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The role of biomarkers in community-acquired pneumonia: predicting mortality and response to adjunctive therapy
Jean-Paul Mira, Adeline Max, Pierre-Regis Burgel
Critical Care , 2008, DOI: 10.1186/cc7028
Abstract: Community-acquired pneumonia (CAP) accounts for 1.3 million hospitalizations each year in the USA, at an annual cost of $8.4 billion [1]. The average duration of hospitalization for CAP managed on the ward is 6 days, at a cost of $7,500. If intensive care unit (ICU) admission (for severe CAP) is required, then the stay increases to 23 days, at a cost of $21,144. The average cost for managing pneumonia in the UK was estimated at £100 per episode, as compared with £1,700 to £5,100 for hospitalized (severe CAP) patients. Hospitalization accounted for 87% of the total annual cost [2,3].Although CAP is very common, it remains a common cause of death. Hence, severe CAP has been reported to be the largest single cause of mortality from infectious diseases in industrialized countries [4]. For example, a study conducted in the USA compared outcomes in more than 150,000 patients aged over 65 years who were hospitalized for CAP with those in 800,000 control individuals matched for age, sex and race who were admitted to hospital for conditions other than pneumonia [4]. The in-hospital mortality rate among CAP patients was significantly higher, at 11%, than that in non-CAP patients (5.5%; P < 0.001). Surprisingly, the 1-year mortality rate among CAP patients remained significantly higher than that in control individuals (41% versus 29%; P < 0.001). Thus, mortality rates in patients with severe CAP remain high and are discussed in detail elsewhere in this supplement [5]. The factors that underlie the poor short-term and long-term survival rates in patients with CAP and severe CAP are not yet completely understood. However, aspects of the pathophysiology of the disease, reflected in some of the recently described biomarkers and genomic markers, may contribute to increased understanding.Hence, in addition to being an infectious disease, severe CAP elicits major systemic responses that could also allow this pathology to be classified as inflammatory (indicated by systemic release of
Overview of medical errors and adverse events
Maité Garrouste-Orgeas, Fran?ois Philippart, Cédric Bruel, Adeline Max, Nicolas Lau, B Misset
Annals of Intensive Care , 2012, DOI: 10.1186/2110-5820-2-2
Abstract: During the past decade, healthcare quality and patient safety have emerged as major targets for improvement. Widely publicized reports from the United States, such as Crossing the Quality Chasm [1] and To Err is Human [2], showed that medical errors were common and adversely affected patient outcomes. These publications made the general public acutely aware of the inadequacies in the health care available to them. They also prompted healthcare providers, governments, and medical societies throughout the world to develop tools for measuring healthcare quality in all the fields of medicine. Institutions promoting error reporting were set up in Australia [3] and the United States [4] in 2000, in the United Kingdom in 2003 [5], and in France in 2006 [6].The concept of quality has evolved from a process grounded in the physician-patient relationship to broader approaches involving the healthcare community, concept of efficiency, and ethical access to care. When discussing quality of care, it should be borne in mind that safety is a global concept encompassing efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Starting in the 19th century, several landmark events laid the foundation for the development of quality of care. During the Crimean war in the 1850s, Florence Nightingale studied mortality rates in military hospitals. In 1912, Ernest Codman developed a method to measure the outcomes of surgical interventions. In 1918, the American College of Surgery defined the minimum standard that hospitals needed to fulfil to obtain accreditation. In 1950, the medical audit method was developed by P. Lembcke in the United States and 1 year later the Joint Commission on Accreditation of Hospitals (JCAH) was created to accredit those hospitals that applied standard quality measures. In 1970, J. Williamson introduced a new method for assessing what is achievable but not achieved by the standard of care to what is actually done, via p
The strategy of antibiotic use in critically ill neutropenic patients
Matthieu Legrand, Adeline Max, Beno?t Schlemmer, Elie Azoulay, Bertrand Gachot
Annals of Intensive Care , 2011, DOI: 10.1186/2110-5820-1-22
