La ponction lombaire (PL) est un geste médical courant mais pour lequel aucune procédure validée n’existe notamment dans les situations à risque hémorragique ou thrombotique. L’objectif de ce travail ...était de déterminer les pratiques cliniques de la PL.
Réalisation d’une enquête d’opinion nationale par Internet. Un questionnaire anonyme de 19 questions a recueilli des informations concernant la réalisation des PL chez des patients à risque hémorragique ou thrombotique.
Deux cent onze praticiens ont répondu au questionnaire parmi les contactés. Sur 13 situations cliniques proposées, aucune des opinions sur les conduites à tenir n’a emporté l’unanimité, 6 pratiques étaient dites « adoptées » par la majorité des participants et 6 par plus d’un tiers. Les pratiques étaient très variables, notamment pour le taux de plaquettes minimal accepté avant la PL, pour la prise en charge des patients sous bithérapie antiagrégante ou traités par les nouveaux anticoagulants par voie orale.
Ces résultats soulignent l’hétérogénéité des opinions et, probablement des pratiques dans ces situations et la carence de recommandations. Il apparaît essentiel de mettre en place des recommandations claires et uniformes dans ce domaine afin de guider les pratiques dans le futur. Dans le but d’augmenter la représentativité des réponses actuellement collectées, l’enquête est toujours en ligne et ouverte jusqu’au 31 juillet à tous praticiens qui souhaiteraient y participer (http://www.surveymonkey.com/s/hemopl).
Lumbar puncture (LP) is a common medical procedure for which no valid consensus exists in situations of hemorrhagic or thrombotic risk. The aim of this study was to identify the opinion-guided practices of LP at a national level.
A national opinion survey on Internet. An anonymous questionnaire of 19 questions collecting information about the LP practice for patients with hemorrhagic or thrombotic risks.
We sent 632 e-mails with the link of the survey and obtained 211 responses in six weeks. None of the responses was unanimous for any of the 13 different clinical situations proposed. Six practices were reported as adopted by the majority of participants, six by more than one-third. Reports of practices were highly variable, particularly for the minimum platelets count accepted, for the management of patients taking two antiplatelet agents or newer anticoagulant agents.
These results underline the heterogeneity of practices and the lack of recommendations. The establishment of a clear consensus in this area seems essential to guide practices in the future. In order to increase the representativeness of our responses, the survey is still going on online and will be open for all practitioners who wish to participate (http://www.surveymonkey.com/s/hemopl).
The objective of the study was to provide an inventory of predictive instruments and their constituting parameters associated with return to work in patients with subacute (2–10 weeks pain duration) ...and chronic (10–24 weeks pain duration) non-specific low back pain (NSLBP). Data sources included systematic review in Medline, Embase, Cinahl, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile up to September 2008, in reference lists of systematic reviews on risk factors, and of included studies. For the systematic review, two reviewers independently assessed study eligibility and quality, and extracted data. Disagreements were resolved by consensus. Risk factors were inventorised and grouped into a somatic and psychosocial domain. 23 studies reporting on subacute and 16 studies reporting on chronic patients were included. The studies on subacute patients reported on a total of 56 biomedical factors out of which 35 (63%) were modifiable and 61 psychosocial factors out of which 51 (84%) were modifiable. The corresponding values in studies on chronic patients were 44 biomedical 27 (62%) modifiable and 61 40 (66%) modifiable respectively. Our data suggest that the interdisciplinary approach in patients at risk to develop persistent NSLBP is justified in both, the subacute and chronic disease stages. Psychosocial interventions might be more effective in subacute stages since a higher proportion of modifiable risk factors were identified in that group.
We investigate, theoretically, the joint relaxation of orbital and structure in postexcitation dynamics of Rydberg states of cluster BaArN (N=250). Mixed quantum-classical dynamics is used to account ...for the nonadiabatic transitions among more than 160 electronic states, represented via a diatomics-in-molecules Hamiltonian. The simulation illustrates the complex multistep relaxation processes and provides detailed insight in the mechanisms contributing to the final-time experimental photoelectron spectrum.
Deux lois de décentralisation récentes ont donné une nouvelle compétence aux intercommunalités en matière de « gestion des milieux aquatiques » et de « prévention des inondations » (GEMAPI). La ...compétence GEMAPI, effective au 1er janvier 2018, a fait l'objet de nombreux débats parlementaires et sénatoriaux et d'une production intense d'écrits en tous genres. Nous avons étudié la fabrique de la GEMAPI en suivant deux objectifs : établir la généalogie de l'inscription de la GEMAPI dans la loi MAPTAM, la loi NOTRe et les documents règlementaires afférents et comprendre les effets de la GEMAPI sur les territoires de l'eau et inversement. Pour cela, nous nous sommes appuyés sur les textes rendant compte des débats politiques et sur des entretiens semi-directifs réalisés auprès d'acteurs de la gestion de l'eau. Notre travail donne à voir les négociations entre administrations centrales, déconcentrées et collectivités notamment autour d'enjeux que sont le financement, les responsabilités des élus et les modalités d'exercice de la compétence. Notre analyse des discours donne à voir comment différents porte-paroles de l'action publique territorialisée ont contribué à modifier les textes législatifs et réglementaires.
Abstract Dentofacial deformities and their treatment have physical and psychological repercussions on quality of life (QOL). Seventy-four patients were evaluated preoperatively (T0) and at 4–6 months ...postoperatively (T1). Oral health-related QOL was assessed using the short form of the Oral Health Impact Profile (OHIP-14). There was a statistically significant reduction in the average overall OHIP-14 score between T0 (13.23 ± 6.45) and T1 (3.26 ± 4.19). In addition, there were significant decreases in all seven OHIP-14 domains. Class III patients benefited in all domains evaluated, while a significant improvement was seen only in the psychological disability domain for class I patients. Class II patients showed a significant benefit in all domains except the domain of functional limitation. With regard to the total sample ( n = 74) and class III patients ( n = 58), correlations between domains were identified for all domains. The same correlation was not identified for class I ( n = 5) and II ( n = 11) patients. The entire sample and class III patients showed significant improvements in OHIP-14 scores for all degrees of postoperative sensory disturbance in the upper and lower lips, except for patients with degree 5 (extreme) disturbance of the upper lip. Orthognathic surgical treatment had a positive impact on oral health-related QOL in the patients evaluated.
Admittance-based rational modeling of multiport systems is prone to error magnification in applications with high-impedance terminations. This problem is overcome by the modal vector fitting method ...(MVF) which is formulated in terms of modal components with inverse least-squares weighting by the eigenvalue magnitude. A direct realization of MVF is very demanding in computation time and memory requirements. This paper overcomes the performance deficiency via three steps: 1) the required number of MVF iterations is reduced by precalculating an improved initial pole set via conventional vector fitting with inverse magnitude weighting; 2) the pole identification step is calculated in an efficient manner by solving for only the few essential unknowns while exploiting the sparse matrix structure; and 3) the residue identification step is calculated efficiently by a row-wise solution procedure that takes advantage of symmetry. The approach is demonstrated to give large savings for the modeling of a frequency-dependent network equivalent.
A new temperature-modulated differential scanning calorimetry (TMDSC) technique is introduced. The technique is based on stochastic temperature modulation and has been developed as a consequence of a ...generalized theory of a temperature-modulated DSC. The quasi-static heat capacity and the frequency-dependent complex heat capacity can be determined over a wide frequency range in one single measurement without further calibration. Furthermore, the reversing and non-reversing heat flows are determined directly from the measured data. Examples show the frequency dependence of the glass transition, the isothermal curing of thermosets and a solid–solid transition.
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