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Haemodynamic monitoring and management of the hypotensive out-of-hospital cardiac arrest patient in the adult intensive care unit: a clinical consensus statement of the Association for Acute CardioVascular Care of the ESC
No full textInternational audienceAbstract Aims Out-of-hospital cardiac arrest (OHCA) represents a major public health challenge, with high mortality and significant neurological impairments among survivors. Haemodynamic instability, particularly hypotension (a mean arterial blood pressure <65 mmHg), may be a key contributor to post-resuscitation morbidity and mortality. Methods and results After return of spontaneous circulation, hypotension can result from various causes, including arrhythmias, mechanical complications, thromboembolism, or different types of shock, as well as sedation, temperature control and positive pressure ventilation. Differentiating between hypotension with vs. without hypoperfusion is critical to avoid unnecessary interventions while ensuring adequate cerebral and myocardial perfusion. Clinical assessment and repeated echocardiography should be routine in all patients. Therapeutic targets should include evidence of preserved end-organ function, including urine output, and normal or decreasing lactate. In selected cases, advanced haemodynamic monitoring with pulmonary artery catheters may be necessary to diagnose the shock-type and monitor treatment effects. Causal treatment of the precipitating cause of hypotension is crucial as well as symptomatic treatment with fluids, vasopressors and inotropes if needed. Mechanical circulatory support may be employed for refractory shock unresponsive to other treatment. Conclusion This clinical consensus statement by the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology (ESC) provides clinical guidance for the haemodynamic monitoring and management of hypotension in OHCA patients in intensive care. The document advocates for a multidisciplinary approach that integrates clinical assessment, imaging, and haemodynamic parameters to guide treatment, with the overarching goal of improving survival rates and neurological outcomes
Toward a Streamlined Optimization Protocol for Patients With Heart Failure With Reduced Ejection Fraction
No full textInternational audienceNo abstract availabl
Une nouvelle logique de description tractable sous la sémantique catégorielle
No full textBiomedical ontologies contain numerous concept or role names involving negative knowledge such as lacks_part, absence_of. Such a representation with labels rather than logical constructors would not allow a reasoner to interpret lacks_part as a kind of negation of has_part. It is known that adding negation to the tractable Description Logic (DL) EL allowing for conjunction, existential restriction and concept inclusion makes it intractable since the obtained logic includes implicitly disjunction and universal restriction which interact with other constructors. In this paper, we propose a new extension of EL with a weakened negation allowing to represent negative knowledge while retaining tractability. To this end, we introduce categorical semantics of all logical constructors of the DL SH including EL with disjunction, negation, universal restriction, role inclusion and transitive roles. The categorical semantics of a logical constructor is usually described as a set of categorical properties referring to several objects without using set membership. To restore tractability, we have to weaken semantics of disjunction and universal restriction by identifying \emph{independent} categorical properties that are responsible for intractability, and dropping them from the set of categorical properties. We show that the logic resulting from weakening semantics is more expressive than EL with the bottom concept, transitive roles and role inclusion
Diagnostic Accuracy of Touchscreen-Based Tests for Mild Cognitive Disorders: A Systematic Review and Meta-Analysis
No full textInternational audienceBackground/Objectives: Mild neurocognitive disorder (mNCD) is a state of vulnerability, in which individuals exhibit cognitive deficits identified by cognitive testing, which do not interfere with their ability to independently perform in daily activities. New touchscreen tools had to be designed for cognitive assessment and had to be at an advanced stage of development but their clinical relevance is still unclear. We aimed to identify digital tools used in the diagnosis of mNCD and assess the diagnostic performance of these tools. Methods: In a systematic review, we searched 4 databases for articles (PubMed, Embase, Web of science, IEEE Xplore). From 6516 studies retrieved, we included 50 articles in the review in which a touchscreen tool was used to assess cognitive function in older adults. Study quality was assessed using the QUADAS-II scale. Data from 34 articles were appropriate for meta-analysis and were analyzed using the bivariate random-effects method (STATA software version 19). Results: The 50 articles in the review totaled 5974 participants and the 34 in the meta-analysis, 4500 participants. Pooled sensitivity and specificity were 0.81 (95%CI: 0.78 to 0.84) and 0.83 (95%CI: 0.79 to 0.86), respectively. High heterogeneity among the studies led us to examine test performance across key characteristics in a subgroup analysis. Tests that are short and self-administered on a touchscreen tablet perform as well as longer tests administered by an assessor or on a fixed device. Conclusions: Cognitive testing with a touchscreen tablet is appropriate for screening for mNCD. Further studies are needed to determine their clinical utility in screening for mNCD in primary care settings and referral to specialized care. This research received no external funding and is registered with PROSPERO under the number CRD42022358725
Learning preferences in Qualitative Choice Logic and some of its variants: an application for antibiotics recommendations
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The evolution of facility-based deliveries at primary healthcare centres during an insecurity and conflict crisis in Burkina Faso: a geospatial analysis
