The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death

BACKGROUND

Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer.

METHODS

The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience.

DISCUSSION

The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted.

TRIAL REGISTRATION

This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.

Malocclusion prevention through the usage of an orthodontic pacifier compared to a conventional pacifier: a systematic review

AIM

This was to investigate the occurrence of malocclusion traits among children who were users of orthodontic or conventional pacifier by means of a systematic review.

METHODS

Search for articles involved five electronic databases: Latin American and Caribbean Health Sciences (LILACS), PsycINFO, PubMed (including MedLine), Scopus and Web of Science. Grey literature was partially assessed. Observational studies with children aged 6-60 months who had used orthodontic or conventional pacifier were included. The risk of bias among included studies was assessed through the Joanna Briggs Institute Tool.

RESULTS

From the 607 initially-identified papers only three were included after the selection process. All presented moderate risk of bias. Although an anterior open bite and accentuated overjet were identified among conventional users of pacifier in one study no differences were identified in the other two selected studies. Posterior crossbite frequency was not different in any of the included studies. There was also no difference regarding frequency and duration of use, except in the study that showed higher occurrence of open bite malocclusion in conventional pacifier users.

CONCLUSIONS

The currently available evidence is insufficient to support the concept that the usage of orthodontic pacifiers is able to prevent malocclusion traits when compared to the usage of conventional pacifiers.

Prevalence of enamel defects and association with dental caries in preschool children

AIM

This was to evaluate the prevalence of the developmental defects of enamel (DDE) in primary teeth and its association with dental caries.

METHODS

A cross-sectional study with a randomised representative sample was carried out with 1101 children aged 2-5 years enrolled in public preschools (50% prevalence of DDE in primary teeth, a standard error of 3%, and a confidence level of 95%). Three calibrated dentists (K > 0.62) performed clinical examination. Data collected were: sex, age, DDE (Modified DDE Index) and dental caries (WHO). Descriptive analysis, Chi-square test and multinomial logistic regression were applied for data analysis.

RESULTS

Among children, 565 (51.3%) were boys; mean age was 3.7 (±0.9 years). The prevalence of enamel defect was 39.1%; the prevalence of diffuse opacities, demarcated opacities and enamel hypoplasia was 25.3, 19.1 and 6.1%, respectively. The prevalence of dental caries was 31.0%, with mean def-t 1.14 (±2.44). Primary teeth with enamel hypoplasia had three times the odds of having dental caries than those with absence of enamel defects (OR = 3.10; 95% CI: 1.91, 5.01).

CONCLUSION

The presence of enamel defects was moderate and associated with dental caries.

Hemangioendothelioma of the lung and pleura: report of three cases

Three patients with hemangioendothelioma of the lung and pleura are reported. Two patients underwent removal of the pulmonary lesion: both recovered and were alive one year and eight years later. The patient with pleural involvement had a radical excision of the pleura with the vascular tumor. He died almost two years later. The main histologic feature of this lesion is the presence of neoplastic cells within the endothelium, evidenced by reticulin silver stain.