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Laroche JP. [A new specialty is born: Vascular medicine]. ACTA ACUST UNITED AC 2016; 41:188-96. [PMID: 27090098 DOI: 10.1016/j.jmv.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
On the 4th of December 2015, the French authorities officially recognized the birth of a specialty in vascular medicine entitled CO-DES cardiology-vascular/vascular Medicine. France is the 7th country to obtain this specialty after Switzerland, Germany, Austria, Czech Republic, Slovakia and Slovenia, six countries in the EEC. It has taken years to achieve a long but exciting experience: we went from hopes to disappointments, sometimes with the blues, but lobbying helping… with sustained confidence. This article tells the story of 30 years of struggle to achieve this vascular medicine specialty. Gaston Bachelard wrote: "Nothing is obvious, nothing is given, all is built." For the construction of vascular medicine, we had to overcome many obstacles, nothing was given to us, everything was conquered. Beware "The specialist is one who knows more and more things about an increasingly restricted field, up to 'knowing everything about nothing"' recalled Ralph Barton Ferry, philosopher; so there is room for modesty and humility but also convictions. The physical examination will remain the basis of our exercise. But let us recall the contributions of all those vascular physicians who practiced in the past, together with those currently active, who built day after day, year after year, a vascular medicine of quality. It is because of the trust of our colleagues and our patients that we can occupy the place that is ours today.
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Affiliation(s)
- J-P Laroche
- Département de médecine vasculaire, hôpital Saint-Eloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; MEDIPOLE, 1139, chemin du Lavarin, 84000 Avignon, France.
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Hammoudi N, Duprey M, Régnier P, Achkar M, Boubrit L, Preud'homme G, Healy-Brucker A, Vignalou JB, Pousset F, Komajda M, Isnard R. Pretest probability of a normal echocardiography: validation of a simple and practical algorithm for routine use. Arch Cardiovasc Dis 2014; 107:105-11. [PMID: 24556190 DOI: 10.1016/j.acvd.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/30/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Management of increased referrals for transthoracic echocardiography (TTE) examinations is a challenge. Patients with normal TTE examinations take less time to explore than those with heart abnormalities. A reliable method for assessing pretest probability of a normal TTE may optimize management of requests. AIM To establish and validate, based on requests for examinations, a simple algorithm for defining pretest probability of a normal TTE. METHODS In a retrospective phase, factors associated with normality were investigated and an algorithm was designed. In a prospective phase, patients were classified in accordance with the algorithm as being at high or low probability of having a normal TTE. RESULTS In the retrospective phase, 42% of 618 examinations were normal. In multivariable analysis, age and absence of cardiac history were associated to normality. Low pretest probability of normal TTE was defined by known cardiac history or, in case of doubt about cardiac history, by age>70 years. In the prospective phase, the prevalences of normality were 72% and 25% in high (n=167) and low (n=241) pretest probability of normality groups, respectively. The mean duration of normal examinations was significantly shorter than abnormal examinations (13.8 ± 9.2 min vs 17.6 ± 11.1 min; P=0.0003). CONCLUSION A simple algorithm can classify patients referred for TTE as being at high or low pretest probability of having a normal examination. This algorithm might help to optimize management of requests in routine practice.
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Affiliation(s)
- Nadjib Hammoudi
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Matthieu Duprey
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Régnier
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Achkar
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lila Boubrit
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France
| | - Gisèle Preud'homme
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aude Healy-Brucker
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France
| | - Jean-Baptiste Vignalou
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France
| | - Françoise Pousset
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Michel Komajda
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Richard Isnard
- Department of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine Pierre et Marie Curie, university Paris 6, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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