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Only few hundred interventions are performed in France each year to remove upper urinary tract stones using a laparoscopic/robotic transperitoneal or retroperitoneal approach. These interventions are proposed to patients with large (>20mm) and complex stones, sometimes after failure of endoscopic techniques or in the presence of malformations that can be treated at the same time. The major interest of these interventions is the possibility to remove the whole stone without prior fragmentation. Some anatomical situations can increase the technical difficulty, particularly the presence of an intrarenal pelvis and the presence of pelvic and periureteral adhesions. The reported complications are essentially urinary fistula and ureteral stenosis, the risks of which are reduced by the use of double J stenting. As struvite stones are more friable, their whole removal is more difficult and may lead to dispersion of fragments, particularly during laparoscopy. Conventional open surgery has a higher stone-free rate, but comes with a greater kidney function loss. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU Guidelines on urolithiasis. 2022) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by simultaneous percutaneous antegrade and retrograde ureteroscopy. The other indication is the simultaneous presence of several kidney and ureteral stones or of an impacted pelvic stone. The combination of the two techniques may increase the stone-free rate and decrease the retreatment rate of complex stones compared with percutaneous nephrolithotomy alone. The patient is usually in the modified supine position. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The French health insurance data warehouse named SNDS is one of the largest medico-administrative in the world allowing for powerful pharmacoepidemiological studies, based on real-life data collected prospectively. In addition to the absolute necessity of a strong pharmacological rationale, recommendations have been thought to improve the quality of pharmacoepidemiological studies. These guidelines emphasize the importance of an accurate definition of the study population, outcome and exposure, especially for studies performed on medico-administrative databases. Compliance with certain guidelines, particularly those concerning the identification of a specific population or an outcome and the definition of risk periods or exposure periods, may be difficult when performing studies on the SNDS because of its structure and the nature of the data recorded. The objective of this article is to provide advice for the conduct of pharmacoepidemiological studies according to the recommendationswhen using the SNDS, given its specificities. The performing of reliable studies from this rich but complex data warehouse requires the expertise of researchers with deep knowledge both in the SNDS and in pharmacological reasoning., (Copyright © 2023 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

It has been shown that the relative risk of cancer is higher in patients with urinary stone disease, probably due to the repeated radiological exams and procedures under fluoroscopic guidance. Reducing the radiation doses delivered to the patient also decreases the doses delivered to the operators and their assistants. The doses delivered during endoscopic procedures decrease with the urologist's experience. Training in radiation protection and the use of protocols can decrease the use of ionizing radiation in the operating room. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they were adaptable to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The main objectives of interventional stone treatment are stone removal, symptom elimination, and kidney function preservation. After treatment of kidney stones (extracorporeal shock wave lithotripsy [ESWL], or endoscopy), fragments may remain in the kidney, either deliberately left in place or due to treatment failure (i.e. residual stone [RS], resistant to ESWL, left or inaccessible by endoscopy), or due to failure to eliminate the obtained fragments (i.e. residual fragments [RF]). Their management may differ. The most commonly used definition of RF in the literature is based on a size cut-off (≤4mm) and on three criteria: spontaneous clearance rate, secondary intervention rate, and disease progression rate. RF may be spontaneously eliminated (42%), persist and increase in size (32%), or become complicated and require a secondary urological procedure (36%). Like for the initial treatment, it is important to consider the stone composition for the treatment decision-making concerning RS/RF. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU, 2022) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Percutaneous nephrolithotomy (Labate et al.) is the standard procedure for the treatment of large (≥2cm) kidney stones. The patient can be in prone or modified supine position. The puncture is performed under fluoroscopy and/or ultrasound guidance. The stone-free rate seems to be comparable between miniaturized and standard PCNL. Procedures performed with smaller diameter instruments tend to be associated with significant lower blood loss, but longer procedure times. The limitation of the number of percutaneous tracts results in better preservation of the kidney function and lowers the risk of complications. The use of tranexamic acid during PCNL may be interesting for reducing the bleeding risk, the transfusion rate, and possibly the intervention duration. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The quality of cancer care in the modern era is based on a precise diagnosis and personalized therapy according to patients and their disease based on validated guidelines with a high level of evidence. During cancer patients' management, the objective is first to make an accurate diagnosis and then offer the best treatment, validated beforehand in a multidisciplinary board meeting, with the best benefit/risk ratio. In the context of many low- and middle-income countries, the limited available means do not allow an adequate offer, resulting in non-optimal patients' care. In addition, in many low- and middle-income countries, priority can be given to other types of disease than cancer, which may considerably reduce allocation of specific resources to cancer care. Thus, the limited availability of systemic therapy, radiotherapy machines, brachytherapy and technological development may come up against another difficulty, that of geographical distribution of the means in the countries or a lack of expertise due to insufficient training programs. For all these reasons, the implementation of the guidelines established in Western countries could be impossible for many low- and middle-income countries which, moreover, have to face a completely different epidemiology of cancers compared to developed countries. In this work, we will discuss through a few examples of common cancers on both borders of the Mediterranean area, the applicability of the guidelines and the limits of their implementation for optimal cancer care., (Copyright © 2023 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Résumé L'essor des techniques de radiologie interventionnelle conduit à exposer régulièrement les patients au potentiel néphrotoxique des produits de contraste iodés. Face à ce risque de néphrotoxicité, les produits de contraste à base de gadolinium pour rehausser l'imagerie à résonance magnétique ont longtemps été considérés comme une alternative sécurisante aux produits de contraste iodés, en particulier chez les sujets sensibles ou à risque. Cependant, ils sont eux-mêmes non dénués de néphrotoxicité et présentent un nouveau risque, dont la physiopathologie est également liée à l'insuffisance rénale, qui est la fibrose systémique néphrogénique. Les recommandations européennes et américaines des agences de santé se sont rapprochées récemment, définissant des groupes de patients à risque de fibrose systémique néphrogénique en fonction de leur niveau de fonction rénale et du type de produit de contraste à base de gadolinium utilisé. Quels sont les réels risques rénaux encourus face à ces produits ? Comment évaluer la balance bénéfice-risque du patient pour lui choisir un examen radiologique, informatif, efficace et sûr ? Cet article s'attache à la description des risques liés aux produits de contraste à base de gadolinium, fait le point sur les recommandations et les bonnes pratiques existantes afin de guider le choix des cliniciens. Abstract The development of interventional radiology techniques regularly exposes patients to the potential renal toxocity of iodinated contrast media. Faced with this risk of nephrotoxicity, gadolinium-based contrast agents have long been considered as a safe alternative to iodinated contrast media, especially in sensitive or at risk patients. However, these gadolinium-based contrast agents are not devoid of nephrotoxicity and present another risk, a complication related to renal failure, the nephrogenic systemic fibrosis. European and US recommendations from health agencies have recently come closer, defining groups of patients at risk of nephrogenic systemic fibrosis according to their level of renal function and the type of gadolinium-based contrast agent used. What are the real renal risks for these products? How to evaluate the benefit-risk balance of the patient to choose a radiological examination in an informative, effective and safe way? This article focuses on the description of the risks of gadolinium-based contrast agents, reviews existing recommendations and best practices to guide the choice of clinicians. [ABSTRACT FROM AUTHOR]

Résumé Le nombre de patients porteurs de stimulateurs et de défibrillateurs automatiques implantables (dispositifs rythmologiques implantables) traités par irradiation est de plus en plus important, justifiant une prise en charge standardisée, en collaboration avec les cardiologues. Les interactions entre les champs électromagnétiques, les particules secondaires des accélérateurs et les appareils implantés peuvent être responsables de dysfonctionnements généralement transitoires et réversibles dont les conséquences cliniques peuvent varier selon la pathologie cardiaque et le rythme sous-jacents. Il existe de nombreuses recommandations internationales sur la prise en charge de ces patients traités par irradiation ; les points clés identifiés sont la dose totale cumulée au boîtier maximale tolérée de 5 Gy et la nécessité d’une évaluation préalable, puis d’une surveillance régulière du dispositif rythmologique implantable jusqu’à six mois après le traitement. L’analyse des données publiées montre une incidence relativement faible d’évènements indésirables, de faible gravité. Les recommandations internationales les plus récentes soulignent la faisabilité et l’intérêt de l’application de protocoles adaptés par tous les centres de radiothérapie. Abstract An increasing number of patients with cardiac implantable electronic devices benefit from radiotherapy, warranting specific collaborative management between both radiation oncologists and cardiologists. Interactions