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Sharshar T, Grimaldi-Bensouda L, Siami S, Cariou A, Salah AB, Kalfon P, Sonneville R, Meunier-Beillard N, Quenot JP, Megarbane B, Gaudry S, Oueslati H, Robin-Lagandre S, Schwebel C, Mazeraud A, Annane D, Nkam L, Friedman D. A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year. Intensive Care Med 2024; 50:665-677. [PMID: 38587553 DOI: 10.1007/s00134-024-07359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Critical illness is associated with long-term increased mortality and impaired quality of life (QoL). We assessed whether multidisciplinary consultations would improve outcome at 12 months (M12) after intensive care unit (ICU) discharge. METHODS We performed an open, multicenter, parallel-group, randomized clinical trial. Eligible are patients discharged alive from ICU in 11 French hospitals between 2012 and 2018. The intervention group had a multidisciplinary face-to-face consultation involving an intensivist, a psychologist, and a social worker at ICU discharge and then at M3 and M6 (optional). The control group had standard post-ICU follow-up. A consultation was scheduled at M12 for all patients. The QoL was assessed using the EuroQol-5 Dimensions-5 Level (Euro-QoL-5D-5L) which includes five dimensions (mobility, self-care, usual activities, pain, and anxiety/depression), each ranging from 1 to 5 (1: no, 2: slight, 3: moderate, 4: severe, and 5: extreme problems). The primary endpoint was poor clinical outcome defined as death or severe-to-extreme impairment of at least one EuroQoL-5D-5L dimension at M12. The information was collected by a blinded investigator by phone. Secondary outcomes were functional, psychological, and cognitive status at M12 consultation. RESULTS 540 patients were included (standard, n = 272; multidisciplinary, n = 268). The risk for a poor outcome was significantly greater in the multidisciplinary group than in the standard group [adjusted odds ratio 1.49 (95% confidence interval, (1.04-2.13)]. Seventy-two (13.3%) patients died at M12 (standard, n = 32; multidisciplinary, n = 40). The functional, psychological, and cognitive scores at M12 did not statistically differ between groups. CONCLUSIONS A hospital-based, face-to-face, intensivist-led multidisciplinary consultation at ICU discharge then at 3 and 6 months was associated with poor outcome 1 year after ICU.
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Affiliation(s)
- Tarek Sharshar
- Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Paris, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France.
| | - Lamiae Grimaldi-Bensouda
- Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, UMR1018 Anti-Infective Evasion and Pharmacoepidemiology Team, University of Versailles Saint-Quentin en Yvelines, INSERM, Versailles, France
| | - Shidasp Siami
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris Paris-Cardiovascular-Research-Center, INSERM U970, 75014, Paris, France
| | - Abdel Ben Salah
- Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France
| | - Pierre Kalfon
- Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France
| | - Romain Sonneville
- France Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Université de Paris, INSERM UMR1148, Team 6, 7501875018, Paris, France
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital: INSERM LNC-UMR1231, INSERM CIC 1432, Clinical Epidemiology University of Burgundy, Dijon, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Stephane Gaudry
- Réanimation Médico-Chirurgicale, Louis Mourier Hospital, Assistance-Publique-Hôpitaux de Paris, 92700, Colombes, France
- Université de Paris. Epidémiologie Clinique-Évaluation Économique Appliqué Aux Populations Vulnérables (ECEVE, INSERM et, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425, Paris, France
| | - Haikel Oueslati
- Department of Anesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisiere University Hospitals, 75010, Paris, France
| | - Segolene Robin-Lagandre
- Anesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, Université de Paris, 75015, Paris, France
| | - Carole Schwebel
- UJF-Grenoble I, Medical Intensive Care Unit, University Hospital Albert Michallon, 38041, Grenoble, France
| | - Aurelien Mazeraud
- Anesthesia and Intensive Care Department, Département Neurosciences, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institut Pasteur, Unité Perception et Mémoire, Université de Paris, Paris, France
| | - Djillali Annane
- General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France
| | - Lionelle Nkam
- Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Diane Friedman
- General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France
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Le Roux E, Meunier-Beillard N, Simonel C, Omorou A, Lejeune C. Spouses of patients treated for colon cancer: identification of key caregiver skills using the Delphi method. Support Care Cancer 2024; 32:263. [PMID: 38564042 DOI: 10.1007/s00520-024-08456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Spouses are often the front-line caregivers for colon cancer patients. Providing this support requires a particular set of coping skills. Our objective was to identify key skills that healthcare and medico-social sector professionals could assess in routine practice that would allow them to propose appropriate support to spouses who are accompanying colon cancer patients in their care pathway. METHODS An online two-round Delphi study was conducted among French colon cancer patients, spouses and professionals. The content of the Delphi study was developed from a previously published qualitative study. RESULTS In the first round of the study, 63% of the participants were professionals (n = 40), 19% spouses (n = 12) and 17% patients (n = 11). In the second round, they were respectively 55% (n = 22), 22% (n = 9) and 22% (n = 9). Twenty-seven of the 75 proposed skills were consensually identified as key skills. Nine were related to emotional and psychological well-being, six to social relations, four to organisation, five to health and three to domestic domains. The three most consensual skills (≥ 90% agreement) for spouses were (1) helping the tired patient in everyday life, (2) stimulating the patient to prevent him/her from giving up and (3) limiting one's amount of personal time to care for the patient. CONCLUSION The study identified the key skills needed by spouses of patients being treated for colon cancer. Better awareness of these skills among professionals would enable them to offer tailored support to help patients and spouses maintain their physical and emotional well-being.
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Affiliation(s)
- Enora Le Roux
- Université Paris Cité, Inserm, ECEVE, F-75010, Paris, France
- AP-HP Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'épidémiologie clinique, Inserm, CIC 1426, Paris, France
| | - Nicolas Meunier-Beillard
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l'Innovation, USMR, Dijon, France
| | - Caroline Simonel
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Abdou Omorou
- Université de Lorraine, CHRU Nancy, Inserm CIC 1433 Clinical Epidemiology, Nancy, France
- 1319 UMR INSPIIRE, Inserm, Université de Lorraine, Nancy, France
- The French National Platform Quality of Life and Cancer, Nancy, France
| | - Catherine Lejeune
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.
- Inserm, Université Bourgogne-Franche-Comté, UMR 1231, EPICAD, Dijon, France.
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Correction: Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study. Intensive Care Med 2023; 49:1438-1439. [PMID: 37755457 PMCID: PMC10622337 DOI: 10.1007/s00134-023-07217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
| | - Isabelle Fournel
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | | | - Eléa Ksiazek
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Martine Nyunga
- Service de Médecine Intensive Réanimation, CH de Roubaix, Roubaix, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | | | - Bertrand Sauneuf
- Service de Médecine Intensive Réanimation, CH Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hopital Nord Franche-Comte, Trevenans, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHRU Roger Salengro, Lille, France
- Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Elise Artaud-Macari
- University of Normandie, UNIROUEN, EA3830, CHU Rouen, Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen, France
| | - Vanessa Bironneau
- Service de Pneumologie, CHU Poitiers, Poitiers, France
- INSERM CIC 1402, ALIVES Research Group, Université de Poitiers, Poitiers, France
| | - Michel Ramakers
- Service de Médecine Intensive Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lô, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU d'Amiens, Amiens, France
| | | | - Béatrice Lacombe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | | | - Walid Oulehri
- Service de Réanimation Chirurgicale, CHRU Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive Réanimation, CH de Tourcoing, Tourcoing, France
| | - Xavier Tchenio
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | | | - Elise Redureau
- Service de Pneumologie, CHD Vendée, La Roche-sur-Yon, France
| | - Gaël Bourdin
- Service de Réanimation Polyvalente, CH Saint Joseph Saint Luc, Lyon, France
| | - Laura Federici
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Mélanie Adda
- Service de Médecine Intensive Réanimation, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d'Angoulême, Angoulême, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirugicale, Groupe Hospitalier du Havre, Le Havre, France
| | | | - Thierry Vanderlinden
- Intensive Care Unit, St Philibert hospital, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Gaëtan Plantefeve
- Service de Médecine Intensive Réanimation, CH d'Argenteuil, Argenteuil, France
| | - David Delacour
- Service de radiologie, Clinique du Cèdre, Bois-Guillaume, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive Réanimation, CHES Evreux, Evreux, France
| | - Nicholas Sedillot
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | - Gaëtan Beduneau
- Normandie Univ, UNIROUEN, UR3830, CHU Rouen, Department of Medical Intensive Care, 76000, Rouen, France
| | - Antoine Rivière
- Service de Réanimation Polyvalente, CH d'Abbeville, Abbeville, France
| | - Nicolas Meunier-Beillard
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Ethique de Normandie, CHU Caen, Caen, France
| | - Marie Labruyère
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France.
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
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Guillermet É, Meunier-Beillard N, Costa M, Defaut M, Millot I, Demassiet V, Roelandt JL, Denis F. Building an empowerment program to improve the health of patients with severe mental disorders. Sante Publique 2023; 35:261-270. [PMID: 37848373 DOI: 10.3917/spub.233.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Introduction Risk factors and cardiovascular diseases are overrepresented in people with severe and persistent mental disorders. A person diagnosed with schizophrenia or bipolar disorder is two to three times more likely to die of cardiovascular disease than the general population. Purpose of research An empowerment program has been co-created to reduce these health inequalities. It is one part of the COPsyCAT project. The people-centered approach has been used. The participation of the patients, caregivers, and health professionals was decisive. Results Stakeholders redefined the objectives of the program. The aim is to improve quality of life, rather than reducing cardiovascular risk. Existing tools -that have been evaluated for their usability - were selected to allow for self-directed patient orientation, so that the constraints between psychiatry and primary care could be circumvented. The program is based on the pooling of existing resources in a territory. The individual power of action and the organization of healthy offers are thus designed to reinforce each other. Conclusions This article concretely describes the steps through to which the COPsyCAT empowerment program was designed, in co-construction by the researchers of the study, the users and user associations and healthcare professionals at based on their experiential knowledge. The feasibility of the program and the appropriation of tools in real situations will soon be evaluated. The measure of the program’s effectiveness on cardiovascular risk will come in second time.
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Affiliation(s)
- Élise Guillermet
- Instance régionale d’éducation et de promotion de la santé – Dijon – France
| | - Nicolas Meunier-Beillard
- CHU François-Mitterrand – Délégation à la recherche clinique et à l’innovation – Dijon – France
- Inserm CIC 1432 Module Épidémiologie clinique – Dijon – France
| | - Marie Costa
- EPSM Lille-Métropole – WHO Collaborating Centre for Research and Training in Mental Health – Hellemmes – France
- EPSM Lille-Métropole – Armentières – France
- INSERM – UMR 1123 – ECEVE Faculté de médecine Paris Diderot Paris 7 – Site Villemin – Paris – France
| | - Marion Defaut
- Instance régionale d’éducation et de promotion de la santé – Dijon – France
| | - Isabelle Millot
- Instance régionale d’éducation et de promotion de la santé – Dijon – France
| | - Vincent Demassiet
- EPSM Lille-Métropole – WHO Collaborating Centre for Research and Training in Mental Health – Hellemmes – France
| | - Jean-Luc Roelandt
- EPSM Lille-Métropole – WHO Collaborating Centre for Research and Training in Mental Health – Hellemmes – France
- EPSM Lille-Métropole – Armentières – France
- INSERM – UMR 1123 – ECEVE Faculté de médecine Paris Diderot Paris 7 – Site Villemin – Paris – France
| | - Frédéric Denis
- EPSM Lille-Métropole – WHO Collaborating Centre for Research and Training in Mental Health – Hellemmes – France
- Clinical Research Unit – La Chartreuse Psychiatric Centre – Dijon – France
- EA 75-05 Éducation Éthique Santé – Faculté de médecine – Université François-Rabelais – Tours – France
- Faculté d’odontologie – Université de Nantes – Nantes – France
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study. Intensive Care Med 2023; 49:1168-1180. [PMID: 37620561 PMCID: PMC10556111 DOI: 10.1007/s00134-023-07180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS. METHODS We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography. RESULTS Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]). CONCLUSIONS In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge.
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Affiliation(s)
| | - Isabelle Fournel
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | | | - Eléa Ksiazek
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Martine Nyunga
- Service de Médecine Intensive Réanimation, CH de Roubaix, Roubaix, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | | | - Bertrand Sauneuf
- Service de Médecine Intensive Réanimation, CH Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hopital Nord Franche-Comte, Trevenans, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHRU Roger Salengro, Lille, France
- Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Elise Artaud-Macari
- University of Normandie, UNIROUEN, EA3830, CHU Rouen, Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen, France
| | - Vanessa Bironneau
- Service de Pneumologie, CHU Poitiers, Poitiers, France
- INSERM CIC 1402, ALIVES Research Group, Université de Poitiers, Poitiers, France
| | - Michel Ramakers
- Service de Médecine Intensive Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lô, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU d’Amiens, Amiens, France
| | | | - Béatrice Lacombe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | | | - Walid Oulehri
- Service de Réanimation Chirurgicale, CHRU Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive Réanimation, CH de Tourcoing, Tourcoing, France
| | - Xavier Tchenio
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | | | - Elise Redureau
- Service de Pneumologie, CHD Vendée, La Roche-sur-Yon, France
| | - Gaël Bourdin
- Service de Réanimation Polyvalente, CH Saint Joseph Saint Luc, Lyon, France
| | - Laura Federici
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Mélanie Adda
- Service de Médecine Intensive Réanimation, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d’Angoulême, Angoulême, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirugicale, Groupe Hospitalier du Havre, Le Havre, France
| | | | - Thierry Vanderlinden
- Intensive Care Unit, St Philibert hospital, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Gaëtan Plantefeve
- Service de Médecine Intensive Réanimation, CH d’Argenteuil, Argenteuil, France
| | - David Delacour
- Service de radiologie, Clinique du Cèdre, Bois-Guillaume, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive Réanimation, CHES Evreux, Evreux, France
| | - Nicholas Sedillot
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | - Gaëtan Beduneau
- Normandie Univ, UNIROUEN, UR3830, CHU Rouen, Department of Medical Intensive Care, 76000 Rouen, France
| | - Antoine Rivière
- Service de Réanimation Polyvalente, CH d’Abbeville, Abbeville, France
| | - Nicolas Meunier-Beillard
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Ethique de Normandie, CHU Caen, Caen, France
| | - Marie Labruyère
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Mathey L, Jacquier M, Meunier-Beillard N, Andreu P, Roudaut JB, Labruyère M, Rigaud JP, Quenot JP, Ecarnot F. ICU stays that are judged to be non-beneficial: A qualitative study of the perception of nursing staff. PLoS One 2023; 18:e0289954. [PMID: 37561766 PMCID: PMC10414562 DOI: 10.1371/journal.pone.0289954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Non-beneficial stays in the intensive care unit (ICU) may have repercussions for patients and their families, but can also cause suffering among the nursing staff. We aimed explore the perceptions of nursing staff in the ICU about patient stays that are deemed to be "non-beneficial" for the patient, to identify areas amenable to intervention, with a view to improving how the nursing staff perceive the patient pathway before, during and after intensive care. METHODS Multicentre, qualitative study using individual, semi-structured interviews. All qualified nurses and nurses' aides who were full-time employees in the ICU of three participating centres were invited to participate. Interviews were recorded, transcribed and analyzed using textual content analysis. RESULTS A total of 21 interviews were performed from February 2020 to October 2021, at which point saturation was reached in the data. Average age of participants was 38.5±7.5 years, and they had an average of 10.7±7.4 years of experience working in the ICU. Four major themes emerged from the interviews, namely: (1) the work is oriented towards life-threatening emergencies, technical procedures and burdensome care; (2) a range of specific criteria and circumstances influence the decisions to admit patients to ICU; (3) there are significant organisational, physical and psychological repercussions associated with a non-beneficial stay in the ICU; (4) respondents made some proposals for improvements to the patient care pathway. CONCLUSION Nursing staff have a similar perception to physicians regarding admission decisions and non-beneficial ICU stays. The possibility of future ICU admission needs to be anticipated, discussed systematically with patients and integrated into healthcare goals that are consistent with the patient's wishes and preferences, in multi-professional collaboration including nursing and medical staff.
