En quoi l'universitarisation de la formation infirmière modifie-t-elle la transmission ?

Atelier 21 : Formation aux métiers du soinL'universitarisation de la formation infirmière est débutée depuis trois ans (2009) avec son corollaire qui est la mise en place d'un référentiel infirmier basé sur le développement des compétences. Nous avons choisi de mettre en exergue une pratique professionnelle incontournable, celle de la transmission. Cette recherche, effectuée en janvier 2012, s'articule autour d'une question centrée sur les attendus de compétences infirmières. L'interrogation de vingt professionnels de santé sur leurs représentations des transmissions permet d'en voir la pluralité de significations comme des manières de faire et la place qu'ils accordent à l'université dans le processus de professionnalisation. Les résultats porteront sur l'analyse des discours des différents professionnels croisés avec les référentiels d'activités, de compétences et de formation infirmière

Aménagement de l’environnement parcellaire en maraîchage biologique: une nouvelle piste pour renforcer l’efficacité des auxiliaires naturels et améliorer la résistance génétique aux pucerons ?

L'objectif de cet essai est d’étudier des dispositifs favorisant les auxiliaires naturels contre les pucerons, qui sont parmi les principaux ravageurs dans le Sud de la France, en particulier sur melon (pour lequel aucun produit phytosanitaire n’est autorisé en AB). Cet essai s'inscrit dans un réseau d'expérimentations (avec l’INRA d’Avignon, le CEFEL) financées pendant 3 ans par le CTPS Parcel-R. D’après les résultats de cet essai, il apparait que les deux types d’aménagements sélectionnés (bandes fleuries et bandes enherbées) et mis en place ont abrité plus de biodiversité fonctionnelle que la végétation spontanée. Le mélange fleuri a attiré plus d’auxiliaires au total et plus d’auxiliaires spécifiques du puceron que la bande enherbée. Ces résultats confirment les observations de la bibliographie selon lesquelles les mélanges fleuris fournissent des sources de nourriture (nectar, pollen) par complémentation et supplémentation (proies alternatives) susceptibles d’attirer un grand nombre d’auxiliaires différents. En effet les périodes de floraison des différentes espèces se sont étalées sur la saison et on a aussi observé beaucoup de pucerons spécifiques du bleuet. De plus, des auxiliaires étaient présents dans les premières aspirations effectuées avant même la plantation du melon. Les conditions étaient donc favorables à une régulation naturelle du puceron par les auxiliaires naturels provenant des aménagements. Les observations de la pression d’Aphis gossypii ont montré une très forte hétérogénéité des effectifs de pucerons sur la parcelle dès la première observation. Des effectifs très élevés ont été observés sur la parcelle à proximité des bandes fleuries, largement supérieurs aux effectifs observés sur la parcelle à proximité des bandes enherbées et sur la parcelle à proximité du sol nu. Cette forte pression est difficile à expliquer et complique l’interprétation des effectifs d’auxiliaires aspirés et observés sur la parcelle. Les effectifs totaux d’auxiliaires et d’auxiliaires spécifiques du puceron sur la parcelle à proximité des bandes fleuries sont en parallèle significativement plus importants que dans les autres parcelles à proximité de la bande enherbée et du sol nu

Mobile Geriatric Team and Length of Hospital Stay Among Older Inpatients: A Case-Control Pilot Study

International audienc

Development and in vitro evaluation of a novel lipid nanocapsule formulation of etoposide.