Abstract: Neutropenia is defined as a neutrophil count ≤ 500/mm3 or ≤ 1000/mm3 with a predicted decrease to ≤ 500/mm3 [1,2]. Infection remains a major complication of neutropenia, and severe sepsis and septic shock are associated with high hospital mortality [3,4]. Fever, defined as a single oral temperature ≥38.3°C or ≥38.0°C for at least 1 hour, develops in 10-50% of patients after chemotherapy for solid tumors and in more than 80% of patients with hematological malignancies [5].Urgent and appropriate antibiotic administration is mandatory to prevent further clinical deterioration, especially in critically ill patients with signs of respiratory distress or severe sepsis. Therefore, the first-line antibiotics should cover the pathogens deemed to be most likely based on the patient's characteristics, neutropenia, and local epidemiology. However, the changing epidemiology of infections, global increase in resistant strains, and need to contain healthcare costs require careful selection of antibiotics. Only 10-40% of episodes of febrile neutropenia are microbiologically documented in neutropenic patients, which hampers appropriate antibiotic spectrum adjustment in most cases [5]. This review provides an up-to-date guide to assist physicians in choosing the optimal antibiotic regimen in neutropenic patients, based on the above-mentioned considerations and on the most recent international guidelines and literature.During the 1990s, Gram-positive bacteria emerged as the leading agents responsible for infections in neutropenic patients worldwide. In adults with bloodstream infections and malignancies in the United States, the proportion of Gram-positive organisms increased from 62% in 1995 to 76% in 2000, whereas the proportion of Gram-negative infections decreased from 22% to 15% [6]. Factors that may increase the risk of Gram-positive sepsis in neutropenic patients include the widespread use of central venous catheters, introduction of prophylactic quinolone therapy, increased us
Clinical features of H1N1 2009 infection in critically ill immunocompromised patients
Laurent Camous, Virginie Lemiale, Emmanuel Canet, Adeline Max, David Schnell, Jerome Le Goff, Antoine Rabbat, Benoit Schlemmer, élie Azoulay
Critical Care , 2010, DOI: 10.1186/cc8927
Abstract: Infection is a major source of morbidity and the leading cause of death in immunocompromised patients [1]. The increased susceptibility to infection results from the intertwined effects of the immunocompromising condition, treatments, and co-morbidities [1]. Human infection with the novel H1N1 influenza virus was first recognized in early April 2009 and declared a worldwide pandemic by the World Health Organization in June 2009. Recent case series provide information on the clinical course, risk factors, and outcome of H1N1(v) infection [2-4]. Both New Zealand and Canada have experienced H1N1(v) outbreaks with severe illness requiring intensive care unit (ICU) admission, ventilatory support, and rescue therapies. However, no case series have specifically described the features of H1NI(v) infection in immunocompromised patients. Here, we report the clinical and epidemiologic features in 10 critically ill immunocompromised patients with H1N1(v) infection.The case definition was ICU admission for acute respiratory failure and a positive specific polymerase chain reaction test for the pandemic influenza A (H1N1) 2009 virus. All patients meeting this case definition were included.In late 2009, 15 patients with H1N1-related acute respiratory failure, including 10 immunocompromised patients, required ICU admission. As reported in Table 1, median time from respiratory symptom onset to ICU admission was 4 days (interquartile range [IQR] 3 to 5 days). Hypoxemia was mild at ICU admission but worsened over the next few days. The chest radiographs consistently showed extensive pulmonary infiltrates (median Murray score 3; IQR 2 to 4), and 80% of cases showed an alveolar pattern. All patients were treated with oseltamivir, which was prescribed 1 day (range 0 to 6 days) after ICU admission. Superinfection (mostly bacterial pneumonia) occurred in all patients in keeping with previous data on seasonal influenza [5]. The clinical course was characterized by prolonged oxygen dependenc
Les conseillers financiers de La Banque Postale : entre les besoins du client et les intérêts de l’employeur
Adeline Gilson
SociologieS , 2010,
Abstract: Le métier de conseiller financier est traversé par une double prescription : vendre et conseiller. Face à cette injonction a priori contradictoire, les conseillers interprètent différemment leur r le professionnel en situation de travail et mettent en place des stratégies pour remédier aux contraintes émanant autant de l’organisation que des clients. Financial advisers working at La Banque Postale in France: between customer needs and employer interestsThe financial adviser job deals with a dual instruction: selling and advising. Being faced with this requirement which seems contradictory, the financial advisers interpret in different ways their professional role in work and implement strategies to bear the pressure that both organization and customers put on them. Los asesores bancarios de la Banque Postale de Francia: entre las necesidades del cliente y los intereses del empleadorEl oficio de asesor bancario está atravesado por una doble prescripción: vender y aconsejar. Frente a este requerimiento en principio contradictoria, los asesores interpretan de maneras diferentes su rol profesional durante la situación de trabajo e implementan distintas estrategias para remediar las dificultades que emanan tanto de la organización como de los clientes.
