Connaissances au sujet de la loi du 22 avril 2005 (enquête auprès de vingt internes en Aquitaine et Poitou-Charentes, septembre 2010)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Difficultés rencontrées par les professionnels de santé libéraux dans le maintien à domicile des patients en fin de vie (à propos d'une enquête réalisée auprès de 270 médecins généralistes et 300 infirmières libérales dans le secteur sanitaire 2 d'Aquitaine)

Alors que 70% des Français affirment vouloir mourir chez eux, 75% décèdent à l'hôpital. Le changement d'attitude de la société face à la mort n'est pas la seule explication, les difficultés rencontrées par les soignants dans le maintien à domicile des patients en fin de vie sont retenues comme facteurs responsables. Une enquête réalisée en mars 2004, auprès de 270 médecins et 300 infirmières dans le secteur sanitaire 2 Aquitain, a permis d'identifier les principales difficultés rencontrées à domicile. Les résultats ont été ensuite comparés aux données bibliographiques. Près de 50% des médecins et 40% des infirmières ont répondu. Ils suivent en moyenne de 1 à 3 malades en fin de vie par an et 69 % des médecins et 89% des infirmières sont prêts à assurer un accompagnement total à domicile. Pourtant 90% des medecins et 76% des infirmières rencontrent des difficultés. Pour les médecins, elles sont surtout organisationnelles (71%) : la difficulté d'assurer la continuité des soins (86%), la pénurie de soignants (60%), le manque de coordination (56%), de travail en équipe (38%) et la non reconnaissance financière (27%) sont autant d'obstacles au maintien à domicile. Les difficultés psychoaffectives sont retenues pour 68% des infirmières : face à la souffrance des patients (76%), lors de l'accompagnement des familles (63%) et face à l'isolement (39%). Les difficultés techniques apparaissent au second plan dans cette étude (36%). Elles concernent des techniques spécifiques utilisées en soins palliatifs. Les difficultés de prise charge des symptômes (80%) : dyspnée, encombrement bronchique, douleur, symptômes intenses, troubles neuropsychiques restent pour 80% des médecins et 50% des infirmières un motif d'hospitalisation.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Enquête et réflexions sur les mémoires du Diplôme Inter-Universitaire d'Accompagnement et de soins Palliatifs en France en 2004

Dans le cadre du Collège National des Enseignants pour la Formation Universitaire en Soins Palliatifs (CNEFUSP), une enquête a été réalisée pour connaître les modalités utilisées pour l’accompagnement pédagogique des enseignés dans la préparation du mémoire validant du Diplôme Inter-Universitaire d’Accompagnements et de Soins Palliatifs

Is training sufficient for ultrasound operators to diagnose deep infiltrating endometriosis and bowel involvement by transvaginal ultrasound?

International audienceObjectives: To assess and compare the diagnostic accuracy of transvaginal ultrasonography (TVUS) by trained or untrained ultrasound operators in deep infiltrating endometriosis (DIE) imaging, for diagnosing DIE and bowel involvement. Methods: This was an observational study of patients with clinically suspected DIE operated in a reference center. TVUS was performed pre-operatively by a trained or/and untrained ultrasound operator to search for DIE and rectal involvement. During surgery, DIE was diagnosed according to macroscopic and histological criteria. Sensitivity (Se), specificity (Sp) and c-index were calculated with 95% confidence intervals for trained and untrained operators, if TVUS results were significantly predictive of DIE and rectal involvement at p < 0.05. Results: 115 patients were included: 100 (87%) had DIE and 34 (29.6%) had bowel involvement. TVUS was performed by a trained ultrasound operator for 70 patients and by an untrained one for 56 patients. When performed by a trained operator, TVUS significantly predicted DIE with a Se of 58% (95% CI, 46–70), a Sp of 87.5% (95% CI, 63–100) and a c-index of 0.73 (95% CI, 0.59–0.87). TVUS performed by an untrained operator was not significantly predictive of DIE (p = 0.58). Rectal involvement was significantly predicted by TVUS performed by a trained operator with a Se of 40% (95% CI, 23–59), a Sp of 93% (95% CI, 86–100) and a c-index of 0.67 (95% CI, 0.56–0.77). None of the untrained ultrasound operators diagnosed a bowel involvement. Conclusion: TVUS is not sufficient to diagnose DIE and bowel involvement, in particular when performed by untrained ultrasound operators

Introducing Tritium (3H) MAS NMR in biosolids: application to crystalline diphenylalanine

