58 research outputs found
Bronchoalveolar lavage cytological alveolar damage in patients with severe pneumonia
INTRODUCTION: Histological examination of lung specimens from patients with pneumonia shows the presence of desquamated pneumocytes and erythrophages. We hypothesized that these modifications should also be present in bronchoalveolar lavage fluid (BAL) from patients with hospital-acquired pneumonia. METHODS: We conducted a prospective study in mechanically ventilated patients with clinical suspicion of pneumonia. Patients were classified as having hospital-acquired pneumonia or not, in accordance with the quantitative microbiological cultures of respiratory tract specimens. A group of severe community-acquired pneumonias requiring mechanical ventilation during the same period was used for comparison. A specimen of BAL (20 ml) was taken for cytological analysis. A semiquantitative analysis of the dominant leukocyte population, the presence of erythrophages/siderophages and desquamated type II pneumocytes was performed. RESULTS: In patients with confirmed hospital-acquired pneumonia, we found that 13 out of 39 patients (33.3%) had erythrophages/siderophages in BAL, 18 (46.2%) had desquamated pneumocytes and 8 (20.5%) fulfilled both criteria. Among the patients with community-acquired pneumonia, 7 out of 15 (46.7%) had erythrophages/siderophages and 6 (40%) had desquamated pneumocytes on BAL cytology. Only four (26.7%) fulfilled both criteria. No patient without hospital-acquired pneumonia had erythrophages/siderophages and only 3 out of 18 (16.7%) had desquamated pneumocytes on BAL cytology. CONCLUSION: Cytological analysis of BAL from patients with pneumonia (either community-acquired or hospital-acquired) shows elements of cytological alveolar damage as hemorrhage and desquamated type II pneumocytes much more frequently than in BAL from patients without pneumonia. These elements had a high specificity for an infectious cause of pulmonary infiltrates but low specificity. These lesions could serve as an adjunct to diagnosis in patients suspected of having ventilator-associated pneumonia
Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group
IntroductionSeclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers.MethodsWithin a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure.ResultsFor the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patientâs transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint.DiscussionS/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures
A randomised controlled trial comparing the effectiveness of Tai Chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: Protocol for The TACIT Trial (TAi ChI for people with dementia).
Background: Falls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD. Methods: A 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 minutesâ Tai Chi plus up to 45 minutes for informal discussion, with up to 10 dyads per class) and home-based exercises (20 minutes per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3-4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden. Discussion: This trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD. Trial registration: NCT02864056
La prĂ©vention des chutes et des blessures dues aux chutes par lâexercice physique chez les personnes ĂągĂ©es
Context: Exercise programmes can prevent falls in older community-dwellers. However, evidence that these programmes can also prevent injurious falls was poor.Objectives : Systematic review of evidence of the effect of exercise interventions on injurious fall prevention from randomised controlled trials (RCT).Evaluate the effectiveness of âOssĂ©boâ, a multi-centre RCT assessing the effectiveness of a 2-year injurious fall prevention balance training programme.Methods:Systematic reviewThe definitions of injurious falls from included studies were classified into more homogeneous categories. This allowed the estimation of a pooled rate ratio for each injurious falls category based on random effects models. OssĂ©bo trial706 women aged 75-85 years ; home-living with diminished functional capacities were included. The 2 groups were compared for rates of injurious falls with a frailty model. Other outcomes included physical functional capacities, and quality of life indicators. Results:Systematic review17 trials involving 4305 participants were included. Four categories were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant preventive effect in all categories.OssĂ©boThere were 305 injurious falls in the intervention group and 397 in the control group, for a HR of 0.81 (0.67 to 0.99). At 2 years, women in the intervention group had significantly better performances on all physical tests and a better perception of their overall physical function. Conclusion:Fall prevention exercise programmes are