53 research outputs found

    2-rang du groupe des classes et courbes elliptiques

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    Dans cet article, nous Ă©tudions la relation qui existe entre le 2-rang du groupe des classes d\u27une famille de corps cubiques et le rang d\u27une famille de courbes elliptiques

    Understanding the factors that contribute to the outcome of cognitive behavioural therapy as adjunct to medical treatment in a sample of individuals with psoriasis : a constructivist grounded theory study

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    Psoriasis is a chronic autoimmune skin condition that can impair psychological, social, and physical functioning. The psychological implications of psoriasis can be highly disturbing and a significant number of patients with psoriasis live with considerable and enduring psychological distress. An accumulating body of evidence suggests that Cognitive Behavioural Therapy (CBT) may be the most effective in ameliorating the psychological distress resulting from living with psoriasis. CBT has been effective in reducing the emotional distress, the quality of life impairment associated with psoriasis and as a result the clinical severity of it. The mechanisms behind these changes are not known, however. Outcome studies in CBT have shown that common factors (i.e., therapeutic relationship) and/or technical ones (i.e., CBT techniques) account for therapeutic change. The aim of this study is to identify the factors that influence the treatment process and the outcome of CBT for individuals with psoriasis and develop a model of it. This study adopted a constructivist Grounded Theory approach. In-depth semi-structured interviews were conducted with nine patients who had completed a course of CBT within the Psychodermatology Clinic of a hospital in England. From the analysis emerged the model of “Guided Therapeutic Growth” which was the core conceptual framework that subsumed the factors that influence the patients’ experiences of their therapeutic processes in CBT. These factors were: (a) “feeling engaged with the therapeutic process”; (b) “establishing a trusting therapeutic relationship”; (c) “legitimising the expression of distress associated with psoriasis”; and (d) “guided cognitive restructuring of the meanings attached to psoriasis”. The integration of these four interrelated factors forms a tentative model that was found to impact the therapeutic growth by reducing distress, alleviating emotional pain and helping individuals with psoriasis to become more self-compassionate, all of which were found to motivate and empower them to move forward and achieve positive changes in their adjustment to their psoriasis. Conversely, the absence of these factors or the presence of certain hindering conditions could compromise the therapeutic experience of CBT and jeopardise progress. In this context, the following hindering conditions were reported: (a) negative preconceived notions about homework; (b) too much or too little directiveness by the therapist; and (c) externalisation process of emotional release experienced by the patient as too revealing

    Elevated Serum Levels of the Antiapoptotic Protein Decoy-Receptor 3 Are Associated with Advanced Liver Disease

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    Background. Decoy-receptor 3 (DcR3) exerts antiapoptotic and immunomodulatory function and is overexpressed in neoplastic and inflammatory conditions. Serum DcR3 (sDcR3) levels during the chronic hepatitis/cirrhosis/hepatocellular carcinoma (HCC) sequence have not been explored. Objective. To assess the levels and significance of sDcR3 protein in various stages of chronic liver disease. Methods. We compared sDcR3 levels between healthy controls and patients with chronic viral hepatitis (CVH), decompensated cirrhosis (DC), and HCC. Correlations between sDcR3 levels and various patient- and disease-related factors were analyzed. Results. sDcR3 levels were significantly higher in patients with CVH than in controls (P<0.01). sDcR3 levels were elevated in DC and HCC, being significantly higher compared not only to controls (P<0.001 for both) but to CVH patients as well (P<0.001 for both). In addition, DcR3 protein was detected in large quantities in the ascitic fluid of cirrhotics. In patients with CVH, sDcR3 significantly correlated to fibrosis severity, as estimated by Ishak score (P=0.019) or by liver stiffness measured with elastography (Spearman r=0.698, P<0.001). In cirrhotic patients, significant positive correlations were observed between sDcR3 levels and markers of severity of hepatic impairment, including MELD score (r=0.653, P<0.001). Conclusions. Circulating levels of DcR3 are elevated during chronic liver disease and correlate with severity of liver damage. sDcR3 may serve as marker for liver fibrosis severity and progression to end-stage liver disease

    Exhaled nitric oxide and clinical phenotypes of childhood asthma

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    Whether exhaled NO helps to identify a specific phenotype of asthmatic patients remains debated. Our aims were to evaluate whether exhaled NO (FENO0.05) is independently associated (1) with underlying pathophysiological characteristics of asthma such as airway tone (bronchodilator response) and airway inflammation (inhaled corticosteroid [ICS]-dependant inflammation), and (2) with clinical phenotypes of asthma

    Exhaled nitric oxide and clinical phenotypes of childhood asthma

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    Whether exhaled NO helps to identify a specific phenotype of asthmatic patients remains debated. Our aims were to evaluate whether exhaled NO (FENO0.05) is independently associated (1) with underlying pathophysiological characteristics of asthma such as airway tone (bronchodilator response) and airway inflammation (inhaled corticosteroid [ICS]-dependant inflammation), and (2) with clinical phenotypes of asthma

