French practical guidelines for the diagnosis and management of relapsing polychondritis

Relapsing polychondritis is a rare systemic disease. It usually begins in middle-aged individuals. This diagnosis is mainly suggested in the presence of chondritis, i.e. inflammatory flares on the cartilage, in particular of the ears, nose or respiratory tract, and more rarely in the presence of other manifestations. The formal diagnosis of relapsing polychondritis cannot be established with certainty before the onset of chondritis, which can sometimes occur several years after the first signs. No laboratory test is specific of relapsing polychondritis, the diagnosis is usually based on clinical evidence and the elimination of differential diagnoses. Relapsing polychondritis is a long-lasting and often unpredictable disease, evolving in the form of relapses interspersed with periods of remission that can be very prolonged. Its management is not codified and depends on the nature of the patient's symptoms and association or not with myelodysplasia/vacuoles, E1 enzyme, X linked, autoinflammatory, somatic (VEXAS). Some minor forms can be treated with non-steroidal anti-inflammatory drugs, or a short course of corticosteroids with possibly a background treatment of colchicine. However, the treatment strategy is often based on the lowest possible dosage of corticosteroids combined with background treatment with conventional immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil, rarely cyclophosphamide) or targeted therapies. Specific strategies are required if relapsing polychondritis is associated with myelodysplasia/VEXAS. Forms limited to the cartilage of the nose or ears have a good prognosis. Involvement of the cartilage of the respiratory tract, cardiovascular involvement, and association with myelodysplasia/VEXAS (more frequent in men over 50years of age) are detrimental to the prognosis of the disease.

Integrating animal welfare into disaster management using an 'all-hazards' approach

Statistics show that disasters have expanded in scope and scale, with impacts on both humans and animals. As animals are valued not only for their economic value, but also for their companionship, people sometimes risk their lives to protect them, and emergency responders are expected to safeguard their welfare during emergencies. This paper discusses experiences from different regions of the world in animal disaster risk reduction and management in terms of legislation, funding streams, planning, capacity development, and communications. It is widely recognised that human, animal and environmental well-being are interconnected; therefore, as this is the case, and as veterinarians are at the forefront in ensuring animal welfare, they should be involved throughout the disaster management cycle. While animals and their welfare should always be considered in national disaster management plans, sub-regional authorities must be empowered to integrate animal welfare principles when responding to emergencies and implementing risk reduction programmes. Capacity development is key for Veterinary Services personnel who work in the fields of disaster management and risk reduction. Training tools and curricula developed by different organisations are available to foster skills such as incident coordination, risk communication, or response planning using tools such as the Livestock Emergency Guidelines and Standards (LEGS). Intergovernmental organisations also play a significant role in setting the standards and frameworks within which professionals operate.

[Healthcare management during COVID-19 pandemia.]

OBJECTIVES

To describe the organization of a hospital during the COVID-19 pandemic, paying attention to both organizational and leadership aspects, and considering all hospital areas, including the operating room.MATERIAL AND METHODS: Review of the literatureregarding the organizational councils for hospital management within the pandemic. In addition, the recommendations of societies, institutions such as the WHO, the CDC, the ECDC, the National Ministry of Health and the Ministry of Health of Madrid and the center's own experience have been taken into account.

RESULTS

Description of the key elements for the organization,as well as the different areas of action within a hospital: emergencies, consultations, hospitalization and operating rooms.

CONCLUSIONS

Management during a pandemic requires a high degree of agility in response and plasticity in people. All hospital structures must adapt to a situationfor which they have not been conceived and all staff must place themselves at the service of a disease that conditions all decisions. Being able to adapt and try to anticipate what is going to happen are the keys to success.

Introduction: Improved aquatic animal health management is vital to aquaculture's role in global food security

Global food security and nutrition depend heavily on aquaculture, the continued growth of which is crucial as the world heads towards a human population of at least 9 billion by 2050, while harvests from wild capture will, at best, stabilise at current levels. Thus, a fundamental question is: how can we sustainably increase aquatic food production? It is clear that aquatic animal diseases present a substantial threat and, consequently, aquatic animal health management has a critical role in food security. An ecosystem approach to aquaculture will mitigate impacts on ecosystem services and biodiversity, and provide the necessary resilience to future disease threats, including those exacerbated by climate change. Due to the nature of aquatic production systems, this approach must encompass fisheries and other sectors that share the same resources. Improved aquatic animal health management must be a key component of aquaculture's future. At the national level, public-private partnerships are vital in achieving objectives of common benefit. Improved disease reporting and response is critical in the control of listed and emerging diseases and can only be achieved through government, industry and stakeholder collaboration. Great potential exists to improve biosecurity from the farm to national level, but this will only be achieved through collaboration. Industry cannot develop effective biosecurity without a clear government strategy and support, specifically legislation which provides an effective framework for safe trade. Governments have a key role in creating a regulatory environment that supports effective biosecurity and is attractive to investment; such as one that supports the development and regulatory approval of therapeutics. The improved control of transboundary diseases requires the wider and more consistent implementation of OIE standards, particularly on disease notification. This can only be achieved through improved collaboration between trading partners and by supporting low- and middle-income countries to strengthen their aquatic animal health services. There is incredible potential for aquaculture to continue its rapid growth and increase its contribution to global food security. However, sustainable growth of aquaculture is threatened by both known diseases, which we cannot effectively control, and new diseases, which may become pandemic. Recent pandemics have shown that global production systems are epidemiologically connected and, consequently, aquatic animal diseases present a shared global threat that demands global solidarity. The world now depends on a sustainable future for aquaculture and improved aquatic animal health management is critical to its continued and growing contribution to global food security.

Medically compromised patients in orthodontic practice: Review of evidence and recommendations

INTRODUCTION

Due to advances in the field of medicine, early diagnosis and high-quality medical management has become available for medically compromised patients. This increases their life expectancy and improves their quality of life. Therefore, orthodontic treatment can be provided to these patients whose medical conditions are well controlled.

OBJECTIVE

This article will discuss some medical conditions that might be seen by orthodontists. Also, recommendations and modifications of the orthodontic treatment plan will be discussed thoroughly.

MATERIALS AND METHODS

A computerized electronic search of the literature was conducted in Google Scholar and PubMed and was limited to publications in English.

RESULTS

Orthodontic management was studied in cases of Infective endocarditis (IE), Thrombocytopenia, Hemophilia, Sickle cell anemia, Thalassemia, Diabetes mellitus (DM), Thyroid Disorders, Asthma, DiGeorge Syndrome, HIV/AIDS, Organ transplantation, Orthodontic management, Juvenile idiopathic arthritis (JIA), Seizure disorders, Autism Spectrum Disorder (ASD), Mood disorders, Schizophrenia and Eating disorders.

[Long-term strategy of the initial management of facial burns: About 3 cases]

INTRODUCTION

The management of facial burns in their acute stage determines most of the sequelae aspect. An initial treatment of good quality should reduce and even prevent scar ransom and should not compromise potential future corrections. This treatment is based on the respect of facial surgery standards and on the use of some particular technical points.

CASE REPORTS

We described our surgical protocol through three case reports. We are performing a surgical excision of the unhealed lesions between the 12th and 15th postburn day. This excision is followed by a dermoepidermal skin graft in the same operative time. This graft must be harvested from the scalp every time it is possible and must be manually perforated. All the aesthetic units junctions are necessarily respected. Flaps can be necessary at this stage.

DISCUSSION AND CONCLUSION

The long-term functional and cosmetic results observed in patients with facial burns vary a lot depending on the initial treatment. Patients with severe burns that benefited from an appropriate initial treatment may thus present better results than patients with less severe burns who were badly treated.

[Leadership influence on safety in cancer care]

Safety in health care is permanently influenced by national and local policies. Since twenty years, number of methodologies and tools inspired from industry, have been implemented to reduce adverse events. Those tools managed to reduce adverse event impact but errors still occur on hospitals and they are difficult to contain. Given the low evolution of the results regarding patient care safety, it seemed important to question other dimensions such as leadership in safety even if the meaning of the word "leadership" is still unknown in almost all hospital organizations. This research analyses the bibliography to identify useful leadership for patient care safety. In order to improve safety results in healthcare, the perception of patient care safety and leadership were studied by using a specifically amended safety culture survey amended. Results prove that the level of leadership employed influences the caregiver's safety perception. Furthermore, the most effective leadership is not the one currently used in hospitals, but rather a leadership with liberated characteristics. Finally, proposals are made to change the leadership characteristics used with the view to improve safety perception of caregiver's.

[Impact of cork oak management on the ectomycorrhizal fungal diversity associated with Quercus suber in the Mâamora forest (Morocco)]

The cork oak forest is an ecosystem playing a major role in Moroccan socio-economy and biodiversity conservation. However, this ecosystem is negatively impacted by extensive human- and climate-driven pressures, causing a strong decrease in its distribution and a worsening of the desertification processes. This study aims at characterising the impact of cork oak forest management on a major actor of its functioning, the ectomycorrhizal (EcM) fungal community associated with Quercus suber, and the determination of EcM bio-indicators. The EcM fungal community has been monitored during spring and winter seasons in two sites of the Moroccan Mâamora forest, corresponding to a forest site either impacted by human activities or protected. A significant impact of cork oak forest management on the EcM fungal community has been revealed, with major differences during the summer season. The results confirmed the potential ecological significance of several EcM fungi (e.g., Cenococcum) in the sustainability of the cork oak forest functioning, but also the significant association of certain EcM fungi (Pachyphloeus, Russula, Tomentella) with a perturbation or a season, and consequently to the cork oak forest status or to climatic conditions, respectively. The development of study at the Mediterranean scale may improve the robustness of ecological models to predict the impact of global changes on this emblematic ecosystem of Mediterranean basin.

