46 research outputs found
Compliance et recours aux méthodes thérapeutiques nonconventionnelles dans une population de polyarthritiques
Conflits d'intĂ©rĂȘt : nouvelle frontiĂšre de la dĂ©mocratie
Ce rapport est issu dâun travail entamĂ© en 2014 et part dâun constat simple. La dĂ©fiance populistes. Cette dĂ©fiance, qui a des effets dĂ©lĂ©tĂšres sur notre dĂ©mocratie, est alimentĂ© par des dysfonctionnements rĂ©els quâil convient de ne pas nier. Un traitement inadĂ©quat dâoĂč le titre du prĂ©sent rapport.Les conflits d'intĂ©rĂȘts peuvent ĂȘtre sommairement dĂ©finis comme des situations dans lesquelles une personne chargĂ©e de dĂ©fendre un intĂ©rĂȘt (intĂ©rĂȘt particulier ou intĂ©rĂȘt gĂ©nĂ©ral) est en situation, ou peut-ĂȘtre soupçonnĂ©e d'ĂȘtre en situation, d'abuser de sa position afin de dĂ©fendre un autre intĂ©rĂȘt.Les conflits dâintĂ©rĂȘts sont inhĂ©rents Ă la vie en sociĂ©tĂ© : ils existent dans tous les champs Ă©conomiques et sociaux et Ă tous les niveaux hiĂ©rarchiques. Dans ce rapport, nous nous intĂ©ressons singuliĂšrement Ă ceux qui affaiblissent notre dĂ©mocratie et la confiance dans nos institutions. Notre fil dâAriane est que les rĂ©ponses Ă apporter doivent ĂȘtre dâautant plus exigeantes que les individus sont en position de responsabilitĂ© Ă lâĂ©gard de la collectivitĂ© et que les « coĂ»ts » sociaux des conflits dâintĂ©rĂȘts non traitĂ©s sont lourds, notamment en termes notamment de dĂ©lĂ©gitimation des institutions dĂ©mocratiques. Nos propositions visent Ă apporter notre pierre Ă la refondation de la vie dĂ©mocratique.Nous dĂ©veloppons nos analyses dans trois champs qui ont Ă©tĂ© choisis du fait de leur importance symbolique, Ă©conomique et/ou de leur incidence sur la vie des citoyens. Il sâagit de la vie publique au sens large, de la banque et de la santĂ©. Ces secteurs sont tructurellement gĂ©nĂ©rateurs de conflits dâintĂ©rĂȘts, situation renforcĂ©e par le fait que les acteurs dĂ©cisionnaires y ont souvent des trajectoires professionnelles qui sâinscrivent synchroniquement ou diachroniquement Ă la fois dans les sphĂšres publique et privĂ©e. Cette approche structurelle des conflits dâintĂ©rĂȘts ne nie pas la complexitĂ© des situations, ni lâimbrication nĂ©cessaire des champs public et privĂ©, et les solutions que nousprĂ©conisons ne sont donc pas duales, ou manichĂ©ennes. Nous envisageons au contraire une gradation qui va de lâincompatibilitĂ© â ou interdiction pure et simple â d'une double position potentiellement conflictuelle, conduisant alors Ă lâĂ©limination du conflit dâintĂ©rĂȘts, Ă des dispositifs de rĂ©gulation beaucoup plus fins. La modulation de nos propositions prend comme critĂšre la gravitĂ© du risque Ă conjurer
Pertinence des prescriptions médicamenteuses, expérience française
La revue de pertinence des soins, appliquée aux prescriptions médicamenteuses, est une
mĂ©thode dâĂvaluation des Pratiques Professionnelles en plein essor, dans un contexte
simultanĂ© de maĂźtrise des dĂ©penses et dâamĂ©lioration du bon usage des mĂ©dicaments. Une
synthÚse de la littŽerature essentiellement française réalisée dans ce domaine sur les dix
derniÚres années a retrouvé 38 publications dont 19 originales. Les résultats montrent le
peu de publication des travaux effectués, et des méthodologies non standardisées. La
construction de grilles de recueil pédagogiques constitue une étape préalable déterminante
Ă la mise en Ćuvre dâactions dâamĂ©lioration via la sensibilisation des
prescripteurs. Lâanalyse doit permettre de mener une Ă©tude approfondie des causes de
non-pertinence, afin de cibler les actions dâamĂ©lioration. Une seconde Ă©valuation est
nĂ©cessaire pour Ă©valuer lâimpact de la revue de pertinence sur les pratiques
professionnelle
New Commercially Available PCR and Microplate Hybridization Assay for Detection and Differentiation of Human Polyomaviruses JC and BK in Cerebrospinal Fluid, Serum, and Urine Samples
