Centre Hospitalier de Gonesse

BackgroundExposure to information about mpox may shape distinct perceptual processes that influence vaccination intent. Understanding how such information impacts perceived risk and vaccination intention is crucial for designing effective risk communication and public health messaging, particularly among populations at high risk such as gay, bisexual, and other men who have sex with men (GBMSM).ObjectiveThis study examined the specific pathways through which mpox information exposure and associated perceptual processes influence vaccination intent. Differences between GBMSM in Beijing and Hong Kong were also examined to explore potential contextual influences.MethodsWe conducted a cross-sectional survey of mpox-unvaccinated GBMSM in Hong Kong (n=470) and Beijing (n=519) between November 2023 and March 2024. Structural equation modeling was conducted to estimate the direct and indirect effects of information exposure, perceptual processes (eg, perceived control and threat perceptions), and perceived risk on vaccination intent. Multigroup structural equation modeling was used to estimate the effect measure modification by city.ResultsExposure to positive mpox information significantly enhanced perceived control (β=0.33; P=.001) and increased vaccination intention through heightened perceived risk of contracting mpox (β=0.27; P<.001) in the following 6 months. The indirect effect of positive information exposure on vaccination intent via perceived control and risk was significant in Hong Kong (B=0.01; Wald test: Z=3.05 and P=.002) but not in Beijing (B=−0.01; P=.25). Conversely, negative information exposure primarily increased threat perceptions (Hong Kong: B=0.33 and P=.001; Beijing: B=0.93 and P<.001) but did not consistently translate to increased perceived risk of contracting mpox (Hong Kong: B=−0.10 and P=.31; Beijing: B=0.20 and P=.11). Notable contextual differences emerged between Beijing and Hong Kong—participants in Beijing reported higher levels of information exposure (eg, international mpox statistics; mean score 2.17, SD 0.97 vs 1.79, SD 0.89; P<.001) and more nonregular sex partners (mean 2.20, SD 6.73 vs 1.65, SD 3.37; P=.02), but the associations among information exposure, perceived risk, and vaccination intent were weaker than in Hong Kong participants.ConclusionsPositive mpox-related information strongly promotes vaccination intent by enhancing perceived control and amplifying perceived risk, particularly in settings with accessible vaccination programs such as Hong Kong. Conversely, negative information appears less effective in driving vaccination intention. Tailored, stigma-free communication is crucial for improving vaccination uptake, especially in mainland China, where subsidized vaccines are scarce and perceptual pathways linking information exposure to vaccination intent are relatively weak. Enhancing access to vaccines and addressing contextual barriers can further optimize the impact of such interventions.

Nausea and vomiting complicating chemotherapy (CINV) remain side effects despite preventive and curative treatments. We hypothesize that acupuncture (ACU), auriculotherapy (AUR), and their combination (ACU-AUR), could decrease, compared to usual treatment (UT), the intensity of acute nausea in patients already treated according to the antiemetic guidelines and presenting nausea with or without vomiting in the earlier cycle. In this multicenter study, patients were treated just before chemotherapy according to randomization. ACU consisted of implanting bilaterally on each forearm, one semi-permanent needle at point P6. AUR consisted of implanting bilaterally on each pavilion of the ear, one semi-permanent needle at point O. All patients received systematic preventive drug treatment according to antiemetic guidelines. Main outcome was intensity of nausea at 24h after chemotherapy using a numeric scale ranging from 0 (no nausea) to 10 (maximum symptoms). One hundred and fifteen patients were included. Baseline characteristics were similar between groups at inclusion. Intensity of nausea at 24h after chemotherapy, was statistically different between the groups (covariance intergroup analysis, p = 0.005) and was significantly lower for the all-treatment groups vs UT group (p = 0.007 for AUR, p = 0.008 for ACU, and p = 0.0009 for AUR-ACU). AUR-ACU also decreased intensity of delayed nausea when compared to UT (p = 0.023). AUR, ACU and AUR-ACU had no effect on acute and delayed vomiting episodes. No serious adverse event due to the studied treatments was reported in our study. AUR or ACU reduce intensity of acute and delayed nausea in patients treated by optimal antiemetic treatment. gov identifier NCT02767791, registered on May 10, 2016.

BackgroundPaediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).ObjectiveTo assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.MethodsThis was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.Results63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).ConclusionsThis study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.Trial registration numberNCT05066464.

Pain is a common out-of-hospital symptom among patients, and opioids are often prescribed. Research suggests that overprescribing for acute traumatic pain is still prevalent, even when limits restricting opioid prescriptions have been implemented. Ketamine hydrochloride is an alternative to opioids in adults with out-of-hospital traumatic pain. To assess the noninferiority of intravenous ketamine compared with intravenous morphine sulfate to provide pain relief in adults with out-of-hospital traumatic pain. The Intravenous Subdissociative-Dose Ketamine Versus Morphine for Prehospital Analgesia (KETAMORPH) study was a multicenter, single-blind, noninferiority randomized clinical trial comparing ketamine hydrochloride (20 mg, followed by 10 mg every 5 minutes) with morphine sulfate (2 or 3 mg every 5 minutes) in adult patients with out-of-hospital trauma and a verbal pain score equal to or greater than 5. Enrollment occurred from November 23, 2017, to November 26, 2022, in 11 French out-of-hospital emergency medical units. Patients were randomly assigned to ketamine (n = 128) or morphine (n = 123). The primary outcome was the between-group difference in mean change in verbal rating scale pain scores measured from the time before administration of the study drug to 30 minutes later. A noninferiority margin of 1.3 was chosen. A total of 251 patients were randomized (median age, 51 [IQR, 34-69] years; 111 women [44.9%] and 140 men [55.1%] among the 247 with data available) and were included in the intention-to-treat population. The mean pain score change was -3.7 (95% CI, -4.2 to -3.2) in the ketamine group compared with -3.8 (95% CI, -4.2 to -3.4) in the morphine group. The difference in mean pain score change was 0.1 (95% CI, -0.7 to 0.9) points. There were no clinically meaningful differences for vital signs between the 2 groups. The intravenous morphine group had 19 of 113 (16.8% [95% CI, 10.4%-25.0%]) adverse effects reported (most commonly nausea [12 of 113 (10.6%)]) compared with 49 of 120 (40.8% [95% CI, 32.0%-49.6%]) in the ketamine group (most commonly emergence phenomenon [24 of 120 (20.0%)]). No adverse events required intervention. In the KETAMORPH study of patients with out-of-hospital traumatic pain, the use of intravenous ketamine compared with morphine showed noninferiority for pain reduction. In the ongoing opioid crisis, ketamine administered alone is an alternative to opioids in adults with out-of-hospital traumatic pain. ClinicalTrials.gov Identifier: NCT03236805.