No full textInternational audienceAbstract Background Access to healthcare in Burkina Faso, particularly obstetric care, is severely reduced by nearby armed conflict. However, systematic assessments of the spatial distribution of facility-based delivery rates and their evolution, as well as how they relate to conflict intensity, facility characteristics, and geo-spatial determinants, are absent. Methods We analysed spatial and temporal shifts in facility-based deliveries in Burkina Faso’s primary healthcare centers in relation to conflict. Using spatial analyses, we examined how conflict-related deaths influenced delivery patterns, considering variations by facility type and pre-conflict service volume. We obtained monthly healthcare facility data (2016–2021) from Burkina Faso’s Health Management Information System (HMIS) and conflict event data from the Uppsala Conflict Data Program (UCDP). The study covered all primary healthcare centers in conflict-affected northern and eastern districts (> 10 UCDP conflict deaths, 2016–2021) and neighboring southern districts: 854 CSPSs (Centres de Santé et de Promotion Sociale) and 53 CMs (Centres Médicaux). Results The study identified geographical variations in facility-based delivery rates, notably from 2018–2019, with spatial clusters of lower rates becoming predominant in northern areas and higher rates doubling along southern routes and cities. This shift coincided spatially and timely with conflict escalation. In conflict hotspots, the average monthly rate of facility-based deliveries decreased over time, irrespective of pre-conflict service volume. However, CM facilities showed an upward trend, contrasting CSPS facilities. Outside conflict hotspots, facilities with exceptional pre-conflict service volume showed similar upward trends, while low- and high-volume facilities showed moderate increases. CM consistently maintained higher facility-based delivery rates over time than CSPS facilities. Conclusion This research provides crucial insights for strengthening Burkina Faso’s health system resilience to conflict by spatially identifying how facility characteristics and geo-spatial determinants shape healthcare disruptions. Mapping these elements at a fine scale enables adaptive policy interventions and dynamic resource allocation based on evolving conflict dynamics, enhancing obstetric care during conflict. By integrating the applied geospatial methods into national health systems, we can enhance responsiveness, enabling targeted and timely interventions, as well as efficient and flexible resource distribution (e.g., funding, personnel, and medical supplies). This also supports improved healthcare demand forecasting, ultimately ensuring a more proactive, data-driven, and conflict-sensitive approach to maternal health policy planning in crisis response
Development, Reproducibility, and Validity of a Semiquantitative Food Frequency Questionnaire for Use among the Adult Population in Reunion Island
No full textInternational audienceTo date, there is no specific food frequency questionnaire (FFQ) to assess dietary habits in any of the French overseas regions. Objectives: This study aimed to describe the development of a culture and context-specific semiquantitative FFQ for use among the adult population in Reunion Island, to assess its reproducibility and its relative validity compared with 24-h dietary recalls (DRs). Methods: The CARI (observatoire des Comportements Alimentaires à la RéunIon) FFQ was adapted from the NutriNet-Santé FFQ, with a revised list of 181 food and beverage items reflecting local dietary practices and nutritional concerns. To assess its reproducibility, the FFQ was administered twice, 4 wk apart, to a purposive sample of 108 adults in Reunion Island. During the same period, participants also completed a weekly DR to evaluate the FFQ's validity. Reproducibility and validity were assessed for 18 food groups, energy, and 38 nutrients using correlations, cross-classification, and weighted κ. Results: Regarding reproducibility, we found a median rank correlation of 0.56 (nutrients) and 0.64 (food groups). Most participants were correctly classified with a median of 78% (nutrients) and 83% (food group), whereas gross misclassification was low (2.8% and 0.9%, respectively). We found a median weighted κ of 0.44 (nutrients) and 0.47 (food groups). Regarding validity, we found a median crude rank correlation of 0.51 (nutrients) and 0.43 (food groups). Most participants were correctly classified with a median agreement of 71% for nutrients and of 68% for food groups, whereas gross misclassification was low (1.9% and 0.9%, respectively). We found a median weighted κ of 0.32 (nutrients) and 0.27 (food groups). Conclusions: The CARI FFQ has a moderate to good level of validity for ranking food and nutrient intakes, and a good level of reproducibility, supporting its use for dietary assessment in Reunion Island
Care , travail et environnement en territoires dévastés, industriels et post-industriels
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Journées Scientifiques du Département Sciences de la Vie et Santé - AgroParisTech
No full textThe "AgroParisTech Life Science and Health division scientific symposium " took place on April 25 and 26, 2024, on the AgroParistech's Palaiseau campus. This event aimed to present, share, and discuss the current research conducted by the department’s scientific teams. It provided an opportunity for everyone to explore ongoing scientific work in SVS, discuss its connections to current challenges in life sciences and agronomy, and see how this research enriches the courses offered at the institution.Les "Premières Journées Scientifiques du Département des Sciences de la Vie et de la Santé" on eu lieu les 25 et 26 avril 2024 sur le campus de Palaiseau. Cet événement visait à présenter, partager et discuter des recherches actuellement menées par les équipes scientifiques du département. Afin de permettre à tous et toutes de découvrir les travaux en cours des scientifiques de SVS, à discuter des liens avec les enjeux actuels en sciences du vivant et en agronomie, et à voir comment ces recherches enrichissent les enseignements dispensés dans l’établissement