Prise en charge de la douleur postopératoire (étude rétrospective comparant différents protocoles après hystérectomie et césarienne)

CHATENAY M.-PARIS 11-BU Pharma. (920192101) / SudocSudocFranceF

Accuracy of Smart Scales on Weight and Body Composition: Observational Study

International audienceBackground Smart scales are increasingly used at home by patients to monitor their body weight and body composition, but scale accuracy has not often been documented. Objective The goal of the research was to determine the accuracy of 3 commercially available smart scales for weight and body composition compared with dual x-ray absorptiometry (DEXA) as the gold standard. Methods We designed a cross-sectional study in consecutive patients evaluated for DEXA in a physiology unit in a tertiary hospital in France. There were no exclusion criteria except patient declining to participate. Patients were weighed with one smart scale immediately after DEXA. Three scales were compared (scale 1: Body Partner [Téfal], scale 2: DietPack [Terraillon], and scale 3: Body Cardio [Nokia Withings]). We determined absolute error between the gold standard values obtained from DEXA and the smart scales for body mass, fat mass, and lean mass. Results The sample for analysis included 53, 52, and 48 patients for each of the 3 tested smart scales, respectively. The median absolute error for body weight was 0.3 kg (interquartile range [IQR] –0.1, 0.7), 0 kg (IQR –0.4, 0.3), and 0.25 kg (IQR –0.10, 0.52), respectively. For fat mass, absolute errors were –2.2 kg (IQR –5.8, 1.3), –4.4 kg (IQR –6.6, 0), and –3.7 kg (IQR –8.0, 0.28), respectively. For muscular mass, absolute errors were –2.2 kg (IQR –5.8, 1.3), –4.4 kg (IQR –6.6, 0), and –3.65 kg (IQR –8.03, 0.28), respectively. Factors associated with fat mass measurement error were weight for scales 1 and 2 (P=.03 and P<.001, respectively), BMI for scales 1 and 2 (P=.034 and P<.001, respectively), body fat for scale 1 (P<.001), and muscular and bone mass for scale 2 (P<.001 for both). Factors associated with muscular mass error were weight and BMI for scale 1 (P<.001 and P=.004, respectively), body fat for scales 1 and 2 (P<.001 for both), and muscular and bone mass for scale 2 (P<.001 and P=.002, respectively). Conclusions Smart scales are not accurate for body composition and should not replace DEXA in patient care. Trial Registration ClinicalTrials.gov NCT03803098; https://clinicaltrials.gov/ct2/show/NCT0380309

Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain

International audienceBACKGROUND:Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and help to optimize pain management.METHODS:We used a multiple criteria decision analysis (MCDA) approach to consider the organizational impact of methoxyflurane (self-administered) in the ED, introduced alone or supported by a trauma care pathway. A MCDA experiment was designed for this specific context, 8 experts in emergency trauma care pathways (leading physicians and pharmacists working in French urban tertiary hospitals) were recruited. The study involved four steps: (i) Selection of organizational criteria for evaluating the innovation's impact; (ii) assessment of the relative weight of each criterion; (iii) choice of appropriate scenarios for exploring the organizational impact of MEOX under various contexts; and (iv) software-assisted simulation based on pairwise comparisons of the scenarios. The final outcome measure was the expected overall organizational impact of methoxyflurane on a 0-to-100 scale (score >50: positive impact).RESULTS:Nine organizational criteria were selected. "Mean length of stay in the ED" was the most weighted. Methoxyflurane alone obtained 59 as a total score, with a putative positive impact for eight criteria, and a neutral effect on one. When a trauma care pathway was introduced concomitantly, the impact of methoxyflurane was greater overall (score: 75) and for each individual criterion.CONCLUSIONS:Our model highlighted the putative positive organizational impact of methoxyflurane in the ED-particularly when supported by a trauma care pathway-and the relevance of expert consensus in this particular pharmacoeconomic context. The MCDA approach could be extended to other research fields and healthcare challenges in emergency medicine

Mitochondrial stress in advanced fibrosis and cirrhosis associated with chronic hepatitis B, chronic hepatitis C, or nonalcoholic steatohepatitis

International audienc