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Affiliation(s)
- Lucas Mathey
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | - Marine Jacquier
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Pascal Andreu
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | | | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
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Friedman D, Grimaldi L, Cariou A, Aegerter P, Gaudry S, Ben Salah A, Oueslati H, Megarbane B, Meunier-Beillard N, Quenot JP, Schwebel C, Jacob L, Robin Lagandré S, Kalfon P, Sonneville R, Siami S, Mazeraud A, Sharshar T. Correction: Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47929. [PMID: 37058710 PMCID: PMC10148211 DOI: 10.2196/47929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023] Open
Abstract
[This corrects the article DOI: 10.2196/30496.].
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Affiliation(s)
- Diane Friedman
- Raymond Poincaré Hospital, Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Lamiae Grimaldi
- U1018 Université Versailles, Saint Quentin en Yvelines-INSERM Unité 1018, Groupe Interrégional de Recherche Clinique er d'Innovation, Île-de-France, France
| | - Alain Cariou
- Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Philippe Aegerter
- U1018 Université Versailles, Saint Quentin en Yvelines-INSERM Unité 1018, Groupe Interrégional de Recherche Clinique er d'Innovation, Île-de-France, France
| | - Stéphane Gaudry
- Louis Mourier Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Colombes, France
| | | | - Haikel Oueslati
- Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Bruno Megarbane
- Lariboisière Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Meunier-Beillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1432, Module Epidémiologie Clinique, CHU Dijon Bourgogne, France;, Dijon, France
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), Unité de Soutien Méthodologique à la Recherche, CHU Dijon Bourgogne, France, Dijon, France
| | - Jean-Pierre Quenot
- François Mitterrand University Hospital, University of Burgundy, Dijon, France
| | | | - Laurent Jacob
- Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ségloène Robin Lagandré
- Georges Pompidou Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | - Romain Sonneville
- Bichat Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | - Aurelien Mazeraud
- GHU-Paris Psychiatrie & Neurosciences, Sainte-Anne Hospital, Université de Paris, Paris, France
| | - Tarek Sharshar
- GHU-Paris Psychiatrie & Neurosciences, Sainte-Anne Hospital, Université de Paris, Paris, France
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Bardou M, Meunier-Beillard N, Godard-Marceau A, Deruelle P, Virtos C, Eckman-Lacroix A, Debras E, Schmitz T. Women and health professionals' perspectives on a conditional cash transfer programme to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomised controlled study. BMJ Open 2023; 13:e067066. [PMID: 36990483 PMCID: PMC10069550 DOI: 10.1136/bmjopen-2022-067066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Women of low socioeconomic status have been described as having suboptimal prenatal care, which in turn has been associated with poor pregnancy outcomes. Many types of conditional cash transfer (CCT) programmes have been developed, including programmes to improve prenatal care or smoking cessation during pregnancy, and their effects demonstrated. However, ethical critiques have included paternalism and lack of informed choice. Our objective was to determine if women and healthcare professionals (HPs) shared these concerns. DESIGN Prospective qualitative research. SETTING We included economically disadvantaged women, as defined by health insurance data, who participated in the French NAITRE randomised trial assessing a CCT programme during prenatal follow-up to improve pregnancy outcomes. The HP worked in some maternities participating in this trial. PARTICIPANTS 26 women, 14 who received CCT and 12 who did not, mostly unemployed (20/26), and - 7 HPs. INTERVENTIONS We conducted a multicentre cross-sectional qualitative study among women and HPs who participated in the NAITRE Study to assess their views on CCT. The women were interviewed after childbirth. RESULTS Women did not perceive CCT negatively. They did not mention feeling stigmatised. They described CCT as a significant source of aid for women with limited financial resources. HP described the CCT in less positive terms, for example, expressing concern about discussing cash transfer at their first medical consultation with women. Though they emphasised ethical concerns about the basis of the trial, they recognised the importance of evaluating CCT. CONCLUSIONS In France, a high-income country where prenatal follow-up is free, HPs were concerned that the CCT programme would change their relationship with patients and wondered if it was the best use of funding. However, women who received a cash incentive said they did not feel stigmatised and indicated that these payments helped them prepare for their baby's birth. TRIAL REGISTRATION NUMBER NCT02402855.
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Affiliation(s)
- Marc Bardou
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Aurélie Godard-Marceau
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive EA 481, Université Bourgogne Franche-Comté, Besancon, Franche-Comté, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynaecology, Strasbourg University Hospital, Starsbourg, France
| | - Claude Virtos
- Service de Gynécologie et Obstétruique, Centre Hospitalier de Dreux, Dreux, France
| | - Astrid Eckman-Lacroix
- Département de Gynécologie et d'Obstétrioque, Centre Hospitalier et Universitaire de Besançon, Besançon, France
| | - Elodie Debras
- Service de Gynécologie et obstrétrique, CHU de Bicêtre DAR, Le Kremlin-Bicetre, Île-de-France, France
| | - Thomas Schmitz
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
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Quenot JP, Jacquier M, Fournel I, Meunier-Beillard N, Grangé C, Ecarnot F, Labruyère M, Rigaud JP. Non-beneficial admission to the intensive care unit: A nationwide survey of practices. PLoS One 2023; 18:e0279939. [PMID: 36730320 PMCID: PMC9894425 DOI: 10.1371/journal.pone.0279939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations. METHODS ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years' experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from "Strongly disagree" to "Strongly agree". RESULTS Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient's history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient's overall healthcare goals was hailed as a means to prevent non-beneficial admissions. CONCLUSION The results of this survey suggest that joint discussions should take place during the patient's healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed "non-beneficial".
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Affiliation(s)
- Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Bourgogne, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
- CHU Dijon-Bourgogne, Centre d’Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France-INSERM
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
- * E-mail:
| | - Marine Jacquier
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Bourgogne, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France-INSERM
| | | | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Bourgogne, France
| | - Clotilde Grangé
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Bourgogne, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Bourgogne, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
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10
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Giabicani M, Arditty L, Mamzer MF, Fournel I, Ecarnot F, Meunier-Beillard N, Bruneel F, Weiss E, Spranzi M, Rigaud JP, Quenot JP. Team-family conflicts over end-of-life decisions in ICU: A survey of French physicians' beliefs. PLoS One 2023; 18:e0284756. [PMID: 37098023 PMCID: PMC10128920 DOI: 10.1371/journal.pone.0284756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Conflicts between relatives and physicians may arise when decisions are being made about limiting life-sustaining therapies (LST). The aim of this study was to describe the motives for, and management of team-family conflicts surrounding LST limitation decisions in French adult ICUs. METHODS Between June and October 2021, French ICU physicians were invited to answer a questionnaire. The development of the questionnaire followed a validated methodology with the collaboration of consultants in clinical ethics, a sociologist, a statistician and ICU clinicians. RESULTS Among 186 physicians contacted, 160 (86%) answered all the questions. Conflicts over LST limitation decisions were mainly related to requests by relatives to continue treatments considered to be unreasonably obstinate by ICU physicians. The absence of advance directives, a lack of communication, a multitude of relatives, and religious or cultural issues were frequently mentioned as factors contributing to conflicts. Iterative interviews with relatives and proposal of psychological support were the most widely used tools in attempting to resolve conflict, while the intervention of a palliative care team, a local ethics resource or the hospital mediator were rarely solicited. In most cases, the decision was suspended at least temporarily. Possible consequences include stress and psychological exhaustion among caregivers. Improving communication and anticipation by knowing the patient's wishes would help avoid these conflicts. CONCLUSION Team-family conflicts during LST limitation decisions are mainly related to requests from relatives to continue treatments deemed unreasonable by physicians. Reflection on the role of relatives in the decision-making process seems essential for the future.
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Affiliation(s)
- Mikhael Giabicani
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, and Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire ETREs, Paris, France
| | - Laure Arditty
- Service de Réanimation, Centre Hospitalier Intercommunal des Alpes du Sud, Gap, France
| | - Marie-France Mamzer
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire ETREs, Paris, France
- Unité Fonctionnelle d'Ethique Médicale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Isabelle Fournel
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besançon, France
- EA3920, Université de Bourgogne-Franche Comté, Besançon, France
| | - Nicolas Meunier-Beillard
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital Center, Le Chesnay, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, and Université Paris Cité, Paris, France
| | - Marta Spranzi
- Center for Clinical Ethics, AP-HP, Paris and Université de Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, CHU de Caen, Caen, France
| | - Jean-Pierre Quenot
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
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Costa M, Meunier-Beillard N, Guillermet É, Cros L, Demassiet V, Hude W, Baleige A, Besnard JF, Roelandt JL, Denis F. Réduire le risque cardiovasculaire chez les personnes vivant avec des troubles psychiques. Sante Publique 2022; 34:633-642. [PMID: 36577662 DOI: 10.3917/spub.225.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This qualitative study based on focus group study aims to identify experiences, expectations, and representations of people with long-term mental illness and their caregivers regarding cardiovascular disease and its risk factors. The aim of this work is to build a cardiovascular risk reduction program for people affected by long-term mental illness. RESULTS Four major themes were identified in the corpus: (1) knowledge concerning physical health, (2) barriers to the implementation of better practices, (3) levers towards a healthier life and (4) expectations and needs for a better lifestyle. CONCLUSIONS This work has provided us with concrete elements for the creation of a cardiovascular risk reduction program for people living with long-term mental illness. The challenges of this program will be to adapt to the needs and expectations of people living with long-term mental illness while facilitating the role of caregivers.
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Denis F, Meunier-Beillard N, Costa M, Guillermet É, Rat C, Roelandt JL. Propositions des professionnels pour réduire le risque cardiovasculaire des patients psychiatriques. Sante Publique 2022; 34:621-632. [PMID: 36577661 DOI: 10.3917/spub.225.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiovascular diseases represent one of the major causes of mortality in France and are the main cause of excess mortality in people suffering from long-term mental disorders (LTMD), apart from causes related to suicide. AIM OF THE STUDY The aim of this article is to identify, from the point of view of primary care and psychiatric professionals, psychiatric users’ expectations and needs in order to help them improve their medical and paramedical management of cardiovascular risk (CVR). METHOD This is a prospective, multi-centered qualitative study carried out in two phases: An exploratory phase, with individual interviews at the beginning of the study to enable the creation of ad hoc collective interview grids, followed by a proper qualitative study, which is in line with medical anthropology and the sociology of health systems. RESULTS The 30 psychiatric professionals interviewed agreed on the need for better coordination with out-of-hospital care providers. Even if openness is advocated, there is a reminder of the specificities of psychiatry and the importance of taking these specificities into account in general. The 26 primary care professionals show a desire to learn more about psychiatric disorders, pathologies, and treatments in order to facilitate the management of these patients with specific needs. CONCLUSION The cross-referencing of these results will allow to propose an appropriate intervention in order to induce convincing effects on the reduction of the CVR in people suffering from LTMD.
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Taha A, Jacquier M, Meunier-Beillard N, Ecarnot F, Andreu P, Roudaut JB, Labruyère M, Rigaud JP, Quenot JP. Anticipating need for intensive care in the healthcare trajectory of patients with chronic disease: A qualitative study among specialists. PLoS One 2022; 17:e0274936. [PMID: 36121869 PMCID: PMC9484637 DOI: 10.1371/journal.pone.0274936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/08/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction We investigated the reflections and perceptions of non-ICU physicians about anticipating the need for ICU admission in case of acute decompensation in patients with chronic disease. Methods We performed a qualitative multicentre study using semi-structured interviews among non-ICU specialist physicians. The interview guide, developed in advance, focused on 3 questions: (1) What is your perception of ICU care? (2) How do you think advance directives can be integrated into the patient’s healthcare goals? and (3) How can the possibility of a need for ICU admission be integrated into the patient’s healthcare goals? Interviews were recorded, transcribed and analysed by thematic analysis. Interviews were performed until theoretical saturation was reached. Results In total, 16 physicians (8 women, 8 men) were interviewed. The main themes related to intensive care being viewed as a distinct specialty, dispensing very technical care, and with major human and ethical challenges, especially regarding end-of-life issues. The participants also mentioned the difficulty in anticipating an acute decompensation, and the choices that might have to be made in such situations. The timing of discussions about potential decompensation of the patient, the medical culture and the presence of advance directives are issues that arise when attempting to anticipate the question of ICU admission in the patient’s healthcare goals or wishes. Conclusion This study describes the perceptions that physicians treating patients with chronic disease have of intensive care, notably that it is a distinct and technical specialty that presents challenging medical and ethical situations. Our study also opens perspectives for actions that could promote a pluridisciplinary approach to anticipating acute decompensation and ICU requirements in patients with chronic disease.
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Affiliation(s)
- Alicia Taha
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | - Marine Jacquier
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Pascal Andreu
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | | | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
- * E-mail:
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Ecarnot F, Lombion S, Pourrez A, Laurent A, Fournier A, Lheureux F, Loiseau M, Rigaud JP, Binquet C, Meunier-Beillard N, Quenot JP. A qualitative study of the perceptions and experiences of healthcare providers caring for critically ill patients during the first wave of the COVID-19 pandemic: A PsyCOVID-ICU substudy. PLoS One 2022; 17:e0274326. [PMID: 36084004 PMCID: PMC9462768 DOI: 10.1371/journal.pone.0274326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Intensive care unit (ICU) staff have faced unprecedented levels of stress, in the context of profound upheaval of their working environment due to the COVID-19 pandemic. We explored the perceptions of frontline ICU staff about the first wave of the COVID-19 pandemic, and how this experience impacted their personal and professional lives. Methods In a qualitative study as part of the PsyCOVID-ICU project, we conducted semi-structured interviews with a random sample of nurses and nurses’ aides from 5 centres participating in the main PsyCOVID study. Interviews were recorded and fully transcribed, and analysed by thematic analysis. Results A total of 18 interviews were performed from 13 August to 6 October 2020; 13 were nurses, and 5 were nurses’ aides. Thematic analysis revealed three major themes, namely: (1) Managing the home life; (2) Conditions in the workplace; and (3) the meaning of their profession. Conclusion In this qualitative study investigating the experiences and perceptions of healthcare workers caring for critically ill patients during the first COVID-19 wave in France, the participants reported that the crisis had profound repercussions on both their personal and professional lives. The main factors affecting the participants were a fear of contamination, and the re-organisation of working conditions, against a background of a media “infodemic”.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital, Besançon, and EA3920, University of Burgundy-Franche-Comté, Besançon, France
| | | | - Aurélie Pourrez
- Unité de Recherche UR3476, Mediation Research Center, University of Lorraine, Nancy, France
| | - Alexandra Laurent
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Florent Lheureux
- Laboratoire de Psychologie, Université de Bourgogne Franche-Comté, Besançon, France
| | - Mélanie Loiseau
- Service de Médecine Légale CHU Dijon, Cellule d’Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive-Réanimation, CH de Dieppe, France
- Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France
| | - Christine Binquet
- Inserm CIC 1432, Module Épidémiologie Clinique (CIC-EC), CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
| | - Nicolas Meunier-Beillard
- Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Jean-Pierre Quenot
- Inserm CIC 1432, Module Épidémiologie Clinique (CIC-EC), CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
- * E-mail:
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15
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Roux-Levy PH, Perrard Y, Mazalovic K, Zabawa C, Meunier-Beillard N, Binquet C, Lejeune C, Faivre L. The place of general practitioner in the management of patients with rare disease and intellectual disability: A qualitative study. Eur J Med Genet 2022; 65:104604. [DOI: 10.1016/j.ejmg.2022.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
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16
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Loiseau M, Ecarnot F, Meunier-Beillard N, Laurent A, Fournier A, François-Purssell I, Binquet C, Quenot JP. Mental Health Support for Hospital Staff during the COVID-19 Pandemic: Characteristics of the Services and Feedback from the Providers. Healthcare (Basel) 2022; 10:healthcare10071337. [PMID: 35885862 PMCID: PMC9324679 DOI: 10.3390/healthcare10071337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 01/01/2023] Open
Abstract
French authorities created mental health support services to accompany HCWs during the pandemic. We aimed to obtain feedback from staff providing these mental health support services within French hospitals to identify positive and negative features and avenues for improvement. A mixed-methods study was performed between 1 April and 30 June 2020. We contacted 77 centres to identify those providing mental health support services. We developed a questionnaire containing questions about the staff providing the service (quantitative part), with open questions to enable feedback from service providers (qualitative part). Of the 77 centres, 36 had mental health support services; 77.8% were created specifically for the epidemic. Services were staffed principally by psychologists, mainly used a telephone platform, and had a median opening time of 8 h/day. Thirty-seven professionals provided feedback, most aged 35–49 years. For 86.5%, it was their first time providing such support. Median self-reported comfort level was 8 (interquartiles 3–10), and 95% would do it again. Respondents reported (i) difficulties with work organisation, clinical situations, and lack of recognition and (ii) a desire for training. This study suggests that mental health support needs to be adapted to the needs of HCWs, both in terms of the content of the service and the timing of delivery.
