La Revue du praticien最新文献

COMPLICATIONS DE LA MALADIE VARIQUEUSE. La maladie variqueuse est souvent considérée, à tort, comme une pathologie benigne. Les troubles trophiques représentent 10 % des complications de la maladie variqueuse et, dans 1 % des cas, un ulcère de jambe peut apparaître. L'hyperpression veineuse est impliquée, mais il existe égalment des phénomènes pro-inflammatoires responsables de lésions endothéliales chroniques qui favorisent le remodelage et la fibrose tissulaire à l'origine des complications cutanées. Stade ultime de l'insuffisance veineuse chronique et témoin de sa gravité, l'ulcère de jambe est souvent négligé et relégué à des soins infirmiers. Véritable problème de santé publique, générant des coûts importants et une altération significative de la qualité de vie des patients, l'ulcère veineux nécessite une meilleure connaissance et une meilleure prise en charge par les soignants. Par ailleurs, des complications graves et potentiellement mortelles ecistent, telles que l'hémorragie aiguë par rupture de varices et la maladie thromboembolique veineuse. Une amélioration de la prise en charge des varices est nécessaire pour limiter la survenue de ces complications.

Palliative care: SOCIAL AND TERRITORIAL. INEQUALITIES.Palliative care can be provided wherever the patient lives or receives care, considering its environment, in coordination with healthcare professionals, social and medico-social professionals. The way in which palliative care is provided varies from one country to another, depending on resources, cultural values, healthcare systems and policies of each country. There are disparities in access, particularly in rural areas and for vulnerable populations. One of the main limitations to the development of palliative care, after budgetary issues, is the insufficient development of a professional workforce specializing in palliative care. The overseas territories are in a specific situation, with populations suffering from a combination of social and territorial health inequalities. This approach to frailty makes it possible to anticipate and plan for palliative care to meet the future patients' needs. French citizens living in extreme poverty, protected persons, people with psychiatric disorders, elderly, people with disabilities and anyone else with one or more vulnerabilities face situations where they cannot exercise all their rights. The national ten-year strategy on « palliative care, pain management and support at the end of life » places priorities to reducing all forms of inequalities in end-of-life journeys.

Research on napping: WHERE DO WE STAND? Sleep specialists have proposed measures to counter the short- and long-term negative consequences of sleep deprivation, suggesting that the recovery nap could be a "powerful physiological public health tool". This article focus on napping as a "countermeasure" to the current epidemic of sleep debt. We review the restorative functions of naps explored in laboratory studies (alertness, memory, stress, immune function, pain sensitivity) with definite public health ramifications (sleep-related accidents, school and work performance, cardiovascular risk). However, the effect of naps and the nature of the sleep stages concerned have yet to be evaluated - in relation to several factors, notably their duration or the age of the subjects - with a view to optimizing adaptation strategies in populations suffering from chronic sleep deprivation.

WHEN SHOULD SHORT-TERM ANTIBIOTIC THERAPY BE CHOSEN? Reducing antibiotic exposure by shortening treatment duration is a public health priority that could mitigate the emergence of bacterial resistance, minimize adverse effects, and lower costs. Additionally, a short yet effective antibiotic regimen is associated with improved patient compliance and satisfaction. Several trials in recent years have confirmed the efficacy of shorter treatment durations. For instance, five days of antibiotics are sufficient for uncomplicated pyelonephritis, while seven days suffice for non-febrile urinary tract infections in males. However, a 14-day regimen appears necessary for febrile urinary tract infections in men. A study examining a five-day treatment period found no difference compared to a 10-day regimen for skin and soft tissue infections. In acute community-acquired pneumonia, two randomized trials found three days of beta-lactam therapy to be effective. In intra-abdominal infections, durations ranging from four to eight days were found to be non-inferior to 15-day courses in two trials. Regarding osteoarticular infections, six weeks are adequate for spondylodiscitis, whereas 12 weeks are required for prosthetic joint infections. These findings validate shorter treatment durations across many clinical scenarios. However, in rare conditions such as febrile male urinary tract infections and prosthetic joint infections, shortening the duration may not be feasible. It is imperative to prescribe the shortest effective antibiotic duration possible in routine medical practice to combat antibiotic resistance.