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Despite the absence of a pattern of use or not of vitamin D in osteoporotic patients by health authorities, vitamin D remains widely prescribed by doctors. This dissonance can give rise to inappropriate prescriptions. This study made it possible to take stock of the prescription of vitamin D in patients taking anti-osteoporotic drugs in Occitanie, as well as to evaluate the prescription methods for cholecalciferol. [ABSTRACT FROM AUTHOR]

Les patients pris en charge en urologie présentent un risque accru d'événements thromboemboliques (ETE). La prophylaxie thromboembolique semble donc justifiée mais favorise le risque de saignement postopératoire via la prescription d'anticoagulants. La décision d'initier une prophylaxie thromboembolique implique donc un équilibre délicat entre la réduction du risque d'ETE et l'augmentation du risque de saignement. À ce jour, l'absence de consensus est à l'origine d'une grande hétérogénéité de pratiques à l'échelle nationale et internationale. Pour y remédier, lAssociation Européene d'Urologie (EAU) a récemment réalisé une revue systématique du risque d'ETE et de saignement pour une grande variété d'interventions urologiques et a formulé des recommandations sur l'utilisation de la thromboprohylaxie périopératoire, fournissant ainsi un cadre pratique pour la gestion de ces risques. Bien que ces recommandations fournissent des lignes directrices utiles, elles n'ont pas été endossées par l'Association française d'urologie. Un résumé de ces recommandations vous est ici proposé. Patients undergoing urological procedures are at increased risk of thromboembolic events (TEE). However, thromboprophylaxis entails anticoagulation, which in turn increases the risk of postoperative bleeding. Thus, the decision to initiate thromboprophylaxis involves a delicate balance between reducing the risk of TEEs and increasing the risk of bleeding. Currently, the lack of consensus leads to significant heterogeneity in practices both nationally and internationally. To tackle this issue, the European Association of Urology (EAU) recently conducted a systematic review regarding the risk of TEEs and bleeding for a wide range of urological procedures, and released guidelines for perioperative thromboprophylaxis, providing a practical framework for managing the latter. Although these recommendations offer useful guidance, they have not been endorsed by the French Association of Urology. They are hereby summarized. [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.)

The rules of good practice in French Assisted Reproduction Technologies (ARTs) aim to ensure the quality and safety of care. These rules, which are mandatory for all ARTs facilities, include measures to prevent the transmission of pathogens and guarantee the safety of patients and practitioners. They evolve with the current state of knowledge, which is why the decrees governing these practices are regularly revised. ARTs including artificial insemination, conventional in vitro fertilization or Intra-cytoplasmic sperm injection (ICSI), gamete storage, gamete donation and embryo transfer, are evolving in the same direction of scientific and regulatory advances. The revision of the decree of October 5, 2023, following the new bioethics law of 2021, introduces major changes, notably the abolition of the specific "viral risk" circuit and the narrowing of mandatory medical biology examinations that initially aims to minimize transmission risks. However, it maintains strict sanitary safety measures to prevent horizontal and vertical transmission, as well as transmission to health-care workers. Good laboratory practice is a common minimum standard that all ARTs' facilities must adhere to. However, laboratories are free to develop their own protocols in line with the decrees, and to carry out additional biological tests to optimize patient care. Learned societies, such as the European Society for Human Reproduction and Embryology (ESHRE), offer specific recommendations for handling gametes from patients infected with agents such as HBV, HCV, HIV, HPV, Zika and SARS-CoV-2. Good laboratory practices for ARTS, which arecontinuously reviewed, ensure a high level of quality and safety. Recent epidemics have underlined the importance of these measures in adapting rapidly to health emergencies, highlighting their necessity for dealing with the threat of new outbreaks of emerging agents. [ABSTRACT FROM AUTHOR]

Les bursites septiques, relativement fréquentes, représentent un tiers des bursites inflammatoires et sont souvent liées aux activités professionnelles. Leur prise en charge est hétérogène, ambulatoire ou hospitalière, et aucune recommandation n'est disponible à ce jour. Cet article propose des recommandations de prise en charge des bursites septiques élaborées par 18 rhumatologues du groupe de travail de la Société française de rhumatologie sur les infections ostéoarticulaires, un infectiologue, deux chirurgiens orthopédistes, un médecin généraliste et un médecin urgentiste. En s'appuyant sur une revue de la littérature et les avis d'expert, le groupe de travail a élaboré trois principes généraux et 11 recommandations de prise en charge des bursites septiques olécraniennes et prépatellaires, selon la méthodologie de la Haute Autorité de santé. Destinées aux médecins rhumatologues, généralistes, urgentistes et orthopédistes, ces recommandations mettent l'accent sur la place des examens d'imagerie et la ponction de bourse dans les deux modalités de prise en charge ambulatoire et hospitalière. Des options d'antibiothérapie (molécules et durées) sont proposées pour les deux contextes de prise en charge. Enfin, des recommandations spécifiques sont consacrées aux indications chirurgicales, aux thérapies non pharmacologiques et à la prévention. Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations. [ABSTRACT FROM AUTHOR]

Context: Currently, clinical practice guidelines (CPGs) recommend the prescription of metformin as a first-line treatment for patients with type 2 diabetes. However, a systematic review and network meta-analysis of randomized clinical trials published in 2022 question the role of metformin as a first-line treatment. The objective of this work was to assess the impact of scientific evidence on the prescription choice. Methods: A randomized experimental study with four arms (1.1.1.1), using clinical vignettes, was conducted in June 2023 at the Faculty of Medicine of Lyon, France, involving 160 general medicine interns present at the faculty for a teaching day. The clinical vignettes all described the same context. Nine antidiabetic medications were presented with their efficacy and safety profiles. The question focused on the choice of first-line treatment and the reasons behind it. The four arms of the study were constituted as follows: two control arms with the names of pharmacological classes (one with benefits and adverse effects (AEs), the other without AEs); two intervention arms without the names of pharmacological classes (one with benefits and AEs, the other without AEs). Results: In all groups, the choice of treatments was strictly limited to the following three pharmacological classes: SGLT2 inhibitors (ISGLT2), GLP1 receptor agonists (AGLP1), and Biguanides (metformin). In the control arm with AEs, the prescription intentions were 10%, 30%, and 60%, respectively. In the control arm without AEs, they were 44.2%, 16.3%, and 39.5%, respectively. In the intervention arm with AEs, the prescription intentions were 48.7%, 51.3%, and 0%, respectively. In the intervention arm without AEs, they were 68.4%, 28.9%, and 2.6%, respectively. There was a significant difference only for ISGLT2 and metformin, with and without mention of AEs. Conclusion: These results suggest that the therapeutic reasoning of interns in general practice is not primarily based on EBM data, but probably on their own knowledge, mainly derived from CPGs. [ABSTRACT FROM AUTHOR]

