Évaluation de la formation à l’endoscopie digestive sur modèle animal « EASIE »

Aim

Training in the performance of endoscopic procedures is very heterogeneous even today from a center to other in spite of different training methods available. The aim of the study is to assess the effectiveness of “EASIE” models on getting endoscopic skills. Materials and methods: Our study is a forward-looking study randomized in two arms, aiming at comparing the training of diagnosis endoscopy by classic way on endoscopic suite versus that on animal model “EASIE”, through training sessions of two groups of physicians, novices in endoscopy.

Results

Comparison of every group to itself before and after training sessions shows a significant improvement of physicians. At the end of the project, physicians of the group trained on “EASIE” model were significantly more skillful than the others.

Conclusions

It seems necessary to homogenize physicians training whatever is the endoscopy center where they evolve. Learning on “EASIE” models seems to be an excellent procedure of training in endoscopy which allows to acquire quickly an autonomy. We suggest adding it systematically to the basic training of all gastroenterologists.     

Évaluation des freins à la pratique de l’activité physique chez les patients porteurs d’une sclérose en plaques, étude qualitative à partir d’entretiens semi-dirigés

Objective

Despite the demonstrated positive effects of physical activity on multiple sclerosis (MS) symptoms, very few MS patients have a regular exercise practice. The aim of this study is to assess barriers to exercise in MS patients with mild disability.

Method

A qualitative study based on semi-structured interviews with seven MS patients was conducted.

Results

Numerous reasons for poor adherence to physical activity in MS patients were found, including personal, social, environmental, and psychological reasons and physical restrictions related to the disease itself. The overall results confirm that fatigue is the most frequently reported limitation for physical activity. However, the data suggest that barriers are not the same for physically active and less active individuals. Physically active patients have less barriers than others.

Conclusion

Regular practice of physical activity for MS patients is a complex and individual process. Healthcare professionals may play a pivotal role to develop strategies to help MS patients overcome barriers. They must take into account all of the barriers for every patient. Further qualitative studies are needed to confirm these results.     

L'ordre « ne pas réanimer » en soins intensifs. Aspects éthiques et position du Conseil d'éthique clinique des hôpitaux universitaires de Genève (Suisse)

The order NTBR (“Not To Be Resuscitated”), or DNR (“Do Not Resuscitate”), or DNAR (“Do Not Attempt a Resuscitation”) is totally specific. It is a medical order prescribing not to begin a cardiopulmonary resuscitation (CPR) when a cardiac and/or respiratory arrest has occurred. This order must not be confounded with the orders to limit or to terminate vital treatments (“withholding” and “withdrawing”), particularly in the intensive care setting. The Clinical Ethics Committee of the University Hospital of Geneva (Switzerland) has recently published guidelines on the DNR order. Essentially, in this text, the authors put the emphasis on the exceptional importance of such an order, which must be written and periodically actualized. This order is ethically acceptable when a competent patient refuses to be submitted to a CPR, or when a patient is severely ill and close to his death. In this latter situation, it is not necessary to discuss this order with the patient, but his expectations and wishes must be discussed however. An information for young physicians concerning DNR orders must be organized by the hospitals.     

Étude de l’effet antidiabétique des saponines extraites d’<Emphasis Type="Italic">Anabasis articulata</Emphasis> (Forssk) Moq,plante utilisée traditionnellement en Algérie

Anabasis articulata is a plant used by Algerian traditional medicine as a remedy for the treatment of diabetes. The aqueous extract was found to be non-toxic until at 1,000 mg/kg during period (24 and 72 hours). Experiments were performed in non-diabetic mice, and in diabetic mice (alloxan treated mice). Our results showed that the orally administration at a dose of 400 mg/kg decreased the glycaemia to 29.89% (p < 0.05), 6 hours after administration, corresponding to the greatest decrease of blood glucose in normoglycaemic mice (hypoglycemic effect). They also show that orally administration at 400 mg/kg decreased the glycaemia to 74.48% (p < 0.05) 21 days after treatment. Phytochemical screening exhibited that the aqueous extract contains alkaloid and saponin components with percentage 1.25 and 1.30%, respectively. Our findings displayed that saponin (at 5 mg/kg) was the active fraction, as it permitted to restore the normal blood glucose levels, after 21 days of treatment, and that the alkaloid fraction did not significantly reduce the blood glucose level. The present study shows the no toxic effect in sub-acute administration and to confirm the anti-diabetic traditional use of Anabasis articulata. With active support in saponin’s triterpenoids compounds.