Presse Med
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Medical culture is both individual and collective. It is also implicit, hidden (hidden curriculum) and binding. ⋯ It strongly impacts the personalities and professional care practices. Awareness of its existence and identification of its main lines are the first steps for fruitful research.
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Pain prevalence increases during cancer course disease. Cancer incidence is increasing in France, but thanks to therapeutic advances in the specific treatment, cancer has become a chronic disease, often associated with persistent pain. Cancer pain evaluation should be multidimensional. ⋯ Today, a wide range of pain medications, including strong opioids, are available. The use of analgesic combinations is strongly recommended for cancer pain management. Medication characteristics knowledge (pharmacodynamics and pharmacokinetics) is essential and must be associated with a good doctor-patient relationship, to ensure optimal treatment of the painful patient at all stages of the disease.
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Prevention of postoperative exacerbation of chronic medical disease requires high standard of safety and quality of care in ambulatory surgery and anesthesia. Age is not a major criterion for selection for ambulatory surgery. Ambulatory surgery may be considered for patients with ASA score I, II or III with stable medical conditions. ⋯ In patients with major comorbidity, ambulatory surgery should be considered instead of conventional hospitalization. Preop treatment must be maintained during the perioperative period. Their interruption does not provide any benefit and could exacerbate an otherwise stable chronic disease.
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Postpartum hemorrhage (PPH) is defined by loss of greater than 500 mL of blood following vaginal delivery or 1,000 mL of blood following cesarean section, in the first 24 hours postpartum. Its incidence is up to 5% and the severe forms represent 1% of births. ⋯ Its management is multidisciplinary (obstetricians, anesthetists, midwives, biologists and interventional radiologists), based on treatment protocols where time is a major prognosis factor. In case of failure of the initial measures (oxytocin, manual placenta removal, uterus and birth canal examination), the management of severe forms includes active resuscitation (intravenous fluids, blood transfusion, vasoactive drugs), haemostatic interventions (sulprostone, tamponnade and haemostatic suture, surgical procedures and arterial embolization) and the correction of any potential coagulopathy (administration of blood products and haemostatic agents).
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Multicenter Study
[Discharge from hospital into nursing home: conditions and quality of transmissions].
Nursing home residents are very old, with multiple comorbidities and disabled for activities of daily living (ADLs). Therefore, they have a higher risk of accidents as falls or fractures or acute diseases as infections, which require hospitalization. Care's coordination and sharing of informations between hospitals and nursing homes are often insufficient even with agreements. Thus, discharge to nursing homes after hospitalization may be difficult for old patients because of incomplete oral or written transmissions. ⋯ Many points concerning discharge from hospital, about old people living in nursing home, have to be improved: oral transmissions about patient's status, notification of the return, discharge's letter, nurse's transmissions and assessment of the loss of autonomy.