Background: To evaluate the tolerance of a concurrent adjuvant trastuzumab (T)-radiotherapy (RT) ... more Background: To evaluate the tolerance of a concurrent adjuvant trastuzumab (T)-radiotherapy (RT) for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation.
Elderly with several pathologies are usually treated with many drugs, and are exposed to a majore... more Elderly with several pathologies are usually treated with many drugs, and are exposed to a majored risk of drug-induced adverse effects. A network of local nursing homes (EHPAD) in the south Seine-Saint-Denis area (France) created a geriatric drug guidelines to improve the quality of the drugs prescriptions. This study assesses the conformity of prescriptions in elderly patients prior and after the distribution of the booklet. This before and after design study focused on the drug prescriptions for patients in eight EHPAD followed for two randomly given days in 2012 (n = 503) and 2013 (n = 334). The geriatric drug guidelines included a list of medicines suitable for the elderly (conformity list) and recommendations for prescription and monitoring. Data collection was conducted from medical records and interviews with coordinators doctors and nursing staff in nursing homes. A 6 items-quality score was calculated, ranging from 0 (lowest quality) to 6 (highest quality). Median age, wei...
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Jan 26, 2014
Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with incr... more Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with increased mortality. Using broad-spectrum antibiotics for 48 h until the results of conventional cultures and antimicrobial susceptibility testing (AST) are available, may promote the emergence of drug-resistant bacteria. Performing AST directly on clinical respiratory samples would hasten the process by at least 24 h. Here, we analysed the diagnostic performance of a rapid method combining mass spectrometry and direct AST (DAST), and compared it with the conventional method (mass spectrometry with conventional AST (CAST)). Additionally, we assessed its potential impact on antimicrobial use in patients. Over a period of 18 months, the two methods were performed on 85 bronchoalveolar lavages obtained from intensive care unit patients with suspected VAP, and in which Gram-negative bacilli were observed on direct examination. Only the CAST results were reported to the clinicians. DAST produced ...
Communications / Revue d'Épidémiologie et de Santé Publique 57S (2009) S3-S59 S35 médecins prescr... more Communications / Revue d'Épidémiologie et de Santé Publique 57S (2009) S3-S59 S35 médecins prescripteurs émanaient plus du secteur privé (79,5 %), ils étaient des généralistes (45,5 %), des spécialistes (49,5 %) et des chirurgiens dentistes (2,5 %). Dans 11 % des ordonnances, nous avons soulevé des erreurs de prescription (anomalies et interactions). L'ordonnance était non conforme du point de vue de la forme dans 90 % des cas. Le coût moyen d'une ordonnance était de 156,77 DH. Conclusion.-Pour aboutir à une prescription réfléchie et un usage rationnel des médicaments, il faut minimiser les erreurs de forme par l'informatisation de l'ordonnance, réduire le coût moyen d'une ordonnance en donnant le droit de substitution par le générique aux pharmaciens, en améliorant la disponibilité de génériques pour certaines pathologies et en organisant des campagnes de sensibilisation et de formation continue pour les acteurs concernés : patients, prescripteurs, pharmaciens, personnels de santé.
proportion de patients soulagés (EVA < 4) à la sortie est de 65 %, mais plus faible pour ceux aya... more proportion de patients soulagés (EVA < 4) à la sortie est de 65 %, mais plus faible pour ceux ayant des douleurs sévères à l'admission (60 %). Discussion.-La douleur aux urgences est un symptôme fréquent. La méthode du recueil prospectif, incitative, entraîne de forts taux d'évaluation initiale mais la réévaluation au cours de la prise en charge est trop souvent oubliée. Son traitement reste insuffisant et souvent inadapté, avec notamment un recours insuffisant aux morphiniques. Cette enquête nationale réalisée sur un nombre important de centres montre que l'oligoanalgésie est un problème fréquent et que sur le terrain, les recommandations ne sont pas appliquées de façon optimale. Ceci incite à mettre en place un programme d'assurance qualité national ciblé sur la douleur.
Poster Sessions prognosis (similar to grade 1) and one with a bad prognosis (similar to grade 3).... more Poster Sessions prognosis (similar to grade 1) and one with a bad prognosis (similar to grade 3). We therefore also raised the question if a single proliferative factor, i.e. cyclin A, can be used for this purpose.