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Affiliation(s)
- Mélanie Loiseau
- Service de Médecine Légale, CHU Dijon, Cellule d’Urgence Médico-Psychologique CUMP-21, 21000 Dijon, France; (M.L.); (I.F.-P.)
| | - Fiona Ecarnot
- EA3920, University of Burgundy Franche-Comté, 25000 Besancon, France
- Department of Cardiology, University Hospital Besancon, 25000 Besancon, France
- Correspondence:
| | - Nicolas Meunier-Beillard
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, INSERM, CIC 1432, Dijon University Hospital, 21000 Dijon, France; (N.M.-B.); (C.B.); (J.-P.Q.)
| | - Alexandra Laurent
- Laboratoire de Psychologie, Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université Bourgogne Franche-Comté, 21000 Dijon, France; (A.L.); (A.F.)
- Service d’Anesthésie et de Réanimation, CHU Dijon-Bourgogne, 21000 Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie, Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université Bourgogne Franche-Comté, 21000 Dijon, France; (A.L.); (A.F.)
| | - Irene François-Purssell
- Service de Médecine Légale, CHU Dijon, Cellule d’Urgence Médico-Psychologique CUMP-21, 21000 Dijon, France; (M.L.); (I.F.-P.)
| | - Christine Binquet
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, INSERM, CIC 1432, Dijon University Hospital, 21000 Dijon, France; (N.M.-B.); (C.B.); (J.-P.Q.)
| | - Jean-Pierre Quenot
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, INSERM, CIC 1432, Dijon University Hospital, 21000 Dijon, France; (N.M.-B.); (C.B.); (J.-P.Q.)
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, 21000 Dijon, France
- Équipe Lipness, Centre de Recherche INSERM UMR1231, 21000 Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), 21000 Dijon, France
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Quenot JP, Meunier-Beillard N, Ksiazek E, Abdulmalak C, Ecarnot F, Roudaut JB, Andreu P, Aptel F, Labruyère M, Jacquier M, Rigaud JP. Criteria deemed important by ICU patients when designating a reference person. J Intensive Med 2022; 2:268-273. [PMID: 36788936 PMCID: PMC9923949 DOI: 10.1016/j.jointm.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Background We investigated the criteria that hospitalized patients in intensive care units (ICUs) deem important when designating relatives who are best qualified to interact with the caregiving staff. Methods We conducted an exploratory, observational, prospective, multicenter study between March 1, 2018, and October 31, 2018, within two ICUs. A 12-item questionnaire was distributed to patients in the ICUs by the investigating physicians. Patients were considered eligible if they had a good understanding of the French language and if they had not officially designated surrogates before ICU admission. Results Seventy-one patients whose average age was 63.9± 17.3 years, of whom 21 (29.5%) were females, completed the questionnaire. The average Charlson comorbidity score was 2.5 ± 2.4, and the average Simplified Acute Physiology Score (SAPS II) was 39.8 ± 16.5. The main etiology was respiratory infection (40.8%), followed by sepsis (23.9%). The most important criteria identified by patients when selecting reference persons were a good knowledge of the patient's wishes and values, an emotional attachment to the patient, and being a family member. Conclusion Our findings reveal that ICU patients considered the following criteria to be critical when designating reference persons: knowledge of their wishes and the existence of emotional and family attachments.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France,Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon 21000, France,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon 21000, France,Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon 21000, France,Corresponding author: Jean-Pierre Quenot, Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, Dijon Cedex 21079, France.
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon 21000, France,DRCI, USMR, CHU Dijon Bourgogne, Dijon 21000, France
| | - Eléa Ksiazek
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon 21000, France
| | - Caroline Abdulmalak
- Department of Intensive Care, Centre Hospitalier William Morey, Châlon sur Saône 71000, France
| | - Fiona Ecarnot
- Department of Cardiology, EA3920, University of Franche-Comté, University Hospital Besancon, Besancon 25000, France
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France
| | - Pascal Andreu
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France
| | - François Aptel
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France
| | - Marie Labruyère
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France
| | - Marine Jacquier
- Department of Intensive Care, University Hospital François Mitterrand, Dijon 21000, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe 76202, France,Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen 14000, France
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18
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Quenot JP, Jacquier M, Fournel I, Ecarnot F, Salisson MA, Ksiazek E, Labruyère M, Rigaud JP, Meunier-Beillard N. Impact socio-économique d’un séjour en réanimation pour les patients : un impensé ? Méd Intensive Réa 2022. [DOI: 10.37051/mir-00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Les patients qui survivent après un séjour en réanimation sont susceptibles de présenter des symptômes regroupés sous le terme de Syndrome Post-Soins Intensifs (PICS en Anglais). Ce syndrome met en lumière l’implication de chacune de ses dimensions dans les principales sphères de la vie quotidienne des patients (vie familiale et sociale, activité professionnelle ou privée…ressources économiques). A côté du PICS, il faut souligner l’impact des Inégalités Sociales de Santé (ISS) et notamment de la précarité sur l’accès aux soins, le retour au domicile et sur la qualité de vie des patients en post-réanimation. La réanimation a également dans certaines situations eu un impact sur le retour à l’emploi des patients survivants et plus globalement sur le revenu de la famille avec parfois une tendance à l’isolement social et au repli sur soi. Un certain nombre de réflexions ont été menées dans de nombreux pays pour anticiper (rôle de l’assistante sociale en France…) et suivre les conséquences socio-économiques après un séjour en réanimation (consultations post-réanimation, groupe et plateforme d’entraides…etc). En revanche, nous manquons en France d’indicateurs fiables et reconnus qui permettraient de proposer un accompagnement personnalisé, médical et social, afin de limiter les conséquences socioéconomiques pour les patients en post-réanimation, source potentielle d’accroissements des ISS.
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Friedman D, Grimaldi L, Cariou A, Aegerter P, Gaudry S, Ben Salah A, Oueslati H, Megarbane B, Meunier-Beillard N, Quenot JP, Schwebel C, Jacob L, Robin Lagandré S, Kalfon P, Sonneville R, Siami S, Mazeraud A, Sharshar T. Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e30496. [PMID: 35532996 PMCID: PMC9127649 DOI: 10.2196/30496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient’s quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. Objective This multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. Methods Patients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. Results The study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. Conclusions The SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year. Trial Registration Clinicaltrials.gov NCT01796509; https://clinicaltrials.gov/ct2/show/NCT01796509 International Registered Report Identifier (IRRID) DERR1-10.2196/30496
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Affiliation(s)
- Diane Friedman
- Raymond Poincaré Hospital, Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Lamiae Grimaldi
- U1018 Université Versailles, Saint Quentin en Yvelines-INSERM Unité 1018, Groupe Interrégional de Recherche Clinique er d'Innovation, Île-de-France, France
| | - Alain Cariou
- Cochin Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Philippe Aegerter
- U1018 Université Versailles, Saint Quentin en Yvelines-INSERM Unité 1018, Groupe Interrégional de Recherche Clinique er d'Innovation, Île-de-France, France
| | - Stéphane Gaudry
- Louis Mourier Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Colombes, France
| | | | - Haikel Oueslati
- Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Bruno Megarbane
- Lariboisière Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Nicolas Meunier-Beillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique 1432, Module Epidémiologie Clinique, CHU Dijon Bourgogne, France;, Dijon, France.,Délégation à la Recherche Clinique et à l'Innovation (DRCI), Unité de Soutien Méthodologique à la Recherche, CHU Dijon Bourgogne, France, Dijon, France
| | - Jean-Pierre Quenot
- François Mitterrand University Hospital, University of Burgundy, Dijon, France
| | | | - Laurent Jacob
- Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ségloène Robin Lagandré
- Georges Pompidou Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | - Romain Sonneville
- Bichat Hospital, Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | - Aurelien Mazeraud
- GHU-Paris Psychiatrie & Neurosciences, Sainte-Anne Hospital, Université de Paris, Paris, France
| | - Tarek Sharshar
- GHU-Paris Psychiatrie & Neurosciences, Sainte-Anne Hospital, Université de Paris, Paris, France
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20
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Declercq PL, Fournel I, Demeyere M, Ksiazek E, Meunier-Beillard N, Rivière A, Clarot C, Maizel J, Schnell D, Plantefeve G, Ampere A, Daubin C, Sauneuf B, Kalfon P, Federici L, Redureau É, Bousta M, Lagache L, Vanderlinden T, Nseir S, La Combe B, Bourdin G, Monchi M, Nyunga M, Ramakers M, Oulehri W, Georges H, Salmon Gandonniere C, Badie J, Delbove A, Monnet X, Beduneau G, Artaud-Macari É, Abraham P, Delberghe N, Le Bouar G, Miailhe AF, Hraiech S, Bironneau V, Sedillot N, Hoppe MA, Barbar SD, Calcaianu GD, Dellamonica J, Terzi N, Delpierre C, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Influence of socioeconomic status on functional recovery after ARDS caused by SARS-CoV-2: a multicentre, observational study. BMJ Open 2022; 12:e057368. [PMID: 35459672 PMCID: PMC9035836 DOI: 10.1136/bmjopen-2021-057368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Prognosis of patients with COVID-19 depends on the severity of the pulmonary affection. The most severe cases may progress to acute respiratory distress syndrome (ARDS), which is associated with a risk of long-term repercussions on respiratory function and neuromuscular outcomes. The functional repercussions of severe forms of COVID-19 may have a major impact on quality of life, and impair the ability to return to work or exercise. Social inequalities in healthcare may influence prognosis, with socially vulnerable individuals more likely to develop severe forms of disease. We describe here the protocol for a prospective, multicentre study that aims to investigate the influence of social vulnerability on functional recovery in patients who were hospitalised in intensive care for ARDS caused by COVID-19. This study will also include an embedded qualitative study that aims to describe facilitators and barriers to compliance with rehabilitation, describe patients' health practices and identify social representations of health, disease and care. METHODS AND ANALYSIS The "Functional Recovery From Acute Respiratory Distress Syndrome (ARDS) Due to COVID-19: Influence of Socio-Economic Status" (RECOVIDS) study is a mixed-methods, observational, multicentre cohort study performed during the routine follow-up of post-intensive care unit (ICU) functional recovery after ARDS. All patients admitted to a participating ICU for PCR-proven SARS-CoV-2 infection and who underwent chest CT scan at the initial phase AND who received respiratory support (mechanical or not) or high-flow nasal oxygen, AND had ARDS diagnosed by the Berlin criteria will be eligible. The primary outcome is the presence of lung sequelae at 6 months after ICU discharge, defined either by alterations on pulmonary function tests, oxygen desaturation during a standardised 6 min walk test or fibrosis-like pulmonary findings on chest CT. Patients will be considered to be socially disadvantaged if they have an "Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examen de Santé" (EPICES) score ≥30.17 at inclusion. ETHICS AND DISSEMINATION The study protocol and the informed consent form were approved by an independent ethics committee (Comité de Protection des Personnes Sud Méditerranée II) on 10 July 2020 (2020-A02014-35). All patients will provide informed consent before participation. Findings will be published in peer-reviewed journals and presented at national and international congresses. TRIAL REGISTRATION NUMBER NCT04556513.
