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Search Results: 1 - 10 of 26995 matches for " Jean-Fran?ois Timsit "
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Attributable cost of methicillin resistance: an issue that is difficult to evaluate
Jean-Franois Timsit
Critical Care , 2006, DOI: 10.1186/cc4994
Abstract: In the previous issue of Critical Care, Shorr and coworkers [1] provided new data on the morbidity and cost burden attributable to methicillin-resistant Staphylococcus aureus (MRSA)-associated early-onset pneumonia (EOP). Based on the data recorded by 42 US hospitals, those investigators found methicillin resistance to be associated with a significant 4- to 6-day excess in mechanical ventilation, and intensive care unit (ICU) and in-hospital days. It was associated with a nonsignificant increase of about US$8000 in total costs, after controlling for case mix and severity. The authors made particular effort to select monomicrobial pneumonias and to adjust the calculations based on underlying illness, and on the severity and duration of ICU stay before EOP. However, this estimated increase in costs should be regarded with caution because of a number of potential biases associated with this type of analysis.First, the observed incidence of EOP was very low. The overall risk for ventilator-associated pneumonia (VAP) is between 9.7% and 22.8% [2]. EOP represents at least one-third of cases. Consequently, the rate of EOP should be higher than 3.2% [3]. Because Shorr and coworkers found that only 499 episodes were recorded in 42 hospitals over 2 years, this suggests that the incidence was unusually low or that EOP was largely under-reported. This could have introduced bias because unrecognized episodes might be different (probably less severe) than reported ones. Any under-recognition of EOP might have resulted from the known lack of reproducibility of ICD-9 (International Classification of Diseases, ninth edition) [4]. Moreover, MRSA VAP has been reported to occur mainly late in the ICU stay [5-8]; MRSA represents fewer than 5% of micro-organisms encountered in EOP episodes [9]. The factors that impact on outcomes of EOP may be different from those in late-onset pneumonia [9,10]. For example, EOP is associated a shorter ICU stay, with significantly fewer days of mechanica
Open the intensive care unit doors to HIV-infected patients with sepsis
Jean-Franois Timsit
Critical Care , 2005, DOI: 10.1186/cc3923
Abstract: In recent years, several papers have noted important modifications in the epidemiology of sepsis and septic shock [1,2]. In the USA, the annual incidence of sepsis increased 8.7% [2], with sepsis more frequent among non-white people and men. Possible reasons for the real increase in the incidence of sepsis include the increased number of immunocompromised patients; HIV infected patients represent more than 10% of patients hospitalized in teaching hospitals with severe sepsis and 6% of patients hospitalized with septic shock [1].In industrialized countries, the introduction of highly active antiretroviral therapy (HAART) has significantly reduced the morbidity and mortality associated with HIV infection [3,4]. The combination of a stable rate of new HIV cases with the longer survival of HIV-infected patients has increased the prevalence of HIV/AIDS [5]. Although the rate of hospital admissions has decreased in the HIV-infected population, the proportion of hospitalized patients admitted to intensive care units (ICUs) did not change [6] or increased [7,8].Between 1990 and 1996 (the beginning of HAART therapy), in-ICU mortality [6-9] improved moderately or did not change, but the three-month [7] and long-term outcome [10] of HIV/AIDS patients admitted to the ICU improved dramatically. For example, in the Claude-Bernard Bichat experience, in-ICU mortality was 20.6% in 1990 to 1992, 27% in 1995 to 1996 and 25% in 1998 to 2000 [7,9]. In contrast, six-month mortality was 49% in 1990 to 1992, 38% in 1995 to 1996 and 30% in 1998 to 2000 [9,10]. Similar results were found in Switzerland [11] and the USA [6].The unmodified ICU prognosis is obviously not related to the absence of improvements in ICU care, but is largely due to modifications in the case-mix and attitudes toward the use of ICU care [12]. Compared to the pre-HAART period, two distinct categories of HIV/AIDS patients are now admitted. The most common of these is a particular subgroup of patients with problems in HI
What is the best site for central venous catheter insertion in critically ill patients?