between electromagnetic fields, secondary particles and cardiac implantable electronic devices may result in transient and reversible malfunctions with significant consequences depending on the underlying cardiac pathology and the level of patient's cardiac implantable electronic devices dependency. Numerous international guidelines on patients’ management have been proposed and all agree on a total cumulated dose limit at the battery of 5 Gy and on the need for an initial as well as repeated evaluation over time, up to 6 months after the last radiation. The analysis of the published data revealed relatively rare incidence of significant adverse events. The most recent international guidelines underline the feasibility and safety of radiotherapy for cardiac implantable electronic devices holders, with the need for systematic local protocol in all radiotherapy centers. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Actualiser sous l'égide de la section os de la Société française de rhumatologie (SFR) et du groupe de recherche et d'information sur les ostéoporoses (GRIO) en collaboration avec des sociétés savantes (Collège national des généralistes enseignants, Collège national des gynécologues et obstétriciens français, Fédération nationale des collèges de gynécologie médicale, groupe d'étude de la ménopause et du vieillissement hormonal, Société française de chirurgie orthopédique, Société française d'endocrinologie, Société française de gériatrie et de gérontologie) les recommandations du traitement médicamenteux de l'ostéoporose post-ménopausique publiées précédemment en 2012. Méthodes Un groupe de travail, représentatif des spécialités médicales intervenant dans la prise en charge de ces patientes a élaboré ces recommandations à partir d'une analyse systématique de la littérature selon la méthode HAS. Discussion et conclusion Ces recommandations insistent sur la prise en charge des femmes avec une fracture sévère chez lesquelles un traitement anti-ostéoporotique est recommandé. En cas de fracture sévère, tous les traitements peuvent être prescrits ; l'acide zolédronique est à privilégier en première intention après une fracture de hanche. Dans les autres cas (avec ou sans fracture non sévère) l'indication thérapeutique dépend des valeurs de la densité minérale osseuse (DMO) et dans les cas difficiles d'outils comme le FRAX®. Tous les traitements peuvent être utilisés ; le raloxifène est à réserver aux patientes à faible risque de fracture périphérique. Le risque de fracture doit réévaluer tous les 2 à 3 ans pour décider des suites de la prise en charge. Ces recommandations abordent le choix du premier traitement et les séquences thérapeutiques. [ABSTRACT FROM AUTHOR]

Résumé Le traitement de l'anaphylaxie en pratique courante repose, en première ligne, sur l'utilisation sans délai de l'adrénaline par voie intramusculaire. Les auto-injecteurs d'adrénaline permettent une injection dans des conditions d'efficacité et de sécurité optimales, mais dans une gamme de doses restreinte, entre 0,15 et 0,50 mg, par injection. Toutes les recommandations internationales sur le traitement de l'anaphylaxie en pratique courante valident une même posologie d'adrénaline de 0,01 mg/Kg de poids par injection intramusculaire (dose maximale de 0,5 mg par injection) malgré l'absence d'étude de qualité sur ce thème. Cette mise au point du groupe de travail « Anaphylaxie » de la Société française d'allergologie analyse les données actuelles concernant le traitement par adrénaline avec les auto-injecteurs, en insistant sur la problématique de la posologie. Abstract Intramuscular adrenaline is the first-line treatment for anaphylaxis. Adrenaline auto-injectors allow injection under conditions of optimal efficacy and safety, but commercially available formulations are restricted to a dose range of 0.15 and 0.50 mg per injection. All the international anaphylaxis guidelines recommend the administration of intramuscular adrenaline at a dose of 0.01 mg/Kg of body weight, with a maximum dose of 0.5 mg per injection, despite the lack of evidence-based data. This position statement, prepared by the Anaphylaxis working group of the French Allergology Society, attempts to analyse current data regarding the use of adrenaline auto-injectors as treatment of anaphylaxis with, in particular, emphasis on the dosage issue. [ABSTRACT FROM AUTHOR]

Résumé Introduction La démarche diagnostique au cours des uvéites n’est pas standardisée. Elle doit prendre en compte l’épidémiologie des uvéites, cibler les affections les plus sévères et/ou les plus fréquentes, et/ou susceptibles de bénéficier d’un traitement spécifique. Ce travail a été réalisé afin de proposer des recommandations pour le diagnostic des uvéites. Méthodes Les recommandations ont été établies par un groupe de 15 experts, internistes, ophtalmologistes et rhumatologues, à partir d’une revue de la littérature et de l’étude ULISSE qui est la première étude prospective à avoir évalué une stratégie diagnostique pour les uvéites. Sont exclues de ces recommandations les uvéites de l’enfant, de l’immunodéprimé, les vascularites rétiniennes sévères et les entités purement ophtalmologiques. Résultats Le bilan paraclinique doit en premier lieu être orienté par les éléments de l’interrogatoire et les signes cliniques. La sérologie syphilitique est la seule sérologie systématique. Les sérologies toxoplasmose et herpès virus seront réalisées en cas de suspicion diagnostique et avant tout prélèvement oculaire. En l’absence de cause identifiée, nous proposons un bilan paraclinique orienté par