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Le Touquet – Paris-Plage, France

Panel P.,Center Hospitalier Of Versailles | Bajka M.,University of Zurich | Le Tohic A.,Center Hospitalier Of Versailles | El Ghoneimi A.,Center Hospitalier University Robert Debre | And 2 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Study objective: To assess face and construct validity of a new virtual reality (VR) training simulator for hysteroscopic placement of tubal sterilization implants. Design Nonrandomized, controlled trial comparing responses and performance of novices and experts on the simulator. Design classification: Canadian task force II-1. Setting: Forty-six gynecologists were personally invited or recruited at the 33rd Conference of the French National College of Gynecologists and Obstetricians (CNGOF) from December 9 to 12, 2009, grouped as 20 experts and 26 novices. They all performed the defined sequence of virtual procedures on the simulator (case 1 for familiarization, case 4 for study assessment) and finally completed the study questionnaire. Measurements and main results: Responses to realism, educational potential, and general opinion were excellent, proving face validity. Significant differences between novices and experts were assessed for 7 of the 15 metrics analyzed, proving construct validity. Conclusions: We established face and construct validity for EssureSim™, an educational VR simulator for hysteroscopic tubal sterilization implant placement. The next steps are to investigate convergent and predictive validity to affirm the real capacity of transferring the skills learned on the training simulator to the patient in the operating room. © Springer Science+Business Media, LLC 2012. Source

Arvaniti K.,Intensive Care Unit | Lathyris D.,Intensive Care Unit | Ruimy R.,Center Hospitalier University Bichat Claude Bernard | Haidich A.-B.,Aristotle University of Thessaloniki | And 4 more authors.
Critical Care | Year: 2012

Introduction: We investigated the role of colonization pressure on multiresistant Acinetobacter baumannii acquisition and defined patient-related predictors for carriage at admission and acquisition during hospitalization in intensive care unit (ICU) patients.Methods: This was a 12-month, prospective, cohort study of all patients admitted to a single ICU of a tertiary hospital. Screening samples were collected at ICU admission to identify imported carriers, and weekly during hospitalization to identify acquisition. Colonization pressure (carriers' patient-days × 100/all patients' patient-days) and the absolute number of carriers were calculated weekly, and the statistical correlation between these parameters and acquisition was explored. Multivariable analysis was performed to identify predictors for A. baumannii carriage at admission and acquisition during hospitalization. A. baumannii isolates were genotyped by repetitive-extragenic-palindromic polymerase chain reaction (PCR; rep-PCR).Results: At ICU admission, 284 patients were screened for carriage. A. baumannii was imported in 16 patients (5.6%), and acquisition occurred in 32 patients (15.7%). Acquisition was significantly correlated to weekly colonization pressure (correlation coefficient, 0.379; P = 0.004) and to the number of carriers per week (correlation coefficient, 0.499; P < 0.001). More than one carrier per week significantly increased acquisition risk (two to three carriers, odds ratio (OR), 12.66; P = 0.028; more than four carriers, OR, 25.33; P = 0.004). Predictors of carriage at admission were infection at admission (OR, 11.03; confidence interval (CI), 3.56 to 34.18; P < 0.01) and hospitalization days before ICU (OR, 1.09; CI, 1.01 to 1.16; P = 0.02). Predictors of acquisition were a medical reason for ICU admission (OR, 5.11; CI, 1.31 to 19.93; P = 0.02), duration of antibiotic administration in the unit (OR, 1.24; CI, 1.12 to 1.38; P < 0.001), and duration of mechanical ventilation (OR, 1.08; CI, 1.04 to 1.13; P = 0.001). All strains were multiresistant. Rep-PCR analysis showed one dominant cluster.Conclusions: Acquisition of multiresistant A. baumannii in ICU patients is strongly correlated to colonization pressure. High levels of colonization pressure and more than two carriers per week independently increase acquisition risk. Patient-related factors, such as infection at admission and long hospitalization before the ICU, can identify imported A. baumannii carriers. Medical patients with extended administration of antibiotics and long duration of mechanical ventilation in the ICU were the most vulnerable to acquisition. © 2012 Arvaniti et al.; licensee BioMed Central Ltd. Source

