Satisfacción de pacientes y profesionales con las nuevas tecnologías de imagen tridimensional aplicadas a la medicina / Patient and healthcare professional satisfaction with 3D imaging new technologies for medical purposes

ANTECEDENTES Y OBJETIVOS: Gracias a los avances en el campo del escaneado tridimensional (3D) existen instrumentos capaces de generar imágenes con utilidad en medicina. Por otra parte, los estudios de satisfacción ganan cada vez más importancia para evaluar la calidad en la asistencia. Nuestro objetivo es valorar la satisfacción de los pacientes con el uso de un escáner 3D aplicado a las malformaciones de la pared torácica, así como de los profesionales implicados en su uso. MATERIAL Y MÉTODOS: Se han desarrollado encuestas de satisfacción para pacientes y profesionales que han completado pacientes sometidos a escáner 3D en el contexto de un estudio para validar los resultados obtenidos con esta nueva tecnología. Se han obtenido los estadísticos descriptivos de los resultados obtenidos. RESULTADOS: Se han incluido 42 pacientes y 10 profesionales. Los pacientes evalúan de manera positiva la velocidad y la inocuidad. La media de satisfacción global es de 4,71 en una escala del 1 al 5. Entre los profesionales, la satisfacción es inferior, sobre todo en lo que respecta al tratamiento de la imagen. La media de satisfacción global es de 3,1. CONCLUSIONES: Los pacientes evaluados tienen una buena aceptación y satisfacción con la tecnología de escaneado 3D. No ocurre lo mismo con los profesionales, ya que debido a la dificultad de tratamiento de la imagen y a la falta de familiaridad con el sistema presentan una satisfacción menor. Son necesarios avances en la difusión y simplificación de esta tecnología para aprovechar al máximo su potencial

BACKGROUND AND OBJECTIVES: Advances in the field of three-dimensional scanning have enabled the development of instruments that can generate images that are useful in medicine. On the other hand, satisfaction studies are becoming increasingly important in the evaluation of quality in healthcare. We aimed to evaluate patients' and professionals' satisfaction with the use of a three-dimensional scanner applied to chest wall malformations. MATERIAL AND METHODS: In the framework of a study to validate the results of three-dimensional scanning technology, we developed questionnaires to measure satisfaction among patients and professionals. We analyzed the results with descriptive statistics. RESULTS: We included 42 patients and 10 professionals. Patients rated the speed and harmlessness positively; the mean overall level of satisfaction was 4.71 on a scale from 1 to 5. Among professionals, the level of satisfaction was lower, especially with regards to the treatment of the image; the mean overall level of satisfaction was 3.1. CONCLUSIONS: Patients rated 3D scanning technology highly, but professionals were less satisfied due to the difficulty of treating the images and lack of familiarity with the system. For this technology to reach its maximum potential, it must be simplified and more widely disseminated

Patient and healthcare professional satisfaction with 3D imaging new technologies for medical purposes. / Satisfacción de pacientes y profesionales con las nuevas tecnologías de imagen tridimensional aplicadas a la medicina.

BACKGROUND AND OBJECTIVES: Advances in the field of three-dimensional scanning have enabled the development of instruments that can generate images that are useful in medicine. On the other hand, satisfaction studies are becoming increasingly important in the evaluation of quality in healthcare. We aimed to evaluate patients' and professionals' satisfaction with the use of a three-dimensional scanner applied to chest wall malformations. MATERIAL AND METHODS: In the framework of a study to validate the results of three-dimensional scanning technology, we developed questionnaires to measure satisfaction among patients and professionals. We analyzed the results with descriptive statistics. RESULTS: We included 42 patients and 10 professionals. Patients rated the speed and harmlessness positively; the mean overall level of satisfaction was 4.71 on a scale from 1 to 5. Among professionals, the level of satisfaction was lower, especially with regards to the treatment of the image; the mean overall level of satisfaction was 3.1. CONCLUSIONS: Patients rated 3D scanning technology highly, but professionals were less satisfied due to the difficulty of treating the images and lack of familiarity with the system. For this technology to reach its maximum potential, it must be simplified and more widely disseminated.

[Impact on the indoor environment of allergic children of the medical counselor on indoor environment, after two successive visits at 6 months interval]. / Impact sur l'habitat de l'enfant atteint d'une affection respiratoire allergique du conseiller médical en environnement intérieur après deux visites successives à 6 mois d'intervalle.