les caractéristiques de l’uvéite. Il comporte un typage HLA B27 (uvéite antérieure aiguë unilatérale non granulomateuse), un dosage de l’enzyme de conversion de l’angiotensine, un test IFN-γ release assay (IGRA) et un scanner thoracique (uvéite chronique), une IRM cérébrale associée à une ponction de chambre antérieure avec dosage de l’interleukine 10 (uvéite intermédiaire ou postérieure après 40 ans). La rentabilité d’examens complémentaires non orientés est très faible. Conclusions Nous proposons une stratégie diagnostique pour les uvéites. Les recommandations doivent être actualisées régulièrement. La place des examens les plus invasifs reste à définir. Introduction Diagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis. Methods Recommendations were developed by a multidisciplinary panel of 15 experts, including internists, ophthalmologists and a rheumatologist and are based on a review of the literature with regard to effectiveness of investigations and the results of the ULISSE study, which is the first prospective study assessing the efficiency of a standardized strategy for the etiological diagnosis of uveitis. Children, immunocompromised patients, severe retinal vasculitis and specific ophthalmological entities are excluded from these recommendations. Results Investigations should be first guided by the history and physical examination. Serological screening for syphilis is the only test appropriate in all forms of uveitis. If no diagnosis is made after this stage, we propose investigations guided by the anatomic characteristics of uveitis. It includes HLA B27 testing (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin converting enzyme, interferon-gamma release assay and chest CT (chronic uveitis), cerebral MRI and anterior chamber tap with IL10 analysis (intermediate or posterior uveitis in patients over 40 years). Investigations ordered in the absence of orientation are almost always unhelpful. Conclusions We propose a strategy for the etiologic diagnosis of uveitis. The recommendations should be updated regularly. The efficiency of more invasive investigations has yet to be evaluated. [ABSTRACT FROM AUTHOR]

This article aims to summarize the literature on the role of physical activity in cancer patients and to propose exercise programs based on studies and recommendations. Medical advances with improved early diagnosis and treatment have increased the number of cancer survivors. At the same time, the quality of life of these patients must also be improved. In the different stages of the disease physical activity has an important role to play with its beneficial effects on fatigue, physical condition, mood etc. Collaboration between health system actors and patient education are the key to success in this multidisciplinary care. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les inhibiteurs de la pompe à protons (IPP) sont largement prescrits pour des indications non reconnues, à forte dose, pour une durée prolongée, malgré des effets indésirables et des interactions médicamenteuses nombreux. En 2009, la HAS a publié des recommandations de bonne prescription mais ces dernières sont peu respectées. Dans ce contexte de surprescription et de surcoût pour la société, nous avons réalisé une évaluation des pratiques professionnelles sur le modèle de la roue de Deming. L’objectif de ce travail était d’optimiser la pertinence des prescriptions des IPP dans deux services de médecine interne et de gériatrie grâce à une évaluation des pratiques professionnelles. Toutes les prescriptions d’IPP étaient analysées qu’elles aient été initiées en externe ou durant l’hospitalisation. Patients et méthodes Le recueil des données était prospectif, sur deux périodes de 2 mois et incluait 163 (première phase) puis 139 patients (deuxième phase). Une grille d’évaluation des prescriptions d’IPP était remplie par les médecins concernant le principe actif, la posologie, la durée et l’indication de la prescription. La pertinence correspondait aux prescriptions d’IPP avec une indication et une durée conformes et aux prescriptions non recommandées arrêtées. À la suite de la première période de recueil des données, une information des internes et médecins sur la pertinence de leurs prescriptions au regard des recommandations actuelles et la distribution de plaquettes d’aide à la prescription étaient faites dans le but d’améliorer les pratiques avant la seconde période d’évaluation (deuxième phase). Résultats Lors de la première phase, seulement 25 % des prescriptions pré-hospitalières et 33 % des prescriptions hospitalières respectaient les recommandations de la HAS. La principale indication des IPP était la prévention d’ulcères gastroduodénaux dans un contexte de prise médicamenteuse estimée à risque. Une amélioration de la pertinence des prescriptions était observée après la sensibilisation des prescripteurs : pertinence de 26 % lors de la première phase à 60 % après rappel auprès des prescripteurs ( p < 0,012). Lors de la seconde phase, la part des prescriptions d’IPP initiées à l’hôpital diminuait de 33 à 17 % et l’arrêt de l’exposition non recommandée avec information des médecins correspondants augmentait de 6 à 33 % ( p < 0,001). Cependant, lors de la deuxième phase, 33 % des prescriptions initiées en hospitalisation étaient toujours non recommandées et 61 % des prescriptions débutées en externe non conformes étaient toujours poursuivis à la sortie, probablement par manque d’information suffisante pour arrêter la prescription d’IPP. Conclusion Notre étude souligne le non-respect fréquent des recommandations