[Implementation of a multi-interventional approach to improve medication safety in older hospitalized patients: Feasibility and impact on 30-day rehospitalization rate]. / Mise en place d'une procédure multi-interventionnelle de prise en charge médicamenteuse chez la personne âgée hospitalisée : faisabilité et efficacité sur la réhospitalisation à 30jours.

BACKGROUND: The impact of a multi-interventional approach for medication safety (MIMS) on rehospitalization rate have been inconstant in the literature. This would be due to difficulty in implementing the interventions and insufficient information transmission at discharge. The purpose of this study was to determine the effect of a MIMS on the 30-day rehospitalization rate after discharge from an acute geriatric unit (AGU). METHOD: This was a single-center interventional randomized controlled trial that included patients hospitalized in an AGU and were at least 75 years old. The intervention group benefited from a MIMS including medication reconciliation at admission and at discharge, medication review, and standardized transmission of hospital's medication changes sent to community practitioners (general practitioners and pharmacists) at discharge. The control group benefited from the usual approach applied in the AGU. RESULTS: One hundred nine patients (mean age 87,5±6,1 years) were included. At intention-totreat analysis, the rehospitalization rate was 30% in the intervention group and 15,2% in the control group. The difference was non-significant before and after adjustments (P=0,27 and 0,28 respectively). However, the intervention protocol was not effectively completed in 40% of patients in the intervention group and no intervention was performed in 10%. CONCLUSION: The implementation of a MIMS in an AGU showed a non-significant decrease in the number of rehospitalizations. Other indicators should be analysed, such as the reason for rehospitalisation or the maintenance of treatment at 30 days.

[Update of the 2013 consensus conference "Management of the preoperative risk of infection"]. / Mise à jour 2013 de la conférence de consensus « Gestion préopératoire du risque infectieux ¼

UNLABELLED: The surgical site infections (SSI) are rare adverse events that may have severe consequences in terms of morbidity, mortality and costs. Guidelines on the preparation of the patient can reduce the risk of SSI. Previous guidelines were published in 2004. MATERIAL: A steering committee and a group of experts were established after seeking professional societies that had participated in the previous guidelines. The working group has defined the objectives of revising and retained two main themes: skin preparation and nasal decolonization of patients with Staphylococcus aureus. We chose to report only the work done on the patient skin preparation. The working group relied on the method of recommendation for clinical practice of the High Authority for Health (HAS). The GRADE approach was used to analyze the articles published since 2004. RESULTS: It is recommended to perform a preoperative shower but when does not matter. The use of a simple soap seems sufficient. Shampoo does not seem essential nor removal of varnish in the field of urology. Impregnated fabrics, adhesives fields and bacteriological insulating films are of little use to reduce the risk of infection. The depilation is not routinely required. It is recommended to perform a cleansing on contaminated skin. The use of an alcohol antiseptic is preferred, the successive application of two different antiseptics range is possible. CONCLUSIONS: The updated guidelines on the patient skin preparation before urological surgery was necessary. It changed some guidelines that should appear in our daily practice.

Depressive symptoms are prevalent in childhood-onset systemic lupus erythematosus (cSLE).

BACKGROUND: Depressive symptoms are common in adolescence and young adulthood; however, their prevalence in childhood-onset systemic lupus erythematosus (cSLE) is unknown. OBJECTIVE: The objective of this study was to examine the prevalence of depressive symptoms and their association with disease characteristics in children, adolescents, and young adults with cSLE. METHODS: A cross-sectional sample of patients with cSLE between 10 to 24 years old completed standardized depression inventories. Demographics and disease characteristics were collected. RESULTS: Total depression inventory scores reported were below standard cut-off values for depression. However, 26% (10/38) of children and adolescents, and 44% (seven of 16) of young adults had scores at or above established cut-offs for elevated depression symptoms. Physical symptoms of depression were endorsed most frequently. There were no differences in depressive symptoms by disease characteristics including disease duration, health-related quality of life inventory scores, antiphospholipid antibody status, and a history of renal involvement or neuropsychiatric SLE (NPSLE). However, two patients had a history of depression as an NPSLE manifestation of their SLE. In the children and adolescents, prednisone dose was associated with negative self-esteem (r = 0.37, p = 0.04) and somatic depressive symptoms (r = 0.39, p = 0.02), but we did not observe a significant association in the young adults. CONCLUSION: Depressive symptoms in cSLE are frequent, although similar to the high prevalence rates in the general population. Physical symptoms are most frequently endorsed. Further study will determine if serial evaluations are recommended for early detection in this at-risk population.

