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Article ; Online: Reply to 'Response to "The opinion of French pulmonologists and palliative care physicians on non-invasive ventilation during palliative sedation at end of life: a nationwide survey'' '.

Guastella, V / Greil, A / Lambert, C / Lautrette, A

2023 Volume 22, Issue 1, Page(s) 17

Abstract: We read with interest the letter by Twycross and al on our article recently published in BMC Palliative Care. The authors suggest that the term palliative sedation has been used inappropriately and they consider that in the situation described the ... ...

Abstract	We read with interest the letter by Twycross and al on our article recently published in BMC Palliative Care. The authors suggest that the term palliative sedation has been used inappropriately and they consider that in the situation described the sedation was a procedural one rather than a continuous deep sedation. We strongly disagree with this point of view. In an end-of-life situation, the priorities are the patient's comfort, pain and anxiety. This type of sedation does not have the characteristics of procedural sedation described in anaesthesia. The French Clayes Leonetti law makes it possible to clarify the intention of the sedation in end-of-life situations.
MeSH term(s)	Humans ; Noninvasive Ventilation ; Pulmonologists ; Palliative Care ; Physicians ; Anesthesia ; Death
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Letter
ZDB-ID	2091556-1
ISSN	1472-684X ; 1472-684X
ISSN (online)	1472-684X
ISSN	1472-684X
DOI	10.1186/s12904-023-01128-1
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Article: Plaidoyer pour la nourriture et le vin en soins palliatifs.

Guastella, Virginie / Braud, Sandrine

Revue de l'infirmiere

2021 Volume 70, Issue 274, Page(s) 28–30

Abstract: In the palliative care unit, the care and treatment provided are aimed at optimizing the quality of life and not the quantity of life. Food is adjusted to the patient's condition and is primarily oriented towards pleasure food. ...

Title translation	Advocacy for food and wine in palliative care.
Abstract	In the palliative care unit, the care and treatment provided are aimed at optimizing the quality of life and not the quantity of life. Food is adjusted to the patient's condition and is primarily oriented towards pleasure food.
MeSH term(s)	Hospice and Palliative Care Nursing ; Humans ; Palliative Care ; Quality of Life ; Wine
Language	French
Publishing date	2021-07-16
Publishing country	France
Document type	Journal Article
ZDB-ID	632538-5
ISSN	1293-8505 ; 0397-7900
ISSN	1293-8505 ; 0397-7900
DOI	10.1016/j.revinf.2021.07.007
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Article ; Online: The Prevalence of Off-label Prescribing of Transmucosal Immediate-Release Fentanyl in France.

Guastella, Virginie / Delorme, Jessica / Chenaf, Chouki / Authier, Nicolas

Journal of pain and symptom management

2022 Volume 63, Issue 6, Page(s) 980–987

Abstract: Context: The abuse of opioids and opioid-related harms, including deaths, in the United States are well documented. In the European Union, opioid use has also been increasing, particularly of fentanyl.: Objective: We assessed the prevalence of off- ... ...

Abstract	Context: The abuse of opioids and opioid-related harms, including deaths, in the United States are well documented. In the European Union, opioid use has also been increasing, particularly of fentanyl. Objective: We assessed the prevalence of off-label prescribing of transmucosal immediate-release fentanyl (TIRF), in France, in 2019. We looked at the patients' and prescribers' characteristics and compared the population of patients who received TIRF in off-label prescriptions with those taking it on-label. We also examined the differences between the patients with and without cancer in the off-label use population. Methods: This was a population-based cross-sectional study conducted in 2019, using the French national insurance claims database Système National d'Informations Inter-Régimes de l'Assurance Maladie, covering 98.8% of the French population, or 66 million people. Results: We selected 224,000 patients with fentanyl prescriptions. Among them, 23,209 had at least one TIRF delivered. The median age was 71 years (59-85) and most patients were female (55.8%). The prevalence of off-label prescribing of TIRF was 51.8% (n = 12,031), corresponding to 9827 patients not diagnosed with cancer. The three main pharmaceutical TIRF specialties prescribed in two groups were Abstral, Pecfent, and Instanyl. Overall, TIRF was mainly prescribed by private general practitioners (64.8%). Conclusion: The prevalence of off-label prescribing of TIRF in France is extremely high. A field survey is now needed 1) to better understand why TIRF is used in conditions not indicated in its marketing authorization, and in what clinical situations, and 2) to determine whether the benefit/risk ratio of such use is favorable.
MeSH term(s)	Aged ; Analgesics, Opioid/therapeutic use ; Cross-Sectional Studies ; Female ; Fentanyl/therapeutic use ; France/epidemiology ; Humans ; Male ; Neoplasms/drug therapy ; Neoplasms/epidemiology ; Off-Label Use ; Practice Patterns, Physicians' ; Prevalence ; United States
Chemical Substances	Analgesics, Opioid ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2022-02-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2022.02.016
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Article ; Online: The effects of foot reflexology on symptoms of discomfort in palliative care: a feasibility study.

