[Evaluation of simulation-based training program intended to improve interprofessional communication skills of community pharmacy and general medicine students]. / Formation des étudiants en pharmacie d'officine et en médecine générale à la communication interprofessionnelle : évaluation d'un programme de simulation.

OBJECTIVES: The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations. METHODS: The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process. RESULTS: During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved. CONCLUSIONS: The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

[Association between screen time and sleep habits in 11-to-12-year-old French middle school students]. / Associations entre les temps d'écran et les habitudes de sommeil chez des jeunes collégiens.

BACKGROUND: Screen media usage has become increasingly commonplace in daily life with children initiating themselves to screen media at an early age. Given the high prevalence of screen viewing among children worldwide, its impact on children's health has become a cause for concern. Unfortunately, little information on the independent association between sleep habits and screen time in French children is currently available. The main aim of this study was to assess possible relationships between screen time and sleep habits (quality, duration, etc.) among young middle school students in France. METHODS: A total of 448 (55 % girls) 11-to-12-year-olds from 5 schools were included. Body weight and height were measured according to standard procedures and BMI percentiles were determined based on international reference values. Sleep parameters were obtained by sleep diaries and visual estimations. A sleep diary was maintained for one week to record sleeping and waking times and related information. Information on lifestyle habits (sedentary behaviours, physical activity, and dietary intake) was obtained via standardised questionnaires. RESULTS: Participants were 11.5 (±0.4) years of age. From total sample, 25.5 % reported screen time ≥2hours/d during school days and 62.7 % during school-free days. High screen time was associated with significantly poorer sleep habits and these results remained valid after adjustment for several confounding factors (body mass index, sex, center and parental level of educational attainment) (P<0.05). CONCLUSION: This study highlights an association between longer screen time and shorter sleep duration in French middle school students aged 11 to 12 years. Preventive measures on use of and exposure to screens are called for. Further studies are necessary to confirm our findings.

A new vascular sealant (Sealgel) to achieve rapid hemostasis after percutaneous angioplasty in anticoagulated patients: clinical feasibility and preliminary results.

The aim of this study was to assess the feasibility of a new vascular sealant (Sealgel) to provide rapid hemostasis in anticoagulated patients after percutaneous transluminal angioplasty (PTA). Sealgel was designed with ancrod (10 mg) and tranexamic acid (80 mg) dissolved in a hyaluronic acid gel (3 ml). Fifty anticoagulated patients (heparin, aspirin, ticlopidin) who underwent PTA of coronary artery were enrolled in the study. Sealgel (3 ml) was delivered under manual compression through a 9-F cannula at the arterial puncture site after the introducer sheath removal at the end of PTA procedure. Hemostasis time as well as complications were recorded. Sealgel was successfully delivered in 98 % of patients. Hemostasis occurred within 15 mn of manual compression in 82 % of patients, within 25 mn in 98 %, and failed in 1 patient (2 %). Hematoma (6-cm diameter) was observed in 1 patient and late bleeding in another one. There were no clinical signs of embolism, inflammatory swelling, local infection, vascular fistula, or pseudoaneurysm. No surgery or blood transfusion was required. Sealgel application after PTA in anticoagulated patient is feasible and secure. Preliminary results suggest that the Sealgel brought about rapid hemostasis; however further studies are needed to determine its clinical efficacy.

Treatment of an ilio-caval thrombosis by mechanical thrombolysis.

In proximal deep vein thrombosis, thrombolytic treatment is more effective than heparin from a recanalization point of view but with a failure rate of 20%. We describe an interventional therapeutic procedure that may be effective in these cases. Mechanical thrombolysis with the thrombolizer (Angiocor, Lille Hellemmes, France) has been tried in 2 cases of deep vein thrombosis, when systemic thrombolysis alone had failed.

Which comes first, Kt/V or PCR--chicken or egg?