Analysis of Incidence-Severity Relationships for Strawberry Powdery Mildew as Influenced by Cultivar, Cultivar Type, and Production Systems.

The relationships between strawberry powdery mildew incidence (I) and severity (S) were investigated for various cultivars, for June-bearing and day-neutral cultivars, and for production systems (open-field and plastic-tunnel) with the objective of deriving a simple relationship for predicting severity (proportion of leaf area diseased [PLAD]) from incidence (proportion of diseased leaves). Data were collected from 2006 to 2011 at 11 commercial and experimental sites, for a total of 2,326 observations (n). For the cultivars grown in open fields, higher severity was observed on 'Seascape', with mean PLAD of 0.299 (n = 427); followed by 'Chambly', with 0.133 (n = 334); 'Cavendish', with 0.115 (n = 250); 'Darselect', with 0.111 (n = 321); and 'Jewel', with 0.105 (n = 276). In general, mean severity was higher when the strawberry plants were grown in plastic tunnels, with PLAD of 0.204, 0.199, and 0.181 for Chambly (n = 204), Darselect (n = 261), and Jewel (n = 253), respectively. A linear model based on complementary log-log transformation of I and S provided a good fit of the data (coefficient of determination [R2] adjusted for degrees of freedom from 0.82 to 0.96). A covariance analysis indicated that the sampling year and site of sampling did not significantly influence the estimated slope of the I-S relationship, nor did the specific cultivar among the June-bearing ones, whereas the production system (open-field versus plastic-tunnel) and the cultivar type (June-bearing versus day-neutral) significantly influenced the estimated slope. From this analysis, we were able to develop three specific models for open-field-grown June-bearing cultivars (R2 = 0.90), for the open-field-grown day-neutral cultivar (Seascape, R2= 0.91), and for June-bearing cultivars grown in plastic tunnels (R2 = 0.92). From these results, it was concluded that strawberry powdery mildew leaf severity can be accurately estimated from incidence of diseased leaves. The I-S relationships developed in the present study may be used in making practical disease management decisions, especially for management programs that use information on disease level in the field to initiate fungicide spraying programs or to time the interval between sprays.

Inpatient target discharge weight for early-onset anorexia nervosa: Restoring premorbid BMI percentile to improve height prognosis.

OBJECTIVE: Early-onset anorexia nervosa (EO-AN) is characterized by restricted food intake leading to low body weight, emerging before 14 years old. Most patients reaching a target body mass index (BMI) around the 25th percentile at hospitalization discharge display an incomplete prospective height catch-up. A better understanding of height prognosis determinants is required. METHODS: In 74 children with an EO-AN, we collected height and weight premorbidly, at hospitalization, and at discharge, 6 months, 12 months, and at longer-term follow-up of 36 months. We defined a height prognosis parameter (HPP) as the difference between the height percentile at follow-up times and the premorbid height percentile. We explored the relationship between weight parameters and height catch-up at follow-up with linear regression analyses. RESULTS: A higher weight suppression (WS) - i.e., difference between premorbid and current BMI - at admission and discharge was associated with lower HPP - i.e., a greater loss of height - at 12 months and 36 months follow-up. Similarly, a higher premorbid BMI percentile was associated with a lower HPP at 12 and 36 months. CONCLUSION: Target discharge weight for EO-AN patients should be tailored and based on premorbid BMI trajectory to improve height prognosis.