BACKGROUND: The aim of this retrospective study was to assess the impact of a medical indoor environment counselor (MIEC) on the allergic child's indoor home environment, as well as the real-life experience of patients' families. METHODS: We enrolled 50 children (age, 4-18 years) with allergic respiratory illness (96 % asthmatics) from March 2011 to January 2012. During the first visit, the CMEI gave advice according to the results of the assessment. Home environmental exposures were assessed 6 months later. A satisfaction questionnaire was completed by the parents. RESULTS: We found a significant decrease in the presence of house dust mites (P = 0.0047), humidity, and molds (P = 0.0047) as well as volatile organic compounds (P = 0.0047). Smoking habits were not significantly changed (P = 0.083), nor was the presence of domestic pets (P = 0.3173). Over 74 % of the families were very satisfied with the CMEI's intervention. DISCUSSION: According to de Blay's study, a home visit by the MEIC increased compliance with mite reduction. The intervention to advise parents of asthmatic children on the risks of passive smoking was ineffective in reducing their children's exposure to environmental tobacco smoke. The advice given by the MEIC was better understood by the patients than that expressed by the medical teams. CONCLUSION: A targeted home-based environmental intervention increased the compliance to mite, humidity, and mold reduction. The role of the CMEI will undoubtedly develop: follow-up studies are necessary to justify their activity (cost-efficacy ratio of their intervention).

[Lemierre syndrome: a complication of an oropharyngeal infection]. / Syndrome de Lemierre : une infection oropharyngée compliquée.

We report a case of Lemierre syndrome in a healthy infant, initially presenting with otitis media and angina. Lemierre syndrome is a disease that every pediatrician must know. Early diagnosis and treatment with antibiotics are necessary to decrease mortality. A review of the history and the complications of Lemierre syndrome is presented.

[Experience of extensive screening of Mycobacterium tuberculosis transmission to patients exposed to a pediatrician]. / Expérience du dépistage à large échelle de la transmission de Mycobacterium tuberculosis par un pédiatre libéral à ses patients.

OBJECTIVE: This study reports the investigation of the patients of a private-practice pediatrician with smear-positive tuberculosis. METHODS AND PATIENTS: One thousand six hundred and fifty-six children were screened. Two screenings (T0 and 3 months later) were proposed, with a tuberculin skin testing (TST) and a chest radiograph. A T-cell-based assay was performed on children with intermediary values. RESULTS: No active tuberculosis was identified. Skin tests on 1171 children (83.1%) were negative on screenings. Nearly all chest radiographs were normal (96.9% on the initial screening, 98.8% on the 2nd). T-cell-based assays were negative. Of the 803 children younger than 2 years of age, 583 (72.6%) were directed to prophylaxis, children older than 2 years of age were treated based on the 2nd screening as latent tuberculosis infection. Sixty non serious side effects were reported 54 children, most of were digestive. Prophylaxis was stopped in 52 cases, in 22 cases a side effect. Compliance to the 2 visits was good (87.7%). CONCLUSION: This investigation concerning a large number of children confirms limited transmission of Mycobacterium tuberculosis from a pediatrician with smear-positive tuberculosis to pediatric outpatients. Coordination screening by the tuberculosis control section is essential. The T-cell-based assay could better correlate the contamination risk to the intensity and the length of exposure compared with TST and could avoid screening a large number of patients.

[Impact of rapid influenza test during influenza epidemic in all febrile children less than 6 years old in a pediatric emergency department]. / Intérêt du test de diagnostic rapide de la grippe aux urgences pédiatriques chez tout enfant âgé de moins de 6 ans et fébrile, en période épidémique.

AIM: To determine the impact of rapid influenza test (RIT) on the prescription of additional tests, antibiotics and oseltamivir, and the influence of oseltamivir on clinical signs and parents' day work stoppage. METHODS: Prospective study in the pediatric emergency department of Nice University Hospital from 29th January 2007 to 3rd March 2007 including children from 1 month to 6 years old with fever greater or equal to 38.5 degrees C for less than 48 h. Virologic research on nasopharyngeal aspiration was: immunofluorescence, cell culture and RIT Quickvue. Clinical informations, additional tests and treatments were registered for each child. An antiviral treatment (oseltamivir) was proposed to children older than 1 year with positive RIT. Evolution at 7 days was evaluated by phone contact. RESULTS: One hundred and seventy-seven children were included (mean age 24 months, sex-ratio 1.88). The RIT was positive in 42.3% (n=75). Compared with cell culture, the sensibility, specificity, positive predictive value and negative predictive value of the RIT were, respectively, 95.6, 91.6, 88 and 97%. Clinical signs significantly correlated to influenza were: impairment, rhinitis and acute otitis media. In the RIT positive group, there were significantly less additional tests (13 versus 36) and particularly urinalysis (5 versus 19), and more spreading in the family (p=0.0002). There was not any significant difference concerning hospitalizations, antibiotic prescriptions, or parents' day work stoppage. CONCLUSION: During influenza epidemic, in a pediatric emergency department, RIT allows a reduction of additional tests in febrile young children, particularly urinalysis.

