Mémento pour la gestion des projets d'assainissement : fascicule 3 : les eaux pluviales

Ce fascicule aborde la gestion des eaux pluviales à deux niveaux : celui de la planification, du fait de l’importance de cette réflexion amont (fiche « enjeux d’urbanisme et d’aménagement »), et celui du projet d'aménagement, public ou privé, de type rénovation urbaine, création de lotissement, de ZAC, de zone industrielle, … Il ne traite pas le projet pluvial "isolé" du projet d'aménagement (création ou réhabilitation de collecteur, dispositif de traitement des eaux pluviales, …). Il insiste sur l’importance de prendre en compte la gestion des eaux pluviales très à l’amont du projet et en associant très tôt l’ensemble des acteurs de l’aménagement

Mémento pour la gestion des projets d'assainissement : fascicule 3 : les eaux pluviales

Ce fascicule aborde la gestion des eaux pluviales à deux niveaux : celui de la planification, du fait de l’importance de cette réflexion amont (fiche « enjeux d’urbanisme et d’aménagement »), et celui du projet d'aménagement, public ou privé, de type rénovation urbaine, création de lotissement, de ZAC, de zone industrielle, … Il ne traite pas le projet pluvial "isolé" du projet d'aménagement (création ou réhabilitation de collecteur, dispositif de traitement des eaux pluviales, …). Il insiste sur l’importance de prendre en compte la gestion des eaux pluviales très à l’amont du projet et en associant très tôt l’ensemble des acteurs de l’aménagement

Mémento pour la gestion des projets d'assainissement : fascicule 3 : les eaux pluviales

Ce fascicule aborde la gestion des eaux pluviales à deux niveaux : celui de la planification, du fait de l’importance de cette réflexion amont (fiche « enjeux d’urbanisme et d’aménagement »), et celui du projet d'aménagement, public ou privé, de type rénovation urbaine, création de lotissement, de ZAC, de zone industrielle, … Il ne traite pas le projet pluvial "isolé" du projet d'aménagement (création ou réhabilitation de collecteur, dispositif de traitement des eaux pluviales, …). Il insiste sur l’importance de prendre en compte la gestion des eaux pluviales très à l’amont du projet et en associant très tôt l’ensemble des acteurs de l’aménagement.41 pages, figures, tableaux, 18 références bibliographique

The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears

INTRODUCTION: The purpose of this cross-sectional study is to determine if the duration of symptoms influences the features seen in patients with atraumatic full thickness rotator cuff tears. Our hypothesis is that increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on MRI, worse shoulder outcome scores, more pain, decreased range of motion, and less strength. METHODS: 450 patients with full thickness rotator cuff tears were enrolled in a prospective cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success. Duration of patient symptoms were divided into four groups: ≤3 months, 4–6 months, 7–12 months, and >12 months. Data collected at patient entry into the study included: 1.) Demographic data, 2.) History and physical exam data, 3.) Radiographic imaging data, and 4.) Validated patient reported measures of shoulder status. Statistical analysis included a univariate analysis with Kruskal-Wallis test and Pearson tests to identify statistically significant differences in these features for different durations of symptoms RESULTS: Longer duration of symptoms does not correlate with more severe rotator cuff disease. Duration of symptoms was not related to weakness; limited range of motion; tear size; fatty atrophy; or validated patient reported outcome measures. CONCLUSIONS: There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease. LEVEL OF EVIDENCE: Level III, Cross Sectional Stud

Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study

PURPOSE: To assess the effectiveness of a specific non-operative physical therapy program in treating atraumatic full thickness rotator cuff tears using a multicenter prospective cohort study design. METHODS: Patients with atraumatic full thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, co-morbidities, willingness to undergo surgery, and patient related outcome assessments (SF-12, ASES, WORC, SANE score, Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits patients could chose one of three courses: 1.) Cured (no formal follow up scheduled), 2.) Improved (continue therapy with scheduled reassessment in 6 weeks), or 3.) No better (offered surgery). Patients were contacted by telephone at 1 and 2 years to determine if they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6 week, and 12 week outcome scores. RESULTS: The cohort consists of 452 patients. Patient reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months. CONCLUSION: Non-operative treatment using this physical therapy protocol is effective for treating atraumatic full thickness rotator cuff tears in approximately 75% of patients followed for two years. LEVEL OF EVIDENCE: Level IV, Case Series, Treatment Stud