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Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit
No full textInternational audienceBACKGROUND Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. METHODS In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours. The primary outcome was a composite of death or persistent organ dysfunction (defined by the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy) on day 28. RESULTS A total of 872 patients underwent randomization (435 to the vitamin C group and 437 to the control group). The primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and in 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% confidence interval [CI], 1.04 to 1.40; P = 0.01). At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05). Findings were similar in the two groups regarding organ-dysfunction scores, biomarkers, 6-month survival, health-related quality of life, stage 3 acute kidney injury, and hypoglycemic episodes. In the vitamin C group, one patient had a severe hypoglycemic episode and another had a serious anaphylaxis event. CONCLUSIONS In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo. (Funded by the Lotte and John Hecht Memorial Foundation; LOVIT ClinicalTrials.gov number, NCT03680274.)
L'analyse lexicale au service de l’évaluation d'un dispositif d'accompagnement socio-sanitaire à destination de personnes vivant avec une schizophrénie
No full textInternational audienceObjective: Through the study of a social and health care program supporting the recovery of people living with schizophrenia (PASSVers), this article aims to show the interest of using the Alceste lexical analysis method to evaluate health-promoting activities. Method: Semi-structured interviews were conducted with users supported for 12 to 20 months (n = 21), nurses and social workers (n = 11), and family caregivers (n = 6). The corpus was analyzed using Alceste software. Results: Each population used a specific vocabulary to evaluate the program, reflecting different viewpoints towards it. The contextualization of the vocabulary significantly present in the discourse classes highlighted the program's effects on each of the three groups. We noticed a shift in posture among professionals with a detachment from purely medical concerns, as well as the impact of the support on the health of the users and on the well-being of their relatives. Discussion: Lexical analysis appeared particularly relevant for evaluating a health promotion program such as PASSVers. Indeed, this tool for interpreting a corpus is based on the distribution of vocabulary, excluding any judgment by the analyst. Thus, this method ensures a rigorous methodological basis for determining the classes of discourse to be interpreted. Conclusion: The Alceste method enables the rigorous study of a corpus through a detailed analysis of the vocabulary. In the evaluation of the PASSVers program, it allowed us to highlight the specific points of view of each group, and to identify the benefits of the program for each of them
Enrichissement sur la plateforme Moodle de l'hôpital virtuel à l'aide de nouveaux cas de gastro-entérologie : complément à l'enseignement du cursus initial en médecine des carnivores domestiques
No full textIn French veterinary schools, teaching follows a new frame of reference since 2018. It defines learning objectives in different skills that the student can build thanks to internal and external resources. In order to help him build those skills, the École vétérinaire nationale d’Alfort tends to adopt an “active” pedagogy. This “active” pedagogy supplements the passive learnings of lecture courses and aims to contextualize the knowledge learnt by students beforehand. The “active” pedagogy, opposite to a more traditional pedagogy, places the student as an actor of his own education through different types of exercises.To be part of this new pedagogy, the “hôpital virtuel” was created in 2017 on the Moodle platform as part of a thesis. This new tool allows the students to work on clinical cases of small animal internal medicine. Cases are presented as tests. The “hôpital virtuel” is aimed at students in their fourth year and years above. It has already been enriched by two thesis work in 2020 and in 2021. Satisfaction surveys conducted in those last works revealed that students found it useful and stimulating. It is clear that they are wishing for new clinical cases.In the present work, four gastro-enterology themed clinical cases were added to the platform. The diseases chosen are megaesophagus, canine parvovirus infection, feline hepatic lipidosis and exocrine pancreatic insufficiency. They were chosen given the frequency with which general practice veterinarians deal with them. Cases are based on real animals’ stories, presented at the Centre hospitalier universitaire vétérinaire d’Alfort. Each clinical case is studied as a test. Questions have grades and offer a feedback so that the student can learn from his mistakes. One other goal is to give stimulating revision tools to students to help them transition from knowledge to skills. Moreover, clinical cases introduce new information on the diseases.In conclusion, the present work is an answer to students’ wishes of an enrichment of a learning tool considered useful and stimulating. This work focuses on small animal internal medicine but other veterinary fields are being asked by the students.L'enseignement en école vétérinaire française s'appuie sur un nouveau référentiel de diplôme depuis 2018. Celui-ci définit des objectifs d'apprentissage par compétences, construites par l'étudiant par des ressources internes et externes. Pour l'aider dans la construction de ces compétences, la pédagogie qui tend à être employée à l'École vétérinaire nationale d'Alfort est celle de la pédagogie active. Elle vient compléter des apprentissages passifs en cours magistraux et a pour but de contextualiser les connaissances apprises par les étudiants en début de cursus. Dans cette optique d'améliorer les apprentissages actifs au sein de l'École vétérinaire nationale d'Alfort, l'hôpital virtuel a été créé en 2017 sur la plateforme Moodle dans le cadre d'un travail de thèse. Cet outil présente des cas cliniques de médecine interne des carnivores domestiques sous forme de questionnaire. Il s'adresse principalement aux étudiants de quatrième année et à ceux des promotions supérieures. Il a déjà été enrichi lors de deux travaux de thèses en 2020 et en 2021. Lors de l'étude de la satisfaction des étudiants, il était évident que cet outil était ressenti comme utile et motivant et les étudiants souhaitent voir l'hôpital virtuel s'enrichir à nouveau. Avec ce travail de thèse, quatre nouveaux cas cliniques ont été ajoutés dans le domaine de la gastro-entérologie. Les thèmes choisis sont ceux du mégaoesophage, de la parvovirose, de la lipidose hépatique et de l'insuffisance pancréatique exocrine. Le choix des thèmes abordés repose sur la fréquence de présentation des affections dans la pratique vétérinaire généraliste. Les cas retracent ceux d'animaux ayant été présentés au centre hospitalier universitaire vétérinaire d'Alfort. Chaque cas est présenté sous forme de questionnaire. Les questions sont notées et proposent un « feedback » à l'étudiant pour l'aider à corriger des lacunes. Les objectifs des questionnaires sont de permettre aux étudiants de bénéficier d'outils de révision motivants et actifs et de faciliter la transition des connaissances abordées en cours magistraux vers des compétences. De plus, la présentation sous forme de cas clinique permet d'apporter de nouvelles informations et d'aller plus en profondeur dans l'étude des affections présentées. En conclusion, ce travail répond à un souhait des étudiants d'enrichir une plateforme d'apprentissage actif jugée utile et motivante. Cet enrichissement est focalisé sur la médecine interne des carnivores domestiques mais d'autres disciplines sont aussi demandées par les étudiants
Clebsch-Gordan Harmonic Decomposition Application to Strain-Gradient Elasticity
No full textup-comech2022: Workshop on design and analysis of non-classical architectured material
MARMIT-2: An improved version of the MARMIT model to predict soil reflectance as a function of surface water content in the solar domain
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The last Hunters-gatherers of the Somme and neighbouring peat valleys: method of study, settlement and taphonomy
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What Is the Optimal Duration for a \textscROAT ? The Experience of the French Dermatology and Allergology Group ( \textscDAG )
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