Input impedance in flow ducts: theory and measurement.

This paper presents both a theoretical and an experimental investigation of the influence of the mean flow on the input impedance of a duct. The input impedance of an axisymetrical flow duct is calculated, taking into account the convective effect of a uniform flow, the dissipative effect of a turbulent flow and the radiation in an open jet. Each of these effects is separately studied. An experimental apparatus has been specifically designed to lower flow noise on the transducers, taking advantage of the Two-Microphone-Three-Calibration (TMTC) method [V. Gibiat and F. Laloë, J. Acoust. Soc. Am. 88, 2533-2545 (1990)], whose full calibration process allows any geometry for the measurement head. Theory and experiments are compared for a 1 m long cylindrical duct carrying a flow whose Mach number equals up to 0.15. The resonant frequencies are in close agreement, within 3%. The relative evolution of the magnitude maxima with increasing flow are in good agreement, within 10%. Despite similar tendencies when modifying the mean flow velocity, the amplitude of variation of the magnitude is 2 to 5 times smaller in the experiments.

Influence of hay and animal feed exposure on respiratory status: a longitudinal study.

Our aim was to study respiratory symptoms and lung function decline in farmers, with particular attention to the influence of handling hay, straw and animal feed. From a cohort recruited in 1993-1994, 219 (82.6%) dairy farmers, 130 (62.5%) nondairy agricultural workers and 99 (66.4%) controls were re-evaluated in 2006. They answered medical and occupational questionnaires, underwent spirometric tests at both evaluations and pulse oximetry in 2006. Dairy and nondairy agricultural workers showed an increased risk for usual morning phlegm (adjusted OR 4.27 (95% CI 1.41-12.95) and 3.59 (95% CI 1.16-11.10), respectively). Animal feed handling was associated with increased risks of wheezing (p = 0.01) and usual morning phlegm (p = 0.04); hay or straw handling was associated with increased risk of wheezing (p = 0.008). Adjusting for smoking, age, height, sex and altitude, dairy farmers had greater declines in forced expiratory volume in 1 s (FEV(1))/forced vital capacity ratio (p = 0.01) than controls. An increased decline in FEV(1) for all agricultural workers was associated with animal feed handling, both measured as a categorical (currently versus never handling; p = 0.05) or quantitative value (years of exposure during the survey period; p = 0.03). Hay, straw or animal feed handling represents a risk factor of bronchial symptoms and, for animal feed only, of accelerated decline in expiratory flows.

Environmental risk factors for haemorrhagic fever with renal syndrome in a French new epidemic area.

In France, haemorrhagic fever with renal syndrome (HFRS) is endemic along the Belgian border. However, this rodent-borne zoonosis caused by the Puumala virus has recently spread south to the Franche-Comté region. We investigated the space-time distribution of HFRS and evaluated the influence of environmental factors that drive the hantavirus reservoir abundance and/or the disease transmission in this area. A scan test clearly indicated space-time clustering, highlighting a single-year (2005) epidemic in the southern part of the region, preceded by a heat-wave 2 years earlier. A Bayesian regression approach showed an association between a variable reflecting biomass (normalized difference vegetation index) and HFRS incidence. The reasons why HFRS cases recently emerged remain largely unknown, and climate parameters alone do not reliably predict outbreaks. Concerted efforts that combine reservoir monitoring, surveillance, and investigation of human cases are warranted to better understand the epidemiological patterns of HFRS in this area.

Activation of the peroxisome proliferator-activated receptor gamma promotes the development of colon tumors in C57BL/6J-APCMin/+ mice.

