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Oral switch versus standard intravenous antibiotic therapy in left-sided endocarditis due to susceptible staphylococci, streptococci or enterococci (RODEO): a protocol for two open-label randomised controlled trials
IntroductionLeft-sided infective endocarditis (IE) is a serious infection with a heavy burden for patients and healthcare system. Oral switch after initial intravenous antibiotic therapy may reduce costs and improve patients’ discomfort without increasing unfavourable outcomes. We describe the methodology of two simultaneously conducted open-label randomised trials aiming to assess non-inferiority of oral switch as compared with entirely intravenous antibiotic therapy for the treatment of left-sided IE.Methods and analysisTwo simultaneous multicentre open-label prospective randomised trials assessing non-inferiority of oral switch during antibiotic treatment as compared with entirely intravenous therapy in patients with left-sided IE are ongoing. One trial is dedicated to left-sided IE caused by multisusceptible staphylococci (Relais Oral Dans le traitement des Endocardites à staphylocoques ou streptOcoques (RODEO)-1) and the other is dedicated to left-sided IE caused by susceptible streptococci or enterococci (RODEO-2). It is planned to randomise 324 patients in each trial after an initial course of at least 10 days of intravenous antibiotic therapy either to continue intravenous antibiotic therapy or to switch to oral antibiotic therapy. The primary outcome is treatment failure within 3 months after the end of antibiotic treatment, a composite outcome defined by all-cause death and/or symptomatic embolic events and/or unplanned valvular surgery and/or microbiological relapse (with the primary pathogen). Secondary outcomes include patient quality of life, echocardiographic outcome, costs and efficiency associated with IE care. Statistical analysis will be performed with a non-inferiority margin of 10% and a one-sided 2.5% type I error.Ethics and disseminationWritten informed consent will be obtained from all participants. This study was approved by Tours Research ethics committee (CPP TOURS-Region Centre-Ouest 1, 2015-R26, 23 February 2016). Study findings will be published in peer-reviewed journals and disseminated through presentation at relevant national and international conferences.Trial registration numberEudraCT Number: 2015-002371-16 and NCT02701608; NCT02701595.
Journal Article
The art of entertaining : Relais & Chateaux : menus, flowers, tablesettings, and more for memorable celebrations
\"The Art of Entertaining presents seventeen seasonal parties, both intimate and grand, held at a variety of Relais & Chateaux venues. These hospitality insiders, who transform their properties into perfect settings, share their ideas for creating parties that can be translated to every home. The themes, floral choices, festive table displays, recipes for cocktails and dishes, and much more show you how to wow guests with unexpected touches.\" -- Provided by publisher.
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To evaluate the accessibility to a Montreal low-threshold methadone program (Relais-Méthadone). This program is aimed at a marginalized population of heroin addicts who are injection drug users (IDU). The data (n = 141 clients) were collected during the first year of the program implementation with questionnaires administered by the programme workers. Analysis of the characteristics of the clients revealed that the program does reach the target population. The program's clientele is characterized by long-time and frequent heroin use, unstable lifestyles, and the presence of numerous behaviours that put them at high risk for HIV transmission. The retention of clients in the program is very high (88%) within the first 30 days. These results demonstrate the importance and value of flexible intervention programs in reaching a marginalized clientele exposed to the HIV virus, who would not have access to regular programs characterized by restrictive selection criteria and limited availability.
Journal Article