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S. Vernaz L. Casanova F. Blanc S. Lebel F. Ughetto O. Paut 《Annales fran?aises d'anesthèsie et de rèanimation》2014
Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P = 0.0008). The rate of CPR failure decreased over the same period (P = 0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality. 相似文献
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Few studies have validated the use of corticosteroid joint injections in sports medicine, and many recent studies have questioned their usefulness. The beneficial effect is essentially short lived, enabling the athlete to complete a specific performance. Local complications have been well described but the systemic effects are underestimated, especially during the first week. Corticosteroid joint injections are not on the regulatory list of products requiring an Authorization for Use for Therapeutic Applications (AUTa) for sportive events. Several studies have demonstrated that the corticotrop axis can be inhibited after a single injection, reflected by decreased production of endogenous cortisol for as long as two weeks. This biological adrenal insufficiency can lead to acute renal insufficiency if the athlete resumes competition too early under stressful conditions. Since there is no known way to identify predisposed individuals, the risk appears to be disproportionate compared with the expected benefit. Rest from sports must therefore be prescribed for any individual given a joint injection. 相似文献
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O. Dufour 《Motricité Cérébrale》2018,39(1):30-37
Pain management for children who have severe neurological diseases (polyhandicap), in a pediatric post-acure care and rehabilitation, is daily and work frequently with palliative approach. Cares for these children, with complex illness are a multidisciplinary approach. Treatments establishment or equipment, intervention, adaptation take place with respect and comfort concern about child or adolescent dignity. For this, drug free techniques are more and more integrated in the pain management in hospitals. Balneotherapy is one of them, essentially used for orthopaedic, rhumatological or neurological diseases (hemiplegia for example). Caregivers doesn’t have specific bath for balneotherapy in our establishment, that why we put in place some bath, called “therapeutic bath” or “relaxation bath”. The impression was a better feeling of comfort and better-being on these children. This encourages us to pursue the study to evaluate the real benefits. 相似文献
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Cytogenetic, molecular and phenotyping features of malignant hematologic diseases succeeded in improving their management by a more accurate stratification of patients according to several groups of risk and by providing a rational for targeted therapy. Three major types of treatment (excluding cellular therapy) are currently available in onco-hematology: conventional chemotherapy, small molecules for targeted therapy and monoclonal antibodies. Conventional chemotherapy with optimization of doses and multidrug-based regimens allowed to substantially improve survival of patients and keeps a place of choice in treatment of these diseases. Targeted treatments came from the cytogenetic and molecular characterization of hemopathies. Thus, the kinase Bcr-Abl, as a result of the translocation t(9;22)(q34;q11), has been successfully targeted by tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia and Ph+ acute lymphoblastic leukemia. Molecular abnormalities like internal-tandem duplication/point activating mutations in FLT3 in some acute myeloblastic leukemia or epigenetic dysregulations in some blood malignancies can also be targeted by small molecules. Hematopoietic malignant cells are phenotypically characterized by expression of cluster of differentiation (CD) on their surface. These CD are detected by flow cytometry using specific antibodies. Monoclonal antibodies targeting different CD have been developed for treatment. Rituximab, an anti-CD20 antibody, was the first monoclonal antibody successfully developed for treatment of malignant hematologic diseases. Since rituximab, many other monoclonal antibodies are being developed. Trends in malignant hematologic diseases presented here will include treatments, which have at least entered phase I/II clinical trials in adult or childhood leukemia. They include some novel drugs of conventional chemotherapy like second-generation nucleoside analogues. We will give an overview of the small molecules targeting the different cellular pathways and we will highlight those appearing as the most promising like novel TKIs. The large field of monoclonal antibodies will be also approached focusing on antibodies developed in leukemias. 相似文献
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Jacot W Pouderoux S Bibeau F Leaha C Chateau MC Chapelle A Romieu G 《Bulletin du cancer》2011,98(9):1059-1070
Breast cancer remains a major public health problem. Even if there is an increase in this cancer curability, metastatic breast cancer remains a lethal disease in the vast majority of cases. Therapeutic advances in the chemotherapeutic and targeted therapies fields induced an increase in survival, however the proportion of long survivors remains low. Phenotypic instability, an early process initiated during tumour progression, and continued on the metastatic stage of the disease, can be one of the putative hypotheses explaining these results. An increasing amount of scientific data are pledging for a reanalysis of the phenotypic profile regarding hormone receptors and HER-2 status of metastatic lesions in order to identify drugable targets and allow individualisation of the treatment of these metastatic breast cancer patients. Phenotypic changes between the primary tumour and the paired metastatic lymph nodes are a challenging pitfall, raising the question of which site has to be assessed in the adjuvant treatment decision process. This article presents a comprehensive analysis of the frequency of theses phenotypic changes altogether with new modalities to evaluate this phenotypic status. 相似文献
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Introduction
Substance related disorders are more prevalent in emergency services than in the general population, about 20% of individuals in emergency care test positive for alcohol. Emergency services are strategic places to identify alcohol misuse. Attitudes to individuals presenting substance related disorders are important in developing therapeutic relationships and applying interventions.Objective
This study explores the attitudes of an emergency staff to these individuals across a range of roles, and evolution in face of an addictology care improvement.Method
Data were gathered from an emergency service sample from the emergency department of a general hospital in Morlaix (France). We used a short questionnaire, adapted from previous similar French studies.Results
Twenty-five persons answered the first questionnaire and 18 the second. A self-administrated attitudes questionnaire showed its interest in our study and helped us to identify attitudes and to initiate a reflection on behaviours in emergency care. Moreover, it helped to change attitudes towards individuals presenting substance related disorders. The daily setting of an addictive disorders specialized unit in emergency changed the point of view on addictive disorders of both physicians and nurses. We showed differences in addictive related disorders prevalence perception among patients attending emergency care between the two evaluations. But we also showed that physicians and nurses stressed that it was more difficult to ask patients in emergency care on the second evaluation, after and despite a daily addictive disorders specialized setting. We showed several limits in emergency staff care relationship with patients with substance related disorders. They identified difficulties to talk about addictive disorders, especially in younger and older patients. Regarding literature, we discuss our study limits and different ways of improving addictology care in emergency services. 相似文献10.