Les expériences de nature relationnelle suscitées par l'écoute musicale en solitaire et leur rôle dans la régulation affective : étude qualitative auprès d'adultes de la population générale

L’écoute de musique est un moyen fréquemment employé pour la régulation d’états affectifs par des individus de tous âges (Hays & Minichiello, 2005; Laukka, 2007; Saarikallio, 2011; Saarikallio & Erkkilä, 2007; Trehub, Ghazban, & Corbeil, 2015). Quelques études qualitatives s’étant intéressées à ce processus ont permis d’établir des bases théoriques sur le sujet (p. ex., Van den Tol & Edwards, 2011; Van Goethem & Sloboda, 2011), entre autres en dégageant une première typologie des fonctions régulatoires de l’écoute musicale. Parmi ces différentes fonctions, plusieurs évoquent l’idée que des bienfaits de nature relationnelle (p. ex., réconfort, présence, soutien, sécurité) puissent être vécus à travers l’écoute musicale (p. ex., Saarikallio, 2011; Skänland, 2013). Toutefois, cela demeure peu compris puisque la majorité de ces résultats sont obtenus sans être présentés et discutés selon un angle spécifiquement « relationnel ». La présente étude à devis qualitatif (analyse par catégories conceptualisantes) vise à identifier et conceptualiser les phénomènes par lesquels l’écoute musicale suscite des expériences de nature relationnelle et à comprendre leurs rôles dans la régulation affective auprès d’adultes de la population générale. Des entrevues semi-structurées ont été réalisées auprès de neuf adultes rapportant accorder une grande importance à l’écoute de musique et en retirer des bienfaits. Au total, 29 phénomènes ont été dégagés. Quatre regroupements d’expériences de nature relationnelle vécues à travers l’écoute musicale ont été conceptualisés (lien à soi; lien à la musique; lien à ses proches; lien à l’artiste). En outre, certains phénomènes apparaissent comme fondements à la régulation affective par l’écoute musicale et certains phénomènes sont identifiés comme évoluant dans le temps. La discussion met en lumière de multiples liens possibles entre ces résultats et les connaissances existantes, non seulement dans ce domaine de recherche, mais aussi dans d’autres domaines (p. ex., théories de l’attachement, neurosciences). Elle soulève également la qualité intégrative de l’étude, ses limites et ses retombées possibles pour les milieux scientifique, clinique et la population générale

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/)

Revue de pertinence sur la prescription des fluoroquinolones au service d'accueil des urgences du centre hospitalier de La Rochelle

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Influence of polymer behaviour in organic solution on the production of polylactide nanoparticles by nanoprecipitation.

International audienceThe aim of this study was to define the parameters determining an optimized yield of monodisperse, nanosized particles after nanoprecipitation of a biodegradable polymer, with a view to industrial scale-up the process. Poly(d,l)-lactides (PLAs) from a homologous series of different molar masses were nanoprecipitated at different initial polymer concentrations from two organic solvents, acetone and tetrahydrofuran (THF), into water without surfactant according to a standardized procedure. Quasi-elastic light scattering and gel permeation chromatography with universal detection were used respectively to size the particles and to determine the molar mass distribution of the polymeric chains forming both nanoparticles and bulk aggregates. The intrinsic viscosity of the polymers as a function of molar mass and solvent were determined by kinematic viscosity measurements in organic solutions. High yields of small nanoparticles were obtained with polymers of lower molar mass (22600 and 32100g/mol). For a given polymer concentration in organic solution, the particle diameter was always lower from acetone than from THF. For initial molar masses higher than 32100g/mol, only dilute organic solutions gave significant yields of nanoparticles. Furthermore, polymer mass fractionation occurred with increasing initial molar mass and/or concentration: the nanoparticles were formed by polymeric chains of molar masses significantly lower than the average initial one. In general, nanoparticle production was satisfactory when the initial organic solution of polymer was in the dilute rather than the semi-dilute regime. Moreover, acetone, which acted as a theta solvent for PLA, always led to smaller particles and better yields than THF

Terminal 6q deletions cause brain malformations, a phenotype mimicking heterozygous DLL1 pathogenic variants : A multicenter retrospective case series

International audienceTerminal 6q deletion is a rare genetic condition associated with a neurodevelopmental disorder characterized by intellectual disability and structural brain anomalies. Interestingly, a similar phenotype is observed in patients harboring pathogenic variants in the DLL1 gene. Our study aimed to further characterize the prenatal phenotype of this syndrome as well as to attempt to establish phenotype-genotype correlations. We collected ultrasound findings from 22 fetuses diagnosed with a pure 6qter deletion. We reviewed the literature and compared our 22 cases with 14 fetuses previously reported as well as with patients with heterozygous DLL1 pathogenic variants. Brain structural alterations were observed in all fetuses. The most common findings (&gt;70%) were cerebellar hypoplasia, ventriculomegaly, and corpus callosum abnormalities. Gyration abnormalities were observed in 46% of cases. Occasional findings included cerebral heterotopia, aqueductal stenosis, vertebral malformations, dysmorphic features, and kidney abnormalities. This is the first series of fetuses diagnosed with pure terminal 6q deletion. Based on our findings, we emphasize the prenatal sonographic anomalies, which may suggest the syndrome. Furthermore, this study highlights the importance of chromosomal microarray analysis to search for submicroscopic deletions of the 6q27 region involving the DLL1 gene in fetuses with these malformations

Terminal Weaning or Immediate Extubation for Withdrawing Mechanical Ventilation in Critically Ill Patients (the ARREVE Observational Study)

International audiencePURPOSE: The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives. METHODS: This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. The primary outcome was posttraumatic stress symptoms (Impact of Event Scale Revised, IES-R) in relatives 3~months after the death. Secondary outcomes were complicated grief, anxiety, and depression symptoms in relatives; comfort of patients during the dying process; and job strain in staff. RESULTS: We enrolled 212 (85.5%) relatives of 248 patients with terminal weaning and 190 relatives (90.5%) of 210 patients with immediate extubation. Immediate extubation was associated with airway obstruction and a higher mean Behavioural Pain Scale score compared to terminal weaning. In relatives, IES-R scores after 3~months were not significantly different between groups (31.9~±~18.1 versus 30.5~±~16.2, respectively; adjusted difference, -1.9; 95% confidence interval, -5.9 to 2.1; p~=~0.36); neither were there any differences in complicated grief, anxiety, or depression scores. Assistant nurses had lower job strain scores in the immediate extubation group. CONCLUSIONS: Compared to terminal weaning, immediate extubation was not associated with differences in psychological welfare of relatives when each method constituted standard practice in the ICU where it was applied. Patients had more airway obstruction and gasps with immediate extubation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01818895

“You helped me keep my head above water”—experience of bereavement research after loss of a loved one in the ICU: insights from the ARREVE study

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ICU physicians’ and nurses’ perceptions of terminal extubation and terminal weaning: a self-questionnaire study

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Correction to: Terminal Weaning or Immediate Extubation for Withdrawing Mechanical Ventilation in Critically Ill Patients (the ARREVE Observational Study)

International audienceCorrection to: Intensive Care Med (2017) DOI 10.1007/s00134-017-4891-0