The Université Hospital of Lyon (French: Hospices Civils de Lyon, HCL) was created on January 18, 1802. It is the second Teaching hospital in France. It has 13 hospitals in the Lyon area and one in the south of France.
Objectives Endometriosis is a chronic disease for which no curative treatment currently exists. The available palliative treatments are not without side effects and must be tailored to the individual expectations and objectives of each patient. This poses significant challenges for clinician–patient communication. This study explores the perceptions of patients and healthcare professionals regarding endometriosis management to identify ways to improve shared decision-making processes. Methods This cross-sectional qualitative study was performed using a semi-structured focus group methodology. Twenty patients with endometriosis and thirteen healthcare professionals were separately involved in this study between June 2024 and January 2025. Focus group topics investigated the representations of the concept of treatment effectiveness, the emotions associated with endometriosis management, and the perceived impact of care pathways on patient-clinician and patient-environment relationships. Results The study highlighted contrasting perspectives between patients and clinicians regarding what constitutes effective hormonal therapies. Long-term amenorrhea is a priority for healthcare professionals, whereas pain reduction remains the immediate priority for patients. Patients also expect surgery to be as effective as possible and are enthusiastic about non-medical treatments. Patients who participated in the focus groups reported a lack of listening and empathy, a deficit of shared information as regards treatment options and side effects, and a need to involve partners and family members in care. These factors contribute to communication issues between patients and clinicians and contribute to substantial psychological burden on both sides. Conclusion The study highlighted the central role of communication and analysed, at different levels, the factors underlying relational issues that affect patient care and quality of life. Several factors should be addressed to improve shared decision-making in the management of endometriosis, which may inform the development of a shared decision-making tool in the near future.
Background Ureteral injury during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is an uncommon but serious complication. The value of prophylactic ureteral stenting remains uncertain. Methods This retrospective monocentric study included patients with Peritoneal Surface Malignancies (PSM) undergoing CRS–HIPEC with ureterolysis and pelvic peritonectomy between 2015 and 2025. Patients were divided according to prophylactic ureteral stent placement. The primary endpoint was the occurrence of a symptomatic ureteral event, defined as a postoperative ureteral fistula or stricture requiring renal drainage. Secondary outcomes included chronic urinary diversion, overall urologic morbidity, and identification of predictive factors associated with ureteral complications. Results Among 122 patients, 34 received a prophylactic stent and 88 did not. Symptomatic ureteral events requiring drainage occurred in 14/34 (41.2%) in the STENT group and 31/88 (35.2%) in the No STENT group. Ureteral fistulas occurred in 3/34 (8.8%) versus 15/87 (17.2%) respectively. Postoperative renal drainage occurred in 12/34 (35.3%) in the STENT group, and 30/87 (34.5%) in the No STENT group. Chronic urinary diversion was more frequent among stented patients 13/34 (38.2%) vs 18/88 (20.5%). No significant difference was observed between groups. Prior Surgical Score, Performance status, rectal resection and history of previous pelvic surgeries were associated with increased urologic morbidity. Conclusions Prophylactic ureteral stenting during CRS–HIPEC did not reduce symptomatic ureteral events requiring renal drainage. The stent group showed a trend toward increased chronic urinary diversion. These findings support a selective, risk-based approach based on patient characteristics and surgical complexity.
Total hip arthroplasty (THA) for hip developmental dysplasia (DDH) carries a high perioperative complication rate, with dislocation representing the most frequent adverse event. Monoblock dual-mobility (DMM) cups have demonstrated promising results in reducing prosthetic instability while ensuring long-term implant survival. However, data specifically addressing DMM THA in low-grade DDH remain scarce. The aim of this study was to evaluate clinical outcomes and complication rates at a minimum ten-year follow-up in patients undergoing DMM THA for low-grade DDH. A single-centre retrospective study was conducted, including all patients who underwent DMM THA for Crowe grade I or II DDH between 2008 and 2018. Clinical outcomes including the Harris Hip Score (HHS), Postel–Merle d'Aubigné (PMA) score, Devane score, visual analog scale (VAS), and range of motion (ROM) were assessed preoperatively, at one year, and at final follow-up. Implant survival was estimated using Kaplan–Meier analysis. Thirty-one THAs were performed in 25 patients (mean age 55.1 ± 13.4 years; mean follow-up 10.06 ± 1,98 years). All functional scores improved significantly at final follow-up (HHS 48 to 98, PMA 11 to 17, Devane 3 to 4, all p < 0.001). No dislocation, loosening, periprosthetic fracture, or septic complication was recorded. Implant survival was 100
OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.
Patients with neuroendocrine tumors (NETs) often face substantial informational gaps and rely on the Internet for medical information despite variable quality and frequent misinformation. These challenges are particularly critical in complex care pathways such as radioligand therapy (RLT), where radiation safety constraints may increase anxiety and impact adherence. Large language models (LLMs) have emerged as promising tools for patient education, offering accessible and empathetic explanations tailored to patients’ level of understanding. However, their performance in specialized settings and across languages remains insufficiently evaluated. In a proof-of-concept study, five commercially available LLMs were evaluated by seven medical experts on 14 common patient questions about RLT for NETs in English and French, across three domains: accuracy, conciseness, and readability. LLMs demonstrated good performance, although significant differences were observed across models and languages. Performance was generally higher in English, highlighting cross-lingual disparities that may affect equitable access to reliable health information. While critical errors were uncommon, some responses illustrated how oversimplified information lacking clinical nuance may be misleading in institution-dependent contexts, particularly regarding hospitalization requirements. Readability analysis using the Flesch–Kincaid Grade Level indicated that responses often exceeded recommended levels for patient education. These findings suggest that LLMs could support patient education in specialized oncology settings but require careful integration into clinically supervised workflows, with potential advantages of domain-specific over general-purpose models. Improving readability, reducing cross-lingual disparities, and ensuring alignment with clinical practice will be essential to ensure safe, reliable, and equitable use of LLMs in patient education.
