[Study of collective nutrition education sessions for diabetic type II patients]. / Étude sur les séances collectives d'éducation nutritionnelle pour des patients diabétiques type II.

AIM: As with many chronic diseases, most French diabetes services for patients with type II diabetes now have a structured reception approach including collective educational sessions in the form of targeted workshops, thematic days, or even programs with several sessions. The aim of our study is to understand the interlocutory dynamics favorable to the adoption of new cognitions and attitudes during these sessions. METHODS: We studied the verbal exchanges of nine collective nutrition education sessions (five focusing on knowledge input, and four implementing behavioral simulation). A total of 76 patients with type II diabetes (per group of six to 13 participants) and 12 group leaders (nurses, dieticians or nutritionists) contributed to this study, based on audio recording, and analysis of these sessions lasting two hours on average (with between 4345 and 8592 words per session). The nine corpora were the subject of two types of content analysis: lexical and dialogic, with the N'vivo 8 software. RESULTS: The results of this study suggest very precisely several ways to improve the content of the informational contributions of these educational sessions. The study of their process also makes it possible to distinguish between self-disclosure and social support in communication between participants. Finally, this study checks the effectiveness of the different types of framing of health messages in the discourse of the group leaders to facilitate the adhesion of the participants. CONCLUSION: In conclusion, it appears that the reaction spontaneously verbalized by the participants during the course of the educational situation, in these sessions, can be considered as an interesting indicator of their impact. The results may have implications for the development of nutritional education programs and group leader training.

Paecilomyces variotii Fungemia in a Patient with Lymphoma Needing Liver Transplant.

Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.

[Assessment of the check-list in the operating room: perceptions of caregivers and physicians (level II assessment)]. / Évaluation de la check-list au bloc opératoire : la perception des soignants et des médecins (évaluation du niveau II).

OBJECTIVE: To assess, a year after the deployment of the check-list in the centre hospitalier Lyon Sud (CHLS - HCL), the perception of medical and nursing staff regarding the advantages of the check-list and its level of integration within the overall organization of the operating room. TYPE OF STUDY: Descriptive study, questionnaires and audits. MATERIALS AND METHODS: Distribution of individual questionnaires to the entire operating room staff, and observational audits in the operating room, to objectively assess the quality of implementation of the check-list (level II of the HAS - French National Autority of Health). RESULTS: The medical and nursing staff participated equally in using the check-list. This was derived from the individual questionnaires and reinforced by the observational audit; they also revealed an uneven implementation of the three phases, with phase 3 almost never performed. In two-third of the cases, the time-out requirements did not comply with HAS instructions. Nurses and physicians perceived the check-list differently. Even though they agreed that the check-list should be a team effort and is useful, nurses noted a lack of investment and leadership from doctors, in addition to communication problems, which led to a feeling of disrespect towards them when they play the role of the check-list coordinator. CONCLUSION: The questionnaire and the audit of practice showed strong adherence to the concept in that the surgical check-list was considered useful by all staff. However, it was also considered to be an added formality and its full implementation was rare in practice. There was a problem of distribution and acceptance of roles with nurses often observing that they were the only ones strictly following the check-list due to a lack of medical investment.

Preoperative plasma B-type natriuretic peptide (BNP) identifies abnormal transthoracic echocardiography in elderly patients with traumatic hip fracture.

INTRODUCTION: This prospective study was designed to evaluate whether preoperative plasma brain natriuretic peptide (BNP) could identify significant preoperative cardiovascular disease in elderly hip-fractured patients. PATIENTS AND METHODS: Preoperative plasma BNP measurement and rest transthoracic echocardiography (TTE) were performed within 24 h after admission in consecutive hip-fractured patients aged ≥65 years. The major echocardiographic abnormality (MEA) group included patients with at least one TTE abnormality, defined as systolic pulmonary artery pressure (PAP(s)) ≥50 mmHg, left ventricular (LV) systolic dysfunction, increased LV filling pressure (LVFP) or severe valvular disease. The control group included the remaining patients. RESULTS: Seventy-five patients (mean±SD (range) age=85±5 (69-97) years) were included during a 6-month period. Twenty-four (32%) patients constituted the MEA group (17 elevated PAP(s), three LV systolic dysfunctions, 10 increased LVFP, one severe aortic stenosis and one severe mitral regurgitation). Median (interquartile) preoperative BNP value was significantly greater in MEA than in the control group (527 (361) vs. 119 (154) pg ml(-1); p<0.0001). A preoperative plasma BNP cut-off value at 285 pg ml(-1) predicted well MEA with an area under the receiver operating characteristic (ROC) curve equal to 0.895 (p<0.0001) and with a hazard ratio (HR) (confidence interval, CI) of 23.8 (3.7-142.9) (p=0.0008) on multivariate analysis. The presence of MEA or BNP≥285 pg ml(-1) was associated with high mortality. DISCUSSION: The incidence of echocardiographic signs of elevated PAP(s) or elevated LVFP in elderly hip-fractured patients was high. A preoperative BNP value ≥285 pg ml(-1) can discriminate between elderly hip-fractured patients with or without MEA.