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Affiliation(s)
| | - Isabelle Fournel
- Centre d'Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Matthieu Demeyere
- Department of Radiology, University Hospital Centre Rouen, Rouen, France
| | - Eléa Ksiazek
- Centre d'Investigation Clinique, Épidémiologie Clinique/Essais Cliniques, University Hospital Centre Dijon, Dijon, France
- Module Epidémiologie Clinique, INSERM CIC 1432, Dijon, France
| | - Nicolas Meunier-Beillard
- Centre d'Investigation Clinique, Épidémiologie Clinique/Essais Cliniques, University Hospital Centre Dijon, Dijon, France
| | - Antoine Rivière
- Service de Médecine Intensive-Réanimation, Abbeville Hospital Centre, Abbeville, France
| | - Caroline Clarot
- Service de Pneumologie, Abbeville Hospital Centre, Abbeville, France
| | - Julien Maizel
- Service de Médecine Intensive-Réanimation, University Hospital Centre Amiens-Picardie, Amiens, France
| | - David Schnell
- Service de Médecine Intensive-Réanimation, Hospital Centre Angouleme, Angouleme, France
| | - Gaetan Plantefeve
- Service de Médecine-Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Alexandre Ampere
- Service de Pneumologie, Hospital Centre Bethune, Bethune, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHRU de Caen, Caen, France
| | - Bertrand Sauneuf
- Service de Médecine Intensive-Réanimation, Cotentin Public Hospital Centre, Cherbourg-Octeville, France
| | - Pierre Kalfon
- Service de Médecine Intensive-Réanimation, Hospital Centre Chartres, Chartres, France
| | - Laura Federici
- Service de Médecine Intensive-Réanimation, Hôpital Louis-Mourier, Colombes, France
| | - Élise Redureau
- Service de Médecine Intensive-Réanimation, Departmental Hospital Centre La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirurgicale, Hospital Group Le Havre, Le Havre, France
| | - Laurie Lagache
- Service de Réanimation Médico-Chirurgicale, Hospital Group Le Havre, Le Havre, France
| | - Thierry Vanderlinden
- Service de Médecine Intensive-Réanimation, Hospital Group of Lille Catholic University, Lille, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Regional and University Hospital Centre Lille, Lille, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Gaël Bourdin
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Mehran Monchi
- Service de Médecine Intensive-Réanimation, Melun Hospital Centre, Melun, France
| | - Martine Nyunga
- Service de Médecine Intensive-Réanimation, Roubaix Hospital Center, Roubaix, France
| | - Michel Ramakers
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lo, France
| | - Walid Oulehri
- Service de Réanimation Chirurgicale, University Hospitals Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive-Réanimation, Hospital Centre Gustave Dron de Tourcoing, Tourcoing, France
| | | | - Julio Badie
- Service de Médecine Intensive-Réanimation, Hopital Nord Franche-Comte, Montbeliard, France
| | - Agathe Delbove
- Réanimation Polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Xavier Monnet
- Service de Médecine Intensive-Réanimation, University Hospitals Southern Paris, Le Kremlin-Bicetre, France
| | - Gaetan Beduneau
- Département de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | - Paul Abraham
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Edouard Herriot, Lyon, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive-Réanimation, University Hospital Centre Rouen, Rouen, France
| | - Arnaud-Felix Miailhe
- Service de Médecine Intensive-Réanimation, University Hospital Centre Nantes, Nantes, France
| | - Sami Hraiech
- Service de Médecine Intensive-Réanimation, Hôpital Nord, Marseille, France
| | - Vanessa Bironneau
- Service de Pneumologie, University Hospital Centre Poitiers, Poitiers, France
| | - Nicholas Sedillot
- Réanimation Polyvalente, Hôpital Fleyriat, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Marie-Anne Hoppe
- Service de Médecine Intensive-Réanimation, Hospital Centre La Rochelle, La Rochelle, France
| | - Saber Davide Barbar
- Intensive Care Unit, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | | | | | - Nicolas Terzi
- Service de Médecine Intensive-Réanimation, University Hospital Centre Grenoble Alpes, Grenoble, France
| | - Cyrille Delpierre
- Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), University of Toulouse, Toulouse, France
| | - Stéphanie Gélinotte
- Service de Médecine Intensive-Réanimation, Hospital Centre Dieppe, Dieppe, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive-Réanimation, Hospital Centre Dieppe, Dieppe, France
| | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, University Hospital Centre Dijon, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine, University Hospital, Seattle, Washington, USA
| | - Christine Binquet
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
- Clinical Epidemiology, INSERM CIC 1432, Dijon, France
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21
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Lejeune C, Robert-Viard C, Meunier-Beillard N, Borel MA, Gourvès L, Staraci S, Soilly AL, Guillemin F, Seror V, Achit H, Bouctot M, Asensio ML, Briffaut AS, Delmas C, Bruel AL, Benoit A, Simon A, Gerard B, Hadj Abdallah H, Lyonnet S, Faivre L, Thauvin-Robinet C, Odent S, Heron D, Sanlaville D, Frebourg T, Muller J, Duffourd Y, Boland A, Deleuze JF, Espérou H, Binquet C, Dollfus H. The Economic, Medical and Psychosocial Consequences of Whole Genome Sequencing for the Genetic Diagnosis of Patients With Intellectual Disability: The DEFIDIAG Study Protocol. Front Genet 2022; 13:852472. [PMID: 35444683 PMCID: PMC9013934 DOI: 10.3389/fgene.2022.852472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Like other countries, France has invested in a national medical genomics program. Among the four pilot research studies, the DEFIDIAG project focuses on the use of whole genome sequencing (WGS) for patients with intellectual disability (ID), a neurodevelopmental condition affecting 1–3% of the general population but due to a plethora of genes. However, the access to genomic analyses has many potential individual and societal issues in addition to the technical challenges. In order to help decision-makers optimally introduce genomic testing in France, there is a need to identify the socio-economic obstacles and leverages associated with the implementation of WGS. Methods and Analysis: This humanities and social sciences analysis is part of the DEFIDIAG study. The main goal of DEFIDIAG is to compare the percentage of causal genetic diagnoses obtained by trio WGS (including the patient and both parents) (WGST) to the percentage obtained using the minimal reference strategy currently used in France (Fragile-X testing, chromosomal microarray analysis, and gene panel strategy including 44 ID genes) for patients with ID having their first clinical genetics consultation. Additionally, four complementary studies will be conducted. First, a cost-effectiveness analysis will be undertaken in a subsample of 196 patients consulting for the first time for a genetic evaluation; in a blinded fashion, WGST and solo (index case, only) genomic analysis (WGSS) will be compared to the reference strategy. In addition, quantitative studies will be conducted: the first will estimate the cost of the diagnostic odyssey that could potentially be avoidable with first-line WGST in all patients previously investigated in the DEFIDIAG study; the second will estimate changes in follow-up of the patients in the year after the return of the WGST analysis compared to the period before inclusion. Finally, through semi-directive interviews, we will explore the expectations of 60 parents regarding genomic analyses. Discussion: Humanities and social sciences studies can be used to demonstrate the efficiency of WGS and assess the value that families associate with sequencing. These studies are thus expected to clarify trade-offs and to help optimize the implementation of genomic sequencing in France. Ethics Statement: The protocol was approved by the Ethics Committee Sud Méditerranée I (June 2019)—identification number: 2018-A00680-55 and the French data privacy commission (CNIL, authorization 919361). Clinical Trial Registration: (ClinicalTrials.gov), identifier (NCT04154891).
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Affiliation(s)
- Catherine Lejeune
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.,Inserm, Université Bourgogne-Franche-Comté, UMR 1231, EPICAD, Dijon, France
| | - Charley Robert-Viard
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.,CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l'Innovation, USMR, Dijon, France
| | - Nicolas Meunier-Beillard
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.,CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l'Innovation, USMR, Dijon, France
| | | | - Léna Gourvès
- CHU Dijon Bourgogne, Direction de la Recherche Clinique, Dijon, France
| | - Stéphanie Staraci
- Unité Fonctionnelle de Génétique Médicale et Centre de Référence « Déficiences Intellectuelles de Causes Rares », APHP Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière et Hôpital Trousseau, Paris, France
| | - Anne-Laure Soilly
- CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l'Innovation, USMR, Dijon, France
| | - Francis Guillemin
- CIC1433-Epidémiologie Clinique, Centre Hospitalier Régional et Universitaire, Inserm, Université de Lorraine, Nancy, France
| | - Valerie Seror
- Aix Marseille Univ, IRD, APHM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Hamza Achit
- CIC1433-Epidémiologie Clinique, Centre Hospitalier Régional et Universitaire, Inserm, Université de Lorraine, Nancy, France
| | - Marion Bouctot
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Marie-Laure Asensio
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Anne-Sophie Briffaut
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | | | - Ange-Line Bruel
- CHU Dijon Bourgogne, Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Dévelopment (TRANSLAD), Inserm, Université Bourgogne-Franche-Comté, UMR1231, Équipe GAD, Dijon, France
| | - Alexia Benoit
- Laboratoires de Diagnostic Génétique, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alban Simon
- Inserm UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, France et Service de Génétique Médicale Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Bénédicte Gerard
- Laboratoires de Diagnostic Génétique, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hamza Hadj Abdallah
- Inserm, IHU Imagine-Institut des Maladies Génétiques, Université Paris Cité, Paris, France.,Fédération de Génétique et Médecine Génomique, Hôpital Necker-Enfants Malades, GHU APHP. Centre-Université Paris Cité, Paris, France
| | - Stanislas Lyonnet
- Inserm, IHU Imagine-Institut des Maladies Génétiques, Université Paris Cité, Paris, France.,Fédération de Génétique et Médecine Génomique, Hôpital Necker-Enfants Malades, GHU APHP. Centre-Université Paris Cité, Paris, France
| | - Laurence Faivre
- CHU Dijon Bourgogne, Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Dévelopment (TRANSLAD), Inserm, Université Bourgogne-Franche-Comté, UMR1231, Équipe GAD, Dijon, France
| | - Christel Thauvin-Robinet
- CHU Dijon Bourgogne, Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Dévelopment (TRANSLAD), Inserm, Université Bourgogne-Franche-Comté, UMR1231, Équipe GAD, Dijon, France
| | - Sylvie Odent
- Service de Génétique Clinique, Centre de Référence Anomalies du Dévelopment CLAD- Ouest, CNRS, IGDR UMR6290 (Institut de Génétique et Dévelopment de Rennes), ERN ITHACA, Université de Rennes, Rennes, France
| | - Delphine Heron
- Unité Fonctionnelle de Génétique Médicale et Centre de Référence « Déficiences Intellectuelles de Causes Rares », APHP Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière et Hôpital Trousseau, Paris, France
| | - Damien Sanlaville
- Hospices Civils de Lyon, GHE, Service de Génétique, Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry Frebourg
- CHU de Rouen, Service de Génétique, Rouen, France.,Inserm, UMR1245, Centre de Génomique et de Médecine Personnalisée, Université de Normandie, Rouen, France
| | - Jean Muller
- Laboratoires de Diagnostic Génétique, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Inserm UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, France et Service de Génétique Médicale Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Unité Fonctionnelle de Bioinformatique Médicale Appliquée au Diagnostic (UF7363), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yannis Duffourd
- CHU Dijon Bourgogne, Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Dévelopment (TRANSLAD), Inserm, Université Bourgogne-Franche-Comté, UMR1231, Équipe GAD, Dijon, France
| | - Anne Boland
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France
| | - Jean-François Deleuze
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France
| | | | - Christine Binquet
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Hélène Dollfus
- Inserm UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, France et Service de Génétique Médicale Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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22
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Perraud F, Ecarnot F, Loiseau M, Laurent A, Fournier A, Lheureux F, Binquet C, Rigaud JP, Meunier-Beillard N, Quenot JP. A qualitative study of reinforcement workers' perceptions and experiences of working in intensive care during the COVID-19 pandemic: A PsyCOVID-ICU substudy. PLoS One 2022; 17:e0264287. [PMID: 35245297 PMCID: PMC8896724 DOI: 10.1371/journal.pone.0264287] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/07/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE During the COVID pandemic, many hospitals had to mobilize reinforcement healthcare workers, especially in intensive care (ICUs). We investigated the perceptions and experiences of reinforcement workers deployed to ICUs, and the impact of deployment on their personal and professional lives. METHODS For this qualitative study, a random sample of 30 reinforcement workers was drawn from 4 centres participating in the larger PsyCOVID-ICU study. Individual semi-structured interviews were held, recorded, transcribed and analyzed by thematic analysis. RESULTS Thirty interviews were performed from April to May 2021 (22 nurses, 2 anesthesiology nurses, 6 nurses' aides). Average age was 36.8±9.5 years; 7 participants had no ICU experience. Four major themes emerged, namely: (1) Difficulties with integration, especially for those with no ICU experience; (2) lack of training; (3) difficulties with management, notably a feeling of insufficient communication; (4) Mental distress relating to the unusual work and fear of contaminating their entourage. CONCLUSION Healthcare workers deployed as reinforcements to ICUs at the height of the pandemic had a unique experience of the crisis, and identified important gaps in organisation and preparation. They also suffered from a marked lack of training, given the stakes in the management of critically ill patients in the ICU.
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Affiliation(s)
- Florian Perraud
- Service d’Accueil des Urgences, University Hospital Dijon, and Université de Bourgogne Franche-Comté, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, 25000 Besançon, France
- EA3920, University of Burgundy-Franche-Comté, 25000 Besançon, France
| | - Mélanie Loiseau
- Service de Médecine Légale, Cellule d’Urgence Médico-Psychologique de Bourgogne Franche-Comté, University Hospital Dijon, Dijon, France
| | - Alexandra Laurent
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université Bourgogne Franche-Comté, Dijon, France
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Dijon, Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université Bourgogne Franche-Comté, Dijon, France
| | - Florent Lheureux
- Laboratoire de Psychologie, University of Burgundy-Franche-Comté, 25000 Besançon, France
| | - Christine Binquet
- Inserm CIC1432, module Épidémiologie Clinique (CIC-EC)- CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive-Réanimation, Hospital Centre of Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France
| | - Nicolas Meunier-Beillard
- CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Direction de la Recherche Clinique et de l’Innovation, University Hospital Dijon, Dijon, France
| | - Jean-Pierre Quenot
- Inserm CIC1432, module Épidémiologie Clinique (CIC-EC)- CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
- Service de Médecine Intensive-Réanimation, University Hospital Dijon, Dijon, France
- Equipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
- * E-mail:
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23
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Laurent A, Fournier A, Lheureux F, Poujol AL, Deltour V, Ecarnot F, Meunier-Beillard N, Loiseau M, Binquet C, Quenot JP. Risk and protective factors for the possible development of post-traumatic stress disorder among intensive care professionals in France during the first peak of the COVID-19 epidemic. Eur J Psychotraumatol 2022; 13:2011603. [PMID: 35096285 PMCID: PMC8794068 DOI: 10.1080/20008198.2021.2011603] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Intensive care units (ICU) are among the healthcare services most affected by the COVID-19 crisis. Stressors related to insecurity, unpredictability, patient death and family distress are significant, and put healthcare workers (HCWs) at high risk of post-traumatic stress disorder (PTSD). The aims of this study were to measure the prevalence of post-traumatic stress disorder in HCWs and to identify risk factors and protective factors during the epidemic in France. METHODS During the first peak of the epidemic (from 22 April to 13 May 2020), we assessed sources of stress (PS-ICU scale), mental health (GHQ-12) and coping strategies (Brief-COPE). Three months later (03 June to 6 July 2020), PTSD was assessed using the IES-R scale, with additional questions about sources of support. Data were collected using self-report questionnaires administered online. RESULTS Among 2153 professionals who participated in the study, 20.6% suffered from potential PTSD, mostly intrusion symptoms. Risk factors for the development of PTSD were having experienced additional difficult events during the crisis, having a high level of psychological distress, a high level of perceived stress related to the workload and human resources issues, the emotional burden related to the patient and family, and stressors specific to COVID-19 during the first peak of the crisis. The use of positive thinking coping strategies decreased the relationship between perceived stress and the presence of PTSD, while social support seeking strategies increased the relationship. Finally, the HCWs preferred to use support from colleagues, relatives and/or a psychologist, and very few used the telephone hotlines. CONCLUSION The epidemic has had a strong traumatic impact on intensive care HCWs. Given the risk of PTSD, we need to consider implementing easily-accessible support services that focus on positive thinking coping strategies, during and after the crisis.
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Affiliation(s)
- Alexandra Laurent
- Laboratoire de Psychologie : Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France.,Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie : Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Florent Lheureux
- Laboratoire de Psychologie, Université de Bourgogne Franche-Comté, Besançon, France
| | - Anne-Laure Poujol
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Équipe VCR, École de Psychologues Praticiens, Université catholique de Paris, Paris, France.,Laboratoire APEMAC, Université de Lorraine, Metz, France
| | - Victoire Deltour
- Laboratoire de Psychologie : Dynamiques Relationnelles Et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital, Besançon, France.,University of Burgundy-Franche-Comté, Besançon, France
| | - Nicolas Meunier-Beillard
- Clinical Epidemiology, University of Burgundy, Dijon, France.,DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Mélanie Loiseau
- Service de Médecine Légale CHU Dijon, Cellule d'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Christine Binquet
- module Epidémiologie Clinique (CIC-EC)- CHU Dijon-Bourgogne, UFR des Sciences de Santé, Dijon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, France-Equipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, université de Bourgogne-Franche Comté, Dijon, France
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24
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Laurent A, Fournier A, Poujol AL, Deltour V, Lheureux F, Meunier-Beillard N, Loiseau M, Ecarnot F, Rigaud JP, Binquet C, Quenot JP. Impact psychologique de la pandémie de COVID-19 sur les soignants en réanimation. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Alors que l’infection à SARS-COV-2 s’est rapidement propagée au niveau mondial, on a assisté à une mobilisation massive des soignants auprès des personnes infectées. En réanimation, les conditions de travail déjà habituellement difficiles se sont durcies, avec une augmentation forte de la charge de travail, une nécessaire et indispensable réorganisation des soins, des décisions complexes relatives à l’admission des patients et une modification de l’accueil des familles. Le tout dans un climat d’incertitude générale et d’insécurité personnelle. Cet article propose une mise au point sur l’impact psychologique de cette crise sur les soignants en réanimation et les possibles dispositifs d’accompagnement à partir des données récentes de la littérature et notamment des données issues de l’étude PsyCOVID-ICU coordonnée par les auteurs de cet article.
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25
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Laurent A, Fournier A, Lheureux F, Louis G, Nseir S, Jacq G, Goulenok C, Muller G, Badie J, Bouhemad B, Georges M, Mertes PM, Merdji H, Castelain V, Abdulmalak C, Lesieur O, Plantefeve G, Lacherade JC, Rigaud JP, Sedillot N, Roux D, Terzi N, Beuret P, Monsel A, Poujol AL, Kuteifan K, Vanderlinden T, Renault A, Vivet B, Vinsonneau C, Barbar SD, Capellier G, Dellamonica J, Ehrmann S, Rimmelé T, Bohé J, Bouju P, Gibot S, Lévy B, Temime J, Pichot C, Schnell D, Friedman D, Asfar P, Lebas E, Mateu P, Klouche K, Audibert J, Ecarnot F, Meunier-Beillard N, Loiseau M, François-Pursell I, Binquet C, Quenot JP. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic. Ann Intensive Care 2021; 11:90. [PMID: 34089117 PMCID: PMC8177250 DOI: 10.1186/s13613-021-00880-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. METHODS This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. RESULTS In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p < 0.001), and higher levels of overall perceived stress (p < 0.001), compared to low-intensity zones. Factors associated with higher overall perceived stress were female sex (B = 0.13; 95% confidence interval [CI] = 0.08-0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09-0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02-0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = - 0.32, 95% CI = - 0.54, - 0.11. CONCLUSION COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).
