Grande fréquence des prescriptions médicamenteuses à visée cardiovasculaire potentiellement inappropriées dans la population âgée [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].

OBJECTIVES: Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria. METHODS: A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed. RESULTS: Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure. CONCLUSION: Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients' comorbidities and/or characteristics.

Consultations infectiologiques ambutatoires non VIH: analyse d'un centre universitaire sur cinq ans [Non-HIV infectious disease outpatient consultations: a 5-year study in a Swiss University Hospital].

Few studies have examined the workload or clinical spectrum of non-HIV infectious diseases outpatient consultations (IDOC). This retrospective study aims to describe IDOC referrals over the past 5 years. In total, 483 patients were referred (with an increase of 63% between 2009 and 2013). Most referrals were received from primary care clinicians (45%). Median patient age was 47 years, 57% of patients were men and 17% were immunosuppressed. Of the diagnoses retained, 74% were infectious, 20% were non-infectious and 6% were of unknown aetiology. Two community outbreaks were identified (tattoo-related mycobacterial infection and Q fever). In conclusion, the infectious diseases outpatient clinic, which has expanded progressively in the past 5 years, provides a specialised service for primary health clinicians and for public health.

Subthalamic (STN) Deep Brain Stimulation (DBS) in Parkinson's Disease (PD): Correlation Between the Location of the Stimulated Contacts and the Clinical Effects in 14 Patients

Objectives: To correlate the chronic stimulated electrode position on postoperative MRI with the clinical response obtained in PD patients. Material and Method: We retrospectively reviewed 14 consecutive parkinsonian patients who were selected for STN-DBS surgery. Coordinates were determined on an IR T2 MRI coronal section per pendicular to AC-PC plane 3 mm posterior to midcommissural point (MCP) and 12 mm lateral to the midline the inferior aspect of subthalamic region. A CRW stereotactic frame was used for the surgical procedure. A 3D IR T2 MRI was performed postoperatively to determine the location of the stimulated contact in each patient. The clinical results were assessed independently by the neurological team. Results: All but 2 patients had monopolar stimulation. The mean coordinates of the stimulated contacts were: AP ^ ÿ4:23G1:4, Lat ^ 1:12G0:15, Vert ^ ÿ4:1 G2:7 to the MCP. With a mean follow-up of 8 months, all stimulated patients had a significant clinical improvement (preop/postop «ON» UPDRS: 25:8G7:0= 23:3 G8:6; preop/postop «OFF» UPDRS: 50:2G11:4=26:0 G7:8), 60% of them without any antiparkinsonian drug. Conclusion: According to the stereotactic atlas of Schaltenbrand and Warren and the 3D shape of the STN, our results show that our targetting is accurate and almost all the stimulated contacts are comprised in the STN volume. This indicates that MRI is a safe, precise and reproducible procedure for targetting the STN. The location of the stimulated contact within the STN volume is a good predictor of the clinical results.

Centre d'interpretació del Poblat ibèric del Castellet de Banyoles. Tivissa, Tarragona

Award-winning

Centre d'assitència primària CAP Concòrdia a Sabadell

Award-winning

Projecte i direcció d'obra de l'ampliació del centre gastronòmic, de convencions i hotel "LA OPERA" a Benicàssim

Projecte i direcció d'obra de l'ampliació de Centre Gastronómic de Convencions i Hotel "La Ópera" a Benicàssim. La ópera - centre gastronómic

Protocol de conservació ex situ del Centre Ictiològic del Parc Natural del Delta de l'Ebre

