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Marc Freysz

Bio: Marc Freysz is an academic researcher from University of Burgundy. The author has contributed to research in topics: Intensive care & Poison control. The author has an hindex of 20, co-authored 80 publications receiving 1205 citations.


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Journal ArticleDOI
TL;DR: Diagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma and may be a global indicator of better management.
Abstract: The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma. The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality. In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups. Diagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

108 citations

Journal ArticleDOI
TL;DR: This study suggests that SMUR management is associated with a significant reduction in 30-day mortality, and the role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.
Abstract: Introduction: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d’Urgences et de Reanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. Methods: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. Results: Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. Conclusions: This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.

92 citations

Journal ArticleDOI
TL;DR: HRV could be helpful as a predictor of imminent brain death and a useful adjunct for predicting the outcome of patients with severe head injury, according to the area under the rMSSD ROC curve.
Abstract: Despite major improvements in the resuscitation of patients with head injury, the outcome of patients with head trauma often remains poor and difficult to establish. Heart rate variability (HRV) analysis is a noninvasive tool used to measure autonomic nervous system (ANS) activity. The aim of this prospective study was to investigate whether HRV analysis might be a useful adjunct for predicting outcome in patients with severe head injury. Twenty patients with severe head trauma (Glasgow Coma Scale [GCS] or= 10) to HRV in patients characterized by a worsened neurologic state (GCS < 10). Statistical analysis used the Kruskal-Wallis test, P < .05. To assess whether HRV could predict evolution to brain death, receiver operating characteristic (ROC) curves were generated the day after trauma for Total Power, natural logarithm of high-frequency component of spectral analysis (LnHF), natural logarithm of low-frequency component of spectral analysis (LnLF), and root mean square for successive interval differences (rMSSD). Seven patients died between Day 1 and Day 5 after trauma. Six of those had progressed to brain death. In these six patients, at Day 1, Global HRV and parasympathetic tone were significantly higher. Referring to the area under the rMSSD ROC curve, HRV might provide useful information in predicting early evolution of patients with severe head trauma. During the awakening period, global HRV and the parasympathetic tone were significantly lower in the worsened neurologic state group. In conclusion, HRV could be helpful as a predictor of imminent brain death and a useful adjunct for predicting the outcome of patients with severe head injury.

82 citations

Journal ArticleDOI
29 Mar 2011
TL;DR: Réanimation des urgences, pôle réanimation-urgence, service d’aide médicale urgente hyperbarie (RUSH), CHU de Sainte-Marguerite and Université de the Méditerranée Aix-Marseille II, France Collège français des anesthésistes réanimateurs (Cfar).
Abstract: B. Vivien (*) Samu de Paris, département d’anesthésie–réanimation et université Paris-Descartes–Paris-V, hôpital Necker–Enfants-Malades, 149, rue de Sèvres, F-75730 Paris cedex 15, France e-mail : benoit.vivien@nck.aphp.fr F. Adnet Samu 93, Université Paris 13 et EA 3409, Bobigny, France V. Bounes Samu 31, pôle de médecine d’urgences, hôpitaux universitaires, Université de Toulouse, Toulouse, France G. Chéron Département des urgences pédiatriques, hôpital Necker–EnfantsMalades et université Paris-Descartes–Paris-V, Paris, France X. Combes Samu de Paris, département d’anesthésie–réanimation et université Paris-Descartes–Paris-V, hôpital Necker–Enfants-Malades, Paris, France J.-S. David Département d’anesthésie–réanimation–urgences, centre hospitalier Lyon-Sud et Université Lyon 1, hospices civils de Lyon, Pierre-Bénite, France J.-F. Diependaele SMUR Pédiatrique Régional de Lille, Centre hospitalier régional universitaire de Lille et Université Lille 2 Nord de France, Lille France J.-J. Eledjam Structure des urgences, hôpital Lapeyronie et Université Montpellier 1, Montpellier, France B. Eon Réanimation des urgences, pôle réanimation-urgence, service d’aide médicale urgente hyperbarie (RUSH), CHU de Sainte-Marguerite et Université de la Méditerranée Aix-Marseille II, France Collège français des anesthésistes réanimateurs (Cfar) Recommandations / Recommendations

76 citations

Journal ArticleDOI
TL;DR: In this paper, the benefits of learning cardiac arrest procedures using a multimedia computer screen-based simulator in 28 Year 2 medical students were evaluated using simulated data and real-life scenarios.
Abstract: Medical Education 2010: 44: 716–722 Objectives What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high-fidelity patient simulators, but have also demonstrated their limits. New computer screen-based multimedia simulators have fewer constraints than high-fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen-based simulator to more realistic situations such as those encountered with high-fidelity patient simulators. Methods We tested the benefits of learning cardiac arrest procedures using a multimedia computer screen-based simulator in 28 Year 2 medical students. Just before the end of the traditional resuscitation course, we compared two groups. An experiment group (EG) was first asked to learn to perform the appropriate procedures in a cardiac arrest scenario (CA1) in the computer screen-based learning environment and was then tested on a high-fidelity patient simulator in another cardiac arrest simulation (CA2). While the EG was learning to perform CA1 procedures in the computer screen-based learning environment, a control group (CG) actively continued to learn cardiac arrest procedures using practical exercises in a traditional class environment. Both groups were given the same amount of practice, exercises and trials. The CG was then also tested on the high-fidelity patient simulator for CA2, after which it was asked to perform CA1 using the computer screen-based simulator. Performances with both simulators were scored on a precise 23-point scale. Results On the test on a high-fidelity patient simulator, the EG trained with a multimedia computer screen-based simulator performed significantly better than the CG trained with traditional exercises and practice (16.21 versus 11.13 of 23 possible points, respectively; p < 0.001). Conclusions Computer screen-based simulation appears to be effective in preparing learners to use high-fidelity patient simulators, which present simulations that are closer to real-life situations.

