Est-il possible d'optimiser le traitement médicamenteux des patients âgés ?

Contexte: La polymédication, définie ici comme la prescription simultanée de M 4 médicaments, est fréquente chez les personnes de M 65 ans. Celle-ci peut s'accompagner d'une mauvaise adhérence aux traitements et provoquer des effets indésirables. Cette revue systématique a évalué l'efficacité des interventions visant à améliorer l'adéquation de la polymédication chez la personne âgée (M 65 ans) présentant deux maladies chroniques ou plus

Dielectric resonator nanoantennas at visible frequencies

Drawing inspiration from radio-frequency technologies, we propose a realization of nano-scale optical dielectric resonator antennas (DRAs) functioning in their fundamental mode. These DRAs operate via displacement current in a low-loss high-permittivity dielectric, resulting in reduced energy dissipation in the resonators. The designed nonuniform planar DRA array on a metallic plane imparts a sequence of phase shifts across the wavefront to create beam deflection off the direction of specular reflection. The realized array clearly demonstrates beam deflection at 633 nm. Despite the loss introduced by field interaction with the metal substrate, the proposed low-loss resonator concept is a first step towards nanoantennas with enhanced efficiency. The compact planar structure and technologically relevant materials promise monolithic circuit integration of DRA

Kasabach-Merritt phenomenon and prenatal counseling: a case series.

Kasabach-Merritt phenomenon can be encountered in the perinatal period. No consensus exists regarding prenatal management. We report one prenatal case leading to therapeutic abortion and one neonatal case, successfully treated by a multimodal therapy. Prenatal counseling should include the possibility of neonatal multimodal treatment that can lead to favorable outcomes

Early mobilisation and rehabilitation in Swiss intensive care units: a cross-sectional survey

BACKGROUND: Patients in intensive care units (ICUs) are at high risk of developing physical, functional, cognitive, and mental impairments. Early mobilisation aims to improve patient outcomes and is increasingly considered the standard of care. This survey aimed to investigate the characteristics, current use and variations of early mobilisation and rehabilitation in Swiss ICUs. METHODS: We conducted a cross-sectional survey among all ICU lead physicians, who provided data on their institutional characteristics, early mobilisation and rehabilitation practices, and their perceptions of the use and variation of early rehabilitation practices in Switzerland. RESULTS: The survey response rate was 44% (37/84). Among ICUs caring for adults (34/37), 26 were in the German-speaking region, five in the French-speaking region, and three in the Italian-speaking region. All ICUs regularly involved physiotherapy in the rehabilitation process and 50% reported having a specialised physiotherapy team. All ICUs reported performing early mobilisation, starting within the first 7 days after ICU admission. About half reported the use of a rehabilitation (45%) or early mobilisation protocol (50%). Regular, structured, interdisciplinary rounds or meetings of the ICU care team to discuss rehabilitation measures and goals for patients were stated to be held by 53%. The respondents stated that 82% of their patients received early mobilisation measures during their ICU stay. Most frequently provided mobilisation measures included passive range of motion (97%), passive chair position in bed (97%), active range of motion muscle activation and training (88%), active side to side turning (91%), sitting on the edge of the bed (94%), transfer from bed to a chair (97%), and ambulation (94%). The proportion of ICUs providing a specific early mobilisation measure, the proportion of patients receiving it, and the time dedicated to it varied across language regions, hospital types, ICU types, and ICU sizes. Almost one third of the ICU lead physicians considered early rehabilitation to be underused in their own ICU and about half considered it to be underused in Switzerland more generally. ICU lead physicians stressed lack of personnel, financial resources, and time as key causes for underuse. Moreover, they highlighted the importance of early and systematic or protocol-based rehabilitation and interprofessional approaches that are adaptive to the patients' rehabilitation needs and potential. CONCLUSION: This survey suggests that almost all ICUs in Switzerland practice some form of early mobilisation with the aim of early rehabilitation. However, the described approaches, as well as the reported use of early mobilisation measures were heterogenous across Swiss ICUs

Angular displacement and velocity sensors based on coplanar waveguides (CPWs) loaded with S-shaped split ring resonators (S-SRR)