Laroche D.,University of Caen Lower Normandy | Laroche D.,University Paris - Sud | Laroche D.,Center Hospitalier University Bichat Claude Bernard | Chollet-Martin S.,Center Hospitalier University | And 7 more authors.
Anesthesiology | Year: 2011

Background: Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods: We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results: For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion: Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features. © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Source

Houze S.,Center Hospitalier University Bichat Claude Bernard | Paris L.,Hopitaux Universitaires la Pitie Salpetriere Charles Foix
Revue Francophone des Laboratoires | Year: 2015

Summary Rapid diagnostic tests whose interest lies in their implementation without specific equipment by unskilled personnel have grown significantly over the past fifteen years to malaria diagnosis with detection of specific Plasmodium proteins, mainly PfHRP2 and pLDH. If the detection of PfHRP2 makes a very good sensitivity for the diagnosis of Plasmodium falciparum malaria attacks, research pLDH or aldolase are lower for other species, imposing retain microscopic diagnosis reference. This methodology is now being applied to the diagnosis of lymphatic filariasis as well. At the same time, the detection of specific antibody developed for Chagas disease and visceral leishmaniasis and recently schistosomiasis. These tests have sensitivities and specificities variables, the biologist must know before choosing the reagent that will implement in his laboratory. Source

De Waele J.J.,Ghent University | Lipman J.,University of Queensland | Akova M.,Hacettepe University | Bassetti M.,Azienda Ospedaliera Universitaria Santa Maria della Misericordia | And 12 more authors.
Intensive Care Medicine | Year: 2014

Purpose: Risk factors for β-lactam antibiotic underdosing in critically ill patients have not been described in large-scale studies. The objective of this study was to describe pharmacokinetic/pharmacodynamic (PK/PD) target non-attainment envisioning empirical dosing in critically ill patients and considering a worst-case scenario as well as to identify patient characteristics that are associated with target non-attainment. Methods: This analysis uses data from the DALI study, a prospective, multi-centre pharmacokinetic point-prevalence study. For this analysis, we assumed that these were the concentrations that would be reached during empirical dosing, and calculated target attainment using a hypothetical target minimum inhibitory concentration (MIC), namely the susceptibility breakpoint of the least susceptible organism for which that antibiotic is commonly used. PK/PD targets were free drug concentration maintained above the MIC of the suspected pathogen for at least 50 % and 100 % of the dosing interval respectively (50 % and 100 % f T >MIC). Multivariable analysis was performed to identify factors associated with inadequate antibiotic exposure. Results: A total of 343 critically ill patients receiving eight different β-lactam antibiotics were included. The median (interquartile range) age was 60 (47-73) years, APACHE II score was 18 (13-24). In the hypothetical situation of empirical dosing, antibiotic concentrations remained below the MIC during 50 % and 100 % of the dosing interval in 66 (19.2 %) and 142 (41.4 %) patients respectively. The use of intermittent infusion was significantly associated with increased risk of non-attainment for both targets; creatinine clearance was independently associated with not reaching the 100 % f T >MIC target. Conclusions: This study found that-in empirical dosing and considering a worst-case scenario-19 % and 41 % of the patients would not achieve antibiotic concentrations above the MIC during 50 % and 100 % of the dosing interval. The use of intermittent infusion (compared to extended and continuous infusion) was the main determinant of non-attainment for both targets; increasing creatinine clearance was also associated with not attaining concentrations above the MIC for the whole dosing interval. In the light of this study from 68 ICUs across ten countries, we believe current empiric dosing recommendations for ICU patients are inadequate to effectively cover a broad range of susceptible organisms and need to be reconsidered. © 2014 Springer-Verlag and ESICM. Source

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