Les troubles du spectre autistique (TSA) peuvent altérer l'état nutritionnel des enfants. Cette étude visait à évaluer les apports alimentaires journaliers (AAJ) en micronutriments, ainsi que la fréquence de consommation (FC) de différents groupes d'aliments, chez des enfants atteints de TSA et à les comparer à ceux d'enfants au développement typique (DT). Elle permettra par ailleurs, de déterminer dans quelle mesure ces apports sont en accord avec les recommandations diététiques (RDA). L'étude comprenait 52 enfants, dont 26 porteurs d'autisme (PA) et 26 au DT. Les AAJ ainsi que les FC ont été évalués au moyen d'un carnet alimentaire de sept jours. Parmi les AAJ, seule la Vit B12 était significativement différente entre les cas et les témoins, mais l'apport était supérieur aux recommandations dans les deux groupes étudiés. Tous les enfants avaient des AAJ inférieurs aux RDA, pour ce qui était du fer, du calcium ainsi que des vitamines E et K1. Toutefois, l'inadéquation aux recommandations la plus marquante concernait les AAJ en fer (6,95 ± 2,87 mg/j vs 7,04 ± 2,98 mg/j, p > 0,05 ; RDA égale à 10 mg/j) en raison d'une faible consommation de produits carnés ; ainsi qu'en calcium (406,96 mg/j vs 399,46 mg/j, p > 0,05 ; RDA de 1000 mg/j). La plupart des enfants présentaient une FC de produits laitiers inférieure à la fréquence de consommation recommandée. Cette étude souligne l'intérêt d'une meilleure orientation diététique pour les deux groupes étudiés, avec une attention particulière pour les enfants PA afin d'éviter toute complication des TSA. Autism Spectrum Disorders (ASD) can affect the nutritional status of children. This study aimed to assess the daily dietary intakes (DDI) of micronutrients, as well as the frequency of consumption (FC) of different food groups, in children with ASD and compare them to those with typical development (TD). It will also determine to what extent these intakes comply with the Recommanded Dietary Allowances (RDA). The study included 52 children, 26 with ASD and 26 with TD. DDI and FC were gathered using a 7-day food diary. Among the DDI of micronutrient, only Vit B12 showed a significant difference between cases and controls, but the DDI was higher than the recommendations in both groups studied. All the children of our study sample had DDI lower than the RDA, in iron, calcium, vitamins E and K1. However, the most notable discrepancy with the recommendations was observed in iron intake (6.95 ± 2.87 mg/d vs 7.04 ± 2.98 mg/d, p > 0.05; RDA equal to 10 mg/d) primarily due to low consumption of meat products, and in calcium (406.96 mg/d vs 399.46 mg/d, p > 0.05; RDA of 1000 mg/d). Most of the children in this study had a FC of dairy products below the recommended consumption frequency. This study highlights the importance of improving dietary guidance for both groups studied, with particular attention to children with ASD to avoid any complications of ASD. [ABSTRACT FROM AUTHOR]

Les patients atteints de polyarthrite rhumatoïde et d'autres rhumatismes inflammatoires chroniques ont un risque de maladie cardiovasculaire et de thrombose veineuse plus élevé que la population générale. De plus, des études récentes alertent sur un possible risque accru d'effets indésirables cardiovasculaires majeurs et de thrombose veineuse en cas de traitement par inhibiteurs de JAK. En octobre 2022, le PRAC a recommandé une série de mesures visant à minimiser le risque d'effets indésirables graves, y compris affections cardiovasculaires et thromboses veineuses, associés à tous les agents approuvés dans les rhumatismes inflammatoires chroniques. Proposer une stratégie adaptée et réaliste pour évaluer le risque de maladie cardiovasculaire et de thrombose veineuse, au niveau individuel, chez les patients présentant un rhumatisme inflammatoire chronique. Un comité de pilotage pluridisciplinaire composé de 11 membres – des rhumatologues experts, un cardiologue, un hématologue spécialisé en thrombophilie et des jeunes rhumatologues – a été constitué. Des recherches systématiques ont été menées dans la littérature et les données probantes ont été classées par catégories selon les recommandations standard. Les preuves ont été étudiées et synthétisées par des experts selon un processus de recherche de consensus et de vote. Trois principes généraux ont été établis. Le premier est que le risque d'effets indésirables cardiovasculaires majeurs et de thrombose veineuse est plus élevé chez les patients atteints de rhumatisme inflammatoire chronique que dans la population générale. Le deuxième est que le rhumatologue joue un rôle central pour l'évaluation du risque de maladie cardiovasculaire et de thrombose veineuse dans les rhumatismes inflammatoires chroniques. Le troisième est que le risque d'évènements cardiovasculaires majeurs et de thrombose veineuse doit être évalué régulièrement chez les patients présentant un rhumatisme inflammatoire chronique et, tout particulièrement, avant la mise en place d'une thérapie ciblée. Onze recommandations ont été élaborées pour prévenir les complications potentiellement mortelles de maladie cardiovasculaire et de thrombose veineuse chez les patients atteints de rhumatisme inflammatoire chronique, avec des conseils pratiques pour évaluer ces complications avant d'envisager la prescription de thérapies ciblées, notamment des inhibiteurs de JAK. Ces recommandations pratiques reposant sur des avis d'experts et des preuves scientifiques font consensus pour la prévention et l'évaluation du risque de maladie cardiovasculaire et de thrombose veineuse. Patients with rheumatoid arthritis (RA) and other chronic inflammatory rheumatic disorders have increased risk of cardiovascular disease (CVD) and venous thromboembolism (VTE) compared with the general population. Moreover, recent data have raised concerns around a possible increased risk of major CV events (MACE) and VTE in patients treated with JAK inhibitors (JAKi). In October 2022, the PRAC has recommended measures to minimize the risk of serious side effects, including CV conditions and VTE, associated with all approved in chronic inflammatory diseases. To provide an adequate and feasible strategy to evaluate, at the individual level, the risk of CVD and VTE in patients with chronic inflammatory rheumatic diseases. A multidisciplinary steering committee comprised 11 members including rheumatologists, a cardiologist, a hematologist expert in thrombophilia and fellows. Systematic literature searches were performed and evidence was categorized according to standard guidelines. The evidence was discussed and summarized by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk of MACE and VTE in patients with chronic inflammatory rheumatic diseases compared with the general population. Second, the rheumatologist has a central role in the evaluation of the risk of CVD and VTE in patient with chronic inflammatory rheumatic diseases. Third, the risk of MACE and VTE should be regularly assessed in patients with chronic inflammatory rheumatic diseases, particularly before initiating targeted therapies. Eleven recommendations were defined to prevent potentially life-threatening complications of CVD and VTE in patients with chronic inflammatory rheumatic diseases, providing practical assessment of CVD and VTE before considering the prescription of targeted therapies, and especially JAKi. These practical recommendations based on expert opinion and scientific evidence provide consensus for the prevention and the assessment of CVD and VTE. [ABSTRACT FROM AUTHOR]