effective in preventing injurious falls, and are feasible for long-term, wide-spread disseminationIntroductionLes chutes et les blessures dues aux chutes reprĂ©sentent un vĂ©ritable enjeu de santĂ© publique. Les programmes dâexercices physiques axĂ©s sur lâĂ©quilibre permettent de rĂ©duire de 30 Ă 40% le taux de chutes chez les personnes ĂągĂ©es vivant Ă leur domicile. Cependant, leur efficacitĂ© sur la prĂ©vention des traumatismes dus aux chutes nâa pas Ă©tĂ© Ă©tablie.Ce travail comporte 2 parties :- Une revue systĂ©matique de la littĂ©rature et mĂ©ta-analyse des rĂ©sultats dâessais contrĂŽlĂ©s randomisĂ©s (ECR) qui Ă©valuent lâefficacitĂ© de lâexercice sur diffĂ©rents types de chutes traumatiques chez les personnes ĂągĂ©es en milieu communautaire. - Lâanalyse des donnĂ©es de lâECR multicentrique âOssĂ©boâ, qui Ă©value lâefficacitĂ© dâun programme dâexercice physique de prĂ©vention de chutes traumatiques chez des femmes ĂągĂ©es.MĂ©thodesRevue systĂ©matiqueDes recherches bibliographiques ont Ă©tĂ© effectuĂ©es pour repĂ©rer les ECR de prĂ©vention des chutes par lâexercice physique, rĂ©alisĂ©s chez des personnes ĂągĂ©es vivant Ă leur domicile, et prĂ©sentant des donnĂ©es sur les chutes traumatiques.Ensuite, on a regroupĂ© les dĂ©finitions des chutes traumatiques trouvĂ©es dans les Ă©tudes sĂ©lectionnĂ©es en 4 catĂ©gories :A/ avec consĂ©quence.B/ avec recours Ă des soins mĂ©dicaux. C/ ayant entraĂźnĂ© un traumatisme grave.D/ avec fracture.On a rĂ©alisĂ© une mĂ©ta-analyse (MA) pour chaque catĂ©gorie, donc on a calculĂ© un effet global (effet poolĂ©) de lâexercice correspondant au ratio des taux dâincidence dans les 2 groupes par un modĂšle Ă effet alĂ©atoire.Lâessai OssĂ©boLes participantes Ă lâessai sont des femmes ĂągĂ©es de 75 Ă 85 ans, vivant Ă leur domicile, et ayant des capacitĂ©s physiques diminuĂ©es. Au total, 706 femmes, dans 20 centres en France, ont Ă©tĂ© randomisĂ©es en 2 groupes : le groupe intervention (GI), et le groupe contrĂŽle (GC).Lâintervention comprend des ateliers hebdomadaires dâexercice en petits groupes pendant 2 ans, et des exercices au domicile.La survenue de chutes a Ă©tĂ© enregistrĂ©e Ă lâaide des cartes-calendriers. Les circonstances et les consĂ©quences de la chute Ă©taient demandĂ©es en cas de signalement dâune chute, afin de classer la chute (sans consĂ©quence, traumatisme modĂ©rĂ©, traumatisme grave).Des bilans ont Ă©tĂ© effectuĂ©s Ă 1 an et 2 ans aprĂšs lâinclusion, selon le mĂȘme protocole que le bilan initial, qui comprenait notamment des tests fonctionnels simples.Le critĂšre principal est le taux dâincidence des âchutes traumatiquesâ (modĂ©rĂ©e et graves). Des modĂšles Ă fragilitĂ© (modĂšles de survie avec un effet alĂ©atoire) ont Ă©tĂ© utilisĂ©s pour modĂ©liser ce taux dans les 2 groupes.LâĂ©volution au cours du temps des capacitĂ©s physiques, et dâautres facteurs ont Ă©tĂ© comparĂ©s grĂące Ă un modĂšle marginal avec un effet alĂ©atoire au niveau du centre.RĂ©sultatsRevue systĂ©matique17 essais totalisant 4305 participants ont Ă©tĂ© sĂ©lectionnĂ©s. Toutes les interventions Ă©valuĂ©es comprenaient des exercices de lâĂ©quilibre. Les rĂ©sultats de la MA montrent que lâexercice est associĂ© Ă une rĂ©duction du taux de chutes traumatiques dans chacune des catĂ©gories considĂ©rĂ©es, avec un effet poolĂ© de 0.63 (IC95% : 0.51-0.77) pour la catĂ©gorie A(10 essais). Le RaR poolĂ© Ă©tait de 0.70 (0.54-0.92) pour la catĂ©gorie B (8 essais), de 0.57 (0.36-0.90) pour la catĂ©gorie C (7 essais), et de 0.39 (IC 95% : 0.22-0.66) pour la catĂ©gorie C (6 essais). Lâessai OssĂ©boOn a recensĂ© 397 chutes traumatiques dans le GC, et 305 dans le GI, correspondant Ă une rĂ©duction significative de 19% du taux de chutes traumatiques (âhazard ratiosâ HR= 0.81 IC95% : (0.67 - 0.99). A 2 ans, les femmes du GI ont des performances significativement meilleures que les femmes du GC sur lâensemble des tests physiquesDiscussionLes programmes dâexercice destinĂ©s Ă prĂ©venir les chutes sont Ă©galement efficaces pour rĂ©duire les traumatismes dus Ă la chute, y compris les plus graves. Aussi, il est possible de mettre en place Ă large Ă©chelle un programme efficace dâexercice de prĂ©vention des chutes traumatiques de longue durĂ©e chez des personnes ĂągĂ©e
Perceptions of plain tobacco packaging among adolescents and adults: DePICT, a French national survey
Background
Social inequalities in the consumption of tobacco in France
are at all-time highs, with adults in lower socio-economic groups having higher
rates of smoking than those who are more privileged. France was the second
country in the world to introduce plain tobacco packaging, with all tobacco
products sold starting January 1st 2017 having plain packaging. We sought to
examine if perceptions of the change in tobacco packaging differs according to
socio-economic position in adolescents as well as in adults.
