Remote monitoring of patients with implantable cardioverter-defibrillators: Can results from large clinical trials be transposed to clinical practice?

SummaryBackgroundRemote monitoring (RM) is increasingly used to follow up patients with implantable cardioverter-defibrillators (ICDs). Randomized control trials provide evidence for the benefit of this intervention, but data for RM in daily clinical practice with multiple-brands and unselected patients is lacking.AimsTo assess the effect of RM on patient management and clinical outcome for recipients of ICDs in daily practice.MethodsWe reviewed ICD recipients followed up at our institution in 2009 with RM or with traditional hospital only (HO) follow-up. We looked at the effect of RM on the number of scheduled ambulatory follow-ups and urgent unscheduled consultations, the time between onset of asymptomatic events to clinical intervention and the clinical effectiveness of all consultations. We also evaluated the proportion of RM notifications representing clinically relevant situations.ResultsWe included 355 patients retrospectively (RM: n=144, HO: n=211, 76.9% male, 60.3±15.2years old, 50.1% with ICDs for primary prevention and mean left ventricular ejection fraction 35.5±14.5%). Average follow-up was 13.5months. The RM group required less scheduled ambulatory follow-up consultations (1.8 vs. 2.1/patient/year; P<0.0001) and a far lower median time between the onset of asymptomatic events and clinical intervention (7 vs. 76days; P=0.016). Of the 784 scheduled ambulatory follow-up consultations carried out, only 152 (19.4%) resulted in therapeutic intervention or ICD reprogramming. We also found that the vast majority of RM notifications (61.9%) were of no clinical relevance.ConclusionRM allows early management of asymptomatic events and a reduction in scheduled ambulatory follow-up consultations in daily clinical practice, without compromising safety, endorsing RM as the new standard of care for ICD recipients

Pneumocystis jirovecii colonization among cystic fibrosis patients: A French prospective multicenter study

Pneumocystis carriage was detected in 12.5% of 104 cystic fibrosis (CF) patients during a prospective multicenter French study, with a prevalence of genotype 85C/248C and geographic variations. It was significantly associated with the absence of P. aeruginosa colonization and better FEV1 values. Results are discussed considering the natural history of CF

The Airway Microbiota in Cystic Fibrosis: A Complex Fungal and Bacterial Community—Implications for Therapeutic Management

International audienceBackground Given the polymicrobial nature of pulmonary infections in patients with cystic fibrosis (CF), it is essential to enhance our knowledge on the composition of the microbial community to improve patient management. In this study, we developed a pyrosequencing approach to extensively explore the diversity and dynamics of fungal and prokaryotic populations in CF lower airways. Methodology and Principal Findings Fungi and bacteria diversity in eight sputum samples collected from four adult CF patients was investigated using conventional microbiological culturing and high-throughput pyrosequencing approach targeting the ITS2 locus and the 16S rDNA gene. The unveiled microbial community structure was compared to the clinical profile of the CF patients. Pyrosequencing confirmed recently reported bacterial diversity and observed complex fungal communities, in which more than 60% of the species or genera were not detected by cultures. Strikingly, the diversity and species richness of fungal and bacterial communities was significantly lower in patients with decreased lung function and poor clinical status. Values of Chao1 richness estimator were statistically correlated with values of the Shwachman-Kulczycki score, body mass index, forced vital capacity, and forced expiratory volume in 1 s (p = 0.046, 0.047, 0.004, and 0.001, respectively for fungal Chao1 indices, and p = 0.010, 0.047, 0.002, and 0.0003, respectively for bacterial Chao1 values). Phylogenetic analysis showed high molecular diversities at the sub-species level for the main fungal and bacterial taxa identified in the present study. Anaerobes were isolated with Pseudomonas aeruginosa, which was more likely to be observed in association with Candida albicans than with Aspergillus fumigatus

Assainissement des agglomérations : objectifs de protection des milieux par temps de pluie - éléments méthodologiques

Il est proposé de déterminer, à partir des objectifs de qualité du milieu naturel définis par la circulaire interministérielle du 17 mars 1978, des objectifs de qualité par temps de pluie suivant une démarche progressive, allant du temps sec à la prise en compte des événements paroxysmiques

Rapport IV. 5 : Le rôle d’une chute d’eau dans le bilan d’oxygène dissous d’une rivière : application au barrage de Pont à Mousson sur la Moselle

The main factors governing the dissolved oxygen balance are recalled ; the rate of oxygenation in a weir water fall is examined in the near and far field in relation with water quality and morphological characteristics of the river. Numerical examples are given for some dams of the Moselle and especially that of Pont-à-Mousson where investigations have been made during summer 1982.Après un rappel des principaux facteurs régissant le bilan d'oxygène dissous d'une rivière, on examine l'effet d'oxygénation d'une chute d'eau de barrage dans les champs proche et lointain, en fonction de la qualité des eaux et des caractéristiques morphologiques de la rivière. Des applications numériques sont données pour les barrages de la Moselle et plus particulièrement celui de Pont-à-Mousson qui ont fait l'objet d'études expérimentales au cours de l'été 1982.Gosse Ph., Salleron J. L. Rapport IV. 5 : Le rôle d’une chute d’eau dans le bilan d’oxygène dissous d’une rivière : application au barrage de Pont à Mousson sur la Moselle. In: L'impact des activités humaines sur les eaux continentales. Dix neuvièmes journées de l'hydraulique - Question I, II, III, IV, V et Compte rendu des séances. Tome 4, 1986