DRINKING PATTERNS AMONG MEDICAL IN-PATIENTS WITH REFERENCE TO MAST CATEGORIES: A COMPARATIVE STUDY

The aim of the study was to describe the drinking patterns and alcohol consumption of patients screened by the Michigan Alcoholism Screening Test (MAST) in a sample of medical patients from a general hospital of a French-speaking, wine-drinking country. Data were recorded using a structured interview administered to 103 consecutively admitted 20-75-year-old MAST-positive patients and 103 age-matched and sex-matched MAST-negative controls admitted to the same ward. Relevant differences between MAST-positive and MAST-negative patients included the frequent report of recent and total abstinence in MAST-positive patients (23% versus 4% in controls), their tendency to drink alone, and less often during mealtimes, at home, or with family or friends than MAST-negative patients. Alcohol consumption was significantly higher in MAST-positive patients of both sexes with 250 and 270 g per week being the optimal discriminative cut-off level of consumption for men and women, respectively (kappa coefficient, 0.70 and 0.81, respectively). Regular drinking was the predominant drinking status of both MAST-positive and MAST-negative patients. This study suggests that a screening test such as the MAST, developed in an English-speaking country may be useful in a French-speaking, wine-drinking country. The test identified patients with drinking patterns that are culturally abnormal, yet in certain respects similar to those of alcoholic patients from other drinking cultures. These findings therefore emphasize the worldwide relevance of the concept of the alcohol dependence syndrome in addition to the transcultural usefulness of alcoholism screening test

Les accidents d'électrisation

Electrical injuries can have serious multisystemic consequences and have to be evaluated regardless of the extent of skin injuries. Emergency department treatment is complex with simultaneous use of ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Trauma Life Support) algorithms, and with particular attention given to fluid resuscitation and musculoskeletal damage management. Beyond the recognized intensive care admission criteria like polytrauma or severe bums, documented arrhythmia or abnormal ECG on initial evaluation, loss of consciousness and high voltage electrical injuries (> 1000 V) each prompt a minimum of 24 hours cardiac monitoring. In addition, severely burned patients should be promptly transferred to specialized facilities

Mox in Reactors: Present and Future

In Europe, MOX fuel has been supplied by AREVA for more than 30 years, to 36 reactors: 21 in France, 10 in Germany, 3 in Switzerland, 2 in Belgium. For the present and future, recycling is compulsory in the frame of sustainable development of nuclear energy. By 2030 the overall volume of used fuel will reach about 400 000 t worldwide. Their plutonium and uranium content represents a huge resource of energy to recycle. That is the reason why, the European Utilities issued an EUR (European Utilities Requirement) demanding new builds reactors to be able of using MOX Fuel Assemblies in up to 50% of the core. AREVA GENIII+ reactors, like EPR™ or ATMEA™1 designed with MHI partnership or BWR KERENA, are designed to answer any utility need of MOX recycling. The example of the EPR™ reactor operated with 100% MOX core optimized for MOX recycling will be presented. A standard EPRTM can be operated with 100% MOX core using an advanced homogeneous MOX (single Pu content) with highly improved performances (burn-up and cycle length). The adaptations needed and the main operating and safety reactor features will be presented. AREVA offers the utilities throughout the world, fuel supply (UO2, ERU, MOX), and reactors designed with all the needed capability for recycling. For each country and each utility, an adapted global solution, competitive and non proliferant can be proposed

Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

OBJECTIVE:The implementation of cardiopulmonary resuscitation guidelines, updated every five years, appears to improve patient survival rates after Out-Of-Hospital Cardiac Arrest (OHCA). The aim of this study is: 1) to measure the level of improvement in the prognosis of OHCA patient survival rates for the years 2009 and 2010 and the following two years 2011 and 2012; and 2) correlate the improvement in prognosis with the updated 2010 Advanced Cardiovascular Life Support (ACLS) Guidelines. METHOD:We performed a retrospective observational study based on Geneva's OHCA register that includes data from January 1, 2009 to December 31, 2012. We compared the evolution of prognostic factors that influenced survival at hospital discharge between the periods before and after the implementation of the 2010 guidelines. We then compared the survival rates between each period. Finally, we adjusted the effects on survival in the second period to prognostic factors not linked with the care provided by Emergency Medical Services (EMS) teams, using a multivariable logistic regression model. Changes in advanced resuscitation treatment provided by EMS personnel were also examined. RESULTS:795 OHCA were resuscitated between 1st January, 2009 and 31st December, 2012. The prognosis of patient survival at the time of hospital discharge rose from 10.33% in 2009-2010 to 17.01% in 2011-2012 (p = 0.007). After making adjustments for the effect of improved survival rates on the second period with factors not related to care provided by EMS teams, the odds ratio (OR) remains comparable (OR = 1.87, 95% CI [1.08-3.22]). Measured changes in treatment provided by EMS personnel were minor. CONCLUSIONS:Survival rate for OHCA patients improved significantly in 2011-2012. This study suggests that it was probably the improvement in the quality of care provided during CPR and post-cardiac arrest care that have contributed to the increase in survival rates at the time of hospital discharge

Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials

Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear

Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study

Aim: The aim of our study was to compare traumatic injuries observed after cardiopulmonary resuscitation (CPR) by means of standard (manual) or assisted (mechanical) chest compression by Lund University Cardiopulmonary Assist System, 2nd generation (LUCAS™2) device. Methods: A retrospective study was conducted including cases from 2011 to 2013, analysing consecutive autopsy reports in two groups of patients who underwent medicolegal autopsy after unsuccessful CPR. We focused on traumatic injuries from dermal to internal trauma, collecting data according to a standardised protocol. Results: The study group was comprised of 26 cases, while 32 cases were included in the control group. Cardiopulmonary resuscitation performed by LUCAS™2 was longer than manual CPR performed in control cases (study group: mean duration 51.5min; controls 29.4min; p = 0.004). Anterior chest lesions (from bruises to abrasions) were described in 18/26 patients in the LUCAS™2 group and in 6/32 of the control group. A mean of 6.6 rib fractures per case was observed in the LUCAS™2 group, but this was only 3.1 in the control group (p = 0.007). Rib fractures were less frequently observed in younger patients. The frequency of sternal factures was similar in both groups. A few trauma injuries to internal organs (mainly cardiac, pulmonary and hepatic bruises), and some petechiae (study 46%; control 41%; p = 0.79) were recorded in both groups. Conclusion: LUCAS™2-CPR is associated with more rib fractures than standard CPR. Typical round concentric skin lesions were observed in cases of mechanical reanimation. No life-threatening injuries were reported. Petechiae were common findings

Effect of noninvasive ventilation on intubation risk in prehospital patients with acute cardiogenic pulmonary edema

The aim of this study was to assess the effect of prehospital noninvasive ventilation for acute cardiogenic pulmonary edema on endotracheal intubation rate and on ICU admission rate. We carried out a retrospective study on patients’ prehospital files between 2007 and 2010 (control period), and between 2013 and 2016 (intervention period). Adult patients were included if a diagnosis of acute cardiogenic pulmonary edema was made by the prehospital physician. Exclusion criteria were a Glasgow coma scale score less than 9 or any other respiratory diagnosis. We analyzed the association between noninvasive ventilation implementation and endotracheal intubation or ICU admission with univariable and multivariable regression models. The primary outcome was prehospital endotracheal intubation rate. Secondary outcomes were admission to an ICU, prehospital intervention length, and 30-day mortality. A total of 1491 patients were included. Noninvasive ventilation availability was associated with a significant decrease in endotracheal intubation rate (2.6% in the control versus 0.7% in the intervention period), with an adjusted odds ratio (OR) of 0.3 [95% confidence interval (CI), 0.1–0.7]. There was a decrease in ICU admissions (18.6% in the control versus 13.0% in the intervention period) with an adjusted OR of 0.6 (95% CI, 0.5–0.9). There was no significant change in 30-day mortality (11.2% in the control versus 11.0% in the intervention period, P = 0.901)