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Objective: To assess both level and type of the initial training on regional anesthesia for French residents after the publication of formalized recommendations of experts on training and practice in regional anesthesia in 2006., Study Design: Practical statement enquiry., Material and Methods: A multiple choice questionnaire was sent to all the French residents in anesthesiology. Questions are focused on demographic data (year of training, university hospital origin, theoretical training, type and length of practical courses) and regional anesthesia practice, particularly about the essentials of regional anesthesia techniques for initial training, level of practice and degree of autonomy, especially for the 5th and the 3rd years students. After sending, two follow-ups were done, responses were obtained by mail or post., Results: The global answer rate was 29.1% (25.3% and 23.4% for the 5th and the 3rd years respectively). Concerning theoretical training, 29% of responders had anatomy course, 33% dissection and 38% a supplemental training. At the end of initial training, the official goal (30 acts for a specific technique) was achieved in 98% of cases for epidural anesthesia, 95% for spinal anesthesia, 82% for both axillary and humeral block and 72% for femoral block, with a declared 100% autonomy at this level., Conclusion: The main goal of the formalized recommendations on training and practice in regional anesthesia is partially reached. This apparent failure can be due to both a lack of regional anesthesia exposure, inadequate faculty training, usual slavery to routine, or technical evolution of medical practice., (Copyright © 2012 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

This study compared the ventilatory responses and exercise tidal flow-volume (Vt) loops during exercise in order to analyze the influence of gender on breathing strategy in a fit aging population. Sixteen trained elderly men (63.0+/-2.9 years) and eight peer women (62.3 +/- 5.5 years) performed an incremental test on a cycle ergometer. At 90% maximal oxygen consumption (VO2max), the women presented a significantly higher expiratory flow limitation (EFL) than the men (38 +/- 10 vs 17 +/- 8% of Vt, respectively) (P<0.01) and a lower value of expiratory reserve volume relative to forced vital capacity (FVC) compared with the men (16.8 +/- 5.3% vs 23.0 +/- 5.2%, respectively) (P<0.05). Inspiratory reserve volume relative to FVC was significantly higher in women than men at 50% (P<0.05), 70% (P<0.01) and 90%VO2max (25.2 +/- 5.4% vs 12.2 +/- 4.2%, respectively, at 90%VO2max) (P<0.01). Mechanical ventilatory constraints occurred in trained elderly men and women. However, different breathing strategies were observed relative to gender. A significantly higher EFL was measured in women, whereas men rather presented a dynamic hyperinflation. This specific breathing strategy measured in trained elderly women would induce lower ventilatory efficiency than in peer men.

The purpose of our investigation was to suggest a new approach to determine exercise intensities in master elderly athletes. Sixteen trained elderly men (63.0 +/- 2.9 years) and 8 trained elderly women (62.3 +/- 5.5 years), performed an exhaustive exercise test on a cycle ergometer. Rating of perceived exertion (RPE) and heart rate reserve (HRr) were determined at the first and second ventilatory thresholds (VT1 and VT2). There was no significant difference between genders in RPE and HRr, whatever the exercise intensity. RPE scores corresponded to 12.4 +/- 0.9 in men and 12.7 +/- 1.3 in women at VT1. At VT2, RPE was 15.2 +/- 0.8 and 15.3 +/- 1.1 in men and women, respectively. HR at VT1 corresponded to 59.3 +/- 7.0% in men and 59.5 +/- 5.1% in women, whereas at VT2, HR was measured at 80.5 +/- 6.4% and 79.5 +/- 5.9% HRr, in men and women, respectively. Because it is not practical to measure VT1 and VT2 in routine clinical practice, the present study indicated that, in trained older men and women, the RPE value of 12 - 13 and/or 60 % HRr might be used to detect the exercise intensity at VT1. An RPE score of 15 and/or 80 % HRr would appear to be good indexes in the prescription of exercise intensity at VT2.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, which results in the progressive development of dyspnea and exercise limitation., Objective and Methods: To compare the effect of tiotropium with placebo on forced vital capacity (FVC) in patients with moderate-to-severe COPD and lung hyperinflation, using exercise endurance, dyspnea and health-related quality of life (HRQoL) as secondary endpoints. One hundred patients were randomized to receive either tiotropium 18 mug once daily or placebo for 12 weeks., Results: Trough (predose) FVC was significantly improved with tiotropium compared to placebo on day 42 (0.27 +/- 0.08 liters) and 84 (0.20 +/- 0.08 liters; p < 0.05 for both). Trough inspiratory capacity (IC) was also significantly improved with tiotropium compared to placebo on day 42 (0.16 +/- 0.07 liters) and 84 (0.15 +/- 0.07 liters; p < 0.05 for both). Tiotropium increased the mean distance walked during the shuttle walking test by 33 +/- 12 (day 42) and 36 +/- 14 m (day 84) compared to placebo (p < 0.05 for both). On day 84, 59% of the patients in the tiotropium group and 35% of the patients in the placebo group had significant and clinically meaningful improvements in the St. George's Respiratory Questionnaire total score (p < 0.05). Numerical decreases in the focal score in the Transition Dyspnea Index in patients receiving tiotropium versus placebo suggest that tiotropium also improved dyspnea during activities of daily living., Conclusion: Tiotropium 18 mug once daily reduced hyperinflation with consequent improvements in walking distance and HRQoL in patients with COPD and lung hyperinflation.

Objectives: Describe patients at risk of chronic obstructive pulmonary disease (COPD) and analyze general practitioners' (GPs) management of COPD patients in France in 2003-2004., Methods: EDEN, a national epidemiological survey, recruited 2 378 GPs. Each GP was to include 3 consecutive patients (aged 36-80 years) who were current or former smokers and presented respiratory symptoms (any of expectoration, cough, or dyspnea) without asthma or previously diagnosed COPD. The physician completed a standardized, anonymous questionnaire for each patient, including measurement of peak expiratory flow (PEF)., Results: The sample of 3 411 current smokers or former smokers with respiratory symptoms included twice as many men as women. The mean age was 58 years, with women significantly younger (p<0.0001). Men and older patients had more severe disease. Women were more often current smokers, but they smoked less than men. All patients had at least one respiratory symptom, but only 63.5% were seeing their GP for that reason. Overall, 56.5% patients reported repeated acute bronchitis, and 36.3% of these at least 3 episodes. PEF was measured in 87.7% of patients and the ratio of mean measured PEF/predicted PEF was 73.2%. GPs concluded that 92.1% of these patients had COPD, but prescribed respiratory function tests useful for only 73.8% and referred only 71.2% to a specialist., Conclusion: Former and current smokers underestimated their respiratory symptoms, and so did the GPs. Accordingly, COPD is diagnosed later and at a more advanced stage. Increasing GPs' awareness of COPD would improve early detection in at-risk subjects.