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Le Touquet – Paris-Plage, France

Preventive perinatal home visits are a powerful and effective tool, particularly to reach the most vulnerable families. These families, who accumulate multiple psycho-social difficulties, seldom use available medical and social institutions and find themselves at greater risk of developing disorders in early parent-child relationship and a subsequent psychopathology. This paper is based on a literature review of home-visiting programs, in France and other countries. Our purpose is both to describe better this practice, which hasn't yet been clearly formalized within institutions, and also to assess its impact and limitations. © Médecine & Hygiène. Tous droits réservés pour tous pays. Source

Varenhorst C.,Uppsala University | Alstrom U.,Uppsala University | Scirica B.M.,Brigham and Womens Hospital | Hogue C.W.,Johns Hopkins University | And 12 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: This study investigated the differences in specific causes of post-coronary artery bypass graft surgery (CABG) deaths in the PLATO (Platelet Inhibition and Patient Outcomes) trial. Background: In the PLATO trial, patients assigned to ticagrelor compared with clopidogrel and who underwent CABG had significantly lower total and cardiovascular mortality. Methods: In the 1,261 patients with CABG performed within 7 days after stopping study drug, reviewers blinded to treatment assignment classified causes of death into subcategories of vascular and nonvascular, and specifically identified bleeding or infection events that either caused or subsequently contributed to death. Results: Numerically more vascular deaths occurred in the clopidogrel versus the ticagrelor group related to myocardial infarction (14 vs. 10), heart failure (9 vs. 6), arrhythmia or sudden death (9 vs. 3), and bleeding, including hemorrhagic stroke (7 vs. 2). Clopidogrel was also associated with an excess of nonvascular deaths related to infection (8 vs. 2). Among factors directly causing or contributing to death, bleeding and infections were more common in the clopidogrel group compared with the ticagrelor group (infections: 16 vs. 6, p < 0.05, and bleeding: 27 vs. 9, p < 0.01, for clopidogrel and ticagrelor, respectively). Conclusions: The mortality reduction with ticagrelor versus clopidogrel following CABG in the PLATO trial was associated with fewer deaths from cardiovascular, bleeding, and infection complications. (Platelet Inhibition and Patient Outcomes [PLATO]; NCT00391872) © 2012 American College of Cardiology Foundation. Source

Calvert P.A.,Hopital Bichat | Calvert P.A.,University of Cambridge | Steg P.G.,Hopital Bichat | Steg P.G.,French Institute of Health and Medical Research | Steg P.G.,University Paris Diderot
European Heart Journal | Year: 2012

Percutaneous coronary intervention (PCI) has matured from a pioneering adventure focused on feasibility to a major sub-specialty delivering real clinical results to patients. Despite delivering reductions in mortality and morbidity in the field of acute coronary syndrome and overcoming in-stent restenosis, several challenges still remain. Firstly, we need to adhere to practices supported by established trials: data relating to PCI in stable angina and late reopening of occluded infarct-related vessels suggest that this is not always the case. Secondly, we must develop new trials asking clinically relevant questions in 'real-world' populations that are focused on patient-based outcomes. Finally, given the current global financial crisis, it is now more important than ever that we demonstrate cost-effectiveness in our clinical practice. In these turbulent times, we discuss the challenges ahead for PCI in its journey towards evidence-based practice. © The Author 2011. Source

Ducrocq G.,Hopital Bichat | Capodanno D.,Policlinico Vittorio Emanuele | Windecker S.,University of Bern | Fajadet J.,Clinique Pasteur
EuroIntervention | Year: 2013

Aims: As part of the EAPCI Young Initiative, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) conducted a survey to address the educational needs of young interventional cardiologists. Methods and results: A questionnaire was distributed to all individuals registered in the ESC database aged <36 years with an interest in interventional cardiology. Nearly two-thirds of participants (60%) indicated that they had difficulty in finding a fellowship training position. The desire for a fellow's course at European level was expressed by 95%, while 94% were in favour of developing a network of young interventional cardiologists in Europe. More than three-quarters of respondents (79%) said they had had difficulty in obtaining funding to attend EuroPCR. Multiple difficulties were identified in setting up a research programme, two of the more frequent being problematic access to research networks and the difficulties of finding a mentor. Career orientation was identified as another issue, with more than half of respondents (59%) declaring they followed career options by chance. Conclusions: The survey underlines the need to fill a gap in order to address the needs of young interventional cardiologists. It may serve as a starting point for developing educational initiatives targeted at young interventional cardiologists. © Europa Digital & Publishing 2013. Source

Oberlin C.,Hopital Bichat | Rantissi M.,Nasser hospital
Chirurgie de la Main | Year: 2011

The authors report their 10-year experience in the treatment of war injuries in the Gaza strip. Bullet injuries to nerves can be assessed using Sunderland's classification. Grade 4 and 5 lesions must be repaired in the same way as any traumatic nerve injuries. A detailed series of sciatic nerve repair is presented. In this series, 12 nerve gaps were repaired by direct nerve coaptation using 90° knee flexion for six weeks. The results of this technique at 1 to 4. years follow-up are better than to those of sciatic nerve grafting. © 2011 Published by Elsevier Masson SAS. Source

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