Facteurs de risque de mort encéphalique des patients hospitalisés en réanimation pour accident vasculaire cérébral

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Analyse de la tâche pour la conception d’un simulateur virtuel pour l’anesthésie locorégionale échoguidée

International audiencePour donner suite aux directives de la Haute Autorité de Santé, la simulation fait partie intégrante des nouvelles techniques d’enseignements en médecine. Cependant, dans certaines spécialités comme l’anesthésiologie, les outils de simulations à disposition ne répondent pas encore aux attentes des praticiens. Afin de remédier à ces problématiques, de nouveaux outils utilisant les nouvelles technologies pourraient être une solution. Néanmoins, leur conception nécessite une attention particulière afin que celle-ci satisfasse les besoins des praticiens. Dans l’intention de concevoir un simulateur en réalité virtuelle dédié à l’apprentissage de la procédure de l’anesthésie locorégionale échoguidée, nous avons adopté une approche centrée-utilisateur. La première étape consistait donc à réaliser une analyse des tâches effectuées par les opérateurs et des compétences pour leur réalisation. Cet article a pour but de proposer un modèle de tâches basé sur le formalisme MAD. Une association entre les tâches recensées et les compétences est également présentée

Validation de l’aspect et du contenu d’un simulateur immersif pour la formation des opérateurs en anesthésie locorégionale échoguidée

International audienceVirtual reality is a promising technology for training healthcare professionals in a safe simulation environment. In this work, we present the design and evaluation of an immersive simulator for training ultrasound-guided locoregional anesthesia operators. Eighteen anesthesiologists participated in a face and content validation study of the first prototype of the system. Responses to seven of the eleven questions on face validity were predominantly positive. The main raised issue concerns the fidelity of the needle haptic feedback, suggesting the use of a six degrees of freedom haptic feedback arm in the future prototypes. Responses to all six questions on content validity were predominantly positive. Participants find that the simulator is a promising training tool particularly suited for developing hand-eye coordination skills. These results support our design choices and suggest improvements for our simulator before its validation as a training tool.La réalité virtuelle est une technologie prometteuse pour former les professionnels de santé dans un environnement de simulation sécurisé. Dans ce travail, nous présentons la conception et l'évaluation d'un simulateur immersif pour la formation de l’anesthésie locorégionale échoguidée. Dix-huit anesthésistes ont participé à la validation de l’aspect et du contenu du premier prototype du système. Les réponses à sept des onze questions sur la validité de l’aspect étaient positives. La problématique soulevée concerne la fidélité du rendu haptique de l'aiguille, suggérant l'utilisation d'un bras haptique à six degrés de liberté dans les futurs prototypes. Les réponses aux six questions sur la validité du contenu étaient positives. Les participants trouvent que le simulateur est un outil de formation prometteur particulièrement adapté pour développer les compétences de coordination œil-main. Ces résultats confortent nos choix de conception et suggèrent des améliorations pour notre simulateur avant sa validation comme outil de formation

Validation de l’aspect et du contenu d’un simulateur immersif pour la formation des opérateurs en anesthésie locorégionale échoguidée

International audienceVirtual reality is a promising technology for training healthcare professionals in a safe simulation environment. In this work, we present the design and evaluation of an immersive simulator for training ultrasound-guided locoregional anesthesia operators. Eighteen anesthesiologists participated in a face and content validation study of the first prototype of the system. Responses to seven of the eleven questions on face validity were predominantly positive. The main raised issue concerns the fidelity of the needle haptic feedback, suggesting the use of a six degrees of freedom haptic feedback arm in the future prototypes. Responses to all six questions on content validity were predominantly positive. Participants find that the simulator is a promising training tool particularly suited for developing hand-eye coordination skills. These results support our design choices and suggest improvements for our simulator before its validation as a training tool.La réalité virtuelle est une technologie prometteuse pour former les professionnels de santé dans un environnement de simulation sécurisé. Dans ce travail, nous présentons la conception et l'évaluation d'un simulateur immersif pour la formation de l’anesthésie locorégionale échoguidée. Dix-huit anesthésistes ont participé à la validation de l’aspect et du contenu du premier prototype du système. Les réponses à sept des onze questions sur la validité de l’aspect étaient positives. La problématique soulevée concerne la fidélité du rendu haptique de l'aiguille, suggérant l'utilisation d'un bras haptique à six degrés de liberté dans les futurs prototypes. Les réponses aux six questions sur la validité du contenu étaient positives. Les participants trouvent que le simulateur est un outil de formation prometteur particulièrement adapté pour développer les compétences de coordination œil-main. Ces résultats confortent nos choix de conception et suggèrent des améliorations pour notre simulateur avant sa validation comme outil de formation

Design and evaluation of UltRASim: An immersive simulator for learning ultrasound-guided regional anesthesia basic skills

International audienceVirtual reality shows great promise as a technology for training healthcare professionals within a secure simulated environment. This work presents the design, development, and assessment of UltRASim: an immersive simulator for ultrasound-guided regional anesthesia. First, task and skills analyses were performed with domain experts to build the task model of the procedure and determine the simulator’s learning objectives and design constraints. Then, a face and content validity study was conducted with eighteen anesthesiologists to assess the simulator’s prototype. The responses to seven of eleven face validity questions were predominantly positive, indicating a favorable reception. The primary concerns pertained to the fidelity of haptic feedback during needle insertion. This suggests incorporating a higher fidelity haptic device in future design iterations. Conversely, responses to all six questions related to the content validity were predominantly positive. Participants found that the simulator held significant potential as a training tool, particularly for developing hand–eye coordination skills. These findings validate several design choices and highlight areas for improvement in subsequent iterations of UltRASim before its formal validation as a training tool

Persistent headaches one year after bacterial meningitis: prevalence, determinants and impact on quality of life

International audienceBackground: Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life.Methods: In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed.Results: Among the 277 alive patients at M12 87/274 (31.8%), 213/271 (78.6%) and 86/277 (31.0%) reported headaches before, at the onset, and at M12, respectively. In multivariate analysis, female sex (OR: 2.75 [1.54-4.90]; p < 0.001), pre-existing headaches before meningitis (OR: 2.38 [1.32-4.30]; p < 0.01), higher neutrophilic polynuclei percentage in the CSF of the initial lumbar puncture (OR: 1.02 [1.00-1.04]; p < 0.05), and brain abscess during the initial hospitalisation (OR: 8.32 [1.97-35.16]; p < 0.01) were associated with M12 persistent headaches. Neither the responsible microorganism, nor the corticoids use were associated with M12 persistent headaches. M12 neuro-functional disability (altered Glasgow Outcome Scale; p < 0.01), M12 physical handicap (altered modified Rankin score; p < 0.001), M12 depressive symptoms (p < 0.0001), and M12 altered physical (p < 0.05) and mental (p < 0.0001) qualities of life were associated with M12 headaches.Conclusion: Persistent headaches are frequent one year after meningitis and are associated with quality of life alteration

One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study

Trial registration: ClinicalTrial.Gov identification number NCT01730690.International audienceIntroduction: COMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year.Methods: Patients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis.Results: Five of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients' disability scores from hospital discharge to 12 months (p = 0.16), but about 10% of the patients had residual disability.Conclusions: Although most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination

Relationship between serotypes, disease characteristics and 30-day mortality in adults with invasive pneumococcal disease

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