTHOR]

Résumé: Objectif : L'objectif de la présente étude est de déterminer si la mise en place d'un suivi régulier et structuré des patients présentant une insuffisance cardiaque (IC) chronique, associé à une éducation thérapeutique, aboutissait à une meilleure prise en charge de ces patients. Patients et méthode : Il s'agissait d'une étude monocentrique, rétrospective, sur une cohorte de patients présentant une IC chronique avérée, suivis sur la région de Mulhouse (France), entre janvier 2016 et décembre 2017, par l'Unité de suivi des patients insuffisants cardiaques (USICAR). Ces patients bénéficiaient d'un suivi régulier protocolisé et d'un programme d'éducation thérapeutique pendant une période de 2 ans. Le critère principal de cette étude était : le nombre de jours d'hospitalisation pour IC par an et par patient. Les critères secondaires étaient : le nombre de jours d'hospitalisation pour autre cause cardiaque que l'IC et le nombre de séjours hospitaliers pour IC par patient. Ces critères étaient recueillis sur la période d'un an avant inclusion, après un an de suivi, puis à deux ans de suivi. Résultats : 159 patients, d'âge moyen de 72,9 ans, ont été inclus dans la présente étude. Ils présentaient tous une IC, essentiellement de stade I-II de la NYHA (88,7 %), d'origine préférentiellement ischémique (50,9 %), à fraction d'éjection ventriculaire gauche altérée dans 69,2 % des cas. En ce qui concerne le critère principal, celui-ci était en moyenne de 8,33 jours (6,84-10,13) durant l'année précédant l'inclusion, de 2,6 jours (1,51-4,47) durant la première année de suivi, et de 2,82 jours (1,30-6,11) (p < 0,01 pour les 2 comparaisons). Le nombre moyen de jours d'hospitalisation pour autre cause cardiaque que l'IC ramené au nombre de patients était : de 1,73 jours (1,16-2,6), de 1,81 jours (1,04-3,16) et de 1,32 jours (0,57-3,08) (p = ns). Le pourcentage d'hospitalisation pour IC pour chaque patient était : de 69,5 % (60,2-77,4) avant inclusion, de 16,2 % (10-25,2) durant la première année de suivi et de 19,3 % (11-31,8) durant la seconde (p < 0,001 pour les 2 comparaisons). Conclusion : La présente étude démontre l'intérêt d'un suivi protocolisé associée à un programme d'éducation thérapeutique pour améliorer la prise en charge des patients IC en ambulatoire, notamment pour les IC modérées. Objective: The objective of this study is to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure (CHF), combined with therapeutic education, led to better management of these patients. Patients and Method: This was a monocentric, retrospective study on a cohort of patients with a proven CHF, followed in the Mulhouse region (France), between January 2016 and December 2017, by the Unit for Monitoring Heart Failure Patients (USICAR). These patients benefited from a regular protocolized follow-up and a therapeutic education program for a period of 2 years. The main criterion of this study was: the number of days of hospitalization for HF per year and per patient. The secondary endpoints were: the number of days of hospitalization for cardiac causes other than HF and the number of hospital stays for HF per patient. These criteria were collected over the one-year period before inclusion, at one-year-follow-up, and at two-years-follow-up. Results: 159 patients with a mean age of 72.9 years were included in this study. They all had a CHF, mainly stage I-II NYHA (88.7%), of predominantly ischemic origin (50.9%), with altered left ventricular ejection fraction in 69.2% of cases. The primary endpoint averaged 8.33 days (6.84-10.13) in the year prior to inclusion, 2.6 days (1.51-4.47) in the first year of follow-up, and 2.82 days (1.30-6.11) (p <0.01 for both comparisons). The mean number of days of hospitalization for other cardiac causes other than HF to patient numbers was: 1.73 days (1.16-2.6), 1.81 days (1.04-3.16), and 1.32 days (0.57-3.08) (p = ns). The percentage of hospitalization for HF for each patient was: 69.5% (60.2-77.4) before inclusion, 16.2% (10-25.2) during the first year of follow-up and 19.3% (11-31.8) during the second (p < 0.001 for both comparisons). Conclusion: This study demonstrates the value of a protocolized follow-up associated with a therapeutic education program to improve the management of ambulatory CHF patients, particularly for moderate CHF. [ABSTRACT FROM AUTHOR]