The development of colorectal cancer, one of the most frequent cancers, is influenced by prostaglandins and fatty acids. Decreased prostaglandin production, seen in mice with mutations in the cyclooxygenase 2 gene or in animals and humans treated with cyclooxygenase inhibitors, prevents or attenuates colon cancer development. There is also a strong correlation between the intake of fatty acids from animal origin and colon cancer. Therefore, the peroxisome proliferator-activated receptor gamma (PPARgamma), a downstream transcriptional mediator for prostaglandins and fatty acids which is highly expressed in the colon may be involved in this process. Activation of PPARgamma by two different synthetic agonists increased the frequency and size of colon tumors in C57BL/6J-APCMin/+ mice, an animal model susceptible to intestinal neoplasia. Tumor frequency was only increased in the colon, and did not change in the small intestine, coinciding with the colon-restricted expression of PPARgamma. Treatment with PPARgamma agonists increased beta-catenin levels both in the colon of C57BL/61-APCMin/+ mice and in HT-29 colon carcinoma cells. Genetic abnormalities in the Wnt/wingless/APC pathway, which enhance the transcriptional activity of the beta-catenin-T-cell factor/lymphoid enhancer factor 1 transcription complex, often underly the development of colon tumors. Our data indicate that PPARgamma activation modifies the development of colon tumors in C57BL/61-APCMin/+ mice.

The three-measurement two-calibration method for measuring the transfer matrix.

Extensive use of transfer matrices (TMs) is made in determining the acoustic properties of a duct and in in-duct acoustic propagation models in the automotive industry and for musical acoustics purposes. The experimental apparatuses of classical TM measurement methods feature two measurement heads. Two microphones are flush with the walls of each head. The pressure signals are processed following the transfer function method constructed on an analytical model of acoustic propagation in measurement heads. The present paper aims at presenting a measurement method based on a three-microphone experimental apparatus and on its acoustic calibration through two reference measurements: the three-measurement two-calibration method for measuring the TM (3M2C-TM). Two microphones are flush with the measurement head walls and one is in the cap closing one side of the measured duct. 3M2C-TM proved essential for an accurate measurement of the four TM elements of two different ducts: a cylindrical duct and an expansion chamber.

Optimal strokes for axisymmetric microswimmers.

We present a theory for low-Reynolds-number axisymmetric swimmers and a general strategy for the computation of strokes of maximal efficiency. An explicit equation characterizing optimal strokes is derived, and numerical strategies to obtain solutions are discussed. The merits of this approach are demonstrated by applying it to two concrete examples: the three linked spheres of Najafi and Golestanian and the pushmepullyou of Avron, Kenneth, and Oakmin.

Pancreatic cancer: incidence, treatment and survival trends--1175 cases in Calvados (France) from 1978 to 2002.

AIM: To assess the trends in incidence, therapeutic modalities and survival of pancreatic cancer between 1978 and 2002 in a well-defined population, as recorded in the Calvados digestive cancer registry database. PATIENTS AND METHODS: All patients living in Calvados with a diagnosis of pancreatic cancer were registered. Clinical data and treatment modalities were prospectively recorded. This 25-year database was divided into five 5-year periods. Data were compared using log-rank tests and the Cox model. RESULTS: A total of 1175 cases of pancreatic cancer (617 men, 558 women) were registered. Its incidence increased with an average annual coefficient of +2.8% in men and +5.1% in women. Therapeutic modalities changed over the five time periods: surgical resection increased from 6.8 to 13.4% (median survival 15 months) while radiation therapy and/or chemotherapy also increased from 5.5 to 13.2%. Palliative surgery decreased from 54.6 to 32.0% and favored interventional endoscopic techniques. Postoperative mortality decreased significantly. Survival increased significantly over the five time periods, although the median survival time remained stable (4 months). CONCLUSION: From 1978 to 2002, pancreatic cancer incidence increased in Calvados (France). Therapeutic modalities changed, with endoscopic treatments preferred over palliative surgery. The improvement in survival could be explained by the decrease in postoperative mortality.

Are systematic drain tip or drainage fluid cultures predictive of surgical site infections?