[The Study Of Biomedical Waste Management In Sanitary District Of Goudry In Senegal]

AIM

Of this study was to explore, in the sanitary district of Goudiry, the practice of biomedical waste management and to analyze its impact.

MATERIALS AND METHODS

The sample consisted of seven health posts, among a total of 11, drawn by simple random sampling and a health centre (district hospital). Data were collected through structured interviews with all staff, participant observation and from secondary data.

RESULTS

The district facilities surveyed produced 111.9 kg (or 16.0 kg/d) over seven days. Waste management is inadequate at all levels.

CONCLUSION

Actions needed to improve waste management are sensitization and training of actors, the involvement of all the stakeholders (local authorities, population, health workers), and advocacy with policy makers.

[Quality and safety management for radiotherapy]

Quality and safety management have been implemented for many years in healthcare structures (hospitals treating cancer, private radiotherapy centres). Their structure and formalization have improved progressively over time. These recommendations aim at describing the link between quality and safety management through its organization scheme based on quality-safety policy, process approach, document management and quality measurement. Dedicated tools, such as experience feedback, a priori risk mapping, to-do-lists and check-lists are shown as examples and recommended as routine practice.

[Charisma and leadership: new challenges for psychiatry]

INTRODUCTION

New challenges arise in medicine, particularly in psychiatry. In the near future, psychiatrists' role may evolve into management of mental health care teams (GPs, nurses, psychologists…) thus creating the need for charisma and leadership. Charisma is defined as « a quality that allows it's possessor to exercise influence, authority over a group »; leadership as « the function, the position of chief, and by extension, a dominant position ».

AIM OF THE STUDY

To offer some reflections on charisma and leadership and the ways to develop them in three situations common in clinical practice: dual communication (between caregivers or with patients), oral communication (e.g., during a symposium) and managing a mental health care team.

METHOD

Medline (1966-hits) and Web of Science (1975-hits) were explored according to the PRISMA criteria. The research paradigm was [(psychiatrist OR physician) AND mental health AND (leadership OR charisma)].

RESULTS

Two hundred and eighty articles were found, but only 34 corresponded to our subject and were included in the qualitative analysis. The leader must first ask himself/herself about his/her vision of the future, so as to share it with passion with his/her mental health team. Charisma and leadership are based on several values, among which we can mention: providing understandable, personalized care for the patient, in continuity and confidentiality; adapting care to the general population's request, maintaining one's own physical and mental health, submitting one's daily practice to peer review, engaging in continuous improvement of one's practices in response to new requirements, and recognizing that research and instruction are part of an M.D's professional obligations. The clinician will work on ways to develop his/her own charisma, through interactions with peers and team members, the care of his/her appearance (especially for first meetings) and workplace, and through positive reinforcement (some cognitive-behavioral techniques like assertiveness have been proposed to enhance the charisma, e.g., visualization and affirmation). Leadership does not depend on hierarchical position and administrative responsibilities: leaders should learn to manage and harmonize the different types of personalities within his/her team, paying special attention to passive-aggressive attitudes. We recall here some techniques to improve charisma during oral communication, such as making relationships with people by calling them by their names, making reference to things and people that the audience can identify with (like sport or cooking), using one's own style without trying to imitate someone else, focusing on one major idea, being brief and using anecdotes, using silences effectively and finally having good non-verbal communication. The conclusion should never be neglected, as an audience especially remembers the beginning and the end of a presentation. Although some features are common to all charismatic leaders (dominance, self-confidence, high energy level), a recent theory of leadership (called contingency theory) seeks to examine how different leadership styles can adapt to circumstances. This theory focuses more on the vision, passion, determination and courage of the leader and depends not only on their intrinsic qualities. No research has indeed shown individual characteristics that differentiate leaders from followers. However, doctors have not been prepared in their training to acquire leadership skills that they can use to adapt to the circumstances of their clinical practice. The most important qualities expected of a leader according to the current leadership theorists are: listening, communication, stress management, development of other's capacities, feedback, introspection and risk taking. Moreover, leadership involves positive reinforcement of the team while maintaining the feeling of individual autonomy, and being able to take an innovative decision alone with shared optimism. There is no need to have great management responsibilities in order to succeed in leadership. We reiterate the importance for a charismatic leader to smile, to be able to mock oneself and to regulate one's emotions.

CONCLUSION

Charisma seems to be an essential dimension for effective leadership and team management. Beyond psychiatry, we believe these reflections to be useful for all branches of medicine.