Résumé: Peu de visites de pré-reprises réalisées par les médecins du travail lors d'arrêt maladie supérieur à trois mois sont à l'initiative des généralistes. Cet article explore les freins perçus par les médecins généralistes, les médecins du travail et les médecins-conseils dans la mise en place de la visite de pré-reprise et dans la communication autour de cette visite. L'étude montre qu'il est nécessaire de mieux informer les généralistes et les salariés de l'intérêt d'initier une visite de pré-reprise précocement et de développer les outils de communication entre les médecins généralistes, les médecins du travail et les médecins-conseils, tout trois acteurs dans la prévention de la désinsertion professionnelle. Few pre-recovery visits by occupational physicians during sick leave of more than 3 months are initiated by GPs. This article explores the obstacles perceived by GPs, occupational physicians and medical officers in setting up the pre-recovery visit and in the communication around this visit. The study shows that it is necessary to better inform GPs and employees of the benefits of initiating a pre-recovery visit at an early stage and to develop communication tools between GPs, occupational physicians and medical officers, all three players in the prevention of professional withdrawal. [ABSTRACT FROM AUTHOR]

Facing breast cancer, women in precarious situations are more likely to be diagnosed at an advanced stage, and when detected at the same stage, they are more to die as well as faster. In this paper, we analyze a corpus of 40 semi-structured interviews conducted in six cancer services in hospitals of the Paris area on the care pathways of women with breast cancer. The analysis focuses on the beginning of the pathways (until the first treatments) and concentrates on their spatial and temporal dimension in the light of precariousness. Depending on the women's situations with regard to precariousness, the spatial and temporal organization of the pathways differs. There are socially differentiated latency periods that delay diagnosis (prior to meeting a medical professional) or the beginning of treatment (in relation to rights, the responsiveness of the health care system, and the interactions between women and the system). Spatially, the geometry of the pathways is variable and reflects different expectations of health institutions and medical staff according to the social profiles of the women. However, a detailed analysis of the pathways allows us to nuance these differences in terms of precariousness. The women's capacity to be autonomous, their network of contacts, the accessibility and responsiveness of the health care system, as well as the sensitive and emotional dimension of this stressful event affect the pathways both in terms of time and space., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Forums are a source of health information and exchange. They can be studied to determine patients' needs and improve caregivers' practices. The aim of this study was to identify the needs of breast cancer patients based on messages posted on a discussion forum., Methods: Initial messages posted in 2021 on the Ligue nationale contre le cancer (LNCC) breast cancer forum were analyzed quantitatively. Message content was classified into three categories: testimonial, request for advice or request for medical opinion. The tone of the message (positive, neutral, or negative) was recorded. The temporality of the illness during which the patient expressed herself was defined. Analysis was carried out on the initial messages using the Chi 2 , Fisher, and Kruskal-Wallis tests, with a significance level of<0.05., Results: In 2021, 640 initial messages posted on the LNCC forum dedicated to breast cancer were analyzed. Messages were posted by 312 authors, including 275 patients and 37 family members. Three main types of messages were identified: requests for medical advice (n=339), advice (n=164), and testimonials (n=137). Requests for medical advice elicited fewer responses than testimonials (P<0.001). A need for supportive care was identified in 42.8% of messages, mostly concerning social (17.3%) and psychological (13%) care., Conclusion: Our study revealed a need for more information especially regarding the social impact of the disease and the side-effects of treatment. The period of greatest need of information was the diagnostic waiting time. However, patients using discussion forums are not representative of all women with breast cancer and our results should not be generalized to all patients treated for breast cancer., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: The "Programme d'Accompagnement du retour à Domicile" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact., Methods: This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization., Results: While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 € higher in the PRADO group., Conclusions: The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Nurses are omniscient in the French healthcare system. They are an essential link in the healthcare system, and their added value is unquestionable. The profession needs to be revamped to keep pace with current developments in nursing practices and the needs of the population., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)