Jean-Franois Timsit
Critical Care , 2003, DOI: 10.1186/cc2179
Abstract: Central venous catheter (CVC) insertion is required in many critically ill patients. Selection of the insertion site should be based both on the ease of placement and on the risks associated with the procedure. The latter include infection, thrombosis and mechanical complications. Two recently published papers [1,2] have provided valuable new information on this issue.There is a dearth of sound data comparing various CVC insertion sites. No well conducted randomized studies have compared complications related to the subclavian and internal jugular approaches. Among prospective cohort studies, most are biased by a preference given to one approach over the other as a result of habits in the intensive care unit (ICU) or experience of the operator. This selection bias may result in overestimation of the benefits of the more commonly used approach.In a recent meta-analysis, Ruesch and coworkers [1] compared complication rates with the subclavian and jugular approaches. To minimize selection bias, they excluded trials with a greater than twofold difference between group sizes. Of 85 studies published before 30 June 2000, only 17 were included in the meta-analysis. The meta-analysis population included ICU and non-ICU patients, and no distinction was made between catheters inserted for dialysis, pulmonary artery catheters and other catheters. Finally, CVC-related complications might have been under-reported in those studies in which they were a secondary end-point.Catheter malposition can have serious consequences. Positioning of the catheter tip in the cardiac silhouette is associated with an increased risk for cardiac tamponade, and positioning in the subclavian vein with a high risk for thrombus formation in cancer patients. Placement of a subclavian catheter tip in the opposite subclavian vein or neck veins may have more severe consequences than placement of a jugular catheter in the right atrium, which can be corrected simply by pulling the catheter back. However, mal
Como realizar ensaios clínicos em terapia intensiva utilizando base de dados de alta qualidade
Francais, Adrien;Vesin, Aurélien;Timsit, Jean-Franois;
Revista Brasileira de Terapia Intensiva , 2008, DOI: 10.1590/S0103-507X2008000300013
Abstract: the sources of intensive care-related information and the means of communication increase rapidly. we presented here an overview of what should be done to collect high quality database. in a second part, the principle of the choice of the research question, the outcome, the explanatory variables and the statistical methods to address the question are overviewed, emphasizing major and frequent pitfalls which should be avoided.
An Ethnomethodological Perspective on the Conflict between Magistrates and Journalists in Cameroon  [PDF]
Jean-Franois Nguegan, Thomas Essono
Advances in Journalism and Communication (AJC) , 2015, DOI: 10.4236/ajc.2015.34013
Abstract: The report of the magistrate profession to that of a journalist in Cameroon can be studied from the perspective both of the sociology of professions and sociology of the conflict; the actors, who belong to different territories, are usually against the quality, legitimacy and competence required to deal with media information, and judicial control, individual freedom. This relationship is mainly studied in this research in terms of symbolic interactionism, to emphasize first of all on the importance that judges and journalists themselves give to their profession and secondly on the rationality of their game in the construction and the demarcation of their respective territories. This article is a contribution to the study of the discourse of these two groups of professionals who compete with each other.
New materials and devices for preventing catheter-related infections
Jean-Franois Timsit, Yohann Dubois, Clémence Minet, Agnès Bonadona, Maxime Lugosi, Claire Ara-Somohano, Rebecca Hamidfar-Roy, Carole Schwebel
Annals of Intensive Care , 2011, DOI: 10.1186/2110-5820-1-34
Abstract: Central venous catheters (CVCs) are inserted in approximately half of all patients in the intensive care unit (ICU). In Europe, the incidence density of catheter-related bloodstream infections (CR-BSI) ranges from 1 to 3.1 per 1,000 patient-days [1]. CR-BSIs were associated with an attributable mortality of 0% to 11.5% [2] and an additional stay length of 9-12 days [3,4].In contrast to other nosocomial infections, CR-BSI has many device-related risk factors. Consequently, prevention should be possible, provided that rigorous policies are implemented. Specific education and training of healthcare workers in CR-BSI prevention and continuous implementation of unit-based quality-improvement programs are essential. We discuss the potential usefulness of new technical developments and put these into perspective according to available recommendations.Colonization of the catheter occurs via two main pathways: the extraluminal route and the intraluminal route. Colonization of short-term CVCs (< 15-20 days) occurs predominantly from the skin puncture site, whereas colonization of long-term CVCs is usually related to intraluminal bacterial spread from a contaminated hub [5]. In both cases, the source of the micro-organisms is the patient's own commensal skin flora. Accordingly, S. epidermidis is responsible for 40-50% of episodes, followed by S. aureus (10-20%). Gram-negative bloodstream infection, especially Pseudomonas aeruginosa, Stenotrophomonas sp., and Acinetobacter baumannii, are recovered in one-third of cases. Candida sp. are recovered in 3-10% of cases.Biofilm formation on the inner and outer surfaces of the catheter contributes to the development of CR-BSI. A biofilm is a complex structure formed by bacteria that have attached to an artificial surface or dead tissue. Bacterial attachment to the catheter surface begins within 24 hours after catheter insertion. The bacteria proliferate and secrete a polysaccharide matrix, which provides a medium for the attachment of
Case report: Greater meningeal inflammation in lumbar than in ventricular region in human bacterial meningitis
Walid Naija, Joaquim Matéo, Laurent Raskine, Jean-Franois Timsit, Anne-Claire Lukascewicz, Bernard George, Didier Payen, Alexandre Mebazaa
