TIMMA : échelle échographique de la surcharge athéromateuse en carotide pratiquée par des neurologues vasculaires

BackgroundCarotid atherosclerosis is a powerful predictive factor of vascular risk at the individual patient level. Ultrasonography is a reference technique for the evaluation of this condition. However, its use in common practice remains difficult due to a lack of standardization and inter-operator variability. We present a new and simple technique for the assessment of carotid atherosclerosis; and evaluate the ability of vascular neurologists to obtain results consistent with those of an expert in vascular ultrasound.Material and methodsThe TIMMA scale is an acronym for the five classes of carotid atherosclerosis in French, VIMMA in English: very important, important, moderate, minimal and absent. Combined, the first two classes make up the group “significant atheroma” and the last three classes make up the group “no significant atheroma”. This scale was evaluated in 38 patients (76 carotid arteries) suffering from ischemic stroke or transient ischemic attack by five operators who are competent in carotid echocardiography: one TIMMA-trained (40 hours of training) vascular neurologist physician (VNP), three VNPs informed on the measurement method (1 hour of information) and one specialized vascular physician (SVP) who was considered to be the reference examiner. We evaluated the concordance between the VNPs and the SVP in classifying patients, firstly into the significant or not atheroma group and, secondly, into the five TIMMA classes.ResultsThe evaluation of the two-group clustering scale found a concordance between the informed VNPs and the SVP on 76 carotid arteries of 86% (kappa = 0.7) and between the trained VNP and the SVP on 58 carotid arteries of 90% (kappa = 0.8). The positive and negative predictive values for significant atheroma diagnosis were 100% and 81%, respectively, for the informed VNPs, and 100% and 80% for the trained VNP. The evaluation of the Five-Class Scale showed a concordance between the informed VNPs and the SVP of 46% (kappa = 0.3), and between the trained VNP and the SVP of 74% (kappa = 0.7).ConclusionTIMMA allows VNPs who are competent in carotid ultrasonography to reproducibly identify subjects with significant carotid atheroma. The contribution of this scale to the determination of cardiovascular risk should be evaluated.     

Représentations de l’hypertension artérielle : étude exploratoire en France

Aim of the studyNon-adherence to treatment is one of the problems practitioners face with regard to hypertension. This lack of compliance is often attributed to disease representations. Understanding their nature can therefore help to better target therapeutic education messages and thus, increase compliance.MethodIt is in this context that the « groupe infirmiers et acteurs de la SFHTA » initiated a qualitative exploratory study of the representations of arterial hypertension in France. The study covered three sites: Bordeaux, Lyon and Nancy. Interviews with patients were conducted by the members of the group. Questions included the disease definition, its causes and consequences. The interviews were recorded and transcribed verbatim; they were analyzed with Nvivo pro® 11 software.ResultsHTA is discovered accidentally. Patients define the disease according to their experience of symptoms, their perceptions of risks and the disease's consequences. The thresholds of systolic and diastolic blood pressure are unknown; most of the patients ignore their levels of both systolic and diastolic blood pressure. Besides, the fluctuating levels of blood pressure and conflicting messages about “lifestyle” generate confusion. HTA remains associated with stress. Regarding the burden of the disease, having to take a daily medication engendered anxieties, before being integrated into daily routines. The study also showed that patients have the desire to “pay attention” to their diet primarily.ConclusionThis study showed the need to strengthen the training of health professionals and harmonize educational messages, which would allow patients to integrate new recommendations without stress.