Perioperative administration of caffeine tablets for prevention of postoperative headaches

Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperative substitution of caffeine on the incidence of postoperative headache was evaluated Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. Daily dietary intake was calculated based on an average weekday consumption using conversion factors from previously published sources. The patients were instructed at the preoperative visit to abstain from all external sources of caffeine. Compliance with these dietary restrictions was verified by blood samples obtained immediately before the surgical procedure and on postoperative day 1. The patients were assessed for headache using a standardised checklist immediately before induction of anaesthesia, on the evening of the day of surgery and on the morning of postoperative day 1. Ten patients (50%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day 1. We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine     

The Dynamic Integrated Evaluation Model (DIEM): Achieving Sustainability in Organizational Intervention through a Participatory Evaluation Approach

Recently, there have been calls to develop ways of using a participatory approach when conducting interventions, including evaluating the process and context to improve and adapt the intervention as it evolves over time. The need to integrate interventions into daily organizational practices, thereby increasing the likelihood of successful implementation and sustainable changes, has also been highlighted. We propose an evaluation model—the Dynamic Integrated Evaluation Model (DIEM)—that takes this into consideration. In the model, evaluation is fitted into a co‐created iterative intervention process, in which the intervention activities can be continuously adapted based on collected data. By explicitly integrating process and context factors, DIEM also considers the dynamic sustainability of the intervention over time. It emphasizes the practical value of these evaluations for organizations, as well as the importance of their rigorousness for research purposes. © 2016 The Authors. Stress and Health published by John Wiley & Sons Ltd.     

Description des traitements immunosuppresseurs d’entretien post-greffe rénale à travers le système national de l’Assurance maladie

The aim of this study was to describe the drug dispensing of maintenance immunosuppression treatment in 2014 for patients who received a kidney transplant in 2012, based on the data of the French national health insurance and to compare those results with the information collected in the national database for kidney recipients. For each patient, are considered all drugs dispensing with their dates of issue, the molecules and their presentations (number of pills and dosage). Among 2463 transplanted adults in 2012, 73% have received tacrolimus monohydrate, 59% mycophenolate mofetil, 54% prednisone and 20% cyclosporin in 2014. The daily doses but not the number of tablets per day declined with age. The most frequent association was tacrolimus monohydrate-mycophenolate mofetil-steroids in 34% of the cases. The use of mTOR inhibitors, rare generally (7%), is more common in patients aged 66–85 years. Associations did not differ significantly according to diabetic status, for patients with a kidney from an elderly donor or according to the number of mismatch. The daily doses estimated from the deliverance in pharmacy are respectively similar, understated and over-estimate for tacrolimus, mycophenolate mofetil and cyclosporin compared to the national database. This study confirms the difficulty of apprehending drug consumption based only on dispensing in pharmacies or punctual recording even if it allows a fairly comprehensive view of French practices.     

Colonialisme et handicap : la situation des aveugles dans l’Algérie colonisée

Our article analyses the mode of assistance to the blind in Algeria from the beginning of the 20th century until the Declaration of Independence of the country (1962). If Moslem blinds face discriminatory practices, all the blind – French citizens and subjects – are victims of unequal treatment because they are not entitled to the social measures granted to the blind in mainland France. Nevertheless, during the first decades of the 20th century, many actors travel between mainland France and the Algerian colony and introduce on the Algerian territory innovating practices developed in mainland France (Braille schools for the blind, eye clinics, promotion of manual work). They thus disrupt traditional practices of assistance to the blind, which are intrinsically related to Islam. Moreover, we want to underline the agency of the blind in the context of colonial Algeria, since blind association leaders take part in the colonial policy making of assistance to the blind. From the 1930s, they start to claim the equality of rights of the blind of Algeria with those of mainland France. This research allows to reflect on the construction of the citizenship of the blind in a colonial context.     

Colonialism and disability: The situation of blind people in colonised Algeria

Our article analyses the mode of assistance to the blind in Algeria from the beginning of the 20th century until the Declaration of Independence of the country (1962). If Muslim blinds face discriminatory practices, all the blind – French citizens and subjects – are victims of unequal treatment because they are not entitled to the social measures granted to the blind in metropolitan France. Nevertheless, during the first decades of the 20th century many actors travel between metropolitan France and the Algerian colony and introduce on the Algerian territory innovating practices developed in France (Braille schools for the blind, eye clinics, promotion of manual work). They thus disrupt traditional practices of assistance to the blind, which are intrinsically related to Islam. Moreover, we want to underline the agency of the blind in the context of colonial Algeria, since blind association leaders take part in the colonial policy making of assistance to the blind. From the 1930's, they start to claim the equality of rights of the blind of Algeria with those of metropolitan France. This research allows to reflect on the construction of the citizenship of the blind in a colonial context.     

