Programme de préparation à la chirurgie bariatrique conçu avec les patients : enjeux et bénéfices

Malgré l'efficacité pondérale et métabolique de la chirurgie bariatrique, près de 35% des patients opérés présentent une reprise pondérale liée à des changements comportementaux insuffisants. Collaborer avec des patients partenaires pour co-construire un programme éducatif de préparation représente une opportunité ajustée à l'évolution sociétale de favoriser l'implication des patients. Ce partenariat débute par l'exploration des besoins des partenaires et suit un processus progressif et sur mesure qui répond aux enjeux de place et de pouvoir soulevés. Il aboutit à la création d'une journée d'enseignement, en début de parcours, visant le consentement éclairé et à un programme, en fin de parcours, centré sur les changements comportementaux dans leur dimension concrète, à l'appui d'un nouvel acteur de santé reconnu: le patient partenaire

A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection

Abstract Background An adjunctive topical therapy with gentamicin-sponges to systemic antibiotic therapy might improve the healing of infected diabetic foot ulcers (DFUI). Methods Single-center, investigator-blinded pilot study, randomizing (1:1) the gentamicin-sponge with systemic antibiotic versus systemic antibiotics alone for patients with DFUI. Results We included 88 DFUI episodes with 43 patients in the gentamicin-sponge arm and 45 in the control arm. Overall, 64 (64/88; 73%) witnessed total clinical cure, 13 (15%) significant improvement, and 46 (52%) showed total eradication of all pathogens at the final visit. Regarding final clinical cure, there was no difference in favour of the gentamicin-sponges (26/45 vs. 31/43; p = 0.16). However, the gentamicin-sponge arm tended to a more rapid healing. In multivariate analysis adjusting for the case-mix, the variable “gentamicin-sponge” was not significantly associated with “cure and improvement”. Gentamicin-sponges were very well tolerated, without any attributed adverse events. Conclusions The gentamicin-sponge was very well tolerated, but did not significantly influence overall cure. Trial registration ClinicalTrials.gov (NCT01951768). Date 2 April 2013

Additional file 1: of A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection

DFUI WOUND SCORE-TARGET INFECTION ( ULCER WITH HIGHEST DFI WOUND (DOC 79 kb