[Respiratory physiotherapy in private practice: Interest and prescription modalities]. / Kinésithérapie respiratoire libérale : intérêts et modalités de prescription.

INTRODUCTION: Respiratory diseases represent a major public health issue and impact both quality of life and life expectancy of the patients. STATE OF ART: Several interventions used in respiratory physiotherapy have been shown to reduce dyspnoea, improve quality of life and reduce hospitalisation in many respiratory diseases. However, respiratory physiotherapy remains poorly known to the medical community and may be under-prescribed. PERSPECTIVES: In order to improve the interdisciplinarity around the patient with respiratory impairment, we describe the interests and prescription modalities of liberal respiratory physiotherapy. In the context of respiratory physiotherapy acts, the precision of drafting prescription directly conditions the means implemented by the physiotherapist regarding care provided to the patient. CONCLUSION: The increased knowledge of prescribers, both concerning the prescription methods and the precise content of the rehabilitation sessions is one of the keys to their success.

[Follow-up and evaluation of plans developed during pulmonary rehabilitation]. / Suivi et évaluation sur une année de projets élaborés en réhabilitation respiratoire.

BACKGROUND: Pulmonary rehabilitation inevitably contains two essential components: therapeutic education and exercise training. The principal aim of this study was to evaluate the evolution over a year of the realization of plans determined during a pulmonary rehabilitation program (PRP). METHODS: At the end of a PRP the patient made plans in accordance with his health condition. A telephone enquiry was undertaken at 3, 7 and 12 months to evaluate the progress of the plans, the motivation to perform them, dyspnoea and quality of life. RESULTS: The data of 65 patients were analyzed (87 inclusions). Fifty-seven percent of the plans continued for one year. Walking had an adherence rating of 71%. Loss of motivation appeared to be the main cause for stopping (20%). Quality of life remained stable (p=0.39) and an increase in dyspnoea, though statistically significant (p<0.01), was of no clinical relevance. CONCLUSION: The majority of plans were maintained but without clinical effect on the quality of life or the level of dyspnoea. Decreased motivation was the major limitation to realization or continuation of the plans. New studies will have to be implemented to analyze the factors which lead to this decrease.

A cross-sectional comparison between the perception of physicians and pharmacists concerning the role of the pharmacist in physician training.

OBJECTIVES: This study aimed to identify and compare physician-pharmacist perceptions concerning drug teaching to physicians by pharmacists in Swiss hospital settings. MATERIAL AND METHODS: Questionnaires were emailed to all French-speaking physicians (survey A) and pharmacists (survey B) working in Swiss hospitals where medical directors/chief-pharmacists had approved the study. Questions were developed based on previous physician interviews. Most questions used four Likert-type response alternatives. A Mann-Whitney U test was used to compare answers to survey A and B. RESULTS: Fourteen out of 18 medical directors and 16/16 chief-pharmacists gave permission for the study. In total, 244 (11%) physicians answered survey A, and 115 (74%) pharmacists answered survey B. Nearly all participants agreed that pharmacists should take part in both medical student and physician postgraduate training. Most physicians answered wanting additional training and pharmacists are unaware of this need. Only two thirds of physicians reported having acquired knowledge about drugs thanks to pharmacists; document diffusion and direct answers to their questions having contributed the most to their training. Participants agreed that physician training by pharmacists needs a clearer delineation regarding the type of training, its aim, its targeted public, when and what pharmaceutical benefits are used. Physicians' priority-training topics are high-risk drugs, novelties and areas in which they consider their basic training was insufficient. Methods preferred for training are: case studies; exercises with individual corrections; and group work. CONCLUSION: Improved resources and planning are needed to meet physicians' expectations. Training is often carried out implicitly, through activities with various other aims, and needs to be better defined and formalized collaboratively.

[Reproducibility of strength and endurance measurements of the quadriceps in patients with COPD]. / Reproductibilité de la mesure de la force et de l'endurance du quadriceps dans la BPCO.

INTRODUCTION: Patients with COPD frequently have lower strength and endurance in their lower limbs compared to healthy subjects and evaluation of their quadriceps strength is recommended in practice. The handheld dynamometer has been validated and is easy to use for this measurement but its reproducibility has never been studied for endurance evaluation and only poorly for strength. The objective of this study was to estimate the inter and intra-operator reproducibility of maximal voluntary strength and endurance measurements of the quadriceps with a handheld dynamometer in patients with COPD. METHODS: The measurements of maximal voluntary strength and endurance were performed with a single handheld dynamometer using isometric contraction. Three measurement sessions were undertaken, separated by 24hours. The intra- and interoperator reproducibility were estimated by calculation of the intraclass correlation coefficient. RESULTS: Overall, 21 patients were included in the study. The intraclass correlation coefficient calculated for the maximal voluntary strength for intra and interoperator reliability ranged between 0.95 and 0.99. For endurance, the coefficient for intra-operator reliability was 0.81 and the two for interoperator reliability were 0.69 and 0.77. CONCLUSION: The handheld dynamometer allows an excellent inter and intra-operator reproducibility for the measurement of quadricipital maximal voluntary strength and a correct to excellent reproducibility for the measurement of quadricipital endurance. This tool may be used for the evaluation of quadriceps strength in clinical practice in COPD patients, particularly during rehabilitation.

Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.

Costo efectividad de los abordajes terapéuticos para tabaco dependencia en La Paz-Bolivia / Cost effectiveness of therapeutic approaches snuff dependence on La Paz-Bolivia

Pregunta de la investigación¿Cuál será el costo efectividad de las diferentes políticas de intervención para el cese de tabaquismo, en La Paz-Bolivia en el periodo2005? Objetivos General Desarrollar un protocolo para evaluar el costo efectividad de las diferentes políticas de intervención para el cese de tabaquismo, en el municipio urbano de la ciudad de La Paz, periodo 2005.Diseño o tipo de estudio Estudio tipo económico: Este consiste en realizar un análisis comparativo de las acciones alternativas tanto en términos de costes comode beneficios, cuyo objetivo principal es evaluar el costo de oportunidad, es decir el costo real de los programas para usar lo mejor con los menores recursos. Tamaño de muestraLa muestra está constituida por aquellos decisores importantes dentro del sistema de salud del país, que representen al Sector Público(incluye seguros públicos, redes públicas de salud, dependencias de organismos del Estado, etc.), al Sector de Seguridad Social (incluyecajas de seguro, Obras Sociales, Empresas prestadoras de servicios y otras organizaciones que reciban financiamiento compulsivo poraportes y contribuciones de los trabajadores y empleadores y/o subsidios del Estado), al Sector privado (incluye empresas con y sinfines lucro que reciben aportes voluntarios de parte de sus adherentes individuales o corporativos) y al Sector Mixto (incluye aquellas organizaciones que combinan 2 o más de los sectores descritos anteriormente).Universo de trabajo Estará constituido por todos los organismos gestores de salud del país.Población objetivoTodos los protagonistas en gestión de políticas de salud anti-tabáquicas...

Research questionWhat is the cost effectiveness of different intervention policies for smoking cessation, in La Paz, Bolivia, in the year 2005? Objective To develop a protocol for assessing the cost effectiveness of different intervention policies to stop smoking in the municipality of the city of La Paz, year 2005. DesignEconomic Survey: this is a comparative analysis of alternative actions in terms of cost and benefits, whose main objective is to evaluate the opportunity cost, the actual cost of the best programs to use with fewer resources.Sample SizeThe sample consists of those key decision makers within the country’s health system, representing the public sector (including public security, public health networks, units of state agencies, etc.), the social security sector (includes health security, social work, service companies and...

Analysis and quantification of prescribing and transcription errors in a paediatric oncology service.

OBJECTIVE: To analyse and quantify the omission errors linked to physicians' prescribing and errors linked to nurses' transcription and to identify the type and frequency of factors associated. No pharmacological factors are taken into account. DESIGN: Analysis of physicians' prescriptions and nurses' transcriptions in chemotherapeutic treatments (20 patient files) and non-chemotherapeutic treatments (20 patient files); retrospective study. SETTING: Paediatric onco-haematology unit. MAIN OUTCOME MEASURES: Categorisation of physicians' prescriptions as complete or incomplete, categorisation of the various nurses' transcriptions as correct or incorrect. RESULTS: Physicians' prescriptions were complete for 61.6% of non-chemotherapy treatments. As each prescription is transcribed twice, two nurses' transcription sheets are filled in by the nurses. At the first transcription 79.3% of non-chemotherapy prescriptions and 88.2% of chemotherapy prescriptions were transcribed correctly, while in the second sheet these percentages were respectively 96.2% and 93.7%. CONCLUSIONS: Too many sheets of paper generate confusion and increase the risk of errors. The several transcriptions are, in both types of treatment, sources of errors. The problems identified in this study allowed us to open a discussion as how to improve the physicians prescriptions and the nurses' transcription sheets.

A 31P nuclear magnetic resonance study of the hydrothermal vent tube worm Riftia pachyptila.

31P nuclear magnetic resonance (NMR) was used to study the major phosphorylated compounds visible in perchloric extracts of three body regions of the vestimentiferan worm Riftia pachyptila: winged vestimentum, trunk and segmented posterior opisthosome. Two phosphagens (PGs) were present in vestimentum and opisthosome. The major resonance corresponded to those of phosphoarginine and phosphotaurocyamine, which cannot be discriminated on 31P NMR spectra. We have identified four distinct phosphodiesters (PDEs) in these tissues: glycerophosphorylethanolamine (GPE), serine ethanolamine phosphodiester (SEP), glycero-phosphorylcholine (GPC) and threonine ethanolamine phosphodiester (TEP). Three phosphonates or derivates (PAs) were observed in the three body regions. The minor one was identified as 2-aminoethyl phosphonate (2-AEP). The phosphorus profile of the trunk was appreciably different: one additional resonance in the PDE region and only one phosphagen peak were observed.