Construction sociale de la désignation des élèves à « besoins éducatifs particuliers » : incidences sur leur scolarisation et sur la formation des enseignants

The contributions to this special issue share the view that difficulties or disabilities reported among some students are – in their development, their expression and their designation – the result of a construction in context, not only cultural and social, but also in the family and the school. In this perspective, the emphasis is not put on these students as “individual bearers of symptoms” and disembodied from their environment, but on the situation or context in which the school activities take place. Contextual and situational characteristics can indeed facilitate the student activity by meeting his needs to perform his tasks and role in learning, but they can also, when they fail to do so, prevent their fulfillment, thus producing a situation of difficulty or a situation of schooling disability. In terms of educational intervention, this contextual reading is susceptible to be translated in a particular posture from the teacher or other school partners, as well as the implementation of practices adapted to the needs of students and professionals. Further understanding of the mechanisms of occurrence of these situations of difficulty or disability, evaluate these needs and identify promising practices were the objectives of researchers who met in a symposium of the Réseau Éducation et Formation (REF) in autumn 2011.     

Dietary recommendations in the prevention and treatment of osteoporosis

IntroductionThis article presents the initial recommendations of the French Rheumatology Society (Société Française de Rhumatologie – SFR) and the Osteoporosis Research and Information Group (Groupe de Recherche et d’Informations sur les Ostéoporoses – GRIO) on the role of diet in the prevention and treatment of osteoporosis.MethodsThe recommendations were produced by a working group composed of rheumatologists, physician nutrition specialists and a geriatrician. Fifteen (15) questions pertaining to “daily practices” were preselected by the working group. For the literature review, the working group focussed mainly on the effects of diet on bone mineral density (BMD) and fractures, and primarily on meta-analyses of longitudinal studies and dietary intervention studies.ResultsA Mediterranean-type diet and the daily consumption of 2 to 3 dairy products are recommended. Together, these provide the calcium and “high quality” protein required to maintain a normal calcium-phosphorus balance and bone metabolism, and are associated with lower fracture risk. Conversely, unbalanced Western diets, vegan diets, weight-loss diets in non-overweight individuals, alcohol consumption and daily consumption of sodas are advised against. In terms of the beneficial effects on bone mineral density and fracture risk, current scientific data are either insufficient or too divergent to recommend increasing or restricting the consumption of tea or coffee, vitamins other than vitamin D, vitamin D-enriched or phytoestrogen-rich foods, calcium-enriched plant-based beverages, oral nutritional supplements, or dietary sources of prebiotics and probiotics.ConclusionsThese are the first set of recommendations addressing the role of diet in the prevention and treatment of osteoporosis. More research is necessary to direct and support guidelines.     

The institutionalisation of peer support in France: Development of a social role and roll out of public policies

In France, the practice of peer support is currently developing and becoming institutionalised in health (particularly mental health), social and medico-social sectors. Despite significant shared values, a common background and a universal acceptance of experiential knowledge as the basis of their expertise, there is a diversification in practices. In a context where public health and social policies encourage the development of the social role of peer supporter and where funding is available for a number of salaried posts, some practitioners opt for a voluntary or informal system. This article aims to explore the varied ways in which the role has developed through an analysis of its institutionalisation process. To do this, data from two surveys will be analysed: one based on peer counsellors who set up an association under the law of 1901 and the other on peer-support workers from “Housing First”, an experimental public policy intervention programme. Two different processes of institutionalisation of the peer-support role emerge from the analysis: one which prioritises the development of a social role and the other the roll-out of public policy. Neither is yet sufficiently successful to guarantee the sustainability of the practices, owing to a lack of legitimation process or shortcomings in reciprocal typification. This situation has delayed the professionalisation of the peer-support role. It also raises two questions: that of the links between experiential knowledge and professional knowledge and that of the effects of a meeting of peer supporters who were hitherto isolated in their respective fields (health, mental health, disability, exclusion, addiction, etc.) and within their causes.     

Reevaluation of current transfusion practices in patients in surgical intensive care units.

Widespread interest in the complications associated with packed red blood cell (PRBC) transfusions has led to the scrutiny of traditional transfusion practices. Recently, attempts have been made to define more clearly the indications for PRBC transfusions in patients, particularly those who are critically ill. At present, however, transfusions continue to be ordered based on a hemoglobin level less than 10 g/dL. We report herein the impact on oxygen consumption of PRBC transfusions administered for a hemoglobin concentration less than 10 g/dL in 30 surgical intensive care unit patients who were euvolemic and hemodynamically stable. For the group as a whole, transfusion had a negligible effect on oxygen consumption. Fifty-eight percent of all such transfusions failed to change oxygen consumption by greater than 10% and could therefore be considered of questionable benefit.     

