[Home care for acute pulmonary embolism: Feasibility and general practitioner acceptability]. / Évaluation de l'acceptabilité du point de vue du médecin traitant et de la faisabilité de la prise en charge ambulatoire de l'embolie pulmonaire.

BACKGROUND: In France, initial management of pulmonary embolism (PE) is performed in the hospital setting. The latest international guidelines suggest that PE at low risk of mortality can be treated in the ambulatory care setting. This means that ambulatory care pathways and general practitioner (GP) opinions concerning such a change in practice need to be determined. OBJECTIVES: To determine: (1) rate of patients eligible for an ambulatory management of their PE and reasons for hospitalization of PE at low risk of mortality; (2) acceptability for GPs of PE home care and patient's desired care pathway. METHODS: Two-part prospective observational study conducted in Montpellier University Hospital from May 2012 to August 2013: (1) in-hospital study including all consecutive patients with non-hospital acquired PE; (2) telephonic survey on PE patient's ambulatory care pathway conducted among GPs. RESULTS: In-hospital study: 99.1% (n=211) of included patients were hospitalized and only 14.1% (n=30) had all criteria for home care. Patient's pathway survey: 68.3% (n=112) of GPs, particularly those aged 40-54 years and those who had already managed patients alone after hospital discharge, were in favour of home care for PE. One hundred and thirty-nine (84.8%) GPs wanted a collaborative management with an expert thrombosis physician and an outpatient follow-up visit at one week. CONCLUSION: Few patients managed at Montpellier University Hospital are eligible for ambulatory management of their PE. GPs have a favorable opinion of home care for PE if it is conducted in collaboration with an expert thrombosis physician.

[Appropriate medication prescribing in older people]. / Bon usage des médicaments chez le sujet âgé.

Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.

[Radiation pneumonitis: a rare and potentially severe pneumonia. Usefulness of corticosteroids]. / Pneumopathie post-radique aiguë: une pneumopathie rare, potentiellement grave et très corticosensible.

We report a 80-year-old woman who presented with asthenia, confusion and abdominal pain, leading to a diagnosis of severe pneumonia complicated by a colonic pseudo-obstruction. The unfavourable outcome with antibiotic treatment and a recent past medical history of thoracic radiotherapy pointed to a possible diagnosis of radiation pneumonitis. Absence of other explanation and the rapid improvement with corticosteroids confirmed this rare and potentially serious diagnosis, especially among elderly people.