We previously hypothesized that PCR is dependent on Kt/V (urea). To test the hypothesis, 30 patients from two hemodialysis (HD) units with PCR values consistently less than 1 regardless of the Kt/V (urea) without an obvious cause (such as malignancy, peptic ulceration, etc.) were identified. These patients were randomized into an experimental group where an increase in the Kt/V (urea) was made or into a control group where a Kt/V (urea) remained unchanged. In the experimental group the minimal increment in Kt/V (urea) was 0.3 plus a minimum requirement of a Kt/V (urea) greater than or equal to 1. The control group were to maintain the existing Kt/V (urea) within +/- 0.2. Urea kinetic modeling was monitored monthly and the patients followed for three months. Of 30 patients, 18 fulfilled the criteria (9 experimental; 9 controls). In the experimental group, the initial Kt/V (urea) was 0.82 +/- 0.19 (means +/- SD); the final Kt/V (urea) was 1.32 +/- 0.21 (P = 0.000). These patients had an initial PCR of 0.81 +/- 0.08. This increased to 1.02 +/- 0.15 (P = 0.005). The control group had an initial Kt/V (urea) of 0.82 +/- 0.16. The final Kt/V (urea) was 0.87 +/- 0.15. Their initial PCR was 0.87 +/- 0.14 and the final PCR was 0.86 +/- 0.087 (P = NS). In the experimental group, the mean increments in Kt/V (urea) and PCR were 0.49 +/- 0.17 and 0.21 +/- 0.16 (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Inoue balloon usefulness in case of failure to stabilize bifoil catheter balloons during percutaneous mitral valvotomy.

A new bifoil balloon catheter has been used in the last 120 percutaneous mitral valvotomies carried out in our institution. The shaft segment between the two balloons of the bifoil catheter has been adjusted to the guide-wire diameter, allowing its introduction through a 14F sheath. This thinner shaft does not always offer enough back up to the balloons during inflation. An Inoue balloon replaced an unstable bifoil balloon in 5 cases of mitral dilatation failure due to balloon instability, regularly providing firm stability until full balloon inflation.

[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients]. / La stimulation électrique médullaire dans les artériopathies des membres inférieurs. Une étude multicentrique chez 244 patients.

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)

[Digital arteriopathies of the arms and their treatment by posterior spinal cord neurostimulation]. / Artériopathies digitales des membres supérieurs et leur traitement par la neurostimulation cordonale postérieure.

Digital arteriopathies of the upper limbs are distinguished from those of the lower limbs by their rarity and their particular etiologies. Digital arteriopathies are defined as the presence of organic lesions causing stenosis and obstruction of the distal upper limb arteries: radial arteries, ulnar arteries, palmar arches, digital arteries.

Kt/V: patients do not get what the physician prescribes.

Monthly urea kinetic modeling is performed [service Kt/V (urea)] to ensure that dialysis prescriptions provide patients a Kt/V greater than or equal to 1 and yield a protein catabolic rate (PCR) greater than or equal to 0.8. The frequency with which the dialysis prescription (physician's order +/- 5%, p +/- 5%) was achieved was calculated by three methods: 1) CompuMod (3 ureas; computer derived), 2) Jindal-Goldstein, and 3) Daugirdas, (2 and 3% reduction of urea). Ten patients were followed serially over 1 month for a total of 120 dialyses. Mean Kt/V values for each method were: prescription, 1.54 +/- 0.36; service, 1.40 +/- t0.63; CompuMod, 1.33 +/- 0.27; Jindal-Goldstein, 1.55 +/- 0.24; and Daugirdas, 1.33 +/- 0.23. The percentages of dialyses within the p +/- 5% were 12.4%, CompuMod; 12.8%, Jindal-Goldstein and 14.3%, Daugirdas. The percentages above p +/- 5% were 20.4%, CompuMod; 47%, Jindal-Goldstein; and 21.4%, Daugirdas. The percentages below p +/- 5% were 67.3%, CompuMod; 40.2%, Jindal-Goldstein; and 64.3%, Daugirdas. The CompuMod and Daugirdas methods of assessment of Kt/V were significantly lower (p less than 0.001) than the prescribed Kt/V, whereas the Jindal-Goldstein estimate was not. The authors conclude that dialysis patients rarely achieve their prescribed Kt/V. The service Kt/V, therefore, is not a useful parameter for prescribing dialysis therapy. The CompuMod and Daugirdas methods are the best estimates of the Kt/V, while the Jindal-Goldstein equation overestimates the Kt/V. The need for frequent urea kinetic modelling is stressed. An online urea monitor for each dialysis would be the ideal solution.

The influence of dialysis membrane upon protein catabolic rate.

