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Search Results: 1 - 10 of 219331 matches for " Cédric Bruel "
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Antithrombin supplementation for anticoagulation during continuous hemofiltration in critically ill patients with septic shock: a case-control study
Damien du Cheyron, Bruno Bouchet, Cédric Bruel, Cédric Daubin, Michel Ramakers, Pierre Charbonneau
Critical Care , 2006, DOI: 10.1186/cc4853
Abstract: We conducted a retrospective case-control analysis based on a 4-year observational study with prospectively collected data in two medical intensive care units in a university hospital. In all, 106 patients with septic shock underwent CRRT during the study period (55 during 2001 to 2002 and 51 during 2003 to 2004). Of these, 78 had acquired AT deficiency (plasma level below 70%) at onset of renal supportive therapy, 40 in the first 2-year period and 38 in the last 2-year period. In the latter intervention period, patients received AT supplementation (50 IU/kg) during CRRT each time that plasma AT activity, measured once daily, fell below 70%.In a case-control analysis of the 78 patients with acquired AT deficiency, groups were similar for baseline characteristics, except in severity of illness as assessed by a higher Simplified Acute Physiology Score (SAPS) II after 2002. In comparison with controls, cases had a significantly greater AT level after AT supplementation, but not at baseline, and a smaller number of episodes of clots, without excess bleeding risk. The median hemofilter survival time was longer in the AT group than in the heparin group (44.5 versus 33.4 hours; p = 0.0045). The hemofiltration dose, assessed by the ratio of delivered to prescribed ultrafiltration, increased during intervention. AT supplementation was independently associated with a decrease in clotting rate, whereas femoral angioaccess and higher SAPS II were independent predictors of filter failure. However, mortality did not differ between periods, in the control period the observed mortality was significantly higher than predicted by the SAPS II score, unlike in the treatment period.In sepsis patients requiring CRRT and with acquired AT deficiency, anticoagulation with unfractionated heparin plus AT supplementation prevent premature filter clotting and may contribute to improving outcome, but the cost-effectiveness of AT remains to be determined.The incidence of septic shock has increase
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
Mild hypothermia during advanced life support: a preliminary study in out-of-hospital cardiac arrest
Cédric Bruel, Jean-Jacques Parienti, William Marie, Xavier Arrot, Cédric Daubin, Damien Du Cheyron, Massimo Massetti, Pierre Charbonneau
Critical Care , 2008, DOI: 10.1186/cc6809
Abstract: This was a prospective, observational, multicenter clinical trial conducted in Emergency Medical Services units and in a medical intensive care unit at Caen University Hospital, Cen, France.In patients who had suffered out of hospital cardiac arrest, hypothermia was induced by infusing 2 l of 4°C NaCl 0.9% over 30 minutes during advanced life support prior to arrival at the hospital. A total of 33 patients were included in the study. Eight patients presented with ventricular fibrillation as the initial cardiac rhythm. Mild hypothermia was achieved after a median of 16 minutes (interquartile range 11.5 to 25.0 minutes) after return of spontaneous circulation. After intravenous cooling, the temperature decreased by 2.1°C (P < 0.0001) to a mean body temperature of 33.3°C (interquartile range 32.3 to 34.3°C). The only observed adverse event was pulmonary oedema, which occurred in one patient.We concluded that prehospital induction of therapeutic hypothermia using infusion of 2 l of 4°C normal saline during advanced life support was feasible, effective and safe. Larger studies are required to assess the impact that this early cooling has on neurological outcomes after cardiac arrest.Out of hospital cardiac arrest (OHCA) is common and associated with a poor outcome, despite improvements in cardiopulmonary resuscitation (CPR) [1,2]. Two major complications may occur after resuscitation from cardiac arrest. The first is postresuscitation disease, which occurs between 4 and 24 hours after resuscitation and is characterized by an ischaemia/reperfusion syndrome and a systemic inflammatory response syndrome [3]. The second complication is severe anoxic brain injury, which kills two-thirds of survivors [3,4].In a hospital setting, mild hypothermia induced 4 to 8 hours after OHCA improves the outcomes of comatose survivors in whom ventricular fibrillation (VF) is the initial rhythm [5,6], and this strategy is currently recommended by the International Liaison Committee On Resusci
Quality of life in patients aged 80 or over after ICU discharge
Alexis Tabah, Francois Philippart, Jean Timsit, Vincent Willems, Adrien Fran?ais, Alain Leplège, Jean Carlet, Cédric Bruel, Benoit Misset, Maité Garrouste-Orgeas
Critical Care , 2010, DOI: 10.1186/cc8231
Abstract: We performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and one-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and one year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed one year after ICU discharge.Of the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 ± 3 years (range, 80 to 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) one year after ICU discharge. In the 23 patients evaluated after one year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after one year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love).Among patients aged 80 or over who were selected at ICU admission, 80% were self-sufficient for activities of daily living one year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.The human lifespan is increasing across the world as a result of economic progress, technol
A Deep Unity between Scientific Disciplines  [PDF]
Cédric Gaucherel
Open Journal of Philosophy (OJPP) , 2013, DOI: 10.4236/ojpp.2013.33061
Abstract:

