The University Hospital of Montpellier is the oldest medical faculty in Europe, part of the University of Montpellier. It has been rated the 6th best hospital in France.
While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation. This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006—2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4—10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed. After 3-year follow-up, 426 patients died (31.1
Intensive care is under increasing pressure due to demographic changes, availability of new complex therapies, and workforce shortages, resulting in a relative reduction in resources. Technological advances such as digitalization, wearable sensors, and artificial intelligence promise to improve care delivery, enabling providers to offer equal or higher-quality care at lower costs. However, no healthcare system has yet demonstrated large-scale gains in the efficiency of intensive care delivery. A central requirement is the capacity to translate ideas and concepts into value, providing changes that make services, products, and optimal care more accessible and affordable to a larger population, generating value. Innovation should thus be acknowledged as a fourth principal pillar of intensive care, alongside clinical excellence, research, and teaching. This paper presents the opinion of a multidisciplinary expert panel, proposing a framework to support the generation, implementation, and evaluation of innovation in intensive care. We identify and examine key areas and applications where innovation is urgently needed, including workforce development, technology adoption, environmental sustainability, and the transformation of medical education. We also highlight barriers and concerns that must be addressed when implementing innovation in ICUs. We integrate these into a comprehensive framework illustrated through concrete examples. Finally, we argue that innovation should not be driven solely by academia or industry, but strategically led by healthcare professionals and patients’ representatives, grounded in ethics and data, interdisciplinary, and centered on patients’ and society’s needs. This framework offers a pathway for innovation, supporting a more inclusive, effective, and sustainable future for intensive care.
Fostamatinib is available in France since October 2021 for the treatment of adult chronic immune thrombocytopenia (ITP). French health authorities requested a 3-year, prospective, multicenter registry to provide real-world evidence about the effectiveness and safety of fostamatinib. Patients' characteristics, treatment response (ongoing exposure to fostamatinib and a platelet count ≥ 30 × 10 9 /L with no rescue in the previous 4 weeks) after 3, 6, 12, and 24 months (M); bleeding; fostamatinib discontinuation; adverse drug reactions (ADRs) and other events of interest have been analyzed. In total, 164 patients were included (median age: 59 years; 55.5% women; 84.1% had previous bleeding; 30 had secondary ITP; 89.0% had chronic ITP). The median ITP duration was 7.2 years and the median number of previous ITP treatments was 6. The response rate was 44.0% (70/159) at M3, 41.9% (62/148) at M6, 32.4% (44/136) at M12 and 20.0% (21/105) at M24. Concomitant treatment (mostly TPO-RA) was used in > 60.0% of responders at each endpoint. The cumulative discontinuation rate at each endpoint was, respectively, 27.0%, 44.6%, 55.9%, and 76.2%. Seventy-one (43.3%) patients experienced at least one bleeding during fostamatinib exposure; none was fatal. One hundred adverse drug reactions (8 serious) were observed in 61 (36.7%) patients, including diarrhea in 28 (17.1%) patients, arterial hypertension in 17 (10.4%). Seven thrombosis (4.3%) and 40 infections (12 serious) were reported in 25 patients (15.2%), mostly in patients with known risk factors. In conclusion, fostamatinib in combination with TPO-RA should be considered in difficult-to-treat ITP patients. No new safety signal was observed.
Background Intrasaccular devices have broadened treatment options for wide necked aneurysms. This study presents the preliminary experience with the Artisse 2.0 device.Methods Innovative NeurovaScular Product SurveIllance REgistry (INSPIRE) is a non-randomized, multicenter, real world clinical study with treatment arms for aneurysms (INSPIRE-A) and acute ischemic stroke (INSPIRE-S). This interim analysis included 87 patients enrolled from November 2022 to April 2024 in the INSPIRE-A Artisse cohort across 16 Europoean centers. Procedures followed standard clinical care, with 6 months of follow-up. Safety and efficacy endpoints included major stroke, neurological death, serious adverse events (SAEs), aneurysm occlusion, and retreatment rates. An independent core laboratory assessed imaging, and all SAEs were reviewed by a clinical events committee. The Artisse steering committee provided independent oversight of the data.Results The Artisse device achieved an overall successful implantation rate of 96.6% (84/87), with satisfactory placement rates of 98.7% (74/75) for unruptured and 88.9% (8/9) for ruptured aneurysms. Following the procedure, 46.2% of unruptured aneurysm patients were receiving antiplatelet therapy (APT), predominantly aspirin monotherapy, while no ruptured aneurysm patients received APT. Device related SAE rate was 1.3% (1/87), and the overall stroke rate was 2.3% (2/87), including both ruptured and unruptured aneurysms. At 6 months, 80.0% (28/35) of patients with unruptured aneurysms showed complete obliteration, with no recurrences or retreatments.Conclusions Preliminary experience with the Artisse 2.0 device demonstrated high technical success, favorable safety, and efficacy in aneurysm obliteration at 6 months. Larger studies with longer follow-up periods are needed to confirm these findings.
Abstract Digital mobility outcomes (DMOs) offer unique insights into recovery of real-world mobility after proximal femoral fracture (PFF), but their clinical validity remains to be established. This study assessed construct validity (convergent, divergent, and known-groups) of 24 DMOs measuring walking activity (amount, pattern) and gait (pace, rhythm, bout-to-bout variability) in patients within one year after PFF. Patients were recruited from inpatient and outpatient lists at five European sites, resulting in 505 included participants (66% female), with mean age of 77.6 ± 9.4 years and supervised gait speed of 0.7 ± 0.4 m/s. Mobility was monitored over seven days using a single wearable device on the lower back. Convergent and divergent validity analyses were stratified by two groups: acute (≤ 14 days since surgery) and non-acute (≥ 15 days since surgery). Correlations between DMOs and related (clinical- and patient-reported mobility outcomes) and unrelated constructs (hearing impairment and systolic blood pressure) were compared to a priori expected correlations. Known-groups validity was assessed across four recovery phases. The results were evaluated individually by experts and in a subsequent consensus meeting, with 17 of 24 DMOs showing evidence of construct validity in non-acute PFF patients. These findings represent an initial step in a larger process towards regulatory endorsement.