JC and BK human polyomaviruses (family Polyomaviridae) may cause severe neurological or urinary tract pathologies in immunocompromised hosts. In the present study, we evaluated a new commercially available PCR and microplate colorimetric hybridization assay for the standardized differential detection of JC virus (JCV) and BK virus (BKV) genomes in clinical samples. This JC/BK Consensus test was first evaluated by testing serial dilutions of JCV or BKV plasmid DNA standards and was then compared with an in-house reference PCR assay for the detection of JC and BK virus genomes in 70 cerebrospinal fluid (CSF) samples of patients with neurological disorders and in 75 serum or plasma samples and 125 urine samples of renal graft recipients. This new test allowed a limit of detection of 10 copies and 1 copy of JC and BK virus genomes, respectively, and was able to differentiate various levels of JCV, BKV, and mixed JCV and BKV DNA genomes in a single reaction tube. Our results showed 100% specificity and sensitivity for the JC/BK Consensus test with CSF samples. With serum or plasma samples, this test had a sensitivity and a specificity of 100% for both JCV and mixed JCV and BKV DNA detection and a sensitivity and a specificity of 100 and 97.8% for BKV DNA detection, respectively. With urine samples, the sensitivity and specificity were 100 and 96.6%, respectively, for JCV DNA detection; 100 and 89.4%, respectively, for BKV DNA detection; and 44.4 and 100%, respectively, for mixed JCV and BKV DNA detection. In conclusion, our data indicate that this new test, the JC/BK Consensus test, is valuable for the sensitive and specific differential detection of single JCV and BKV infections in CSF, serum or plasma, and urine samples. The use of this reliable PCR assay would improve the routine virological diagnosis as well as the clinical care of immunocompromised patients with polyomavirus-related pathologies
Detection of Human Metapneumovirus RNA Sequences in Nasopharyngeal Aspirates of Young French Children with Acute Bronchiolitis by Real-Time Reverse Transcriptase PCR and Phylogenetic Analysis
Human metapneumovirus (HMPV) was the unique viral pathogen detected by a real-time reverse transcriptase PCR (RT-PCR) assay in 6 (6.4%) of 94 consecutive French children hospitalized for acute bronchiolitis from September 2001 to June 2002. This virus was identified as the third etiological cause of bronchiolitis, after respiratory syncytial virus and rhinovirus (35 [37%] and 21 [22%] of 94 cases, respectively). Phylogenetic analysis of F-gene sequences demonstrated the cocirculation of distinct HMPV genotypes during this study. These findings highlight the need to implement a rapid HMPV RT-PCR detection assay for the clinical diagnosis of respiratory infections in pediatric patients with bronchiolitis
Pratiques managĂ©riales, bien-ĂȘtre des personnels soignants et qualitĂ© des soins en oncologie
National audienc
Satisfaction au travail des personnels soignants, intentions de quitter et qualité des soins en cancérologie
National audienc
High-resolution melting analysis for rapid characterization of qnr alleles in clinical isolates and detection of two novel alleles, qnrB25 and qnrB42.
International audienceOBJECTIVES: qnr genes are plasmid-mediated quinolone resistance genes. Five qnr families have been described with several alleles (7 alleles of qnrA, 53 alleles of qnrB, 1 allele of qnrC, 1 allele of qnrD and 6 alleles of qnrS). Their detection requires a PCR specific for each qnr family and further sequencing for allele characterization. METHODS: High-resolution melt curve analysis (HRMA) was coupled to multiplex and simplex real-time PCR assays for detection and characterization of qnrA, qnrB and qnrS alleles. The protocol was set using 27 reference strains harbouring the most frequent alleles and was applied to 55 clinical isolates unknown for qnr positivity. RESULTS: Out of the 27 reference strains tested, 21 alleles showed distinct profiles using HRMA: 6 qnrA, 12 qnrB and 3 qnrS. For the qnrB alleles showing similar profiles, we gathered them into four groups that were easily distinguished. For the alleles that we could not test, in silico analysis showed that they would be identified using the HRMA protocol set. Among the clinical isolates, 28 qnr-positive isolates were detected and the qnr allele was characterized as 8 qnrA1, 4 qnrB1, 5 qnrB2, 3 qnrB4, 1 qnrB8, 1 qnrB5, 3 qnrS1 and 1 qnrS2, with concordant results with PCR sequencing. Two new qnrB alleles were detected and distinguished using HMRA. They were further designated as qnrB25 and qnrB42. CONCLUSIONS: We developed an HRMA assay for characterizing the qnr alleles in clinical isolates. This high-throughput method can be used to screen a large number of isolates. This method allowed the detection of new qnrB alleles
Ethical leadership, professional caregivers' well-being, and patients' perceptions of quality of care in oncology
International audienc