[Nutrition-obesity. New program about behavioural issues involved in weight loss through surgery]. / Nutrition-obésité. Nouveau programme ciblant les enjeux comportementaux de la perte de poids à l'aide de la chirurgie.

Bariatric surgery is an effective treatment to improve metabolic health as long as behavioural changes are made. Opting for this therapeutic choice represents a real commitment on the part of patients which is complementary to the informative bariatric surgery consultation. After all, what practitioner has not been confronted with an urgent request from patients suffering from obesity who are over-investing in this operation? Therapeutic Patient Education offers the opportunity to work with patients to develop their status as committed actors through a new outpatient educational program. Increased feelings of self-efficacy and socio-cognitive conflict are ingredients that allow patients to invest in long-term changes.

Pour perdre du poids en situation d'obésité, la chirurgie bariatrique est un traitement efficace améliorant la santé métabolique sous réserve de changements comportementaux. Opter pour ce choix thérapeutique représente un véritable travail sur l'engagement des patients qui s'inscrit en complément de la consultation informative de chirurgie bariatrique. En effet, quel praticien n'a-t-il pas été confronté à l'impasse d'une demande urgente par des patients en souffrance surinvestissant cette intervention ? L'éducation thérapeutique du patient offre l'opportunité de travailler avec les patients à leur statut d'acteur engagé au travers d'un nouveau programme éducatif ambulatoire. L'augmentation du sentiment d'auto-efficacité et le conflit sociocognitif sont des ingrédients qui permettent aux patients en réflexion d'investir les changements à long terme.

[Preparation program for bariatric surgery designed with patients: challenges and benefits]. / Programme de préparation à la chirurgie bariatrique conçu avec les patients : enjeux et bénéfices.

Despite the weight and metabolic efficiency of bariatric surgery, nearly 35 % of operated patients regain weight due to insufficient behavioral changes. Collaborating with patient partners to co-construct an educational preparation program represents an opportunity to promote patient involvement adjusted to societal developments. This partnership starts with an exploration of the partners' needs and follows a progressive and tailored process that responds to the issues of place and power raised. It leads to the creation of a day of teaching, at the beginning of the course, aimed at informed consent and to a program, at the end of the course, focused on behavioral changes in their concrete dimension in support of a new and recognized health actor: the patient partner.

Malgré l'efficacité pondérale et métabolique de la chirurgie bariatrique, près de 35 % des patients opérés présentent une reprise pondérale liée à des changements comportementaux insuffisants. Collaborer avec des patients partenaires pour co-construire un programme éducatif de préparation représente une opportunité ajustée à l'évolution sociétale de favoriser l'implication des patients. Ce partenariat débute par l'exploration des besoins des partenaires et suit un processus progressif et sur mesure qui répond aux enjeux de place et de pouvoir soulevés. Il aboutit à la création d'une journée d'enseignement, en début de parcours, visant le consentement éclairé et à un programme, en fin de parcours, centré sur les changements comportementaux dans leur dimension concrète, à l'appui d'un nouvel acteur de santé reconnu : le patient partenaire.

A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection.

BACKGROUND: An adjunctive topical therapy with gentamicin-sponges to systemic antibiotic therapy might improve the healing of infected diabetic foot ulcers (DFUI). METHODS: Single-center, investigator-blinded pilot study, randomizing (1:1) the gentamicin-sponge with systemic antibiotic versus systemic antibiotics alone for patients with DFUI. RESULTS: We included 88 DFUI episodes with 43 patients in the gentamicin-sponge arm and 45 in the control arm. Overall, 64 (64/88; 73%) witnessed total clinical cure, 13 (15%) significant improvement, and 46 (52%) showed total eradication of all pathogens at the final visit. Regarding final clinical cure, there was no difference in favour of the gentamicin-sponges (26/45 vs. 31/43; p = 0.16). However, the gentamicin-sponge arm tended to a more rapid healing. In multivariate analysis adjusting for the case-mix, the variable "gentamicin-sponge" was not significantly associated with "cure and improvement". Gentamicin-sponges were very well tolerated, without any attributed adverse events. CONCLUSIONS: The gentamicin-sponge was very well tolerated, but did not significantly influence overall cure. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01951768 ). Date 2 April 2013.