Right over left ventricular end-diastolic area relevance to predict hemodynamic intolerance of high-frequency oscillatory ventilation in patients with severe ARDS

BACKGROUND: High-frequency oscillatory ventilation (HFOV) does not improve the prognosis of ARDS patients despite an improvement in oxygenation. This paradox may partly be explained by HFOV hemodynamic side-effects on right ventricular function. Our goal was to study the link between HFOV and hemodynamic effects and to test if the pre-HFOV right over left ventricular end-diastolic area (RVEDA/LVEDA) ratio, as a simple parameter of afterload-related RV dysfunction, could be used to predict HFOV hemodynamic intolerance in patients with severe ARDS. METHODS: Twenty-four patients were studied just before and within 3 h of HFOV using transthoracic echocardiography and transpulmonary thermodilution. RESULTS: Before HFOV, the mean PaO(2)/FiO(2) ratio was 89 ± 23. The number of patients with a RVEDA/LVEDA ratio >0.6 significantly increased after HFOV [11 (46 %) vs. 17 (71 %)]. Although HFOV did not significantly decrease the arterial pressure (systolic, diastolic, mean and pulse pressure), it significantly decreased the cardiac index (CI) by 13 ± 18 % and significantly increased the RVEDA/LVEDA ratio by 14 ± 11 %. A significant correlation was observed between pre-HFOV RVEDA/LVEDA ratio and CI diminution after HFOV (r = 0.78; p < 0.0001). A RVEDA/LVEDA ratio superior to 0.6 resulted in a CI decrease >15 % during HFOV with a sensitivity of 80 % (95 % confidence interval 44–98 %) and a specificity of 79 % (confidence interval 49–95 %). CONCLUSION: The RVEDA/LVEDA ratio measured just before HFOV predicts the hemodynamic intolerance of this technique in patients with severe ARDS. A high ratio under CMV raises questions about the use of HFOV in such patients. Trial registration: ClinicalTrials.gov: NCT0116762

Using Discharge Abstracts to Evaluate a Regional Perinatal Network: Assessment of the Linkage Procedure of Anonymous Data

To assess the Burgundy perinatal network (18 obstetrical units; 18 500 births per year), discharge abstracts and additional data were collected for all mothers and newborns. In accordance with French law, data were rendered anonymous before statistical analysis, and were linked to patients using a specific procedure. This procedure allowed data concerning each mother to be linked to those for her newborn(s). This study showed that all mothers and newborns were included in the regional database; the data for all mothers were linked to those for their infant(s) in all cases. Additional data (gestational age) were obtained for 99.9% of newborns

Psychometric properties of a Creole version of Medical Outcome Study – Short Form 36 among type II diabetes patients on Reunion Island

IntroductionHealth quality of life assessment is particularly important to measure the impact of chronic diseases. The aims of this study were to provide a cross-culturally adapted Creole-translation of the Medical Outcome Study Short-Form 36 (SF-36) and to assess psychometric performance of the Creole and French versions of the SF-36 among patients with type II diabetes in Reunion Island.Materials and methodsThe Creole translation and cross-cultural adaptation processes were based on the International Quality Of Life Assessment (IQOLA) methods. Internal consistency, test–retest reliability, convergent and discriminant validity using Multi-Trait-Multi-Method analysis and structural validity using exploratory factor analysis of the SF-36 for both versions were performed.ResultsIn the Creole version of the SF-36, Cronbach’s alpha exceeded 0.70 for all subscales except general health. In the French SF-36, Cronbach’s alpha exceeded 0.70 on all subscales except general health and bodily pain. In the Creole SF-36, intraclass correlation coefficient (ICC) for reproducibility was suboptimal. Multi-trait multi-method analysis showed that item-scale correlation exceeded 0.4 for all items except two general health items of the Creole SF-36 and one of the French SF-36. Factor analysis of 2 versions showed that the physical functioning, vitality, and mental health were each divided into two subscales.DiscussionOverall, our findings provided evidence that the SF-36 is adapted to Reunion Island in both Creole and French versions. However, further research could be conducted to investigate French–Creole differences in perceived health status and a cultural adaptation of the French version will be considered