It has been hypothesized that the protein catabolic rate (PCR) is dependent upon the amount [Kt/V (urea)] and the type of dialysis (synthetic vs. cellulosic membrane). In an ongoing multicenter study comparing short hour-high flux with conventional cellulosic dialysis, 49 patients have completed 6 months and serial urea kinetic data has been obtained. Of the 49, 28 were on AN69S membrane dialyzers, and 21 on cellulosic. The patients on AN69S received significantly less Kt/V than those on cellulosic dialyzers (0.97 +/- 0.3 vs. 1.20 +/- 0.2; p = 0.0016), yet attained similar PCRs (1.07 +/- 0.2 vs. 1.02 +/- 0.1, NS). Significant (p = 0.002) linear relationships between PCR and Kt/V (urea) were found, yet the line slopes were higher for AN69S (average 0.46) than cellulose (average 0.25). Patients on AN69S achieve the same PCR for less Kt/V than patients on cellulosic dialyzers, supporting the hypothesis.

A multicenter study of short hour dialysis using AN69S. Preliminary results.

A multicenter prospective study of short hour (SH, less than or equal to 3 hr) dialysis using a high flux membrane (AN69S) plus volumetric control (VC), versus conventional (greater than or equal to 4 hr) (CNV) cellulosic non-VC dialysis, is ongoing. The study hypothesizes that SH treatment over 1 year will provide adequate dialysis, will not increase morbidity, and may improve quality of life. To date, 112 patients have been entered, and 54 have completed 6 months, 30 by SH. There were no differences in biophysiologic parameters at 6 months. Mean hospitalization was 5.24 days per patient. The SH group had a higher (p = 0.0374) hospitalization rate because of two patients. Quality of life was similar in SH and CNV groups. The study indicates that SH dialysis is feasible, safe, and as comfortable as CNV.

Peripheral laser angioplasty with sapphire tip.

UNLABELLED: To improve the result of peripheral laser recanalization (less perforation with wider tunnels of vaporization), we used the technique of sapphire laser angioplasty. A Nd:YAG laser with continuous emission was connected to a catheter with a 600 mum fiber and a sapphire probe to its extremity (1.8-3 mm in diameter). Treatment was performed on 127 patients with severe stenosis or occlusion of peripheral arteries (iliac, femoral, or popliteal arteries). Recanalization was obtained in 102 cases (80%) and was further embellished by balloon dilatation. The rate of success decreased proportionally with the length of occlusions (93% for 3 cm, 33% for 15 cm and more). Most failures were due to wall perforation or wall entry of the probe; passage of the sapphire tip was rarely blocked by the occlusion. At follow-up, 26.4% of arteries were reoccluded after 2 months. IN CONCLUSION: laser angioplasty with a sapphire tip can totally recanalize occluded arteries with low rate of failure and complications.

Percutaneous transvenous caval interruption with the "LGM" filter: early results of a multicenter trial.

From September 1985 to December 1986, 100 patients undergoing percutaneous placement of a transvenous "LGM" caval filter were included in a multicenter prospective trial. Peripheral venograms completed by pulmonary arteriography or scintigraphy were obtained for all patients. Eighty-five patients had experienced pulmonary embolism, 59 had iliocaval thrombosis, while 40 had venous thrombosis confined to the lower limbs. In two instances, insertion or passage of the catheter was impossible. Ninety-eight "LGM" filters were placed percutaneously through the internal jugular vein, 82 of which were correctly positioned in the infrarenal inferior vena cava. Eight filters were positioned with a tilt of more than 15 degrees with respect to the vertical axis, five failed to open correctly, and three were incompletely open and tilted. No postoperative deaths were observed; there were two recurrent embolisms, and seven caval thromboses occurred during the year that followed insertion of the filter. The "user-friendliness" and efficacy of this percutaneous filter makes it a treatment of choice in the partial interruption of the inferior vena cava.

[The new LEM caval filter in the prevention of pulmonary embolism. Preliminary results of a French multicenter study]. / Le nouveau filtre cave LEM(1) préventif de l'embolie pulmonaire. Résultats préliminaires d'une étude multicentrique française.