International audienceTritium ($^3$H) possesses the highest gyromagnetic ratio of the periodic table and its negligible natural abundance (3×10-16 %) ensures that no background signal is observed, in contrast to ubiquitous proton ($^1$H), so that one can work at a very low concentration (in the present work less than 0.1%) while maintaining a very good sensitivity. Despite these appealing features, only very few $^3$H MAS NMR study has been reported so far, probably due to the safety issues that need to be carefully addressed for rotating a radioactive sample. We have recently developed an appropriate NMR instrumentation (using a DOTY $^3$H/ $^1$H/X XC4 probehead) and demonstrated the feasibility of $^3$H MAS NMR experiments on model compounds: distance measurements up to 14$\mathring{A}$ could be reached and medium-range distances (4-8$\mathring{A}$) could be determined with an unprecedented resolution (0.02$\mathring{A}$). In this work, we extend these experiments to a relevant system for biological studies, the diphenylalanine peptide which has recently attracted great attention for the development of DNP-based $^{13}$C-$^{13}$C distances measurements at natural abundance. Reliable distances could be determined up to 7A so that our methodology can perfectly complement these experiments. Regarding NMR methodologies, $^1$H-$^3$H Cross Polarization was found to work very effectively and yielded a significant enhancement of the signal, mainly as a consequence of the much shorter relaxation time of protons. A moderate spinning rate of typically 8 kHz was found to be sufficient in obtaining narrow $^3$H MAS NMR peaks with an excellent resolution of 0.01-0.02 ppm. Specificities of the strongly coupled $^1$H-$^3$H nuclear spins system will be discussed, especially with regards to the choice of the pulse sequences for $^3$H-$^3$H dipolar recoupling where HORROR was found to be the most efficient one. Indeed, it requires only a moderate $^3$H RF field while strong $^1$H decoupling can be applied, thus keeping the total RF power reasonable on the two channels which are very close in frequency. Our distance measurements were combined to Molecular Dynamics simulations and DFT computations of NMR shifts in the perspective to develop an integrated $^3$H MAS NMR methodology to determine conformation of a small molecule self-assembled to form large-architecture

Introducing Tritium (3H) MAS NMR in biosolids: application to crystalline diphenylalanine

International audienceTritium ($^3$H) possesses the highest gyromagnetic ratio of the periodic table and its negligible natural abundance (3×10-16 %) ensures that no background signal is observed, in contrast to ubiquitous proton ($^1$H), so that one can work at a very low concentration (in the present work less than 0.1%) while maintaining a very good sensitivity. Despite these appealing features, only very few $^3$H MAS NMR study has been reported so far, probably due to the safety issues that need to be carefully addressed for rotating a radioactive sample. We have recently developed an appropriate NMR instrumentation (using a DOTY $^3$H/ $^1$H/X XC4 probehead) and demonstrated the feasibility of $^3$H MAS NMR experiments on model compounds: distance measurements up to 14$\mathring{A}$ could be reached and medium-range distances (4-8$\mathring{A}$) could be determined with an unprecedented resolution (0.02$\mathring{A}$). In this work, we extend these experiments to a relevant system for biological studies, the diphenylalanine peptide which has recently attracted great attention for the development of DNP-based $^{13}$C-$^{13}$C distances measurements at natural abundance. Reliable distances could be determined up to 7A so that our methodology can perfectly complement these experiments. Regarding NMR methodologies, $^1$H-$^3$H Cross Polarization was found to work very effectively and yielded a significant enhancement of the signal, mainly as a consequence of the much shorter relaxation time of protons. A moderate spinning rate of typically 8 kHz was found to be sufficient in obtaining narrow $^3$H MAS NMR peaks with an excellent resolution of 0.01-0.02 ppm. Specificities of the strongly coupled $^1$H-$^3$H nuclear spins system will be discussed, especially with regards to the choice of the pulse sequences for $^3$H-$^3$H dipolar recoupling where HORROR was found to be the most efficient one. Indeed, it requires only a moderate $^3$H RF field while strong $^1$H decoupling can be applied, thus keeping the total RF power reasonable on the two channels which are very close in frequency. Our distance measurements were combined to Molecular Dynamics simulations and DFT computations of NMR shifts in the perspective to develop an integrated $^3$H MAS NMR methodology to determine conformation of a small molecule self-assembled to form large-architecture

Control of peptide nanotube diameter by chemical modifications of an aromatic residue involved in a single close contact.

International audienceSupramolecular self-assembly is an attractive pathway for bottom-up synthesis of novel nanomaterials. In particular, this approach allows the spontaneous formation of structures of well-defined shapes and monodisperse characteristic sizes. Because nanotechnology mainly relies on size-dependent physical phenomena, the control of monodispersity is required, but the possibility of tuning the size is also essential. For self-assembling systems, shape, size, and monodispersity are mainly settled by the chemical structure of the building block. Attempts to change the size notably by chemical modification usually end up with the loss of self-assembly. Here, we generated a library of 17 peptides forming nanotubes of monodisperse diameter ranging from 10 to 36 nm. A structural model taking into account close contacts explains how a modification of a few Å of a single aromatic residue induces a fourfold increase in nanotube diameter. The application of such a strategy is demonstrated by the formation of silica nanotubes of various diameters