Emergency department outcome of elderly patients assisted by professional home services, the EPIGER study.

BACKGROUND: For the elderly population living at home, the implementation of professional services tends to mitigate the effect of loss of autonomy and increases their quality of life. While helping in avoiding social isolation, home services could also be associated to different healthcare pathways. For elderly patients, Emergency Departments (EDs) are the main entrance to hospital where previous loss of autonomy is associated to worst hospital outcomes. Part of elderly patients visiting EDs are still admitted to hospital for having difficulties coping at home without presenting any acute medical issue. There is a lack of data concerning elderly patients visiting EDs assisted by home services. Our aim was to compare among elderly patients visiting ED those assisted by professional home services to those who do not in terms of emergency resources' use and patients' outcome. METHODS: A multicenter, prospective cohort study was performed in 124 French EDs during a 24-h period on March 2016.Consecutive patients living at home aged ≥80 years were included. The primary objective was to assess the risk of mortality for patients assisted by professional home services vs. those who were not. Secondary objectives included admission rate and specific admission rate for "having difficulties coping at home". The primary endpoint was in-hospital mortality. Cox proportional-hazards regression model was used to test the association between professional home services and the primary endpoint. Multi variables logistic regressions were performed to assess secondary endpoints. RESULTS: One thousand one hundred sixty-eight patients were included, median age 86(83-89) years old,32% were assisted by professional home services. The overall in-hospital mortality rate was 7%. Assisted patients had more investigations performed. Home services were not associated with increased in-hospital mortality (HR = 1.34;95%CI [0.68-2.67]), nor with the admission rate (OR = 0.92;95%CI [0.65-1.30]). Assisted patients had a lower risk of being admitted for "having difficulties coping at home" (OR = 0.59;95%CI [0.38-0.92]). CONCLUSION: Professional home services which assist one-third of elderly patients visiting EDs, were not associated to lower in-hospital mortality or to an increased admission rate. Assisted patients were associated to a lower risk of being admitted for «having difficulties coping at home».Professional home services could result in avoiding some admissions and their corollary complications. TRIAL REGISTRATION: Clinicaltrial.gov - NCT02900391 , 09/14/2016, retrospectively registered

Symptoms of Infarction in Women: Is There a Real Difference Compared to Men? A Systematic Review of the Literature with Meta-Analysis

(1) Context: The management of acute coronary syndrome (ACS) is based on a rapid diagnosis. The aim of this study was to focus on the ACS symptoms differences according to gender, in order to contribute to the improvement of knowledge regarding the clinical presentation in women. (2) Methods: We searched for relevant literature in two electronic databases, and analyzed the symptom presentation for patients with suspected ACS. Fifteen prospective studies were included, with a total sample size of 10,730. (3) Results: During a suspected ACS, women present more dyspnea, arm pain, nausea and vomiting, fatigue, palpitations and pain at the shoulder than men, with RR (95%CI) of 1.13 [1.10; 1.17], 1.30 [1.05; 1.59], 1,40 [1.26; 1.56], 1.08 [1.01; 1.16], 1.67 [1.49; 1.86], 1.78 [1.02; 3.13], respectively. They are older by (95%CI) 4.15 [2.28; 6.03] years compared to men. The results are consistent in the analysis of the ACS confirmed subgroup. (4) Conclusions: We have shown that there is a gender-based symptomatic difference and a female presentation for ACS. The "typical" or "atypical" semiology of ACS symptoms should no longer be used

The Time to Offer Treatments for COVID-19

Introduction: COVID-19 has several overlapping phases. Treatment has focused on the late stage of the disease in hospital. Yet, the continuation of the pandemic is by propagation of the disease in outpatients. The current public health strategy relies solely on vaccines to prevent disease. Areas Covered: We searched the major national registries, pubmed.org, and the preprint servers for all ongoing, completed and published trial results with subject numbers of 100 or more on, and used a targeted search to find announcements of unpublished trial results. As of 2/15/2021, we found 111 publications reporting findings in human studies on 14 classes of agents, and on 9 vaccines. There were 62 randomized controlled studies, the rest retrospective observational analyses. Only 21 publications dealt with outpatient care, the rest all in hospitalized patients. Remdesivir and convalescent plasma have emergency use authorization for hospitalized patients in the U.S.A. There is also support for glucocorticoid treatment of the COVID-19 respiratory distress syndrome. Monoclonal antibodies are authorized for outpatients, but the supply is inadequate to treat all at time of diagnosis. Favipiravir, ivermectin, and interferons are approved in certain countries Expert Opinion: Worldwide vaccination is now underway. Vaccines and antibodies are highly antigen specific and new variants are appearing. There is a need for treatment of outpatients who contract the disease, in addition to mass immunization. We call on public health authorities to authorize treatments with known low risk and potential benefit for use in parallel with mass immunization

Impact of the pandemic on emergency medicine and its future

International audienc

Caractérisation de la dysfonction cardiovasculaire dans un nouveau modèle murin de décompensation aiguë d'insuffisance cardiaque chronique

