Modulation of cardiac ventricular conduction: Impact on QRS duration, amplitude and dispersion.

Alterations in cardiac impulse conduction may exert both beneficial and detrimental effects. The assessment of ventricular conduction properties is of paramount importance both in clinical and in experimental settings. Currently the duration of the QRS complex is regarded as hallmark of in-vivo assessment of global ventricular conduction time. In addition, the amplitude of the QRS complex has been suggested to reflect ventricular conduction time in man and in rats. Here, for the first time, we systematically investigated the relationship between QRS duration ("QRS") and QRS amplitude ("RS-height"; RSh) in the murine ECG obtained during anesthesia. In mice harbouring a homozygous knockout of the transmembrane protein podoplanin (PDPN-/-; n = 10) we found both a shorter QRS and a greater RSh than in wild-type animals (n = 13). In both genotypes cumulative i.p. administration of 5 mg/kg and 10 mg/kg of the Na channel blocker flecainide resulted in dose-dependent QRS increase and RSh decrease, whereby the drug-induced changes in RSh were greater than in QRS. In both genotypes the flecainide-induced changes in QRS and in RSh were significantly correlated with each other (R = -0.56, P = 0.004). Whereas dispersion of QRS and RSh was similar between genotypes, dispersion of the ratio QRS/RSh was significantly smaller in PDPN-/- than in wild-types. We conclude that in the murine ECG QRS is inversely related to RSh. We suggest that both parameters should be considered in the analysis of ventricular conduction time in the murine ECG.

[Building partnerships from the training of advanced practice nurses]. / Construction de partenariats dès la formation des infirmiers en pratique avancée.

The introduction of advanced practice nurses in France is recent. It requires the development of partnerships from the training stage onwards, in order to promote the integration of these new professionals in the field. In this sense, the university and the university hospital of Bordeaux, in Gironde, have undertaken joint actions.

Degraded Psychophysiological Status in Caregivers and Human Resources Staff during a COVID-19 Peak Unveiled by Psychological and HRV Testing at Workplace.

During COVID-19 pandemic peaks, healthcare professionals are a frontline workforce that deals with death on an almost daily basis and experiences a marked increase in workload. Returning home is also associated with fear of contaminating or be contaminated. An obvious consequence is stress accumulation and associated risks, especially in caregivers in mobility and possibly in human resource teams managing mobility. Here, during the second pandemic peak, we designed a 15-min testing procedure at the workplace, combining HADS and Brief COPE questionnaires with heart rate variability (HRV) recordings to evaluate psychophysiological status in four groups: caregivers in mobility (MOB); human resources teams managing mobility (ADM); caregivers without mobility (N-MOB); and university researchers teaching online (RES). Anxiety, depression, coping strategies, vagally-mediated heart rate regulation, and nonlinear dynamics (entropy) in cardiac autonomic control were quantified. Anxiety reached remarkably high levels in both MOB and ADM, which was reflected in vagal and nonlinear HRV markers. ADM maintained a better problem-solving capacity. MOB and N-MOB exhibited degraded problem-solving capacity. Multivariate approaches show how combining psychological and physiological markers helps draw highly group-specific psychophysiological profiles. Entropy in HRV and problem-solving capacity were highly relevant for that. Combining HADS and Brief COPE questionnaires with HRV testing at the workplace may provide highly relevant cues to manage mobility during crises as well as prevent health risks, absenteeism, and more generally malfunction incidents at hospitals.

Structured Pre-Consultation Interview at the First Call of Caregiver Regarding Memory Consultation: Effects on Caregiver Burden, Expectations, and Quality of Life.

