L'amélioration énergétique des logements existants. Le rôle des artisans dans l'information de leurs clients

Eric Lagandré Improving the energy efficiency of existing buildings The role of tradesmen in informing their customers. Technical standards for insulation and energy-saving equipment developed for new-buildings can only be adapted for old buildings on a case-by-case basis. Tradesmen play a key role in passing on information about the public funding available and the possible technologies. The National Agency for Home Improvement supports less well-off homeowners and tenants, whose needs are often greatest and whose homes, being the cheapest, are in the worst condition.Les normes techniques d'isolation et d'équipement énergétique mises au point pour les bâtiments neufs ne peuvent être adaptées aux bâtiments anciens qu'au cas par cas. Les artisans jouent un rôle essentiel de transmission de l'information sur les aides publiques et les techniques possibles. L'Agence nationale de l'amélioration de l'habitat soutient les propriétaires et les locataires peu fortunés, dont les besoins sont souvent parmi les plus importants, l'habitat le plus vétusté étant le moins cher.Lagandré Eric. L'amélioration énergétique des logements existants. Le rôle des artisans dans l'information de leurs clients. In: Les Annales de la recherche urbaine, N°103, 2007. La ville dans la transition énergétique. pp. 95-99

Enhanced serum creatine kinase after neurosurgery in lateral position and intraoperative neurophysiological monitoring

OBJECTIVE: Several cases of highly elevated serum levels of creatine kinase (CK) after surgical interventions have been described in the literature. A consensus on possible risk factors is still lacking. We therefore studied CK-levels in a large population of patients undergoing neurosurgical interventions and sought to determine possible risk factors. METHODS: We retrospectively analyzed 150 elective neurosurgical interventions where pre- and postoperative CK serum levels were determined. The cases were selected such that 50 patients were operated in lateral position and 100 in prone or supine position. During the hospital stay, routine clinical diagnostics were conducted, including medical status and laboratory examinations. RESULTS: In the patient group (median age 50, 63 male) there were 129 cranial and 21 spinal interventions. In 55 cases, intraoperative neurophysiological monitoring (IONM) was performed so that in these patients muscles were not relaxed pharmacologically. In a linear regression model, the maximal postoperative CK-level increased compared to baseline (p<0.001). While age and obesity were not identified as risk factors, the CK-level was enhanced after surgery in lateral position (p<0.001) and if IONM was performed (p=0.04). CONCLUSIONS: The strong association of postoperative serum CK-level with intraoperative positioning and IONM may be related to the elevated body pressure on the operating table in the lateral position, in particular if muscles are not relaxed pharmacologically, which was the case if intraoperative monitoring was performed. In these cases special care has to be taken for the positioning and during the peri-operative management

Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial

International audienceBackground: Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient's quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. Objective: This multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. Methods: Patients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. Results: The study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. Conclusions: The SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year