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Ducloyer JB, Poinas A, Duchesne L, Caillet P, Ivan C, Lejus-Bourdeau C, Limousin N, Desmidt T, Pladys P, Pisella PJ, Bernard A, Lardy H, Gohier P, Martin L, Mouriaux F, Lebranchu P, Khanna RK. Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study. Ophthalmol Ther 2023; 12:2801-2812. [PMID: 37531031 PMCID: PMC10441871 DOI: 10.1007/s40123-023-00774-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs' successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. METHODS AND PLANNED OUTCOMES This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the "College des Ophtalmologistes Universitaires de France" in order to set up a future "licence to operate." Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT05722080.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Alexandra Poinas
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France.
| | - Léa Duchesne
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Pascal Caillet
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Catherine Ivan
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Corinne Lejus-Bourdeau
- Department of Anaesthesia and Intensive Care, CHU Nantes-Nantes University, Nantes, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, Tours, France
| | - Thomas Desmidt
- Inserm, UMR 1253, IBrain, Université de Tours, Tours, France
- CHU de Tours, Tours, France
| | - Patrick Pladys
- LTSI-UMR 1099, INSERM, CHU Rennes-Rennes University, Rennes, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, CHU Tours-Bretonneau Hospital, 37000, Tours, France
| | - Anne Bernard
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Hubert Lardy
- Division of Pediatric Surgery, CHU-Centre de Pédiatrie de Clocheville, Tours, France
| | - Philippe Gohier
- Department of Ophthalmology, CHU de Angers, 49100, Angers, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, Angers, France
- All'Sims Centre for Healthcare Simulation, Angers University Hospital, Angers, France
| | - Frederic Mouriaux
- Ophthalmology Department, CHU Rennes-Université Rennes 1, Rennes, France
| | - Pierre Lebranchu
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Raoul Kanav Khanna
- Department of Ophthalmology, UMR 1253, iBrain, Bretonneau University Hospital of Tours, Tours, France
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Mouillet G, Fritzsch J, Paget-Bailly S, Pozet A, Es-Saad I, Meurisse A, Vernerey D, Mouyabi K, Berthod D, Bonnetain F, Anota A, Thiery-Vuillemin A. Health-related quality of life assessment for patients with advanced or metastatic renal cell carcinoma treated with a tyrosine kinase inhibitor using electronic patient-reported outcomes in daily clinical practice (QUANARIE trial): study protocol. Health Qual Life Outcomes 2019; 17:25. [PMID: 30717745 PMCID: PMC6360763 DOI: 10.1186/s12955-019-1085-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Two main therapies, pazopanib and sunitinib, are used in the first-line setting for metastatic renal cell carcinoma (mRCC). These two tyrosine kinase inhibitors (TKI) are equally effective in terms of survival; however, they frequently induce adverse events. In this setting, Health-Related Quality of life (HRQoL) is a key element in the choice between these two treatments and the evaluation of treatment effectiveness. It could be of interest to evaluate HRQoL in daily clinical practice to aid adequate therapy choice and management. Currently, the development of information and communication technology may allow HRQoL monitoring in routine practice. The objective of the QUANARIE study is to evaluate the use of HRQoL assessment in daily clinical practice for patients with mRCC treated with TKI using electronic patient-reported outcomes (e-PRO). The present article describes the key elements of the study protocol. METHODS The QUANARIE study is an interventional, prospective, multicentre trial. Patients diagnosed with mRCC initiating sunitinib or pazopanib treatment will be invited to complete the EORTC QLQ-C30 questionnaire, nine additional questions from the EORTC items library, and the EuroQoL EQ-5D, prior to each visit with the physician. Questionnaires will be completed by patients using tablets and/or computer terminals via the e-PRO software. The physician will have real-time access to a visual summary of the HRQoL evaluation. The primary objective is to assess the proportion of patients having good compliance with Routine Electronic Monitoring of HRQoL (REMOQOL) during the first 12 months. Physicians' satisfaction with REMOQOL will be assessed as a secondary objective. We hypothesise that 80% of patients having good compliance with REMOQOL would be meaningful. A sample size of 56 patients would be needed. DISCUSSION The results of this study will show whether REMOQOL is feasible on a large scale and whether patients are receptive to this new practice. This study will also determine how real-time multidimensional evaluation of patient perception can help physicians in their daily practice and how they used it in conjunction with other clinical information to manage patient care. TRIAL REGISTRATION ClinicalTrials.gov; Identifier: NCT03062410 ; First Posted: February 23, 2017; Last Update Posted: August 9, 2017.