Background and purpose: Our aim was to characterize the clinical profile, temporal changes and ou... more Background and purpose: Our aim was to characterize the clinical profile, temporal changes and outcomes of patients with severe encephalitis. Methods: A retrospective cohort study was conducted on adult patients with encephalitis admitted to the medical intensive care unit (ICU) of a university hospital over a 20-year period. Patients' characteristics and outcomes were compared between two 10-year periods: (i) 1991-2001 and (ii) 2002-2012. Multivariate logistic regression was used to analyze factors associated with a poor outcome, as defined by a modified Rankin scale (mRS) score of 4-6 (severe disability or death) 90 days after admission. Results: A total of 279 patients were studied. Causes of encephalitis were infections (n = 149, 53%), immune-mediated causes (n = 41, 15%) and undetermined causes (n = 89, 32%). The distribution of causes differed significantly between the two periods, with an increase in the proportion of encephalitis recognized to be of immunemediated causes. At day 90, 208 (75%) patients had an mRS = 0-3 and 71 (25%) had an mRS = 4-6. After adjustment for functional status before admission, the following parameters were independently associated with a poor outcome: coma [odds ratio (OR) 7.09, 95% confidence interval (95% CI) 3.06-17.03], aspiration pneumonia (OR 4.02, 95% CI 1.47-11.03), a lower body temperature (per 1 degree, OR 0.72, 95% CI 0.53-0.97), elevated cerebrospinal fluid protein levels (per 1 g/l, OR 1.55, 95% CI 1.17-2.11) and delayed ICU admission (per 1 day, OR 1.04, 95% CI 1.01-1.07). Conclusions: Indicators of outcome in adult patients with severe encephalitis reflect both the severity of illness and systemic complications. Our data suggest that patients with acute encephalitis may benefit from early ICU admission.
Résultats.-Au total, 376 patients majeurs hospitalisés entre janvier 2009 et décembre 2012 en mal... more Résultats.-Au total, 376 patients majeurs hospitalisés entre janvier 2009 et décembre 2012 en maladies infectieuses et pneumologie ont été inclus. La majorité était des hommes (75 %) né France (26,3 %) ou en Afrique (47,4 %). Une structure d'âge différente entre cas et témoins a nécessité un ajustement sur l'âge en univarié. L'âge est également forcé dans l'analyse multivariée. En univarié, les facteurs identifiés étaient liés à la survenue d'une pathologie pulmonaire aiguë (détresse respiratoire aiguë, douleur thoracique, dyspnée, expectorations ≤ 15 jours), antécédent de tuberculose, radio de thorax normale. L'hémoptysie, classiquement décrite comme un signe de la maladie, était associée avec OR = 0,6 ([0,3-0,9], p = 0,03), suggérant des corrélations avec d'autres variables. Les autres facteurs associés étaient voyage en zone d'endémie, prise d'antibiotiques avant hospitalisation, présence de sueurs nocturnes, diabète, perte de poids (avec une relation dose-effet pour des pertes de poids croissantes), toux prolongée (> 15 jours), et la présence à la radiographie de thorax : d'une caverne (OR = 7,2 [4,3-12,1], p = 5,7e -14 ) et d'une anomalie de localisation apicale (OR = 4,5 [2,2], p = 1,9e -10 ). Ces deux facteurs étant associés, seule la caverne a été retenue dans le modèle. La construction et la validation du score est en cours. Conclusion.-Les analyses descriptives et univariées ajustées sur l'âge ont mis en évidence des facteurs associés classiques de TB. Le modèle final et sa validation seront présentés lors du congrès. http://dx.
The presence of autoantibodies in systemic lupus erythematosus, particularly those of the IgG sub... more The presence of autoantibodies in systemic lupus erythematosus, particularly those of the IgG subclass, have long been associated with disease onset and activity. Here we explored the prevalence of autoreactive IgE in SLE and its relevance to disease in French (n = 79) and United States (US) (n = 117) cohorts with a mean age of 41.5612.7 and 43.6615.3 years and disease duration of 13.568.5 and 16.6611.9 years, respectively. Our findings show that approximately 65% of all SLE subjects studied produced IgE antibodies to the seven autoantigens tested. This positivity was increased to almost 83% when only those subjects with active disease were considered. SLE subjects who were positive for anti-dsDNA, -Sm, and -SSB/La -specific IgE showed a highly significant association in the levels of these antibodies with disease activity similar to that of the corresponding IgG's. A strong association of IgE autoantibodies with active nephritis was also found in the combined cohort analysis. A test of the predictive value of autoreactive IgE's and IgGs for disease activity (SLE Disease Activity Index (SLEDAI) $4) revealed that the best predictors were dsDNA-specific IgE and IgG, and that the age of an SLE subject influenced this predictive model. The finding argue that the overall levels of IgE autoantibodies, independently or in combination with IgG autoantibodies, may serve as indicators of active disease.
