BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Infrared thermotransmittance-based temperature field measurements in semitransparent media

Contactless temperature field measurements in or at the surfaces of semitransparent media are a scientific challenge as classical thermography techniques based on proper material emission cannot be used. In this work, an alternative method using infrared thermotransmittance for contactless temperature imaging is proposed. To overcome the weakness of the measured signal, a lock-in acquisition chain is developed and an imaging demodulation technique is used to retrieve the phase and amplitude of the thermotransmitted signal. These measurements, combined with an analytical model, enable the estimation of the thermal diffusivity and conductivity of an infrared semitransparent insulator (wafer of Borofloat 33 glass) and the monochromatic thermotransmittance coefficient at 3.3 µm. The obtained temperature fields are in good agreement with the model, and a detection limit of ±2 °C is estimated with this method. The results of this work open new opportunities in the development of advanced thermal metrology for semitransparent media

Faisabilité de la néphrectomie partielle robotique pour tumeur kystique

National audienceObjectifs L’utilisation de la néphrectomie partielle robot assistée (NPRA) s’est beaucoup répandue ces dernières années. Des doutes ont été émis sur la sécurité de la NPRA pour les tumeurs kystiques. L’objectif de cette vidéo était de montrer la faisabilité de la NPRA dans cette situation. Méthodes Dans un centre universitaire où le nombre de NPRA est important, une technique simple et codifiée de NPRA a été établie. Elle a été progressivement appliquée à des situations chirurgicales plus complexes dont les tumeurs kystiques. Résultats Nous présentons le cas d’un patient de 43 ans ayant une tumeur kystique Bosniak III de 5 cm du pôle inférieur du rein gauche classée RENAL SCORE 9ah sur rein unique (antécédent de néphrectomie élargie droite pour néphroblastome dans l’enfance). En préopératoire, la créatininémie était de 88 micromoles, soit une clairance à 100 mL/min. La durée opératoire était de 150 minutes et la durée d’ischémie chaude de 14 minutes. Il n’y a pas eu de complications per- ou postopératoires. Le patient a quitté le service à j3. La fonction rénale à 1 mois était préservée avec une créatinine à 100 micromoles, soit une clairance à 78 mL/min. L’examen anatomo-pathologique retrouvait un carcinome multiloculaire kystique pT1b R0. Conclusion La NPRA est faisable pour les tumeurs kystiques avec des résultats peropératoires et une sécurité oncologique identiques aux tumeurs solides. Néanmoins, il s’agit d’une situation délicate qui nécessite : – une sélection des patients (complexité et taille raisonnable) ; – une équipe expérimentée en chirurgie robotique ; – une attention particulière pour ne pas faire d’effraction tumoral

Photo-elicitation with adolescents in qualitative research: an example of its use in exploring family interactions in adolescent psychiatry

Abstract Background Photo-elicitation is a method used increasingly often in qualitative health research, and its positive effect on the research process is well established today. Photo-elicitation appears to facilitate verbalization and insight and to improve relationships between the researcher and participants, thereby enriching the quality of the data collected. Nonetheless, it is barely used at all in the field of adolescent psychiatry. With the aim of exploring the potential of these methods for research with adolescents receiving psychiatric care, we conducted a qualitative photo-elicitation data collection study with this population, asking them about family interactions around food. Methods The data were collected from 15 adolescents and 17 parents during semi-structured interviews in which a photo taken by the adolescent served as the focus of discussion. Data were explored through inductive thematic analysis. Results Photo-elicitation played a threefold role in this study: (1) it induced the teens’ interest, thought, and pleasure, (2) it played a mediating function during the interviews, and (3) it enabled family interactions to be viewed from the adolescent’s perspective. Three themes concerning family interactions were found: (1) parent–child relationship patterns, (2) the functioning of the family group, and (3) the adolescent’s individual relation with food, that is, the issue of the adolescent’s autonomy. Conclusions Photo-elicitation proved to be an innovative technique in qualitative research in the area of adolescent psychiatry, one that enriched the data and enabled the emergence of new themes in this field, related in particular to the process by which adolescents develop autonomy

Ring contraction for the synthesis of original pyrrole derivatives

Communication par affiche (présentée par S. Naud

Étude multicentrique sur l’impact des anticoagulants et antiagrégants sur la morbidité de la néphrectomie partielle robotique