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Affiliation(s)
- Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Joëlle Fritzsch
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Astrid Pozet
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Ikram Es-Saad
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Aurelia Meurisse
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Dewi Vernerey
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Kristina Mouyabi
- Clinical Research and Innovation Office, University Hospital of Besançon, F-25000 Besançon, France
| | - Diane Berthod
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
| | - Franck Bonnetain
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Amélie Anota
- Methodological and Quality of Life Unit, University Hospital of Besançon, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
- French National Platform Quality of Life and Cancer, Besançon, France
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, University Hospital of Besançon, Boulevard Fleming, F-25000 Besançon, France
- INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, F-25000 Besançon, France
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Le Moullec N, Fianu A, Maillard O, Chazelle E, Naty N, Schneebeli C, Gérardin P, Huiart L, Charles MA, Favier F. Sexual dimorphism in the association between gestational diabetes mellitus and overweight in offspring at 5-7 years: The OBEGEST cohort study. PLoS One 2018; 13:e0195531. [PMID: 29621322 PMCID: PMC5886576 DOI: 10.1371/journal.pone.0195531] [Citation(s) in RCA: 30] [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: 11/22/2017] [Accepted: 03/23/2018] [Indexed: 01/10/2023] Open
Abstract
Evidence from literature is mixed regarding a possible association of maternal gestational diabetes mellitus (GDM) and overweight in the offspring. Sexual dimorphism, or sex disparities in the pathogenesis linking GDM exposure to overweight, could be at play. The objective of this study was to investigate the association between GDM and child overweight at 5–7 years. Six hundred pairs (1:1) of Reunionese liveborn singletons selected from a hospital-based birth registry, matched for sex, gestational age, and birth period, underwent a prospective in-home follow-up and were analyzed with respect to their exposure to GDM. The primary outcome was child overweight at 5–7 years, as defined by the International Obesity Task Force. The association between GDM exposure and child overweight was estimated by the odds ratio (OR) using conditional logistic regression models. For the subset of children exposed to GDM with available maternal glycemic data, we analyzed the relationship between maternal glycemic levels during pregnancy and child body mass index (BMI) at 5–7 years with a linear regression model. In light of the significant interaction between sex and GDM, all statistical analyses were then stratified by sex. After controlling for pre-pregnancy BMI and maternal sociodemographic characteristics, the risk of overweight increased with exposure to GDM for boys (adjusted OR: 2.34; 95% confidence interval = 1.26–4.34, P = 0.007) but not for girls (adjusted OR: 0.56; 95%CI = 0.28–1.10, P = 0.093). Consistent with this, the linear increase of boys’ BMI at 5–7 years with maternal blood glucose levels during pregnancy, in the exposed group, displayed a dose-response relationship. Our findings indicate that exposure to GDM is a risk factor for childhood overweight in boys but not in girls, which adds to the growing body of evidence suggesting greater sensitivity of male offspring to intrauterine hyperglycemia.
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Affiliation(s)
- Nathalie Le Moullec
- Department of Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire (CHU) Réunion, Saint-Pierre, Reunion, France
| | - Adrian Fianu
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
- UMR1027, Université de Toulouse, UPS, Inserm, Toulouse, France
- * E-mail:
| | - Olivier Maillard
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Emilie Chazelle
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Nadège Naty
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Chantal Schneebeli
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Patrick Gérardin
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Laetitia Huiart
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
| | - Marie-Aline Charles
- Center for Research in Epidemiology and Population Health, Paris, France
- Paris Descartes University, Paris, France
| | - François Favier
- INSERM CIC 1410 Clinical and Epidemiology/ CHU Réunion/Université de la Réunion, Saint-Pierre, Reunion, France
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