Aim: To assess cerebral lesions and other medical as well as social characteristics as predictors... more Aim: To assess cerebral lesions and other medical as well as social characteristics as predictors of risk of mild and severe cognitive deficiencies in very preterm infants.
Background: To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumabradiother... more Background: To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumabradiotherapy for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation.
Background: Legislative measures have been identified as one effective way of changing attitude o... more Background: Legislative measures have been identified as one effective way of changing attitude or behaviour towards health care. The aim of this study was to describe trends in patients' complaints for medical issues; to evaluate the contribution of a law regarding patients' rights, and to identify factors associated to patients' perception of a medical error.
Objective: Neuropathic pain (NP) in acute conditions has been poorly investigated. A diagnostic s... more Objective: Neuropathic pain (NP) in acute conditions has been poorly investigated. A diagnostic score, the DN4 scale (DN4), has been developed to help physicians to detect and treat NP appropriately. DN4 is a 10-item questionnaire. If you have 4 or more positive responses out of 10 items, the answer to the questionnaire is positive and you have a neuropathic pain. We aimed to determine the prevalence of NP in emergency department (ED) patients and to describe this population. Methods: We used the DN4 in the patients with NP visiting the adult ED of a university hospital.
Résumé -Objectif. Évaluer de façon rétrospective la qualité des prescriptions des résidents des é... more Résumé -Objectif. Évaluer de façon rétrospective la qualité des prescriptions des résidents des établissements d'hébergement pour personnes âgées dépendantes (EHPAD) avant la diffusion d'un livret thérapeutique. Méthodes. L'étude a porté sur les prescriptions de 495 résidents de 8 EHPAD, un jour donné. Un score de conformité de prescription a été calculé par rapport au livret à partir de 6 items. Résultats. Le nombre médian de médicaments par ordonnance était de 8,5. Sur 4 311 médicaments prescrits, le score moyen de conformité de la prescription au livret thérapeutique était de 4,96 ± 0,45, (3,4 ± 1,02 pour la prescription manuscrite et 4,54 ± 0,70 pour la prescription informatisée). Parmi ces 4 311 médicaments, 939 (21,8 %) appartenaient à des classes à risque, et devraient être accompagnés d'une surveillance prescrite ; seuls 154 (16,4 %) étaient associés à une prescription de surveillance. Conclusion. Il existe un défaut dans la surveillance des médicaments appartenant aux classes à risque. L'informatisation de la prescription permet d'améliorer la conformité des prescriptions comme le montre le score de conformité.
Background: To evaluate the tolerance of a concurrent adjuvant trastuzumab (T)-radiotherapy (RT) ... more Background: To evaluate the tolerance of a concurrent adjuvant trastuzumab (T)-radiotherapy (RT) for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation.
Elderly with several pathologies are usually treated with many drugs, and are exposed to a majore... more Elderly with several pathologies are usually treated with many drugs, and are exposed to a majored risk of drug-induced adverse effects. A network of local nursing homes (EHPAD) in the south Seine-Saint-Denis area (France) created a geriatric drug guidelines to improve the quality of the drugs prescriptions. This study assesses the conformity of prescriptions in elderly patients prior and after the distribution of the booklet. This before and after design study focused on the drug prescriptions for patients in eight EHPAD followed for two randomly given days in 2012 (n = 503) and 2013 (n = 334). The geriatric drug guidelines included a list of medicines suitable for the elderly (conformity list) and recommendations for prescription and monitoring. Data collection was conducted from medical records and interviews with coordinators doctors and nursing staff in nursing homes. A 6 items-quality score was calculated, ranging from 0 (lowest quality) to 6 (highest quality). Median age, wei...
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Jan 26, 2014
Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with incr... more Inappropriate antibiotic therapy in ventilator-associated pneumonia (VAP) is associated with increased mortality. Using broad-spectrum antibiotics for 48 h until the results of conventional cultures and antimicrobial susceptibility testing (AST) are available, may promote the emergence of drug-resistant bacteria. Performing AST directly on clinical respiratory samples would hasten the process by at least 24 h. Here, we analysed the diagnostic performance of a rapid method combining mass spectrometry and direct AST (DAST), and compared it with the conventional method (mass spectrometry with conventional AST (CAST)). Additionally, we assessed its potential impact on antimicrobial use in patients. Over a period of 18 months, the two methods were performed on 85 bronchoalveolar lavages obtained from intensive care unit patients with suspected VAP, and in which Gram-negative bacilli were observed on direct examination. Only the CAST results were reported to the clinicians. DAST produced ...