68 citations


Cited by
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TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means.
Abstract: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. Unpublished clinical trial results have not been taken into account. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 . The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period …

2,297 citations

Journal ArticleDOI
TL;DR: Investigating the incidence, case fatality, and functional outcome of intracerebral haemorrhage in relation to age, sex, ethnic origin, and time period in studies published since 1980 found casefatality is lower in Japan than elsewhere, increases with age, and has not decreased over time.
Abstract: Summary Background Since the early 1980s, imaging techniques have enabled population-based studies of intracerebral haemorrhage. We aimed to assess the incidence, case fatality, and functional outcome of intracerebral haemorrhage in relation to age, sex, ethnic origin, and time period in studies published since 1980. Methods From PubMed and Embase searches with predefined inclusion criteria, we identified population-based studies published between January, 1980, and November, 2008. We calculated incidence and case fatality. Incidences for multiple studies were pooled in a random-effects binomial meta-analysis. Time trends of case fatality were assessed with weighted linear-regression analysis. Findings 36 eligible studies described 44 time periods (mid-year range 1983–2006). These studies included 8145 patients with intracerebral haemorrhage. Incidence did not decrease between 1980 and 2008. Overall incidence was 24·6 per 100 000 person-years (95% CI 19·7–30·7). Incidence was not significantly lower in women than in men (overall incidence ratio 0·85, 95% CI 0·61–1·18). Using the age group 45–54 years as reference, incidence ratios increased from 0·10 (95% CI 0·06–0·14) for people aged less than 45 years to 9·6 (6·6–13·9) for people older than 85 years. Median case fatality at 1 month was 40·4% (range 13·1–61·0) and did not decrease over time, and was lower in Japan (16·7%, 95% CI 15·0–18·5) than elsewhere (42·3%, 40·9–43·6). Six studies reported functional outcome, with independency rates of between 12% and 39%. Incidence of intracerebral haemorrhage per 100 000 person-years was 24·2 (95% CI 20·9–28·0) in white people, 22·9 (14·8–35·6) in black people, 19·6 (15·7–24·5) in Hispanic people, and 51·8 (38·8–69·3) in Asian people. Interpretation Incidence of intracerebral haemorrhage increases with age and has not decreased between 1980 and 2006. Case fatality is lower in Japan than elsewhere, increases with age, and has not decreased over time. More data on functional outcome are needed. Funding Netherlands Heart Foundation.

1,974 citations

Journal ArticleDOI
TL;DR: Results suggest games show higher learning gains than simulations and virtual worlds, and for simulation studies, elaborate explanation type feedback is more suitable for declarative tasks whereas knowledge of correct response is more appropriate for procedural tasks.
Abstract: The purpose of this meta-analysis is to examine overall effect as well as the impact of selected instructional design principles in the context of virtual reality technology-based instruction (i.e. games, simulation, virtual worlds) in K-12 or higher education settings. A total of 13 studies (N?=?3081) in the category of games, 29 studies (N?=?2553) in the category of games, and 27 studies (N?=?2798) in the category of virtual worlds were meta-analyzed. The key inclusion criteria were that the study came from K-12 or higher education settings, used experimental or quasi-experimental research designs, and used a learning outcome measure to evaluate the effects of the virtual reality-based instruction.Results suggest games (FEM?=?0.77; REM?=?0.51), simulations (FEM?=?0.38; REM?=?0.41), and virtual worlds (FEM?=?0.36; REM?=?0.41) were effective in improving learning outcome gains. The homogeneity analysis of the effect sizes was statistically significant, indicating that the studies were different from each other. Therefore, we conducted moderator analysis using 13 variables used to code the studies. Key findings included that: games show higher learning gains than simulations and virtual worlds. For simulation studies, elaborate explanation type feedback is more suitable for declarative tasks whereas knowledge of correct response is more appropriate for procedural tasks. Students performance is enhanced when they conduct the game play individually than in a group. In addition, we found an inverse relationship between number of treatment sessions learning gains for games.With regards to the virtual world, we found that if students were repeatedly measured it deteriorates their learning outcome gains. We discuss results to highlight the importance of considering instructional design principles when designing virtual reality-based instruction. A comprehensive review of virtual reality-based instruction research.Analysis of the moderation effects of design features in a virtual environment.Using an advance statistical technique of meta-analysis to study the effects.Virtual reality environment is effective for teaching in K-12 and higher education.Results can be used by instructional designers to design the virtual environments.

1,040 citations

Journal ArticleDOI
01 Apr 2009-Stroke
TL;DR: Worldwide, stroke is more common among men, but women are more severely ill, with large variations between age bands and between populations, and the mismatch between the sexes is larger than previously described.
Abstract: BACKGROUND AND PURPOSE: Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women In recent years, sex-specific data on stroke i

853 citations