Clinical guidelines are evidence-based recommendations developed by healthcare organizations or expert panels to assist healthcare providers and patients in making appropriate and reliable decisions regarding specific health conditions, aiming to enhance the quality of healthcare by promoting best practices, reducing variations in care, and at the same time, allowing tailored clinical decision-making. European Hernia Society (EHS) guidelines aim to provide surgeons a reliable set of answers to their pertinent clinical questions and a tool to base their activity as experts in the management of abdominal wall defects. The traditional approach to guideline production is based on gathering key opinion leader in a particular field, to address a number of key questions, appraising papers, presenting evidence and produce final recommendations based on the literature and consensus. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method offers a transparent and structured process for developing and presenting evidence summaries and for carrying out the steps involved in developing recommendations. Its main strength lies in guiding complex judgments that balance the need for simplicity with the requirement for complete and transparent consideration of all important issues. EHS guidelines are of overall good quality but the application of GRADE method, began with EHS guidelines on open abdomen, and the increasing adherence to the process, has greatly improved the reliability of our guidelines. Currently, the need to application of this methodology and the creation of stable and dedicated group of researchers interested in following GRADE in the production of guidelines has been outlined in the literature. Considering that the production of clinical guidelines is a complex process, this paper aim to highlights the primary features of guideline production, GRADE methodology, the challenges associated with their adoption in the field of hernia surgery and the project of the EHS to establish a stable guidelines committee to provide technical and methodological support in update of previously published guideline or the creation of new ones.

Haematologic malignancies are particular in that they can generally be cured, even when distant metastases are present at diagnosis, unlike solid malignancies. Systemic treatments, including chemotherapy, targeted therapies, and immunotherapy, are the standard of care with excellent results. The considerable progress made in the management of these diseases in the last 20 years has redefined the role of radiation therapy as minor in many clinical situations. We propose a literature review of data, showing that radiation therapy still has a role in curative, salvage, and palliative therapy situations. A document and literature search was carried out in the following databases: Medline and ClinicalTrial.gov, for the terms "radiotherapy", "haematologic malignancies", "Hodgkin lymphoma", "non-Hodgkin lymphoma", "CAR T cells", "multiple myeloma", "solitary plasmocytoma", "intensity-modulated radiotherapy", "extracranial stereotactic body radiation therapy" and "proton therapy references". Haemopathological malignancies include a wide range of diseases and radiation therapy indications have been assessed over the past 20 years. Currently, radiation therapy is indicated for localized disease (solitary plasmocytoma), as an adjuvant (Hodgkin lymphoma), in palliative settings, or after systemic treatment in relapsed patients (chimeric antigen receptor [CAR] T-cells) with a low recurrence burden, which can therefore be considered "oligorecurrence". Radiation therapy, through total body irradiation, has important indications, thanks to its immunomodulatory and/or myeloablative effects. Moreover, recent technological developments have made possible significant improvement in safety, contributing to radiation therapy being positioned in the treatment strategy of several indications. Given the effectiveness of systemic treatments in hematologic malignancies, the oligometastasis stage is of little importance. A curative intent after local radiation therapy, even advanced stage, is possible, both with residual disease for advanced Hodgkin lymphoma, aggressive non-Hodgkin lymphoma, or solitary plasmocytoma, and even without evidence of disease after chemotherapy for Hodgkin or non-Hodgkin lymphoma. The role of new treatments, such as CAR T cells, allows us to consider radiation therapy after systemic treatment of relapsed diseases with low volume recurrence, which can be considered oligorecurrence. [ABSTRACT FROM AUTHOR]

These recommendations on the management of MGUS are intended to encourage collaboration between general practitioners, organ specialists and haematologists when a monoclonal component is discovered. The aim is to correctly diagnose MGCS, myeloma and low-grade lymphoma, while sparing as much as possible unnecessary investigations and avoid anxiety, since the most frequent conclusion of the diagnostic process is by far MGUS. [ABSTRACT FROM AUTHOR]

Proton pump inhibitors (PPIs), effective in the treatment of acid gastro-esophageal pathologies, represent a huge cost for the Assurance Maladie due to the reimbursements. However, the description of serious side effets is emerging in the medical literature. In the meantime, some French investigators showed a large rate of PPI prescriptions not compliant with the French guidelines in general medicine, whereas there is a lack of reevaluation before renewing prescriptions. The purpose of AquIPP study is to establish a global evaluation of the PPI prescription in general medicine in Acquitaine. Methods: We conducted a cross-sectional quantitative descriptive in real time study. Data have been collected by the interns of general medicine in internship level 1, when a PPI prescription was made by their internship teacher during the observation phase of the clinics. Results: We analyzed 393 filled in forms. About 35% of the prescriptions were not compliant with the Haute Autorité de Santé guidelines regarding the indication, and about 26% were not either due to the duration and/or the posology. In total, about 61% of all the prescriptions were not compliant with the guidelines done on the basis of the scientific studies. Moreover, only 11 % of the prescribers informed their patients about the side effects. Half of the prescriptions was not reconsidered before being prescribed again. Conclusion: A lot of PPIs prescriptions are not compliant with the French guidelines, and there is a lack of reevaluation before renewing prescriptions and of side effects information. It could cause adverse effects to patients who take PPI where no benefit is expected, and it represents a huge economic cost. It could be interesting to improve the information and develop tools for general practitioners to help them to optimize their PPI prescriptions. [ABSTRACT FROM AUTHOR]

Copyright of Dialogue: Canadian Philosophical Review is the property of Cambridge University Press 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.)

