Renouveler la gestion du risque par l’ouverture à un système de vigilance ?

Cet article rédigé par un groupe multidisciplinaire de vétérinaires et de politologues propose une analyse contextualisée des transformations à l’œuvre dans le réseau de surveillance des maladies animales face aux menaces nouvelles dites « émergentes » suite aux changements globaux, en l’inscrivant dans le cadre de la gestion des risques. Le travail se base sur une présentation d’une émergence récente, celle de la fièvre catarrhale ovine due au Bluetongue virus serotype 8 (BTV-8) en 2006 en Belgique. Celle-ci permet de mettre en contexte les enseignements d’une enquête récente de type Delphi organisée auprès des responsables administratifs et des scientifiques concernés, qui a montré que la plupart des moyens proposés par les autorités reposent sur une logique de gestion des risques connus. On observe néanmoins des tentatives de renouvellement et d’ouverture, par la mise en place de nouveaux instruments de vigilance : s’appuyant sur une double logique de prévention et d’anticipation de la catastrophe, ils tentent d’adapter les structures de surveillance et d’alerte pour améliorer leur réactivité face aux évènements non prévus. Une double remise en cause se dessine, qui pousse à admettre la permanence d’une incertitude irréductible et à reconnaître le nécessaire décloisonnement des savoirs experts.This contribution proposed by a multidisciplinary group of veterinary and political scientists gives an analysis of the transformations of an epidemiosurveillance system dedicated to animal diseases, when confronted to new emerging threats in the wake of global changes, within the frame of risk management. The research field refers to the emergence of bluetongue virus serotype 8 in 2006 in Belgium. This research is complemented with the results of a recent survey based on Delphi method involving relevant public servants and scientists, which showed that most of the means proposed by the authorities are based on the logic of known risk management. However we can identify attempts for renewal and organisational learning, especially with the proposal of a new vigilance system. This system develops two dimensions (prevention and anticipation of the catastrophe) and tries to accommodate the surveillance system reactivity against uncertain events. Finally the article draws two drivers for change, by admitting the persistence of unavoidable uncertainty and by recognising the importance for opening up expert knowledge

Renouveler la gestion du risque par l’ouverture à un système de vigilance ? Le cas de la fièvre catarrhale ovine

Cet article rédigé par un groupe multidisciplinaire de vétérinaires et de politologues propose une analyse contextualisée des transformations à l’oeuvre dans le réseau de surveillance des maladies animales face aux menaces nouvelles dites « émergentes » suite aux changements globaux, en l’inscrivant dans le cadre de la gestion des risques. Le travail se base sur une présentation d’une émergence récente, celle de la fièvre catarrhale ovine due au Bluetongue virus serotype 8 (BTV-8) en 2006 en Belgique. Celle-ci permet de mettre en contexte les enseignements d’une enquête récente de type Delphi organisée auprès des responsables administratifs et des scientifiques concernés, qui a montré que la plupart des moyens proposés par les autorités reposent sur une logique de gestion des risques connus. On observe néanmoins des tentatives de renouvellement et d’ouverture, par la mise en place de nouveaux instruments de vigilance : s’appuyant sur une double logique de prévention et d’anticipation de la catastrophe, ils tentent d’adapter les structures de surveillance et d’alerte pour améliorer leur réactivité face aux évènements non prévus. Une double remise en cause se dessine, qui pousse à admettre la permanence d’une incertitude irréductible et à reconnaître le nécessaire décloisonnement des savoirs experts.This contribution proposed by a multidisciplinary group of veterinary and political scientists gives an analysis of the transformations of an epidemiosurveillance system dedicated to animal diseases, when confronted to new emerging threats in the wake of global changes, within the frame of risk management. The research field refers to the emergence of bluetongue virus serotype 8 in 2006 in Belgium. This research is complemented with the results of a recent survey based on Delphi method involving relevant public servants and scientists, which showed that most of the means proposed by the authorities are based on the logic of known risk management. However we can identify attempts for renewal and organisational learning, especially with the proposal of a new vigilance system. This system develops two dimensions (prevention and anticipation of the catastrophe) and tries to accommodate the surveillance system reactivity against uncertain events. Finally the article draws two drivers for change, by admitting the persistence of unavoidable uncertainty and by recognising the importance for opening up expert knowledge

Renouveler la gestion du risque par l’ouverture à un système de vigilance ?