Small cell lung cancer (SCLC) is the most aggressive carcinoma in thoracic oncology, unfortunately, despite chemotherapy, relapse is constant. The effect of etoposide, a major drug used against SCLC, can potentially be enhanced after its encapsulation in nanocarriers. The aim of this study was to use the technology of lipid nanocapsules (LNCs) to obtain nanocarriers with drug loadings compatible with clinical use and with an industrial process. Solubility studies with different co-solvent were first performed, then several process were developed to obtain LNCs. LNCs were then characterized (size, zeta potential, and drug loading). The best formulation called Ω-LNCs had a size of 54.1±2.0 nm and a zeta potential of -5.8±3.5 mV and a etoposide drug loading of 5.7±0.3mg/g. The characteristics of this formulation were maintained after freeze drying and after a 15× scale-up. Release studies in a media mimicking plasma composition showed that 40% of the drug was released from the LNCs after 48 h. Moreover the activity of etoposide after encapsulation was enhanced on H209 cells, IC50 was 100 μM and 2.5 μM for etoposide and etoposide LNCs respectively. Unfortunately the formulation failed to be more cytotoxic than etoposide alone on H69AR cells that are resistant to etoposide. This study showed that is was possible to obtain a new etoposide nanocarrier without the use of organic solvent, that the process is suitable for scale-up and freeze drying and finally that etoposide activity is maintained which is very promising for future treatment of SCLC

Pneumopathie médicamenteuse sous traitement par venlafaxine et propranolol

Introduction Venlafaxine and propranolol have rarely been identified as causes of pulmonary pathology. We describe a case of drug-induced pneumonitis occurring in a patient treated with these two medications. Case report A 55 years old woman with liver cirrhosis treated with venlafaxine for 1 year and propranolol for 1 month was admitted to the intensive care unit because of acute respiratory failure. A Mycoplasma pneumoniae pneumonitis was diagnosed. After initial improvement under antibiotics, a new deterioration of respiratory status was observed 4 days after the reintroduction of venlafaxine and propranolol. Spontaneous recovery occurred after these treatments were withheld. Co administration of venlafaxine and propranolol, 2 drugs with affinity for the same cytochrome P450 isoenzyme (CYP2D6), may have contributed to drug accumulation and pulmonary toxicity. The liver cirrhosis of our patient may also have contributed to decreased cytochrome P450 enzymatic activity. Conclusions Venlafaxine and propranolol share the same metabolic pathway and their co-administration may be complicated by drug induced pneumonitis

Toxicological study and efficacy of blank and paclitaxel-loaded lipid nanocapsules after i.v. administration in mice

PURPOSE: Lipid nanocapsules (LNCs) are solvent-free drug nanocarriers permitting entrapment of paclitaxel and increasing its antitumoural effect in animal models after i.v. injection. The tolerance and efficacy of LNCs after repeated dose i.v. administration were assessed in mice. The maximum tolerated dose (MTD) and 50 percent lethal dose (LD50) were studied.METHODS: Paclitaxel-loaded LNC formulation was given i.v. at the dose of 12 mg/kg per day for 5 consecutive days in comparison with blank LNCs and saline. Histological examination, complete blood counts and biochemical quantification were performed after a recovery of 7 days. Growth of NCI-H460 subcutaneous xenografts in nude mice receiving one of the aforementioned schedules was assessed. MTD and LD50 were determined by Irwin test. RESULTS: No mortality was observed in repeated injections studies. Histological studies revealed no lesions and no accumulation of lipids. Blood studies were normal. The tumoural growth was significantly reduced in the group treated by paclitaxel-loaded LNCs. The MTDs/LD50s of Taxol, paclitaxel-loaded LNCs and blank LNCs were 12/19.5, 96/216 and above 288/288 mg/kg, respectively. CONCLUSIONS: This study demonstrates that a five-day i.v. injection schedule of paclitaxel-loaded LNC dispersions induces no histological or biochemical abnormalities in mice and improves paclitaxel efficacy and therapeutic index in comparison with Taxol

A Rare Cause of Chronic Hypokalemia with Metabolic Alkalosis: Case Report and Differential Diagnosis

