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Poitiers, France

Within medical care units, administrative and managerial functions are often overshadowed by the curative or diagnostic acts. In this context, health managers must give their availability in order to legitimize their action. Compared to the medical procedures, their gift of time often remains invisible, unseen and therefore unacknowledged. © 2014 Elsevier Masson SAS. Source

Bon D.,University of Poitiers | Bon D.,French Institute of Health and Medical Research | Claire B.,CHU La Pitie Salpetriere | Thuillier R.,University of Poitiers | And 10 more authors.
Transplantation | Year: 2014

BACKGROUND: Machine perfusion use has been reported to promote graft outcome in case of donation after cardiac death. Our objective was to evaluate the potential for nuclear magnetic resonance (NMR) to predict graft outcome by analyzing perfusates during machine perfusion time. METHOD: We used a renal autotransplantation model mimicking deceased after cardiac death donors with pigs. Organs were subjected to 60 min of warm ischemia before the hypothermic machine preservation during 22 hr. We studied the correlation between creatinemia after transplantation and the NMR data from perfusates. RESULTS: A metabonomic analysis allowed us to highlight the evolution of several metabolites during perfusion: the concentration of lactate, choline, or amino acids such as valine, glycine, or glutamate increased with time, whereas there was a diminution of total glutathione during this period. The changes in these biomarkers were less severe in the group with the better outcome. Statistical analysis revealed a strong association between the level of those metabolites during machine perfusion and function recovery (Spearman rank 0.89; P<0.05). CONCLUSION: Multivariate analysis of lesion biomarkers during kidney perfusion using NMR data could be an interesting tool to assess graft quality, particularly because analyses times (2 hr total) are compatible with clinical application. © 2014 Lippincott Williams and Wilkins. Source

Gregoire N.,French Institute of Health and Medical Research | Gregoire N.,University of Poitiers | Mimoz O.,French Institute of Health and Medical Research | Mimoz O.,University of Poitiers | And 11 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

Colistin is an old antibiotic that has recently gained a considerable renewal of interest as the last-line defense therapy against multidrug-resistant Gram-negative bacteria. It is administered as colistin methanesulfonate (CMS), an inactive prodrug, and it was shown that due to slow CMS conversion, colistin plasma concentrations increase very slowly after treatment initiation, which constitutes the rationale for a loading dose in critically ill patients. However, faster CMS conversion was observed in healthy volunteers but using a different CMS brand, which may also have a major impact on colistin pharmacokinetics. Seventythree critically ill patients not undergoing dialysis received multiple doses of CMS. The CMS concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and a pharmacokinetic analysis was conducted using a population approach. We confirmed that CMS renal clearance and colistin concentrations at steady state are mostly governed by creatinine clearance, but we predict a typical maximum concentration of drug in serum (Cmax) of colistin close to 2 mg/liter, occurring 3 h after an initial dose of 2 million international units (MIU) of CMS. Accordingly, the estimated colistin half-life (t1/2) was relatively short (3.1 h), with rapid attainment of steady state. Our results are only partially consistent with other recently published results. We confirm that the CMS maintenance dose should be adjusted according to renal function in critically ill patients. However, much higher than expected colistin concentrations were observed after the initial CMS dose, with rapid steady-state achievement. These discrepancies challenge the pharmacokinetic rationale for a loading dose, which may still be appropriate for rapid bacterial eradication and an improved clinical cure rate. Copyright © 2014, American Society for Microbiology. All Rights Reserved. Source

Loupec T.,CHU Poitiers | Debaene B.,CHU Poitiers
Oxymag | Year: 2013

No clinical signs enable residual paralysis to be detected. The adductor pollicis muscle is the site to monitor in order to gauge residual paralysis. The reversal of neuromuscular blockades must be carried out in accordance with rigorous rules which require monitoring expertise and extensive knowledge of the use of the two reversal agents. © 2013 Elsevier Masson SAS. Source

The reform of nursing studies has helped to strengthen the partnership between nurse training institutes (IFSIs) and hospitals. In line with the socio-constructivist pedagogical project of the IFSI of Poitiers University Hospital, the heart-lung unit has undertaken an innovative supervisory approach with a new design of the work placement. © 2014 Elsevier Masson SAS. Source

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