[Phot. de la baie de Gravosa (Adriatique) en oct. 1880, lors de l'affaire de Dulcigno (aujourd'hui Ulcinj, Montenegro), avec 9 navires de l'escadre internationale: le Marco Antonio Colonna (Italie), le Zrini (Autriche), le Suffren (France), le Laudon (Autriche), le Palestro (Italie), I'Alexandra (Grande-Bretagne), le Friedland (France), le Svetlana (Russie), le Djeguita (Russie). Phot. par Silvino Masacarich, phot. à Raguse] / [don Edgar Humann]

Donateur : Humann, Edgar (1838-1914)

[9 phot. de Pise par Van Lint, phot. à Pise, et de Gênes par C. Degoix et A. Noack, phot. à Gênes, don Romanet du Caillaud en 1886]

Donateur : Romanet Du Caillaud, Frédéric (18..-19..?)

"I don't know how you are" or indirect questioning in oncology interviews: an ongoing exploratory study

Background: The exploratory study is part of an evaluation of the pre-graduate teaching of communication skills (Lausanne Medical School). It is based on the data of a project highlighting the impact of individualized vs. group training for medicine students in breaking bad news to simulated patients who are diagnosed with cancer. The analysis of the video-taped interviews of the students (N=63) with the RIAS has shown a current usage of utterances such as I don't know if -you have any plans for the future / you have already heard about chemotherapy / ... or I don't know how -you are feeling today after this surgery / you like that all this stuff takes place / ...Aim: The present study questions the specificity of these assertive utterances used as questions (indirect), the specificity of their content, and their intentionality - specific vs. exploratory.Methods: The mentioned utterances are qualitatively analyzed (content analysis, intentionality analysis, etc).Results: 26 students (41%) used 1 to 6 times I don't know utterances during the interviews that contain 53 of such utterances in total. In contrast, they are atypical in an oncologist sample who conducted similar interviews (N=31; 4 oncologist used them 1 to 2 times). In more than half of the cases (29/53), simulated patients interpret I don't know questions as giving them a space to speak (open responses). Conclusions: The atypicality of the I don't know utterances in the oncologist sample may have linguistic explanations in terms of generational marker, but the specificity of the content suggests psychological explanations in terms of defense mechanism as well (marker of "toning down" or insecurity as regards the discussed topic).Keywords: Breaking bad news, communication skills, oncology, pre-graduate medical education, indirect questioning

Pancreatic stone protein: a marker of organ failure and outcome in ventilator-associated pneumonia.

Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired, life-threatening infection. Poor outcome and health-care costs of nosocomial pneumonia remain a global burden. Currently, physicians rely on their experience to discriminate patients with good and poor outcome. However, standardized prognostic measures might guide medical decisions in the future. Pancreatic stone protein (PSP)/regenerating protein (reg) is associated with inflammation, infection, and other disease-related stimuli. The prognostic value of PSP/reg among critically ill patients is unknown. The aim of this pilot study was to evaluate PSP/reg in VAP.Methods: One hundred one patients with clinically diagnosed VAP were assessed. PSP/reg was retrospectively analyzed using deep-frozen serum samples from VAP onset up to day 7. The main end point was death within 28 days after VAP onset.Results: Serum PSP/reg was associated with the sequential organ failure assessment score from VAP onset (Spearman rank correlation coefficient 0.49 P < .001) up to day 7. PSP/reg levels at VAP onset were elevated in nonsurvivors (n = 20) as compared with survivors (117.0 ng/mL [36.1-295.3] vs 36.3 ng/mL [21.0-124.0] P = .011). The areas under the receiver operating characteristic curves of PSP/reg to predict mortality/survival were 0.69 at VAP onset and 0.76 at day 7. Two PSP/reg cutoffs potentially allow for identification of individuals with a particularly good and poor outcome. Whereas PSP/reg levels below 24 ng/mL at YAP onset were associated with a good chance of survival, levels above 177 ng/mL at day 7 were present in patients with a very poor outcome.Conclusions: Serum PSP/reg is a biomarker related to organ failure and outcome in patients with VAP.

[Phot. de Montbéliard par Eugène Sahler, phot. dans cette ville, don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)

[5 phot. d'Odessa, don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)

[12 phot. des Alpes suisses (Valais et canton de Berne) par J. Beck, don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)

[2 phot. de Galicie, dans le cercle de Zloczow / phot. E. Trzemeski, phot. à Lemberg (?) ; don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)

[Phot. d'Amsterdam par P. Oosterhuis, phot. dans cette ville, don E. Reclus en 1886]

Donateur : Reclus, Élisée (1830-1905)