Savoirs mondains, savoirs savants : les femmes et leurs cabinets de curiosités au siècle des Lumières
Adeline Gargam
Genre & Histoire , 2010,
Abstract: Dans la France des Lumières, la culture de la curiosité est un phénomène de mode mais surtout un jeu social et intellectuel. La présente étude entend retracer l’histoire d’une trentaine de cabinets féminins de curiosité tenus à cette époque. Des femmes fortunées de l’aristocratie et de la bourgeoisie parisienne et provinciale ont alors constitué sous l’emprise de leur libido sciendi des cabinets d’alchimie, de minéralogie, de physique chimie, d’histoire naturelle et d’anatomie naturelle et artificielle. Ces cabinets obéissent à une typologie particulière. Il en existe deux catégories : les cabinets d’amateurs, constitués pour la parade et le spectacle des visiteurs et fonctionnant comme de véritables écoles de plaisirs intellectuels et éducatifs ; les cabinets à finalité scientifique et didactique, formés par des savantes expérimentées qui se livrent dans leurs laboratoires à des recherches personnelles et expérimentales au nom des progrès de la science médicale et de l’instruction publique. La réflexion porte aussi sur le fonctionnement de ces cabinets privés de curiosité, particulièrement sur leur mode de constitution, leur décor intérieur ainsi que sur le contenu des collections qui nécessitaient certaines techniques d’organisation, d’acquisition et de conservation communes à celles de leurs homologues masculins. During the Enlightenment in France, curiosity culture constituted both a fashion and an intellectual and social game. This article explores thirty cabinets of curiosities run by women during this period. Wealthy women from the Parisiain and provincial aristocracy and middle classes organized cabinets in alchemy, mineralogy, physics and chemistry, natural history and biology studies. These cabinets can be divided into two distinct categories. The first represented amateur interests; they were developed for show and served as schools for intellectual and éducational pleasure. The second category were run by experienced women scientists who used their laboratories to conduct experimental research in the name of medical progress and public instruction. This article also describes how these private cabinets functioned, their composition, their interior décor as well as the contents of the collections, which required the organisation, acquisition and preservation techniques used in their male counterparts.
Parcours croisés de Dominique Cabrera, cinéaste, et de ses proches collaborateurs. Intersecting careers: Dominique Cabrera, film director, and her close collaborators.
Adeline Lamberbourg
Temporalités , 2010,
Abstract: Le métier de réalisateur de cinéma a été peu étudié en sciences humaines et sociales. Les études cinématographiques et la presse spécialisée s’intéressent beaucoup moins aux parcours des collaborateurs de l’équipe technique qu’aux comédiens et aux projets des auteurs que l’on pourrait croire retranchés dans leur intériorité créatrice. Pour échapper à ce travers biographique, le sociologue peut rendre compte de l’itinéraire d’un réalisateur en examinant ses liens avec ses collaborateurs. On prend ici l’exemple des liens de travail récurrents qui unissent Dominique Cabrera, réalisatrice de cinéma, à ses proches collaborateurs, en montrant de quelle manière des liens de travail peuvent s’approfondir en dépit d’un contexte sectoriel où l’organisation par projet de l’activité cinématographique favorise a priori la fugacité des relations de travail. On postule ainsi que le contexte pertinent pour éclairer les contours de cet itinéraire de carrière est le réseau des relations socioprofessionnelles au sein duquel naissent les projets de films et qui contribuent à ancrer ce parcours dans le paysage professionnel des pratiques cinématographiques. In France, social sciences and humanities have paid little attention to the profession of film director. Film studies and the press are much less interested in the professional careers of technical teams in comparison with the lives of actors and authors of projects who seem to be cut into their inner creativity. To escape the biographical pitfall, sociologists may account for a director’s itinerary by analyzing his/her ties with colleagues. Here, we examine the recurrent work relations between film director Dominique Cabrera and her close colleagues, to underline the strong relationships which paradoxically unite both the director and her staff in a project-based industry that is rather conducive to short-lived work relations. We postulate that the professional network produced consistently helps to describe and understand the course of a career, and that the relevant context to illuminate its contours is the network of professional relations that engenders film projects and is instrumental in fastening the career in the professional landscape of cinema.
ROUQUIé, Alain. à l’ombre des dictatures. La démocratie en Amérique Latine . París: Albin Michel, 2010. 377 pp. ISBN 978-2-226-18718-5.
América Latina Hoy , 2011,
Rese a de "à l'ombre des dictatures. La démocratie en Amérique Latine" de Alain ROUQUIé
América Latina Hoy , 2010,
Adeline Joffres
Nuevo mundo - Mundos Nuevos , 2007,
Abstract: Azul oscuro, casi negro, asi es el traje que esperaba llevar Jorge (Quim Guitiérrez) el primer día de su nuevo trabajo. Un trabajo a la imagen de sus estudios: prometedor y prestigioso. Pero el destino no lo entiende así, y Jorge, un joven madrile o, tendrá que luchar con amargura para librase del peso de una vida que nunca eligió y que le tiene encerrado; encerrado en su papel de pilar de la familia, encerrado en su barrio, encerrado con los mismos amigos de siempre que intentan compartir su...
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