Objectif
: La douleur abdominale aiguë est un motif fréquent de consultation aux urgences. L’identification des urgences chirurgicales est parfois difficile devant la faible spécificité des signes ...cliniques. L’objectif de cette étude était de déterminer si la présence d’une douleur intense était associée à un diagnostic d’urgence chirurgicale.
Méthodes
: Il s’agit d’une étude observationnelle, rétrospective, monocentrique. Les patients adultes admis aux urgences pour une douleur abdominale aiguë entre le 1er janvier et le 31 décembre 2018 ont été inclus. L’intensité de la douleur était mesurée par l’infirmier d’orientation et d’accueil via une échelle numérique (EN). Les patients ont été classés en deux groupes selon l’intensité de leur douleur (EN ≥ 6 et EN < 6). Le diagnostic posé aux urgences était réparti en deux catégories : urgences chirurgicales et pathologies médicales. Les comparaisons ont été réalisées à l’aide des tests univariés de Wilcoxon et du Chi2 puis d’un modèle logistique multivarié.
Résultats
: Au total, 4 493 patients ont été inclus, dont 2 491 femmes (55 %). L’âge médian était de 39 ans EIQ : 27–56. Un diagnostic d’urgence chirurgicale a été posé chez 677 patients (15 %), l’appendicite et l’occlusion digestive étant les diagnostics les plus fréquents. Une douleur intense était significativement associée à une urgence chirurgicale (OR : 1,28 ; IC 95 % : 1,04–1,57), tout comme le sexe masculin et un âge, une fréquence cardiaque et une température plus élevés.
Conclusion
: La présence d’une douleur intense (EN ≥ 6) est associée à un diagnostic d’urgence chirurgicale chez les patients consultant aux urgences pour une douleur abdominale aiguë.
Aim
: Acute abdominal pain is a common reason for emergency department (ED) visits. The identification of surgical emergencies is sometimes difficult due to the low specificity of clinical signs. The aim of our study was to assess whether the presence of severe pain was associated with a surgical emergency diagnosis.
Procedure
: This was a single-center, retrospective, observational study. All adult patients admitted to the ED with acute abdominal pain between January 1st and December 31st, 2018, were included. Pain intensity was measured by the triage nurse on a numerical scale (NS). Patients were classified into two groups according to their pain intensity (NS ≥ 6 and NS < 6). The diagnosis made in the ED was divided into two categories: surgical or medical cases. Comparisons between groups were made using Wilcoxon and Chi2 tests and then a multivariate logistic model.
Results
: A total of 4,493 patients were included, out of which 2,491 were women (55%). The median age was 39 years (IQR: 27–56). A surgical diagnosis was made in 677 patients (15%), appendicitis and bowel obstruction being the most common diagnoses. Severe pain was significantly associated with surgical emergency (OR: 1.28; CI 95%: 1.04–1.57), as were male gender and higher age, heart rate, and temperature.
Conclusion
: The presence of severe pain (NS ≥ 6) is associated with a surgical emergency diagnosis in patients visiting the ED for acute abdominal pain.
Parasitoid wasps are valuable biological control agents that suppress their host populations. Factors introduced by the female wasp at parasitization play significant roles in facilitating successful ...development of the parasitoid larva either inside (endoparasitoid) or outside (ectoparasitoid) the host. Wasp venoms consist of a complex cocktail of proteinacious and non-proteinacious components that may offer agrichemicals as well as pharmaceutical components to improve pest management or health related disorders. Undesirably, the constituents of only a small number of wasp venoms are known. In this article, we review the latest research on venom from parasitoid wasps with an emphasis on their biological function, applications and new approaches used in venom studies.
Objectif
: Le taux de vacance de poste des médecins est estimé à 23 % dans les services d’urgence (SU). L’objectif de l’étude était d’identifier des facteurs d’attractivité potentiels des SU en ...France.
Méthodes
: Cette étude est composée de deux enquêtes observationnelles transversales nationales. La première, adressée aux responsables de service, comparait les facteurs d’attractivité entre les SU à faible et forte vacance de poste. La seconde, réalisée auprès des médecins urgentistes, hiérarchisait par évaluation numérique (échelle de 1 à 10) l’attractivité des différents facteurs.
