Mechanical ventilation pneumonia (VAP) is defined as pneumonia that develops 48 hours after the beginning of invasive mechanical ventilation, and is considered up to 48 hours after extubation. Patients using the orotracheal tube (TOT) presented a deficit for self-care, showing a greater susceptibility to biofilm accumulation in the buccal cavity, favoring the incidence of nosocomial pneumonia in the Intensive Care Unit (ICU). Thus, this study aimed to carry out a systematic review on the main oral prophylactic methods used in the prevention of VAP. Search sources were PubMed, Scopus and Cochrane databases from May 23, 2017 through May 26 of this year. The selected studies evaluated the efficacy of oral antimicrobials in mechanically ventilated patients in controlled randomized controlled trials (RCTs) according to inclusion criteria. Papers presenting non-established themes, animal studies, patents and systematic reviews were excluded from the process. After analyzing the data, the articles were classified according to the level of evidence. The results showed that of the 503 abstracts found, of these, 15 articles included the review criteria. The selected studies indicated as prophylactic oral methods used in ECRC: chlorhexidine, Listerine, iodo-povidine and ceftazidime. It was observed in the 15 chosen articles that 8 presented unsatisfactory results for the reduction of VAP. In this perspective, the oral prophylactic methods applied in patients admitted to the ICU found in clinical trials were not favorable to the reduction of VAP indexes. / A pneumonia associada à ventilação mecânica (PAVM) é definida como a pneumonia que se desenvolve 48 horas a partir do início da ventilação mecânica invasiva, sendo considerada até 48 horas após a extubação. Os pacientes em uso do tubo orotraqueal (TOT) apresentam déficit para o autocuidado, exibindo maiorsusceptibilidade ao acúmulo de biofilme na cavidade bucal favorecendo a incidência das pneumonias nosocomiais em Unidade de Terapia Intensiva (UTI). Assim, este trabalho teve como objetivo realizar uma revisão sistemática sobre os principais métodos profiláticos orais utilizados na prevenção da PAVM. As fontes de busca foram as bases PubMed, Scopus e Cochrane de 23 de maio de 2017 até 26 de maio do corrente ano. Os estudos selecionados avaliaram a eficácia dos antimicrobianos orais em pacientes sob ventilação mecânica em ensaios clínicos randomizados controlados (ECRC) de acordo com os critérios de inclusão. Os trabalhos que apresentaram temas não relacionados ao estabelecido, estudos com animais, patentes e revisões sistemáticas foram excluídos do processo. Após análise dos dados os artigos foram classificados quanto ao nível de evidência. Os resultados mostraram que dos 503 resumos encontrados, destes, 15 artigos contemplaram os critérios da revisão. Os estudos selecionados apontaram como métodos profiláticos orais utilizados nos ECRC: a clorexidina, Listerine, iodo-povidine e ceftazidima. Foi observado nos 15 artigos elegidos que 8 apresentaram resultados não satisfatórios para a redução da PAVM. Nesta perspectiva, os métodos profiláticos orais aplicados nos pacientes admitidos na UTI encontrados nos ensaios clínicos não foram favoráveis à redução dos índices de PAVM. / Lagarto, SE

La recherche d'information nécessite la mise en place de stratégies qui consistent à (1) cerner le besoin d'information ; (2) formuler le besoin d'information ; (3) repérer les sources pertinentes ; (4) identifier les outils à exploiter en fonction de ces sources ; (5) interroger les outils ; et (6) évaluer la qualité des résultats. Ce domaine n'a cessé d'évoluer pour présenter des techniques et des approches permettant de sélectionner à partir d'un corpus de documents l'information pertinente capable de satisfaire le besoin exprimé par l'utilisateur. De plus, dans le contexte applicatif du domaine de la RI biomédicale, les sources d'information hétérogènes sont en constante évolution, aussi bien du point de vue de la structure que du contenu. De même, les besoins en information peuvent être exprimés par des utilisateurs qui se caractérisent par différents profils, à savoir : les experts médicaux comme les praticiens, les cliniciens et les professionnels de santé, les utilisateurs néophytes (sans aucune expertise ou connaissance du domaine) comme les patients et leurs familles, etc. Plusieurs défis sont liés à la tâche de la RI biomédicale, à savoir : (1) la variation et la diversité du besoin en information, (2) différents types de connaissances médicales, (3) différences de compé- tences linguistiques entre experts et néophytes, (4) la quantité importante de la littérature médicale ; et (5) la nature de la tâche de RI médicale. Cela implique une difficulté d'accéder à l'information pertinente spécifique au contexte de la recherche, spécialement pour les experts du domaine qui les aideraient dans leur prise de décision médicale. Nos travaux de thèse s'inscrivent dans le domaine de la RI biomédicale et traitent les défis de la formulation du besoin en information experte et l'identification des sources pertinentes pour mieux répondre aux besoins cliniques. Concernant le volet de la formulation et l'analyse de requêtes expertes, nous proposons des analyses exploratoires sur des attributs de requêtes, que nous avons définis, formalisés et calculés, à savoir : (1) deux attributs de longueur en nombre de termes et en nombre de concepts, (2) deux facettes de spécificité terme-document et hiérarchique, (3) clarté de la requête basée sur la pertinence et celle basée sur le sujet de la requête. Nous avons proposé des études et analyses statistiques sur des collections issues de différentes campagnes d'évaluation médicales CLEF et TREC, afin de prendre en compte les différentes tâches de RI. Après les analyses descriptives, nous avons étudié d'une part, les corrélations par paires d'attributs de requêtes et les analyses de corrélation multidimensionnelle. Nous avons étudié l'impact de ces corrélations