This contribution proposed by a multidisciplinary group of veterinary and political scientists gives an analysis of the transformations of an epidemiosurveillance system dedicated to animal diseases, when confronted to new emerging threats in the wake of global changes, within the frame of risk management. The research field refers to the emergence of bluetongue virus serotype 8 in 2006 in Belgium. This research is complemented with the results of a recent survey based on Delphi method involving relevant public servants and scientists, which showed that most of the means proposed by the authorities are based on the logic of known risk management. However we can identify attempts for renewal and organisational learning, especially with the proposal of a new vigilance system. This system develops two dimensions (prevention and anticipation of the catastrophe) and tries to accommodate the surveillance system reactivity against uncertain events. Finally the article draws two drivers for change, by admitting the persistence of unavoidable uncertainty and by recognising the importance for opening up expert knowledge

Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia The ANTICOVID Randomized Clinical Trial

International audienceIMPORTANCE Given the high risk of thrombosis and anticoagulation-related bleeding in patients with hypoxemic COVID-19 pneumonia, identifying the lowest effective dose of anticoagulation therapy for these patients is imperative. OBJECTIVES To determine whether therapeutic anticoagulation (TA) or high-dose prophylactic anticoagulation (HD-PA) decreases mortality and/or disease duration compared with standard-dose prophylactic anticoagulation (SD-PA), and whether TA outperforms HD-PA; and to compare the net clinical outcomes among the 3 strategies. DESIGN, SETTINGS, AND PARTICIPANTS The ANTICOVID randomized clinical open-label trial included patients with hypoxemic COVID-19 pneumonia requiring supplemental oxygen and having no initial thrombosis on chest computer tomography with pulmonary angiogram at 23 health centers in France from April 14 to December 13, 2021. Of 339 patients randomized, 334 were included in the primary analysis-114 patients in the SD-PA group, 110 in the HD-PA, and 110 in the TA. At randomization, 90% of the patients were in the intensive care unit. Data analyses were performed from April 13, 2022, to January 3, 2023. INTERVENTIONS Patients were randomly assigned (1:1:1) to receive either SD-PA, HD-PA, or TA with low-molecular-weight or unfractionated heparin for 14 days. MAIN OUTCOMES AND MEASURES A hierarchical criterion of all-cause mortality followed by time to clinical improvement at day 28. Main secondary outcome was net clinical outcome at day 28 (composite of thrombosis, major bleeding, and all-cause death). RESULTS Among the study population of 334 individuals (mean [SD] age, 58.3 [13.0] years; 226 [67.7%] men and 108 [32.3%] women), use of HD-PA and SD-PA had similar probabilities of favorable outcome (47.3% [95%CI, 39.9% to 54.8%] vs 52.7%[95%CI, 45.2%to 60.1%]; P = .48), as did TA compared with SD-PA (50.9% [95%CI, 43.4%to 58.3%] vs 49.1% [95%CI, 41.7%to 56.6%]; P = .82) and TA compared with HD-PA (53.5%[95%CI 45.8% to 60.9%] vs 46.5% [95%CI, 39.1% to 54.2%]; P = .37). Net clinical outcome was met in 29.8% of patients receiving SD-PA (20.2%thrombosis, 2.6%bleeding, 14.0% death), 16.4% receiving HD-PA (5.5%thrombosis, 3.6%bleeding, 11.8%death), and 20.0% receiving TA (5.5% thrombosis, 3.6% bleeding, 12.7%death). Moreover, HD-PA and TA use significantly reduced thrombosis compared with SD-PA (absolute difference, -14.7 [95%CI -6.2 to -23.2] and -14.7 [95%CI -6.2 to -23.2], respectively). Use of HD-PA significantly reduced net clinical outcome compared with SD-PA (absolute difference, -13.5; 95%CI -2.6 to -24.3). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that compared with SD-PA, neither HD-PAnor TAuse improved the primary hierarchical outcome of all-cause mortality or time to clinical improvement in patients with hypoxemicCOVID-19 pneumonia; however, HD-PA resulted in significantly better net clinical outcome by decreasing the risk of de novo thrombosis