Critères de suivi en rééducation et d’orientation en ambulatoire ou en soins de suite ou de réadaptation. Après chirurgie des ruptures de coiffe et arthroplasties d’épaule.
Les recommandations professionnelles, élaborées par la Haute Autorité de Santé (HAS), sur le thème des « critères de suivi en rééducation et d’orientation en ambulatoire ou en soins de suite et de réadaptation, après chirurgie des ruptures de coiffe des rotateurs ou arthroplasties de l’épaule », complètent les recommandations de la HAS de mars 20061. Ces dernières avaient été établies en application des dispositions de la loi de financement de la Sécurité sociale pour 2006. L’objectif de ces différents travaux de la HAS3 est d’éviter les hospitalisations inappropriées en soins de suite ou de réadaptation (SSR), après certains traitements orthopédiques ou chirurgicaux.
>>> Reco médecin. HAs. Janvier 2008
>>> Prise en charge chirurgicale des tendinopathies rompues de la coiffe des rotateurs de l’épaule chez l’adulte. HAs. Mars 2008
>>> Reco kinésithérapeute. HAs. Novembre 2008
Les médecins traitants ont-ils, selon vous, le choix de ne pas participer aux campagnes nationales de dépistage quand ils n’approuvent pas les choix qui ont été faits ?
Un entretien avec le Dr Jérôme VIGUIER
Responsable du département dépistage à l’Institut national du cancer
Quelle serait la responsabilité de ceux qui priveraient leurs patients d’un diagnostic précoce ?
Dr Jérôme Viguier : Notre rôle premier est de convaincre les confrères de l’intérêt de proposer ces dépistages. Les médecins traitants qui refuseraient de participer au dépistage organisé doivent avoir en tête que l’article 12 du code de déontologie médicale (article R. 4127-12 CSP) dispose que « les médecins doivent apporter leur concours à l’action entreprise par les autorités compétentes en vue de la protection de la santé ». De plus, un patient ayant développé ultérieurement un cancer pourrait reprocher à son médecin traitant de ne pas lui avoir proposé ou rappelé le dépistage existant et réclamer l’indemnisation de la perte de chance liée au retard de sa prise en charge.
>>> Site de la MACSF
Mills EJ et coll. : Primary prevention of cardiovascular mortality and events with statin treatments. A network meta-analysis involving more than 65 000 patients. J Am Coll Cardiol 2008;52:1769-81
OBJECTIVES: This study aimed to evaluate the effectiveness of 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins) in primary prevention of cardiovascular events.
BACKGROUND: The role of statins is well established for secondary prevention of cardiovascular disease (CVD) clinical events and mortality. Little is known of their role in primary cardiovascular event prevention.
METHODS: We conducted comprehensive searches of 10 electronic databases from inception to May 2008. We contacted study investigators and maintained a comprehensive bibliography of statin studies. We included randomized trials of at least 12-month duration in predominantly primary prevention populations. Two reviewers independently extracted data in duplicate. We performed random-effects meta-analysis and meta-regression, calculated optimal information size, and conducted a mixed-treatment comparison analysis.
RESULTS: We included 20 randomized clinical trials. We pooled 19 trials (n = 63,899) for all-cause mortality and found a relative risk (RR) of 0.93 (95% confidence interval [CI]: 0.87 to 0.99, p = 0.03 [I(2) = 5%, 95% CI: 0% to 51%]). Eighteen trials (n = 59,469) assessed cardiovascular deaths (RR: 0.89, 95% CI: 0.81 to 0.98, p = 0.01 [I(2) = 0%, 95% CI: 0% to 41%]). Seventeen trials (n = 53,371) found an RR of 0.85 (95% CI: 0.77 to 0.95, p = 0.004 [I(2) = 61%, 95% CI: 38% to 77%]) for major cardiovascular events, and 17 trials (n = 52,976) assessed myocardial infarctions (RR: 0.77, 95% CI: 0.63 to 0.95, p = 0.01 [I(2) = 59%, 95% CI: 24% to 74%]). Incidence of cancer was not elevated in 10 trials (n = 45,469) (RR: 1.02, 95% CI: 0.94 to 1.11, p = 0.59 [I(2) = 0%, 95% CI: 0% to 46%]), nor was rhabdomyolysis (RR: 0.97, 95% CI: 0.25 to 3.83, p = 0.96 [I(2) = 0%, 95% CI: 0% to 40%]). Our analysis included a sufficient sample to reliably answer our primary outcome of CVD mortality.
