Du processus aux soins intégrés: Expérience de gestion de projet bottom-up

Le service de chirurgie cardiaque du CHU de Liège a soutenu des recherches visant à développer un programme d’épargne sanguine, enjeu actuel de taille dans ce secteur des soins de santé. Ce projet a évolué vers la création d’un itinéraire clinique chirurgical cardiaque et d’un modèle institutionnel pour le développement d’autres itinéraires cliniques. Une évolution qui permet de déterminer les missions spécifiques de l’institution et ses objectifs stratégiques, et de s’associer aux projets nationaux. L’adhésion multidisciplinaire, soutenue par un leadership médical et infirmier, ainsi que la reconnaissance institutionnelle sont les déterminants de la pérennité de cette démarche bottom-up

Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants

Background. Glucosamine (GlcN) used by patients with osteoarthritis was demonstrated to reduce pain, but the working mechanism is still not clear. Viscosupplementation with hyaluronic acid (HA) is also described to reduce pain in osteoarthritis. The synthesis of HA requires GlcN as one of its main building blocks. We therefore hypothesized that addition of GlcN might increase HA production by synovium tissue. Methods. Human osteoarthritic synovium explants were obtained at total knee surgery and pre-cultured for 1 day. The experimental conditions consisted of a 2 days continuation of the culture with addition of N-Acetyl-glucosamine (GlcN-Ac; 5 mM), glucosamine-hydrochloride (GlcN-HCl; 0.5 and 5 mM), glucose (Gluc; 0.5 and 5 mM). Hereafter HA production was measured in culture medium supernatant using an enzyme-linked binding protein assay. Real time RT-PCR was performed for hyaluronic acid synthase (HAS) 1, 2 and 3 on RNA isolated from the explants. Results. 0.5 mM

Human chondrocytes in tridimensional culture.

peer reviewedCartilage was taken from the macroscopically normal part of human femoral heads immediately after orthopedic surgical operations for total prothesis consecutive to hip arthrosis. After clostridial collagenase digestion and repeated washings, chondrocytes (10(6) cells) were cultivated in a gyrotory shaker (100 rpm). Under these conditions, cells were kept in suspension and after 3 to 5 d formed a flaky aggregate which, on Day 10, became dense. These chondrocytes were morphologically differentiated: they had a round shape, were situated inside cavities, and were surrounded by a new matrix. Histochemical methods showed the presence of collagen and polysaccharides in cell cytoplasm and in intercellular matrix, and the immunofluorescence method using specific antisera (anticartilage proteoglycans and anti-type II collagen) showed that these two constituents were in intercellular matrix. The measurement of the amounts of proteoglycans (PG) released into culture medium and those present in chondrocyte aggregate (by a specific PG radioimmunoassay) showed a maximum production on Days 3 to 5 of culture, then the production decreased and stabilized (from Day 10 to the end of culture). The observed difference between the amounts of PG in aggregates after 20 d and those after 2 h of culture demonstrated that PG neosynthesis did occur during cultivation. This conclusion was supported by other results obtained by [14C]glucosamine incorporation in chondrocyte aggregates. Moreover, the aggregate fresh weight related to cell number (appreciated by DNA assay) increased significantly with culture duration. Three-dimensional chondrocyte culture represents an interesting model: chondrocytes were differentiated morphologically as well as biosynthetically and synthesized a new cartilage matrix

Ultraviolet Irradiation Induces the Accumulation of Chondroitin Sulfate, but Not Other Glycosaminoglycans, in Human Skin

Ultraviolet (UV) light alters cutaneous structure and function. Prior work has shown loss of dermal hyaluronan after UV-irradiation of human skin, yet UV exposure increases total glycosaminoglycan (GAG) content in mouse models. To more fully describe UV-induced alterations to cutaneous GAG content, we subjected human volunteers to intermediate-term (5 doses/week for 4 weeks) or single-dose UV exposure. Total dermal uronyl-containing GAGs increased substantially with each of these regimens. We found that UV exposure substantially increased dermal content of chondroitin sulfate (CS), but not hyaluronan, heparan sulfate, or dermatan sulfate. UV induced the accumulation of both the 4-sulfated (C4S) and 6-sulfated (C6S) isoforms of CS, but in distinct distributions. Next, we examined several CS proteoglycan core proteins and found a significant accumulation of dermal and endothelial serglycin, but not of decorin or versican, after UV exposure. To examine regulation in vitro, we found that UVB in combination with IL-1α, a cytokine upregulated by UV radiation, induced serglycin mRNA in cultured dermal fibroblasts, but did not induce the chondroitin sulfate synthases. Overall, our data indicate that intermediate-term and single-dose UVB exposure induces specific GAGs and proteoglycan core proteins in human skin in vivo. These molecules have important biologic functions and contribute to the cutaneous response to UV

L'empowerment des patients.

peer reviewe

Les événements indésirables dans les soins de santé hospitaliers: une situation complexe améliorable par un support électronique?

Développer un système de gestion de la sécurité et augmenter la culture de sécurité en milieu hospitalier sont des objectifs essentiels dans des systèmes complexes et dynamiques. Après avoir passé en revue les mécanismes et la prévention des événements indésirables, nous proposons une réflexion sur une approche complémentaire pour le choix d’un outil capable de s’intégrer dans le quotidien des soins. Dans un esprit Safety-II, l’effort se porte vers une élévation des connaissances mais aussi des compétences pour que les tâches et donc les processus soient exécutés avec facilité et sans erreur

L'empowerment des patients: pourquoi et comment.

La participation du patient à ses soins et surtout son implication dans son projet de vie, depuis la loi des droits du patient, ont accéléré la réflexion sur son encadrement, principalement dans les maladies chroniques, pour faciliter sa sortie d’hospitalisation et son autonomisation. Nous en passons en revue les éléments principaux et nous suggérons quelques pistes simples