[Upper-extremity venous thrombosis: A retrospective study about 160 cases]. / Épidémiologie des thromboses veineuses des membres supérieurs : étude rétrospective de 160 thromboses aiguës.

AIM: To describe the clinical features and etiologies of upper limb venous thrombosis (ULVT). METHODS: All patients with a clinically suspected ULVT, were included retrospectively from January to December 2016. Diagnosis of ULVT was based on doppler-ultrasonography. Clinical features, topography and symptomatic pulmonary embolism (PE) were analyzed. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative value (NPV) of clinical symptoms leading to ULVT suspicion were estimated by comparing patients with and without ULVT. RESULTS: Among 488 patients with a suspected ULVT, 160 were diagnosed with ULVT, including, 80 with deep venous thrombosis (DVT) and 80 with superficial venous thrombosis (SVT). Symptomatic PE was found in 2.5 % of cases (n=4). None of the clinical symptoms of ULVT had a sensitivity greater than 40 %. For DVT, presence of superior vena cava syndrome had a 100 % PPV, 71.6 % NPV and 100 % Sp. For SVT, the presence of an cord-like induration had a 85.7 % PPV, 75.3 % NPV and 98.4 % Sp. An endovenous device was present in 87.5 % of DVT and 97.5 % of SVT cases. Malignant hemopathy was found in 43.8 % and 31.3 % of cases of DVT and SVT, respectively. Sepsis and solid neoplasia were present in 25 % and 15 % of cases of ULVT, respectively. Peripherally inserted central catheter or implantable sites were present in 40 % and 17.5 % of DVT patients. No solid neoplasia, hematological malignancy or thrombophilia were diagnosed in patients with ULVT. CONCLUSION: An endovenous device was involved in 92.5 % of cases of ULVT. The prevalence of symptomatic PE was low. Hematological malignancies, sepsis and neoplasia were the most common conditions present in patients with ULVT.

[Oral anticoagulants adherence in elderly patients treated for atrial fibrillation in the era of direct oral anticoagulants]. / Observance du traitement anticoagulant oral chez le sujet âgé à l'ère des anticoagulants oraux directs.

BACKGROUND: The aim of this study was to determine the level of adherence to oral anticoagulants in the population of elderly patients treated for a non-valvular atrial fibrillation (AF) in the era of direct oral anticoagulants. PATIENTS AND METHOD: This transversal study used Morisky scale to assess adherence to oral anticoagulants. We also collected patients' reviews about the treatment and factors explaining a poor adherence. RESULTS: Between January and June 2015, 64 patients were included in Loire Atlantique. Average age was 77.8 years, CHA2DS2-VASc score was 4.06 and treatment (vitamin K antagonists [VKAs] in 78% patients) was prescribed since 4.3 years. According to Morisky scale, 84.4% of patients had a good adherence. There was 88% of good adherence with AVK versus 71% with direct oral anticoagulant, there was no statistically significant difference. The prescriber and the knowledge of anticoagulant treatment role seemed to be determinant factors. CONCLUSIONS: The level of adherence for oral anticoagulant appears higher than in most published studies. Diversification of therapeutic options could constitute an aid to personalize the prescription in order to improve it.

[Design and implementation of occupational health programs in the workplace: the Québec approach]. / L'élaboration et la mise en application des programmes de santé spécifiques aux établissements: l'approche québécoise.

This paper describes the Québec experience in the design and implementation of occupational health programs in the workplace. To begin with, a brief overview of the historical context and organisational framework of occupational health are presented. Next, each of the phases involved in the design of occupational health programs is described: identification of workers' health and safety problems, selection of action priorities, and program design, implementation and evaluation.... In the end, the roles and responsibilities of the doctors, nurses and industrial hygienists generally involved in these multidisciplinary teams are presented.

Correlation between the gross motor function measure scores and gait spatiotemporal measures in children with neurological impairments.

Twenty six children with a diagnosis of cerebral palsy and four with a diagnosis of head injury, aged between 1 and 8 years, participated in this study, undertaken to determine the relation between spatiotemporal measures (STM) of gait (velocity, cadence, stride length, and cycle duration) and the results of a standardized clinical test of motor function. STM were assessed by a clinical videographic gait test (VGT) whereas the Gross Motor Function Measure (GMFM) was used to assess motor function. For the total group of children, significant linear relations (r = 0.91, r = 0.93; p < 0.0001) were obtained between gait velocity and the GMFM sections D and E which include gait-related activities. These indicate that velocity is a parameter capable of reflecting functional locomotor behavior of these children. The results suggest that GMFM sections D and E may be used as locomotor predictors. The effect of walking with or without support was also investigated. The correlation between gait velocity and the GMFM(E) score was higher (r = 0.69) in the group of children walking with support than in those walking without (r = 0.35). The first group were younger and walked at velocities under 45 cm/s whereas children walking without support were older and walked at velocities ranging from 55 to 110 cm/s. These results suggest that the GMFM(E) score becomes less discriminant at gait velocities above 45 cm/s.