dans la prescription des IPP. De manière intéressante, une évaluation des pratiques professionnelles a permis une amélioration de la pertinence des prescriptions avec un arrêt plus fréquent des expositions chroniques non conformes et une baisse des prescriptions hors indications. Notre étude suggère qu’il est primordial de poursuivre la sensibilisation des internes et des médecins hospitaliers et de ville dans leur prescription d’IPP. Une information des patients sur les indications et la durée limitée de la prescription, les effets indésirables potentiellement graves d’une prise prolongée et le risque d’interactions médicamenteuses reste également nécessaire pour faciliter l’arrêt de l’exposition et limiter l’automédication. Introduction Proton pump inhibitors (PPI) are widely prescribed for unrecognized indications, at high a dose and for a long duration, in spite of side effects and numerous drug interactions. In 2009, the HAS (French Health Authority) published recommendations of good prescription but the latter are poorly respected. In this context of over prescription and additional cost for the society, we performed a professional practice evaluation of on the model of the Deming wheel. The objective of this work was to optimize the relevance of the prescriptions of the IPP in two services of internal medicine and geriatrics through an evaluation of the professional practices. All PPI prescriptions introduced in outpatient visits or during hospitalization were analyzed. Patients and methods Data collection was prospective, over two periods of 2 months and included 163 (first phase), then 139 patients (second phase). An assessment grid of PPI prescriptions was completed by physicians regarding the active substance, the dose, the duration and the indication of the prescription. The relevance of the prescription corresponded to PPI with a conformed indication and duration and to the prescriptions no recommended stopped. Following the first period of data collection, information was given to medical students and physicians on the relevance of their prescriptions with regard to the current recommendations and informative flyers were offered with the aim of improving the practices before the second period of evaluation (second phase). Results During the first phase, only 25% of the pre-hospital prescriptions and 33% of the hospital prescriptions respected the HAS recommendations. The main indication of the PPI was the prevention of peptic ulcers in a context of associated drug estimated at risk. An improvement of the global relevance of prescription was observed after awareness of the physicians: 26% relevance during the first phase and 60% in the second one ( P < 0.012). During the second phase, the part of PPI prescriptions introduced at hospital decreased from 33 to 17% and the discontinuation of the not corresponding prescriptions increased from 6 to 33%, with an additional information given to the general practitioner ( P < 0.001). However, during the second phase, 33% of the prescriptions introduced in hospitalization were always not corresponding and 61% of the not corresponding prescriptions begun in outpatient visits were always pursued on discharge, probably due to the lack of sufficient information to stop the prescription. Conclusion Our study underlines the frequent disrespect of the indications in the prescription of PPI. Interestingly, a professional practices evaluation improved the relevance of the prescriptions with a more frequent withdrawal of the not corresponding exposure and a decrease in global not corresponding prescriptions. Our study suggests that it is crucial to regularly inform physicians on the good prescription of PPI. Patient information focused on the indications and the limited duration of PPI prescription, potentially severe side effects of chronic exposure and on the risk of drug interactions also remains necessary in order to facilitate the stop of the exposure and restrict self-medication. [ABSTRACT FROM AUTHOR]

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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The long-term impact of treatment strategies proposed by the IDSA guidelines for patients presenting with methicillin-susceptible S. aureus (MSSA) prosthetic joint infection (PJI) is not well-known. Patients and methods Retrospective (2000–2010) cohort study including patients presenting with MSSA hip or knee PJI. A univariate Cox analysis was performed to determine if the non-compliance with IDSA surgical guidelines was a risk factor for treatment failure. Results Eighty-nine patients with a mean follow-up of 2.8 years were included. Non-compliance with IDSA surgical guidelines was associated with treatment failure (hazard ratio 2.157; 95% CI [1.022–4.7]). The American Society of Anesthesiologists score, inadequate antimicrobial therapy, and a rifampicin-based regimen did not significantly influence patient outcome. Conclusion Based on the IDSA guidelines, if a patient presenting with MSSA PJI is not eligible for implant retention, complete implant removal is needed to limit treatment failure. [ABSTRACT FROM AUTHOR]

