Presse Med
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Guillain-Barré syndrome (GBS) is an acute polyneuropathy with a variable degree of weakness that reaches its maximal severity within 4 weeks. The disease is mostly preceded by an infection and generally runs a monophasic course. Both intravenous immunoglobulin (IVIg) and plasma exchange (PE) are effective in GBS. ⋯ This study is currently going on. The international GBS outcome study (IGOS) is a new worldwide prognostic study that aims to get further insight in the (immune)pathophysiology and outcome of GBS, both in children and adults. Hopefully these and other studies will further help to improve the understanding and especially the outcome in patients with GBS.
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Anaphylaxis is the most serious form of the IgE-dependent food allergy, with lethal risk. The incidence is sharply rising. ⋯ The actual management of anaphylaxis does not fit with the International Guidelines. Anaphylaxis treatment protocols according to the international criteria should be applied in ED. Risk reduction strategies cannot rely only on the self-administration of epinephrine by the patient and should put forward a better efficiency of all first-aid care providers. A targeted educational intervention should be developed to improve the care of emergency medical services providers. They should have self-injectable-epinephrine available and should be coached to use it properly.
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In France, the law has introduced the possibility to write advance directives since 2005. In this paper, we will present the results of a study designed for checking how much people over 75 years are interested by this new tool. ⋯ Around 20% of people are very much concerned by advance directives and do really expect that their wishes will be respected. The authors suggest that advance directives should be for them really respected, even if the French law let doctors free at this point to decide what the best interest of the patient actually is and if they should or not respect in this case what the patient wrote as advance directives. Around 30% of other people appear interested to speak with someone of the time they will still live. Their concern is more to express what is important for them in terms of still living and quality of life, than to express very clear advance directives about the way they would like to dye. The last learning of the study is that there is still a lot to do if we want more people precisely express something on the conditions of their dying. Doctors might have a fundamental pedagogic role in that respect: they should better inform patients about the limits of medicine and tell them more about the new complexity of medical decision-making at the end of life due to recent improvements in techniques.