En aquest Treball de Fi de Grau es pretén establir un protocol per a la conservació ex situ de les espècies que hi ha en el Centre Ictiològic del Parc Natural del Delta de l’Ebre. Les espècies que es troben en el CI són espècies vulnerables o en perill: espinós, samaruc, fartet, rabosa, llopet de riu i tritó palmat. Els objectius d’aquest protocol són: que el CI tingui un protocol propi, aprendre com funciona tot el centre, totes les espècies, com alimentar-les, com manipular-les i com tractar-les durant tot el seu cicle de vida. Un altre objectiu és el de veure si a finals d’any s’obté una alta població de cada espècie, quines són reintroduïdes, les patologies sorgides i els valors dels paràmetres químics de les basses naturals exteriors. El protocol s’elabora a partir de les pràctiques realitzades durant l’estiu del 2013 i els coneixements adquirits, la bibliografia i les dades del CI. Gràcies a això s’ha elaborat el treball. S’ha tractat la conservació ex situ; la problemàtica que sofreixen les espècies; cadascuna d’aquestes espècies; com funciona el CI a nivell de centre i a nivell de personal; les tasques que hi ha diàriament, setmanalment i ocasionalment segons les necessitats de l’estoc; el maneig sanitari; les patologies i com tractar-les; i l’anàlisi genètic. Els resultats obtinguts d’aquest protocol són els resultats numèrics obtinguts de l’any 2013 que són: 1. El gran nombre de cries nascudes de samaruc i fartet, menys de raboseta de riu, poques d’espinós i tritó palmat, i menys de llopet que tot just comença ara en el CI. 2. El total d’uns 5700 individus reitnroduits (samaruc, raboseta de riu i espinós de Girona). 3. La patologia més sorgida és el punt blanc. 4. I els paràmetres químics (amoni, nitrits, nitrats i fòsfor) no són molt elevats. La conclusió final i més important a la que arribo en fer el protocol és la gran importància que té el CI per a conservar aquestes espècies que no es saben apreciar fins que comencen a desparèixer. La existència del CI és més aviat una mesura correctora de tots els impactes que han sofert els habitatges de les espècies tractades i de la introducció d’espècies exòtiques que són una amenaça per les autòctones.

La relation thérapeutique centrée sur les motifs. Comment individualiser l'offre relationnelle sous l'angle de la responsivité appropriée

Un cas exemplaire, un cas d'école, un beau cas, un cas de figure, un cas extrême, un cas particulier, un cas épineux, un cas limite ... Les modalités de l'étude de cas sont multiples et expriment le fait que tout raisonnement suivi, toute explication, toute théorie bute une fois ou l'autre sur la nécessité d'explorer et d'approfondir les propriétés d'une singularité accessible à l'observation. Publier un ouvrage sur la question du cas unique, c'est participer à ce moment de réflexion sur les méthodes scientifiques en psychologie. C'est aussi oeuvrer à un repositionnement constructif de cette modalité de faire science, en donnant la parole aux auteurs spécialistes de ces questions ou directement concernés par celles-ci à travers leurs recherches ou leurs pratiques.

Le médecin au centre: pour une approche de l'expérience vécue [Toward the lived experience of the physician].

For manyyears, a major focus of interest has been the patient, in the context of a constantly changing society and increasingly complex medical practices. We propose to shift this focus on the physician, who is entangled in a similar, but less evident way. In these three articles, we explore, in succession, the lived experience of the contemporary physician, the ethos which brings together the medical community, and the education of the future physician, using research projects currently under way within the Service of Liaison Psychiatry at Lausanne University Hospital. In this first article, we particularly raise the question of what is the lived experience of the physician and sketch the outline of <physician-centered> research.

Etude descriptive des médicaments non utilisés collectés dans une officine française de la Région Centre

[...] Cette étude a permis d'évaluer ce que représente le coût des MNU [médicaments non utilisés] à l'officine sur une période donnée. Les résultats ont traduit un gaspdlage certain des ressources de santé. La fin du recyclage humanitaire des médicaments étant décidé par les autorités publiques depuis le 11 janvier 2007, la collecte des MNU à l'officine garde un intérêt dans la protection de l'environnement et la prévention des accidents domestiques. Mais les pharmaciens pourraient participer à la prévention de ces gaspillages par un renforcement des mesures d'informations sur le bon usage des médicaments et par une attention particulière donnée au monitoring et au soutien de l'adhésion thérapeutique des patients ('programmes de soins pharmaceutiques).[Auteure, p. 4]

La consultation infirmière dans un centre d'urgence pédiatrique universitaire suisse [The nurse consultation in a Swiss university paediatric emergency department].

In Switzerland, overcrowding in tertiary emergency departments is a frequent problem, resulting in lengthy waiting times, lower satisfaction on the part of families and a risk for patient's safety. The setting up of a nurse consultation in a university paediatric emergency centre has helped to improve the quality of care in this context.

Centre socio-sanitari a l’edifici Xaloc

Award-winning