Are scientific disciplines really different? This question often crystallizes into the old debate: Are Physics and Biology different? If Physics and Biology worked on highly different entities (objects), or if they had highly different methods, it would be straightforward to close the debate by a negative answer. However, if we cannot identify any differences, we should explore more deeply the status of the laws found in Physics and questioned in Biology. By slightly modifying the definition of what is a law, I argue here that both disciplines possess some laws exhibiting various “degrees of confirmation”. I finally propose explanations for why P and B give the illusion differing radically, although they both belong to the same continuum of a unified scientific domain.

New Materials for Vacuum Chambers in High Energy Physics  [PDF]
Cédric Garion
World Journal of Mechanics (WJM) , 2014, DOI: 10.4236/wjm.2014.43008
Abstract:

Vacuum chambers must fulfil ultra-high vacuum requirements while withstanding thermo-mechanical loads. This is particularly true in high energy particle accelerator where interactions of particles with matter may induce thermal load, material activation, background… The choice of the material of the vacuum chamber is crucial for the final application. Metals such as stainless steel, copper and aluminium are usually used. Even with outstanding mechanical and physical properties, beryllium is used for very specific applications because of its cost and toxicity.Ceramics such as alumina are usually used for fast magnet vacuum chambers. With the next generation of high energy physics accelerator generation such as CLIC and TLEP, the problematic of high cyclic thermal load induced by synchrotron radiation is raised. This paper aims at defining some figures of merit of different materials with respect to several load scenarios and presents briefly their vacuum compatibility.

Mechanical Properties for Reliability Analysis of Structures in Glassy Carbon  [PDF]
Cédric Garion
World Journal of Mechanics (WJM) , 2014, DOI: 10.4236/wjm.2014.43009
Abstract:

Despite its good physical properties, the glassy carbon material is not widely used, especially for structural applications. Nevertheless, its transparency to particles and temperature resistance are interesting properties for the applications to vacuum chambers and components in high energy physics. For example, it has been proposed for fast shutter valve in particle accelerator [1] [2]. The mechanical properties have to be carefully determined to assess the reliability of structures in such a material. In this paper, mechanical tests have been carried out to determine the elastic parameters, the strength and toughness on commercial grades. A statistical approach, based on the Weibull’s distribution, is used to characterize the material both in tension and compression. The results are compared to the literature and the difference of properties for these two loading cases is shown. Based on a Finite Element analysis, a statistical approach is applied to define the reliability of a structural component in glassy carbon. In this paper, the determination of the mechanical properties of glassy carbon allows the analysis of reliability of structures in glassy carbon.