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Affiliation(s)
- Alexandra Laurent
- Laboratoire de Psychologie: Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France.,Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | - Alicia Fournier
- Laboratoire de Psychologie: Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Florent Lheureux
- Laboratoire de Psychologie, Université de Bourgogne Franche-Comté, Besançon, France
| | - Guillaume Louis
- Service de Réanimation Polyvalente et USC, Hôpital de Mercy, CHR Metz-Thionville, Thionville, France
| | - Saad Nseir
- Critical Care Center, CHU Lille and Lille University, Lille, France
| | - Gwenaelle Jacq
- Medical-Surgical Intensive Care Unit, CH de Versailles, Le Chesnay, France
| | - Cyril Goulenok
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Grégoire Muller
- Service de Médecine Intensive-Réanimation, CHR d'Orléans, Orléans, France
| | - Julio Badie
- Service de Réanimation Polyvalente-USC, Hôpital Nord Franche-Comté, Trevenans, France
| | - Bélaïd Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
| | | | - Paul-Michel Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Hamid Merdji
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg, France.,Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincent Castelain
- Hôpitaux Universitaires de Strasbourg, Médecine Intensive - Réanimation, Hôpital de Hautepierre, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Caroline Abdulmalak
- Service de Médecine Intensive-Réanimation, CH de Chalon sur Saône, Chalon sur Saône, France
| | - Olivier Lesieur
- Intensive Care Unit, Groupement Hospitalier La Rochelle-Ré-Aunis, La Rochelle, France
| | | | - Jean-Claude Lacherade
- Service de Médecine Intensive-Réanimation, CH de La Roche-sur-Yon, Chalon sur Saône, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive-Réanimation, CH de Dieppe, Dieppe, France.,Espace de Réflexion Éthique de Normandie, Université de Caen, Caen, France
| | - Nicholas Sedillot
- Réanimation Polyvalente, CH de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Damien Roux
- Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Colombes, France.,Université de Paris, INSERM, UMR 1137 Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, CHU de Grenoble, Grenoble, France
| | - Pascal Beuret
- Service de Réanimation-Soins Continus du CH de Roanne, Roanne, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Sorbonne University, INSERM, UMR-S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.,Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Anne-Laure Poujol
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.,Équipe VCR, École de Psychologues Praticiens, Université Catholique de Paris, EA, 7403, Paris, France.,Laboratoire APEMAC, Université de Lorraine, EA 4360, Université́ de Lorraine, Metz, France
| | | | - Thierry Vanderlinden
- Service de Médecine Intensive Réanimation, Groupe des Hôpitaux de L'Institut Catholique de Lille (GHICL), France, Université Catholique de Lille, Lille, France
| | - Anne Renault
- Service de Réanimation Médicale et Urgences Médicales, CHU de Brest, Brest, France
| | - Bérengère Vivet
- Service de Réanimation Polyvalente, Groupe Hospitalier Intercommunal de La Haute-Saône, Site de Vesoul, Luxeuil-les-Bains, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation-Unité de Sevrage Ventilatoire et Réhabilitation, CH de Bethune, Bethune, France
| | - Saber Davide Barbar
- Service des Réanimations, Faculté de Médecine de Montpellier-Nîmes, CHU de Nîmes, France and Université de Montpellier, Nîmes, France
| | - Gilles Capellier
- Réanimation Médicale, University Hospital Besançon, Besançon, France.,EA3920, University of Burgundy-Franche-Comté, Besançon, France
| | | | - Stephan Ehrmann
- Service de Médecine Intensive-Réanimation, Tours, France.,CIC INSERM 1415, CRICS-TriggerSep Network, Tours, France.,INSERM, Centre d'étude des pathologies respiratoires, Université de Tours, U1100, Tours, France
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Julien Bohé
- Service D'anesthésie - Réanimation-Médecine Intensive, CH Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite, Tours, France
| | - Pierre Bouju
- Service Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, Nancy, France
| | - Bruno Lévy
- Service de Réanimation Médicale, Centre Hospitalier Universitaire Nancy Brabois, Nancy-France-Institut du Cœur et des Vaisseaux. Groupe Choc, équipe 2, Inserm U1116. Faculté de Médecine, Nancy-Brabois, France
| | | | - Cyrille Pichot
- Unité de Surveillance Continue, CH de Dôle, Dôle, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d'Angoulême, Angoulême, France
| | - Diane Friedman
- Service de Médecine Intensive et Réanimation, Hôpital Raymond Poincaré, Garches, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU Angers, Angers, France
| | - Eddy Lebas
- Service de Réanimation-USC de Bretagne Atlantique, Vannes, France
| | - Philippe Mateu
- Service de Médecine Intensive-Réanimation-Unité de Recherche Clinique Ardennes Nord, CH de Charleville-Mézieres, Charleville-Mézieres, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, University Hospital of Montpellier-PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Juliette Audibert
- Service de Réanimation Polyvalente, CH de Chartres, Hôpital Louis Pasteur, Le Coudray, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital, Besançon, and EA3920, University of Burgundy-Franche-Comté, Besançon, France
| | - Nicolas Meunier-Beillard
- CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.,DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Mélanie Loiseau
- Service de Médecine Légale CHU Dijon, Cellule D'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Irène François-Pursell
- Service de Médecine Légale CHU Dijon, Cellule D'Urgence Médico-Psychologique de Bourgogne Franche-Comté, Dijon, France
| | - Christine Binquet
- Inserm et CHU Dijon-Bourgogne, CIC1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, France-Equipe Lipness, centre de recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France. .,INSERM, Module Épidémiologie Clinique, Université de Bourgogne Franche-Comté, CIC 1432, Dijon, France. .,Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Besançon, France. .,Critical Care Department, University Hospital François Mitterrand, 14 rue Paul Gaffarel, 21079, Dijon, France.
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Nambot S, Sawka C, Bertolone G, Cosset E, Goussot V, Derangère V, Boidot R, Baurand A, Robert M, Coutant C, Loustalot C, Thauvin-Robinet C, Ghiringhelli F, Lançon A, Populaire C, Damette A, Collonge-Rame MA, Meunier-Beillard N, Lejeune C, Albuisson J, Faivre L. Incidental findings in a series of 2500 gene panel tests for a genetic predisposition to cancer: Results and impact on patients. Eur J Med Genet 2021; 64:104196. [PMID: 33753322 DOI: 10.1016/j.ejmg.2021.104196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
With next generation sequencing, physicians are faced with more complex and uncertain data, particularly incidental findings (IF). Guidelines for the return of IF have been published by learned societies. However, little is known about how patients are affected by these results in a context of oncogenetic testing. Over 4 years, 2500 patients with an indication for genetic testing underwent a gene cancer panel. If an IF was detected, patients were contacted by a physician/genetic counsellor and invited to take part in a semi-structured interview to assess their understanding of the result, the change in medical care, the psychological impact, and the transmission of results to the family. Fourteen patients (0.56%) were delivered an IF in a cancer predisposition gene (RAD51C, PMS2, SDHC, RET, BRCA2, CHEK2, CDKN2A, CDH1, SUFU). Two patients did not collect the results and another two died before the return of results. Within the 10 patients recontacted, most of them reported surprise at the delivery of IF, but not anxiety. The majority felt they had chosen to obtain the result and enough information to understand it. They all initiated the recommended follow-up and did not regret the procedure. Information regarding the IF was transmitted to their offspring but siblings or second-degree relatives were not consistently informed. No major adverse psychological events were found in our experience. IF will be inherent to the development of sequencing, even for restricted gene panels, so it is important to increase our knowledge on the impact of such results in different contexts.
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Affiliation(s)
- S Nambot
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France.
| | - C Sawka
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - G Bertolone
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - E Cosset
- CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - V Goussot
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France
| | - V Derangère
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France
| | - R Boidot
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; CNRS, 6302 Unit, Dijon, France
| | - A Baurand
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - M Robert
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France
| | - C Coutant
- Département de Chirurgie, Centre Georges François Leclerc, F-21000, Dijon, France
| | - C Loustalot
- Département de Chirurgie, Centre Georges François Leclerc, F-21000, Dijon, France
| | - C Thauvin-Robinet
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France
| | - F Ghiringhelli
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; Département D'oncologie Médicale, Centre Georges François Leclerc, Dijon, France; Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France
| | - A Lançon
- CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - C Populaire
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - A Damette
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - M A Collonge-Rame
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - N Meunier-Beillard
- INSERM, CIC1432, Module épidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Centre D'investigation Clinique, Module épidémiologie Clinique/essais Cliniques, Dijon, France
| | - C Lejeune
- Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France; INSERM, CIC1432, Module épidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Centre D'investigation Clinique, Module épidémiologie Clinique/essais Cliniques, Dijon, France
| | - J Albuisson
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France
| | - L Faivre
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France.
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Jacquier M, Meunier-Beillard N, Ecarnot F, Large A, Aptel F, Labruyère M, Dargent A, Andreu P, Roudaut JB, Rigaud JP, Quenot JP. Non-readmission decisions in the intensive care unit: A qualitative study of physicians' experience in a multicentre French study. PLoS One 2021; 16:e0244919. [PMID: 33444323 PMCID: PMC7808577 DOI: 10.1371/journal.pone.0244919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Deciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU. Materials and methods Multicenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis. Results In total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous. Conclusions Non-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.
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Affiliation(s)
- Marine Jacquier
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - François Aptel
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Marie Labruyère
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Dieppe General Hospital, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Espace de Réflexion Éthique de Bourgogne Franche-Comté, Dijon, France
- * E-mail:
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Labruyère M, Meunier-Beillard N, Ecarnot F, Large A, Aptel F, Roudaut JB, Andreu P, Dargent A, Rigaud JP, Quenot JP. Family perceptions of clinical research and the informed consent process in the ICU. J Crit Care 2020; 68:141-143. [PMID: 33012581 DOI: 10.1016/j.jcrc.2020.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated experiences of families who provide consent for research on behalf of a loved-one hospitalized in intensive care (ICU). METHODS Multicentre, qualitative, descriptive study using semi-directive interviews in 3 ICUs. Eligible relatives were aged >18 years, and had provided informed consent for a clinical trial on behalf of a patient hospitalized in ICU. Interviews were conducted from 06/2018 to 06/2019 by a qualified sociologist, recorded and transcribed. RESULTS Fifteen relatives were interviewed; average age 50.3 ± 15 years. All emphasized their interest in clinical research, seeing it as a duty. Involving their loved-one in research allowed them to find meaning in the events. Participants underlined that trust in caregivers and communication are determinant. The strict regulation of research was perceived as a guarantee of safety. Participants felt they lacked the intellectual capacity and knowledge to question explanations. The greatest fear was not that they might incur a risk for the patient, but rather, that they might deprive the patient of a chance at a cure. CONCLUSION Acceptance of research opportunities by relatives on behalf of decisionally-incapacitated patients is underpinned by trust in the physicians and the legislative framework. Communication and the quality of information provided by the caregivers are key.
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Affiliation(s)
- Marie Labruyère
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France.
| | - Nicolas Meunier-Beillard
- Clinical Epidemiology, University of Burgundy, INSERM CIC 1432, Dijon, France; DRCI, USMR, CHU, Dijon, Bourgogne, France.
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, EA3920, France.
| | - Audrey Large
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France.
| | - François Aptel
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France.
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France.
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France.
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, France; Espace de Réflexion Ethique de Normandie, University Hospital Caen, France.
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France; Clinical Epidemiology, University of Burgundy, INSERM CIC 1432, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.
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Quenot JP, Meunier-Beillard N, Ksiazek E, Abdulmalak C, Berrichi S, Devilliers H, Ecarnot F, Large A, Roudaut JB, Andreu P, Dargent A, Rigaud JP. Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU. J Crit Care 2020; 57:191-196. [PMID: 32179249 DOI: 10.1016/j.jcrc.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. METHODS Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. RESULTS In total, 87 relatives of 73 patients completed the questionnaire, average age of relatives was 58 ± 15 years, 46% were the spouse, 30% were children/grandchildren. Items classed as being the most important attributes for a reference person were: good knowledge of the patient's wishes and values; an emotional attachment to the patient; being a family member; and having an adequate understanding of the clinical status and clinical history. CONCLUSION This study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France; DRCI, USMR, CHU Dijon, Bourgogne, France.
| | - Eléa Ksiazek
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Caroline Abdulmalak
- Department of Intensive Care, Centre Hospitalier William Morey, Châlon sur Saône, France.
| | - Samia Berrichi
- Department of Intensive Care, Centre Hospitalier de Dieppe, France
| | - Hervé Devilliers
- Department of Internal Medicine, François Mitterrand University Hospital, Dijon, France.
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, France.
| | - Audrey Large
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Pascal Andreu
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France.
| | - Auguste Dargent
- Department of Intensive Care, University Hospital François Mitterrand, Dijon, France; Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, France; Espace de Réflexion Ethique de Normandie, University Hospital Caen, France.
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30
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Quenot JP, Helms J, Labro G, Dargent A, Meunier-Beillard N, Ksiazek E, Bollaert PE, Louis G, Large A, Andreu P, Bein C, Rigaud JP, Perez P, Clere-Jehl R, Merdji H, Devilliers H, Binquet C, Meziani F, Fournel I. Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study. Ann Intensive Care 2020; 10:20. [PMID: 32048075 PMCID: PMC7013026 DOI: 10.1186/s13613-020-0637-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission. Methods The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score. Results Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = − 1.85 [95% CI − 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders. Conclusions Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients. Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013
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Affiliation(s)
- Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France. .,INSERM, U1231, Equipe Lipness, Dijon, France. .,LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, Dijon, France. .,INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.
| | - Julie Helms
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Guylaine Labro
- Service de Réanimation Médicale, CHU de Besançon, Besançon, France
| | - Auguste Dargent
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France.,INSERM, U1231, Equipe Lipness, Dijon, France.,LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Elea Ksiazek
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | | | | | - Audrey Large
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France
| | - Pascal Andreu
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079, Dijon Cedex, France
| | - Christophe Bein
- Service de Réanimation Polyvalente, CH de la Haute-Saône, Vesoul, France
| | | | - Pierre Perez
- Service de Réanimation Médicale, CHRU Brabois, Nancy, France
| | - Raphaël Clere-Jehl
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Hamid Merdji
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France
| | - Hervé Devilliers
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.,Service de Médecine Interne et Maladies Systémiques, CHU Dijon Bourgogne, Dijon, France
| | | | - Ferhat Meziani
- Hôpitaux universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Strasbourg, France.,Université de Strasbourg (UNISTRA), Faculté de Médecine, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
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Ecarnot F, Meunier-Beillard N, Quenot JP, Meneveau N. Factors associated with refusal or acceptance of older patients (≥ 65 years) to provide consent to participate in clinical research in cardiology: a qualitative study. Aging Clin Exp Res 2020; 32:133-140. [PMID: 30903598 DOI: 10.1007/s40520-019-01172-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical research is an essential step in the successful translation of knowledge from basic research into concrete clinical applications, yet many people are reluctant to provide consent when actually approached to actively participate in clinical trials. AIMS We investigated the factors that influence older patient's (≥ 65 years) decisions to accept or refuse to participate in a prospective randomized clinical trial in secondary prevention after acute coronary syndrome. METHODS Qualitative approach based on individual semi-structured interviews with patients who were approached for consent to participate in a currently ongoing clinical trial was adopted. Patients were interviewed after the consent process (8 accepted; 8 refused the trial). Interviews were analysed using grounded theory methodology. RESULTS Sixteen patients aged ≥ 65 years participated. The main concept to emerge from these interviews is that the actual trial itself does not appear to be the primary determinant in the decision to participate in clinical research. Rather, patients' decisions to participate (or not) in clinical research appear to be primarily determined by their capacity to deal with the current health event that has disrupted their life, and by their available mental and physical resources. DISCUSSION AND CONCLUSION Older patients display varying levels of engagement in their own health, ranging from low engagement with high trust in the medical profession, to high engagement mirrored by distrust of the medical profession. Structural conditions, such as personal benefit from trial participation, or logistic barriers to participation, seem to affect both accepters and refusers in the same manner.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France.
