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Search Results: 1 - 10 of 208324 matches for " Rapha?l Favory "
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Microcirculatory assessment in daily clinical practice – not yet ready but not too far!
Diamantino Ribeiro Salgado,Raphal Favory,Daniel De Backer
Einstein (S?o Paulo) , 2010,
Abstract: Shock is characterized by an alteration in tissue perfusion that may lead to tissue hypoxia. Recent guidelines recommend aggressive and early resuscitation therapy, but mortality rate is still unacceptably high. Unfortunately, traditional clinical surrogates used to guide resuscitation therapy poorly correlate with microcirculatory blood flow, a key determinant of tissue perfusion. New techniques that directly assess microcirculatory perfusion at the bedside have emerged as a complement to traditional macrohemodynamic parameters. These techniques have been supported by several studies showing microcirculatory alterations in different clinical settings. In addition, these microcirculatory alterations are related with outcome and persist regardless of arterial pressure normalization, being a better predictor of organ dysfunction and mortality than global hemodynamic and laboratory parameters. These findings allowed the concept of “microcirculatory-goal directed therapy”, which is now in its preliminary phase, as the impact of many interventions still needs to be assessed. Finally, microcirculation assessment has also been explored in other medical fields such as perioperative, systemic arterial hypertension, heart failure, and hyperviscosity syndromes. In this review, we shortly present the characteristics of microcirculation and the main determinants of capillary blood flow, and we discuss advantages and limitations of some recently available techniques to evaluate microcirculation at the bedside, and how they could be useful for the general clinician in daily practice.
Effects of changes in arterial pressure on organ perfusion during septic shock
Aurélie Thooft, Raphal Favory, Diamantino Salgado, Fabio S Taccone, Katia Donadello, Daniel De Backer, Jacques Creteur, Jean-Louis Vincent
Critical Care , 2011, DOI: 10.1186/cc10462
Abstract: This was a single center, prospective, interventional study conducted in the medico-surgical intensive care unit of a university hospital. Thirteen patients in septic shock for less than 48 hours who required NE administration were included. NE doses were adjusted to obtain MAPs of 65, 75, 85 and (back to) 65 mmHg. In addition to hemodynamic and metabolic variables, we measured thenar muscle oxygen saturation (StO2), using near infrared spectroscopy (NIRS), with serial vaso-occlusive tests (VOTs) on the upper arm. We also evaluated the sublingual microcirculation using sidestream dark field (SDF) imaging in 6 of the patients.Increasing NE dose was associated with an increase in cardiac output (from 6.1 to 6.7 l/min, P<0.05) and mixed venous oxygen saturation (SvO2, from 70.6 to 75.9%, P<0.05). Oxygen consumption (VO2) remained stable, but blood lactate levels decreased. There was a significant increase in the ascending slope of StO2 (from 111 to 177%/min, P<0.05) after VOTs. SDF imaging showed an increase in perfused vessel density (PVD, from 11.0 to 13.2 n/mm, P<0.05) and in microvascular flow index (MFI, from 2.4 to 2.9, P<0.05).In this series of patients with septic shock, increasing MAP above 65 mmHg with NE was associated with increased cardiac output, improved microvascular function, and decreased blood lactate concentrations. The microvascular response varied among patients suggesting that individualization of blood pressure targets may be warranted.Septic shock is characterized by an alteration in tissue perfusion associated with persistent arterial hypotension - generally defined as a systolic arterial pressure of less than 90 mm Hg [1] - despite adequate fluid resuscitation [2]. This leads to organ dysfunction and even death in around 50% of cases [3]. Evaluation of systemic hemodynamic variables can be inadequate to identify tissue perfusion, which is directly influenced by additional microvascular factors. De Backer and colleagues [4] showed that sepsis
Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study
Saad Nseir, Raphal Favory, Elsa Jozefowicz, Franck Decamps, Florent Dewavrin, Guillaume Brunin, Christophe Di Pompeo, Daniel Mathieu, Alain Durocher, the VAT Study Group
Critical Care , 2008, DOI: 10.1186/cc6890
Abstract: We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median [interquartile range], 12 [8 to 24] versus 2 [0 to 6] days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.ClinicalTrials.gov, number NCT00122057.Ventilator-associated tracheobronchitis (VAT) is common among mechanically ventilated critically ill patients [1-3]. Previous studies found VAT to be associated with increased duration of mechanical ventilation and intensive care unit (ICU) stay [1,4,5]. VAT is p
How to Pool Medical Services in Preventive Medicine Unit at 01/01/18 of Orléans Metropole/Orléans City Hall Structure: A Multi Disciplinary Network  [PDF]
Raphal Serreau
Journal of Biosciences and Medicines (JBM) , 2018, DOI: 10.4236/jbm.2018.61003
Abstract:
To reform the unit of preventive medicine in Orleans metropole, the Director of the Administration decided to co-sign an agreement to optimize the organization of a common preventive medicine service: we made a deliberation model to permit for others towns which wanted to join us. The cost evaluated to reach the service was the cost for medical examination, regardless of the professional which included staff costs and operating costs (social benefits, costs of supplies and materials, training costs). A statement of the tasks performed for the beneficiary community was kept daily by the SMP. A strong will of the Metropolis and municipalities is to develop a synergy around health and safety at work. A joint Metropolis of Orleans, an organization chart since 1/2/2016 integrates the preventive medicine service within a Quality of Life at Work service: a multi-disciplinary service composed of prevention specialists, social workers, responsible for social action and SMP, a Department of Preventive Medicine was developed and itself multidisciplinary in accordance with the law of July 20, 2011: including doctors, nurses, psychologists, sophrologist, and a dietician. A new and active network of health is now operant with specialist correspondents. An audit is programmed in April 2018 to assess the efficacy of this network.