Introduction: Case managers can guide caregivers during their search for care for relatives with neurocognitive disorders. The present study aimed to evaluate the effects of this procedure on caregiver burden and quality of life. Methods: Family caregivers searching for care at a memory clinic before the first consultation were provided written information and they provided verbal consent to participate in this pre-post intervention study. Intervention was a structured pre-consultation phone call interview given by the case manager to inform and organize individualize pathway of care. The mini-Zarit Burden Interview and the EuroQol five-dimensional questionnaire quality of life scores were recorded by an independent assessor before the intervention and 1 month thereafter. An expectation questionnaire was also completed during the assessments. The pre and post scores were compared using the Wilcoxon signed-rank test. Results: In total, 45 participants were enrolled and 35 were assessed twice. There was no significant change in the total mini-Zarit Burden Interview score; however, the levels of stress due to caring and meeting familial responsibilities (p = 0.025), and the fear of what the future holds for the participants' relative (p = 0.01) was lower at 1 month. The need for information about the pathways of care decreased, but no change in support satisfaction was observed. Quality of life was good and did not change. Conclusions: During the pre-consultation intervention, the case manager may fulfill several needs of caregivers, particularly to obtain personalized information, which should be implemented in memory clinics.

Randomized study of antiseptic application technique in healthy volunteers before vascular access insertion (TApAS trial).

BACKGROUND: In France about 32% of hospitalized patients have a vascular access placement. However, a common complication associated with these is catheter-related bloodstream infection (CRBI) due to the introduction of microorganisms from the skin during catheter insertion. There is no consensus on the best way to clean the skin prior to catheter insertion, which could be a key element of CRBI prevention. The two techniques most commonly used to apply antiseptic to the skin are the concentric circle and back-and-forth techniques, but these have not been compared in clinical trials. Hence, this study conducted this comparison. METHODS: This single-center, non-comparative, randomized, matched pilot study investigated the levels of cutaneous microorganisms before and after antiseptic application using both techniques in a population of healthy French volunteers. The two application methods were used on each participant's arms at the elbow fold, with randomization for the application side (right or left). Quantification of cutaneous microorganisms was performed in a blinded manner with regard to the technique used. FINDINGS: From April 8 to July 17, 2019, 132 healthy volunteers participated in the study. For the whole study population, the mean initial colonization level was 2.68 log10 colony forming units (CFU)/mL (SD 0.82) before the back-and-forth technique, and 2.66 log10 CFU/mL (SD 0.85) before the concentric circle technique. The mean differences in number of microorganisms between the initial sample and the final sample were 2.45 log10 CFU/mL (95% CI: 2.29 to 2.61) for the back-and-forth technique and 2.43 log10 CFU/mL (95% CI: 2.27 to 2.59) for the concentric circle technique. The mean difference in reduction in microorganisms between the back-and-forth technique and the concentric circle technique was 0.02 log10 CFU/mL (95% CI: -0.11 to 0.15). INTERPRETATION: There was no clinically difference in reduction of microorganisms between the concentric circle and back-and-forth techniques at the bend of the healthy volunteer's elbow, after the 30 s of drying of the antiseptic. These findings have a significant impact on time required to achieve antiseptic application before catheter insertion because there is yet no argument to justify application for 30 s, because a single concentric circle pass was much faster with similar results. Future studies should investigate the impact of skin application technique on the prevention of infectious risk associated with catheter insertion on admission to health care facilities (conventional, outpatient, or emergency) and throughout the period of stay in a health care facility.

Effect of personalised citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomised controlled trial (RCT).

INTRODUCTION: The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the Accompagnement-citoyen Personnalisé d'Intégration Communautaire (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation. METHODS AND ANALYSIS: A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated. ETHICS AND DISSEMINATION: The Research Ethics Committee of the CIUSSS Estrie - CHUS has approved the study (MP-31-2018-2424). An informed consent form will be read and signed by all study participants. Findings will be published and presented at conferences. TRIAL REGISTRATION NUMBER: NCT03161860; Pre-results.

[The impact of conversational hypnosis on the pre- and postoperative anxiety of patients in gynecological surgery versus ordinary practice: A comparative study]. / L'impact de l'hypnose conversationnelle sur l'anxiété pré et post opératoire des patientes en chirurgie gynécologique versus pratique courante : étude comparative.