Methods
DePICT is a two waves cross-sectional national telephone
survey of residents of Metropolitan France, whose first wave was completed on
November 15 th 2016 and included more than 6,000 participants aged 12
to 64 years. Using multivariate logistic regression
models, we examined the association between participants' educational attainment and
their perceptions of plain tobacco packaging. Analyses were conducted separately
among adults (≥18 years, n=4,342) and adolescents (n=2,042), and were adjusted
for multiple potential confounders such as socio-demographic characteristics, variables
related to health warnings' salience and perceptions of tobacco smoking. All
analyses were weighted to be representative of the French population.
Results
77% of adults and 28% of adolescents had heard of plain packaging;
respectively 38% of adults and 42% of adolescents had a favourable opinion of this
policy. Higher education level was associated with a positive perception of plain
packaging among adults, and schooling in a technical/vocation setting was
associated with negative perceptions among adolescents. Smokers - adult
and adolescent - were also more likely to have a negative perception of plain
packaging.
Conclusions
A negative perception of plain packaging is
associated with a lower educational level among adolescents and adults. Thus,
the impact of this policy change on patterns of smoking could differ depending
on individuals' socio-economic position
The 'Ossebo' intervention for the prevention of injurious falls in elderly women: background and design
International audienceBackground: Falls and fall-related injuries are a major cause of morbidity and mortality among older people. Extensive research into falls prevention has established physical exercise as an efficient method to reduce falls, but the effect of exercise on serious injuries caused by falls remains unclear. Moreover, populations that would benefit most from these interventions, as well as factors that determine adherence to exercise remain underreported. Methods: âOssĂ©boâ is an on-going multicentre randomized controlled trial, aiming to assess the effect of a 2-year community-based group physical exercise program on the prevention of falls among women aged 75 to 85 years old. The primary outcomes examined are the rate of falls and injurious falls; secondary outcomes include functional capacities, fear of falling and quality of life.Discussion: This study will help determine the effectiveness of a large scale falls prevention program and the factors that can potentially assist its success
Factors associated with successful vs. unsuccessful smoking cessation: Data from a nationally representative study
International audienceIntroduction: A substantial proportion of smokers who attempt to stop smoking relapse in the first months. Yet to date, there is limited understanding of the predictors of smoking attempts and their success. We examine the role of tobacco use characteristics, other substance-related factors, as well as socio-demographic characteristics in relation to successful and unsuccessful smoking cessation.Methods: DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme) is a nationally representative sample of adults aged between 18 and 64 years residing in metropolitan France, who were interviewed by telephone survey (n = 4342). Among current or former smokers (n = 2110) we distinguished participants characterized by: a) no quit attempt or quit < 6 months; b) unsuccessful smoking cessation (current smokers who previously quit smoking ℠6 months); c) successful smoking cessation (℠6 months). Factors associated with successful vs. unsuccessful smoking cessation were studied using multivariate multinomial logistic regression analyses.Results: Successful and unsuccessful smoking cessation share some predicting factors including no cannabis use, older age, and intermediate or high occupational grade. Factors specifically associated with successful smoking cessation included no e-cigarette use, no environmental tobacco exposure, fear of the health consequences of smoking, perceived harmfulness of smoking, and high educational attainment and a good overall health.Conclusions: Smokers' environmental tobacco exposure, concurrent cannabis use, and the perception of the health consequences of smoking should be taken into account in efforts aiming to promote smoking cessation at the individual as well as collective levels. Our data also suggest that e-cigarette use is associated with unsuccessful rather than successful smoking cessation, which should be verified in additional, longitudinal, studies
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