Management of patients with chronic kidney disease: a French medical centre database analysis

Abstract Objective(s) Chronic kidney disease (CKD) is an insidious disease that requires early nephroprotective measures to delay progression to end-stage kidney disease. The objective of this study was to describe the management of patients with CKD in primary care, including clinical and biological monitoring and prescribed treatments. A retrospective, single-centre study was conducted on adult patients who were treated in the Maison de Neufchâtel (France) between 2012 and 2017 at least once a year. The inclusion criteria were 2 estimated glomerular filtration rate (eGFR) measurements <60 mL/min more than 3 months apart. Two subgroups were constituted according to whether CKD was coded in the electronic medical records (EMRs). Results A total of 291 (6.7%, CI95% 5.9–7.4) patients with CKD were included. The mean eGFR was 51.0 ± 16.4 mL/min. Hypertension was the most frequent health problem reported (n = 93, 32%). Nephrotective agents were prescribed in 194 (66.7%) patients, non-steroidal anti-inflammatory drugs (NSAIDs) in 22 (8%) patients, and proton-pump inhibitors (PPIs) in 147 (47%) patients. CKD coding in EMRs was associated with dosage of natraemia (n = 34, 100%, P < 0.01), albuminuria (n = 20, 58%, P < 0.01), vitamin D (n = 14, 41%, P < 0.001), and phosphorus (n = 11, 32%, P < 0.001). Eighty-one patients (31.5%) with low eGFR without an entered code for CKD were prescribed an albuminuria dosage. Clinical monitoring could not be analysed due to poor coding. Conclusion This pilot study reinforces the hypothesis that CKD is underscreened and undermanaged. More systematic coding of medical information in EMRs and further studies on medical centre databases should improve primary care practices

A survey in France about caregiver administered paracetamol to children under 12

International audienc

Portfolio national en DES de médecine générale : résultats d’un processus de consensus formalisé

International audienceContexte. La réforme du 3e cycle des études médicales requerrait une harmonisation des procédures de formation et d’évaluation au cours du DES de médecine générale (MG). Un portfolio national en ligne était prévu par les tutelles pour chaque discipline. Il n’existait pas de consensus sur le contenu et les modalités de production et d’évaluation du portfolio.Objectif. Proposer des recommandations pour la mise en place du portfolio national de MG à partir d’un consensus national.Méthode. Une méthode de consensus formalisé, décrite par la Haute Autorité de santé (HAS) en 2010 a été utilisée. Tous les départements de MG (DMG) et de leurs responsables pédagogiques ainsi que d’experts nationaux et internationaux ont été sollicités. Une revue initiale de la littérature a permis de proposer au groupe cotation une première liste de propositions. Deux tours de cotation puis un tour de relecture suivis d’une réunion de synthèse se sont succédé, à la recherche d’un consensus.Résultats. 95 % des DMG et plusieurs experts en pédagogie ont participé au consensus formalisé qui a abouti à une liste de recommandations permettant de définir les procédures de supervision, d’élaboration et d’évaluation du portfolio de MG. Un document de synthèse les a regroupées. Conclusion. La perspective de la réforme du DES et de l’harmonisation du portfolio rendaient nécessaire un consensus national. Ce consensus est un support de la mise en œuvre de la réforme et un support d’équité dans la formation initiale des MG

Impact of urgent surgery in non-complicated left-sided native-valve infective endocarditis with large vegetations

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Healthcare-seeking behaviour in case of influenza-like illness in the French general population and factors associated with a GP consultation: an observational prospective study