Hysterectomies are often linked to benign pathologies, but they are nevertheless the cause of anxiety and lead to significant physiological and psychological changes for these women. The uterus, as a symbol of femininity for women, has a unique meaning in relation to its reproductive function and its role in sexuality. Given this fact, does conversational hypnosis-used when a patient arrives at the hospital-have an impact on the pre- and postoperative anxiety of patients hospitalized for gynecological surgery in the form of a hysterectomy? To answer this question, a pilot study of comparative monocentric feasibility was performed with two parallel groups of 10 patients in 2014. The first group was received using ordinary practices, while the second group was received using techniques of conversational hypnosis. The main objective of this study was to estimate the effect of the use of conversational hypnosis upon reception compared to the use of the ordinary care protocol on perioperative anxiety upon reception, measured on the Visual Analog Scale (VAS) of anxiety for patients undergoing a hysterectomy associated with a benign pathology.The results show that patients who received the techniques of conversational hypnosis upon reception to the hospital had clearly lower pre- and postoperative anxiety.The results of this pilot feasibility study made it possible to perform follow-up research to confirm these first results in the context of a call for projects by SIRIC BRIO (Call for projects 2016: Site de Recherche Intégrée en Cancérologie - Bordeaux Recherche Intégrée en Oncologie). This research is currently underway to examine the impact of a formal preoperative hypnosis session on the perioperative anxiety of patients hospitalized for hysterectomy related to pelvic gynecologic cancer.

Public and private hospital nurses' perceptions of the ethical climate in their work settings, sari city, 2011.

BACKGROUND: Nurses' perceptions of ethical climate patterns have certain undeniable effects on hospitals. There is little evidence of possible differences in this element between public and private hospitals and contributing factors. OBJECTIVES: This study investigated whether the perceptions of the ethical climate in nurses' working in public hospitals differ from that of nurses in private hospitals, and which factors may affect nurses' perceptions. MATERIALS AND METHODS: A cross-sectional study of randomly selected registered nurses (n = 235), working in four public hospitals affiliated to Mazandaran University of Medical Sciences, and three private hospitals, was conducted in Sari City, Iran. A self-administered questionnaire, containing demographic characteristics and the Hospital Ethical Climate Survey (HECS), were used to assess registered nurses' perceptions of public and private hospitals ethical climate. An independent t-test and one-way ANOVA were used to analyze the data. RESULTS: Across the five factors of HECS, the highest and lowest mean scores pertained to managers and physicians, respectively, in both public and private hospitals. Nurses who had a conditional employment situation and those working in pediatric intensive care units showed significantly more positive perceptions of the ethical work climate when compared to their peers (P < 0.05). Although the mean score of ethical work climate in private hospitals (3.82 ± 0.61) was higher than that in public hospitals (3.76 ± 0.54), no significant difference was found (P = 0.44). CONCLUSIONS: Hospital managers need to discover better ways to promote safety and health programs for their staff according to nurses' area of work and their type of units. They should also encourage greater levels of participation in safety-enhancing initiatives in the hospital's ethical climate, especially in the areas of nurses' perceptions of their physician colleagues, and for nurses with a conditional employment situation.

[Oral communication, for the spread and transfer of knowledge]. / La communication orale, pour la diffusion et le transfert de connaissances.

The continuous improvement of the quality of care in the personalised management of each patient requires practitioners to consciously use the best current data resulting from clinical research. The oral communication of the results of research work is one of the methods of optimising the scientific, pedagogical and social value of nursing and allied healthcare research.

[Constipation in the hospital. Ethical reflection on its care by the nursing staff]. / Elimination intestinale à l'hôpital. Réflexion éthique sur sa prise en charge par les soignants.

