Background: Cystic fibrosis (CF) is a life-shortening genetic condition that usually affects several organs and involves significant treatment burden. Adherence to medication is important for successful CF management. Objective: To describe medication adherence according to age, therapeutic class, and pharmaceutical form in adults and children followed in four regional CF centers in France. Methods: We conducted a cross-sectional study with non-transplanted patients followed in two adult and two pediatric centers during 2015 who were covered by the French National Health Insurance (NHI). Sociodemographic, clinical, hospitalization, and prescription data were collected from patient medical records. Medication dispensations were extracted from the regional French NHI database. Adherence was calculated over 12 months using continuous medication availability (CMA) accounting for dose adjustments and hospitalizations. Drug-specific CMA was computed in R with the AdhereR package for each medication prescribed more than 3 months, which was averaged to obtain a composite CMA score (cCMA) for all treatments and per therapeutic class as well as pharmaceutical form for each patient. Results: A total of 228 patients were included. The number of chronic medications increased with age (r=0.50, p<0.001): a median of 7 medications per patient were prescribed. The mean±SD cCMA was significantly different between age groups (p=0.0098): it was 0.71±0.20 for the 0–5 years age group, 0.73±0.16 for 6–11 years, 0.64±0.17 for 12–17 years, 0.57±0.23 for 18–25 years, and 0.65±0.20 for the over 25 years age group. cCMA varied significantly according to pharmaceutical forms: the mean±SD cCMA was 0.70±0.21 for oral medications and 0.54±0.28 for inhaled medications (p<0.001). Conclusion: This study suggests that adherence to medication regimens in CF patients remains suboptimal and varies substantially between age groups and pharmaceutical forms. These variations in adherence should be considered when developing effective strategies to improve adherence.

Background: Online resources constitute a new and effective way to obtain support or information during bereavement processes. However, little is known about the needs, use and expectations of people bereaved by suicide regarding online resources. Method: The objective of our national cross-sectional online survey was to collect the use, needs and expectations of people bereaved by suicide regarding online resources. The data were collected from July to October 2021 through a 26-item online questionnaire hosted on the website LimeSurvey. Results: A total of 401 respondents fully completed the questionnaire. Their mean age was 45.7. The majority of participants were women bereaved by the suicide of their child or partner. Half of the participants were bereaved for less than 3 years and benefited from counselling during their bereavement process. Three-quarters of the participants used the Internet for their bereavement process, mainly to obtain information on suicide bereavement and suicide prevention and to access testimonies of other people bereaved by suicide. Three-quarters of the participants found that available online resources for people bereaved by suicide are insufficient and expected a dedicated web platform to be developed. Finding information on suicide bereavement and on suicide prevention, discussing with a mental health professional and accessing testimonies of other people bereaved by suicide were expected by a majority of the participants regarding the future platform. Receiving counselling and being bereaved by the death of a child were the most important factors in explaining patterns of use and expectations regarding online resources. Discussion: Our results offer precise insights into the needs, use and expectations of people bereaved by suicide regarding online resources. The development of web platforms offering access to reliable information on suicide bereavement and on suicide prevention to peers bereaved by suicide and help to seek counselling are urgently needed.

Purpose: Cystic fibrosis (CF) is an inherited life-shortening disease involving a significant treatment burden. Few interventions have been proven effective in improving adherence, and of these fewer have been adopted for implementation. Patient participation in research is increasingly desired in developing relevant health care services. A participatory approach was implemented in an adult CF center to co-design an adherence-enhancing intervention toolkit. We aimed to report on the participatory process and the results regarding the co-designed intervention. Patients and Methods: Two focus group sessions and four working sessions were conducted at 4-week intervals with three healthcare professionals (HCP; physician, nurse, physiotherapist), eight patients, and two researchers (sociologist, public health pharmacist). The two initial focus group sessions were dedicated to the collection of narratives about CF treatment experiences to identify drivers of adherence. The next four working sessions were dedicated to the reflection on solutions that could alleviate the difficulties identified and be used in current clinical practice. The researchers observed during all sessions the interactions between participants, group dynamics, and process of implementation of the collective reflection. Results: The process facilitated an active participation of patients and HCP, who contributed equally to the intervention development. The co-design adherence-enhancing intervention toolkit consisted in a self-questionnaire to be completed by patients before the medical consultation and used as a communication support during the consultation, plus a toolkit of solutions to be proposed by the HCP for each barrier identified by patients, and to be followed up during the next consultation. Conclusion: This study demonstrated that a participatory approach involving CF patients and HCP lead to the development of an adherence-enhancing intervention toolkit, using a 6-session format; the benefits of the co-designed intervention on the medication adherence have yet to be tested in a multicenter, open-label study in 3 centers in France.