In this paper, angular displacement and angular velocity sensors based on coplanar waveguide (CPW) transmission lines and S-shaped split ring resonators (S-SRRs) are presented. The sensor consists of two parts, namely a CPW and an S-SRR, both lying on parallel planes. By this means, line-to-resonator magnetic coupling arises, the coupling level being dependent on the line-to-resonator relative angular orientation. The line-to-resonator coupling level is the key parameter responsible for modulating the amplitude of the frequency response seen between the CPW ports in the vicinity of the S-SRR fundamental resonance frequency. Specifically, an amplitude notch that can be visualized in the transmission coefficient is changed by the coupling strength, and it is characterized as the sensing variable. Thus, the relative angular orientation between the two parts is measured, when the S-SRR is attached to a rotating object. It follows that the rotation angle and speed can be inferred either by measuring the frequency response of the S-SRR-loaded line, or the response amplitude at a fixed frequency in the vicinity of resonance. It is in addition shown that the angular velocity can be accurately determined from the time-domain response of a carrier time-harmonic signal tuned at the S-SRR resonance frequency. The main advantage of the proposed device is its small size directly related to the small electrical size of the S-SRR, which allows for the design of compact angular displacement and velocity sensors at low frequencies. Despite the small size of the fabricated proof-of-concept prototype (electrically small structures do not usually reject signals efficiently), it exhibits good linearity (on a logarithmic scale), sensitivity and dynamic range.Jordi Naqui, Jan Coromina, Ali Karami-Horestani, Christophe Fumeaux and Ferran Martí

Changing trends in end-stage renal disease patients with diabetes.

Worldwide, diabetes has become the most common cause of end-stage renal disease (ESRD), yet Swiss data are largely lacking. This observational study examined ESRD patients with diabetes mellitus (ESRD-DM) at end of 2009 and 2014. The prevalence and characteristics of ESRD-DM patients were collected in all dialysis facilities in the Canton of Vaud of Switzerland in 2009 and in 2014, and the 5-year mortality rate was assessed. A total of 107 and 140 ESRD-DM patients underwent dialysis at end of 2009 and 2014, respectively. Within the 5-year period a total of 167 incidental ESRD-DM patients required dialysis, corresponding to an estimated incidental rate of 0.84/1000 person-years in the diabetic population. In 2009, all patients with ESRD-DM underwent haemodialysis, decreasing to 96.2% in 2014, with 3.8% on peritoneal dialysis. Age, sex, body mass index, type of diabetes, duration of diabetes, cause of ESRD, dialysis duration, dialysis frequency, vascular access, and glycosylated haemoglobin levels did not differ between 2009 and 2014. In 2014, macrovascular comorbidity was reported more often than in 2009, but not amputations. Haemoglobin level decreased significantly from 117.9 g/l to 112.3 g/l. Calcium-containing phosphate binder and angiotensin-converting enzyme inhibitor use significantly decreased, whereas iron therapy significantly increased with time. The 5-year mortality rate was 61.7%. Five-year survivors were significantly younger and had a higher body mass index. The growing prevalence of ESRD-DM emphasises that prevention of chronic kidney disease and its progression should be a public health priority in Switzerland

Efficiency of a compact elliptical planar ultra-wideband antenna based on conductive polymers

Extent: 11p.A planar antenna for ultra-wideband (UWB) applications covering the 3.1–10.6 GHz range has been designed as a test bed for efficiency measurements of antennas manufactured using polymer conductors. Two types of conductive polymers, PEDOT and PPy (polypyrrole), with very different thicknesses and conductivities have been selected as conductors for the radiating elements. A comparison between measured radiation patterns of the conductive polymers and a copper reference antenna allows to estimate the conductor losses of the two types of conductive polymers. For a 158 μm thick PPy polymer, an efficiency of almost 80% can be observed over the whole UWB spectrum. For a 7 μm thick PEDOT layer, an average efficiency of 26.6% demonstrates, considering the room for improvement, the potential of this type of versatile materials as flexible printable alternative to conductive metallic paints. The paper demonstrates that, even though the PEDOT conductivity is an order of magnitude larger than that of PPy, the thicker PPy layer leads to much higher efficiency over the whole UWB frequency range. This result highlights that high efficiency can be achieved not only through high conductivity, but also through a sufficiently thick layer of conductive polymers.Thomas Kaufmann, Akhilesh Verma, Van-Tan Truong, Bo Weng, Roderick Shepherd, and Christophe Fumeau