Presse Med
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The 3 poles of treatment. These are the hemodynamic management, early antibiotherapy and more specific treatments, based on improved physiopathological knowledge. From a hemodynamic point of view The first stage must always be to detect and correct the hypovolemia. ⋯ Treatments based on the physiopathology The activated protein C possesses pro-fibrinolytic, anticoagulant and anti-inflammatory properties; it obtained marketing Authorization in Europe for patients with severe sepsis and at least 2 organ failures or hypotension. Low-dose corticosteroids should be prescribed in the case of septic shock with prolonged use of catecholamines, and if possible following a test with Synacthène(R) (relative adrenal insufficiency). Intensive insulin therapy is aimed at maintaining normal glycemia in the patients for as long as possible.
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Doubt, one of the fundamental symptoms of depression. Patients frequently believe they're incurable. They are persuaded that nothing can be done for them. ⋯ The sharing of the tasks is always very positive for the patients. The patients, as those who surround them, are reassured by the fact that the family doctor and a specialist are collaborating in order to optimise treatment as rapidly as possible. The organisation of such co-therapies requires that the general practitioner also have good knowledge of the various types of psychotherapy available for the patient.
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To evaluate the impact of optimization of treatment and improvement in observance awareness in patients with type 2 diabetes on compliance with oral antidiabetic drug therapy and long-term glycemic control. Method Evaluation of compliance with oral antidiabetic therapy and of HbA1c levels in a cohort of 4 802 patients with type 2 diabetes followed by their general practitioner, before and after 6 Months on optimized treatment: reduction in percentage of combination treatments from 69.5 to 56.8%, and increase in percentage of once-daily dosing regimen from 12 to 58.4%. ⋯ These findings suggest that optimization of oral antidiabetic therapy favoring the use of oral antidiabetic agents with once-daily dosing administration modalities may improve metabolic control in patients with type 2 diabetes.