Can CT-based gap and step-off displacement predict outcome after nonoperative treatment of acetabular fractures?

Aims: The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. Methods:A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and step-off values in the weightbearing dome were digitally measured by two trauma surgeons. Native hip survival was reported using Kaplan-Meier curves. Predictors for conversion to THA were determined using Cox regression analysis. Results: Of 170 patients, 22 (13%) subsequently received a THA. Native hip survival in patients with a step-off ≤ 2 mm, &gt; 2 to 4 mm, or &gt; 4 mm differed at five-year follow-up (respectively: 94% vs 70% vs 74%). Native hip survival in patients with a gap ≤ 2 mm, &gt; 2 to 4 mm, or &gt; 4 mm differed at five-year follow-up (respectively: 100% vs 84% vs 78%). Step-off displacement &gt; 2 mm (&gt; 2 to 4 mm hazard ratio (HR) 4.9, &gt; 4 mm HR 5.6) and age &gt; 60 years (HR 2.9) were independent predictors for conversion to THA at follow-up. Conclusion: Patients with minimally displaced acetabular fractures who opt for nonoperative fracture treatment may be informed that fracture displacement (e.g. gap and step-off) up to 2 mm, as measured on CT images, results in limited risk on conversion to THA. Step-off ≥ 2 mm and age &gt; 60 years are predictors for conversion to THA and can be helpful in the shared decision-making process.</p

Spacers and Valved Holding Chambers—The Risk of Switching to Different Chambers

© 2020 Spacers are pressurized metered-dose inhaler (pMDI) accessory devices developed to reduce problems of poor inhaler technique with pMDIs. Spacers that feature a 1-way inspiratory valve are termed valved holding chambers (VHCs); they act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a 2-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Both spacers and VHCs have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce corticosteroid-related side effects such as throat irritation, dysphonia, and oral candidiasis commonly seen with the use of pMDIs alone. Spacers and VHCs are not all the same, and also are not interchangeable: the performance may vary according to their size, shape, material of manufacture and propensity to become electrostatically charged, their mode of interface with the patient, and the presence or otherwise of valves and feedback devices. Thus, pairing of a pMDI plus a spacer or a VHC should be considered as a unique delivery system. In this Rostrum we discuss the risk potential for a patient getting switched to a spacer or VHC that delivers a reduced dose medication

Physiological maps and chemical-induced disease ontologies: tools to support NAMs development for next-generation risk assessment

editorial reviewedPhysiological maps (PM) can be defined as a graphical representation of cellular and molecular processes associated to specific organ functions (Vinken et al. 2021). Within the ONTOX project, we designed a total of 6 PMs describing physiological processes in the liver, the kidney and the brain. These PMs are then used as a tool to assess relevant mechanistic coverage and linkage between a specific organ function and a toxicological endpoint. Based on the Disease Maps project (Mazein et al. 2018) pipeline, we developed the first version of 6 PMs describing the following physiological processes: bile secretion & lipid metabolism (liver), vitamin D metabolism & urine composition (kidney), neural tube closure (update of the work of Heusinkveld et al. 2021) & brain development (brain). Our workflow included: (i) data collection from expert curated literature (ii) identification of the relevant biological mechanisms, (iii) screening of online databases (e.g. Wikipathways, Reactome, and KEGG) for previously described pathways, (iv) manual curation and integration of the data into a PM using CellDesigner, and (v) visualization on the MINERVA platform (Hoksza et al. 2019). These qualitative PMs represent an important tool for exploring curated literature, analyzing networks and benchmarking the development of new adverse outcome pathways (AOPs). These PMs provide the basis for developing quantitative disease ontologies, integrating different layers of pathological and toxicological information, chemical information (drug-induced pathways) and kinetic data. The resulting chemical-induced disease ontologies will provide a multi-layered platform for integration and visualization of such information. The ontologies will contribute to improving understanding of organ/disease related pathways in response to chemicals, visualize omics datasets, develop quantitative methods for computational disease modeling and for predicting toxicity, set up an in vitro & in silico test battery to detect a specific type of toxicity, and develop new animal-free approaches for next generation risk assessment

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24&nbsp;h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2&nbsp;years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9&nbsp;J/min [IQR 9.2-15.1], 13&nbsp;J/min [IQR 10-17], and 14&nbsp;J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9&nbsp;J/min, aRR at 17&nbsp;J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Guidance to 2018 good practice : ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

AimsMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.MethodsMASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.StakeholdersInclude patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.ResultsMASK is deployed in 23 countries and 17 languages. 26,000 users have registered.EU grants (2018)MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).Lessons learnt(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.Peer reviewe

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research

Présentation

Le C.E.L.F.A. avait inscrit dans son programme quadriennal 1998-2002 un axe de recherches portant sur l’intertextualité. Deux journées d’études, tenues les 31 mars 2000 et 11 mai 2001, ont balisé le parcours de travail ; la plupart des textes publiés ici sont issus de communications présentées dans ce cadre. D’autres s’y sont adjoints, poursuivant la réflexion qui connaîtra, sinon un aboutissement, du moins une amplification certaine dans le colloque « L’entredire francophone » qui sera organ..