The intestinal elimination of the hospitalized patients is a function insufficiently taken into account by the nursing staff from a preventive point of view. Nevertheless, numerous patients present transit disorders which are mostly translated into a diagnosis of constipation requiring therapeutic prescriptions and sometimes even aggressive and expensive medical examinations. The objective of this work is to lead an ethical reflection on the care of intestinal elimination by the nursing staff. Through a questionnaire, we wish to answer 3 questions: how come the nursing staff have difficulties taking care of the intestinal elimination of the hospitalized patients? What are the determiners which influence the care of the intestinal elimination by the nursing staff? Does training prepare the nursing staff to take care of the intestinal elimination of the hospitalized patients? The questionnaire was distributed to doctors, male and female nurses, nursing auxiliaries and students in care of the sick working in medicine, surgery and intensive care of the same hospital. This survey allowed to question 130 persons among whom 36 doctors, 37 male and female nurses, 30 nursing auxiliaries and 27 students. We were able to confirm that the care of the intestinal elimination is insufficiently taken into account in a preventive way, because 56 % of the people interviewed explain that the problem of intestinal elimination is not approached before the complaint of the patient Several determiners make that the nursing staff are not in a preventive approach. This care does not meet much interest, is experienced as devaluing, taboo and the relation nursing staff-patient is hindered because everyone has difficulties to speak about it. Institutional difficulties are also discussed, such as the lack of coordination of the nursing staff and the lack of time. Another point of this survey shows that work experience is not an element which facilitates this care because the more the nursing staff have experience, the more they postpone this care and more the embarrassment is felt Finally, we were able to point out that the received training does not prepare the nursing staff to take care of this function. Indeed, 61% of the people interviewed explain that certain difficulties are inferred by the lack of social skills of the professionals, like the discomfort to speak about this particular need. This work thus allowed to lead this ethical reflection on the care of the intestinal elimination to understand its meaning.As Spinoza said: "One should not laugh, one should not despair, one should not curse, but one should understand".

Interaction of ochratoxin A with human intestinal Caco-2 cells: possible implication of a multidrug resistance-associated protein (MRP2).

Ochratoxin A (OTA), a nephrotoxic mycotoxin, is absorbed from small intestine and, in plasma, binds to serum albumin. Prolonged half-live results from reabsorption by proximal tubules and enterohepatic circulation. The mechanism whereby OTA crosses intestine was investigated by means of a cell culture system consisting of Caco-2 cells, as in vitro model of human intestinal epithelium. Cytotoxicity assays on proliferating Caco-2 cells showed that 0.4 microM OTA inhibits MTT reduction by 50%. Transepithelial transport and intracellular accumulation of OTA were studied in Caco-2 cells, differentiated in bicameral inserts. At pH 7.4, OTA is transported preferentially in basolateral (BL) to apical (AP) direction, suggesting a net secretion. Conditions closer to in vivo situation in duodenum (AP pH 6.0, BL pH 7.4) increase intracellular accumulation and transepithelial transport. AP to BL transport becomes higher than BL to AP transport, suggesting OTA absorption. Addition of serum albumin in BL compartment further increases OTA absorption across Caco-2 cells and suggests that in vivo OTA transport from serosal to luminal side of enterocytes is prevented, due to its binding to plasma proteins. Competition experiments showed that carrier systems for large neutral amino acids, H(+)/dipeptides cotransporter, organic anion (p-aminohippurate) carrier and organic anion transporter (oatp) are not implicated in OTA transport across Caco-2 cells, in contrast to what was reported in kidney and liver. AP and BL transport and intracellular accumulation of OTA are increased in the presence of non specific inhibitors of MRPs (indomethacin, genistein and probenecid) and of 1-chloro-2,4-dinitrobenzene (biotransformed into 2,4-dinitrophenyl-gluthatione, a specific inhibitor of MRPs), but are affected by verapamil, an inhibitor of P-gp. This suggests that the multidrug resistance-associated protein (MRP2) could be implicated in transepithelial transport. Therefore, absorption of OTA across the intestinal mucosa would be limited thanks to its excretion through MRP2 at the apical pole of enterocytes.