CONCLUSIONS: Statins have a clear role in primary prevention of CVD mortality and major events.
>>> PubMed
Bruley des Varannes S, Philippe Ducrotté Ph, Bueno L, Chassany O, Coffin B, Dapoigny M, Bonaz B, Savarieau B, Salin B. Profil symptomatique et modalités de prise en charge des gastro-entérites aiguës de l’adulte en médecine générale : Résultats d’une enquête transversale à grande échelle portant sur 17 273 patients.
Objectif
L’attitude des patients ayant une gastro-entérite aiguë et leur prise en charge médicale sont peu documentées. L’objectif de ce travail était de préciser chez des patients adultes consultant pour une gastro-entérite aiguë, leurs caractéristiques cliniques et sociodémographiques, leurs motifs de consultation, et leur prise en charge thérapeutique.
Conclusion
Cette étude précise les comportements des patients et des médecins face à la gastro-entérite aiguë et montre des variations importantes selon l’âge et la CSP. Elle confirme la gêne et le retentissement important de la gastro-entérite aiguë notamment sur le nombre de prescription d’arrêt de travail.
>>> Résumé
Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clin Rehabil. 2009 Jan;23(1):3-14.
Objective: To examine the effectiveness of therapeutic aquatic exercise in the treatment of low back pain.
Design: A systematic review.
Methods: A search was performed of PEDro, CINAHL (ovid), PUBMED, Cochrane Controlled Trials Register and SPORTDiscus databases to identify relevant studies published between 1990 and 2007.
Population: Adults suffering from low back pain.
Intervention: All types of therapeutic aquatic exercise.
Comparison: All clinical trials using a control group.
Outcomes: Oswestry Disability Index, McGill Pain Questionnaire, subjective assessment scale for pain (e.g. visual analogue scale) and number of work days lost as a direct result of low back pain. Methodological quality was assessed using the PEDro scale and the SIGN 50 assessment forms.
Results: Thirty-seven trials were found and seven were accepted into the review. Therapeutic aquatic exercise appeared to have a beneficial effect, however, no better than other interventions. Methodological quality was considered low in all included studies. The heterogeneity among studies, in numbers of subjects, symptoms durations, interventions and reporting of outcomes, precluded any extensive meta-analysis of the results.
Conclusion: There was sufficient evidence to suggest that therapeutic aquatic exercise is potentially beneficial to patients suffering from chronic low back pain and pregnancy-related low back pain. There is further need for high-quality trials to substantiate the use of therapeutic aquatic exercise in a clinical setting.
>>> PubMed
Moore, Sally A. Cognitive abnormalities in posttraumatic stress disorder. University of Washington, Department of Psychology and VA Puget Sound Healthcare System, Seattle, USA.
Purpose of review : The current review aims to describe and evaluate research on cognitive difficulties associated with posttraumatic stress disorder (PTSD) published between January 2007 and June 2008.
Recent findings : The reviewed studies provide additional evidence that negative appraisals and decrements on verbal and autobiographical memory tasks are exhibited by individuals with PTSD relative to controls and may represent preexisting risk factors for PTSD rather than a result or concomitant of PTSD symptoms. In addition, the reviewed findings provide further evidence for source monitoring difficulties and attentional biases toward trauma-relevant information in PTSD. Recent research also provides evidence that, although memories of traumatic events differ in PTSD relative to other types of memories and memories of depressed individuals, they are likely on the same continuum as nontraumatic memories rather than qualitatively different.
