Radioprotection opérationnelle pour la réalisation des scintigraphies myocardiques aux Hôpitaux Universitaires de Genève: travail de Bachelor

Les maladies cardiovasculaires représentent aujourd'hui la première cause de décès dans les pays développés dont la Suisse. Ces maladies sont caractérisées par une atteinte du cœur ainsi que des vaisseaux de l'organisme et plus particulièrement des artères coronaires qui nourrissent le muscle cardiaque, le myocarde. Ce sont principalement des maladies qui évoluent dans le temps, leurs fréquences augmentent avec certains facteurs de risques comme l'âge, le mode de vie telle que la sédentarité, le tabac, l'alcool, le diabète, l'obésité, l'hypertension ou encore le taux de cholestérol. D'autres facteurs peuvent impliquer cette maladie comme les antécédents familiaux ou le sexe. La maladie coronarienne est l'une des maladies cardio-vasculaires les plus fréquentes. Elle correspond à un rétrécissement ou une obstruction des artères coronaires, telles que des parties du cœur ne reçoivent plus ou pas assez de sang. Ceci peut entraîner l'angine de poitrine, un infarctus du myocarde, ou encore un arrêt cardio-circulatoire. En suisse, le risque d'en être atteint est de 23% chez les hommes et de 18% chez les femmes. Elle représente donc un défi et un enjeu majeur de santé publique. Diverses techniques d'imageries peuvent être réalisées afin de diagnostiquer la maladie, définir son extension, faire un choix de traitement et réaliser un suivi des patients. La scintigraphie du myocarde est l'un des principaux examens réalisés dans le cadre du diagnostic de l'infarctus. Cette technique d'imagerie médicale de médecine nucléaire consiste à utiliser un produit radioactif afin d'évaluer le fonctionnement du myocarde. L'utilisation de la radioactivité implique un principe de radioprotection pour les patients, le personnel soignant mais aussi de l'environnement de soin, c'est à dire la zone de réalisation de l'examen et plus précisément, le service de cardiologie des HUG dans le cadre de notre étude. Il devient alors primordial de réaliser des contrôles, des mesures ainsi qu'une interprétation pointilleuse des résultats obtenus

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Does displaying buildings on the map improve GPS pedestrian navigation performance? An ecological approach.

International audienc

GPS piéton : quels points de repères pour faciliter la navigation ?

International audienceThe orientation from a map is a cognitively complex activity. The success or performance of an orientation task particularly depends on the characteristics of the map used (e.g. [5-6]). The purpose of the present study was to identify, through eye movement recording, the effects on navigation of adding 2D or 3D buildings to maps, and to link these effects with working memory capabilities of individuals. Thus, 64 participants had to make Google StreetView routes using a static map 1) without any building, 2) with 2D buildings, or 3) with 3D buildings. The results indicate that the 3D map is most effective for participants with high visuospatial processing capabilities, but is an inconvenience for participants with low visuospatial capabilities. These results lead to recommend to designers of pedestrian GPS to take into account the variability of users' cognitive profiles by offering configurable devices.L'orientation à partir d'une carte est une activité complexe sur le plan cognitif. La réussite ou la performance à une tâche d'orientation dépend notamment des caractéristiques de la carte utilisée (e.g. [5-6]). L'objectif de la présente étude était d'identifier, grâce à l'enregistrement des mouvements oculaires, les effets sur la navigation de l'ajout des bâtiments en 2D ou en 3D sur des cartes, et de mettre en lien ces effets avec les capacités de mémoire de travail des individus. Ainsi, 64 participants devaient réaliser des parcours sur Google StreetView en s'aidant d'une carte statique 1) sans bâtiment, 2) avec des bâtiments en 2D, ou 3) avec des bâtiments en 3D. Les résultats indiquent que la carte en 3D est la plus efficace pour les participants dont les capacités de traitement visuospatiales sont élevées, mais constitue une gêne pour les participants dotés de faibles capacités visuospatiales. Ces résultats conduisent à préconiser aux concepteurs de dispositifs d'aide à la navigation de prendre en compte la variabilité des profils cognitifs des utilisateurs en proposant des systèmes adaptatifs paramétrables

GPS piétons : quels points de repères pour faciliter la navigation?

International audienc

Development of hard and scratch-resistant photo-polymerizable coatings based on bio-sourced monomers, for thermoplastic substrates

International audienc

Development of hard and scratch-resistant photo-polymerizable coatings based on bio-sourced monomers, for thermoplastic substrates

International audienc