Evaluation de l'impact de la mise en place de la prescription connectée et de la formation à la juste prescription des examens biologiques dans un service des maladies infectieuses et tropicales (intérêt en épidémiologie interventionnelle)

La prescription d examens biologiques joue un rôle déterminant dans la prise en charge médicale des patients, et a considérablement augmenté au cours des dix dernières années. Si une part de cette inflation traduit une amélioration des pratiques, une fraction non négligeable semble pourtant correspondre à une prescription inappropriée, responsable de nombreux effets délétères. Différentes stratégies ont été expérimentées afin de maîtriser cette dérive, et tendre vers une juste prescription des examens biologiques. Dans ce contexte, l hôpital Saint-Antoine s est engagé dans une démarche d amélioration de la qualité de ses prescriptions. L introduction d un système de prescription connectée des examens biologiques a été décidée, complétée dans un second temps par l éducation des médecins prescripteurs et la mise en place d alertes informatiques. Cette intervention concernait le service des maladies infectieuses et tropicales, pilote pour l étude. Les critères de jugement étaient le volume total d examens biologiques prescrits, le volume d examens biologiques répétés et leurs délais de répétition, avant et après les deux volets de l intervention, et ce pour un panel d examens usuels sélectionnés. L analyse des résultats ne retrouvait aucun effet de la mise en place de la prescription connectée sur l ensemble des critères choisis. En revanche, la période correspondant à l éducation des prescripteurs et à l installation des alertes informatiques enregistrait une diminution sensible du volume total d examens biologiques, du volume d examens répétés, et des répétitions précoces de prescription de protéine C-réactive. L intervention initiée a donc permis de manière simple, de contrôler efficacement la prescription d examens biologiques, et de diminuer les répétitions inutiles. Dans notre étude, la mise en place de la prescription connectée, à elle seule, n a pas eu d effet sur les prescriptions. Néanmoins, l installation de cet outil est l occasion d initier une ou plusieurs stratégies de maîtrise de la prescription d examens biologiques. Parmi celles-ci, l éducation des prescripteurs et l utilisation d alertes répétition semblent pertinentes.Laboratory tests prescription is crucial to take care of patients, and has considerably increased during the last ten years. If a part of this enhancement results from an improvement of medical consciousness, inappropriate prescription seems to be the principal source of this trend, causing several deleterious effects. Several strategies have been experimented to control this problem. Considering this situation, Saint-Antoine hospital (Paris XII) engaged an initiative for better laboratory tests prescription. Computer physician order entry (CPOE) was installed, completed in second place by physicians education and repetition informatics alerts. This intervention was conducted in the department of infectious and tropical diseases of the hospital, chosen as testing department. Outcomes were the total volume of laboratory tests, the volume of repeated tests, and time before repeated prescriptions, before and after the intervention, regarding a sample of selected tests. CPOE did not have any effect on the outcomes. On the contrary, physician s education and alerts allowed an important reduction of laboratory tests prescription, and an extension of the time preceding a repeated prescription.Thus, our intervention was an effective and simple way to contain laboratory tests prescription. In our study, CPOE alone, was inefficient, but its installation was the occasion and a comfortable support to initiate useful strategies like physician s education and informatics alerts.PARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Alpha-glutathion-S-transférase plasmatique en hépatologie (aspects analytiques et cliniques)

PARIS-BIUP (751062107) / SudocSudocFranceF

Etude des mécanismes impliqués dans la survenue des lésions hépatiques d'hypoxie-réoxygénation (interactions entre polynucléaires neutrophiles et cellules endothéliales sinusoïdales de rat)

PARIS-BIUP (751062107) / SudocSudocFranceF

Proteomic study of human umbilical vein endothelial cells in culture

The endothelium is a single layer of cells lining the inside face of all blood vessels. It constitutes a major metabolic organ which is critically involved in the generation and the regulation of multiple physiological and pathological processes such as coagulation, hemostasis, inflammation, atherosclerosis, angiogenesis and cancerous metastasis dissemination. In order to increase our knowledge about the protein content and the main biological pathways of human vascular endothelial cells, we have undertaken the proteomic analysis of the most explored present endothelial cell model, i.e. primocultures of human umbilical vein endothelial cells (HUVECs). Using low levels of protein loads (~ 30 νg), the association of two-dimensional electrophoresis with matrix-assisted laser desorption/ionization-time of flight mass spectrometry, liquid chromatography-tandem mass spectrometry and database interrogations allowed us to identify 53 proteins of suspected endothelial origin in quiescent HUVECs. Beside cytoskeletal proteins such as actin, tubulin, tropomyosin and vimentin, we identified various proteins more especially implicated in cellular motility and plasticity (e.g. cofilin, F-actin capping protein and prefoldin), in regulation of apoptosis and senescence (protease inhibitor 9, glucose related proteins, heat shock proteins, thioredoxin peroxidase, nucleophosmin) as well as other proteins implicated in coagulation (annexin V, high mobility group protein), antigen presentation (valosin containing protein and ubiquitin carboxyl terminal hydrolase isozyme L1) and enzymatic capabilities (glutathione-S-transferase, protein disulfide isomerases, lactate deshydrogenase). The presented annotated 2-D maps of HUVECs will be soon available on the web at http://www. huvec.com

Proteomics of human umbilical vein endothelial cells applied to etoposide-induced apoptosis

International audienc

Proteomics Analysis of Morphogenic Changes of Human Umbilical Vein Endothelial Cells Induced by a Phorbol-Ester Mimicking Angiogenesis

Phorbol 12-myristate 13-acetate (PMA) can induce proliferation and migration of endothelial cells, mimicking vessel formation. We analysed by two-dimensional electrophoresis and MALDI-TOF/TOF the effects of PMA on cultured Human Umbilical Vein Endothelial Cells (HUVECs) to further investigate the complex mechanisms related to protein kinase C activation in this angiogenesis model. At 1 μg/ml for 24 hours, PMA induced transition of HUVECs from quiescent type into the proliferative-migrating phenotype. After 2D gel analysis, 15 differences were detected between PMA-treated samples and controls, including 8 increased proteins and 7 decreased proteins. The three main proteins identified by mass spectrometry and increased after PMA are directly involved in cell stress (α-glucosidase, heat-shock protein 70, and 150 kDa oxygen-regulated protein). Four other proteins varied in function of time, two increasing after PMA (heat shock protein 90β, protein-disulfide isomerase A3), and two other decreasing after this treatment (glucose-related protein 75, cathepsin B). These four proteins are involved in protein folding, apoptosis or tumour dissemination. Our data show that phorbol esters modify a number of proteins involved in multiple and intricate pathways for promoting a phenotype ensuring cell survival and cell migration for new vessels formation