sur les performances de recherche d'autre part. Nous avons pu ainsi comparer et caractériser les différentes requêtes selon la tâche médicale d'une manière plus généralisable. Concernant le volet lié à l'accès à l'information, nous proposons des techniques d'appariement et d'expansion sémantiques de requêtes dans le cadre de la RI basée sur les preuves cliniques. / The research topic of this document deals with a particular setting of medical information retrieval (IR), referred to as expert based information retrieval. We were interested in information needs expressed by medical domain experts like praticians, physicians, etc. It is well known in information retrieval (IR) area that expressing queries that accurately reflect the information needs is a difficult task either in general domains or specialized ones and even for expert users. Thus, the identification of the users' intention hidden behind queries that they submit to a search engine is a challenging issue. Moreover, the increasing amount of health information available from various sources such as government agencies, non-profit and for-profit organizations, internet portals etc. presents oppor- tunities and issues to improve health care information delivery for medical professionals, patients and general public. One critical issue is the understanding of users search strategies and tactics for bridging the gap between their intention and the delivered information. In this thesis, we focus, more particularly, on two main aspects of medical information needs dealing with the expertise which consist of two parts, namely : - Understanding the users intents behind the queries is critically important to gain a better insight of how to select relevant results. While many studies investigated how users in general carry out exploratory health searches in digital environments, a few focused on how are the queries formulated, specifically by domain expert users. We address more specifically domain expert health search through the analysis of query attributes namely length, specificity and clarity using appropriate proposed measures built according to different sources of evidence. In this respect, we undertake an in-depth statistical analysis of queries issued from IR evalua- tion compaigns namely Text REtrieval Conference (TREC) and Conference and Labs of the Evaluation Forum (CLEF) devoted for different medical tasks within controlled evaluation settings. - We address the issue of answering PICO (Population, Intervention, Comparison and Outcome) clinical queries formulated within the Evidence Based Medicine framework. The contributions of this part include (1) a new algorithm for query elicitation based on the semantic mapping of each facet of the query to a reference terminology, and (2) a new document ranking model based on a prioritized aggregation operator. we tackle the issue related to the retrieval of the best evidence that fits with a PICO question, which is an underexplored research area. We propose a new document ranking algorithm that relies on semantic based query expansion leveraged by each question facet. The expansion is moreover bounded by the local search context to better discard irrelevant documents. The experimental evaluation carried out on the CLIREC dataset shows the benefit of our approaches.

Après avoir dressé dans une première partie un bref panorama des approches psychiatriques et psychanalytiques de la psychose, nous présenterons dans une seconde partie la théorie structurale de la psychose suivant Jacques Lacan. Cette théorie s'appuie sur le concept central du Nom-du-Père et de sa forclusion. Nous envisagerons les conséquences de l'échec de la métaphore paternelle et les prolongements théoriques du second classicisme de Lacan avec l'introduction du "père réel" et l'extension du concept de forclusion par d'autres auteurs. La question de la clinique et de sa transmission fera l'objet de la troisième partie. Nous nous appuierons sur la critique des vignettes cliniques de Guy Le Gaufey afin d'introduire ce que pourrait être une clinique en acte, une clinique qui implique le praticien dans le témoignage du cas. Nous dégagerons la spécificité du transfert dans l'abord clinique des psychoses qui implique "un transfert au psychotique" et nécessairement, à l'encontre de la classique vignette clinique, le témoignage du clinicien dans l'écriture du cas. Pour illustrer notre propos sur une clinique in vivo, nous aurons recours aux présentations de malades de Jacques Lacan à l'Hôpital Sainte-Anne en 1975-1976 ainsi qu'à deux autres vignettes cliniques où les praticiens font montre de leur implication dans la cure de patients psychotiques. / The first section gives a brief overview of psychiatric and psychoanalytical approaches to psychosis. In the second section, we set out the structural theory of psychosis according to Jacques Lacan. This theory revolves around the core concept of Name-of-the-Father (Nom-du-Père) and its foreclosure. We consider the consequences of the failure of the father metaphor and the theoretical continuation of Lacan’s second classicism with the introduction of the “real father” and the development of the concept of foreclosure by other authors. The question of clinical practice and it evidence is dealt with in the third section. We draw on Guy Le Gaufey’s criticism of clinical vignettes to introduce what could be considered as active clinical practice, that is a practice involving the practitioner in case evidence writing. We point to the specific nature of transference in the clinical context, which implies “transference to the psychotic” and the inclusion of clinician’s evidence in case writing, contrary to conventional clinical vignettes. To illustrate our point in favour of in vivo clinical practice, we refer to the presentation of patients by Jacques Lacan at the Hospital Saint-Anne in 1975-1976, and to two clinical vignettes where the therapists show their engagement in the cure of psychotic patients.