Résultats
: Concernant l’enquête auprès des responsables de service, 76 SU ont été inclus : 47 à forte vacance de poste et 29 à faible vacance de poste. Le taux de vacance globale était de 23 %. En analyse univariée, les facteurs associés significativement à une faible vacance de poste étaient un nombre annuel de passages élevé (OR = 1,03 1,01–1,06 pour 1 000 passages supplémentaires ;
p
= 0,03), un faible taux d’hospitalisation (OR = 0,93 0,85–0,99 par pourcentage supplémentaire ;
p
= 0,04), la possibilité d’enseignement facultaire (OR = 3,07 1,05–9,33 ;
p
= 0,02), le respect du temps de travail hebdomadaire (OR = 0,10 0,01–0,54 si temps de travail ≥ 48 heures par rapport à 39 heures ;
p
= 0,02) et une bonne ambiance au sein du service (OR = 10,0 2,12–74,5 si ambiance excellente par rapport à moyenne ;
p
= 0,02). Concernant l’enquête auprès des médecins urgentistes, 971 ont répondu. Les trois facteurs considérés comme les plus attractifs étaient l’ambiance au sein du service, la facilité d’aval et la présence d’un service de réanimation. La qualité de vie au travail était la thématique d’attractivité la plus importante pour les médecins urgentistes.
Conclusion
: Les facteurs liés à la qualité de vie au travail et certaines caractéristiques hospitalières sont associés à une plus faible vacance de poste et qualifiés d’attractifs par les médecins urgentistes.
Aim
: The vacancy rate for physicians is estimated at 23% in emergency departments (EDs). The aim of the study was to identify potential attractiveness factors in French EDs.
Procedure
: This study consisted of two national cross-sectional observational surveys. The first, addressed to ED’s heads, compared the attractiveness factors between EDs with low and high vacancies. The second, addressed to emergency physicians, ranked the attractiveness of the different factors by numerical evaluation (scale of 1–10).
Results
: For the department heads survey, 76 EDs were included: 47 with high vacancy and 29 with low vacancy. The overall vacancy rate was 23%. In univariate analysis, factors significantly associated with low vacancy were higher number of annual visits (odds ratio OR = 1.03 1.01–1.06 per 1,000 additional visits;
P
= 0.03), lower hospitalisation rate (OR = 0.93 0.85–0.99 per additional percentage;
P
= 0.04), opportunity for faculty teaching (OR = 3.07 1.05–9.33;
P
= 0.02), respect for weekly working hours (OR = 0.10 0.01–0.54 if working time ≥ 48 vs. 39 h;
P
= 0.02) and a good working atmosphere within the department (OR = 10.0 2.12–74.5 if excellent vs. moderate;
P
= 0.02). Regarding the survey of emergency physicians, 971 responded. The three factors considered most attractive were the working atmosphere within the department, the ease of movement out of the ED and the presence of an intensive care unit. Quality of work life was the most important attractiveness factor for emergency physicians.
Conclusion
: Factors related to quality of work life and few hospital characteristics are associated with lower vacancy rates and considered as attractive by emergency physicians.
La transfusion est un acte médical délégué couramment effectué en unités de soins. L’hémovigilance nationale, suite à des évènements indésirables graves, dispose d’une réglementation fournie. Le ...recueil des données centralisées dans la base nationale e-FIT et son analyse nous permettent de détecter les dysfonctionnements survenant au décours de l’acte transfusionnel. La sécurité transfusionnelle repose sur un respect strict des étapes d’un processus qui va de la prescription des produits sanguins labiles et des examens immuno-hématologiques érythrocytaires nécessaires jusqu’à l’administration de PSL au receveur et à son suivi. Dans la circulaire relative à l’acte transfusionnel, plusieurs étapes du processus, moins explicites, peuvent être interprétées différemment par les professionnels et être à l’origine de dysfonctionnements graves. La protocolisation de la pose de la transfusion et de sa surveillance, permettrait d’uniformiser sa réalisation et son suivi de manière sécurisée et d’éviter un risque potentiel chez le patient.
Blood transfusion is currently a delegated medical act in patient care services. Following severe adverse events, hemovigilance now disposes of a dense regulation. Data collection and analysis in the national hemovigilance “e-FIT” database allow detection of errors or malfunctions in the transfusion act. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. In the circular relative to the transfusion act, many steps of the transfusion process, less explicit, can be interpreted differently by health care professionals and thus lead to errors or severe adverse events. Standardization of procedures for the transfusion act and its surveillance would increase their safety and avoid potential risks for the patient.
Bacterial control and decontamination are crucial to industrial safety assessments. However, most recently developed materials are not compatible with standard heat sterilization treatments. Advanced ...oxidation processes, and particularly non-thermal plasmas, are emerging and promising technologies for sanitation because they are both efficient and cheap. The applications of non-thermal plasma to bacterial control remain poorly known for several reasons: this technique was not developed for biological applications and most of the literature is in the fields of physics and chemistry. Moreover, the diversity of the devices and complexity of the plasmas made any general evaluation of the potential of the technique difficult. Finally, no experimental equipment for non-thermal plasma sterilization is commercially available and reference articles for microbiologists are rare. The present review aims to give an overview of the principles of action and applications of plasma technologies in biodecontamination.
