Manipulation de l’anabolisme au cours des états d’agression

The metabolic response to stress could lead to malnutrition which, by increasing the patient’s susceptibility to infection, will major the stress situation. In first instance, this is related to the mobilisation and progressive depletion of body stores. As artificial nutrition can theoretically substitute for body stores, various approaches have been proposed in order to favour anabolism or to dampen catabolism. Assuming that patient requirement are adequately met, different studies have evaluated the interest of specific nutrients (pharmaconutrients such as glutamine, arginine and their derivatives/precursors) or of specific anabolic hormones (growth hormone, insulin, anabolic steroids) which have been demonstrated to positively influence nitrogen metabolism either in the healthy man or in experimental model of hypercatabolism. A survey of the literature shows that beside sometimes significant anabolic effects in terms of protein gain, functional benefits are often limited. Moreover, it is frequently the improvement of immune status which comes forward and benefits to the patient.     

Contamination fongique de l’alimentation des patients d’onco-hématologie

ObjectiveThe aim of our study was to evaluate the level of fungal contamination of food served to patients in the hematology unit of Farhat Hached hospital, Sousse (Tunisia).MethodsWe analyzed 159 food served to 90 patients during the post-chemotherapy aplasia period.ResultsThe overall rate of fungal contamination was 66.6%. Fruits and green salads’ contamination was very high (90 and 100%, respectively). Aspergillus species were the most frequent (48.4%) followed by Candida (25.1%), Penicillium (22%), Rhizopus (17.6%) and Cladosporium (17%). The presence of Aspergillus on fruits (66.6%) represents a real source of contamination by inhalation of spores and the presence of Candida (25.1%) in any type of food is a source of gastrointestinal colonization.ConclusionThe diet of neutropenic patients should be submitted to a strict surveillance to reduce the risk of fungal infections of food.     

Prise en charge d’un patient adulte atteint de mucoviscidose

The authors describe the case report of a patient with cystic fibrosis. The nutritional management is discussed during the different stages of disease treatment and progression.     

Dépister la dénutrition de l’enfant

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. PEM increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Paediatric Society recommends weighing and measuring any child when hospitalized or seen as outpatients. Body mass index (BMI) must be calculated and analyzed according to references anytime growth kinetics cannot be analyzed. Any child with a BMI below the third centile or –2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an aetiology, and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing a nutritional strategy along with the global care plan. A target weight needs to be determined as well as the quantitative, qualitative and modality of nutritional care. This plan must be evaluated afterwards in order to adapt nutritional therapy.     

Intérêt de la détection et de la prise en compte d’une surdispersion dans un modèle de Poisson : illustration à partir d’un exemple

BackgroundResearchers often use the Poisson regression model to analyze count data. Overdispersion can occur when a Poisson regression model is used, resulting in an underestimation of variance of the regression model parameters. Our objective was to take overdispersion into account and assess its impact with an illustration based on the data of a study investigating the relationship between use of the Internet to seek health information and number of primary care consultations.MethodsThree methods, overdispersed Poisson, a robust estimator, and negative binomial regression, were performed to take overdispersion into account in explaining variation in the number (Y) of primary care consultations. We tested overdispersion in the Poisson regression model using the ratio of the sum of Pearson residuals over the number of degrees of freedom (χ²/df). We then fitted the three models and compared parameter estimation to the estimations given by Poisson regression model.ResultsVariance of the number of primary care consultations (Var[Y] = 21.03) was greater than the mean (E[Y] = 5.93) and the χ²/df ratio was 3.26, which confirmed overdispersion. Standard errors of the parameters varied greatly between the Poisson regression model and the three other regression models. Interpretation of estimates from two variables (using the Internet to seek health information and single parent family) would have changed according to the model retained, with significant levels of 0.06 and 0.002 (Poisson), 0.29 and 0.09 (overdispersed Poisson), 0.29 and 0.13 (use of a robust estimator) and 0.45 and 0.13 (negative binomial) respectively.ConclusionDifferent methods exist to solve the problem of underestimating variance in the Poisson regression model when overdispersion is present. The negative binomial regression model seems to be particularly accurate because of its theorical distribution ; in addition this regression is easy to perform with ordinary statistical software packages.     

Approche terminologique de l’engagement des patients : point de vue d’un établissement de santé français

BackgroundThe establishment of a common pragmatic terminology represents the first step in structuring patient engagement initiatives in healthcare facilities. However, none is currently available in French. As part of the deployment of patient engagement within a French University Hospital Center, we propose a terminology of patient engagement.MethodsWe conducted a scoping review of the international literature that aimed at identifying the main conceptual and terminological frameworks for the engagement of patients, users and citizens in the healthcare system until 2019 in the PubMed and Cairn.info databases for English and French language articles. Additionally, we identified concepts and practices in the leading organizations of countries where this approach was implemented (United States, Canada and especially the province of Quebec, United Kingdom) and completed this approach by close exchanges and reflections with the team that developed the Montreal model.ResultsIn total, 75 references and Internet resources were consulted. Patient, interaction, patient experience, experiential knowledge, patient engagement, patient partner and its variations as a resource patient, peer-supporter, trainer, researcher and coach have been defined.ConclusionThis terminology of patient engagement proposes an initial stabilization of the vocabulary, using a pragmatic approach. This contribution is a first step aiming at promoting the development of a new model of care and more broadly of healthcare system management, involving scientific and experiential knowledge.