Marcolin, Marie Lavarelo / Tarot, Andréa / Lombardo, Véronique / Pereira, Bruno / Lander, Axelle Van / Guastella, Virginie

BMC complementary medicine and therapies

2023 Volume 23, Issue 1, Page(s) 66

Abstract: Background: In palliative care, the relief of discomfort is sought by an overall approach, combining prescribed medication and additional therapies, such as foot reflexology (FR). The main objective of this study was to assess the feasibility of FR in a ...

Abstract	Background: In palliative care, the relief of discomfort is sought by an overall approach, combining prescribed medication and additional therapies, such as foot reflexology (FR). The main objective of this study was to assess the feasibility of FR in a population of inpatients in a palliative care unit (PCU).The precariousness of the patients led us to perform a feasibility study and not a cohort study from the outset. Its secondary objective was to assess the impact of an FR session on some symptoms of discomfort (anxiety, pain, troubled sleep, and psychological distress). Methods: This is a feasibility study designed as a randomized controlled two-arm therapeutic trial. One arm tested FR, the other an active control, massage therapy (MT). The evaluators were blinded. Results: FR was feasible for 14 patients out of the 15 included in the FR group (95% CI [68%; 100%]). These patients were in the palliative care phase of cancer, motor neuron disease, or terminal organ failure. Concerning the symptoms of discomfort, ESAS sleep quality score was on average 3.9 (± 2.5) before a session in the FR group. It was improved to an average of 3 (± 2.3) on the day after the session (effect-size = 0.38 [0.03; 0.73]). Conclusion: This study confirms the feasibility of an FR session for patients hospitalized in a PCU. It resulted in a slight improvement in sleep quality. For other discomfort symptoms such as anxiety, pain and distress, FR yielded a non-significant improvement. Significant results would have needed a larger cohort.
MeSH term(s)	Humans ; Palliative Care ; Feasibility Studies ; Pain ; Anxiety/therapy ; Musculoskeletal Manipulations
Language	English
Publishing date	2023-02-28
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ISSN	2662-7671
ISSN (online)	2662-7671
DOI	10.1186/s12906-023-03873-5
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Article ; Online: Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit.

Boulton, Kelsie A / Raghupathy, Veena / Guastella, Adam J / Bowden, Michael R

Journal of affective disorders

2022 Volume 305, Page(s) 1–7

Abstract: Background: In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient ... ...

Abstract	Background: In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions. Method: Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions. Results: There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant. Limitations: Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change. Conclusions: Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.
MeSH term(s)	Adolescent ; Australia ; Child ; Hospitals, Psychiatric ; Humans ; Inpatients/psychology ; Mental Disorders/therapy ; Patient Isolation ; Restraint, Physical
Language	English
Publishing date	2022-02-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	135449-8
ISSN	1573-2517 ; 0165-0327
ISSN (online)	1573-2517
ISSN	0165-0327
DOI	10.1016/j.jad.2022.02.066
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Article ; Online: Prescription d’opioïdes pour les patients atteints de cancer avec métastases osseuses ; étude pharmaco-épidémiologique nationale transversale.

Tarot, Andréa / Delorme, Jessica / Authier, Nicolas / Guastella, Virginie

Bulletin du cancer

2021 Volume 108, Issue 12, Page(s) 1120–1125

Abstract: Oncological situations represent the majority of palliative situations. Labeling the palliative stage often comes too late in oncology. Pain comes first among discomfort symptoms with the greatest impact on quality of life. We wondered whether the ... ...

