Anemia and bleeding in patients receiving anticoagulant therapy for venous thromboembolism: comment

International audienc

Longitudinal changes in activity patterns, physical capacities, energy expenditure, and body composition in severely obese adolescents during a multidisciplinary weight-reduction program

International audienceOBJECTIVE: To determine the longitudinal changes in body composition, physical capacities, and time and energy expenditure (EE) devoted to various activities in the course of a 9-month weight-reduction period. DESIGN: Longitudinal, clinical intervention including lifestyle education, moderate energy restriction, progressive training, and psychological follow-up. SUBJECTS: A total of 27 (13 boys and 14 girls) severely obese adolescents (mean BMI: 33.9 kg/m2; 41.5% fat mass (FM)), aged 12-16 y. MEASUREMENTS: Before the beginning and after the weight-reduction program, body composition was assessed by dual-energy X-ray absorptiometry (DXA), physical capacities by multistage treadmill test, and EE both by whole-body calorimetry and in free-living conditions using the heart rate-recording method. During 8 months of the weight-reduction period, type and duration of each activity were recorded using a daily controlled activity diary. RESULTS: One boy resigned after 5 months. Body weight (BW) and FM decreased (-19 and -42%, respectively, P<0.001) both in boys and in girls, but fat-free mass (FFM) decreased only in girls (-6%, P<0.001). VO2max (l/min) did not vary significantly, but strength and fitness were improved (P<0.001). Time and EE spent at sedentary activities decreased significantly (P<0.001) to the benefit of moderate (recreational) activities and total physical activities (P<0.001) at the institution during the weekdays, and at home during the weekends and holidays. CONCLUSION: The great BW and FM losses, preservation of FFM, and improvement of physical capacities of obese adolescents obtained under experimental conditions were associated with increases in leisure physical activities in free-living conditions at the expense of sleep and sedentary activities

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

BACKGROUND:Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it. OBJECTIVE:To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants. MATERIALS AND METHOD:We based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control. RESULTS:GASAC consists of four adherence subscales: drug prescriptions; blood tests/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach's alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01). The median score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariaable analysis, infection was more conducive of good adherence (cut off at ≥ 0.8; n = 115/154; 74.7% [67.0-81.3]) than trauma (OR 3.69; CI [1.60-8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02-1.10]) also influenced adherence. CONCLUSIONS:GASAC is a generic score to measure all dimensions of patient adherence following emergency departments visits, for use in clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and Doctor-Patient Communication was a major determinant of adherence

A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review

International audienc

A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review.

There is no validated generic tool to measure Doctor-Patient-Communication (DPC) in a context of acute conditions.To create and validate such a scale in a real population.We performed a systematic review of validated DPC scales available in English. From these, using a theoretical model based on a multidisciplinary approach, we selected pertinent items that met the inclusion criteria and included them in a simple questionnaire. This tool based on a synthesis of the literature was then validated in a prospective study in two hospital emergency departments.We found 22 pertinent questionnaires and scoring systems. From these, we extracted items and built a scale based on 15 questions with graded responses (Likert from 1 to 4). The mean time for questionnaire completion was 3 minutes. We included 189 adults and adolescents in the study and analyzed complete responses to the questionnaire by 149 patients, gathered over the phone one week after their consultation. The scale had high internal consistency (Cronbach's alpha = 0.89) and good external validity. Two questions were removed due to redundancy giving a scale based on 13 questions.We have created an easy-to-use and validated generic questionnaire to assess DPC in a context of acute conditions, usable both in clinical research and in routine practice

Short interval or continuous training programs to improve walking distance for intermittent claudication: Pilot study

International audienc

Inclusion and exclusion criteria for scales and items (based on the criteria proposed by Zill et al. and our theoretical model).

<p>Inclusion and exclusion criteria for scales and items (based on the criteria proposed by Zill et al. and our theoretical model).</p

Scales found assessing DPC in diverse conditions and settings.

<p>Scales found assessing DPC in diverse conditions and settings.</p

Literature search equations and selection of evaluation tools.

<p>Literature search equations and selection of evaluation tools.</p