Traitement des tumeurs malignes du foie par radiologie interventionnelle: techniques ablatives [Interventional radiology procedures for malignancies of the liver: ablation procedures].

Percutaneous ablative procedures allow curative treatment of stage BCLC 0 or BCLC A hepatocellular carcinoma, as well as liver metastases of colorectal cancer. Several methods exist including radiofrequency ablation, the most commonly used. These techniques can be used in combination with surgical excision or alone if surgery is contraindicated. They are associated with significantly reduced mortality as compared to surgery.

A Comparative Study of Transvaginal Tape, Transobturator Tape Outside-in, and Transvaginal Tape-obturator Inside-out Surgical Procedures in the Treatment of Stress Urinary Incontinence

The aim of this work was to use the Urinary Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) questionnaires to compare 3 surgical techniques for stress urinary incontinence: the transvaginal tape (TVT) (105 women), the transobturator tape outside-in (TOT) (43 women), and the transvaginal tape-obturator inside-out (TVT-O) (54 women). There were no significant differences in frequent urination, urine leakage related to the feeling of urgency, urine leakage related to physical activity, or small amounts of urine leakage. TVT-operated women had a lower percentage of micturition difficulties compared with TOT women. TVT-O-operated women described slight discomfort in the genital area compared with the TVT technique, but this difference was not significant when compared with the TOT technique. When utilizing the UDI-6 and IIQ-7 scoring modifications before and after surgery, no difference among these 3 techniques is apparent.

Chirurgie bariatrique en 2013: principes, avantages et inconvénients des interventions a disposition [Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures].

For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures.

As the mortality associated with invasive Candida infections remains high, it is important to make optimal use of available diagnostic tools to initiate antifungal therapy as early as possible and to select the most appropriate antifungal drug. A panel of experts of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) undertook a data review and compiled guidelines for the clinical utility and accuracy of different diagnostic tests and procedures for detection of Candida infections. Recommendations about the microbiological investigation and detection of candidaemia, invasive candidiasis, chronic disseminated candidiasis, and oropharyngeal, oesophageal, and vaginal candidiasis were included. In addition, remarks about antifungal susceptibility testing and therapeutic drug monitoring were made.

ROBETH: un logiciel pour les procédés statistiques robustes [ROBETH: a library for robust statistical procedures].

In the past 20 years the theory of robust estimation has become an important topic of mathematical statistics. We discuss here some basic concepts of this theory with the help of simple examples. Furthermore we describe a subroutine library for the application of robust statistical procedures, which was developed with the support of the Swiss National Science Foundation.

The Impact of Digitization on the Management of Administrative Procedures : The Case of Building Permits

Information and Communication Technologies provide public administrations new ways to meet their users' needs. At the same time, e-Government practices support the public sector in improving the quality of service provision and of its internal operations. In this paper we discuss the impacts of digitization on the management of administrative procedures. The theoretical framework and the research model that we will use in this study help us tackle the question of how digitization transforms administrative procedures as, for example, in terms of time and roles. The multiplicity of institutions involved in issuing building permits led us to consider this administrative procedure as a very interesting case study. An online survey was first addressed to Swiss civil servants to explore the field, and here we present some of its results. We are currently undertaking an in-depth case study of the building permit procedures in three Swiss Cantons, which we will also present in this paper. We will conclude with a discussion and the future steps of this project.

Fluoroscopy-guided procedures in cardiology: is patient exposure being reduced over time?

The number of fluoroscopy-guided procedures in cardiology is increasing over time and it is appropriate to wonder whether technological progress or change of techniques is influencing patient exposure. The aim of this study is to examine whether patient dose has been decreasing over the years. Patient dose data of more than 7700 procedures were collected from two cardiology centres. A steady increase in the patient dose over the years was observed in both the centres for the two cardiological procedures included in this study. Significant increase in dose was also observed after the installation of a flat-panel detector. The increasing use of radial access may lead to an increase in the patient exposure. The monitoring of dose data over time showed a considerable increase in the patient exposure over time. Actions have to be taken towards dose reduction in both the centres.

Recommendations to reduce hand exposure for standard nuclear medicine procedures

The optimization of the extremity dosimetry of medical staff in nuclear medicine was the aim of the Work Package 4 (WP4) of the ORAMED project, a Collaborative Project (2008-2011) supported by the European Commission within its 7th Framework Programme. Hand doses and dose distributions across the hands of medical staff working in nuclear medicine departments were evaluated through an extensive measurement program involving 32 hospitals in Europe and 139 monitored workers. The study included the most frequently used radionuclides, (99m)Tc- and (18)F-labelled radiopharmaceuticals for diagnostic and (90)Y-labelled Zevalin (R) and DOTATOC for therapy. Furthermore, Monte Carlo simulations were performed in different predefined scenarios to evaluate separately the efficacy of different radiation protection measures by comparing hand dose distributions according to various parameters. The present work gives recommendations based on results obtained with both measurements and simulations. This results in nine practical recommendations regarding the positioning of the dosemeters for an appropriate skin dose monitoring and the best protection means to reduce the personnel exposure.

Neuromonitoring after major neurosurgical procedures.

