Fibrillation atriale et infarctus du myocarde : un risque accru de mortalité

RésuméLa fibrillation atriale coexiste souvent avec l’infarctus du myocarde, et son incidence au décours de l’infarctus du myocarde varie entre 4% et 25%. La présence d’une fibrillation atriale chez les patients présentant un infarctus du myocarde est associée à un risque accru de mortalité, malgré l’ajustement sur des facteurs de confusion connus et indépendamment du moment de survenue de la fibrillation atriale. Cette augmentation de 40% du risque de mortalité conduit à porter une attention particulière à la fibrillation atriale chez les patients présentant un infarctus du myocarde. Des études sont nécessaires pour identifier les moyens de prévenir la survenue de la fibrillation atriale au cours de l’infarctus du myocarde et déterminer les thérapeutiques optimales de la fibrillation atriale chez les patients présentant un infarctus du myocarde afin de réduire la mortalité.SummaryAtrial fibrillation is a common finding in patients with myocardial infarction, its incidence vanes between 4% and 25% in the acute phase of myocardial infarction. The présence of atrial fibrillation is associated with an increased risk of mortality in patients with a myocardial infarction, even after adjustment for several important atrial fibrillation risk factors and regardless of the timing of onset of atrial fibrillation. This subsequent 40% increase in mortality associated with atrial fibrillation during myocardial infarction suggests that closer attention should be paid to these patients. Further research is needed to identify ways to prevent the occurrence of atrial fibrillation during myocardial infarction and to determine the optimal atrial fibrillation therapeutics strategies to reduce mortality in patients with myocardial infarction

Healthcare professionals' intentions to use wiki-based reminders to promote best practices in trauma care: a survey protocol

<p>Abstract</p> <p>Background</p> <p>Healthcare professionals are increasingly using wikis as collaborative tools to create, synthesize, share, and disseminate knowledge in healthcare. Because wikis depend on collaborators to keep content up-to-date, healthcare professionals who use wikis must adopt behaviors that foster this collaboration. This protocol describes the methods we will use to develop and test the metrological qualities of a questionnaire that will assess healthcare professionals' intentions and the determinants of those intentions to use wiki-based reminders that promote best practices in trauma care.</p> <p>Methods</p> <p>Using the Theory of Planned Behavior, we will conduct semi-structured interviews of healthcare professionals to identify salient beliefs that may affect their future use of wikis. These beliefs will inform our questionnaire on intended behavior. A test-retest of the survey will verify the questionnaire's stability over time. We will interview 50 healthcare professionals (25 physicians and 25 allied health professionals) working in the emergency departments of three trauma centers in Quebec, Canada. We will analyze the content of the interviews and construct and pilot a questionnaire. We will then test the revised questionnaire with 30 healthcare professionals (15 physicians and 15 allied health professionals) and retest it two weeks later. We will assess the internal consistency of the questionnaire constructs using Cronbach's alpha coefficients and determine their stability with the intra-class correlation (ICC).</p> <p>Discussion</p> <p>To our knowledge, this study will be the first to develop and test a theory-based survey that measures healthcare professionals' intentions to use a wiki-based intervention. This study will identify professionals' salient beliefs qualitatively and will quantify the psychometric capacities of the questionnaire based on those beliefs.</p

Muscles in “Concert”: Study of Primary Motor Cortex Upper Limb Functional Topography

BACKGROUND: Previous studies with Transcranial Magnetic Stimulation (TMS) have focused on the cortical representation of limited group of muscles. No attempts have been carried out so far to get simultaneous recordings from hand, forearm and arm with TMS in order to disentangle a 'functional' map providing information on the rules orchestrating muscle coupling and overlap. The aim of the present study is to disentangle functional associations between 12 upper limb muscles using two measures: cortical overlapping and cortical covariation of each pair of muscles. Interhemispheric differences and the influence of posture were evaluated as well. METHODOLOGY/PRINCIPAL FINDINGS: TMS mapping studies of 12 muscles belonging to hand, forearm and arm were performed. Findings demonstrate significant differences between the 66 pairs of muscles in terms of cortical overlapping: extremely high for hand-forearm muscles and very low for arm vs hand/forearm muscles. When right and left hemispheres were compared, overlapping between all possible pairs of muscles in the left hemisphere (62.5%) was significantly higher than in the right one (53.5% ). The arm/hand posture influenced both measures of cortical association, the effect of Position being significant [p = .021] on overlapping, resulting in 59.5% with prone vs 53.2% with supine hand, but only for pairs of muscles belonging to hand and forearm, while no changes occurred in the overlapping of proximal muscles with those of more distal districts. CONCLUSIONS/SIGNIFICANCE: Larger overlapping in the left hemisphere could be related to its lifetime higher training of all twelve muscles studied with respect to the right hemisphere, resulting in larger intra-cortical connectivity within primary motor cortex. Altogether, findings with prone hand might be ascribed to mechanisms facilitating coupling of muscles for object grasping and lifting -with more proximal involvement for joint stabilization- compared to supine hand facilitating actions like catching. TMS multiple-muscle mapping studies permit a better understanding of motor control and 'plastic' reorganization of motor system