Systematic cultures of drain tips or drainage fluids for the early detection of surgical site infections (SSIs) are controversial. To examine the association between the results of systematic drain tip or drainage fluid cultures and the occurrence of SSIs in clean or clean-contaminated surgery. Searches were performed in the PubMed, and Cat.inist databases for observational studies published before 31st March 2017. Studies reporting results of drain tip or drainage fluid systematic cultures and SSIs after clean or clean-contaminated surgeries were included, and meta-analyses were performed. Seventeen studies, including 4390 patients for drain tip cultures and 1288 for drainage fluid cultures, were selected. The pooled negative predictive values were high (99%, 95% confidence interval (CI) 98-100 for drain tip cultures and 98%, 95% CI 94-100 for drainage fluid cultures). The positive predictive values were low (11%, 95% CI 2-24 for drain tip cultures and 12%, 95% CI 3-24 for drainage fluid cultures). The sensitivities were low (41%, 95% CI 12-73 for drain tip cultures and 37%, 95% CI 16-60 for drainage fluid cultures). The specificities were high (93%, 95% CI 88-96) for drain tip cultures and moderate (77%, 95% CI 54-94) for drainage fluid cultures. Systematic cultures of drain tips or drainage fluids appear not to be relevant, because their positive predictive values were low in the prediction of SSIs.

A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence.

BACKGROUND: Since 1990, several studies have focused on safety and patient satisfaction in connection with day surgery. However, to date, no meta-analysis has investigated the overall prevalence of surgical site infections (SSI). AIM: To estimate the overall prevalence of SSI following day surgery, regardless of the type of surgery. METHOD: A systematic review and a meta-analysis of the prevalence of SSI following day surgery, regardless of the type of surgery, was conducted, seeking all studies before June 2016. A pooled random effects model using the DerSimonian and Laird approach was used to estimate overall prevalence. A double arcsine transformation was used to stabilize the variance of proportions. After performing a sensitivity analysis to validate the robustness of the method, univariate and multi-variate meta-regressions were used to test the effect of date of publication, country of study, study population, type of specialty, contamination class, time of postoperative patient visit after day surgery, and duration of hospital care. FINDINGS: Ninety articles, both observational and randomized, were analysed. The estimated overall prevalence of SSI among patients who underwent day surgery was 1.36% (95% confidence interval 1.1-1.6), with a Bayesian probability between 1 and 2% of 96.5%. The date of publication was associated with the prevalence of SSI (coefficient -0.001, P = 0.04), and the specialty (digestive vs non-digestive surgery) tended to be associated with the prevalence of SSI (coefficient 0.03, P = 0.064). CONCLUSION: The meta-analysis showed a low prevalence of SSI following day surgery, regardless of the surgical procedure.

Composition analysis of semiconductor quantum wells by energy filtered convergent-beam electron diffraction.

We show how energy-filtered convergent-beam electron diffraction (EFCBED) patterns can be used to determine the chemical composition of buried semiconductor strained quantum wells. Our method is based on a quantitative analysis of the intensities of high-order Bragg lines in the transmitted disc of EFCBED patterns taken from plan-view samples. This analysis makes it possible to determine the displacement vector R introduced between the top and bottom parts of the matrix by the deformation of the quantum well and consequently to determine its composition. This is illustrated in the case of an In(x)Ga(1-)(x)As quantum well buried in a GaAs matrix. A detailed analysis of the effect of experimental parameters on Bragg lines intensity is performed. In particular, the importance of the choice of the diffraction vector is pointed out. The relative uncertainty on the measurement of the indium content x is found to be lower than 5% and a possible occurrence of slight compositional fluctuations in the (001) growth plane is pointed out.

[Bronchoscopic treatment of bronchopleural fistula]. / Traitement endoscopique des fistules bronchopleurales.

Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.

Thiazolidinediones repress ob gene expression in rodents via activation of peroxisome proliferator-activated receptor gamma.

