[Terminology of patient engagement for French healthcare organizations]. / Approche terminologique de l'engagement des patients : point de vue d'un établissement de santé français.

BACKGROUND: The establishment of a common pragmatic terminology represents the first step in structuring patient engagement initiatives in healthcare facilities. However, none is currently available in French. As part of the deployment of patient engagement within a French University Hospital Center, we propose a terminology of patient engagement. METHODS: We conducted a scoping review of the international literature that aimed at identifying the main conceptual and terminological frameworks for the engagement of patients, users and citizens in the healthcare system until 2019 in the PubMed and Cairn.info databases for English and French language articles. Additionally, we identified concepts and practices in the leading organizations of countries where this approach was implemented (United States, Canada and especially the province of Quebec, United Kingdom) and completed this approach by close exchanges and reflections with the team that developed the Montreal model. RESULTS: In total, 75 references and Internet resources were consulted. Patient, interaction, patient experience, experiential knowledge, patient engagement, patient partner and its variations as a resource patient, peer-supporter, trainer, researcher and coach have been defined. CONCLUSION: This terminology of patient engagement proposes an initial stabilization of the vocabulary, using a pragmatic approach. This contribution is a first step aiming at promoting the development of a new model of care and more broadly of healthcare system management, involving scientific and experiential knowledge.

[Benefits of a beta-blocking agent (carvedilol) on bilateral atherosclerotic renal artery stenosis. A case report]. / Effet d'un traitement bêtabloquant (carvédilol) en cas de sténoses bilatérales des artères rénales. A propos d'une observation.

A 77 year old man with coronary artery disease was referred to our institution for recurrent (flash) episodes of pulmonary edema due to malignant hypertension. A selective contrast-enhanced angiography showed severe bilateral renal artery stenosis. We also found a high level of plasma renin production identifying intense renin-angiotensin system activation. We first considered revascularisation. Percutaneous intervention initially failed and thereafter the patient denied surgical revascularisation. We have then recommended medical therapy, namely a beta-blocker after adequate correction of fluid retention. We used CARVEDILOL which has no nephrotoxicity and effectively inhibit the renin-angiotensin system. The patient feels significant functional and clinical improvement with no fluid retention relapse with a follow-up of more than 18 months.

Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).

BACKGROUND: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS: Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

[Severe cardiac insufficiency and type Ib pseudohypoparathyroidism]. / Insuffisance cardiaque sévère et pseudo-hypoparathyroïdisme de type Ib.

The authors report the case of a 28 year old woman with acute left ventricular failure associated with severe hypocalcaemia (1.7 mmol/l) without chronic renal failure or hypoproteinaemia. The echocardiographic appearances were those of dilated and globally hypokinetic cardiomyopathy with a severely depressed left ventricular ejection fraction (23%). Haemodynamic improvement was only obtained by the association of calcium supplements and Vitamin D derivatives (Un-Alfa) to conventional treatment. A low serum calcium associated with hyperphosphotaemia, hypocalciuria, hypophosphaturia and, above all, a high parathormone concentration, provided the diagnosis of a sporadic form of type Ib pseudohypoparathyroidism. Secondary cardiac failure to the hypocalcaemia is mainly observed in children and young adults in the context of chronic renal failure or true hypoparathyroidism. Pseudohypoparathyroidism is a very rare condition and systolic LV dysfunction for which hypocalcaemia is responsible, would seem to be totally reversible after calcium supplementation.

[Semiquantitative evaluation of mitral insufficiency by pulsed Doppler technic. Value of a simple index of left auricular cartography (apropos of a series of 63 patients)]. / Appréciation semi-quantitative de l'insuffisance mitrale par la technique doppler pulsé. Valeur d'un index simple de cartographie auriculaire gauche (a propos d'une série de 63 patients).

The authors advocate a semiquantitative evaluation of mitral regurgitation (MR), based on the extent of the left intra-atrial systolic jet. Their study was performed in a series of 63 consecutive patients explored by: (1) catheterization with left ventriculography on two planes for either ischaemic heart disease (24 cases) or cardiac valve disease (39 cases including 2 with mitral valve prosthesis), and (2) pulsed Doppler ultrasound combined with two-dimensional echocardiography for evaluation of MR carried out 24 or 48 hours prior to catheterization. Five grades of MR (0 to IV) were determined by ventriculography according to the time and degree of left atrial opacification. Similarly, five grades of MR (0 to IV) were determined by Doppler ultrasound, considering only the maximum distance from the mitral annulus plane. This distance was evaluated on at least 3 projections: apical for the 4 and 2 cavities, parasternal for the greater axis. The Doppler method correlated fairly well with the angiography, whether or not grade 0 was included (r = 0.87 and r = 0.72 respectively). However, some major MR may be underestimated; thus, out of 13 RM of angiographic grade III or IV, three (23 p. 100) were graded II by the Doppler technique. Conversely, some minute or moderate MR may be overestimated: out of 33 MR of angiographic grade I or II, four (12 p. 100) were graded III or IV by the Doppler technique.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electrophysiologic effects of intravenous carocainide]. / Effets électrophysiologiques du carocaïnide intraveineux.