Résumé Actualisation des recommandations de la Société française de rhumatologie pour la prise en charge en pratique des patients atteints de spondyloarthrite (SpA). La SpA est prise en compte avec ses différentes expressions cliniques (axiale, périphérique, enthésitique) et ses manifestations associées et comprend le rhumatisme psoriasique. Procédures standardisées selon les recommandations EULAR pour l’élaboration des recommandations : analyse de la littérature depuis la version précédente (juin 2013), groupe de travail, élaboration de recommandations avec regroupement et synthèse, vote et niveau d’accord. Quatre principes généraux et 15 recommandations sont proposés. Les 4 premières recommandations concernent les objectifs du traitement et les considérations générales (outils d’évaluation, comorbidités). Les recommandations 5 et 6 s’intéressent aux moyens non pharmacologiques. La recommandation 7 concerne les AINS, base du traitement, et les items 8 à 10 l’utilisation des antalgiques, de la corticothérapie et des traitements d’action lente conventionnels. Les recommandations 11 à 14 s’intéressent à l’usage des biomédicaments, intégrant les nouvelles classes, dans leurs indications (maladie active malgré le traitement conventionnel, et pour les formes axiales non radiographiques, présence de signes objectifs d’inflammation) et suivi, leur gestion en cas d’échec ou en rémission. La recommandation 15 concerne le recours à la chirurgie. Cette actualisation, intégrant les données récentes, offre des recommandations en nombre plus réduit et de formulation plus simple, dans le but d’une utilisation plus facile pour guider la prise en charge en pratique des patients atteints de spondyloarthrite. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les antivitamines K (AVK) sont une cause majeure de iatrogénie. La gestion des surdosages a fait l’objet de recommandations qui font référence en France (HAS 2008). L’objectif de ce travail a été de vérifier si la prise en charge de ces situations était en adéquation avec ces recommandations. Méthode Il s’agit d’une étude rétrospective multicentrique. Cent-dix événements de surdosage ont été recensés par le laboratoire d’hémostase et ont été analysés. Résultats Cinquante-huit pour cent des prises en charge étaient en accord avec les recommandations. Néanmoins, pour les surdosages les plus importants, i.e., INR > 6, le taux d’adéquation s’établissait à 33 %. Les principales erreurs concernaient le choix d’un traitement complémentaire (vitamine K). Le taux de mortalité hospitalière de la cohorte était de 20 %. Conclusion La prise en charge hospitalière des surdosages en AVK est largement perfectible. Il est nécessaire de mettre en place des procédures visant à sécuriser les comportements des prescripteurs. Introduction Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians’ adherence to those guidelines. Methods We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed. Results Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR > 6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%. Conclusion Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians. [ABSTRACT FROM AUTHOR]

Considering recent phase III trials results, moderate hypofractionated radiotherapy can be considered as a standard treatment for low and intermediate risk prostate cancer management. This assessment call for a framework allowing homogeneous and reproducible practices in the different centers using this radiotherapy schedule. The French Genito-Urinary Group (GETUG) provides here recommendations for daily practice of moderate hypofractionated radiotherapy for prostate cancer, with indications, dose, fractionation, pre-treatment planning, volume of interest delineation (target volume and organs at risk) and margins, dose constraints and radiotherapy techniques. [ABSTRACT FROM AUTHOR]

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Résumé La transfusion de concentrés de globules rouges (CGR) est fréquente chez le sujet âgé avec peu de recommandations pour cette population de patients. Nous avons souhaité étudier les pratiques transfusionnelles chez les patients de 75 ans et plus transfusés en CGR dans tous les services de soins du CHRU de Brest. Ce travail a pour but de décrire cette population de patients et de comparer les pratiques transfusionnelles aux recommandations de la HAS et de l’ANSM de 2014. Méthodologie Une enquête observationnelle a été réalisée chez les patients de 75 ans et plus transfusés en CGR du 27 janvier au 27 mars 2014. Une grille de recueil a été élaborée afin d’analyser la typologie des patients, les caractéristiques de l’anémie, les indications et les modalités de transfusion, ainsi que l’adéquation aux recommandations de 2014. Résultats Deux cents quarante-et-un patients ont été transfusés pendant cette période avec 422 épisodes transfusionnels (âge moyen 83 ± 5,2 ans, sex-ratio femmes/hommes 1,4 avec 4,4 ± 2 pathologies et 6,7 ± 3,2 traitements en moyenne). Seulement 4,5 % des patients ont été transfusés dans le service de médecine gériatrique. L’anémie était aiguë dans 61 % des cas et chronique dans 39 % des cas. Les critères de mauvaise tolérance étaient majoritairement l’asthénie (50,6 %) et la dyspnée (31,7 %). Chez 31,1 % des patients, du furosémide était prescrit pour l’acte transfusionnel. Le rendement transfusionnel moyen était de 1,2 ± 0,5 g/dL. Deux effets indésirables receveurs ont été signalés. Au total, seulement 10,4 % des indications transfusionnelles n’étaient pas conformes aux recommandations de 2014. Conclusion Cette étude a permis d’évaluer les pratiques transfusionnelles chez les patients de 75 ans et plus. Bien que le taux de non-conformité soit faible, il est possible d’améliorer les pratiques en prenant en compte les particularités gériatriques. Des études prospectives à plus grande échelle restent nécessaires afin d’aboutir à une prise en charge plus consensuelle. Red blood cell transfusion is commonly required for elderly patients with little specific guidelines for this population. We