As part of the NorthTick project, co-funded by the European Union through the European Regional Development Fund and the North Sea Region Programme, specialists in the field of tick-borne diseases from seven North Sea countries co-operated with patient organisations and governmental health care institutions to provide this comprehensive overview of diagnostics and treatment recommendations in the region for Lyme borreliosis, Borrelia miyamotoi infection, tick-borne encephalitis, human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis and babesiosis. The main conclusion is that the recommendations in these northern countries are essentially the same, with very few differences. This overview presents the current diagnostics and provides useful clinical guidance.

La Haute Autorité de santé et la Fédération Française de Nutrition ont publié en 2019 et 2021 de nouvelles recommandations cliniques relatives à la dénutrition chez l'enfant, l'adulte et la personne âgée. De nouvelles définitions sont ainsi proposées, basée sur une mise à jour des critères diagnostiques et de leurs valeurs seuil. Le défi est désormais la diffusion de ces recommandations et leur mise en pratique au quotidien par les professionnels de santé concernés. Le conseil scientifique et le comité éducationnel et de pratique clinique de la société francophone de nutrition clinique et métabolisme ont appliqué à ces recommandations nouvelles la méthode Pronovost, validée comme un des outils d'aide à la transposition/implémentation des recommandations à la pratique clinique. Le modèle Pronovost a permis de proposer un cadre servant de guide à l'implémentation des recommandations sur la dénutrition dans la pratique, avec l'aide de document et d'outils adaptés. Les quatre étapes-clé de transposition clinique des recommandations sont suivies : résumer les recommandations ; identifier les freins locaux à l'implémentation ; mesurer la performance ; s'assurer que l'ensemble des patients bénéficie de ces recommandations. Des checklists pertinentes sont proposées pour l'implémentation et l'évaluation de la compliance aux recommandations, ainsi que des tableaux détaillant les missions respectives de chaque professionnel. La méthode Pronovost fournit un cadre et des outils aux professionnels de santé, afin de faciliter la transposition des récentes recommandations du diagnostic et dépistage de la dénutrition. The French ministry of health and the French federation of nutrition published in 2019 and 2021 updated clinical recommendations around nutritional status assessment in children, adults and elderly people. New definitions of undernutrition were produced based on new criteria and/or new thresholds. The challenge now is to engage with healthcare professionals to implement these into their daily practice. This practical implementation guide uses the established implementation model Pronovost to help implementing these evidence-based clinical recommendations into clinical practice. The Pronovost implementation model of evidence into practice allowed us to provide a practical framework with associated documents and tools to facilitate implementation of these clinical recommendations into healthcare professional practice. The paper is structured around the four steps of the Pronovost model: summary of the evidence; identification of local barriers to implementation; measurement of performance; ensuring all patients receive the intervention. Relevant checklists for implementation and compliance monitoring are proposed, in addition to tables outlining professional respective responsibilities and tasks. Implementation science models like the Pronovost model help implementing clinical recommendations into clinical practices. [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 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.)

Sjögren's disease (SD), also known as Sjögren's syndrome (SS) or Gougerot-Sjögren's syndrome in France, is a rare systemic autoimmune disease in its primary form and is characterised by tropism for the exocrine glandular epithelia, particularly the salivary and lacrimal glands. The lymphocytic infiltration of these epithelia will clinically translate into a dry syndrome which, associated with fatigue and pain, constitutes the symptom triad of the disease. In about one third of patients, SD is associated with systemic complications that can affect the joints, skin, lungs, kidneys, central or peripheral nervous system, and lymphoid organs with an increased risk of B-cell lymphoma. SD affects women more frequently than men (9/1). The peak frequency is around the age of 50. However, the disease can occur at any age, with paediatric forms occurring even though they remain rare. SD can occur alone or in association with other systemic autoimmune diseases. In its isolated or primary form, the prevalence of SD is estimated to be between 1 per 1000 and 1 per 10,000 inhabitants. The most recent classification criteria were developed in 2016 by EULAR and ACR. The course and prognosis of the disease are highly variable and depend on the presence of systemic involvement and the severity of the dryness of the eyes and mouth. The current approach is therefore to identify at an early stage those patients most at risk of systemic complications or lymphoma, who require close follow-up. On the other hand, regular monitoring of the ophthalmological damage and of the dental status should be ensured to reduce the consequences. [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.)

Les recommandations de l'European Society for Clinical Nutrition and Metabolism (ESPEN) sur la nutrition au cours des hépatopathies ont été actualisées en 2020. L'objet de cet article est de les discuter à partir de quelques vignettes cliniques. La valeur pronostique de la malnutrition est bien établie mais les recommandations de prise en charge de niveau de preuve élevé restent peu nombreuses, et beaucoup de recommandations sont basées sur des avis d'expert. Practical guidelines on clinical nutrition in liver disease from European Society for Clinical Nutrition and Metabolism (ESPEN) were updated in 2020. The purpose of this article is to discuss them from clinical cases. The prognostic value of malnutrition is well established but strong recommendations on management are scarce, and many guidelines are based on expert opinion. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence 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 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.)