Summary : Individuals with PTSD experience cognitive alterations ranging from impairments in overall memory functioning to difficulties specific to trauma-related cues. These cognitive difficulties appear to be importantly related to the development and/or maintenance of the disorder. At this point, it is unclear whether common mechanisms may account for these diverse cognitive difficulties and whether cognitive impairments are attributable to comorbid depression.
>>> sante.classique.com (inscription gratuite au site nécessaire)
Hawkridge A et coll. : Efficacy of percutaneous versus intradermal BCG in the prevention of tuberculosis in South African infants: randomised trial. BMJ 2008;337:a2052, doi: 10.1136/bmj.a2052 ;
OBJECTIVE: To compare the incidence of tuberculosis over two years in infants vaccinated at birth with intradermal BCG or with percutaneous BCG.
DESIGN: Randomised trial.
SETTING: South Africa.
PARTICIPANTS: 11,680 newborn infants.
INTERVENTIONS: Infants were randomised by week of birth to receive Tokyo 172 BCG vaccine through the percutaneous route (n=5775) or intradermal route (n=5905) within 24 hours of birth and followed up for two years.
MAIN OUTCOME MEASURES: The primary outcome measure was documented Mycobacterium tuberculosis infection or radiological and clinical evidence of tuberculosis disease. Secondary outcome measures were rates of adverse events, all cause and tuberculosis specific admissions to hospital, and mortality.
RESULTS: The difference in the cumulative incidence of definite, probable, and possible tuberculosis between the intradermal group and the percutaneous group, as defined using study definitions based on microbiological, radiological, and clinical findings was -0.36% (95.5% confidence interval -1.27% to 0.54%). No significant differences were found between the routes in the cumulative incidence of tuberculosis using a range of equivalence of "within 25%." Additionally, no significant differences were found between the routes in the cumulative incidence of adverse events (risk ratio 0.98, 95% confidence interval 0.91 to 1.06), including deaths (1.19, 0.89 to 1.58).
CONCLUSION: Equivalence was found between intradermal BCG vaccine and percutaneous BCG in the incidence of tuberculosis in South African infants vaccinated at birth and followed up for two years. The World Health Organization should consider revising its policy of preferential intradermal vaccination to allow national immunisation programmes to choose percutaneous vaccination if that is more practical.
>>> PubMed
publication avancée en ligne le 13 novembre 2008.
Panickar J et coll. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009;360:329-38
BACKGROUND: Attacks of wheezing induced by upper respiratory viral infections are common in preschool children between the ages of 10 months and 6 years. A short course of oral prednisolone is widely used to treat preschool children with wheezing who present to a hospital, but there is conflicting evidence regarding its efficacy in this age group.
METHODS: We conducted a randomized, double-blind, placebo-controlled trial comparing a 5-day course of oral prednisolone (10 mg once a day for children 10 to 24 months of age and 20 mg once a day for older children) with placebo in 700 children between the ages of 10 months and 60 months. The children presented to three hospitals in England with an attack of wheezing associated with a viral infection; 687 children were included in the intention-to-treat analysis (343 in the prednisolone group and 344 in the placebo group). The primary outcome was the duration of hospitalization. Secondary outcomes were the score on the Preschool Respiratory Assessment Measure, albuterol use, and a 7-day symptom score.
RESULTS: There was no significant difference in the duration of hospitalization between the placebo group and the prednisolone group (13.9 hours vs. 11.0 hours; ratio of geometric means, 0.90; 95% confidence interval, 0.77 to 1.05) or in the interval between hospital admission and signoff for discharge by a physician. In addition, there was no significant difference between the two study groups for any of the secondary outcomes or for the number of adverse events.
