B Acad Nat Med Paris
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B Acad Nat Med Paris · Jan 2000
[Aged parents and aging handicapped persons: a new situation, an attempt to respond].
The longevity increase which characterises the society evolution at the end of the 20th century, also concerns the handicapped people. The fact is particularly outstanding for mentally handicapped people such as the Down's Syndrome population. We are nowadays discovering the first generation of the "over 40 year-old people". ⋯ Many parents of mentally handicapped people who live at home, even though they are not yet too old, seem to get more and more tired with their ageing advance, which, day after day, makes their unremitting action harder and harder towards their child who is also getting older. The makers relate the innovating and experimental initiative of a "Hameau Services", nowadays located at Sommières-du-Clain, a rural parish in the south of Vienne country, which offers to welcome still valid ageing parents and their mentally handicapped ageing child who lives in their own house. The collective services which are assured by the managing association, tend to relieve them in their daily material tasks in the aim of contributing to the prejudice of the unexpected arrival of the manifestations of the subordination through a proposition of a better life quality of the handicapped adult and his parents.
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B Acad Nat Med Paris · Jan 2000
Historical Article[How has the management of mentally disabled people changed?].
Greeting the mentally disabled has largely changed with time. The first attempts to assume "idiots", as Esquirol characterized them, are due to him and his followers, among whom must be mentioned Seguin and Bourneville, whose ward in Bicêtre Hospital was unfortunately suppressed in 1920. ⋯ Nothing has been planned to greet them when grown adults, probably because their life expectancy was then precarious. It is not so at the present time, and their ageing creates a great problem.
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Septic shock is one of the leading cause of death in modern countries. Scientists have made huge improvement in the understanding of mechanisms of inflammation, and the sequence of activation of the various pro and anti-inflammatory markers is now well known. By contrary, physicians have failed to improve survival from septic shock, in spite of the development of specific targets of the various points of the cytokine cascade sought to have a key role in host survival to sepsis. ⋯ More recent findings highlighting the role of the integrity of the hypothalamic-pituitary -adrenal axis to appropriately respond to a septic insult, have led to a reappraisal of the use of steroids in septic shock. Several high quality randomised controlled trials have evaluated the efficacy and safety of a prolonged treatment with low dose hydrocortisone in severe sepsis. These trials strongly suggested that this strategy of corticotherapy reduced the morbidity of septic shock and may favourably affect survival from septic shock.
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To evaluate the performance of intensive care unit (ICU) the severity scores are measured on the first day; organ system dysfunctions are measured several times during the stay. The severity scores are developed from large data bases of thousands of patients. They include the patient age, previous health status, severity and sometimes the main diagnosis. ⋯ By comparing the observed and expected mortality rates the Standard Mortality Ratio (SMR) may be measured. The data collection must be rigorous, the studied population must be similar to the population of the large data bases. Other elements of performance may be evaluated, such as the cost-efficiency or the quality of life or surviving patients.
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In recent years, considerable improvement has been achieved in the field of mechanical ventilation. A lot of experimental and clinical research has been done to reduce the adverse effects of mechanical ventilation. ⋯ Pressure-assisted ventilatory modes, such as pressure support have been introduced, resulting in better patient-ventilator synchronisation, good tolerance and easier weaning process. Pressure support is also a largely used mode in noninvasive ventilation which has been proved to improve outcome in chronic obstructive pulmonary diseases.