La République Démocratique du Congo (RDC) a ratifié plusieurs traités qui garantissent des droits, des devoirs et créent la Commission Africaine des Droits de l’Homme et des Peuples (CADHP) ainsi que la Cour africaine des droits de l'homme et des peuples, notamment. Ces derniers sont dotés de mécanismes, rendent des décisions et adressent des recommandations concernant la République Démocratique du Congo. Ces décisions et recommandations sont généralement adressées au Gouvernement. Ce dernier décide souvent de les ignorer. L’Assemblée nationale peut contribuer à leur mise en œuvre à travers ses moyens d’information et de contrôle (question orale avec ou sans débat non suivie de vote, question écrite, question d’actualité, audition par les commissions, interpellation, commission d’enquête) et grâce aux réformes législatives. En plus, la ressemblance des missions législatives de la CADHP et du Parlement est telle que l’interaction devrait être automatique. Malheureusement, le Parlement congolais ne semble pas s’inspirer directement des décisions de la CADHP dans les réformes législatives. Voilà pourquoi nous proposons entre autres de sensibiliser les parlementaires congolais sur l’existence et les missions de la CADHP, de renforcer les capacités des membres de la Commission permanente des droits de l’homme de l’Assemblée Nationale, de continuer les réformes du système africain de protection des droits de l’homme, de sorte à crédibiliser ses mécanismes, au besoin par une lex specialis rendant ses décisions contraignantes, d’investir dans les relations interinstitutionnelles, dans un partenariat avec la CADHP.

Improving equity, diversity, and inclusion (EDI) within Canadian radiology is critical for optimal patient care and to reduce health disparities. Although there are increasing national EDI initiatives, there is a paucity of resources available to assist radiology departments as the culture of EDI evolves and faculty and institutions are expected to incorporate EDI in their practice. We present practical recommendations for radiology departments, radiology training programs, and individual radiologists wishing or mandated to improve EDI in the workplace. Actionable strategies for creating an environment that promotes EDI, attracting and supporting diverse trainees, and for how individual radiologists can be allies are presented. These EDI strategies are imperative to provide the best patient care and to strengthen the future of Canadian radiology. [ABSTRACT FROM AUTHOR]

Psychological assessment is essential before spinal cord stimulation and is a requirement of the French recommendations. The "Neuromodulation and Psychology" working group, which is part of the professional commission of psychologists of the French Society for the Study and Treatment of Pain, has carried out a literature review. He proposes a several recommendations concerning the psychological and psychopathological aspects of implanted neurostimulation with a three-stage approach: pre-implantation, after the trial phase and before the final implantation, and postimplantation. It also endeavored to propose specific clinical interview methods to grasp the representation of the equipment, the implantation, the body image, the bodily experience of pain, the functions of pain in the patient's psychic economy, the perceptions of the technique by the relatives, the impact of relief, possible cognitive disorders, the personality, thymic disorders, and personal and family history. The recommendations in this article intend to give reference points for psychological and psychopathological assessment and to promote more appropriate studies. [ABSTRACT FROM AUTHOR]

L'inertie thérapeutique est le comportement médical qui consiste à ne pas instaurer ou intensifier une prise en charge chez un patient lorsque les recommandations en vigueur le justifieraient. Notre enquête est, à notre connaissance, la première étude nationale à explorer l'inertie thérapeutique dans le rhumatisme psoriasique. Au total, 825 rhumatologues français ont été contactés entre janvier et mars 2021 pour répondre à un questionnaire en ligne composé de 7 vignettes cliniques : 5 cas (oligoarthrite, enthésite, polyarthrite, antécédent néoplasique, risque cardiovasculaire) nécessitant d'optimiser le traitement et deux cas « témoins » (arthrite distale, axiale atypique) ne nécessitant pas d'adapter le traitement. Des questions de pratique et perceptions étaient également posées. Au total, 101 rhumatologues ont participé à l'étude. Quarante-sept pour cent (n = 47) des répondants ont fait preuve au moins une fois d'inertie sur les 5 vignettes qui justifiaient une optimisation thérapeutique. Ce taux d'inertie est en accord avec les données de la littérature dans d'autres pathologies chroniques. Les profils les plus complexes (oligoarthrite et enthésite) ont induit le plus d'inertie avec, respectivement, 20 % et 19 % de répondants ne modifiant pas le traitement. Les profils pour lesquels il y avait le moins d'incertitude (polyarthrite, antécédent néoplasique et risque cardiovasculaire) ont généré le moins d'inertie avec, respectivement, 11 %, 8 % et 6 % des répondants ne modifiant pas le traitement. Notre étude est la première à montrer l'existence d'une inertie thérapeutique dans le rhumatisme psoriasique. Il convient maintenant d'explorer les raisons qui peuvent conduire le binôme médecin-patient à ne pas suivre les recommandations. [ABSTRACT FROM AUTHOR]

It has been shown that physical exercise reduced fall risk by 23–42% in community-dwelling adults aged 65+. This is particularly true for physical exercises with functional, balance and strength components. Growing evidence shows that functional training is particularly effective in reducing fall risk. Functional training is composed by exercises which reflect activities of daily life, supported by weights and other aids. [ABSTRACT FROM AUTHOR]