National audienceObjectifs La néphrectomie partielle peut avoir des complications hémorragiques qui sont d’autant plus redoutées que les patients sont sous traitement antiagrégant ou anticoagulant. L’objectif de cette étude était d’évaluer l’impact des traitements antiagrégants plaquettaires (AAP) ou anticoagulants (AVK) sur la morbidité de la néphrectomie partielle robot-assistée (NPRa). Méthodes Nous avons analysé les patients opérés dans deux centres universitaires sur une période de quatre ans et avons recensé les patients sous AAP et/ou AVK. Pour chaque patient, les modalités d’arrêt et de reprise des AAP et/ou AVK ont été précisément recherchées. Nous avons ainsi pu évalué l’impact des ces traitements sur l’incidence des complications hémorragiques (pseudoanévrisme, fistule artério-veineuse, hématome nécessitant une transfusion). Un modèle de régression logistique a été utilisé pour déterminer les facteurs prédictifs de ces complications avec ajustement pour l’ASA, l’âge, l’IMC, l’utilisation d’agents hémostatiques, le Renal Score et la taille tumorale. Résultats Sur 533 patients, 70 avaient un AAP ou un AVK (50 % aspirine, 25 % clopidogrel, 28 % AVK, 8 % NACO). Clopidogrel, AVK et NACO étaient systématiquement arrêtés en préopératoire. Le Kardégic était maintenu pour la NPRA dans 25 % des cas. En analyse univariée (Tableau 1), les complications globales et hémorragiques étaient plus fréquentes chez les patients sous AVK ou AAP. Le taux de transfusion était supérieur dans les groupes AAP, aspirine et clopidogrel. En analyse multivariée, les facteurs de risques de complications étaient la prise d’AVK (OR = 5,8 ; IC95 % [1,5–24,1] ; p = 0,01) et la taille tumorale (OR = 1,9 ; IC 95 % [1,4–9,1] ; p = 0,02). Le clopidogrel (OR = 1,9 ; IC 95 % [0,4–9,3] ; p = 0,42) et l’aspirine (OR = 2,9 ; IC9 5 % [0,9–9,7] ; p = 0,07) n’avaient pas d’impact sur la morbidité. Conclusion Lors de la NPRA, les traitements anticoagulants sont associés à une augmentation de la morbidité périopératoire. Des études sur des plus grandes populations sont nécessaires pour confirmer ces résultat

Impact de l’acquisition d’un urétéroscope souple sur le traitement des calculs du haut appareil urinaire chez l’enfant [Impact of the acquisition of a flexible ureteroscope on the management of upper urinary tract stones in children]

National audienceIntroduction - Firstly reported in the early 1990s for the treatment of upper urinary tract stones in adult patients, flexible ureteroscopy (F-URS) has been used in children during the past 10 years and is now considered as a viable, but still second-line alternative to extracorporeal shockwave lithotripsy in these patients (ESWL). The aim of this study was to assess the impact of the acquisition of a F-URS on the management of upper urinary tract stones in children. Patients and methods - Data of all ESWL, F-URS and percutaneous nephrolithotomy performed for upper urinary tract stones in children from 0 to 18 years old in a single center from 2000 to 2014 have been collected retrospectively. Patients have been divided into two groups: group 1 before the acquisition of the F-URS (2000-2008) and group 2 after the acquisition of the F-URS (2008-2014). Preoperative data and peri-operative outcomes were compared between both groups using the χ(2) test and Fisher exact test for discrete variables and the Mann-Whitney test for continuous variables. Results - Thirty-seven children have been treated during the first era and 32 during the second one. The two groups were similar in terms of age (7.2 years vs 8.1 years; P=0.54), size of the largest stone (15 mm vs 16.2mm; P=0,56) and number of stones per patient (1.4 vs 2; P=0,07) but the sum of stone diameters was higher in group 2 (16.9 mm vs 24.2mm; P=0,048). The stone-free rates were comparable in both groups (28.1% vs 32.2% after the first procedure; P=0.72), as were the mean number of procedures per patient (2.4 vs 2.5; P=0.78), the total length of stay (2.7 days vs 2.9 days; P=0.77), and the number of patients who experienced at least one complication (37.8% vs 40.6%; P=0.87). Conclusion - The acquisition of a F-URS allowed the treatment of more complex stones with a similar efficacy and without increasing morbidity. Further studies are needed to define the role of F-URS in the management of upper urinary tract stones in children