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Biomedical subjects

P Michel

Publications and source records attributed to P Michel.

At least 19 recordsLinked to original sources
PubMed2003

[Damage control laparotomy for haemorragic abdominal trauma. A retrospective multicentric study about 109 cases].

AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.

Abdominal Injuries↗
PubMed2003

[Individual and collective facilitators of and barriers to the use of clinical practice guidelines by physicians: a literature review].

BACKGROUND: The effectiveness of Clinical Practice Guidelines (CPG) diffusion to physicians depends on local barriers or facilitators related to the CPG, to the individual clinician and the professional context. Our project aimed to retrieve, by a literature review, all the facilitators of and barriers to physician's adherence to CPG and propose a classification of these barriers and facilitators. METHOD: A comprehensive review of the literature. We searched in Medline, Healthstar, Current contents, Cochrane library databases, consulted experts in the domain of CPG implementation and reviewed study bibliography to retrieve all original reports studying facilitators of and barriers to physician's adherence to CPG (inclusion criteria). The article selection followed a two stepped procedure: first, quick reading of the retrieved articles, then reading in depth of the potentially appropriate articles. RESULTS: Fifty nine studies published between 1986 and 2001 were eligible. The majority (29 studies) used a quantitative design, having studied the statistical association between some a priori defined barriers or facilitators (collected by questionnaires or by record audits) and CPG use. The others have used a qualitative design (barriers and facilitators collected through qualitative methods or open-ended questions in questionnaires) (21 studies) or a mixed design (qualitative and quantitative) (8 studies). Study samples sizes ranked between 10 and 1878 physicians. The CPG were mostly about prevention or curative care. The retrieved barriers or facilitators were classified into three categories: 1) the CPG characteristics (form, compatibility, trialability, scientific basis, observability, adaptability, legal implications) (27 articles), 2) the physician characteristics (knowledge about CPG, attitude and agreement to CPG, psychological and socio-demographic and economic characteristics, job satisfaction, training) (38 articles), 3) the physician environment (divided into 3a the physician human environment--the patient influence and the pairs influence (16 articles)--and 3b the physician organizational environment--the internal environment and the external environment (33 articles). CONCLUSION: The interpretation of the results is hampered by the absence of previous conceptual framework of the barriers or facilitators and by the absence of multifactorial analysis.

Clinical Competence↗
PubMed2003

[The development of a core set of quality of care indicators in a psychiatric hospital].

The Camille Claudel psychiatric hospital developed a table of a core set of quality indicators based upon a standarized description form and a critical appraisal grid that were recently released. The authors' aims were to study the validity of these tools and the main methodological difficulties faced professionals in the field in the process of developing their indicators. A multi-disciplinary working group from this hospital developed 43 indicators which were subsequently analysed by methodologists. Out of the 43 indicators, variables needed to calculate the indicators were incomplete for 30, the sampling method inappropriate in five, the means of data quality control not defined in 18, and the stratification and adjustment concepts mixed up in 6. Moreover, 14 indicators were excluded due to their lack of relevance or feasibility. The experience demonstrates the capacity of a hospital, without internal epidemiological or methodological competence, to develop its own set of quality indicators. The provision of methodological assistance and supervision, based upon tools proven to be relevant and effective, seems to be crucial in training professionals and helping them to select and improve their indicators.

France↗
PubMed2003

[Mycotic aneurysm of the extracranial internal carotid artery].

Extracranial internal carotid artery aneurysm is rare. They usually appear as an enlarging pulsatile neck mass with associated tenderness and fever. The diagnosis is difficult and can lead to significant medical morbidity. Treatment of these lesions requires expert surgical management and necessitates an assiduous search for an underlying source. We report a case of a mycotic aneurysm of the extracranial carotid artery in an immunosuppressed patient successfully treated by wide excision and saphenous vein patch angioplasty.

Aneurysm, Infected↗
PubMed2002

Reduction of the coherence time of an intense laser pulse propagating through a plasma.