| | - Nicolas Meunier-Beillard
- Unité de Soutien Méthodologique à la Recherche - Délégation à la Recherche Clinique et à l'Innovation, François Mitterand University Hospital, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France
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Baleige A, Besnard JF, Meunier-Beillard N, Demassiet V, Monnier A, Ouezini A, Lambert O, Charrel C, Mazas O, Oberlin J, Roelandt JL, Denis F. A collaboration between service users and professionals for the development and evaluation of a new program for cardiovascular risk management in persons with a diagnosis of severe mental illness: French multicenter qualitative and feasibility studies. Int J Ment Health Syst 2019; 13:74. [PMID: 31889999 PMCID: PMC6933686 DOI: 10.1186/s13033-019-0331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Persons with a diagnosis of severe mental illness have a life expectancy that is 20 years lower than the general population, and they are disproportionately affected by cardiovascular disorders. Improving the management of cardiovascular risk is one of the main challenges for the public health system. In the care pathway of persons with a diagnosis of severe mental illness, a better understanding of limiting and facilitating factors is required. The objective was to include persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals in the creation and evaluation (feasibility) of a health promotion program designed to improve cardiovascular risk management through empowerment. Methods This study combines a mixed methodology with qualitative and quantitative components. A multicenter prospective qualitative study was conducted in seven mental health units in France and was coordinated by a steering committee composed of persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals. Results This health promotion program must enable persons with a diagnosis of severe mental illness to assert their right to self-determination and to exercise greater control over their lives, beyond their diagnosis and care. Following a preliminary feasibility study, the effectiveness of this new tool will be evaluated using a randomized controlled trial in a second study. Conclusions The findings can be used by health organizations as a starting point for developing new and improved services for persons with a diagnosis of severe mental illness.Trial registration Clinical Trials Gov NCT03689296. Date registered September 28, 2018.
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Affiliation(s)
- Antoine Baleige
- EPSM Lille-Métropole, WHO Collaborating Centre for Research and Training in Mental Health, 211 Rue Salengro, 59260 Hellemmes, France.,EPSM Lille-Métropole, 104 Rue Général Leclerc, 59280 Armentières, France
| | | | - Nicolas Meunier-Beillard
- CHU F. Mitterrand, Délégation à la Recherche Clinique et à l'Innovation, 21000 Dijon, France.,INSERM CIC 1432 Module Epidémiologie Clinique, 21000 Dijon, France
| | - Vincent Demassiet
- EPSM Lille-Métropole, WHO Collaborating Centre for Research and Training in Mental Health, 211 Rue Salengro, 59260 Hellemmes, France
| | | | - Amel Ouezini
- CASH, Nanterre, 403, Avenue de la République, 92014 Nanterre, France
| | - Olivier Lambert
- CESAME, Angers, Ste Gemmes-Sur-Loire, 49137 Les Ponts De Ce, France
| | - Claire Charrel
- EPSM Lille-Métropole, 104 Rue Général Leclerc, 59280 Armentières, France
| | | | - Joël Oberlin
- CH Rouffach, 27, Rue du 4ème RSM, 68250 Rouffach, France
| | - Jean-Luc Roelandt
- EPSM Lille-Métropole, WHO Collaborating Centre for Research and Training in Mental Health, 211 Rue Salengro, 59260 Hellemmes, France.,EPSM Lille-Métropole, 104 Rue Général Leclerc, 59280 Armentières, France.,11INSERM, UMR 1123, ECEVE Faculté de Médecine Paris Diderot, Paris 7 Site Villemin, 10 Avenue de Verdun, 75010 Paris, France
| | - Frédéric Denis
- EPSM Lille-Métropole, WHO Collaborating Centre for Research and Training in Mental Health, 211 Rue Salengro, 59260 Hellemmes, France.,Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033 Dijon, France.,13EA 75-05 Education Ethique Santé, Faculté de Médecine, Université François-Rabelais Tours, 37032 Tours, France.,14Faculté d'Odontologie, Université de Nantes, Nantes, France
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Quenot JP, Large A, Meunier-Beillard N, Pugliesi PS, Rollet P, Toitot A, Andreu P, Devilliers H, Marchalot A, Ecarnot F, Dargent A, Rigaud JP. What are the characteristics that lead physicians to perceive an ICU stay as non-beneficial for the patient? PLoS One 2019; 14:e0222039. [PMID: 31490986 PMCID: PMC6730882 DOI: 10.1371/journal.pone.0222039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/20/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We sought to describe the characteristics that lead physicians to perceive a stay in the intensive care unit (ICU) as being non-beneficial for the patient. Materials and methods In the first step, we used a multidisciplinary focus group to define the characteristics that lead physicians to consider a stay in the ICU as non-beneficial for the patient. In the second step, we assessed the proportion of admissions that would be perceived by the ICU physicians as non-beneficial for the patient according to our focus group’s definition, in a large population of ICU admissions in 4 French ICUs over a period of 4 months. Results Among 1075 patients admitted to participating ICUs during the study period, 155 stays were considered non-beneficial for the patient, yielding a frequency of 14.4% [95% confidence interval (CI) 8.9, 19.9]. Average age of these patients was 72 ±12.8 years. Mortality was 43.2% in-ICU [95%CI 35.4, 51.0], 55% [95%CI 47.2, 62.8] in-hospital. The criteria retained by the focus group to define a non-beneficial ICU stay were: patient refusal of ICU care (23.2% [95%CI 16.5, 29.8]), and referring physician’s desire not to have the patient admitted (11.6% [95%CI 6.6, 16.6]). The characteristics that led physicians to perceive the stay as non-beneficial were: patient’s age (36.8% [95%CI 29.2, 44.4]), unlikelihood of recovering autonomy (61.9% [95%CI 54.3, 69.6]), prior poor quality of life (60% [95%CI 52.3, 67.7]), terminal status of chronic disease (56.1% [95%CI 48.3, 63.9]), and all therapeutic options have been exhausted (35.5% [95%CI 27.9, 43.0]). Factors that explained admission to the ICU of patients whose stay was subsequently judged to be non-beneficial included: lack of knowledge of patient’s wishes (52% [95%CI 44.1, 59.9]); decisional incapacity (sedation) (69.7% [95%CI 62.5, 76.9]); inability to contact family (34% [95%CI 26.5, 41.5]); pressure to admit (from family or other physicians) (50.3% [95%CI 42.4, 58.2]). Conclusions Non-beneficial ICU stays are frequent. ICU admissions need to be anticipated, so that patients who would yield greater benefit from other care pathways can be correctly oriented in a timely manner.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- * E-mail:
| | - Audrey Large
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- DRCI, USMR, Francois Mitterrand University Hospital, Dijon, France
| | - Paul-Simon Pugliesi
- Department of Intensive Care, William Morey Hospital, Chalon sur Saône, France
| | - Pamina Rollet
- Department of Intensive Care, Nord Franche-Comté Hospital, Trevenans, France
| | - Amaury Toitot
- Department of Intensive Care, Nord Franche-Comté Hospital, Trevenans, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France
| | - Hervé Devilliers
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Department of Internal Medicine, François Mitterrand University Hospital, Dijon, France
| | - Antoine Marchalot
- Department of Intensive Care, Dieppe General Hospital, Dieppe, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand, University Hospital, Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Dieppe General Hospital, Dieppe, France
- Espace de Réflexion Ethique de Normandie, University Hospital Caen, France
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Rigaud JP, Giabicani M, Meunier-Beillard N, Ecarnot F, Beuzelin M, Marchalot A, Dargent A, Quenot JP. Non-readmission decisions in the intensive care unit under French rules: A nationwide survey of practices. PLoS One 2018; 13:e0205689. [PMID: 30335804 PMCID: PMC6193659 DOI: 10.1371/journal.pone.0205689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/28/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We investigated, using a multicentre survey of practices in France, the practices of ICU physicians concerning the decision not to readmit to the ICU, in light of current legislation. MATERIALS AND METHODS Multicentre survey of practices among French ICU physicians via electronic questionnaire in January 2016. Questions related to respondents' practices regarding re-admission of patients to the ICU and how these decisions were made. Criteria were evaluated by the health care professionals as regards importance for non-readmission. RESULTS In total, 167 physicians agreed to participate, of whom 165 (99%) actually returned a completed questionnaire from 58 ICUs. Forty-five percent were aged <35 years, 74% were full-time physicians. The findings show that decisions for non-readmission are taken at the end of the patient's stay (87%), using a collegial decision-making procedure (89% of cases); 93% reported that this decision was noted in the patient's medical file. While 73% indicated that the family/relatives were informed of non-readmission decisions, only 29% reported informing the patient, and 91% considered that non-readmission decisions are an integral part of the French legislative framework. CONCLUSION This study shows that decisions not to re-admit a patient to the ICU need to be formally materialized, and anticipated by involving the patient and family in the discussions, as well as the other healthcare providers that usually care for the patient. The optimal time to undertake these conversations is likely best decided on a case-by-case basis according to each patient's individual characteristics.
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Affiliation(s)
- Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
- * E-mail:
| | - Mikhael Giabicani
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Nicolas Meunier-Beillard
- Service de Médecine Intensive Réanimation, Université de Bourgogne Franche Comté, CHU de Dijon, Dijon, France
- UMR 7366 CNRS, Université de Bourgogne Franche Comté, Centre Georges Chevrier, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, and University of Burgundy Franche Comté, Besançon, France
| | - Marion Beuzelin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Antoine Marchalot
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Auguste Dargent
- Service de Médecine Intensive Réanimation, Université de Bourgogne Franche Comté, CHU de Dijon, Dijon, France
- Lipness Team, INSERM, UMR 1231, Université de Bourgogne Franche Comté, Dijon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Université de Bourgogne Franche Comté, CHU de Dijon, Dijon, France
- Lipness Team, INSERM, UMR 1231, Université de Bourgogne Franche Comté, Dijon, France
- INSERM CIC 1432, Faculté de médecine de Dijon, Université de Bourgogne Franche Comté, Dijon, France
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Ecarnot F, Meunier-Beillard N, Seronde MF, Chopard R, Schiele F, Quenot JP, Meneveau N. End-of-life situations in cardiology: a qualitative study of physicians' and nurses' experience in a large university hospital. BMC Palliat Care 2018; 17:112. [PMID: 30290818 PMCID: PMC6173879 DOI: 10.1186/s12904-018-0366-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. METHODS We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses' aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienced end-of-life situations. Interviews were recorded, transcribed and coded using thematic analysis to identify major and secondary themes. RESULTS All physicians (N = 16)(average age 43.5 ± 13 years), 16 nurses (average age 38.5 ± 7.6 years) and 5 nurses' aides (average age 49 ± 7.8 years) participated. Interviews were held between 30 March and 17 July 2017. The main themes to emerge from the physicians' discourse were the concept of cardiology being a very active discipline, and a very curative frame of mind was prevalent. Communication (with paramedical staff, patients and families) was deemed to be important. Advance directives were thought to be rare, and not especially useful. Nurses also reported communication as a major issue, but their form of communication is bounded by several factors (physicians' prior discourse, legislation). They commonly engage in reconciling: between the approach (curative or palliative) and the reality of the treatment prescribed; performing curative interventions in patients they deem to be dying cases causes them distress. The emergency context prevents nurses from taking the time necessary to engage in end-of-life discussions. They engage in comfort-giving behaviors to maximize patient comfort. CONCLUSION Current perceptions and practices vis-à-vis end-of-life situations in our department are individual, heterogeneous and not yet aligned with recommendations of professional societies.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France. .,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France.
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRS, University of Burgundy, 21000, Dijon, France
| | - Marie-France Seronde
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.,Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000, Dijon, France.,Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, 21000, Dijon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
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Meunier-Beillard N, Ponthier N, Lepage C, Gagnaire A, Gheringuelli F, Bengrine L, Boudrant A, Rambach L, Quipourt V, Devilliers H, Lejeune C. Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study. Support Care Cancer 2018; 26:4121-4131. [PMID: 29872944 DOI: 10.1007/s00520-018-4283-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Family caregivers play an important role in caring for patients with advanced cancer. To become competent, individuals must draw on and mobilise an adequate combination of resources. Our goal was to identify the skills developed by caregivers of patients with advanced cancer and the associated resources mobilised. We chose to do it with partners of patients with colon cancer. METHODS The study used a cross-sectional qualitative design based on 20 individual interviews and a focus group. Partners were recruited from patients treated in three hospitals of France. Semi-structured interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes. RESULTS Results from the individual and focus group interviews showed that the skills implemented by the partners (in domains of social relationships and health, domestic, organisational, emotional and well-being dimensions) were singular constructs, dependant on if resources (personal, external and schemes) may have been missing and insufficient. In addition, partners may have had these resources but not mobilised them. CONCLUSION The identification of the skills and associated resources could allow healthcare professionals better identifying and understanding of the difficulties met by partners in taking care of patients. This could enable them to offer appropriate support to help the caregivers in their accompaniment.
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Affiliation(s)
- N Meunier-Beillard
- Centres Georges Chevrier UMR 7366 CNRS-Univ. Bourgogne Franche-Comte, Dijon, France
| | | | - C Lepage
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France.,Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - A Gagnaire
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - F Gheringuelli
- Department of Medical Oncology, Center Georges Francois Leclerc Dijon, Dijon, France.,CADIR LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - L Bengrine
- Department of Medical Oncology, Center Georges Francois Leclerc Dijon, Dijon, France
| | - A Boudrant
- Department of Hepato-gastroenterology, Wiliam Morey Hospital, Chalon-sur-Saône, France
| | - L Rambach
- CADIR LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - V Quipourt
- Hopital de jour gériatrique, centre de Champmaillot, CHU, Dijon, France
| | - H Devilliers
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France.,Inserm CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 7 bd Jeanne d'Arc, BP 87900, 21079, Dijon Cedex, France
| | - Catherine Lejeune
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France. .,Inserm CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 7 bd Jeanne d'Arc, BP 87900, 21079, Dijon Cedex, France.
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Quenot JP, Meunier-Beillard N, Ecarnot F, Dargent A, Rigaud JP. How can we best organise communication with patients' families? Anaesth Crit Care Pain Med 2018; 37:187-189. [PMID: 29578077 DOI: 10.1016/j.accpm.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jean-Pierre Quenot
- Department of intensive care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000 Dijon, France; Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000 Dijon, France; Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France.
| | - Nicolas Meunier-Beillard
- Department of intensive care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000 Dijon, France; Départment of sociology,centre Georges Chevrier UMR 7366 CNRS-University of Burgundy, 21000 Dijon, France
| | - Fiona Ecarnot
- EA3920, department of cardiology, University Hospital Besançon, 25000 Besançon, France
| | - Auguste Dargent
- Department of intensive care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000 Dijon, France; Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000 Dijon, France
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Rigaud JP, Large A, Meunier-Beillard N, Gélinotte S, Declercq PL, Ecarnot F, Dargent A, Quenot JP. What are the ethical aspects surrounding intensive care unit admission in patients with cancer? Ann Transl Med 2017; 5:S42. [PMID: 29302598 DOI: 10.21037/atm.2017.12.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Improvements in living conditions and increasing life expectancy have combined to result in ever older patients being admitted to hospital. In parallel, the increasing incidence of cancer, along with the improved efficacy of anti-cancer therapies has led to greater needs for intensive care among cancer patients. The objectives underpinning the management of cancer patients in the intensive care unit (ICU) are to achieve a return to a clinical status that would allow the patient to be either, transferred back to the original unit, or discharged from the hospital with an acceptable quality of life, and where warranted, pursuit of cancer therapy. The relevance of ICU admission should be assessed systematically for patients with active cancer. The decision needs to be made taking into account the expected benefit for the patient, the life-support therapies that are possible with discussion about a care project, and also considering the future quality of life and the short and long-term prognosis. Anticipating the question of potential ICU admission should help protect the patient against both inappropriate refusal of intensive care, and inappropriate admission to the ICU that might only lead to unreasonable therapeutic obstinacy. The intensive care physician has a major role to play in helping the cancer patient to develop an appropriate and flexible healthcare project. Anticipating the question of ICU admission in advance, as well as a close alliance between the oncologist and the intensive care physician are the two keys to the success of a healthcare project focused on the patient.