Background: Although suicide bereavement is highly distressing and is associated with an increased risk of suicidal behaviors and mental and physical health impairments, those bereaved by suicide encounter difficulties accessing support. Digital resources offer new forms of support for bereaved people. However, digital resources dedicated to those bereaved by suicide are still limited. Objective: This paper aimed to develop and implement an evidence-based, innovative, and adaptive online resource for people bereaved by suicide, based on their needs and expectations. Methods: We performed a mixed methods, participatory, user-centered study seeking to build resources from the perspectives of people bereaved by suicide and professionals or volunteers working in the field of postvention. We used the Information System Research framework, which uses a three-stage research cycle, including (1) the relevance cycle, (2) the design cycle, and (3) the rigor cycle, and the Design Science Research framework. Results: A total of 478 people participated in the study, including 451 people bereaved by suicide, 8 members of charities, and 19 mental health professionals working in the field of postvention. The development stage of the resource lasted 18 months, from October 2021 to March 2023. A total of 9 focus groups, 1 online survey, 30 usability tests, and 30 semistructured interviews were performed. A website for people bereaved by suicide named “espoir-suicide” was developed that includes (1) evidence-based information on suicide prevention and bereavement, (2) testimonies of people bereaved by suicide, (3) a delayed chat to ask questions on suicide and bereavement to a specialized team of mental health professionals, and (4) an interactive nationwide resource directory. The mean system usability score was 90.3 out of 100 for 30 participants, with 93% (n=28) of them having a rating above 80. Since the implementation of espoir-suicide in March 2023, a total of 19,400 connections have been recorded, 117 local resources have been registered nationwide, and 73 questions have been posted in the chat. Conclusions: The use of a mixed methods, participatory, user-centered design allowed us to implement an evidence-based, innovative, and functional website for people bereaved by suicide that was highly relevant for fulfilling the needs and expectations of French people bereaved by suicide. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2021.770154

AimIn the present study, we evaluated the triage process particularly for older patients after calls to Emergency Medical Call Centers (ECC), according to the geriatric assessment tool. MethodsIn this observational population-based cross-sectional study in the Rhone (France), we analyzed the audiotapes of all calls received by ECC concerning patients aged >= 75 years, during seven randomly selected days, over a period of 1 year. We analyzed whether information about seven key items, predefined by a panel of experts as essential for quality telephone triage of seniors, was actually collected. ResultsAmong 4168 calls, 712 (17.1%) concerned patients >75 years (mean +/- SD, age 84.6 +/- 5.6 years). The mean duration of calls was 3 min 28 s. Information about living arrangements (alone or not), dependency, multiple pathologies, polymedication, ability to walk independently or with help, and hospitalization in the previous 3 months was not collected in 20%, 42%, 40%, 45%, 58% and 61% of calls, respectively. All seven geriatric items were collected for only 54 (7.8%) calls, and only three criteria collected for 277 (40%) calls. Nurse-managed calls were significantly associated with the collection of less geriatric items compared with physician-managed calls. ConclusionKey information is particularly important to guide the orientation, and further management of older patients may be lacking during the telephone triage of patients in ECCs. This may represent an important level of improvement of the triage process, to address the needs of older patients better and avoid inappropriate emergency department visits. Geriatr Gerontol Int 2023; 23: 54-59.

BACKGROUND Although suicide bereavement is highly distressing and is associated with an increased risk of suicidal behaviors and mental and physical health impairments, those bereaved by suicide encounter difficulties accessing support. Digital resources offer new forms of support for bereaved people. However, digital resources dedicated to those bereaved by suicide are still limited. OBJECTIVE This paper aimed to develop and implement an evidence-based, innovative, and adaptive online resource for people bereaved by suicide, based on their needs and expectations. METHODS We performed a mixed methods, participatory, user-centered study seeking to build resources from the perspectives of people bereaved by suicide and professionals or volunteers working in the field of postvention. We used the Information System Research framework, which uses a three-stage research cycle, including (1) the relevance cycle, (2) the design cycle, and (3) the rigor cycle, and the Design Science Research framework. RESULTS A total of 478 people participated in the study, including 451 people bereaved by suicide, 8 members of charities, and 19 mental health professionals working in the field of postvention. The development stage of the resource lasted 18 months, from October 2021 to March 2023. A total of 9 focus groups, 1 online survey, 30 usability tests, and 30 semistructured interviews were performed. A website for people bereaved by suicide named “espoir-suicide” was developed that includes (1) evidence-based information on suicide prevention and bereavement, (2) testimonies of people bereaved by suicide, (3) a delayed chat to ask questions on suicide and bereavement to a specialized team of mental health professionals, and (4) an interactive nationwide resource directory. The mean system usability score was 90.3 out of 100 for 30 participants, with 93% (n=28) of them having a rating above 80. Since the implementation of espoir-suicide in March 2023, a total of 19,400 connections have been recorded, 117 local resources have been registered nationwide, and 73 questions have been posted in the chat. CONCLUSIONS The use of a mixed methods, participatory, user-centered design allowed us to implement an evidence-based, innovative, and functional website for people bereaved by suicide that was highly relevant for fulfilling the needs and expectations of French people bereaved by suicide. INTERNATIONAL REGISTERED REPORT RR2-10.3389/fpsyt.2021.770154