We present direct measurements of the coherence time of a laser beam after propagation through an underdense plasma. At an intensity of 10(14) W/cm(2), a large decrease of the coherence time is observed, from 300 ps to a few picoseconds. This decrease is larger as the plasma density is increased or as the light is scattered at larger angles. The amount of temporal decorrelation as well as the effect of the plasma density, laser intensity, and scattering angle all coincide with trends observed in recent numerical simulations.

Journal Article↗
PubMed2002

[Adaptation of perfusion flow during reperfusion to protect ischemic myocardium from calcium loading].

The aim of this study was (i) to evaluate calcium exchanges occurring during the first stage of reperfusion, and (ii) to investigate the effect of reperfusion flow applied on safe and ischemic hearts. Pig hearts (n = 20) were arrested with cardioplegia and randomly assigned into 2 groups: an ischemic group (1 hour in vitro ischemia at 38 degrees C) versus control group, before being subjected to aortic reperfusion (using 1 and 0.1 ml min-1 g-1 perfusion flow). Both oedema and arterio-venous differences in calcium were analysed during reperfusion. The data showed myocardial Ca++ loading in control hearts reperfused at low flow (p < 0.01) and in ischemic hearts reperfused at high flow (p < 0.01), whereas a low flow reperfusion appeared to protect ischemic hearts. In all groups, reperfusion oedema was greater than 20%. In conclusion, the data suggest that reperfusion flow of arrested hearts should be adapted to the state of the heart: a high flow, necessary for a safe heart, can be deleterious for ischemic heart, whereas a low flow, protective for ischemic hearts, can be deleterious for safe heart.

Animals↗
PubMed2002

Escherichia coli O157:H7 infection in cows and calves in a beef cattle herd in Alberta, Canada.

Escherichia coli O157:H7 infection of cows and calves in a naturally-infected beef cattle herd in Alberta, Canada, was investigated over 2 years, encompassing two calf production cycles. In both years of the study, E. coli O157:H7 was isolated from the faeces of cows shortly after but not before parturition in late winter: 6/38 (16%) in 1996 and 13/50 (26%) in 1997. At < 1 week post-partum, 13/52 (25%) calves born in 1997 were shedding the organism. Faecal shedding of E. coli O157:H7 by cows and calves continued over the 7 weeks that they were in the calving pens, with the organism being isolated from the faeces of 2-18% of cows and 23-26% of calves during this period. Five weeks after they were moved onto a native grass pasture, all the calves and all but one cow in 1997 had ceased shedding the organism. When the calves were weaned in the fall, E. coli O157:H7 was isolated from the faeces of 0-1.5% of the calves 1 week prior to weaning and from 6-14% of the calves within 2 weeks after weaning. Parturition, calving pens and weaning appear to be important factors in maintaining E. coli O157:H7 infections in this beef cattle herd. Isolates from cows and calves during the immediate post-partum period were mostly of the same pulsed-field gel electrophoresis (PFGE) type of E. coli O157:H7. Similarly, at weaning a common PFGE type of E. coli O157:H7, which differed slightly from the post-partum PFGE type, was isolated from the calves. These typing data suggest a common source of infection for the animals as well as demonstrate clonal turnover of resident populations of this pathogen.

Animals↗
PubMed2001

Collisions and gravitational reaccumulation: forming asteroid families and satellites.

Numerical simulations of the collisional disruption of large asteroids show that although the parent body is totally shattered, subsequent gravitational reaccumulation leads to the formation of an entire family of large and small objects with dynamical properties similar to those of the parent body. Simulations were performed in two different collisional regimes representative of asteroid families such as Eunomia and Koronis. Our results indicate that all large family members must be made of gravitationally reaccumulated fragments; that the post-collision member size distribution and the orbital dispersion are steeper and smaller, respectively, than for the evolved families observed today; and that satellites form frequently around family members.

Journal Article↗
PubMed2001

[Evaluation of pain management at a university hospital center].