Phenomenologic analysis of healthcare worker perceptions of intensive care unit diaries
Antoine Perier, Anne Revah-Levy, Cédric Bruel, Nathalie Cousin, Stéphanie Angeli, Sandie Brochon, Fran?ois Philippart, Adeline Max, Charles Gregoire, Benoit Misset, Maité Garrouste-Orgeas
Critical Care , 2013, DOI: 10.1186/cc11938
Abstract: We used a phenomenologic approach to conduct a qualitative study of 36 semistructured interviews in a medical-surgical ICU in a 460-bed tertiary hospital.Two domains of perception were assessed: reading and writing in the diaries. These two domains led to four main themes in the ICU workers' perceptions: suffering of the families; using the diary as a source of information for families but also as generating difficulties in writing bad news; determining the optimal interpersonal distance with the patient and relatives; and using the diary as a tool for constructing a narrative of the patient's ICU stay.The ICU workers thought that the diary was beneficial in communicating the suffering of families while providing comfort and helping to build the patient's ICU narrative. They reported strong emotions related to the diaries and a perception of intruding into the patients' and families' privacy when reading the diaries. Fear of strong emotional investment may adversely affect the ability of ICU workers to perform their duties optimally. ICU workers are in favor of ICU diaries, but activation by the diaries of emotions among younger ICU workers may require specific support.Patient diaries were first used in Denmark, Sweden, and Norway, and then introduced several decades later in other European countries, such as the UK, Switzerland, and, finally, France [1]. Diary entries were found to fall into four main categories: sharing the story, sharing the presence, sharing feelings, and sharing through support [2]. The multiple roles of diaries kept for ICU patients include reconstruction of the illness narrative [3], communication of caring intent [4], debriefing to deal with posttraumatic stress syndrome (PTSD) [5], and the promotion of family healing [3]. ICU diaries have been reported to help in the transition of patients from critical illness to normalcy [2,5-8].We previously evaluated the effect of an ICU diary on the well-being of patients and families and found that th
A Single Center Retrospective Analysis of Kraske’s Transsacral Approach: A Review  [PDF]
Cédric Bouts, Kurt Van der Speeten
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.510070
Abstract: Aim: Presacral lesions are uncommon and represent a diagnostic and surgical challenge. The aim of this study is to present our experience with Kraske’s transsacral resection and to review current literature. Methods: Seven patients who had a transsacral resection between 2001 and 2013 were reviewed retrospectively. Results: Two men and five women with a mean age of 39 (range 17 - 60) years were diagnosed with a presacral lesion. The clinical presentation was nonspecific; pain was the most common symptom. All lesions were palpable on digital rectal examination. Magnetic resonance imaging (MRI) was necessary to assess the tumor’s extent, biological behavior and relationship to adjacent structures. MRI predicted malignancy with 100% accuracy. All lesions were located below S3 and underwent a transsacral resection. Pathological examination revealed four tailgut cysts, two epidermoid cysts and one chordoma. Postoperative complications included wound infections (two cases) and spasms of the gluteus muscle (one case). We reported no recurrence or mortality. Conclusion: Clinical awareness, the use of MRI in the routine work-up and avoidance of an incisional biopsy result in a good outcome after surgical resection of presacral lesions. Kraske’s approach can be used for presacral lesions below S3, resulting in low morbidity, no recurrence and no mortality.
Collision dynamics of two $^{238}$U atomic nuclei
Cédric Golabek,Cédric Simenel
Physics , 2009, DOI: 10.1103/PhysRevLett.103.042701
Abstract: Collisions of actinide nuclei form, during very short times of few $10^{-21}$ s, the heaviest ensembles of interacting nucleons available on Earth. Such very heavy ions collisions have been proposed as an alternative way to produce heavy and superheavy elements. These collisions are also used to produce super-strong electric fields by the huge number of interacting protons to test spontaneous positron-electron ($e^+e^-$) pair emission predicted by the quantum electrodynamics theory. The time-dependent Hartree-Fock theory which is a fully microscopic quantum approach is used to study collision dynamics of two $^{238}$U atomic nuclei. In particular, the role of nuclear deformation on collision time and on reaction mechanisms such as nucleon transfer is emphasized. These calculations are pessimistic in terms of transfermium elements ($Z>100$) production. However, the highest collision times ($\sim4\times10^{-21}$ s at 1200 MeV) should allow experimental signature of spontaneous $e^+e^-$ emission. Surprisingly, we also observe ternary fission due to purely dynamical effects.
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