C. Auclair

Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: A French multicentre randomised controlled trial

PURPOSE OF THE RESEARCH The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. METHODS AND SAMPLE A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m(2). The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. KEY RESULTS The main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the womens ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. CONCLUSIONS Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

Clinical Decision-Making in the Treatment of Schizophrenia: Focus on Long-Acting Injectable Antipsychotics

The purpose of this study was to identify clinician characteristics associated with higher prescription rates of long-acting injectable (LAI) antipsychotics, as well as the sources that influence medical decision-making regarding the treatment of schizophrenia. We surveyed 202 psychiatrists during six regional French conferences (Bordeaux, Lyon, Marseille, Nice, Paris, and Strasbourg). Data on the characteristics of practice, prescription rates of antipsychotic, and information sources about their clinical decisions were collected. Most psychiatrists used second-generation antipsychotics (SGAs), and preferentially an oral formulation, in the treatment of schizophrenia. LAI SGAs were prescribed to 30.4% of schizophrenic patients. The duration and type of practice did not influence the class or formulation of antipsychotics used. The clinicians following the higher percentage of schizophrenic patients were associated with a higher use of LAI antipsychotics and a lower use of oral SGAs. Personal experience, government regulatory approval, and guidelines for the treatment of schizophrenia were the three main contributing factors guiding clinicians’ decision-making regarding the treatment of schizophrenia. The more clinicians follow schizophrenic patients, the more they use LAI antipsychotics. The development of specialized programs with top specialists should lead to better use of LAI antipsychotics in the treatment of schizophrenia.

P100 Complications diabétiques : intérêt du dépistage des populations précaires par le score EPICES

Introduction Dans l’hypothese ou la situation de precarite serait liee a des formes de diabete plus compliquees, le reperage des patients diabetiques en situation de precarite permettrait une action de prevention plus ciblee et d’intensifier leur suivi. Le score EPICES (Evaluation de la Precarite, Indice des Centres d’Examen de Sante), valide comme score de precarite pourrait permettre de reperer ces patients a risque. Patients et methodes Il s’agit d’une etude monocentrique descriptive realisee en CHU de novembre 2006 a juillet 2007. Les patients diabetiques ont ete repartis en 2 groupes selon leur statut de precarite (score EPICES > 30,17) ou non. L’equilibre du diabete ainsi que les differentes complications ont ete ensuite comparees dans les 2 groupes. La qualite de vie de ces 2 groupes de patients a egalement ete etudiee grâce au questionnaire SF-36. Resultats Cent deux patients ont rempli le questionnaire. 97 patients ont ete inclus : 18 porteurs d’un diabete de type 1 et 79 d’un diabete de type 2. Aucun lien statistique n’a pu etre mis en evidence entre score EPICES et valeur de l’HbA1c. Concernant les complications, la nephropathie est statistiquement reliee au seuil de precarite (p = 0,0489) tandis que la neuropathie tend a l’etre sans etre significative (p = 0,0624). Aucun lien n’apparait avec les autres complications. Les patients diabetiques precaires presentent par contre plus de comorbidites : surpoids (p = 0,001) et hypoHDLemie (p = 0,0424), cette derniere relation disparaissant apres ajustement sur l’âge, le delai d’evolution du diabete et le sexe. La qualite de vie des patients diabetiques precaires est bien moindre dans tous les aspects de la vie quotidienne etudies. Conclusion Alors que precarite et equilibre glycemique ne sont pas correles, les sujets diabetiques precaires depistes grâce au score EPICES sont exposes a un plus haut risque renal et cardio-vasculaire. La qualite de vie de ces patients est correlee a leur score EPICES de precarite.