Chronic wounds consultation by telemedicine between a rehabilitation healthcare center and nursing home or home

Saint-Hélier Rehabilitation Center (pôle MPR Saint-Hélier), located in Rennes, has been selected for a regional telemedicine project in 2014 about chronic wounds.AimTo make care access easier for heavy disabilities patients in nursing homes or at home with chronic wounds.MethodThe members of TLM Pl@ies chronic team are specialist doctors and nurses for wounds. On request, the occupational therapist or dietician involve in the consultation (multidisciplinary approach). A secure videoconference (web) is used.ResultsSince July 2014, over 100 teleconsultations have been done. Targeted population is constituted by patients:– whose access to care is decreased due to moving difficulties;– of which the health care team is crossing difficulties in the care process (wound care but also disability, nutrition..).Seventy percent of requests come from the nursing home, 30% from homes (pressure ulcers stages 3 and 4, arterial ulcers, venous or mixed). Middle age: 78 years (20–101 years). Only 3 patients refused. Time to organize the teleconsultation is on average 13 days. Consultations last on average 25 minutes. In 30% of cases the teleconsultation is extended by a real live training time for the nurse at home guided by the TLM Pl@ies chroniques team. We evaluate professional satisfaction and technical satisfaction. Without teleconsultation, in 77% of cases transportation request for consultation would be made, in 5% hospitalization. In 18% no request would be done.Discussion/conclusionThese first results, encouraging, confirms the interest of specialized consultations in medico-social settings, and telemedicine can be an effective solution

Debris avalanches on the western flank of Piton des Neiges shield volcano (Reunion Island)

Les faciès bréchiques reconnus à terre dans la région littorale de Saint-Gilles, sur le flanc ouest du volcan Piton des Neiges, sont clairement identifiés comme des dépôts d’avalanche de débris. Leur étude pétrographique, texturale et structurale permet de montrer, grâce à la présence de coulées autochtones interstratifiées, qu’au moins quatre glissements successifs se sont produits. Le premier est de grande ampleur puisqu’il affecte la zone centrale hydrothermalisée du volcan. Il est proposé que ce premier glissement, favorisé par la présence de matériaux ayant subi une importante altération hydrothermale, crée une zone d’instabilité qui influe sur le comportement ultérieur du Piton des Neiges. Dans ce même secteur, les glissements postérieurs concernent uniquement des domaines plus superficiels, mettant en jeu des matériaux non hydrothermalisés et vacuolaires. La bréchification des formations, et en particulier la désagrégation progressive des “blocs” durant le transport de l’avalanche de débris, implique une vitesse de progression élevée. Dans la zone du Cap La Houssaye, l’abrasion et la striation des formations laviques situées sous les unités bréchiques, ainsi que les phénomènes de tassement observés, sont interprétés comme des figures d’arrêt de l’avalanche

Medicosocial outcome after admission in post-intensive care unit at PRM St-Hélier, Rennes

IntroductionPost-Intensive Care Units (PICU) are PRM structures aiming to start the appropriated rehabilitative care as early as possible even though persistent complex medical issues.ObjectiveTo assess medicosocial outcomes of patients away from their admission in PICU.MethodsA retrospective descriptive study that included 81 consecutive patients (mean age 51 years) admitted from 2008 to 2012 in the PICU of Pôle St-Helier Rennes based on called semi-structured interviews between March 2014 and March 2015. Exhaustive data (only 4 lost, 5%) by the patient himself and/or a member of family on autonomy, place of life, structures since the release and reintegration, of patients for 85% of them brain damaged.ResultsThere is 29% (21/77) of death (post-exit life: 1,6 years±1.18). Eighty percent live at home (46/56) of which only 5 without family environment, 10% (5/56) in medicosocial structures (foster or nursing homes…), 10% in hospital (hospital at home, persistent vegetative units…). Fourteen percent (8/56) are completely autonomous and work, all with adaptations. Twenty-three percent (13/56) had a significant dependence for activities of daily life and instrumental ones. Forty percent (22/56) have no hobby. Use of different downstream structures, long-term readaptative monitoring, legal and families’ feelings were also analyzed.Discussion and ConclusionMedical and social outcome of patients in the aftermath of a stay in PICU is disparate, depending on the pathology involved, but also the pre-social situation that seems to be the main predictor of returning home. Most patients have regained a relatively large autonomy for the daily life activities but are embarrassed to complex instrumental activities impeding social inclusion. These results are consistent with those of the literature on head trauma patients but no other study has focused for the moment on the specific population of patients admitted to the PICU. We see the value of such early rehabilitative care units with a real impact on the subsequent independence and opportunities back home