International audienceBackground: GP consultation rates for influenza-like illness (ILI) are poorly known in France and there is a paucity of literature on this topic. In the few articles that have been published, the results are heterogeneous.Aim: The aim of the present study was to estimate the proportion of ILI inducing a GP consultation, and to assess its determinants.Design & setting: Participants of a French web-based cohort study who reported ≥1 ILI episode between 2012 and 2015 were included. Sociodemographic characteristics, access to health care, and health status variables were collected.Method: Healthcare-seeking behaviour was analysed and factors associated with a GP consultation identified using a conditional logistic regression.Results: Of the 6023 ILI episodes reported, 1961 (32.6%) led to a GP consultation, with no difference between those at risk of influenza complications and those not (P = 0.42). A GP consultation was more frequent for individuals living in a rural area (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02 to 1.43); those with a lower educational level (OR = 1.43, 95% CI = 1.18 to 1.74); those using the internet to find information about influenza (OR = 1.63, 95% CI = 1.30 to 2.03); patients presenting with worrying symptoms (fever, cough, dyspnoea, sputum, or asthenia); patients having a negative perception of their own health status (OR = 1.51, 95% CI = 1.07 to 2.13; and those having declared a personal doctor (OR = 2.86, 95% CI = 1.72 to 4.76). A GP consultation was less frequent for individuals using alternative medicine (OR = 0.68, 95% CI = 0.58 to 0.78).Conclusion: This study allows the identification of specific factors associated with GP consultation for an ILI episode. These findings may help to coordinate health information campaigns and to raise awareness, especially among individuals at risk of influenza complications

Global decline of pelagic fauna in a warmer ocean

International audiencePelagic fauna is expected to be impacted under climate change according to ecosystem simulations. However, the direction and magnitude of the impact is still uncertain and still not corroborated by observational-based statistical studies. Here we compile a global underwater sonar database and 20 ocean climate projections to predict the future distribution of sound-scattering fauna around the world's oceans. We show that global pelagic fauna will be seriously compromised by the end of the 21 st century, if we continue under the current greenhouse emission scenario. Low and mid latitudes are expected to lose from 3 to 22% of animal biomass due to the expansion of low-productive systems, while higher latitudes would be populated by present-day temperate fauna, supporting conclusions drawn from ecosystem simulations. We further show that strong-mitigation measures to contain global warming below 2°C would reduce these impacts to less than half

A rare oasis effect for forage fauna in oceanic eddies at the global scale

Oceanic eddies are recognized as pivotal components in marine ecosystems, believed to concentrate a wide range of marine life spanning from phytoplankton to top predators. Previous studies have posited that marine predators are drawn to these eddies due to an aggregation of their forage fauna. In this study, we examine the response of forage fauna, detected by shipboard acoustics, across a broad sample of a thousand eddies across the world’s oceans. While our findings show an impact of eddies on surface temperatures and phytoplankton in most cases, they reveal that only a minority (13%) exhibit significant effects on forage fauna, with only 6% demonstrating an oasis effect. We also show that an oasis effect can occur both in anticyclonic and cyclonic eddies, and that the few high-impact eddies are marked by high eddy amplitude and strong water-mass-trapping. Our study underscores the nuanced and complex nature of the aggregating role of oceanic eddies, highlighting the need for further research to elucidate how these structures attract marine predators

Unsupervised Clustering of Patients with Severe Aortic Stenosis: A Myocardial Continuum.

International audienceBACKGROUND: Traditional statistics, based on prediction models with a limited number of prespecified variables, are probably not adequate to provide an appropriate classification of a condition that is as heterogeneous as aortic stenosis (AS). AIMS: To investigate a new classification system for severe AS using phenomapping. METHODS: Consecutive patients from a referral centre (training cohort) who met the echocardiographic definition of an aortic valve area (AVA) ≤q~1~cm(2) were included. Clinical, laboratory and imaging continuous variables were entered into an agglomerative hierarchical clustering model to separate patients into phenogroups. Individuals from an external validation cohort were then assigned to these original clusters using the K nearest neighbour (KNN) function and their 5-year survival was compared after adjustment for aortic valve replacement (AVR) as a time-dependent covariable. RESULTS: In total, 613 patients were initially recruited, with a mean±standard deviation AVA of 0.72±0.17~cm(2). Twenty-six variables were entered into the model to generate a specific heatmap. Penalized model-based clustering identified four phenogroups (A, B, C and D), of which phenogroups B and D tended to include smaller, older women and larger, older men, respectively. The application of supervised algorithms to the validation cohort (n=1303) yielded the same clusters, showing incremental cardiac remodelling from phenogroup A to phenogroup D. According to this myocardial continuum, there was a stepwise increase in overall mortality (adjusted hazard ratio for phenogroup D vs A 2.18, 95% confidence interval 1.46-3.26; P<0.001). CONCLUSIONS: Artificial intelligence re-emphasizes the significance of cardiac remodelling in the prognosis of patients with severe AS and highlights AS not only as an isolated valvular condition, but also a global disease

Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis

Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P&lt;0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia