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The VEntriculostomy-Related Infection Score: An Antibiotic Stewardship Tool in Ventriculostomy-Related Infections
No full textInternational audienceBACKGROUND AND OBJECTIVES: Diagnosing ventriculostomy-related infection (VRI), a common complication after external ventricular drainage (EVD), is challenging and often associated with delayed initiation of antibiotic therapy. We aimed to develop a stewardship score to help in the decision of antibiotic therapy initiation when VRI is suspected. METHODS: This retrospective, single-center cohort study included patients admitted to the intensive care unit after EVD placement who were suspected of having healthcare-associated ventriculitis and/or meningitis between January 1, 2012, and August 31, 2022. A multiple logistic regression model was used to identify factors associated with the development of healthcare-associated meningitis or ventriculitis after EVD placement. RESULTS: A total of 331 patients were included. Eighty-one (23%) patients developed VRI between January 1, 2012, and August 31, 2022, whereas 250 (77%) did not (from January 1, 2018, to August 31, 2022). VRI-associated factors were EVD count >1 (odds ratio [OR] 3.69, P < .001), EVD duration >8 days (OR 6.71, P < .001), immunosuppression (OR 3.45, P = .028), recent neurosurgery (OR 7.74, P < .001), cerebrospinal fluid leak (OR 6.08, P < .001), and prophylactic antimicrobials (OR 0.26, P < .001). The VEntriculostomy-Related Infection score (VERI) score categorized VRI risk into 4 levels, with an area under the curve of 0.84. CONCLUSION: The VERI score is a robust, predictive tool for assessing the risk of VRI in patients with EVD, potentially guiding more judicious use of antibiotic therapy in the intensive care unit setting
Acute Heart Failure: Transitioning From Symptom-Based Care to Remission
No full textInternational audienceDuring the past century, the characteristics of patients with heart failure (HF) and acute HF (AHF) have shifted from patients with severe pump failure due to rheumatic, hypertensive and ischemic heart disease to older and more obese patients with multiple severe comorbidities. The pathophysiology of AHF has shifted, in parallel, from that of advanced, end-stage pump failure caused by severe left ventricular dysfunction to age, obesity and comorbidity-related cardiovascular dysfunction combined with neurohormonal and inflammatory dysregulation or "inflammaging." With the advent of neurohormonal blockers leading to improved outcomes of patients with chronic HF, the focus of AHF therapy has also changed from care directed at early symptom improvement to therapies directed toward longer-term improvements in quality of life and outcomes. Studies conducted in the past 5 years suggest that the beneficial effects seen with the 4 pillars of guideline-directed medical therapy for HF, mostly comprising neurohormonal blockade, can be extended to AHF when these therapies are initiated and rapidly uptitrated during admission and after discharge. A recent pilot study, CORTAHF (Effect of Short-Term Prednisone Therapy on CRP Change in Emergency Department Patients With Acute Heart Failure and Elevated Inflammatory Markers), has suggested that these benefits can be extended by treating patients with AHF and markers of inflammatory activation with anti-inflammatory therapies. Future studies should further examine whether combined anti-inflammatory therapy and neurohormonal blockade can lead to the reversal of disrupted underlying pathophysiology and remission in patients with AHF
A Rocq Formalization of Monomial and Graded Orders
No full textEven if binary relations and orders are a common formalization topic, we need to formalize specific orders (namely monomial and graded) in the process of formalizing in Rocq the finite element method. This article is therefore definitions, operators, and proofs of properties about relations and orders, thus providing a comprehensive Rocq library. We especially focus on monomial orders, that are total orders compatible with the monoid operation. More than its definition and proved properties, we define several of them, among them the lexicographic and grevlex orders. For the sake of genericity, we formalize the grading of an order, a high-level operator that transforms a binary relation into another one, and we prove that grading an order preserves many of its properties, such as the monomial order property. This leads us to the definition and properties of four different graded orders, with very factorized proofs. We therefore provide a comprehensive and user-friendly library in Rocq about orders, including monomial and graded orders, that contains more than 700 lemmas
Revised Orphanet nomenclature and classification for spina bifida and other spinal dysraphisms (SBoD)