Résumé: Malgré la disponibilité de la culture bactérienne dans les laboratoires publics et privés, l'examen est rarement pratiqué simplement parce que la grande majorité des patients ayant une endoscopie n'ont pas de symptômes ou de maladies évocateurs de la gastrite liée à la bactérie. La découverte de H. pylori est donc le plus souvent fortuite sur des prélèvements à visée anatomo-pathologique. Deux traitements empiriques sont également envisageables : la quadrithérapie bismuthée de dix jours et la trithérapie optimisée associant amoxicilline- clarithromycine avec un IPP. Concernant la trithérapie, il paraît important de respecter une longue durée de prescription de 14 jours, des posologies d'amoxicilline de 3 g/j (ou de 50 mg/kg/j) et la prescription des certains IPP, comme l'ésoméprazole et le rabéprazole. Après un traitement empirique contenant du métronidazole à forte posologie et ou prolongé, la represcription de cet antibiotique est associée à un risque d'échec d'éradication. Le GEFH assure une réunion de concertation pluridisciplinaire composée de cliniciens, bactériologistes et pharmaciens pour des cas d'éradications difficiles de H. pylori. Despite the availability of bacterial culture in public and private laboratories, the test is rarely performed simply because most patients undergoing endoscopy have no symptoms or pathology suggestive of gastritis related to the bacteria. The discovery of H. pylori is therefore most often incidental on pathological specimens. Two empirical treatments are also possible: 10-day bismuth quadruple therapy and optimised triple therapy combining amoxicillin and clarithromycin with a PPI. In the case of triple therapy, it seems important to respect a long prescription period of 14 days, amoxicillin doses of 3G/d (or 50 mg/kg/d) and the prescription of certain PPIs, such as esomeprazole and rabeprazole. After empirical treatment with high-dose and/or prolonged metronidazole, re-prescribing this antibiotic is associated with a risk of eradication failure. The GEFH provides a multidisciplinary consultation meeting composed of clinicians, microbiologists, and pharmacists for cases of difficult eradication of H. pylori. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP, ORPHA: 90050) is the main cause of visual impairment in preterm infants and the leading preventable cause of childhood blindness in high- and middle-income countries. However, severe stages of the disease remain rare. While screening recommendations for the disease are well-established in France, management of ROP requiring treatment is less standardized, especially since new therapeutic options have been approval on this indication. The management of preterm infants requiring treatment for ROP is complex and involves a multidisciplinary team, including pediatric ophthalmologists, vitreoretinal surgeons, neonatologists, pediatric anesthetists, nurses, and orthoptists, within an adapted structure for premature infants care. There is a genuine need to unify national practices, with a strong demand from physicians involved in ROP care along the country. The objective of this National Diagnostic and Care Protocol (PNDS) is to provide guidelines for diagnostic and management for ROP, and to optimize and harmonize the management of this disease across the country. The main treatment indications, the different treatment modalities including laser photocoagulation, anti-VEGF injections, and vitreoretinal surgery as well as follow-up calendar, are reviewed to establish the best practice recommendations on ROP., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Fetal death is defined as the spontaneous cessation of cardiac activity after fourteen weeks of amenorrhea. In France, the prevalence of fetal death after 22 weeks is between 3.2 and 4.4/1000 births. Regarding the prevention of fetal death in the general population, it is not recommended to counsel for rest and not to prescribe vitamin A, vitamin D nor micronutrient supplementation for the sole purpose of reducing the risk of fetal death (Weak recommendations; Low quality of evidence). It is not recommended to prescribe aspirin (Weak recommendation; Very low quality of evidence). It is recommended to offer vaccination against influenza in epidemic periods and against SARS-CoV-2 (Strong recommendations; Low quality of evidence). It is not recommended to systematically look for nuchal cord encirclements during prenatal screening ultrasounds (Strong Recommendation; Low Quality of Evidence) and not to perform systematic antepartum monitoring by cardiotocography (Weak Recommendation; Very Low Quality of Evidence). It is not recommended to ask women to perform an active fetal movement count to reduce the risk of fetal death (Strong Recommendation; High Quality of Evidence). Regarding evaluation in the event of fetal death, it is suggested that an external fetal examination be systematically offered (Expert opinion). It is recommended that a fetopathological and anatomopathological examination of the placenta be carried out to participate in cause identification (Strong Recommendation. Moderate quality of evidence). It is recommended that chromosomal analysis by microarray testing be performed rather than conventional karyotype, in order to be able to identify a potentially causal anomaly more frequently (Strong Recommendation, moderate quality of evidence); to this end, it is suggested that postnatal sampling of the placental fetal surface for genetic purposes be preferred (Expert Opinion). It is suggested to test for antiphospholipid antibodies and systematically perform a Kleihauer test and a test for irregular agglutinins (Expert opinion). It is suggested to offer a summary consultation, with the aim of assessing the physical and psychological status of the parents, reporting the results, discussing the cause and providing information on monitoring for a subsequent pregnancy (Expert opinion). Regarding announcement and support, it is suggested to announce fetal death without ambiguity, using simple words and adapting to each situation, and then to support couples with empathy in the various stages of their care (Expert opinion). Regarding management, it is suggested that, in the absence of a situation at risk of disseminated intravascular coagulation or maternal vitality, the patient's wishes should be taken into account when determining the time between the diagnosis of fetal death and induction of birth. Returning home is possible if it's the patient wish (Expert opinion). In all situations excluding maternal life-threatening emergencies, the preferred mode of delivery is vaginal delivery, regardless the history of cesarean section(s) history (Expert opinion). In the event of fetal death, it is recommended that mifepristone 200mg be prescribed at least 24hours before induction, to reduce the delay between induction and delivery (Low recommendation. Low quality of evidence). There are insufficient data in the literature to make a recommendation regarding the route of administration (vaginal or oral) of misoprostol, neither the type of prostaglandin to reduce induction-delivery time or maternal morbidity. It is suggested that perimedullary analgesia be introduced at the start of induction if the patient asks, regardless of gestational age. It is suggested to prescribe cabergoline immediately in the postpartum period in order to avoid lactation, whatever the gestational age, after discussing the side effects of the treatment with the patient (Expert opinion). The risk of recurrence of fetal death after unexplained fetal death does not appear to be increased in subsequent pregnancies, and data from the literature are insufficient to make a recommendation on the prescription of aspirin. In the event of a history of fetal death due to vascular issues, low-dose aspirin is recommended to reduce perinatal morbidity, and should not be combined with heparin therapy (Low recommendation, very low quality of evidence). It is suggested not to recommend an optimal delay before initiating another pregnancy just because of the history of fetal death. It is suggested that the woman and co-parent be informed of the possibility of psychological support. Fetal heart rate monitoring is not indicated solely because of a history of fetal death. It is suggested that delivery not be systematically induced. However, induction can be considered depending on the context and parental request. The gestational age will be discussed, taking into account the benefits and risks, especially before 39 weeks. If a cause of fetal death is identified, management will be adapted on a case-by-case basis (expert opinion). In the event of fetal death occurring in a twin pregnancy, it is suggested that the surviving twin be evaluated as soon as the diagnosis of fetal death is made. In the case of dichorionic pregnancy, it is suggested to offer ultrasound monitoring on a monthly basis. It is suggested not to deliver prematurely following fetal death of a twin. If fetal death occurs in a monochorionic twin pregnancy, it is suggested to contact the referral competence center, in order to urgently look for signs of acute fetal anemia on ultrasound in the surviving twin, and to carry out weekly ultrasound monitoring for the first month. It is suggested not to induce birth immediately., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Management of acquired aplastic anemia (AA) in emerging countries depends on the means of prognostic stratification, treatment and logistics available. During the 13th annual harmonization workshop of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines for allogeneic hematopoietic cell transplantation (Allo-HCT) in this disease. In terms of practice, the conclusions are as follows; The use of anti-tymocyte globuline (ATG) is mainly from rabbit and very little from horse. Access to bone marrow graft, total body irradiation, and the international unrelated donor registries is limited, which justifies the use of peripheral blood stem cells, chemotherapy-based conditioning, and related alternative donor. The workshop recommends matched sibling allo-HCT in all patients aged less than 40 years with acquired severe or very severe AA. For patients aged over than 40 years, or who lack an HLA-identical donor, treatment with the combination of cyclosporin, horse ATG, eltrombopag or cyclosporine, eltrombopag is recommended. If horse ATG and eltrombopag are not available, matched sibling allo-HCT may be indicated as first-line therapy in patients aged between 40-60 years, and good performance status. Although, in patients who have failed immunosuppressive treatments and thrombopoietin agonists, and in the absence of HLA-matched donor, a haplo-identical allo-HCT with modified Baltimore conditioning is recommended., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