wished to study the transfusion practices for patients aged ≥ 75 years transfused with red blood cells in all units of our institution. The aim of this work is to describe this population of patients and to compare the transfusion practices to the HAS and ANSM guidelines published in 2014. Methods An observational study was performed including patients ≥ 75 years, transfused with red blood cells between 27th January to 27th March 2014. Analysis of data included the patients’ typology, the characteristics of anemia, the indications and transfusion practices, and the adequation with the guidelines. Results Two hundred and forty-one patients were transfused during the period with 422 transfusion episodes (mean age 83 ± 5.2 years, sex-ratio women/men 1.4 with 4.4 ± 2 pathologies and 6.7 ± 3.2 treatments). Only 4.5% of the patients were transfused in geriatric wards. In 61% of the cases, the anemia is acute and chronic in 39%. Fatigue was reported in 50.6% of the cases and dyspnee in 31.7%. A percentage of 31.1 of the patients were prescribed furosemide for transfusion. The mean transfusion recovery was 1.2 ± 0.5 g/dL. Two adverse events were reported. Overall, only 10.4% of the prescriptions were not compliant with the guidelines of 2014. Conclusion In this study, we describe transfusion practices for patients aged ≥ 75 years. Although the non-compliance with the guidelines is weak, it is possible to improve the transfusion practices taking care of the geriatric characteristics. Prospective studies on a larger scale have to be done to converge on a more consensual management. [ABSTRACT FROM AUTHOR]

The main goal of these treatm ent recommendations is to provide experts w ith current evidence on diagnostic procedures and therapy of depression in the elderly. After description of current diagnostics according to ICD-10, the special presentation of symptoms in old-age depression is highlighted and, in particular, the risk factors of the markedly increased suicide risk in the elderly are described. Assessment instrum ents are helpful in the diagnosis and are discussed in detail. Most im portantly, prodromal dem entia has to be taken into consideration in differential diagnosis. Additional im portant com orbidities are substance use disorders, and chronic somatic diseases such as pain syndromes, cardiovascular diseases or metabolic disorders. Moreover, facing the frequent polypharmacy in old age, the triggering of depression by m edication has to be considered. Besides the known age-specific psychosocial triggers and the classic aminergic deficiency hypothesis, neuroendocrinology and neurodegeneration as well as vascular factors are discussed as crucial pathogenetic mechanisms. Flowever, genetics may also play an im portant role in the elderly patient. F ortreatm ent of depression in old age, an integrated biopsychosocial approach with targeted psychosocial interventions, specific psychotherapy and antidepressant pharmacotherapy is deemed adequate. Biological non-pharm acological treatm ents are also treatm ent options in elderly depressed patients, i.e. chronobiological procedures and electroconvulsive therapy In conclusion, the present treatm ent recommendations for old age depression by the Swiss professional societies provide an aid for therapy based on evidence and clinical expertise. The latter is most im portant, since evidence is often lacking in this patient population. Finally, in view of the frequent age-related polypharmacy, a comprehensive understanding of the pharmacotherapeutical evidence is an im portant prerequisite for its careful application. [ABSTRACT FROM AUTHOR]

Résumé Les recommandations pré-analytiques en gazométrie sont très strictes. Outre les difficultés rencontrées dans la gestion du délai d’acheminement en routine ou dans le cadre de la biologie délocalisée, se pose le problème du passage des examens en cas de panne d’automate (mode dégradé). La réglementation en matière d’accréditation demande une étude d’analyse des risques avec la population locale de patients représentée ici par un pool de 67 patients. Les résultats de certains paramètres comme le pH, la pCO2 et les bicarbonates n’ont pas paru altéré par le stockage une heure à température ambiante. The pre-analytical recommendations in gasometry are very strict. In addition to the difficulties encountered in the management of the routing time in routine or in the framework of the delocalized biology, there arises the problem of passing examinations in case of automated failure (degraded mode). Accreditation regulations require a risk analysis study with the local population of patients represented here by a pool of 67 patients. The results of certain parameters as pH, pCO2 and bicarbonates did not appear to be altered by storage for one hour at room temperature. [ABSTRACT FROM AUTHOR]