Title translation	Opioid prescriptions in bone metastatic cancer patients: A cross sectional nationwide pharmacoepidemiological study.
Abstract	Oncological situations represent the majority of palliative situations. Labeling the palliative stage often comes too late in oncology. Pain comes first among discomfort symptoms with the greatest impact on quality of life. We wondered whether the evolutionary stage of the cancer was linked with the prescriptions of opioid analgesics. We observed the prescriptions of strong opioids in patients suffering from metastatic bone cancer 3 months before and after identifying the situation as palliative. This is a cross-sectional observational study performed between January 1, 2012 and December 31, 2016 using data from the French (nationwide claims database). We included 38,399 patients with cancer with at least one metastatic bone location in a palliative situation. Seventeen percent (n=6544) of patients had a prescription of opioid analgesics after palliative care labeling, 19.8 % (n=7606) had a prescription before, 31.1 % (n=11 949) had a prescription before and after and 32.0 % had no prescription of opioid analgesics. An increase in the dosage of opioid analgesics is observed between before and after labeling the stage of the disease as palliative with an average dosage ranging from 99.6 to 142.3mg per day. This study shows that labeling a situation as palliative affects prescriptions of strong opioid analgesics. An early identification of the situation as palliative is essential to provide appropriate care.
MeSH term(s)	Adult ; Aged ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/therapeutic use ; Bone Neoplasms/secondary ; Cancer Pain/drug therapy ; Cross-Sectional Studies ; Female ; France ; Humans ; Male ; Middle Aged ; Palliative Care ; Time Factors
Chemical Substances	Analgesics, Opioid
Language	French
Publishing date	2021-10-20
Publishing country	France
Document type	Journal Article ; Observational Study
ZDB-ID	213270-9
ISSN	1769-6917 ; 0007-4551
ISSN (online)	1769-6917
ISSN	0007-4551
DOI	10.1016/j.bulcan.2021.08.006
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Article ; Online: The opinion of French pulmonologists and palliative care physicians on non-invasive ventilation during palliative sedation at end of life: a nationwide survey.

Guastella, V / Piwko, G / Greil, A / Lambert, C / Lautrette, A

BMC palliative care

2021 Volume 20, Issue 1, Page(s) 68

Abstract: Background: Deciding to withdraw non-invasive ventilation (NIV) at end-of-life (EOL) in patients with chronic respiratory failure is a challenge. The European Association for Palliative Care recommends not maintaining artificial therapies that could ... ...

Abstract	Background: Deciding to withdraw non-invasive ventilation (NIV) at end-of-life (EOL) in patients with chronic respiratory failure is a challenge. The European Association for Palliative Care recommends not maintaining artificial therapies that could prolong life during palliative sedation (PS) at EOL. The aim of this survey was to assess palliative care physicians' and pulmonologists' opinion on withdrawing or maintaining NIV in patients with chronic respiratory failure during PS at EOL. Methods: From April to May 2019, we performed a prospective survey among pulmonologists (n = 1545) and palliative care physicians (n = 631) in France to determine the prevalence of opinion in favour of maintaining NIV and identify the factors associated with opinion in favour of withdrawing or maintaining NIV with multiple logistic regression. Results: A total of 457 participants were enrolled comprising 202 pulmonologists and 255 palliative care physicians. An opinion in favour of maintaining NIV was found in 88 (19.3 95%CI [15.7; 23.2]) physicians comprising 57 (28.2%) pulmonologists and 31 (12.2%) palliative care physicians (p < 0.001). The factors associated with an opinion in favour of maintaining NIV were spending time looking for advanced directives (AD) in the patient's file (odds ratio (OR): 6.54, 95%CI [2.00; 21.32], p = 0.002) and personal ethics of physicians (OR: 17.97, 95%CI [9.52; 33.89], p < 0.001). The factor associated with an opinion in favour of withdrawing NIV was palliative care training (OR: 0.31, 95%CI [0.16; 0.60], p < 0.001). The three main reasons in favour of maintaining NIV among the nine identified were emotional comfort for close relatives, reducing discomfort of dyspneoa and anticipation of suffocation. Conclusion: In France, around 20% of pulmonologists and palliative care physicians declared an opinion in favour of maintaining NIV during PS at EOL because of their personal ethics and spending time looking for AD, if any, in the patient's file. Palliative care training can stimulate reflection help foster a change of opinion about practices, especially in the case of patients with NIV during PS at EOL.
MeSH term(s)	Death ; Humans ; Noninvasive Ventilation ; Palliative Care ; Physicians ; Prospective Studies ; Pulmonologists
Language	English
Publishing date	2021-05-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2091556-1
ISSN	1472-684X ; 1472-684X
ISSN (online)	1472-684X
ISSN	1472-684X
DOI	10.1186/s12904-021-00755-w
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Article ; Online: Withholding or withdrawing life-sustaining treatments in the COVID-19 pandemic: adherence to legal standards.

Guastella, Virginie / Lambert, Céline / Lafforgue, Aurore / Metretin, Pauline / Verstreate, Aude / Watelet, Sophie / Perceau-Chambard, Élise / Lautrette, Alexandre

BMJ supportive & palliative care

2023

Abstract: Objectives: In France, when the patient is unable to express his wishes, the decision to withhold or withdraw life-sustaining treatment (WWLST) is made following a collegial procedure described by a law. The aim of our study was to assess how closely ... ...