Critical Care , 2004, DOI: 10.1186/cc2972
Abstract: Bacterial meningitis and ventriculitis remain the most frequent complication in neurosurgery. Diagnosis is based almost exclusively on biochemical and bacteriological analysis of cerebrospinal fluid (CSF) withdrawn either by puncture in the lumbar space or through an external drain located either in the lumbar or ventricular space. It is established that CSF infection is strongly suspected in the presence of a positive CSF culture and/or of a CSF : serum glucose ratio of less than 0.6 and/or of a CSF leukocyte count of more than 11/mm3 in the lumbar space [1].Differences in the composition of ventricular and lumbar CSF, based on single pairs of CSF samples, were previously described [2-4]. These studies showed a rostrocaudal gradient of leukocytes and protein and an inverse gradient of glucose in the first CSF withdrawn in patients with a confirmed diagnosis of meningitis. However, the time course of a ventricular-to-lumbar gradient of leukocytes, glucose and protein, during the occurrence and the relief of meningitis, remains unknown.Here we describe a patient who developed, after surgery for a chordoma of the clivus, three episodes of recurrent meningitis due to Pseudomonas aeruginosa O12. The last two episodes were monitored by daily biochemical and bacteriological analysis of CSF withdrawn in parallel from the lumbar space and ventricles by external lumbar drainage (ELD) and external ventricular drainage (EVD).A 20-year-old Caucasian man with no medical history was admitted for elective surgery of a chordoma that extended from the sphenoidal sinus to the anterior face of C2. The first surgical step consisted of a subtotal removal of the tumour by a transfrontal approach. An EVD was inserted at day 1 (D1) because of the appearance of hydrocephalia.At D10, the second approach consisted in a transoral resection of the tumour with a reconstruction of the pharyngeal wall with skin taken from the arm. However, the wall was not totally occlusive, with a continuous CSF
Adipocytes modulate vascular smooth muscle cells migration potential through their secretions  [PDF]
Souhad El Akoum, Isabelle Cloutier, Jean-Franois Tanguay
Journal of Diabetes Mellitus (JDM) , 2013, DOI: 10.4236/jdm.2013.34035
Abstract:

Impairment of vascular smooth muscle cells (VSMC) is recognized as a predisposition factor for atherosclerosis development. We hypothesize that the metabolic syndrome has a direct impact on VSMC migration and phenotypic switching, which may increase the incidence of atherosclerotic events. Aortic VSMC were extracted from 10 weeks old C57BL6 mice and incubated for 24 hr in adipocytes conditioned cell culture medium. Adipocytes were extracted from diabetic C57BL6 male mice fed with either a vegetal or an animal High-Fat-Diet (HFD) for 20 weeks. Migration of VSMC in response to conditioned media stimulations was significantly modulated compared to control. The most extended effects on VSMC were triggered by adipocytes from mice fed with animal HFD. These effects were concurrent with increased leptin concentrations and decreased adiponectin levels in conditioned media. A significant up-regulation of CD36 mRNA level was found in VSMC treated with adipocytes from HFD-fed mice. In conclusion, we have shown that the development of adipocyte-induced VSMC alterations is linked to diet fatty acid composition and the degree of metabolic alterations. The modulation of adipokine secretions in the adipose tissue that is linked to metabolic alterations may alter the physiology of VSMC and thus accelerate the development of metabolic-related vascular diseases.

Universality in Statistical Measures of Trajectories in Classical Billiard Systems  [PDF]
Jean-Franois Laprise, Ahmad Hosseinizadeh, Helmut Kr?ger
Applied Mathematics (AM) , 2015, DOI: 10.4236/am.2015.68132
Abstract: For classical billiards, we suggest that a matrix of action or length of trajectories in conjunction with statistical measures, level spacing distribution and spectral rigidity, can be used to distinguish chaotic from integrable systems. As examples of 2D chaotic billiards, we considered the Bunimovich stadium billiard and the Sinai billiard. In the level spacing distribution and spectral rigidity, we found GOE behaviour consistent with predictions from random matrix theory. We studied transport properties and computed a diffusion coefficient. For the Sinai billiard, we found normal diffusion, while the stadium billiard showed anomalous diffusion behaviour. As example of a 2D integrable billiard, we considered the rectangular billiard. We found very rigid behaviour with strongly correlated spectra similar to a Dirac comb. These findings present numerical evidence for universality in level spacing fluctuations to hold in classically integrable systems and in classically fully chaotic systems.
Oxytocin and Collective Bargaining: Propositions for a New Research Protocol  [PDF]
Jean-Franois Tremblay, Sébastien Rivard, Eric Gosselin
American Journal of Industrial and Business Management (AJIBM) , 2017, DOI: 10.4236/ajibm.2017.77063
Abstract: This paper contributes to collective bargaining research by providing a causal theoretical biological link path between negotiation behaviors and their substantive and relational results. Specifically, the role of oxytocin is described in light of the scientific knowledge that comes from organizational neurosciences, neuroeconomics and, psychology fields. The properties of the hormone, its place in neuroeconomics research and, their links with the psychology of the collective bargaining processes are discussed to determine guidelines for a new experimental protocol meant to study decision-making processes during collective bargaining. In addition, the conceptual model of strategic negotiations serves as a theoretical framework to consolidate the propositions that can be deduced from the results of the interaction processes in collective bargaining according to two dimensions of the outcome of the negotiations. Finally, the parameters of a new experimental protocol derived from the trust game are presented for the first time. This new game presents a more ecological perspective and is developed to offer a better fit with the specific domain of collective bargaining.
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