Usage du modèle de Reason dans un cadre méthodologique contraint, pour l'argumentation de la mise en place de la sécurité construite par tous

International audienceThis publication describesan intervention conducted in the context of the master’s degree of Ergonomics from the CNAM of Paris. It took place in a particularsettingcombining both variouswork tasks withlong cycles andconstrained methodological environment. In order to offset the difficulties encountered during the analysis of work activity phase, we used Reason’s model both as a support decisiontoolfor the risks prevention related issues at stake in the work activity. This enabledmanagementtoadapttheir procedures in regards towork associated risks. Despite its original as arequest fortechnical investigation, theimpactsofsuchtoolsuccessfully transformedprior management guidelinesand lead to safety improvement.Cette publication présente une intervention conduite dans le cadre de l’obtention du Master d’ergonomie du CNAM de Paris. Elle s’est déroulée dans un environnement spécifique, combinant travail varié intervenant sur des temporalités longues et contraintes méthodologiques. Pour compenser les difficultés rencontrées lors de la phase d’analyse de l’activité, nous avons utilisé le modèle de Reason à la fois comme outil d’aide à l’analyse de l’activité et comme support de restitution des enjeux liés à la prévention des risques qui se jouaient dans l’activité. Cet outil a facilité le changement de regard des demandeurs sur le travail et les risques associés. En effet, malgré une demande portant uniquement sur des solutions techniques, les axes de transformations envisagés suite à la restitution couvraient également l’organisation de travail et les rôles de chacun dans l’amélioration de la sécurité

Hospital costs of Balloon Pulmonary Angioplasty (BPA) procedure and management for CTEPH patients: An observational study based on the French national hospital discharge database (PMSI)

International audienceIntroduction Since 2014, Balloon Pulmonary Angioplasty (BPA) has become an emerging and complementary strategy for chronic thromboembolic hypertension (CTEPH) patients who are not suitable for pulmonary endarterectomy (PEA) or who have recurrent symptoms after the PEA procedure. Objective To assess the hospital cost of BPA sessions and management in CTEPH patients. Methods An observational retrospective cohort study of CTEPH-adults hospitalized for a BPA between January 1st, 2014 and June 30th, 2016 was conducted in the 2 centres performing BPA in France (Paris Sud and Grenoble) using the French national hospital discharge database (PMSI-MCO). Patients were followed until 6 months or death, whichever occurred first. Follow-up stays were classified as stays with BPA sessions, for BPA management or for CTEPH management based on a pre-defined algorithm and a medical review using type of diagnosis (ICD-10), delay from last BPA procedure stay and length of stay. Hospital costs (including medical transports) were estimated from National Health Insurance perspective using published official French tariffs from 2014 to 2016 and expressed in 2017 Euros. Results A total of 191 patients were analysed; mainly male (53%), with a mean age of 64,3 years. The first BPA session was performed 1.1 years in median (IQR 0.3–2.92) after the first PH hospitalisation. A mean of 3 stays with BPA sessions per patient were reported with a mean length of stay of 8 days for the first stay and 6 days for successive stays. The total hospital cost attributable to BPA was € 4,057,825 corresponding to €8,764±3,435 per stay and €21,245±12,843 per patient. Results were sensitive to age classes, density of commune of residence and some comorbidities. Conclusions The study generated robust real-world data to assess the hospital cost of BPA sessions and management in CTEPH patients within its first years of implementation in France

Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2.

Right ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe. Echocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure. RV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180. In the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term

Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2): a multinational, multicentre, single-arm, phase 4 trial

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Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease

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