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]

L’ostéoporose est une maladie fréquente, liée à l’âge. Elle touche préférentiellement les femmes notamment après la ménopause. Près d’une femme ménopausée sur deux sera victime d’une fracture liée à l’ostéoporose, C’est une pathologie qui est largement sous-estimée dans la population générale. L'ostéoporose rend les os poreux et plus fragiles et augmente ainsi le risque de fracture à la moindre chute ou choc. Elle peut évoluer en l’absence de prise en charge adéquate vers des fractures qui peuvent être graves pouvant entraîner une grande perte d’autonomie voire le décès. La prise en charge de cette pathologie comporte 3 axes, des mesures hygiéno-diététiques, une correction d’un déficit vitamino-D-calcique, et des traitements médicamenteux spécifiques de l’ostéoporose. L’objet de notre travail est de compiler à travers une revue de la littérature les connaissances actuelles les plus pertinentes concernant l’ostéoporose, que ce soit en ce qui concerne ses facteurs de risques, que ses conséquences cliniques en termes de morbimortalité, son coût socio-économique. Il est aussi question ici de faire une revue des traitements efficaces, et de sensibiliser sur l’ostéoporose et ses conséquences auprès de la population et des professionnels de santé.

Actualisation des recommandations de la Société française de rhumatologie (SFR) pour la prise en charge en pratique courante des malades atteints de spondyloarthrite, incluant le rhumatisme psoriasique. Suivant les procédures standardisées, une revue systématique de la littérature, effectuée par 4 rhumatologues juniors supervisés, à partir des questions individualisées par le groupe de travail (16 rhumatologues séniors), a servi de base à trois réunions de travail, avec détermination de la force des recommandations et du degré d'accord des experts. Cinq principes généraux et 15 groupes de recommandations ont été élaborés. Ils prennent en compte les aspects non pharmacologiques et pharmacologiques ainsi que les modalités de la prise en charge, en fonction de la présentation phénotypique dominante (axiale, articulaire, enthésite/dactylite) et des manifestations extra-rhumatologiques (psoriasis, maladie inflammatoire de l'intestin, uvéite). Les AINS représentent le traitement pharmacologique de première intention dans les différentes présentations. Les traitements d'action lente conventionnels (csDMARDs) ne sont pas indiqués dans les formes axiales et enthésitiques isolées. En cas de réponse inadéquate au traitement conventionnel, les traitements ciblés (biologiques, synthétiques) sont à envisager avec des indications différentes selon le type de présentation et la présence de manifestations extra-rhumatologiques. Cette mise à jour tient compte des données de la littérature (disponibles depuis la précédente révision publiée en 2018) et de la présentation clinique prédominante. Elle a vocation à aider le médecin dans la prise en charge en pratique quotidienne de patients atteints de spondyloarthrite, incluant le rhumatisme psoriasique. [ABSTRACT FROM AUTHOR]

• Il s'agit des premières recommandations sur l'alimentation des patients ayant un rhumatisme inflammatoire chronique • Ces recommandations ont été établies par un groupe de travail pluridisciplinaire et ont abouti à 8 principes généraux et 9 recommandations. • Les recommandations proposent l'accompagnement vers une perte de poids pour les sujets présentant un excès pondéral, une alimentation de type méditerranéen et une supplémentation en oméga-3, à visée symptomatique. • Le régime sans gluten, le régime végétalien/végétarien, le jeûne, l'éviction des produits laitiers ne devraient pas être proposés. • Des études méthodologiquement solides doivent être menées afin de clarifier l'intérêt de certaines pratiques alimentaires à l'efficacité non démontrée mais fréquemment essayées par les patients. Cet article présente les 1res recommandations de la Société française de rhumatologie sur l'alimentation des patients ayant un rhumatisme inflammatoire chronique (RIC) réalisées par un groupe de travail constitué de 12 experts rhumatologues, 3 médecins nutritionnistes, 1 médecin interniste, 1 diététicienne et 3 représentants des associations de patients. Ce groupe s'est appuyé sur une analyse systématique de la littérature et sur des avis d'experts, en prenant en compte à la fois les effets articulaires de l'alimentation dans les RIC, mais aussi ses effets extra-articulaires. Huit principes généraux et 9 recommandations ont été émis. Les principes généraux mettent en avant que les conseils nutritionnels ne doivent pas se substituer au traitement pharmacologique des RIC et font partie intégrante de la prise en charge globale des patients, pouvant notamment permettre au patient de s'impliquer activement dans sa prise en charge. Les recommandations proposent l'accompagnement vers une perte de poids pour les sujets en surpoids ou avec une obésité, une alimentation de type méditerranéen et une supplémentation en acides gras polyinsaturés principalement oméga-3. À l'inverse, le régime sans gluten (en l'absence de maladie cœliaque), le régime végétalien/végétarien, le jeûne, l'éviction des produits laitiers ne devraient pas être proposés. Les supplémentations en vitamines ou oligoéléments ne sont pas indiquées pour contrôler l'activité du RIC et l'utilisation de probiotiques ou d'épices n'est pas conseillée du fait de données hétérogènes ou limitées. [ABSTRACT FROM AUTHOR]