Abstract	Objectives: In France, when the patient is unable to express his wishes, the decision to withhold or withdraw life-sustaining treatment (WWLST) is made following a collegial procedure described by a law. The aim of our study was to assess how closely this WWLST decision-making procedure in end of life patients was maintained during the COVID-19 pandemic. Methods: This retrospective observational multicentre study compared the rate of non-compliance with WWLST decision-making procedures during the pandemic period from March to June 2020 with control period in 2019, in Clermont-Ferrand and Lyon Hospitals. Secondary objectives were to determine the factors associated with non-compliance. Results: In 430 deceased patients included (176 in 2019 and 254 in 2020), the rate of non-compliance was 61.4% in 2019 and 59.1% in 2020 (p=0.63). In multivariable analysis, non-compliance was associated with immunosuppression status (OR 1.69, 95% CI (1.12 to 2.54), p=0.01) but was lower in intensive care unit (OR 0.54, 95% CI (0.36 to 0.82), p=0.003) and when the patient had visits from relatives (OR 0.41, 95% CI (0.22 to 0.75), p=0.004). Conclusion: In France, more than half of WWLST decisions do not comply with the law. The COVID-19 pandemic did not increase this non-compliance rate. Further studies are needed for a better understanding of the mechanisms underlying non-compliance with WWLST decision-making procedure. Trial registration number: NCT04452487.
Language	English
Publishing date	2023-08-03
Publishing country	England
Document type	Journal Article
ISSN	2045-4368
ISSN (online)	2045-4368
DOI	10.1136/spcare-2023-004504
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Article: Le "bar à vin" ou une autre façon de prendre soin.

Guastella, Virginie / Raynaud, Nathalie

Revue de l'infirmiere

2016 , Issue 220, Page(s) 29–30

Abstract: The "wine bar" in the palliative care unit of Clermont-Ferrand general hospital is an example of a different way of providing care. It defends the right of patients at the end of life to treat themselves and others. Acknowledging that life is present ... ...

Title translation	The "wine bar", or a different way of caring.
Abstract	The "wine bar" in the palliative care unit of Clermont-Ferrand general hospital is an example of a different way of providing care. It defends the right of patients at the end of life to treat themselves and others. Acknowledging that life is present right up until the end, patients are invited to drink wine at mealtimes and caregivers are encouraged to learn the basics of oenology.
MeSH term(s)	Complementary Therapies ; Humans ; Palliative Care ; Wine
Language	French
Publishing date	2016-04
Publishing country	France
Document type	English Abstract ; Journal Article
ZDB-ID	632538-5
ISSN	1293-8505 ; 0397-7900
ISSN	1293-8505 ; 0397-7900
DOI	10.1016/j.revinf.2016.01.010
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Article: Patterns of Urban Spatial Expansion in European Cities

Guastella, Gianni / Oueslati, Walid / Pareglio, Stefano

Sustainability. 2019 Apr. 15, v. 11, no. 8

2019

Abstract: In representing urban sprawl, the decline in population and employment density from the city centre to the periphery has been identified as the main character associated with the spatial expansion of built-up areas. Urban spatial discontinuity, which ... ...

Abstract	In representing urban sprawl, the decline in population and employment density from the city centre to the periphery has been identified as the main character associated with the spatial expansion of built-up areas. Urban spatial discontinuity, which occurs when the urban fabric includes built-up or green areas and a relevant share of vacant spaces, has gained recent attention. In this paper, we use Global Human Settlement Layer data to track urbanisation dynamics in European Functional Urban Areas (FUAs) from 1990 to 2014. We represent urban sprawl as the spatial expansion of FUAs associated with either or both declining population density and increasing built-up area discontinuity. We also consider the association with the demographic trends that have been described as the primary driver of urban spatial expansion. We use configural frequency analysis to explore the local association between the different characters of sprawl. We found evidence that urban sprawl effectively took differentiated forms across European FUAs. Even though FUAs have generally become less dense and more disperse, our results show that the extent of these phenomena appears to be more contained in recent years than in previous decades. Both elements of sprawl characterise FUAs with a shrinking population, confirming the decoupling of urban development policies and demographic trends in cities. The results call for better controlled urban development, favouring compact cities and subjecting land-use changes to a perspective of urban population growth.
Keywords	cities ; development policy ; employment ; fabrics ; land use change ; population density ; population growth ; urban areas ; urban population ; urbanization
Language	English
Dates of publication	2019-0415
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2518383-7
ISSN	2071-1050
ISSN	2071-1050
DOI	10.3390/su11082247
Database	NAL-Catalogue (AGRICOLA)

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