Prise en charge des pneumopathies aiguës communautaires de l'adulte au Centre Hospitalier de Troyes. Etude prospective à propos de 64 cas

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Complications of radial head prostheses

International audienceRadial head prostheses are indicated for treatment of complex radial head fractures not amenable for fixation. After the initial experience with silastic implants, metallic or pyrocarbon arthroplasty have been used for 20 years. Little is known about complications related to these implants. Main complications are related to loosening whether they are cemented or not cemented. Hypotheses have been proposed like inadequate stem design, insufficient cement technique, stress shielding, and foreign body reactions secondary to polyethylene wear. Pain and stiffness are other common complications often related to oversized radial head component or overstuffing of the joint with excessive lengthening of the radius. Instability can be another complication in the context of more complex trauma with lateral collateral ligament complex lesion and coronoid fracture. Fixation of the coronoid fracture, reinsertion of the lateral collateral ligament complex, and the use of monobloc radial head prosthesis are recommended to stabilize the joint. Finally, osteoarthritis is common with follow-up

Multidimensional analyses to assess the relations between treatment choices by physicians and patients’ characteristics: the example of COPD

BACKGROUND: In some situations, practice guidelines do not provide firm evidence-based guidance regarding COPD treatment choices, especially when large trials have failed to identify subgroups of particularly good or poor responders to available medications. METHODS: This observational cross-sectional study explored the yield of four types of multidimensional analyses to assess the associations between the clinical characteristics of COPD patients and pharmacological and non-pharmacological treatments prescribed by lung specialists in a real-life context. RESULTS: Altogether, 2494 patients were recruited by 515 respiratory physicians. Multiple correspondence analysis and hierarchical clustering identified 6 clinical subtypes and 6 treatment subgroups. Strong bi-directional associations were found between clinical subtypes and treatment subgroups in multivariate logistic regression. However, although the overall frequency of prescriptions varied from one clinical subtype to the other for all types of pharmacological treatments, clinical subtypes were not associated with specific prescription profiles. When canonical analysis of redundancy was used, the proportion of variation in pharmacological treatments that was explained by clinical characteristics remained modest: 6.23%. This proportion was greater (14.29%) for non-pharmacological components of care. CONCLUSION: This study shows that, although pharmacological treatments of COPD are quantitatively very well related to patients’ clinical characteristics, there is no particular patient profile that could be qualitatively associated to prescriptions. This underlines uncertainties perceived by physicians for differentiating the respective effects of available pharmacological treatments. The methodology applied here is useful to identify areas of uncertainty requiring further research and/or guideline clarification

Nature et société

Appréhendée par les liens qu’elle entretient avec les sociétés humaines, notamment par le triptyque ressources-contraintes-risques, la nature ne constitua pas, en tant que telle, un sujet d’étude pour les sciences humaines jusqu’aux années 2010. Le regain d’intérêt, motivé par la multiplicité et la diversité des crises climatiques, écologiques et sanitaires, s’inscrit dans la prise de conscience d’une appartenance de l’être humain au vivant et d’une destinée partagée. Outre un renouvellement conceptuel, il suscite tout à la fois des regards originaux, des outils inédits et s’intéresse à de nouveaux objets, parfois hybrides, de nature. Apprehended through the links it maintains with human societies, notably through the triptych resources-constraints-risks, nature did not constitute, as such, a subject of study for the human sciences until the 2010s. The renewed interest, motivated by the multiplicity and diversity of climatic, ecological and sanitary crises, is part of the awareness that human beings belong to the living world and that their destiny is shared. In addition to a conceptual renewal, it gives rise to original views, new tools and interest in new objects, sometimes hybrids, of nature

Position paper of the French Society of Respiratory Diseases regarding pharmacological treatment optimization for stable COPD in 2021

The previous French Society of Respiratory Diseases (SPLF, Société de Pneumologie de Langue Française) position paper on pharmacological treatment optimization in stable COPD was released in 2016 [1]. Many randomized clinical trials assessing new pharmacological treatments/devices have been published since then. The concept of a personalized approach in COPD based on phenotypes, endotypes, and treatable traits generates a growing interest although much uncertainty remains regarding the best way to optimize pharmacological therapy in COPD, and especially regarding the use of biomarkers in addition to clinical characteristics. Therefore, existing propositions and guidelines need to be regularly updated, as recently done by several national or international societies or working groups including Global Obstructive Lung Disease, GOLD [2], National Institute for Health and Care Excellence, NICE [3], European respiratory Society, ERS [4] and American Thoracic Society, ATS [5]. In this context, the SPLF decided to update its position on pharmacological treatment optimization in stable COPD in 2021. A working group expert in COPD, representative of pulmonologists, pharmacists, physiologists and general practitioners, reviewed the literature published between 2016 and 2021 [6]. The basis for this position paper is derived from randomized controlled trials, large cohorts, real-world-evidence and expert advices

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.[Prise en charge des exacerbations de la bronchopneumopathie chronique obstructive (BPCO). Recommandations de la Société de pneumologie de langue française (texte court)] La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu’elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d’activité, des exacerbations, du risque d’insuffisance respiratoire chronique et des manifestations extra-respiratoires qu’elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d’investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l’évaluation de la sévérité de l’exacerbation et de la prise en charge pharmacologique