Structural determination of the exopolysaccharide of Pseudoalteromonas strain HYD 721 isolated from a deep-sea hydrothermal vent.

The structure of the exopolysaccharide produced by Pseudoalteromonas reference strain HYD 721 recovered from a deep-sea hydrothermal vent has been investigated. By means of methylation and beta-elimination analysis, selective degradation of the uronic acids, partial depolymerization and NMR studies, the repeating unit of the polymer was deduced to be a branched octasaccharide with the structure shown. [formula: see text]

Structure of the exopolysaccharide of Vibrio diabolicus isolated from a deep-sea hydrothermal vent.

The structure of the exopolysaccharide produced under laboratory conditions by Vibrio diabolicus, a bacterium recovered from a deep-sea hydrothermal vent, has been investigated using sugar and methylation analysis and NMR spectroscopy. The polysaccharide consists of a linear tetrasaccharide repeating unit with the following structure. -->3)-beta-D-Glcp Nac-(1-->4)-beta-D-Glcp A-(1-->4)-beta-D-Glcp A-(1-->4)-alpha-D-Galp NAc-(1-->

Hydroxylation of carbon atoms of the alkyl chain of symmetrical N-nitrosodialkylamines by rat liver microsomes.

Liver microsomal preparations from control and treated rats (cytochromes P450 1A, 2B, 3A and 2E1-induced) metabolized at variable metabolic rates three nitrosodialkylamines (N-nitroso-dipropyl, dibutyl and diamyl-amines) into aldehydes and hydroxy-nitrosamines. The longer the alkyl chain, the smaller was the metabolic rate of the alpha-hydroxylation of alkyl chain yielding aldehyde and the greater was the metabolic rate of the corresponding (omega-1)-hydroxyl metabolite formation. Thus, the (omega-1) hydroxylation of the alkyl chain was the major metabolic pathway of N-nitrosodiamylamine (NDAA) so far as it represented 22-fold the alpha-hydroxylation. The balance between beta to omega hydroxylation and alpha-hydroxylation depends upon the alkyl chain length and also on specific P450 isoform induction.

Osmoregulation by trehalose synthesis in Salmonella manhattan after exposure to waste waters.

A 24 h period in waste waters improved the subsequent survival of Salmonella in oligotrophic sea water, at 20 degrees C, compared to a direct input control. The main osmoprotective compound accumulated, investigated by 1H-NMR spectroscopy (nuclear magnetic resonance), after 6 d in sea water was trehalose. Taking into account these observations, this paper put forward the following explanation concerning the survival mechanism: (1) stress in waste waters induces the endogenous synthesis of trehalose via the activation of the gene kat F; (2) when exposed to an osmotic stress, two degradative cytoplasmic enzymes are repressed and the bacteria accumulate trehalose which acts as an osmoprotectant. The succession of the two steps enables Salm. manhattan to immediately resist to the high salinity of oligotrophic seawater.

Detection of phosphodiester resonances in the perfused heart from vertebrate ectotherms with nuclear magnetic resonance.

In vivo 31P NMR has been used to characterize the phosphorylated compounds present in the heart from vertebrate ectotherms. The perfused hearts from all animals experimented showed prominent resonances between the inorganic phosphate and phosphocreatine peaks. The pattern of these compounds was found to be different in the heart of the different species. As shown by 31P and proton NMR of perchloric extracts, the chemical shift of some of the compounds was characteristic of glycerophosphorylcholine, glycerophosphorylinositol, phosphorylcholine, phosphorylserine, phosphorylethanolamine and phosphoenolpyruvate. The non-identified resonances were found to be phosphodiesters, as demonstrated by alkaline phosphatase hydrolysis. The physiological significance of these high levels of phosphodiesters in the heart from vertebrate ectotherms is discussed.

Quantitation of pentobarbital in serum by enzyme immunoassay.

Pentobarbital was quantitated in serum by a homogeneous enzyme immunoassay (EMIT), and the method evaluated for accuracy and precision. A comparison was performed against the authors' modified Goldbaum ultraviolet spectrophotometric procedure. The analytical sensitivity was 2 micrograms/mL with a linearity to 10 micrograms/mL and a coefficient of variation of 6.24%. Linear regression analysis revealed a correlation coefficient of 0.977, a slope of 1.05, and an intercept of -0.07. The t test demonstrated no difference between the two methods at a level of P less than 0.01. The enzyme immunoassay also had the advantages of speed and small sample requirement.