43 research outputs found
Supplemental Material, Online_Supplementary_Material_Cuff_Leak_Test_JICM_R1 - Cuff Leak Test for the Diagnosis of Post-Extubation Stridor: A Multicenter Evaluation Study
No full textSupplemental Material, Online_Supplementary_Material_Cuff_Leak_Test_JICM_R1 for Cuff Leak Test for the Diagnosis of Post-Extubation Stridor: A Multicenter Evaluation Study by David Schnell, Benjamin Planquette, Asaël Berger, Sybille Merceron, Julien Mayaux, Lucas Strasbach, Stéphane Legriel, Sandrine Valade, Michael Darmon and Ferhat Meziani in Journal of Intensive Care Medicine</p
Les troubles psycho-organiques et le test de Rorschach, hier et aujourd'hui
No full textAmbroise Darbellay, Frieda Rossel, Colette Merceron, Psycho-organic troubles and the Rorschach test. Yesterday and today.
Several authors up until the fiftees developed degrees of signals to detect a cerebral organic pathology ; the method used by Piotrowski being the most common. We can distinguish the qualitative observations made by this author from the quantitative evaluation he perfected. During the last thirty years with the development of medical techniques, of neuropsycology as well as the evolution in the comprehension of « organic » and « functional » pathologies, we notice a clear diminution of work on the Rorschach based on Piotrowskis' method. We recognise that certain qualitative signs underlined by Piotrowski in order to reveal a brain damage are eminently pertinent and in particular in general psychiatry consultation. It concerns « impotence » (a sign pathognomonic), « perplexity » and « repetition », these two signs being to distinguish psychotic expressions which may occur therein.
Keywords : Rorschach - Brain damage - Piotrowski Z. - Impotence - Perplexity - Perseveration.Plusieurs auteurs, jusque dans les années cinquante, ont développé des échelles de signes pour le repérage d'une pathologie organique cérébrale ; la méthode de Piotrowski est la plus répandue. Nous distinguons les observations qualitatives réalisées par cet auteur de la démarche quantitative qu'il a mise au point.
Ces trente dernières années avec le développement des techniques médicales, de la neuropsychologie ainsi qu'avec l'évolution dans la compréhension des pathologies "organiques" et "fonctionnelles", on assiste à un net recul des travaux sur le Rorschach se fondant sur la méthode de Piotrowski.
Nous soutenons que certains signes qualitatifs relevés par Piotrowski pour dépister une problématique organique sont éminemment pertinents et ceci en particulier dans un service de consultation de psychiatrie générale. Il s'agit de T'impotence" (signe pathognomonique), de la "perplexité" et de la "répétition", ces deux derniers signes étant à distinguer d'expressions psychotiques qui peuvent s'y apparenter.
Mots-clés : Rorschach - Pathologie organique cérébrale - Piotrowski Z. - Impotence - Perplexité - Perseveration.Ambroise Darbellay, Frieda Rossel, Colette Merceron, Los Trastornos Psico-orgánicos y el Test de Rorschach, Ayer y Hoy.
Hasta los años cincuenta, varios autores han desarrollado escalas de señales para descubrir una patologia orgánica cerebral ; el método de Piotrowski reveló ser el más generalizado. Distinguimos las observaciones cualitativas realizadas por este autor del método cuantitativo que él perfeccionó.
Estos últimos treinta anos, con el desarrollo de las técnicas medicales, de la neuro-psicologia, como también con la evolución en la comprensión de las patologías « orgánicas » y « funcionales », asistimos a un retroceso claro de los trabajos sobre el Rorschach que se fundan en el método de Piotrowski.
Sostenemos que algunas señales cualitativas remarcadas por Piotrowski para descubrir una problemática orgánica, son eminentemente pertinentes y esto particularmente, en un servicio de consulta de psicatría general. Se habla de la « impotencia » (señal patognmonica), de la « perplejidad » y de la « repetición » ; debemos distinguir estas dos últimas señales que pueden emparentarse con expresiones psicóticas.