CONCLUSIONS: In preschool children presenting to a hospital with mild-to-moderate wheezing associated with a viral infection, oral prednisolone was not superior to placebo.
>>> PubMed
>>> NEJM
Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Jan 15;359:1108-15.
BACKGROUND: Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that the symptoms are attributable to them. However, there is a paucity of data regarding the prevalence of meniscal damage in the general population and the association of meniscal tears with knee symptoms and with radiographic evidence of osteoarthritis.
METHODS: We studied persons from Framingham, Massachusetts, who were drawn from census-tract data and random-digit telephone dialing. Subjects were 50 to 90 years of age and ambulatory; selection was not made on the basis of knee or other joint problems. We assessed the integrity of the menisci in the right knee on 1.5-tesla MRI scans obtained from 991 subjects (57% of whom were women). Symptoms involving the right knee were evaluated by questionnaire.
RESULTS: The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on MRI ranged from 19% (95% confidence interval [CI], 15 to 24) among women 50 to 59 years of age to 56% (95% CI, 46 to 66) among men 70 to 90 years of age; prevalences were not materially lower when subjects who had had previous knee surgery were excluded. Among persons with radiographic evidence of osteoarthritis (Kellgren-Lawrence grade 2 or higher, on a scale of 0 to 4, with higher numbers indicating more definite signs of osteoarthritis), the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalences among persons without radiographic evidence of osteoarthritis were 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.
CONCLUSIONS: Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.
>>> PubMed
Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003 Oct 7;139(7):575-88.
BACKGROUND: The evaluation of acute knee pain often includes radiography of the knee.
OBJECTIVE: To synthesize the literature to determine the role of radiologic procedures in evaluating common causes of acute knee pain: fractures, meniscal or ligamentous injuries, osteoarthritis, and pseudogout.
DATA SOURCES: MEDLINE search from 1966 to October 2002.
STUDY SELECTION: We included all published, peer-reviewed studies of decision rules for fractures. We included studies that used arthroscopy as the gold standard for measuring the accuracy of the physical examination and magnetic resonance imaging (MRI) for meniscal and ligamentous knee damage. We included all studies on the use of radiographs in pseudogout.
DATA EXTRACTION: We extracted all data in duplicate and abstracted physical examination and MRI results into 2 x 2 tables.
DATA SYNTHESIS: Among the 5 decision rules for deciding when to use plain films in knee fractures, the Ottawa knee rules (injury due to trauma and age >55 years, tenderness at the head of the fibula or the patella, inability to bear weight for 4 steps, or inability to flex the knee to 90 degrees) have the strongest supporting evidence. When the history suggests a potential meniscal or ligamentous injury, the physical examination is moderately sensitive (meniscus, 87%; anterior cruciate ligament, 74%; and posterior cruciate ligament, 81%) and specific (meniscus, 92%; anterior cruciate ligament, 95%; and posterior cruciate ligament, 95%). The Lachman test is more sensitive and specific for ligamentous tears than is the drawer sign. For meniscal tears, joint line tenderness is sensitive (75%) but not specific (27%), while the McMurray test is specific (97%) but not sensitive (52%). Compared with the physical examination, MRI is more sensitive for ligamentous and meniscal damage but less specific. When the differential diagnosis for acute knee pain includes an exacerbation of osteoarthritis, clinical features (age >50 years, morning stiffness <30 minutes, crepitus, or bony enlargement) are 89% sensitive and 88% specific for underlying chronic arthritis. Adding plain films improves sensitivity slightly but not specificity. Plain films for pseudogout are not sensitive or specific, according to limited-quality studies.
CONCLUSIONS: We recommend the Ottawa knee rules to decide when to obtain plain films for suspected knee fracture. A careful physical examination should be sufficient to decide whether to refer patients with potential meniscal and ligament injuries, and we prefer clinical criteria rather than plain films for evaluating osteoarthritis. We do not recommend using plain films to diagnose pseudogout.
>>> PubMed