Heart failure is a public health concern facing a natural evolution of acute decompensation episodes that worsen the prognosis, and for which there are no major therapeutic advance in the last 25 years. Until recently, acute heart failure syndromes had received little attention from the pharmacological research, in part because of the lack of reliable experimental model. We have developed a new animal model of an acute decompensation of congestive heart failure by sodium overload in Wistar rats with heart failure 4 months after coronary ligation in order to mimic the acute decompensation of chronic heart failure in humans. During its development, we have shown that salt overload caused acute myocardial dysfunction associated with pulmonary edema. We have characterized incomplete recovery phase of the cardiac output associated with coronary endothelial dysfunction and myocardial perfusion failure. Pharmacologically, we have conducted a preclinical therapeutic trial by S38® (e.g. ivabradine), which when applied to our model, improves myocardial and endothelial dysfunction in the acute phase, and myocardial performance in the recovery phase with the waning of the sodium overload. Even though it must be completed, we have shown that this reliable and reproducible experimental model was adapted for seeking new therapeutic targets in acute decompensation of chronic heart failure.Keywords: Acute heart failure – Animal model – Pharmacology – Preclinical trial – Endothelial dysfunctionL'insuffisance cardiaque est un problème majeur de santé publique marquée par une évolution naturelle émaillée d'épisodes de décompensation aiguë qui aggravent son pronostic et pour laquelle il n'existe pas d'avancée thérapeutique majeure depuis 25 ans. Jusque récemment, les syndromes d'insuffisance cardiaque aiguë n'avaient reçu que peu d'attention de la part de la recherche pharmacologique, en partie à cause de l'absence de modèle expérimental fiable. Nous avons développé un modèle de décompensation aiguë par surcharge sodée chez le rat Wistar rendu insuffisant cardiaque à 4 mois d'évolution d'une ligature coronaire dans le but de mimer la décompensation aiguë de l'insuffisance cardiaque chronique chez l'homme. Lors de son développement, nous avons montré que la surcharge hydrosodée provoquait une dysfonction myocardique aiguë associée à un œdème pulmonaire. Nous avons pu caractériser une phase de récupération incomplète du débit cardiaque au décours, associée à une dysfonction endothéliale coronaire et un défaut de perfusion myocardique. Sur le plan pharmacologique, nous avons pu procéder à un essaithérapeutique préclinique par la molécule S38®, biosimilaire de l'ivabradine, qui, appliqué ànotre modèle, améliore la dysfonction myocardique et endothéliale à la phase aiguë ainsi que les capacités de récupération des performances myocardiques au décours de la surcharge sodée. Ainsi, même s'il doit être complété, nous avons montré que ce modèle expérimental fiable et reproductible était adapté à la recherche de nouvelles cibles thérapeutiques dans la décompensation aiguë de l'insuffisance cardiaque chronique.Mots clefs : insuffisance cardiaque aiguë – modèle expérimental – pharmacologie – essai préclinique – dysfonction endothélial

Le mal aigu des montagnes (de la physiologie à la pratique médicale)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Towards Efficient Coordination in Open MAS using Graphical Utility Models

International audienceThis paper presents a prospective work on the problem of efficient agent coordination in open and decentralised multiagent systems (MAS). We use a graphical utility model, the General Additive Independence networks (GAI-net), as the basic tool for coordination inside MAS. We extend this formalism and propose two algorithms in order to take into account inherent MAS operational characteristics. The first algorithm is able to deal efficiently with a restricted notion of openness. It provides an optimal solution but requires a central coordinator. The second algorithm we propose takes moreover into account the decentralised nature of MAS. It is an approximate algorithm with performance guarantee

Associativity for Binary Parallel Processes: a Quantitative Study

International audienceWe investigate the common interpretation of parallel processes as computation trees. The basis for our approach is the combinatorics of increasingly labelled structures, and our main objective is to provide quantitative results relying on advanced analytic techniques. Unlike previous works, the combinatorial model we propose captures the following ingredients of the algebraic presentation : a binary parallel operator with associativity law. The switch from general trees to binary encodings in this paper makes everything more complex (but eventually workable). Ultimately, we provide a precise characterization and asymptotic approximations of various measures of parallel processes in the average case, especially the average size of the computation trees and their average number of paths, providing a more meaningful notion of combinatorial explosion than in the (rather trivial) worst-case. Beyond the measures, we also provide a precise characterization of the typical combinatorial shape of the computation trees, especially their level-decomposition, an interesting notion of process depth. From a more practical point of view, we develop efficient algorithms for the uniform random sampling of computations. Thanks to our typical shape analysis, it is possible to uniformly sample computation prefixes at a given depth in a very efficient way. Indeed, these algorithms work directly on the syntax trees of the processes and do not require the explicit construction of the state space, hence completely avoiding the combinatorial explosion

Neurosciences et mémoires collectives : les schémas entre cerveau, sociétés et cultures

Ces vingt dernières années, l’influence des rapports intersubjectifs sur la cognition a été un sujet d’étude émergeant dans les neurosciences cognitives conduisant, à travers ce qui a été décrit comme un « tournant social », à l’apparition de ramifications intégrant sociétés et cultures à ce domaine de recherche. Cette tendance concerne aujourd’hui l’étude de la mémoire collective, définie comme un ensemble de représentations du passé constitutives de l’identité d’un groupe, sélectionnées et partagées par l’ensemble de ses membres connectés par une histoire commune. Après une description de ces évolutions dans l’exploration du cerveau et des comportements, nous proposons une revue des recherches récentes qui ont amorcé la réunion de la psychologie cognitive, des neurosciences et des sciences sociales dans l’étude de la mémoire collective. En utilisant le concept de schéma mnésique, qui a été largement mobilisé dans la neuropsychologie et la neurobiologie de la mémoire, nous proposons un cadre théorique qui permettrait de rendre compte de la formation de souvenirs collectifs en nous concentrant sur les processus d’encodage d’événements historiques. Nous soulignons le fait que l’intégration des recherches sur les bases neurales des schémas mnésiques avec les études sur la mémoire collective pourrait conduire à une meilleure compréhension des interactions réciproques entre la mémoire individuelle et les ressources culturelles tels que les médias ou l’éducation