Compliance with HIPAA regulations: ethics and excesses

HIPAA regulations have been seen by many physicians as providing innumerable administrative hoops that require jumping through with no clear benefit for individual patients. Although this article has not comprehensively explored the requirements of HIPAA regulations, it has focused on the issues of "incidental disclosures" that are so important to the daily interactions of physicians and patients. Through the use of illustrative cases, it has been shown that HIPAA regulations frequently are based on well-accepted ethical principles. Although one should never conclude that changing something from an ethical responsibility to a legal responsibility makes it more important, there is no question that HIPAA regulations have forced physicians to consider more carefully how confidential information may be transmitted to others. As such, physicians should look on HIPAA regulations as largely supporting the use of professional judgment in providing good quality medical care. Although not all aspects of HIPAA are grounded in ethical practices, the overall thrust of the HIPAA regulations is consistent with the ethical practice of medicine and surgery. As a result of this general alignment of the legal and ethical requirements, more attention should be directed by physicians at using good judgment in deciding how to disclose private information, rather than adopting an unreasonable approach that confidentiality may never be breached. As Lo and colleagues have very appropriately pointed out: In the context of inadvertent disclosure, the legal risks of good practice are very low. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy. By adopting such an approach to HIPAA, physicians can abide by the regulations while maintaining high ethical standards and minimizing the impact of the new requirements on physician-patient relationships.     

Glycated haemoglobin (HbA1C) as an indicator of job strain

As a part of the WHO-initiated MONICA project 248, 50- and 60-year-old men participated in a study on the relations between HbA₁C (glycated haemoglobin) and job stress indicators. The participants answered a questionnaire on work, social and health conditions and underwent clinical examinations which included measurements of blood pressure, serum cholesterol, triglycerides, HDL and HbA₁C. Using the demand—control model for measuring job strain suggested by Karasek, we classified the employed participants according to those who had suffered job strain and those who had not. This was done in two different ways. The subjective classification was based on the participants' statements regarding demand and control in their job, whereas the objective one was based on job title, mode of payment, etc. The levels of HbA₁C were significantly higher among participants with objective job strain, high daily coffee consumption and low alcohol consumption. Coronary risk factors and subjective job strain did not correlate significantly with the level of HbA₁C.     

Abdominal compartmental syndrome in non-injured patients

Abdominal compartment syndrome (ACS) is characterized by increased intraabdominal pressure and a set of secondary pathophysiological changes in the abdominal. ACS has reappeared in the literature recently in relation to the surgical concept to damage control, applied particularity in contexts of severe abdominal injury polytraumatized patients. We report two cases of ACS that appeared after scheduled abdominal surgery: one after repair of a large eventration and the other in the context of septic shock due to fecaloid peritonitis. Both patients died of multisystem organ failure in spite of surgical decompression. We wish to emphasize that ACS can appear in contexts other than surgery for damage control, and we stress the need to measure intravesical pressure as a reflection of intraabdominal pressure, particularly in certain high risk patients in the postoperative recovery ward. Finally, we review the pathophysiology of ACS and its management, which is based on early treatment to prevent multisystem organ failure with an associated high risk of death.     

Renal protection

While considerable progress has been made in the understanding of renal injury in the context of major vascular surgery, successful strategies for providing renal protection still remain elusive. The literature is disappointingly unenlightening, as adequately powered clinical trials evaluating approaches to peri-operative renal protection are lacking. Consequently, a considerable proportion of commonly employed practices aimed at preserving the kidney are based on small studies, anecdotal information or personal experience. This chapter will attempt to summarize what actually is known about peri-operative renal injury, identifying patients who are at high risk and procedures that place patients at high risk, and reviewing the current practices for renal protection in those settings. We will then consider both theoretical and experimental approaches to preventing or attenuating renal injury in patients at risk. Finally, we will suggest techniques, based on the best available evidence, for providing renal protection for our patients undergoing major vascular surgery.     

Type of wine and risk of lung cancer: a case-control study in Spain

BACKGROUND: Few epidemiological studies have examined the effect of wine on the risk of lung cancer. A study was therefore undertaken to estimate the effect of wine consumption, both overall and by type of wine, on the risk of developing lung cancer. METHODS: A hospital based case-control study was conducted on 319 subjects (132 cases, 187 controls) in 1999-2000. All subjects were interviewed about their lifestyles with particular reference to alcohol consumption and tobacco use. The results were analysed using non-parametric logistic regression. The main outcome measure was the risk of lung cancer associated with consumption of wine and its individual types. RESULTS: A very slight but significant association was observed between the risk of lung cancer and white wine consumption (odds ratio (OR) 1.20 for each daily glass). Red wine consumption, on the other hand, had an OR of 0.43 (95% CI 0.19 to 0.96), with each daily glass of red wine having an inverse association with the development of lung cancer (OR 0.87 (95% CI 0.77 to 0.99)). There was no apparent association between lung cancer and consumption of beer or spirits. CONCLUSIONS: These results suggest that the consumption of red wine is negatively associated with the development of lung cancer. Further studies are needed to test this finding in cancer induced laboratory animals.     