Objectives Adults with hematological malignancies are at high-risk of Clostridium difficile infection (CDI), but no guidelines for CDI treatment are available in this population. Our primary objective was to evaluate the clinical outcomes in CDI patients with hematological malignancies. Our secondary objectives were to describe CDI severity using the main clinical guidelines and to evaluate the compliance of treatment choice with published guidelines. Patients and methods Single-center, retrospective, observational case series including every consecutive adult patient with a confirmed diagnosis of CDI admitted in the hematology unit of our teaching hospital. Each CDI episode was classified as moderate, severe, or complicated according to the main clinical guidelines (IDSA 2010, AJG 2013, ESCMID 2014). Results Twenty-three episodes of CDI in 19 patients admitted to the hematology unit occurred between June 2012 and October 2013. Clinical cure was achieved for 20 episodes (87%). Ten weeks after diagnosis, global cure was reached for 14 episodes (61%) whereas recurrence occurred in two episodes (10%). The mortality rate reached 37% (7/19) but the attributable mortality rate was 5% (1/19). ESCMID criteria more frequently classified patients in the severe category compared with the two other classifications. Prescription compliance with clinical guidelines was observed in 61% of episodes with IDSA criteria, 43% with AJG, and 9% with ESCMID. Conclusions IDSA and AJG assessment may underestimate the potential risk of unfavorable clinical outcome. Further prospective studies on a larger cohort are needed to develop adequate treatment guidelines for CDI in hematology settings. [ABSTRACT FROM AUTHOR]

Résumé Ces recommandations formalisées d’experts ont été élaborées par la Société française de médecine d’urgence, avec la collaboration de la Société française d’allergologie, le Groupe francophone de réanimation et urgences pédiatriques, et le soutien de la Société pédiatrique de pneumologie et d’allergologie. Leur but est de sensibiliser les urgentistes au diagnostic précoce de cette réaction d’hypersensibilité sévère potentiellement fatale, aux particularités liées à l’âge et à l’identification de ses facteurs de risque. Le diagnostic d’anaphylaxie est clinique et repose sur l’utilisation des critères cliniques de Sampson. Les auteurs proposent des fiches d’aide à la régulation médicale ainsi que des critères de tri pour les infirmières organisatrices de l’accueil. Comme le soulignent les recommandations internationales, le traitement principal repose sur l’administration précoce d’adrénaline par voie intramusculaire. En présence d’un auto-injecteur d’adrénaline (AIA), le médecin régulateur du service d’aide médical urgente (Centre 15) doit favoriser son utilisation sans attendre l’arrivée des secours. Puis en fonction du contexte, le traitement repose sur l’éviction du facteur déclenchant, une position d’attente adaptée, une oxygénothérapie et, en fonction des symptômes, un remplissage intraveineux, des aérosols de bronchodilatateur ou d’adrénaline. La gravité du pronostic et le caractère imprévisible de l’évolution justifient l’engagement d’une unité mobile hospitalière. Une surveillance minimale de six heures est indiquée en structure hospitalière. Le dosage de la cinétique de la tryptase contribue au diagnostic, a posteriori. À la sortie de l’hôpital, le patient doit avoir une prescription de trousse d’urgence (comportant au minimum deux AIA et des β2-mimétiques), des consignes écrites et un compte rendu écrit détaillé. Une orientation vers une consultation allergologique est indispensable. These formalized expert guidelines were written by the French Society of Emergency Medicine (SFMU), in partnership with the French Allergology Society (SFA) and the French Speaking Group in Pediatric Intensive Care and Emergency (GFRUP), and the support of the French Pediatric Pneumology and Allergology Society (SP2A). Their goal is to educate emergency physicians to early diagnosis of this potentially fatal reaction of severe hypersensitivity, the specific features associated with age, and risk factors identification. Anaphylaxis diagnosis is clinical and used Sampson's clinical criteria. The authors offer helps sheets for emergency medical services dispatch and triage criteria for emergency department nurses. As underlined by the international guidelines, the main treatment is early administration of intramuscular epinephrine. If an epinephrine auto-injector is available, the emergency medical services dispatch center on-call physician (112-call) should encourage its immediate use. The second line of treatment is based on the eviction of the triggering factor, the appropriate waiting position, oxygen therapy, and depending on the symptoms, fluid therapy, bronchodilator and epinephrine nebulization. The severity of the prognosis and the unpredictability of developments justify the deployment of a mobile intensive care unit. A minimum six-hour hospital observation is indicated. Tryptase kinetics evaluation contributes to a posteriori diagnosis. At emergency department discharge, the patient must have a prescription of an emergency kit (containing two epinephrine auto-injectors and β2-agonists), written instructions and a detailed written hospital report. A specialized consultation with an allergologist is essential after the emergency department discharge. [ABSTRACT FROM AUTHOR]

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The Recommendations and opinions as mechanisms of interventionat the disposel of independent administrative authorities, are one of the aspects of technical legal developments at the procedural level, and that of the content of law, wich coincides with the development that the world has experienced over the past two decades at least, and continues to experience, in all areas ; economic, financiel, administrative, computing and technology, as well as in communications. This type of flexible rules adapted to the interventions of these authorities to exercise their fonction of sectors’ regulation, even if it devoid of the element of obligation wich is the main element in the composent of the classical law, however it benifits from credibility resulting from the convition and trust of the concerned persons in particular and the public opinion more generally.