OBJECTIVE: A hospital-wide evaluation of the process and results of pain management was set up at the Bordeaux University Hospital, France, as part of a pain management quality improvement program. The methods and the main results of a cross-sectional survey are reported. METHODS: All hospitalized patients, all nurses, and all head physicians the day of the survey were interviewed in a "given day" cross-sectional study. Six validated self-assessment or behavioral rating scales of pain were administered by three trained interviewers. Six process and result indicators were elaborated by a multiple-professional working group to allow simple and rapid feedback to the wards. RESULTS: A total of 2254 patients (87% of the population), age range 1 day to 101 years, and 203 physicians and 314 nurses in 140 wards participated in the survey. Two processes were satisfactorily performed: delivery of information on pain control at the arrival of the patient and rapidity of medication administration. On the contrary, two out of three painful patients were not detected by both nurses and physicians; one out of three patients were given no treatment in medical wards and one out of five in surgical wards. These proportions were greater for patients unable to self-assess their pain. Nearly 40% did not understand the information on their pain medication. One out of two patients felt that their pain was unrelieved by the treatment. The prevalence of pain was nearly 50% except in geriatric wards (21%) and in pediatric patients aged 5 to 15 years (26%). Patient satisfaction was good for 75% of the adult patients. CONCLUSION: A complete evaluation kit was developed for this first hospital-wide study in France on pain management. The individual and global results, sent to each ward, were designed to help all healthcare workers to become more aware of the urgent need to improve pain management and to serve as a basis for future evaluations.

Adolescent↗
PubMed2001

[Organizational and operational work of death analysis committees: review of experiences].

OBJECTIVES: Among deaths occurring in hospital, some are unexpected at the time of admission and unexplained by the course of the illness at the time of death. Health care givers agree that analysis of the circumstances of death is a powerful method for improving the quality of medical care but are nevertheless reluctant to set up mortality conferences. We present institution-wide experience with mortality conferences, detailing methods used and reviewing adverse care events and avoidable organizational and medical errors associated with unexpected deaths. METHODS: We reviewed literature cited in the Medline and Pascal Biomed databases and completed our findings with consultations with key-informants of hospital evaluation units. Institution-wide experiences alone were analyzed. RESULTS: The death analysis committees were composed of health care givers who review the deaths occurring in their units (internal committees). In rare cases, hospitals set up in addition an external committee for methodological assistance. Implicit criteria were almost always used for death case analysis. DISCUSSION: Death analysis by internal committees appears to contribute to physician's knowledge and provokes a global improvement in patient care. This analysis relies however on implicit criteria which leads to minimal reliability. The lack of reliability has two consequences: the impossibility of identifying causes of preventable deaths and related factors, and the impossibility of evaluating the impact of the internal committee. As there is no available epidemiological data, a sentinel system cannot be proposed: a systematic analysis of all deaths is therefore advisable. Other limitations on internal committees are the difficulty of obtaining autopsies and the problem of the confidentiality of death analysis, a serious handicap recognized by all physicians. A national guide on methodology should be developed.

Cause of Death↗
PubMed2001

Expression and purification of polyhistidine-tagged firefly luciferase in insect cells--a potential alternative for process scale-up.

The coleopteran firefly, Photinus pyralis, luciferase was produced in lepidopteran Trichoplusia ni insect cells using a baculovirus expression vector. The recombinant protein was equipped with a polyhistidine affinity tag at the carboxyl terminus and purified by immobilized metal-ion affinity chromatography in combination with an expanded bed adsorption system. This approach enabled an efficient, one-step purification protocol of a genetically modified luciferase with properties similar to those of the authentic counterpart. According to light emission measurements, the final yield of highly purified protein was 23 mg l(-1) of cell culture. In addition, no specific interaction of interfering substances, such as, ATP, adenylate kinase, nucleoside diphosphokinase, as well as, creatine kinase of the final preparation were identified. Together, the results presented here clearly show that the baculovirus expression system in combination with immobilized metal-ion affinity chromatography is a potential strategy for process scale-up of polyhistidine tagged insect luciferase.

Animals↗