Les troubles de la production du langage chez les patients schizophrènes jeunes : altération des compétences ou des performances ?

PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

Empleo de satélites militares de observación terrestre y el apoyo a las patrullas de la 1ra Brigada de Fuerzas Especiales, 2016

En esta investigación se planteó determinar en qué medida el empleo de satélites militares de observación terrestre influye en el desempeño de las patrullas de la 1ra Brigada de Fuerzas Especiales, 2016. Para ello, se realizó una investigación exhaustiva sobre el empleo de satélites militares de observación terrestre desde la perspectiva del desempeño de las patrullas de la 1ra Brigada de Fuerzas Especiales. En la presente investigación se utilizó un enfoque cuantitativo, siendo una investigación de tipo básica de nivel descriptivo correlacional, de un diseño no experimental, de carácter transversal, se utilizó la técnica de la encuesta y cuestionario para los oficiales de la 1ra Brigada de Fuerzas Especiales; mediante un análisis de contenidos de la doctrina militar vigente, aplicándose el estadístico de la Chi cuadrada para realizar las contrastaciones de las hipótesis planteadas, para una población y muestra no probabilística de treinta (30) oficiales pertenecientes a la 1ra Brigada de Fuerzas Especiales. El resultado y conclusión del presente trabajo nos ha permitido determinar que los satélites de observación, se emplean tanto para uso civil como militar; siendo este último el que se encargan de ayudar en las operaciones militares, con el objetivo de garantizar nuestra Seguridad Nacional. En nuestro país y particularmente en la actualidad en la región del VRAEM, los satélites de observación se constituyen en una herramienta primordial para dar seguridad al personal y proporcionar información en tiempo real para el desarrollo de las operaciones. Atendiendo a los calibres, los tipos de armamento de última generación y las características técnicas y tácticas; lo cual valida la hipótesis planteada; por lo tanto, se ha logrado alcanzar los objetivos planteados. Palabras clave: empleo de satélite, apoyo a las patrullas, fuerzas especiales

National prospective study on the use of local haemostatic agents during partial nephrectomy

International audienceOBJECTIVE:To assess the use of local haemostatic agents (HAs) in a prospective multicentre large series of partial nephrectomies (PNs).PATIENTS AND METHODS:Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy (NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010. In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed.RESULTS:The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm. An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024). In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%). One or more additional haemostatic action(s) was needed in 12.3% of the cases. When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size (P = 0.542), collecting system drainage (P = 0.538), hospital stay (P = 0.508), operation time (P = 0.169), blood loss (P = 0.387) or transfusion rate (P = 0.713).CONCLUSION:HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)