No full textInternational audienceBackground: The Spina Bifida and other Dysraphisms working group (SBoD WG) is an interdisciplinary group, comprising experts on spinal dysraphism from 11 European countries. In 2022, the SBoD WG was tasked by 2 European Rare Disease Networks (ERN ITHACA and ERN eUROGEN) to revise the Orphanet classification of spinal dysraphism. Over the past two decades numerous subcategories of spinal dysraphism have been described in the medical literature resulting in a proliferation of terms, numerous synonyms and variously applied definitions. In the light of this, a revision of all terms and definitions was conducted by a Delphi approach in 3 steps by neurosurgeons (fetal/paediatric/adult), urologists (paediatric/adult), rehabilitation medicine specialists, fetal medicine and perinatal imaging specialists, geneticists, pathologists, nephrologists and patient representatives, all members of the International Federation for Spina Bifida and Hydrocephalus (IFSBH).Results: In the first instance, 39 experts reviewed and refined the terminology that could be used to describe the anatomical characteristics of all forms of SBoD. At the second stage, 24 experts established terms and unambiguous definitions for 16 skin findings, 7 bone findings and 33 spinal cord findings that were considered essential features capable of describing all forms of spinal dysraphism. In the third stage, 29 experts validated 24 spinal dysraphic anomalies using these pre-agreed findings. All terms and definitions were validated by vote with a threshold of 80% approval (abstention was permitted). No terms with disagreement were retained in the subsequent classification. The revised SBoD classification was transferred to the Orphanet nomenclature (ORPHA:823). 16 existing ORPHAcodes were deemed obsolete, 10 ORPHAcodes were updated (terms and/or textual definitions) and 25 new ORPHAcodes were created. The SBoD working group also developed a 'decision tree' for new users, to assist them in the practical aspects of applying the revised classification and designating appropriate ORPHAcodes.Conclusions: An update of the Orphanet Classification of spinal dysraphism was conducted by a European interdisciplinary group of experts encompassing all aspects of healthcare for patients with these disorders. This new classification, based on essential skin, bone and spinal cord findings offers a more logical and reproducible means to categorise SBoD. It is hoped that this will permit more precise disease delineation, consistent diagnostic accuracy and better prognostication
Les oppositions contemporaines autour de l’avortement
No full textDans l’introduction au numéro thématique, R. Perrin, M. Mathieu et M. Le Guen rappellent que, si le droit à l’avortement a été libéralisé dans de nombreux pays, le processus connait des reculs et reste ailleurs inachevé. Cinquante ans après le vote de la loi Veil, ce numéro analyse les obstacles persistants à l’autonomie procréative des femmes.Le délai légal de recours à l’IVG est progressivement passé en France de 10 semaines en 1975 à 14 en 2022. M. Le Guen analyse les débats parlementaires pour montrer comment la norme juridique délimite cette autonomie procréative, éclairant l’évolution des arguments autour des registres éthiques, médicaux et pragmatiques.Alors que le gouvernement sénégalais a ouvert une réflexion sur une possible libéralisation du droit à l’avortement en invoquant l’enjeu de santé publique, Marième N’Diaye étudie le mouvement des opposant·es fait d’une coalition aux intérêts divers, au sein de laquelle alternent action radicale, menace de recours à la violence et discours de responsabilité.À l’aide d’observations menées dans trois centres d’IVG, R. Perrin examine la pratique de l’IVG comme un enjeu professionnel, montrant comment les médecins gynécologues-obstétriciens délèguent cette tâche tout en cherchant à maintenir leur contrôle symbolique. L’article met en lumière la dimension relationnelle du « sale boulot » ainsi que l’utilisation du dégoût comme « pratique de pouvoir professionnel ».À partir d’entretiens avec une cinquantaine de femmes ayant avorté, Laurine Thizy analyse les stratégies de résistance à la stigmatisation, en se concentrant sur le travail émotionnel. Elle explore comment ces femmes gèrent leurs sentiments et expériences émotionnelles pour surmonter la stigmatisation intériorisée et expérimentée, en lien avec leur trajectoire procréative
Clinical Characteristics, Management and Outcomes of Enterococcal Infective Endocarditis: An Ancillary Study from the ESC-EORP EURO-ENDO Registry
No full textInternational audienceBackground Enterococcal infective endocarditis (EIE) represents a growing proportion of infective endocarditis (IE) cases, particularly among elderly and comorbid patients. EIE poses diagnostic and therapeutic challenges, notably regarding optimal antimicrobial therapy and surgical decision-making. We aimed to compare the clinical characteristics, management, and outcomes of EIE versus non-enterococcal IE (NEIE) in the ESC-EORP EURO-ENDO registry. Methods This ancillary analysis of the prospective EURO-ENDO registry included adult patients with definite or possible IE enrolled between January 2016 and March 2018. Patients with monomicrobial EIE were compared with those with NEIE. Clinical, microbiological, imaging, and therapeutic data were analyzed. Multivariable logistic regression including EuroSCORE II and valve status identified independent predictors of in-hospital mortality. Results Among 3 083 patients, 365 (12 %) had monomicrobial EIE. Compared with NEIE, EIE patients were older (mean 68 vs 58 years), had more comorbidities, and more frequent prosthetic valve involvement (41 % vs 26 %). Aortic valve localization and colonic uptake on PET/CT were also more common. In-hospital mortality was similar (16 % vs 17 %). After adjustment for EuroSCORE II and valve status, EIE was not independently associated with higher in-hospital mortality (adjusted OR 0.67 [95 % CI 0.42–1.04]; p = 0.083). Among 195 EIE patients with one-year follow-up, recurrence occurred in 6 %. Healthcare-associated acquisition, prosthetic valve infection, and recurrence were associated with worse outcomes and lower surgical rates. Conclusions EIE affects older, high-risk patients. After adjustment for operative risk, mortality was comparable to other etiologies, highlighting the need for tailored diagnostic and therapeutic strategies
Simulation de la propagation de fissures de fatigue sous hydrogène en milieu hétérogène
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Postoperative subclinical AKI is common and associated with complications in non-critically ill patients undergoing cytoreductive and hyperthermic intraperitoneal chemotherapy surgery: The penkCHIP study
No full textInternational audienceNo abstract availabl
Physical scaling laws in dislocation microstructures and avalanches from dislocation dynamics simulations
No full textAvalanche-like plastic bursts in crystalline materials follow power law statistics, but the scaling exponents and cutoff parameters vary widely in the literature ( ranging from -1 to -2.2), hindering predictive modeling. Since distributions do not follow Gaussian behavior, the average of plastic kinetics is not correctly defined. Larger-scale models that rely on average behavior are therefore fundamentally flawed. We performed extensive 3D Dislocation Dynamics simulations of FCC Cu deformation across three orders of magnitude in dislocation density () under constant strain rates. Our results demonstrate that the power law exponent ( -1.6 to -1.7 ) is invariant to both dislocation density and loading direction, resolving previous inconsistencies. However, dislocation density strongly controls the power law truncation scaling () and the distribution of avalanche triggering stresses. We quantify correlations between slip system activities and show how individual system contributions evolve with avalanche size. These findings reconcile experimental scatter in avalanche statistics and provide quantitative scaling laws for mesoscale-to-continuum plasticity models
Acceptability of the routine use of pulse oximetry by healthcare workers and caregivers within primary healthcare in West Africa: mixed-methods study
No full textInternational audienceIntroduction To better identify severe hypoxaemia as a major risk factor for specific illnesses in children aged under 5 years, the Améliorer l’Identification des détresses Respiratoires chez l’Enfant (AIRE) project implemented routine use of pulse oximetry within implementation of Integrated Management of Childhood Illness (IMCI) guidelines at primary health centres (PHCs) in Burkina Faso, Guinea, Mali and Niger. We aimed to measure and understand the acceptability of pulse oximeter (PO) use among healthcare workers (HCWs) and children’s families (CFs). Methods Based on an original conceptual framework, we conducted a convergent mixed methods study to assess acceptability. We conducted repeated cross-sectional studies among all HCWs on duty within the 202 PHCs involved in the AIRE project, using quantitative Likert-scale questionnaires. These were administered at four key time points: (1) just before the PO use training, (2) immediately after the training, (3) 6 months after the introduction of PO devices in PHCs and (4) 2 months after the completion of all AIRE project activities. We also conducted semistructured interviews with HCWs (n=100) and CFs (n=59). Quantitative data were analysed using descriptive statistics and multivariable ordinal logistic regression. Qualitative data were thematically analysed with NVivo, and both were interpreted in light of the conceptual framework to explore convergence and divergence across acceptability dimensions. Results From March 2021 to December 2022, 486, 537, 538 and 476 HCWs completed the four acceptability surveys. Overall, 31% of HCWs had mixed feelings about PO use before the training, 46% found it somewhat acceptable and 23% strongly acceptable. At the end of the project, it was respectively 15%, 34% and 51%. PO training was consistently associated with greater HCWs acceptability. HCWs reported many advantages in using PO, such as a more accurate diagnosis and a boost in their confidence in sick child management. Nevertheless, challenges reported by HCWs included perceived increased workload and consultation time, as well as difficulties in referring children to hospital. CFs did not necessarily understand the device’s purpose, but their opinions of the technology were generally positive. Conclusion PO use, integrated into IMCI consultations, was reported to be accepted by HCWs and CFs, although sustainable challenges in implementation remain