The electrophysiological properties of carocainide a new Class I antiarrhythmic agent (Delalande Research Centre) were studied after intravenous injection of 3.5 mg/kg in 5 minutes in 16 patients aged 24 to 66 years. Five minutes after the injection there was a significant increase (p less than 0.01) in the HV (+/- 12.8 +/- 10.5 msec), AH (+ 21.8 +/- 14 msec) and PR intervals (+ 43.8 +/- 24.2 msec) and in the duration of QRS (+ 20.6 +/- 9.9 msec). The anterograde and retrograde Wenckebach points were decreased (-42 +/- 43 bpm and - 52 +/- 36 bpm respectively, p less than 0.05). All these effects reverted progressively 20 minutes after injection and disappeared by the 40th minute, which corresponds to the pharmaco-kinetic profile of the patient. There were no changes in blood pressure, sinus node function or refractory periods except for the retrograde refractory periods which were prolonged (+ 87 +/- 41 msec). Atrial fibrillation was induced in 2 patients and atrial flutter in 2 others by the extrastimulus technique. These arrhythmias could not be reproduced in these 4 patients during the 40 minutes after injection of carocainide. Five other patients with reciprocating nodal tachycardia induced by atrial extrastimuli had their arrhythmia interrupted by the carocainide injection. We conclude that carocainide acts mainly on atrio-ventricular and intra-ventricular conduction. The results obtained in patients with tachycardias suggest that the product is effective in atrial arrhythmias and paroxysmal junctional tachycardia.

[Sudden death and obstructive hypertrophic cardiomyopathy]. / Mort subite et cardiomyopathie hypertrophique obstructive.

Sudden death is the most common cause of death in obstructive hypertrophic cardiomyopathies. Ventricular arrhythmias appear to be involved most frequently. The typical clinical picture is that of a young, asymptomatic male subject with a family history of sudden death and obstructive hypertrophic cardiomyopathy. The electrocardiogram at rest, the left ventricular pressure gradient, and the width of the septum are not good predictive criteria. Holter monitoring with the discovery of a run of ventricular tachycardia is the only method which identifies a subgroup at high risk for sudden death. Treatment with beta blockers does not protect patients with obstructive hypertrophic cardiomyopathy from sudden death and only combined therapy with an antiarrhythmic agent can control ventricular rhythm disturbances and decrease the number of sudden deaths in this condition.

[Vectorcardiography in inferior infarction associated with left bundle-branch block]. / Le vectocardiogramme dans l'infarctus inférieur associé au bloc de branche gauche.

The authors report a series of 13 patients, 8 men and 5 women, with an average age of 68 years (range 39 to 87 years) presenting with documented inferior infarction with anteroseptal extension in 2 cases. These patients developed LBBB (complete in 9 cases, incomplete in 4 cases). This complications occurred in the acute phase in 8 cases and 4 months to 9 years later (average 4,5 years) in the other 5 cases. The block was intermittent in 4 patients and became permanent in all cases. The diagnosis of inferior infarction with LBBB was made by vectorcardiography (VCG) in 5 out of the 13 patients (38,4 p. 100) on the criteria suggested by Starr. 3 of the 8 false negative results were directly related to the block which masked the ECG and VCG signs of inferior infarction. The VCG signs observed were an upwards displacement of the QRS loop with preservation of the superior orientation of the initial forces (5 cases). Atypical appearances of LBBB were observed in 2 cases with a posterior and right-sided shift of the efferent loop following the anterior and left-sided orientations of the initial forces. The sensitivity of the VCG and ECG is mediocre in inferior infarction with LBBB because the block may mask the electrical signs of inferior infarction. The specificity of the VCG could not be assessed because of the mode of selection of the patients and the small number of cases.

[Long-duration electrocardiographic recording in 33 patients with obstructive cardiomyopathy]. / Enregistrements électrocardiographiques de longue durée chez 33 patients atteints de cardiomyopathie obstructive.

A prospective study of arrhythmias was performed in 33 patients with hypertrophic cardiomyopathy with obstruction by Holter monitoring. The aim of the study was to assess the incidence of "occult" arrhythmias in this condition and to establish a "profile" of high risk patients from clinical, echocardiographic and haemodynamic data. The Holter monitoring demonstrated asymptomatic arrhythmias in 31 of the 33 patients (94%). A supraventricular arrhythmia was detected in 15 cases (45%), including 7 episodes of supraventricular tachycardia (21%). Ventricular arrhythmias were observed in 28 patients (85%), including 5 episodes of ventricular tachycardia (15%). Some patients presented several types of arrhythmia. A number of patients with arrhythmia including short bursts of ventricular tachycardia were asymptomatic during Holter monitoring; conversely, other patients complained of dizziness or syncope but had no arrhythmias. A retrospective study of clinical, echocardiographic and haemodynamic data showed no difference between patients with and patients without arrhythmias. Medium-dose betablocker therapy (propranolol, 110 mg/day) did not seem to protect patients with hypertrophic cardiomyopathy with obstruction from arrhythmias. We conclude that Holter monitoring should form part of the routine evaluation of patients with cardiomyopathy with obstruction, and that potentially dangerous arrhythmias should be treated by anti-arrhythmic agents other than betablockers. This attitude could reduce the incidence of syncope and eventually decrease the risk of sudden death in this condition.

[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study]. / Signification d'un trouble du rythme supraventriculaire déclenché au cours d'une exploration endocavitaire.

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)