La Gironde: le département et sa métropolisation
Michel Favory
Mappemonde , 1999,
Abstract: Un modèle spatial d'organisation des espaces girondins est proposé à partir des héritages croisés de l'attraction bordelaise et de l'action historique de l'état et des collectivités territoriales actuelles. Le département conna t une métropolisation rapide, qui s'inscrit et dans la continuité de l'aménagement territorial de la Gironde et dans la dynamique d'expansion de l'espace urbanisé, entre tendance atlantique et tendance terrienne des pays intérieurs. Ces différences pèsent sur l'action territoriale du département.
Représentations graphiques des territorialités sociales dans la ville
Michel FAVORY
Mappemonde , 1994,
Abstract: L’analyse de la territorialité sociale en milieu urbain peut être conduite dans la recherche de ses effets géographiques par des méthodes graphiques. Après traitement de l’information par matrices ordonnables, les images mentales et les pratiques sociales sont expliquées par des graphes spécifiques: idéogrammes et sociographes. Des modèles graphiques de la territorialité sont ensuite réalisés.
Le lecteur de fran ais : un acteur essentiel au c ur de la coopération linguistique, culturelle et universitaire
Raphal Bruchet
Synergies Espagne , 2012,
Abstract: Le lecteur de fran ais joue un r le clé au sein des universités étrangères dans le cadre de la promotion et de la diffusion de la langue et de la culture fran aises. C’est un acteur essentiel de la coopération linguistique, culturelle et universitaire, mais souvent au-dehors des cadres officiels. Il existe actuellement à travers le monde non pas un mais bel et bien des lecteurs, avec une impressionnante diversité de statuts, missions et modalités d’intervention. Cela représente à la fois une grande richesse mais aussi un risque de dispersion. Il faut, de plus, prendre conscience que les lecteurs sont des membres à part au sein des départements universitaires d’études fran aises. Afin de mieux profiter de cette singularité, il est indispensable que leurs missions ne se cantonnent pas uniquement aux activités d’enseignement. Il faut aussidéfinir clairement et officiellement la place et le r le des lecteurs dans la promotion et la diffusion du fran ais, et élargir leur champ d’action aux diverses activités de coopération linguistique, culturelle et universitaire, tout en leur en donnant les moyens nécessaires. La création d’un réseau , avec à la fois une coordination globale et une action locale, semble être un projet pertinent.
Amossy, Ruth. 2010. La présentation de soi. Ethos et identité verbale (Paris : PUF)
Raphal Micheli
Argumentation et Analyse du Discours , 2011,
Abstract: En l’espace d’une quinzaine d’années, l’usage de la notion d’ethos a connu un essor spectaculaire dans le champ de l’analyse du discours francophone, et cela aussi bien dans les travaux portant sur des corpus politiques ou médiatiques que dans ceux portant sur des corpus littéraires. Pour autant, on ne saurait dire que le maniement de cette notion soit aisé. En effet, l’ethos s’avère particulièrement difficile à théoriser de fa on rigoureuse : à partir de ses origines rhétoriques, on assiste ...
Method for Qualification and Selection of Open Source Software
Raphal Semeteys
Technology Innovation Management Review , 2008,
Abstract: For a company, the choice to opt for software as a component of its information system, whether this software is open source or commercial, rests on the analysis of needs and constraints and on the adequacy of the software to address these needs and constraints. However, when one plans to study the adequacy of open source software (OSS), it is necessary to have a method of qualification and selection adapted to the characteristics of this type of software and to precisely examine the constraints and risks specific to OSS. Since the open source field has a very broad scope, it is also necessary to use a qualification method that differentiates between numerous candidates to meet technical, functional and strategic requirements. This document describes the QSOS (Qualification and Selection of software Open Source) method, conceived by the technology services company Atos Origin SA to qualify, select and compare OSS in an objective, traceable and argued way. The method can be integrated within a more general process of technological watch which is not presented here. It describes a process to set up identity cards and evaluation sheets for OSS.
éloge du tiers toujours exclu : reconsidérer le monisme de l’esprit
Simard, Raphal
Phares : Revue Philosophique étudiante de l’Université Laval , 2009,
Abstract:
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