[HIV exposure accidents in children. Experience at the emergency admission services of the CHU of Nice]. / Accidents d'exposition au VIH chez l'enfant. Expérience du service d'admission d'urgence du CHU de Nice.

UNLABELLED: Accidental exposure to human immunodeficiency virus (HIV), either by injury with a discarded syringe or after sexual abuse, increases among the children population. PATIENTS AND METHODS: The entire period of the study was seven-year. Twenty-eight children (14 males, 14 females) underwent three visits after an accidental exposure at Day 0, Day 30th and Day 90th. During each visit, a physical examination, liver enzymes, Ag P24, PCR-RNA HIV, B, C hepatitis serologies were performed. An antiretroviral prophylaxis was proposed when a high risk of HIV transmission was recognized. Anti hepatitis B globulins were administrated when no previous immunization had been made. RESULTS: The median age was 9.3 years (range: 1.5 to 16.7 years). 93% of the children consulted within 48 hours after exposure. Five of them consulted after a sexual aggression with penetration, two after a mucosus exposition and two after deep needle injuries. The source of the contamination was known in five cases. Nine patients were given an antiretroviral treatment for four weeks (seven bitherapy, two tritherapy), with no major side effects. Eighteen and 11 children were seen at the second and third visits, respectively. No case of HIV or HCV infection was observed. CONCLUSION: No case of infection after injury with a discarded syringe was found in our study. This situation differs from what is observed in health care workers, where the higher risk factor is observed. Even if no contamination was found after sexual aggression in our population, the risk of HIV is actual. This is why we propose an antiretroviral prophylaxis against HIV in only one indication, corresponding to sexual penetration.

Spirometry in children aged 3 to 5 years: reliability of forced expiratory maneuvers.

The aim of this study was to evaluate the feasibility and reproducibility of forced expiratory maneuvers during standard spirometric evaluation in preschool children. Among 570 young children attending our laboratory, we retrospectively selected 355 patients (14% 3-4-year-olds, 48% 4-5-year-olds, and 38% 5-6-year-olds) who carried out spirometric tests for the first time. The indications for such tests were history of asthma (70%), followed by chronic cough (20%) and other miscellaneous conditions (10%). Eighty-eight, 175, and 92 children performed one, two, and three acceptable tests respectively. Forced expired volume in 1 sec (FEV(1)) and forced vital capacity (FVC) did not differ significantly between attempts in children performing either two or three attempts. Forced expiratory time (FET), i.e., the total time required for the forced expiratory maneuver, was 1.7 +/- 0.1 sec (mean +/- SEM), and was no greater than 1 sec in 21.3% of all tested children. Consequently, FEV(1) does not appear to be well-suited to this age group. Forced expiratory volume in 0.50 and 0.75 sec (FEV(0.5), FEV(0.75)) were thus measured in the group of children performing three attempts (n = 92), and there was no statistical difference between attempts. In 267 children performing two or three tests, the ATS criteria of reproducing FEV(1) and FVC within

Churg-Strauss syndrome revealed by acute abdominal pain.

We describe a 10-year-old girl with Churg-Strauss syndrome, who presented with acute abdominal pain, bloody diarrhea, and pulmonary infiltrates. She had a 6-year history of severe asthma. Bronchoalveolar lavage showed marked eosinophilia. She responded well to high-dose intravenous corticosteroid pulse therapy for 3 consecutive days, followed by oral steroids without developing major side effects. This case should remind pediatricians of the rare existence of this vasculitis in children. Relapse is not uncommon, and long-term careful supervision is necessary.

[Value of thoracoscopy in purulent pleuresies in children younger than four years]. / Intérêt de la thoracoscopie dans les pleurésies purulentes de l'enfant de moins de quatre ans.

UNLABELLED: Video-assisted thoracoscopic surgery is widely performed in adults but there are few publications concerning the paediatric population. The objective is to effect optimal adhesiolysis of post-pneumonic loculated empyema with lower morbidity. PATIENTS AND METHODS: Over a 4-year period we used thoracoscopic debridement in five children younger than 4 years of age with loculated thoracic empyema. All patients failed initial treatment, including antibiotics and chest tube drainage. Early sonographic evaluation of the empyema organization guided the most appropriate moment for the intervention. The average duration of tube drainage after thoracoscopy was 4 days (range: 1 to 7 days). RESULTS: All patients made an uneventful postoperative recovery. At a follow-up visit 1 month after discharge, the children were clinically asymptomatic; however, some degree of pleural thickening was still visible on chest X-rays. CONCLUSION: In skilled hands, thoracoscopy is a safe procedure for post-pneumonic empyema in young children, providing a rapid clinical and radiological recovery with a good cosmetic result.