Postoperative care of major neurosurgical procedures is aimed at the prevention, detection and treatment of secondary brain injury. This consists of a series of pathological events (i.e. brain edema and intracranial hypertension, cerebral hypoxia/ischemia, brain energy dysfunction, non-convulsive seizures) that occur early after the initial insult and surgical intervention and may add further burden to primary brain injury and thus impact functional recovery. Management of secondary brain injury requires specialized neuroscience intensive care units (ICU) and continuous advanced monitoring of brain physiology. Monitoring of intracranial pressure (ICP) is a mainstay of care and is recommended by international guidelines. However, ICP monitoring alone may be insufficient to detect all episodes of secondary brain insults. Additional invasive (i.e. brain tissue PO2, cerebral microdialysis, regional cerebral blood flow) and non-invasive (i.e. transcranial doppler, near-infrared spectroscopy, EEG) brain monitoring devices might complement ICP monitoring and help clinicians to target therapeutic interventions (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Several independent studies demonstrate such multimodal approach may optimize patient care after major neurosurgical procedures. The aim of this review is to evaluate some of the available monitoring systems and summarize recent important data showing the clinical utility of multimodal neuromonitoring for the management of main acute neurosurgical conditions, including traumatic brain injury, subarachnoid hemorrhage and stroke.

HRM Practices, Intrinsic Motivators, and Organizational Performance in the Public Sector

This article aims to determine the impact of human resource management (HRM) practices on public service motivation (PSM) and organizational performance. Based on a survey of Swiss cantonal public employees (N = 3,131), this study shows that several HRM practices may be considered as organizational antecedents of PSM and strong predictors of perceived organizational performance. Fairness, job enrichment, individual appraisal, and professional development are HRM practices that are positively and significantly associated with PSM and perceived organizational performance. Moreover, these results suggest that HRM practices are stronger predictors than either PSM or organizational commitment when explaining the individual perception of organizational performance.

Hypertension and intra-operative incidents : a multicentre study of 125000 surgical procedures in Swiss hospitals

Rapport de synthèse : Bien que les complications sévères de l'anesthésie soient actuellement rares, des informations contradictoires existent à propos du rôle et de l'importance de l'hypertension artérielle chronique sur la survenue de complications en cours d'anesthésie. En raison de la prévalence élevée de l'hypertension artérielle dans la population et du grand nombre d'anesthésies effectuées, il est important de clarifier cette relation. Le but de l'étude était d'évaluer si les personnes hypertendues étaient à risque accru de présenter des complications lors d'anesthésies à partir de données collectées de routine lors d'anesthésies usuelles réalisées en Suisse. Nous avons utilisé les données figurant dans le registre ADS (Anesthésie Données Suisse) correspondant à des anesthésies, générales ou locorégionales, réalisées pour chirurgie élective chez des adultes, entre 2000 et 2004 dans 24 hôpitaux suisses. L'attention était portée principalement sur les incidents cardio-vasculaires, mais les autres incidents relevés de routine ont aussi été évalués. La présence d'une hypertension artérielle chronique était définie par la présence d'un traitement antihypertenseur ou par l'anamnèse d'une hypertension artérielle, combinée à la mesure d'une pression artérielle élevée (systolique >160 mm Hg ou diastolique >100 mm Hg) lors de l'examen préopératoire de l'anesthésiste. Les incidents relevés en cours d'anesthésie ont été définis a priori et sont enregistrés de routine sur la feuille d'anesthésie et reportés dans une base de données centralisée. En raison de la structure des données, des analyses hiérarchiques ont été effectuées incluant des variables individuelles (niveau 1), liées aux groupes d'interventions chirurgicales (niveau 2) et à l'hôpital (niveau 3). Parmi les 124 939 interventions, 27 881 (22%) concernaient des patients connus pour une hypertension artérielle chronique. Au moins un incident est survenu dans 16,8% des interventions (95% Cl 16,6 -17,0%). Chez 7 549 patients, au moins un incident cardio- vasculaire est survenu, soit dans 6% des anesthésies (95% Cl 5.9-6.2%). Le rapport des cotes (odds ratio) moyen ajusté pour les incidents cardio-vasculaires chez les patients hypertendus était de 1.38 (95% Cl 1.27-1.49), indiquant une augmentation du risque chez les patients hypertendus. Cependant, l'hypertension n'était pas liée à un risque augmenté de survenue d'un autre incident. Les rapports de cotes ajustés de la survenue d'une complication cardiovasculaire en présence d'une hypertension artérielle variaient selon les hôpitaux entre 0.41 et 2.25. Ainsi, cette étude confirme la présence d'un risque accru de survenue d'une complication cardiovasculaire chez un patient hypertendu lors d'une anesthésie pour chirurgie élective. Il s'agissait le plus souvent d'une arythmie ou d'une perturbation hémodynamique. Cette augmentation du risque proche de 40% a aussi été trouvée dans une revue systématique avec méta-analyse. L'hétérogénéité des institutions -qui persiste même en tenant compte des ajustements pour le type d'intervention chirurgicale et des variables individuelles (case-mix) - suggère des différences de pratique de l'anesthésie selon l'hôpital.

Traitement des tumeurs maligne du foie par radiologie interventionnelle: techniques intra-artérielles [Interventional radiology procedures for malignancies of the liver treatment: Intraarterial procedures].

Intraarterial procedures such as chemoembolization and radioembolization aim for the palliative treatment of advanced hepatocellular carcinoma (stage BCLC B and C with tumoral portal thrombosis). The combination of hepatic intraarterial chemotherapy and systemic chemotherapy can increase the probability of curing colorectal cancer with hepatic metastases not immediately accessible to surgical treatment or percutaneous ablation.