Palabras-clave : Rorschach - Patología orgónica cerebral - Piotrowski Z. - Impotencia - Perplejidad - Perseveración.Darbellay Ambroise, Rossel Frieda, Merceron Colette. Les troubles psycho-organiques et le test de Rorschach, hier et aujourd'hui. In: Psychologie clinique et projective, vol. 5, 1999. Interfaces de la neuropsychologie et de la psychologie projective. pp. 1-20
Evaluation non invasive de la pression intracrânienne par l'échographie oculaire chez les patients de neuro-réanimation
No full textPARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Assessment of cerebral blood flow changes in nonconvulsive status epilepticus in comatose patients: A pathophysiological transcranial Doppler study
No full textAbstractPurposeWe assessed the accuracy of transcranial Doppler (TCD) in helping to diagnose nonconvulsive status epilepticus (NCSE) in comatose patients admitted to the intensive care unit (ICU) for acute neurological disorders at high risk for NCSE.MethodsA 2-year prospective observational study in 38 consecutive patients requiring continuous electroencephalography (EEG) monitoring and intracranial pressure monitoring with TCD.ResultsOf the 38 patients, 10 (26.3%) had NCSE by continuous EEG monitoring. Bilateral mean and maximal systolic and diastolic TCD velocities were significantly different between patients with and those without NCSE. Areas under the receiver-operating characteristic (ROC) curves of mean and maximal systolic velocities by TCD were 0.82 (95%CI, 0.64–1.00) and 0.79 (95%CI, 0.62–0.95) with cutoffs of 95cm/s and 105cm/s, respectively. Areas under the ROC curves of mean and maximal diastolic velocities were 0.76 (95%CI, 0.56–0.95) and 0.78 (95%CI, 0.60–0.96) with cutoffs of 31cm/s and 40cm/s, respectively. For none of the velocity parameters did the areas under the ROC curves differ significantly between the left and right sides. The best performance was obtained using mean systolic (SV) and a cutoff of 95cm/s, which yielded a positive likelihood ratio of 3.8 and a negative likelihood ratio of 0.25.ConclusionOur preliminary results showed a significant association between increased TCD velocities and NCSE in comatose patients. However, the likelihood ratios suggested a limited role for TCD in helping to diagnose seizure activity. Further studies with larger samples of NCSE patients are warranted to determine the exact contribution of TCD for NCSE detection in comatose ICU patients
Association of targeted temperature management on progression to brain death after severe anoxic brain injury following cardiac arrest: an observational study
No full textObjective Targeted temperature management (TTM), through its physiological effects on intracranial pressure, may impede the progression to brain death (BD) in severe anoxic brain injury post-cardiac arrest (CA). We examined the potential association between the use of TTM and the occurrence of BD after CA.Design Monocentric, retrospective study.Setting Intensive care unit, Versailles Hospital, France.Participants Comatose survivors of CA who died from BD or postanoxic encephalopathy (PAE) after 24 hours.Main outcome measures PAE deaths corresponded to withdrawal of life-sustaining therapy (WLST) due to irreversible postanoxic coma or vegetative state according to prognostication guidelines. BD corresponded to the cessation of cerebral vascularisation secondary to intracranial hypertension. The diagnosis of BD was definite by clinical diagnosis of deep coma according to the Glasgow Coma Scale 3, loss of all brainstem reflexes and the demonstration of apnoea during a hypercapnia test. A cerebral omputed tomography (CT) scan or two isoelectric and unreactive electroencephalograms were used to confirm BD. To identify the independent association between TTM and BD, we conducted a multivariable logistic regression analysis.Results Out of 256 patients included between 2005 and 2021, 54.3% received TTM for at least 24 hours, and 56 patients (21.9%) died from BD. In the multivariable analysis, TTM for 24 hours or more was not associated with a decrease in BD (Odds Ratio 1.08, 95% CI 0.51 to 2.32). Factors associated with BD included a total duration of no-flow plus low-flow exceeding 30 min, CA due to neurological causes or hanging and a high arterial partial pressure of carbon dioxide between days 1 and 2 after admission.Conclusions This exploratory analysis of post-CA patients with severe anoxic brain injury did not find an association between TTM ≥24 hours and a reduction in BD. Further studies are needed to identify specific subgroups of post-CA patients for whom TTM may be especially futile or even harmful
Open learner models and learning analytics dashboards: a systematic review
Get PDFThis paper aims to link student facing Learning Analytics Dashboards (LADs) to the corpus of research on Open Learner Models (OLMs), as both have similar goals. We conducted a systematic review of literature on OLMs and compared the results with a previously conducted review of LADs for learners in terms of (i) data use and modelling, (ii) key publication venues, (iii) authors and articles, (iv) key themes, and (v) system evaluation. We highlight the similarities and differences between the research on LADs and OLMs. Our key contribution is a bridge between these two areas as a foundation for building upon the strengths of each. We report the following key results from the review: in reports of new OLMs, almost 60% are based on a single type of data; 33% use behavioral metrics; 39% support input from the user; 37% have complex models; and just 6% involve multiple applications. Key associated themes include intelligent tutoring systems, learning analytics, and self-regulated learning. Notably, compared with LADs, OLM research is more likely to be interactive (81% of papers compared with 31% for LADs), report evaluations (76% versus 59%), use assessment data (100% versus 37%), provide a comparison standard for students (52% versus 38%), but less likely to use behavioral metrics, or resource use data (33% against 75% for LADs). In OLM work, there was a heightened focus on learner control and access to their own data
ozoe
No full textInternational audienceBeyond rigorous inspection of the literature, selected comments and drawings from the Nozoe Autograph Books show how concepts and targets of the chemistry of today already existed 40 years ago. This is illustrated for the chemistry of carbo-mers, which was actually unknowingly inspired by chemists of the golden age. After a personal travel through time and pages by the last author of this essay, who meets autographs by people who have been important in his career, in particular on the occasions of Nozoe's visits to France or past ISNA events, unpublished results in non-benzenoid chemistry are dedicated to Nozoe's memory. Experimental advances are first disclosed on the comparative chemistry of the three ortho, meta and para isomers of tetraphenyl-carbo-benzene C18H2Ph4, the known ortho isomer serving as a reference. The two CH vertices of these chromophores make their [6]pericyclyne precursors quite sensitive and their yields and purifications challenging to optimize. The meta isomer was, however, isolated in 18% yield, and described by NMR and UV-vis absorption spectroscopy and crystallography. The para isomer was characterized both in pure form and in a 1:1 mixture with a single isomer of its HCl adduct, including by X-ray diffraction analysis of a co-crystal showing that the interior of the C-18 ring of the HCl adduct is filled by the Cl atom. Theoretical advances are then offered regarding the aromatic character of a triple bond, by showing that the topological acyclic reference of acetylene is the Mobius-twisted cyclobutadiene. Acetylenoids are finally proposed as a novel class of non-benzenoid aromatics
Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments
No full textInternational audienceObjective: Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired. Methods: We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure. Results: The 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55–3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71–4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43–3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75–4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37–3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31–1.22, P = 0.17). Significance: Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives. Study Registration: #NCT03457831