    NIOX VERO: Individualized Asthma Management in Clinical Practice

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    As we move toward an era of precision medicine, novel biomarkers of disease will enable the identification and personalized treatment of new endotypes. In asthma, fractional exhaled nitric oxide (FeNO) serves as a surrogate marker of airway inflammation that often correlates with the presence of sputum eosinophils. The increase in FeNO is driven by an upregulation of inducible nitric oxide synthase (iNOS) by cytokines, which are released as a result of type-2 airway inflammation. Scientific evidence supports using FeNO in routine clinical practice. In steroid-naive patients and in patients with mild asthma, FeNO levels decrease within days after corticosteroid treatment in a dose-dependent fashion and increase after steroid withdrawal. In difficult asthma, FeNO testing correlates with anti-inflammatory therapy compliance. Assessing adherence by FeNO testing can remove the confrontational aspect of questioning a patient about compliance and change the conversation to one of goal setting and ways to improve disease management. However, the most important aspect of incorporating FeNO in asthma management is the reduction in the risk of exacerbations. In a recent primary care study, reduction of exacerbation rates and improved symptom control without increasing overall inhaled corticosteroid (ICS) use were demonstrated when a FeNO-guided anti-inflammatory treatment algorithm was assessed and compared to the standard care. A truly personalized asthma management approach—showing reduction of exacerbation rates, overall use of ICS and neonatal hospitalizations—was demonstrated when FeNO testing was applied as part of the treatment algorithm that managed asthma during pregnancy. The aim of this article is to describe how FeNO and the NIOX VERO¼ analyzer can help to optimize diagnosis and treatment choices and to aid in the monitoring and improvement of clinical asthma outcomes in children and adults

    Le diagnostic clinique des pneumopathies aigĂŒes communautaires de l'enfant en mĂ©decine gĂ©nĂ©rale

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    PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

    Analyse de la pratique des médecins généralistes du sud de l'Oise concernant l'adressage à l'hÎpital des enfants suspects d'infection respiratoire basse

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    Face à l encombrement des services de soins, et notamment des services d urgences pédiatriques, nous avons voulu savoir si l adressage des patients par les médecins généralistes pour infection respiratoire basse était justifié et s il y avait une différence de pratique entre différentes catégories de médecins généralistes. Pour cela, nous avons fait une étude rétrospective, descriptive, portant sur les dossiers des enfants et adolescents ùgés de 0 à 18 ans, qui ont consulté aux urgences pédiatriques du centre hospitalier Laennec de Creil du 01/01/2009 au 31/12/2010, et qui ont été adressés par un médecin généraliste pour suspicion d infection respiratoire basse. L étude a inclus 214 patients adressés par 91 médecins. Il y avait 102 bronchiolites, 72 bronchites, 40 pneumonies. Les courriers des médecins généralistes étaient peu détaillés, et il n y avait pas de concordance entre les signes de gravité sur les courriers et les signes de gravité sur les examens des urgences sauf pour les patients adressés pour bronchiolite. Les enfants adressés avaient eu trÚs peu d examens complémentaires en ambulatoire. Sur l ensemble des patients adressés, 50% n avaient aucun signe de gravité et seuls 40% avaient été hospitalisés. 25% des patients adressés n avaient aucun signe de gravité, n avaient pas été hospitalisés, mais avaient eu des examens complémentaires avant de quitter les urgences. Ces patients auraient pu avoir leurs examens en ambulatoire. 19% des patients adressés n avaient aucun signe de gravité, n avaient eu aucun examen complémentaire et n avaient pas été hospitalisés. Leur consultation aux urgences ne semble avoir aucune justification. L hospitalisation dépendait de la présence de signes de gravité, de l ùge des enfants, de la pathologie, mais ne dépendait pas des différentes catégories de médecins étudiés. L adressage des patients par les médecins remplaçants étaient moins justifié que pour les autres catégories de médecin. Une meilleur formation des médecins généralistes et un meilleur accÚs aux examens complémentaires en ambulatoire permettraient de diminuer l adressage aux urgences des enfants sans signe de gravité.In front of the congestion of the departments of care, in particular the departments of pediatric emergencies, we wanted to know if the addressing of the patients by the general practitioners for low respiratory infection was justified and if there was a difference of practice between various categories of general practitioners. For that purpose, we made a retrospective, descriptive study, concerning the files cases of the children and the teenagers from 0 to 18 years old, who consulted in the pediatric emergencies of the Laennec hospital center of Creil from 01/01/2009 till 12/31/2010, and who were sent by a general practitioner for suspicion of low respiratory infection. The study included 214 patients sent by 91 doctors. There were 102 bronchiolitis, 72 bronchitis, 40 pneumonias. The letters of the general practitioners were little detailed, and there was no concordance between the signs of gravity on the letters and the signs of gravity on the examinations of emergencies except for the patients sent for bronchiolitis. The sent children had had very few complementary examinations in ambulatory. On all the sent patients, 50 % had no sign of gravity and only 40 % had been hospitalized. 25 % of the sent patients had no sign of gravity, had not been hospitalized, but had had complementary examinations before leaving emergencies. These patients would have been able to have their examinations in ambulatory. 19 % of the sent patients had no sign of gravity, had not had any complementary examinations and had not been hospitalized. Their consultation in emergencies seems to have no justification. The hospitalization depended on the presence of signs of gravity, the age of the children, the pathology, but did not depend on various categories of studied doctors. The addressing of the patients by the replacing doctors was less justified than for the other categories of doctor. A better training of the general practitioners and a better access to the complementary examinations in ambulatory would allow decreasing the addressing in the emergencies of the children without sign of gravity.AMIENS-BU Santé (800212102) / SudocSudocFranceF

    Impact de l'exposition à la fumée de tabac environnementale sur la mesure du monoxyde d'azote de l'air expire chez l'enfant asthmatique allergique

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    PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF
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