The ob gene product, leptin, is a signaling factor regulating body weight and energy balance. ob gene expression in rodents is increased in obesity and is regulated by feeding patterns and hormones, such as insulin and glucocorticoids. In humans with gross obesity, ob mRNA levels are higher, but other modulators of human ob expression are unknown. In view of the importance of peroxisome proliferator-activated receptor gamma (PPARgamma) in adipocyte differentiation, we analyzed whether ob gene expression is subject to regulation by factors activating PPARs. Treatment of rats with the PPARalpha activator fenofibrate did not change adipose tissue and body weight and had no significant effect on ob mRNA levels. However, administration of the thiazolidinedione BRL49653, a PPARgamma ligand, increased food intake and adipose tissue weight while reducing ob mRNA levels in rats in a dose-dependent manner. The inhibitory action of the thiazolidinedione BRL49653 on ob mRNA levels was also observed in vitro. Thiazolidinediones reduced the expression of the human ob promoter in primary adipocytes, however, in undifferentiated 3T3-L1 preadipocytes lacking endogenous PPARgamma, cotransfection of PPARgamma was required to observe the decrease. In conclusion, these data suggest that PPARgamma activators reduce ob mRNA levels through an effect of PPARgamma on the ob promoter.

Bilateral plication of the puborectal muscles: A new surgical concept for treating vulvar widening.

OBJECTIVES: This study describe a new myorraphy technique by bilateral plication of the puborectalis bundles (PRP) of the levator ani muscle to treat vulvovaginal widening. The aim of this work was to report our preliminary experience in terms of morbidity and results (anatomical and functional) in the short and medium term. MATERIALS AND METHODS: This single centre retrospective study concerned 69 women who underwent PRP between January 2011 and December 2014. The main criterion for judging success was the GH before and after surgery (Genital Hiatus in the POP-Q classification: Pelvic Organ Prolapse Quantification System). The secondary criteria were the quality of sexual intercourse and the morbidity. RESULTS: The average GH post-surgery was 31, 35 and 35mm at 6 weeks, 6 and 12 months respectively compared to 65±5mm preoperatively (P<0.00001). Among the 27 patients who were sexually active prior to surgery, 18.52% deemed the quality of sexual intercourse satisfactory. After surgery, more than 88% of the patients observed an improvement (P<0.00001). After the surgery the reported rate of minor complications was under 3%. CONCLUSION: This preliminary study of PRP confirms the feasibility of the procedure, its low morbidity and the stability of the anatomical outcomes at 12 months.

Detection of temporal clusters of health care-associated infections or colonizations with Pseudomonas aeruginosa.

We investigated temporal clusters of Pseudomonas aeruginosa cases between 2005 and 2014 in 1 French university hospital, overall and by ward, using the Kulldorff method. Clusters of positive water samples were also investigated at the whole hospital level. Our results suggest that water outlets are not closely involved in the occurrence of clusters of P aeruginosa cases.

Association between Pseudomonas aeruginosa positive water samples and healthcare-associated cases: nine-year study at one university hospital.

OBJECTIVE: To study the association between the results of water samples and Pseudomonas aeruginosa healthcare-associated cases in a French university hospital. METHODS: Generalized Estimating Equations were used on complete case and imputed datasets. The spatial unit was the building and the time unit was the quarter. RESULTS: For the period 2004-2013, 2932 water samples were studied; 17% were positive for P. aeruginosa. A higher incidence of P. aeruginosa cases was associated with a higher proportion of positive water samples (P=0.056 in complete case analysis and P=0.031 with the imputed dataset). The association was no longer observed when haematology and intensive care units were excluded, but was significant in analyses of data concerning intensive care units alone (P<0.001). CONCLUSION: This study suggests that water outlet contamination in hospitals can lead to an increase in healthcare-associated P. aeruginosa cases in wards dealing with susceptible patients, but does not play a significant role in other wards.