Abstract Objective Indocyanine green fluorescence-guided surgery (ICG-FGS) has emerged as a potential new imaging modality for improving the detection of hepatic, lymph node (LN), and peritoneal ...metastases in colorectal cancer (CRC) patients. The aim of this paper is to review the available literature in the clinical setting of ICG-FGS for tumoral detection in various fields of metastatic colorectal disease. Methods PubMed and Medline literature databases were searched for original articles on the use of ICG in the setting of clinical studies on colorectal cancer. The search terms used were “near-infrared fluorescence”, “intraoperative imaging”, “indocyanine green”, “human” and “colorectal cancer”. Results ICG fluorescence imaging (ICG-FI) is clearly supported as an intraoperative technique that allows the detection of additional superficial hepatic metastases of CRC. Data on the role of ICG-FI in the intraoperative detection of peritoneal metastases and LN metastases are scarce but encouraging and ICG-FI could potentially improve the staging and treatment of these patients. Conclusion ICG-FI is a promising imaging technique in the detection of small infraclinic LN, hepatic, and peritoneal metastatic deposits that may allow better staging and more complete surgical resection with a potential prognostic benefit for patients.
Les vigilances sanitaires sont apparues au fil du temps. Certaines possèdent un échelon régional, et toutes se trouvent regroupées à l’Agence nationale de sécurité du médicament et des produits de ...santé. Avec la certification des établissements de santé (ES), la coordination des vigilances a évolué : son existence semblait facultative dans la première version de la certification, puis s’est imposée aux ES dans les versions suivantes, en précisant les actions à entreprendre. En parallèle, la gestion des risques au sein d’un établissement de santé est en plein essor. La coordination des vigilances trouve avantage dans le partage d’un système déclaratif commun avec la gestion des risques associés aux soins. La collaboration de la coordination des vigilances et de la gestion des risques permet d’élaborer une cartographie a priori des risques, de mettre en place des analyses des évènements indésirables et d’utiliser la notion de criticité dans le cadre d’une culture sécuritaire globale pour l’établissement de santé.
Health care vigilance committees appeared with time in France. Some vigilance entities are present at a regional level, but all are found at the National Drugs and Health Care Products Safety Agency. Along with health care centers’ certification, vigilance committees’ coordination has evolved: whereas its presence was optional in the first version of certification, it has now imposed itself within health care centers with the more recent versions of certification, detailing the actions it must undertake. In parallel, a lot of attention is put on health care-related risk management with a health care center. Vigilances’ coordination can thus take advantage of this in sharing an incident declaration system common with that of health care-related risks management. This collaboration will enable the generation of a priori risks’ maps, help analyze adverse events and use the notion of criticality within a global safe care policy in each health care facility.
Carbonaceous asteroids, such as (101955) Bennu, preserve material from the early Solar System, including volatile compounds and organic molecules. We report spacecraft imaging and spectral data ...collected during and after retrieval of a sample from Bennu’s surface. The sampling event mobilized rocks and dust into a debris plume, excavating a 9-meter-long elliptical crater. This exposed material is darker, spectrally redder, and more abundant in fine particulates than the original surface. The bulk density of the displaced subsurface material was 500 to 700 kilograms per cubic meter, which is about half that of the whole asteroid. Particulates that landed on instrument optics spectrally resemble aqueously altered carbonaceous meteorites. The spacecraft stored 250 ± 101 grams of material, which will be delivered to Earth in 2023.
Grabbing a sample of asteroid Bennu
The near-Earth carbonaceous asteroid Bennu was the target of the OSIRIS-REx (Origins, Spectral Interpretation, Resource Identification, Security-Regolith Explorer) sample return mission. After rendezvousing with the asteroid, the spacecraft spent 2 years studying its surface and selecting a suitable site. Lauretta
et al
. describe the sample collection process and its effects on Bennu. The asteroid provided almost no resistance to contact, and the gas released by the spacecraft blew a crater several meters wide, exposing redder rocks and dust. So much material was gathered that the collection chamber overflowed. Approximately 250 grams was successfully stowed, well above the mission goal of 60 grams. The samples are expected to arrive on Earth in September 2023. —KTS
Samples of the near-Earth asteroid Bennu were collected by the OSIRIS-REx mission and should arrive on Earth in 2023.
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