Hypokalemia and metabolic alkalosis can be present in different rare diseases, and the differential diagnosis of these forms is challenging. Apparent mineralcorticoid (AME) excess syndrome is one of these conditions. Characterized by increased blood pressure due to excessive sodium retention and plasma volume, it is caused by a mutation in the HSD11B2 gene encoding the oxydoreductase enzyme 11β-hydroxysteroide dehydrogenase type 2. We report the case of a child presenting with failure to thrive associated with early detection of hypokalemia, metabolic alkalosis, nephrocalcinosis and hypertension in which AME syndrome was detected. A novel mutation in the HSD11B2 gene was identified in this patient. In clinical pictures characterized by metabolic alkalosis and hypokalemia, the evaluation of renin, aldosterone and blood pressure is crucial for accurate diagnosis. AME syndrome is a rare disorder that can be an insidious but lethal disease, if untreated. With clinical signs appearing during the first days of life. Early diagnosis is imperative in order to enable prompt and adequate treatment to improve the outcome of these patients

A new approach for a physicochemical characterization of nanoparticles in complex media: a pilot study

Présentation PosterInternational audienceCurrent techniques used to measure the phys-icochemical characteristics of nanoparticles in simple media are poorly predictive of their behavior observed during in vivo experi-ments1. As a consequence, some pharmaco-kinetic or toxicokinetic issues are detected too late. In this contribution, we are proposing an innovative approach to tackle this challenge2. The goal is to develop a generic characteriza-tion process that could be used in any labora-tory with different categories of measurement technologies. The proposed solution is com-posed of three main steps:1.Sample preparation;2.Measurement phase;3.Statistical analysis.The sample preparation relies on a set of n serum-free media initially designed for cell culture but used herein to mimic heterogenei-ty of biological context. Each culture medium is composed of a large number (p), around a hundred, of biological compounds (proteins, vitamins, mineral salts, etc.), which may indi-vidually and synergistically interact with the nanoparticle surface. The nanoparticle to be characterized is added to each medium of the kit with the same concentration.The resulting mixtures are then analyzed by an appropriate technology compatible with complex media to measure the size distribu-tion of constitutive nano-objects. In a third step, all the experimental data com-ing from the n series of measurement are used to solve a “ large p small n” regression problem. This statistical analysis informs about the most likely medium compounds to affect the size distribution of nanoparticles compared to their initial dimensions. This communication presents the first results of a pilot study in which the proposed approach was tested on gold nanoparticles mixed in n=8 cell free culture media provided by Thermo Fisher Scientific. The nanoparticle size distributions were measured by a Dy-namic light scattering system (Nanosight, Malvern). A partial least squares method was used to solve the “ large p small n” regression problem. Preliminary results confirms signifi-cant changes of the size distribution between the culture media and the feasibility of the statistical method to identify a set of medium compounds that may explain those variations

Stealth nanocarriers based sterosomes using PEG post-insertion process

Sterosomes (STEs), a new and promising non-phospholipidic liposome platform based on palmitic acid (PA) and cholesterol (Chol) mixtures, need to have polyethylene glycol (PEG) chains grafted to their surface in order to obtain long-circulating nanocarriers in the blood stream. A post-insertion method was chosen to achieve this modification. The post-insertion process of PEG-modified distearoylphosphoethanolamine (DSPE-PEG) was monitored using the zeta potential value of STEs. Various conditions including PEG chain length and the DSPE-PEG/PA-Chol ratio, were explored. Zeta potential of STEs changed from about -40mV for non-modified STEs to values close to 0 mV by the end of the process, i.e. for PEG-modified STEs. The kinetics of DSPE-PEG insertion and the stability of the resulting PEG-modified STEs were not considerably influenced, within the investigated range, by changes in PEG chain lengths and in DSPE-PEG/PA-Chol proportion. The post-insertion of PEG chains reduced in vitro complement activation as well as in vitro macrophage uptake compared to the non-modified STEs. Moreover, longer blood circulation time in mice was established for PEG-modified STEs intravenously injected compared to non-modified STEs. These results establish that post-insertion process of PEG chains to STEs is a promising strategy for developing long-term circulating drug delivery nanocarriers