Preliminary results are reported of a prospective multicenter trial of a new caval filter (LEM*) implanted by the percutaneous jugular route in 100 patients, 55 men and 45 women, mean age 67 +/- 13 years, to produce partial interruption of inferior vena cava (IVC). Of the 100 attempts to insert the LEM* filter, 2 failures to catheterize the jugular vessel were reported, 98 filters being placed in the IVC with 82 implantation considered adequate. Of the remaining 16 cases, the filter was inclined (7 cases) or incompletely open (9 cases) with total lack of success in 3 cases. Overall efficacy was obtained therefore in 95 cases. Follow up included 94 patients seen after one week, 63 after 3 months and 10 after 6 months: 3 embolic recurrences were noted (3.2%) of cases. None of the 8 deaths reported was related to the thromboembolic disease. Standard frontal abdominal radiographic images showed migration of filter in 13 cases (13.7%) not exceeding the height of a vertebral body: 9 were caudal and 4 proximal, the LEM* filter remaining within the IVC. Phlebocavography in 90 cases showed the IVC to be permeable in 84 cases (93.3%). Incomplete opening or inclination of filter had no effect on the course. These findings demonstrate that the advantages of the LEM* filter include: a percutaneous introduction allowing rapid, certain insertion, and a form studied for limitation of inclination and avoidance of perforation of the IVC.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of femoro-popliteal thrombosis by peripheral angioplasty. Value of the laser]. / Le traitement des thromboses fémoro-poplitées par angioplastie périphérique. Intérêt du laser.

In a series of 197 dilatations of the peripheral arteries performed over a 5-year period (1980-1985), 38 concerned complete thrombosis (less than 12 cm long) of the femoral and popliteal arteries. While in patients with femoral stenosis (n = 49) the primary success rate was 95 p. 100 with an annual recurrence rate of 8 p. 100, in patients with complete thrombosis the primary success rate was only 52 p. 100, and the recurrence rate was 30 p. 100 at 6 months. Such results would justify the use of new therapeutic methods. Percutaneous laser thermal angioplasty is now being evaluated, and it appears that the primary success rate is considerably increased by combined laser and balloon angioplasty. Recurrences raise a much more complex problem and require a multifactorial management with improved dilatation techniques, anti-platelet or anticoagulant treatment, abstention from smoking and close surveillance.

Are physical properties of totally implanted systems modified by long-term chemotherapy? Preliminary results.

The physical properties of totally implanted systems for long term chemotherapy were tested before and after in vitro and in vivo chemotherapy. The results show that the drugs used (Cisplatin, Vinblastine and Bleomycin) did not alter the mechanical and microscopic properties of the catheter walls. Although the results cannot be extrapolate to others antineoplastic agents, they confirm the usefulness of the systems for long-term chemotherapy.

[Early detection of myocardial alterations in mitral insufficiency with the angiotensin test]. / Dépistage précoce des altérations myocardiques de l'insuffisance mitrale par le test à l'angiotensine.

Left ventricular function was assessed at rest and after increasing systemic arterial resistance by angiotensin in 40 patients with isolated mitral insufficiency. Angiotensin was administered intravenously at a dose of 0,4 micrograms/mn until the systolic blood pressure rose by at least 30 mm Hg. Left ventricular and aortic pressures, cardiac index and left ventriculography in the 30 degree right anterior oblique projection (50 frames per second) were recorded before and during angiotensin infusion. The mean rise in systolic left ventricular pressure was 40 +/- 2,8 mm Hg; the heart rate increased slightly but significantly; left ventricular and diastolic pressure rose from 12,0 +/- 1,0 to 24,0 +/- 1,2 mmHg. The systolic index (Fick's method) was significantly decreased (37 +/- 1,6 ml/m2 to 26 +/- 1,6 ml/m2) though the angiographic systolic index remained unchanged. This is explained by an increase in the regurgitant fraction (51 +/- 2,5% ao 65 +/- 3%). The end diastolic volume index was unchanged; the ejection fraction was significantly decreased. The resting hemodynamic status was only slightly disturbed in 29 patients (mean capillary pressure less than 15 mm Hg, 8,8 +/- 0,52 mmHg). The left ventricular function curves with angiotensin distinguished two groups of patients: Group A (20 patients) with left ventricular dysfunction induced by angiotensin, Group B (9 patients) who maintained the systolic index despite the increase in left ventricular end diastolic pressure. These results suggest that the angiotensin test may be useful for detecting early left ventricular dysfunction in patients with isolated mitral insufficiency and virtually normal resting hemodynamic parameters.