Dissociation des réponses cardiorespiratoires et neuromusculaires à l’exercice à la suite de 4 semaines de réentraînement à l’effort chez des patients cardiaques

Previous studies showed that changes in peak of oxygen uptake value (VO_2peak) with training were poorly related to changes in Maximal Tolerated Power output (MTP) among patients with cardiovascular disease. This result could be due to a difference between cardiopulmonary adaptation to training and the skeletal muscle conditioning.ObjectiveThe aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters.MethodsNine cardiac patients (64.0 ± 3.1 y, 172.9 ± 4.8 cm, 83.4 ± 16.3 kg, BMI: 27.8 ± 4.5) performed an incremental cycling exercise test to determine MTP, VO_2peak and peak values of heart rate, before and after an aerobic training. Ventilatory thresholds were respectively determined as the breakpoint in the curve of carbon dioxide output against oxygen uptake plot (VT₁) and the point at which the ratio of minute ventilation to carbon dioxide output starts to increase (VT₂). EMG_th1 and EMG_th2 were defined as the first and the second breakpoints in the rms-EMG – power output relationship.ResultsShort-term exercise training (23.7 ± 8.8 days) induced a significant increase in VO_2peak (P = 0.004), MTP (P = 0.015), VT₁ (P = 0.001) and VT₂ (P = 0.001). Changes in VO_2peak only attained the survival criteria (3.5 ± 2.9 mL min⁻¹ kg⁻¹). No significant differences (P > 0.05) existed between mean power values of VT₁ and EMG_th1 (60.5 ± 4.1 vs. 59.2 ± 9.6% of MTP, respectively), or between VT₂ and EMG_th2 (78.3 ± 5.7 vs. 80.2 ± 5.2% of MTP). After training, EMG_th1 occurred significantly before VT₁ (60.5 ± 6.2 vs. 64.8 ± 4.8% of MTP, P = 0.049).ConclusionThis might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients.     

Corrélation entre les notes obtenues aux ECOS et aux épreuves de connaissances et analyse des facteurs associés à une meilleure réussite aux ECOS chez les étudiants de DFASM1 et 2 au CHU de Dijon

RationaleObjective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital.MethodsThis was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021–2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R).ResultsOf 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r = 0.39, P < 0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy.ConclusionOur results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills.     

Facteurs associés à la non-observance chez les hommes et chez les femmes hypertendus non contrôlés : étude ODACE

ObjectivesThe aim of this study was (1) to measure adherence in males and females with uncontrolled hypertension, and (2) to identify factors associated with non-adherence to antihypertensive medication.Patients and methodsEach general practitioner (GP) should include the first two male and the first two female patients with uncontrolled treated hypertension. Adherence to antihypertensive treatment was estimated by the GP and using the French League Against High blood pressure (FLAH) self-administered questionnaire. A stepwise logistic regression analysis was used to identify factors associated with non-adherence on the FLAH scale, independently in males and in females.ResultsA total of 1630 males and 1612 females were included in the analysis. Adherence to treatment was significantly better in females or when estimated by the GP. Lack of motivation was the first factor associated with poor adherence in both sexes. Considering hypertension as a simple anomaly and not a disease that can lead to cardiac or cerebral disorders was the second common parameter in both sexes. Other common factors were: having monthly periods of financial difficulties in facing his/her needs and absence of regular screening for colon cancer.ConclusionAdherence to treatment is better in uncontrolled hypertensive females. Poor adherence is mainly associated with non-clinical factors. The lack of motivation is the most important element.