A computer-based method of measuring facial asymmetry. Results from an assessment of the repair of cleft lip deformities

The appearance of the nose, mouth and nostrils was analysed in two series of unilateral, complete cleft lip patients. A programme was written for use on a BBC microcomputer to measure the symmetry of facial features traced from photographs. Symmetry was measured using one of two methods: determining the area of non-overlap when one side was reflected on the other (area method) or calculating the distance from regularly spaced points on the outline of one side to the nearest point on the reflection of the opposite side (curve method). The rankings of the photographs based on these results were compared with the subjective rankings given by a lay panel. The results based on the curve method agreed well with the subjective rankings (P for Spearman Rank Correlation Coefficients = less than 0.02). The technique provides a cheap, simple and quick method of comparing symmetry in groups of patients.     

Sedation and analgesia in the paediatric intensive care unit

Sedation and analgesia are a constant challenging issue in paediatric intensive care units, for ethical reasons among others. Basically, goals and available treatments in that context do not differ from those in adults. For instance, while we propose midazolam as the first choice benzodiazepine, there is no evidence for encouraging the use of one morphinomimetic rather than others in children. On the other hand, numerous paediatric specificities do exist: understanding and expression of pain both different and difficult, presence and involvement of the parents, pain assessment methods, pharmacology, pathologies. It is therefore mandatory to know these specificities to ensure a proper use of evaluation tools and therapeutics. The paucity of strong evidence from the literature does not allow producing definitive consensus guidelines. However, some practices can be highlighted such as the use of written protocol on pain/sedation evaluation and therapeutics adapted to children, literature data and local habits, the training of medical/nursing staff and the constitution of local referring team. A particular attention should be paid to propofol: its use longer than several hours should be strongly discouraged in infants and children due to the risk of Propofol Infusion Syndrome. Further clinical studies should be conducted in an attempt to provide answers to routine, daily issues and questions, for example, how to tailor the level of sedation to the needs of the patient, how to stop it, which drug must be preferred or what place for non-pharmacological approaches.     

泌尿外科诊疗工作中防控新型冠状病毒肺炎的建议

2019年12月武汉陆续出现新型冠状病毒肺炎(COVID-19)疫情并蔓延至全球多个国家和地区。为更好地增强泌尿外科医护人员防控工作的针对性和有效性,我们结合本专业临床诊疗工作特点及疫区防控措施和经验,起草了泌尿外科诊疗工作中防控新型冠状病毒肺炎的建议,以供泌尿外科医护人员参考。     

When the Living and the Deceased Cannot Agree on Organ Donation: A Survey of US Organ Procurement Organizations (OPOs)

The legal concept of first person authorization (FPA) is based on the principle that a decision by a person with decision‐making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web‐based survey of all 58 Organ Procurement Organization (OPO) executive directors in the United States to assess OPOs' procurement policies and practices in the context of family objections. All 58 respondents (100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs (89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was <10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.     

A historical review of selected nursing and medical literature on urinary incontinence between 1850 and 1976

The nursing and medical literature on urinary incontinence from 1850 to 1976 was reviewed to provide a historic perspective on care patterns before the current surge in interest in this common condition. Relevant nursing and medical journals and a number of textbooks from both fields were systematically examined to document the evolution of treatments and practices regarding urinary incontinence. Throughout the article, findings are examined in light of the broader historical context to reveal how and why practices were favored or disfavored at given times during the years under investigation. As expected, attitudes, values, and practices in the field reflected the state of knowledge and beliefs commonly held by nurses, physicians, and the general population.     

Treatment of recurrent urinary tract infections: efficacy of an orally administered biological response modifier

64 out-patients suffering from recurrent UTI were treated under double-blind conditions with one capsule daily of either the biological response modifier OM-8930 or the placebo for 3 months, followed by a 3-month observation period. Dysuria, bacteriuria, leucocyturia and antibiotic or chemotherapeutic consumption showed a significant reduction under OM-8930 in comparison with the placebo. As to the tolerance, a single case of allergic exanthema on the neck was observed in the OM-8930 group. Both the curative efficacy in the acute crisis and the consolidative efficacy in preventing further recurrences showed a highly significant superior effect of OM-8930 with respect to the placebo.