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Affiliation(s)
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRS, University of Burgundy, Dijon, France
| | | | | | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Large A, Andreu P, Rigaud JP. What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care? Ann Transl Med 2017; 5:S43. [PMID: 29302599 DOI: 10.21037/atm.2017.04.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of expressing themselves. A number of questions still remain unanswered regarding how decisions to limit or withdraw treatment are taken in daily practice, especially when this decision can be anticipated. We discuss here the collegial procedure for decision-making, in particular in the context of recent French legislation on end-of-life issues. We describe how collegial decision-making procedures should be carried out, and what points are covered in shared discussions regarding decisions to limit or withdraw life-sustaining therapies.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France.,INSERM Besancon, CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRSUniversity of Burgundy, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
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Andaluz-Ojeda D, Nguyen HB, Meunier-Beillard N, Cicuéndez R, Quenot JP, Calvo D, Dargent A, Zarca E, Andrés C, Nogales L, Eiros JM, Tamayo E, Gandía F, Bermejo-Martín JF, Charles PE. Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity. Ann Intensive Care 2017; 7:15. [PMID: 28185230 PMCID: PMC5307393 DOI: 10.1186/s13613-017-0238-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/27/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. METHODS This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association between biomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. Patients were divided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of the biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS A total of 326 patients with severe sepsis (21.7%) or septic shock (79.3%) were enrolled with a 28-day mortality rate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazard ratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysis over the entire cohort (AUROC [95% CI] 0.79 [0.74-0.84]) (p < 0.001). When patients were stratified by the degree of organ failure, MR-proADM was the only biomarker to predict mortality in all severity groups (SOFA ≤ 6, SOFA = 7-12, and SOFA ≥ 13), AUROC [95% CI] of 0.75 [0.61-0.88], 0.74 [0.66-0.83] and 0.73 [0.59-0.86], respectively (p < 0.05). All patients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the addition of MR-proADM to the SOFA score increased the ability of SOFA to identify non-survivors, AUROC [95% CI] 0.70 [0.58-0.82] and 0.77 [0.66-0.88], respectively (p < 0.05 for both). CONCLUSIONS The performance of prognostic biomarkers in sepsis is highly influenced by disease severity. MR-proADM accuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in the early identification of sepsis patients with moderate disease severity but at risk of mortality.
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Affiliation(s)
- David Andaluz-Ojeda
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - H. Bryant Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Nicolas Meunier-Beillard
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Ramón Cicuéndez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jean-Pierre Quenot
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Dolores Calvo
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Auguste Dargent
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Esther Zarca
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Cristina Andrés
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Leonor Nogales
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jose María Eiros
- Departmento de Microbiología, Facultad de Medicina, Universidad de Valladolid, Avda/Ramón y Cajal 7, 47005 Valladolid, Spain
| | - Eduardo Tamayo
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario, Avda/Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Francisco Gandía
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jesús F. Bermejo-Martín
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Pierre Emmanuel Charles
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
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Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Large A, Andreu P, Rigaud JP. What are the ethical questions raised by the integration of intensive care into advance care planning? Ann Transl Med 2017; 5:S46. [PMID: 29302602 DOI: 10.21037/atm.2017.08.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A major goal of intensive care units (ICUs) is to offer optimal management, but for many patients admitted to the ICU, they are unlikely to yield any lasting benefit. In this context, the ICU physician remains a key intermediary, particularly when a decision regarding possible limitation or withdrawal of life-sustaining therapy becomes necessary. The possibility of admission to the ICU, and the type of care the patient would like to receive there, should be integrated into the healthcare project in agreement with the patient, regardless of the stage of disease that the patient suffers from. These dispositions should be recorded in the patient's file, and should respect the progressive nature of both the disease itself, and the discussions necessary in such complex situations. The ICU physician can serve as a valuable consultant for the treating physician, in particular to guide patient choices when formalizing their healthcare preferences in the form of advance care planning (ACP) or advance directives (AD). Ideally, the best time to address this issue is before the patient's clinical situation deteriorates towards an acute emergency, and providing complete and transparent information to inform the patient's choices.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | | | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
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Meunier-Beillard N, Ecarnot F, Rigaud JP, Quenot JP. Can qualitative research play a role in answering ethical questions in intensive care? Ann Transl Med 2017; 5:S45. [PMID: 29302601 DOI: 10.21037/atm.2017.09.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Scientific and technological progress, as well as increased patient autonomy have profoundly changed the world of healthcare, giving rise to new situations that are increasingly complex and uncertain. Quantitative paradigms, of which the main bastion is evidence-based medicine (EBM), are beginning to reach their limits in daily routine practice of medicine, and new approaches are emerging that can provide novel heuristic perspectives. Qualitative research approaches can be useful for apprehending new areas of knowledge that are fundamental to recent and future developments in intensive care.
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Affiliation(s)
- Nicolas Meunier-Beillard
- Département de sociologie, Centre Georges Chevrier UMR 7366 CNRS-Université de Bourgogne, Dijon, France.,Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, EA3920, University Hospital Besancon, Besancon, France
| | | | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Large A, Andreu P, Rigaud JP. What are the ethical issues in relation to the role of the family in intensive care? Ann Transl Med 2017; 5:S40. [PMID: 29302596 DOI: 10.21037/atm.2017.04.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A large proportion of patients admitted to the intensive care unit (ICU) are unable to express themselves, often due to acute illness, shock or trauma, and this precludes any communication and/or consent for care that might reflect their wishes and opinions. In such cases, the only solution for the ICU physician is to include the patient's family in the healthcare decisions. This can represent a significant burden on the family, on top of the psychological distress of the ICU environment and hospitalisation of their relatives, and many family members may suffer from anxiety, depression or symptoms of post-traumatic stress disorder (PTSD) during or after the hospitalisation and/or death of a loved one in the ICU. Good communication remains the cornerstone of family satisfaction in the ICU. Information imparted to the patient and/or family should cover diagnosis, prognosis and treatment. Information should be given orally, in person, using accessible language. Several other measures that can lessen the burden on the families of patients in the ICU and help to reduce anxiety and stress are also detailed in this review. Overall, family-centred care in the ICU requires a systematic communication strategy within the healthcare team, combined with an environment that is as amenable as possible to the family's presence and involvement, in order to maximize family satisfaction with ICU care, and ensure that the patient's values and preferences are respected.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRS, University of Burgundy, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
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Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Eraldi JP, Bougerol F, Large A, Andreu P, Rigaud JP. What are the ethical dimensions in the profession of intensive care specialist? Ann Transl Med 2017; 5:S47. [PMID: 29302603 DOI: 10.21037/atm.2017.09.34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two essential components of the profession of a medical doctor are the constant review of the patient's therapeutic project, and collaboration between healthcare professionals. The profession of intensive care unit (ICU) physician goes further in terms of responsibility, vis-à-vis the intensive treatments dispensed to the patients, and the physician's responsibilities towards the patient's family and the caregiving team, also bearing in mind that ICU care is costly in terms of human and financial resources. In this review, we address the profession of ICU physician from the perspective of the ethical questions that arise constantly, focusing on the timeframe of the reflection process. Firstly, admission to the ICU must be anticipated. The concept of advance care planning is a suitable tool for this, and in case of non-admission to the ICU, does not by any means constitute an abandonment of the patient, because palliative care can also be anticipated, with a view to avoiding suffering for the patient and their family. Next, during an ICU stay, while the technical aspects undoubtedly characterise the ICU best at the start of the patient's stay, the process of reflection rapidly becomes preponderant, and involves the analysis of often complex situations with a view to defining the level of therapeutic engagement and optimizing the care dispensed to the patient. Last, a further ethical issue concerns the decision to re-admit (or not) a patient to the ICU. This decision can be made, for example, in the framework of a systematic, formalised, structured, multidisciplinary meeting at the end of an ICU stay, using a similar procedure to that implemented for decisions relating to withholding or withdrawal of life-sustaining therapies. The profession of ICU physician is not simply a question of prolonging or sustaining life, but is also fraught with ethical questions about how best to employ their competences. In this regard, it is essential to foster interdisciplinary collaboration, and emphasise the need for ICU physicians to be involved in the development of therapeutic projects, particularly when the disease in question is likely to be complicated by acute situations that may require admission of the patient to the ICU.
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Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Département de sociologie, Centre Georges Chevrier UMR 7366 CNRS-Université de Bourgogne, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | | | - François Bougerol
- Department of Intensive Care, Dieppe General Hospital, Dieppe, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
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Meunier-Beillard N, Dargent A, Ecarnot F, Rigaud JP, Andreu P, Large A, Quenot JP. Intersecting vulnerabilities in professionals and patients in intensive care. Ann Transl Med 2017; 5:S39. [PMID: 29302595 PMCID: PMC5750249 DOI: 10.21037/atm.2017.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 08/29/2017] [Indexed: 11/06/2022]
Abstract
In the context of healthcare delivery, the vulnerabilities of patients in the intensive care unit (ICU) are intricately linked with those experienced on a daily basis by caregivers in the ICU in a symbiotic relation, whereby patients who are suffering can in turn engender suffering in the caregivers. In the same way, caregivers who are suffering themselves may be a source of suffering for their patients. The vulnerabilities of both patients and caregivers in the ICU are simultaneously constituted through a process that is influenced on the one hand by the healthcare objectives of the ICU, and on the other hand, by the conformity of the patients who are managed in that ICU. The specific challenges of management in high-technology units such as an ICU may have consequences on the practices and work conditions of healthcare professionals. Constructing the patient, collectively redefining the patient's identity, and ascribing the patient to a specific healthcare trajectory enables professionals to circumscribe, contain and fight against the spectrum of extreme vulnerabilities of their patients. Imposing this normative framework is the sole means of guiding these professionals through their daily practices. In spite of this, situations of suffering remain a constitutive feature of the caregiving relation in the ICU.
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Affiliation(s)
- Nicolas Meunier-Beillard
- Département de sociologie, Centre Georges Chevrier, UMR 7366 CNRS, Université de Bourgogne, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, EA 3920, University Hospital Besancon, Besancon, France
| | | | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
- Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Bardou M, Crépon B, Bertaux AC, Godard-Marceaux A, Eckman-Lacroix A, Thellier E, Falchier F, Deruelle P, Doret M, Carcopino-Tusoli X, Schmitz T, Barjat T, Morin M, Perrotin F, Hatem G, Deneux-Tharaux C, Fournel I, Laforet L, Meunier-Beillard N, Duflo E, Le Ray I. NAITRE study on the impact of conditional cash transfer on poor pregnancy outcomes in underprivileged women: protocol for a nationwide pragmatic cluster-randomised superiority clinical trial in France. BMJ Open 2017; 7:e017321. [PMID: 29084796 PMCID: PMC5665235 DOI: 10.1136/bmjopen-2017-017321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Prenatal care is recommended during pregnancy to improve neonatal and maternal outcomes. Women of lower socioeconomic status (SES) are less compliant to recommended prenatal care and suffer a higher risk of adverse perinatal outcomes. Several attempts to encourage optimal pregnancy follow-up have shown controversial results, particularly in high-income countries. Few studies have assessed financial incentives to encourage prenatal care, and none reported materno-fetal events as the primary outcome. Our study aims to determine whether financial incentives could improve pregnancy outcomes in women with low SES in a high-income country. METHODS AND ANALYSIS This pragmatic cluster-randomised clinical trial includes pregnant women with the following criteria: (1) age above 18 years, (2) first pregnancy visit before 26 weeks of gestation and (3) belonging to a socioeconomically disadvantaged group. The intervention consists in offering financial incentives conditional on attending scheduled pregnancy follow-up consultations. Clusters are 2-month periods with random turnover across centres. A composite outcome of maternal and neonatal morbidity and mortality is the primary endpoint. Secondary endpoints include maternal or neonatal outcomes assessed separately, qualitative assessment of the perception of the intervention and cost-effectiveness analysis for which children will be followed to the end of their first year through the French health insurance database. The study started in June 2016, and based on an expected decrease in the primary endpoint from 18% to 14% in the intervention group, we plan to include 2000 women in each group. ETHICS AND DISSEMINATION Ethics approval was first gained on 28 September 2014. An independent data security and monitoring committee has been established. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02402855; pre-results.