Informations concernant cette traduction Dans le cadre d’un accord de partenariat entre l’ISPD et le RDPLF, le RDPLF est le traducteur français officiel des recommandations de l’ISPD. La traduction ne donne lieu à aucune compensation financière de la part de chaque société et le RDPLF s’est engagé à traduire fidèlement le texte original sous la responsabilité de deux néphrologues connus pour leur expertise dans le domaine. Avant publication le texte a été soumis à l’accord de l’ISPD. La traduction est disponible sur le site de l’ISPD et dans le Bulletin de la Dialyse à Domicile. Le texte est, comme l’original, libremement téléchargeable sous licence copyright CC By 4.0 https://creativecommons.org/licenses/by/4.0/ Cette traduction est destinée à aider les professionnels de la communauté francophone à prendre connaissance des recommandations de l’ISPD dans leur langue maternelle.

We present the updated recommendations of the French society for radiation oncology on radiotherapy of oesophageal cancer. Oesophageal cancer still remains a malignant tumour with a poor prognosis. Surgery remains the standard treatment for localized cancers, regardless of histology. For locally advanced stages, surgery remains a standard for adenocarcinomas after neoadjuvant treatment with chemotherapy or chemoradiotherapy. However, it is a therapeutic option after initial chemoradiotherapy for stage III squamous cell carcinomas, given the increased morbidity and mortality with a multimodal treatment, which results in an equivalent overall survival with or without surgery. Preoperative or exclusive chemoradiotherapy should be delivered according to validated regimens with an effective total dose (50 Gy), if surgery is not planned or if the tumour is deemed resectable before chemoradiotherapy. Intensity-modulated radiotherapy significantly reduces irradiation of the lungs and heart and may reduce the morbidity of this treatment, especially in combination with surgery. In case of exclusive chemoradiotherapy, dose escalation beyond 50 Gy is not currently recommended. Some technical considerations still remain questionable, such as the place of prophylactic lymph node irradiation, adaptive radiotherapy, evaluation of response during and after chemoradiotherapy and the value of proton therapy. [ABSTRACT FROM AUTHOR]

We present the update of the recommendations of the French s ociety of radiation oncology on soft tissue sarcomas. Currently, the initial management of sarcomas is very important as it may impact on patients' quality of life, especially in limb soft tissue sarcomas, and on overall survival in trunk sarcomas. Radiotherapy has to be discussed within a multidisciplinary board meeting with results of biopsy, eventually reexamined by a dedicated sarcoma pathologist. The role of radiotherapy varies according to localization of soft tissue sarcoma. It is part of the standard treatment in grade 2 and 3 sarcomas of the extremities and superficial trunk > 5 cm. In case of R1 or R2 resection, reexcision should be discussed. In such cases, it may be delivered preoperatively (50 Gy/25 fractions of 2 Gy) or postoperatively. In retroperitoneal sarcomas, preoperative conformal radiotherapy with or without modulated intensity cannot be proposed systematically in daily practice. Concomitant chemoradiotherapy cannot be considered a standard treatment. Intensity-modulated radiotherapy has become widely available. Other soft tissue sarcoma sites such as trunk, head and neck and gynaecological soft tissue sarcomas will be addressed, as well as other techniques that may be used such as brachytherapy and proton therapy. [ABSTRACT FROM AUTHOR]

We present the update of the recommendations of the French society of oncological radiotherapy on bone metastases. This is a common treatment in the management of patients with cancer. It is a relatively simple treatment with proven efficacy in reducing pain or managing spinal cord compression. More complex treatments by stereotaxis can be proposed for oligometastatic patients or in case of reirradiation. In this context, increased vigilance should be given to the risks to the spinal cord. [ABSTRACT FROM AUTHOR]

We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of cutaneous cancers. The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomized trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and located in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70 Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50 Gy), for locally advanced tumors (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radio- therapy (50 to 56 Gy) for Merkel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30 Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules. [ABSTRACT FROM AUTHOR]

A third of children with cancer receive radiotherapy as part of their initial treatment, which represents 800 paediatric irradiations per year in France carried out in 15 specialized centres approved on the recommendations of the French national cancer institute in decreasing order of frequency, the types of cancer that require irradiation are: brain tumours, neuroblastomas, Ewing's sarcomas, Hodgkin's lymphomas, soft tissue sarcomas including rhabdomyosarcomas, and nephroblastomas. The treatment guidelines follow the recommendations of the French society for childhood cancers (SFCE) or the French and European prospective protocols. The therapeutic indications, the technical and/and ballistic choices of complex cases are frequently discussed during bimonthly paediatric radiotherapy technical web-conferences. All cancers combined, overall survival being 80%, long-term toxicity logically becomes an important concern, making the preparation of treatments complex. The irradiation methods include all the techniques currently available: 3D conformational irradiation, intensity modulation radiation therapy, irradiation under normal or hypofractionated stereotaxic conditions, brachytherapy and proton therapy. We present the update of the recommendations of the French society for radiation oncology on the indications, the technical methods of realization and the organisation and the specificities of paediatric radiation oncology. [ABSTRACT FROM AUTHOR]

Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose–constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up. [ABSTRACT FROM AUTHOR]

The number of patients with metallic implant and treated with radiotherapy is constantly increasing. These hardware are responsible for the deterioration in the quality of the CT images used at each stage of the radiation therapy, during delineation, dosimetry and dose delivery. We present the update of the recommendations of the French society of oncological radiotherapy on the pros and cons of the different methods, existing and under evaluation, which limit the impact of metallic implants on the quality and safety of radiation treatments. [ABSTRACT FROM AUTHOR]

Primary vaginal cancers are rare tumours, for which external beam radiotherapy and brachytherapy are major treatment tools. Given the complexity of brachytherapy techniques, the treatment should be performed in specialised centres. We present the recommendations of the French society for radiation oncology on the indications and techniques for external beam radiotherapy and brachytherapy for primary vaginal cancer. [ABSTRACT FROM AUTHOR]

We present the recommendations of the French society of oncological radiotherapy on the indications and techniques for external beam radiotherapy for bladder cancer. [ABSTRACT FROM AUTHOR]