[Optimization of systolic heart failure treatment by general practitioners after hospital discharge: Are guidelines applied?] / Optimisation du traitement de l'insuffisance cardiaque chronique par les médecins généralistes en sortie d'hospitalisation : les recommandations sont-elles appliquées ?

Heart failure is a common and serious disease, with constantly increasing incidence. General practitioners have an essential role in its management. AIM OF THE STUDY: Describe general practitioner's practice in optimizing heart failure treatment after hospital discharge. PATIENTS AND METHOD: All patients admitted for heart failure with altered ejection fraction in Nanterre's hospital cardiology department between February 2014 and January 2015 and having a general practitioner were included. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge. RESULTS: A total of 82 patients (age 76±12years, left ventricular ejection fraction 36±8%) were included. The target dose of angiotensin-converting-enzyme inhibitors and beta-blockers was reached for 18% of patients during hospitalization. Forty-two general practitioners answered the questionnaire, which concerned 60% of patients (n=49). None of them modified angiotensin-converting-enzyme inhibitors nor beta-blockers. The reasons were the lack of patient consultation (43%), the good tolerance (43%), the absence of habit (24%), and the attribution of this role to the cardiologist (41%). Possible improvements are: more precise hospitalization reports, alternating consultations and educational sessions. CONCLUSION: Patients with heart failure are under-treated at discharge and general practitioners do not optimize the treatment after hospital discharge. The main axis of improvement is to establish a better defined care pathway.

Transfer of a near infrared spectroscopy laboratory application to an online process analyser for in situ monitoring of anaerobic digestion.

A near infrared (NIR) spectroscopy online process analyser was used for in situ monitoring of anaerobic digestion of energy crops and livestock residues. Spectra were measured on a lab instrument and subjected to piecewise direct standardisation for a spectra transfer. The transfer was used in conjunction with samples for which data was recorded online for the partial least squares regression of volatile solids, ammonium, total inorganic carbon, and volatile fatty acids parameters in the fresh matter of a digester slurry. Validation was performed on independent time series spectra. The results confirmed that the procedure is robust in terms of NIR monitoring of these parameters in order to support the high potential for cross-linking different spectrometers, which may help in making this technology practical.

[Patent foramen ovale and hypoxaemia with or without elevated right heart pressures]. / Foramen ovale perméable et hypoxémie avec ou sans élévation des pressions droites.

The prevalence of patent foramen ovale (PFO) is high. As identified at autopsy it is found in approximately 25% of the general population. Anatomically a PFO represents a channel through which unidirectional blood flow from the right to the left atrium may occur. This potential interatrial shunt of unoxygenated venous blood into the oxygenated arterial system may lead to hypoxaemia. Usually right to left shunting across a PFO is transient and without clinical significance. Increased pulmonary arterial pressure may give rise to left-right pressure gradient reversal and right to left shunting across a PFO. High pressure in the right heart chambers, even without pulmonary arterial hypertension, can potentially lead to the reopening of a foramen ovale. In other cases inferior vena cava flow deviation might lead to right to left shunting across a PFO. Right to left shunting without pressure increase inside the right heart chambers is usually transient and even positional and its diagnosis is more difficult.