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Affiliation(s)
- Marc Bardou
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
- Centre de Recherche INSERM LNC-UMR1231, UFR Sciences Santé, Dijon, France
- Université Bourgogne-Franche Comté, Dijon, France
| | - Bruno Crépon
- Centre de Recherche en Economie Statistique (CREST), Malakoff, France
| | - Anne-Claire Bertaux
- Unité de Soutien Méthodologique à la Recherche, CHU Dijon-Bourgogne, Dijon, Bourgogne, France
| | - Aurélie Godard-Marceaux
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
- “Ethique et Progrès médical”, CIC INSERM 1431, Centre Hospitalier et Universitaire de Besançon, Besançon, France
| | | | - Elise Thellier
- Service de Gynécologie Obstétrique, CHU de Bicetre, Paris, France
| | | | | | - Muriel Doret
- Service de Gynécologie Obstétrique, Hospices Civils de Lyon—Hôpital Femme Mère Enfant, Lyon, Rhône-Alpes, France
| | - Xavier Carcopino-Tusoli
- Service de Gynécologie Obstétrique, CHU de Marseille Hôpital Nord, Marseille, Provence-Alpes-Côte d’Azu, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, CHU Robert Debré, Paris, Île-de-France, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Mathieu Morin
- Service de Gynécologie Obstétrique, CHU de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Franck Perrotin
- Service de Gynécologie Obstétrique, CHU Bretonneau, Tours, France
| | - Ghada Hatem
- Service de Gynécologie Obstétrique, Centre Hospitalier de Saint Denis, Saint Denis, Île-de-France, France
| | - Catherine Deneux-Tharaux
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris France, Paris, France
| | - Isabelle Fournel
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Laurent Laforet
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Nicolas Meunier-Beillard
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
| | - Esther Duflo
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Isabelle Le Ray
- Service de Gynécologie Obstétrique, CHRU Strasbourg, Strasbourg, Alsace, France
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, Rodriguez J, Taddei M, Di Bari M, Hickmann C, Castanares-Zapatero D, Sayed FE, Deldicque L, Van Den Bergh P, Caty G, Roeseler J, Francaux M, Laterre PF, Dupuis B, Machayeckhi S, Sarfati C, Moore A, Dinh A, Mendialdua P, Rodet E, Pilorge C, Stephan F, Rezaiguia-Delclaux S, Dugernier J, Hesse M, Jumetz T, Bialais E, Depoortere V, Charron C, Michotte JB, Wittebole X, Jamar F, Geri G, Vieillard-Baron A, Repessé X, Kallel H, Mayence C, Houcke S, Guegueniat P, Hommel D, Dhifaoui K, Hajjej Z, Fatnassi A, Sellami W, Labbene I, Ferjani M, Dachraoui F, Nakkaa S, M’ghirbi A, Adhieb A, Braiek DB, Hraiech K, Ousji A, Ouanes I, Zaineb H, Abdallah SB, Ouanes-Besbes L, Abroug F, Klein S, Miquet M, Thouret JM, Peigne V, Daban JL, Boutonnet M, Lenoir B, Merhbene T, Derreumaux C, Seguin T, Conil JM, Kelway C, Blasco V, Nafati C, Harti K, Reydellet L, Albanese J, Aicha NB, Meddeb K, Khedher A, Ayachi J, Fraj N, Sma N, Chouchene I, Boussarsar M, Yedder SB, Samoud W, Radhouene B, Mariem B, Ammar A, Cheikh AB, Lakhal HB, Khelfa M, Hamdaoui Y, Bouafia N, Trampont T, Daix T, Legarçon V, Karam HH, Pichon N, Essafi F, Foudhaili N, Thabet H, Blel Y, Brahmi N, Ezzouine H, Kerrous M, Haoui SE, Ahdil S, Benslama A, Abidi K, Dendane T, Oussama S, Belayachi J, Madani N, Abouqal R, Zeggwagh AA, Ghadhoune H, Chaari A, Jihene G, Allouche H, Trabelsi I, Brahmi H, Samet M, Ghord HE, Habiba BSA, Hajer N, Tilouch N, Yaakoubi S, Jaoued O, Gharbi R, Hassen MF, Elatrous S, Arcizet J, Leroy B, Abdulmalack C, Renzullo C, Hamet M, Doise JM, Coutet J, Cheikh CM, Quechar Z, Joris M, Beauport DT, Kontar L, Lebon D, Gruson B, Slama M, Marolleau JP, Maizel J, Gorham J, Ameye L, Berghmans T, Paesmans M, Sculier JP, Meert AP, Guillot M, Ledoux MP, Braun T, Maestraggi Q, Michard B, Castelain V, Herbrecht R, Schneider F, Couffin S, Lobo D, Mongardon N, Dhonneur G, Mounier R, Le Borgne P, Couraud S, Herbrecht JE, Boivin A, Lefebvre F, Bilbault P, Zelmat SA, Batouche DD, Mazour F, Chaffi B, Benatta N, Sik AH, Talik I, Perrier M, Gouteix E, Koubi C, Escavy A, Guilbaut V, Fosse JP, Jazia RB, Abdelghani A, Cungi PJ, Bordes J, Nguyen C, Pierrou C, Cruc M, Benois A, Duprez F, Bonus T, Cuvelier G, Ollieuz S, Machayekhi S, Paciorkowski F, Reychler G, Coudroy R, Thille AW, Drouot X, Diaz V, Meurice JC, Robert R, Turki O, Ben HC, Assefi M, Deransy R, Brisson H, Monsel A, Conti F, Scatton O, Langeron O, Ghezala HB, Snouda S, Ben CI, Kaddour M, Armel A, Youness L, Abdelhak B, Youssef M, Najib AH, Mustapha A, Noufel M, Mohamed Z, Salma EK, Ghizlane M, Mohamed B, Benyounes R, Montini F, Moschietto S, Gregoire E, Claisse G, Guiot J, Morimont P, Krzesinski JM, Mariat C, Lambermont B, Cavalier E, Delanaye P, Benbernou S, Ilies S, Azza A, Bouyacoub K, Louail M, Mokhtari-Djebli H, Arrestier R, Daviaud F, Francois XL, Brocas E, Choukroun G, Peñuelas O, Lorente JA, Cardinal-Fernandez P, Rodriguez JM, Aramburu JA, Esteban A, Frutos-Vivar F, Bitker L, Costes N, Le Bars D, Lavenne F, Devouassoux M, Richard JC, Mechati M, Gainnier M, Papazian L, Guervilly C, Garnero A, Arnal JM, Roze H, Richard JC, Repusseau B, Dewitte A, Joannes-Boyau O, Ouattara A, Harbouze N, Amine AM, Olandzobo AG, Herbland A, Richard M, Girard N, Lambron L, Lesieur O, Wainschtein S, Hubert S, Hugues A, Tran M, Bouillard P, Loteanu V, Leloup M, Laurent A, Lheureux F, Prestifilippo A, Cruz MDM, Romain R, Antonelli M, Blanch TL, Bonnetain F, Grazzia-Bocci M, Mancebo J, Samain E, Paul H, Capellier G, Zavgorodniaia T, Soichot M, Malissin I, Voicu S, Garçon P, Goury A, Kerdjana L, Deye N, Bourgogne E, Megarbane B, Mejri O, Hmida MB, Tannous S, Chevillard L, Labat L, Risede P, Fredj H, Léger M, Brunet M, Le Roux G, Boels D, Lerolle N, Farah S, Amiel-Niemann H, Kubis N, Declèves X, Peyraux N, Baud F, Serafini M, Alvarez JC, Heinzelman A, Jozwiak M, Millasseau S, Teboul JL, Alphonsine JE, Depret F, Richard N, Attal P, Richard C, Monnet X, Chemla D, Jerbi S, Khedhiri W, Necib H, Scarfo P, Chevalier C, Piagnerelli M, Lafont A, Galy A, Mancia C, Zerhouni A, Tabeliouna K, Gaja A, Hamrouni B, Malouch A, Fourati S, Messaoud R, Zarrouki Y, Ziadi A, Rhezali M, Zouizra Z, Boumzebra D, Samkaoui MA, Brunet J, Canoville B, Verrier P, Ivascau C, Seguin A, Valette X, Du Cheyron D, Daubin C, Bougouin W, Aissaoui N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Dumas F, Marijon E, Jouven X, Cariou A, Poirson F, Chaput U, Beeken T, Maxime L, Haikel O, Vodovar D, Chelly J, Marteau P, Chocron R, Juvin P, Loeb T, Adnet F, Lecarpentier E, Riviere A, De Cagny B, Soupison T, Privat E, Escutnaire J, Dumont C, Baert V, Vilhelm C, Hubert H, Leteurtre S, Fresco M, Bubenheim M, Beduneau G, Carpentier D, Grange S, Artaud-Macari E, Misset B, Tamion F, Girault C, Dumas G, Chevret S, Lemiale V, Mokart D, Mayaux J, Pène F, Nyunga M, Perez P, Moreau AS, Bruneel F, Vincent F, Klouche K, Reignier J, Rabbat A, Azoulay E, Frat JP, Ragot S, Constantin JM, Prat G, Mercat A, Boulain T, Demoule A, Devaquet J, Nseir S, Charpentier J, Argaud L, Beuret P, Ricard JD, Teiten C, Marjanovic N, Palamin N, L’Her E, Bailly A, Boisramé-Helms J, Champigneulle B, Kamel T, Mercier E, Le Thuaut A, Lascarrou JB, Rolle A, De Jong A, Chanques G, Jaber S, Hariri G, Baudel JL, Dubée V, Preda G, Bourcier S, Joffre J, Bigé N, Ait-Oufella H, Maury E, Mater H, Merdji H, Grimaldi D, Rousseau C, Mira JP, Chiche JD, Sedghiani I, Benabderrahim A, Hamdi D, Jendoubi A, Cherif MA, Hechmi YZE, Zouheir J, Bagate F, Bousselmi R, Schortgen F, Asfar P, Guérot E, Fabien G, Anguel N, Sigismond L, Matthieu HL, Gonzalez F, François L, Guitton C, Schenck M, Jean-Marc D, Dreyfuss D, Radermacher P, Frère A, Martin-Lefèvre L, Colin G, Fiancette M, Henry-Laguarrigue M, Lacherade JC, Lebert C, Vinatier I, Yehia A, Joret A, Menunier-Beillard N, Benzekri-Lefevre D, Desachy A, Bellec F, Plantefève G, Quenot JP, Meziani F, Tavernier E, Ehrmann S, Chudeau N, Raveau T, Moal V, Houillier P, Rouve E, Lakhal K, Gandonnière CS, Jouan Y, Bodet-Contentin L, Balmier A, Messika J, De Montmollin E, Pouyet V, Sztrymf B, Thiagarajah A, Roux D, De Chambrun MP, Luyt CE, Beloncle F, Zapella N, Ledochowsky S, Terzi N, Mazou JM, Sonneville R, Paulus S, Fedun Y, Landais M, Raphalen JH, Combes A, Amoura Z, Jacquemin A, Guerrero F, Marcheix B, Hernandez N, Fourcade O, Georges B, Delmas C, Makoudi S, Genton A, Bernard R, Lebreton G, Amour J, Mazet C, Bounes F, Murat G, Cronier L, Robin G, Biendel C, Silva S, Boubeche S, Abriou C, Wurtz V, Scherrer V, Rey N, Gastaldi G, Veber B, Doguet F, Gay A, Dureuil B, Besnier E, Rouget A, Gantois G, Magalhaes E, Wanono R, Smonig R, Lermuzeaux M, Lebut J, Olivier A, Dupuis C, Radjou A, Mourvillier B, Neuville M, D’ortho MP, Bouadma L, Rouvel-Tallec A, Rudler M, Weiss N, Perlbarg V, Galanaud D, Thabut D, Rachdi E, Mhamdi G, Trifi A, Abdelmalek R, Abdellatif S, Daly F, Nasri R, Tiouiri H, Lakhal SB, Rousseau G, Asmolov R, Grammatico-Guillon L, Auvet A, Laribi S, Garot D, Dequin PF, Guillon A, Fergé JL, Abgrall G, Hinault R, Vally S, Roze B, Chaplain A, Chabartier C, Savidan AC, Marie S, Cabie A, Resiere D, Valentino R, Mehdaoui H, Benarous L, Soda-Diop M, Bouzana F, Perrin G, Bourenne J, Eon B, Lambert D, Trebuchon A, Poncelet G, Le Bourgeois F, Michael L, Camille G, Naudin J, Deho A, Dauger S, Sauthier M, Bergeron-Gallant K, Emeriaud G, Jouvet P, Tiebergien N, Jacquet-Lagrèze M, Fellahi JL, Baudin F, Essouri S, Javouhey E, Guérin C, Lampin M, Mamouri O, Devos P, Karaca-Altintas Y, Vinchon M, Brossier D, Eltaani R, Teyssedre S, Sabine M, Bouchut JC, Peguet O, Petitdemange L, Guilbert AS, Aoul NT, Addou Z, Aouffen N, Anas B, Kalouch S, Yaqini K, Chlilek A, Abdou R, Gravellier P, Chantreuil J, Travers N, Listrat A, Le Reun C, Favrais G, Coppere Z, Blanot S, Montmayeur J, Bronchard R, Rolando S, Orliaguet G, Leger PL, Rambaud J, Thueux E, De Larrard A, Berthelot V, Denot J, Reymond M, Amblard A, Morin-Zorman S, Lengliné E, Pichereau C, Mariotte E, Emmanuel C, Poujade J, Trumpff G, Janssen-Langenstein R, Harlay ML, Zaid N, Ait-Ammar N, Bonnal C, Merle JC, Botterel F, Levesque E, Riad Z, Mezidi M, Yonis H, Aublanc M, Perinel-Ragey S, Lissonde F, Louf-Durier A, Tapponnier R, Louis B, Forel JM, Bisbal M, Lehingue S, Rambaud R, Adda M, Hraiech S, Marchi E, Roch A, Guerin V, Rozencwajg S, Schmidt M, Hekimian G, Bréchot N, Trouillet JL, Besset S, Franchineau G, Nieszkowska A, Pascal L, Loiselle M, Sarah C, Laurence D, Guillemette T, Jacquens A, Kerever S, Guidet B, Aegerter P, Das V, Fartoukh M, Hayon J, Desmard M, Fulgencio JP, Zuber B, Soufi A, Khaleq K, Hamoudi D, Garret C, Peron M, Coron E, Bretonnière C, Audureau E, Audrey W, Christophe D, Christian J, Daniel A, Cyrille F, Aissaoui W, Rghioui K, Haddad W, Barrou H, Carteaux-Taeib A, Lupinacci R, Manceau G, Jeune F, Tresallet C, Habacha S, Fathallah I, Zoubli A, Aloui R, Kouraichi N, Jouet E, Badin J, Fermier B, Feller M, Serie M, Pillot J, Marie W, Gisbert-Mora C, Vinclair C, Lesbordes P, Mathieu P, De Brabant F, Muller E, Robaux MA, Giabicani M, Marchalot A, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Meunier-Beillard N, Devilliers H, Rigaud JP, Verrière C, Ardisson F, Kentish-Barnes N, Jacq G, Chermak A, Lautrette A, Legrand M, Soummer A, Thiery G, Cottereau A, Canet E, Caujolle M, Allyn J, Valance D, Brulliard C, Martinet O, Jabot J, Gallas T, Vandroux D, Allou N, Durand A, Nevière R, Delguste F, Boulanger E, Preau S, Martin R, Cochet H, Ponthus JP, Amilien V, Tchir M, Barsam E, Ayoub M, Georger JF, Guillame I, Assaraf J, Tripon S, Mallet M, Barbara G, Louis G, Gaudry S, Barbarot N, Jamet A, Outin H, Gibot S, Bollaert PE, Holleville M, Legriel S, Chateauneuf AL, Cavelot S, Moyer JD, Bedos JP, Merle P, Laine A, Natalie DS, Cornuault M, Libot J, Asehnoune K, Rozec B, Dantal J, Videcoq M, Degroote T, Jaillette E, Zerimech F, Malika B, Llitjos JF, Amara M, Lacave G, Pangon B, Mavinga J, Makunza JN, Mafuta ME, Yanga Y, Eric A, Ilunga J, Kilembe M, Alby-Laurent F, Toubiana J, Mokline A, Laajili A, Amri H, Rahmani I, Mensi N, Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Large A, Andreu P, Rigaud JP. Intensive care unit strain should not rush physicians into making inappropriate decisions, but merely reduce the time to the right decisions being made. Ann Transl Med 2016; 4:316. [PMID: 27668236 DOI: 10.21037/atm.2016.07.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France; ; Lipness Team, INSERM Research Center UMR 866 and LabExLipSTIC, University of Burgundy, Dijon, France; ; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France; ; Department of Sociology, UMR 7366 CNRS, University of Burgundy - Franche-Comté, Dijon, France
| | - Auguste Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Audrey Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
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Rigaud JP, Meunier-Beillard N, Aubry R, Dion M, Ecarnot F, Quenot JP. Le médecin réanimateur : un consultant extérieur pour un choix éclairé du patient et de ses proches ? Réanimation 2016. [DOI: 10.1007/s13546-016-1189-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rigaud JP, Hardy JB, Meunier-Beillard N, Devilliers H, Ecarnot F, Quesnel C, Gelinotte S, Declercq PL, Eraldi JP, Bougerol F, Quenot JP. The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person. J Crit Care 2015; 32:89-92. [PMID: 26787167 DOI: 10.1016/j.jcrc.2015.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/22/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate. METHODS We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs. RESULTS Among 144 staff, 128 were contacted; 99 completed the questionnaire (77% response rate; 20 physicians [11 residents], 51 nurses, 28 nurse's aides). Items classed as most important attributes for a reference person were knowledge of patient's wishes and values, emotional attachment, adequate understanding of the clinical history, and designation as a surrogate before admission. There were no significant differences according to respondent's age, job title, or experience. CONCLUSION Caregivers identify a reference person based on criteria such as knowledge of the patient's wishes, emotional bond with the patient, an adequate understanding of the clinical history, and designation as surrogate before admission.
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Affiliation(s)
| | - Jean-Baptiste Hardy
- Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France.
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François Mitterrand University Hospital, 21079 Dijon, France; UMR 7366 CNRS, University of Burgundy, Dijon, France.
| | - Hervé Devilliers
- Department of Internal Medicine, François Mitterrand University Hospital, 21079 Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Fiona Ecarnot
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France.
| | - Corinne Quesnel
- Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France.
| | - Stéphanie Gelinotte
- Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France.
| | | | - Jean-Pierre Eraldi
- Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France.
| | - François Bougerol
- Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France.
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 21079 Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France; Lipness Team, INSERM Research Center UMR 866, University of Burgundy, Dijon, France.
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