Financial and relational impact of having a boy with posterior urethral valves

IntroductionChildhood chronic diseases affect family functioning and well-being. The aim of this study was to measure the impact of caring for a child with PUV, and the factors that most impact the burden of care.Patients and methodWe gave a questionnaire on the familial impact of having a child with posterior urethral valves to all parents of a child included in the CIRCUP trial from 2015 onwards. The questionnaire included questions about the parents' demographics, health, professional, financial and marital status and how these evolved since the child's birth as well as the “impact on family scale” (IOFS), which gives a total score ranging from 15 (no impact) to 60 (maximum impact). We then analyzed both the results of the specific demographic questions as well as the factors which influenced the IOFS score.ResultsWe retrieved answers for 38/51 families (74.5% response rate). The average IOFS score was 23.7 (15–51). We observed that the child's creatinine level had an effect on the IOFS score (p = 0.02), as did the parent's gender (p = 0.008), health status (p = 0.015), being limited in activity since the birth of the child (p = 0.020), being penalized in one's job (p = 0.009), being supported in one's job (p = 0.002), and decreased income (p = 0.004). Out of 38 mother/father binomials, 8/33 (24.2%) declared that they were no longer in the same relationship afterwards.ConclusionIn conclusion, having a boy with PUV significantly impacts families. The risk of parental separation and decrease in revenue is significant. Strategies aiming to decrease these factors should be put in place as soon as possible

Burnout amongst members of the French-speaking Society of Pediatric and Adolescent Urology (SFUPA). Are there specific risk factors?

International audienceBackground: Burnout, which includes emotional fatigue, cynicism and low personal accomplishment is linked to poor job satisfaction, decreased empathy, job withdrawal, increased absenteeism and increased medical errors, and is present among pediatric urologists.Objective: We aimed to determine the incidence of burnout among the members of the French-speaking Society of Pediatric and Adolescent Urology (SFUPA) and determine which external factors, such as marital or familial status, gender, age, type of practice or religious belief, impacted burnout rates.Material and method: We sent all members of the French-speaking Society for Pediatric and Adolescent Urology (SFUPA) an anonymous online questionnaire containing the validated French version of the 22-item Maslach Burnout Inventory - Human Services Survey (MBIHSS). The questionnaire comprised further questions on age, gender, marital status, presence of children at home, type of practice, professional status (trainee, consultant, or academic position), spirituality and whether responders believed they presented signs of burnout.Results: 70 out of 94 members of the SFUPA answered the questionnaire (response rate 74%). The number of responders who presented high scores in one, two or the three domains of the questionnaire were respectively 48.6% (IC 95%: 36-61%), 21.4% (IC 95%: 12.5-33%) and 8.6% (IC 95%: 3-18%). 34.6% of responders who believed they presented no signs of burnout actually did have a high burnout score in at least one domain. There was no significant association between age, gender, having children or being a trainee and the presence of burnout. However, marital status and workplace were significantly associated with presence of signs of burnout.Discussion: Burnout is a distinct type of work-related stress - a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. In our study the most significant factor was working in Academic hospitals which can be associated with administrative workload, long hours and a lack of institutional resources. Being in a couple was also associated with less burnout, thus showing the importance of healthy relationships and sharing on burnout rate. Age, however was not associated significantly with burnout nor was gender, which is in coherence with previous findings.Conclusion: Amongst members of the French-speaking Society of Pediatric and Adolescent Urology, nearly half presented signs of burnout, especially those working in academic hospitals. Marital status also influenced burnout rates. Scientific societies should work on developing tools to identify and accompany affected individuals

A Population-Based Study of Meconium Aspiration Syndrome in Neonates Born between 37 and 43 Weeks of Gestation

International audienceThe epidemiology of meconium aspiration syndrome (MAS) in term neonates is described in a population-based retrospective study of data recorded for all births from 2000 to 2007 in a French region (Burgundy). Of the 132 884 eligible term newborns, the rate of meconium-stained amniotic fluid (MSAF) was 7.93%. The prevalence of severe MAS was 0.067% in the overall population. MAS rate was 0.11% at 37-38 weeks of gestation (WG), 0.20% at 39-41 WG, and 0.49% at 42-43 WG. Factors independently associated with severe MAS were identified by a case-control study, that is, thick meconium amniotic fluid, fetal tachycardia, Apgar score ≤3 at 1 minute, and birth in a level III facility. Our results confirm the high prevalence of MSAF after 37 WG but also show the low frequency of severe MAS in a period corresponding to the new international recommendations on the management of birth with MSAF

Neonatal problems of late and moderate preterm infants

International audienceLate and moderate preterm infants account for \textgreater80% of premature births. These newborns experience considerable mortality and morbidity in comparison with full-term born infants. The purpose of this paper is to summarise the most common morbidities of late and moderate preterm infants in the neonatal period, their incidence, severity, risk factors and need for admission to the different levels of care. The recent findings on preventive strategies and management priorities for clinical care of these vulnerable babies are also reviewed