Benthic oxygen fluxes in a coastal upwelling system (Ria de Vigo, NW Iberia) measured by aquatic eddy covariance

Organic carbon mineralization and nutrient cycling in benthic environments are critically important for their biogeochemical functioning, but are poorly understood in coastal up - welling systems. The main objective of this study was to determine benthic oxygen fluxes in a muddy sediment in the Ria de Vigo (NW Iberian coastal upwelling), by applying the aquatic eddy covariance (AEC) technique during 2 campaigns in different seasons (June and October 2017). The main drivers of benthic fluxes were studied and compared among days in each season and between seasons. The 2 campaigns were characterized by an upwelling-relaxation period followed by a downwelling event, the last of which was due to the extratropical cyclone Ophelia in October. The mean (±SD) seasonal benthic oxygen fluxes were not significantly different for the 2 campaigns despite differences in hydrodynamic and biogeochemical conditions (June: -20.9 ± 7.1 mmol m-2d-1vs. October: -26.5 ± 3.1 mmol m-2d-1). Benthic fluxes were controlled by different drivers depending on the season. June was characterized by sinking labile organic material, which enhanced benthic fluxes in the downwelling event, whereas October had a significantly higher bottom velocity that stimulated the benthic fluxes. Finally, a comparison with a large benthic chamber (0.50 m2) was made during October. Despite methodological differences between AEC and chamber measurements, concurrent fluxes agreed within an acceptable margin (AEC:benthic chamber ratio = 0.78 ± 0.13; mean ± SD). Bottle incubations of water sampled from the chamber interior indicated that mineralization could explain this difference. These results show the importance of using non-invasive techniques such as AEC to resolve benthic flux dynamicsPostprin

Pleural Mesothelioma in New Caledonia: Associations with Environmental Risk Factors

International audienceBackground: High incidences of malignant mesothelioma (MM) have been observed in New Caledonia. Previous work has shown an association between MM and soil containing serpentinite. Objectives: We studied the spatial and temporal variation of MM and its association with environmental factors. Methods: We investigated the 109 MM cases recorded in the Cancer Registry of New Caledonia between 1984 and 2008 and performed spatial, temporal, and space-time cluster analyses. We conducted an ecological analysis involving 100 tribes over a large area including those with the highest incidence rates. Associations with environmental factors were assessed using logistic and Poisson regression analyses. Results: The highest incidence was observed in the Houaïlou area with a world age-standardized rate of 128.7 per 100,000 person-years [95% confidence interval (CI), 70.41-137.84]. A significant spatial cluster grouped 18 tribes (31 observed cases vs. 8 expected cases; p = 0.001), but no significant temporal clusters were identified. The ecological analyses identified serpentinite on roads as the greatest environmental risk factor (odds ratio = 495.0; 95% CI, 46.2-4679.7; multivariate incidence rate ratio = 13.0; 95% CI, 10.2-16.6). The risk increased with serpentinite surface, proximity to serpentinite quarries and distance to the peridotite massif. The association with serpentines was stronger than with amphiboles. Living on a slope and close to dense vegetation appeared protective. The use of whitewash, previously suggested to be a risk factor, was not associated with MM incidence. Conclusions: Presence of serpentinite on roads is a major environmental risk factor for mesothelioma in New Caledonia