P. Boyer

General Practitioners' Clinical Impression in the Screening for Frailty: Data From the FAP Study Pilot

BACKGROUNDnThe progression of frailty is marked by an increased risk of adverse health outcomes in the elderly including falls, physical and/or cognitive disability, hospitalizations, and mortality. In primary care, the general practitioners (GPs) clinical impression about their elderly patients frailty state seems to be a key point in identifying frail individuals in their clinical practice. The aim of this article is to examine if GPs clinical impressions regarding frailty concurs with objective measures of the gold standard frailty phenotype as described by Fried in community-dwelling older persons.nnnDESIGNnCross-sectional study in 14 primary care GP offices in the Toulouse area from May 1st to October 31st,xa02015.nnnPARTICIPANTSnFourteen GPs screened their patients ≥70xa0years old.nnnMEASUREMENTSnGPs frailty impression was based on the Gérontopôle Frailty Screening Tool. Objective measures of the five Fried frailty criteria were obtained by a geriatric nurse through standardized testing. The capacity of the GPs clinical impression to detect participants objectively measured as frail was examined with diagnostic values of observed sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).nnnRESULTSnA total of 268 participants were screened by GPs and assessed by a nurse. Mean age was 81 years and 62.3% were female. According to the objective measures of Frieds criteria, frailty (three to five criteria) and pre-frailty (one to two criteria) states were identified in 31% and 45.2% of participants, respectively. The Se of the GPs impression was good (80.39%; 95% confidence interval [CI], 74.27%-85.61%), and the Sp was moderate (64.06%; 95% CI, 5.10%-75.68%). The overall PPV of the GPs impression was 87.70% (95% CI, 82.12%-92.04%), and the NPV was 50.51% (95% CI, 39.27%-61.91%). Although the PPV increased with age reaching 93.33% (95% CI, 85.12%-97.80%) among patientsxa0≥xa085xa0years old, the NPV decreased accordingly to a minimal 21.43% (95% CI, 4.66%-50.80%) in that subgroup.nnnCONCLUSIONnThe present study highlights the importance of the GPs clinical impression on frailty as a fair means to identify this syndrome in community-dwelling older patients in primary care. This clinical impression may not be sufficient, however, and some objective tests could be added to improve the accuracy of frailty detection in older patients in primary care.

Controverses en AMP : faut-il congeler les ovocytes ou les embryons ? Les ovocytes

Since the beginning of IVF, cryopreservation concern spermatozoa or embryos due to the poor efficiency of oocyte freezing. To date, oocyte vitrification allows changing our practice privileging female gamete vitrification instead of human embryo freezing.

Enquête de satisfaction des couples à propos de la vitrification ovocytaire autologue en assistance médicale à la procréation

OBJECTIVESnWe organized a survey for in-vitro fertilization couples who beneficiated on self-preservation of part of the oocyte cohort. The main objective was to measure couples satisfaction. Secondary objectives were; to identify how patients had been informed; to verify that the use of the ART technique met their expectations, and how they felt about oocyte or embryo freezing.nnnMETHODSnThe data were collected by a questionnaire sent electronically to couples who had undergone partial vitrification of the oocyte cohort and at least one warming cycle. The questionnaire consisted of 2 components; one for the women and another one for their husband.nnnRESULTSnEighty-eight women and 62 men responded to the survey respectively, representing 50.86% and 35.84% of the targeted patients. They were satisfied with a 90% rate, men and women combined. The information we give in the center is heard by couples and is part of the trust in the medical staff. Men are more worried than women about the risks of stimulation or ovarian pick-up and are not displeased to be called upon for sperm recovery for every attempt at oocyte warming. The ambiguity of the answers on the representation of the embryo confirms what is already described, but is independent of the acceptance of freezing whether it is oocyte or embryo.nnnCONCLUSIONnIn the same way as evaluating the results, the evaluation of patient satisfaction is useful for the implementation of therapeutic strategies and care pathways.

Entre lecture pragmatique et vision anxiogène : vécu de la cryoconservation embryonnaire par les patients en parcours de FIV

OBJECTIVESnThe aim of this article is to question the feeling of IVF patients towards embryonic cryopreservation, in order to understand their potential reluctance to freeze embryos and their difficulties to consider the fate of their frozen embryos once their parental project completed.nnnMETHODSnTwenty-seven semi-directive interviews with homologous IVF patients were conducted. These persons were followed in two fertility centres in Marseille.nnnRESULTSnIf all the patients interviewed have accepted embryonic cryopreservation or have accepted on principle, a majority have an ambivalent attitude towards this technique. If some share the pragmatic vision of professionals (embryologists, technicians and gynaecologists), they are numerous to worry about a possible deterioration of embryonic quality, or again about a disrupted order of generation. Finally, it appears that patients do not anticipate the possible fate of their frozen embryos if they are uninscribed from their parental project.nnnCONCLUSIONSnPatients are mainly ambivalent towards embryonic cryopreservation. They prioritize different rationality depending on the situations and issues they are dealing with.