Communications / Revue d'Épidémiologie et de Santé Publique 57S (2009) S3-S59 S35 médecins prescr... more Communications / Revue d'Épidémiologie et de Santé Publique 57S (2009) S3-S59 S35 médecins prescripteurs émanaient plus du secteur privé (79,5 %), ils étaient des généralistes (45,5 %), des spécialistes (49,5 %) et des chirurgiens dentistes (2,5 %). Dans 11 % des ordonnances, nous avons soulevé des erreurs de prescription (anomalies et interactions). L'ordonnance était non conforme du point de vue de la forme dans 90 % des cas. Le coût moyen d'une ordonnance était de 156,77 DH. Conclusion.-Pour aboutir à une prescription réfléchie et un usage rationnel des médicaments, il faut minimiser les erreurs de forme par l'informatisation de l'ordonnance, réduire le coût moyen d'une ordonnance en donnant le droit de substitution par le générique aux pharmaciens, en améliorant la disponibilité de génériques pour certaines pathologies et en organisant des campagnes de sensibilisation et de formation continue pour les acteurs concernés : patients, prescripteurs, pharmaciens, personnels de santé.
proportion de patients soulagés (EVA < 4) à la sortie est de 65 %, mais plus faible pour ceux aya... more proportion de patients soulagés (EVA < 4) à la sortie est de 65 %, mais plus faible pour ceux ayant des douleurs sévères à l'admission (60 %). Discussion.-La douleur aux urgences est un symptôme fréquent. La méthode du recueil prospectif, incitative, entraîne de forts taux d'évaluation initiale mais la réévaluation au cours de la prise en charge est trop souvent oubliée. Son traitement reste insuffisant et souvent inadapté, avec notamment un recours insuffisant aux morphiniques. Cette enquête nationale réalisée sur un nombre important de centres montre que l'oligoanalgésie est un problème fréquent et que sur le terrain, les recommandations ne sont pas appliquées de façon optimale. Ceci incite à mettre en place un programme d'assurance qualité national ciblé sur la douleur.
Poster Sessions prognosis (similar to grade 1) and one with a bad prognosis (similar to grade 3).... more Poster Sessions prognosis (similar to grade 1) and one with a bad prognosis (similar to grade 3). We therefore also raised the question if a single proliferative factor, i.e. cyclin A, can be used for this purpose.
Background and purpose: Our aim was to characterize the clinical profile, temporal changes and ou... more Background and purpose: Our aim was to characterize the clinical profile, temporal changes and outcomes of patients with severe encephalitis. Methods: A retrospective cohort study was conducted on adult patients with encephalitis admitted to the medical intensive care unit (ICU) of a university hospital over a 20-year period. Patients' characteristics and outcomes were compared between two 10-year periods: (i) 1991-2001 and (ii) 2002-2012. Multivariate logistic regression was used to analyze factors associated with a poor outcome, as defined by a modified Rankin scale (mRS) score of 4-6 (severe disability or death) 90 days after admission. Results: A total of 279 patients were studied. Causes of encephalitis were infections (n = 149, 53%), immune-mediated causes (n = 41, 15%) and undetermined causes (n = 89, 32%). The distribution of causes differed significantly between the two periods, with an increase in the proportion of encephalitis recognized to be of immunemediated causes. At day 90, 208 (75%) patients had an mRS = 0-3 and 71 (25%) had an mRS = 4-6. After adjustment for functional status before admission, the following parameters were independently associated with a poor outcome: coma [odds ratio (OR) 7.09, 95% confidence interval (95% CI) 3.06-17.03], aspiration pneumonia (OR 4.02, 95% CI 1.47-11.03), a lower body temperature (per 1 degree, OR 0.72, 95% CI 0.53-0.97), elevated cerebrospinal fluid protein levels (per 1 g/l, OR 1.55, 95% CI 1.17-2.11) and delayed ICU admission (per 1 day, OR 1.04, 95% CI 1.01-1.07). Conclusions: Indicators of outcome in adult patients with severe encephalitis reflect both the severity of illness and systemic complications. Our data suggest that patients with acute encephalitis may benefit from early ICU admission.
Résultats.-Au total, 376 patients majeurs hospitalisés entre janvier 2009 et décembre 2012 en mal... more Résultats.-Au total, 376 patients majeurs hospitalisés entre janvier 2009 et décembre 2012 en maladies infectieuses et pneumologie ont été inclus. La majorité était des hommes (75 %) né France (26,3 %) ou en Afrique (47,4 %). Une structure d'âge différente entre cas et témoins a nécessité un ajustement sur l'âge en univarié. L'âge est également forcé dans l'analyse multivariée. En univarié, les facteurs identifiés étaient liés à la survenue d'une pathologie pulmonaire aiguë (détresse respiratoire aiguë, douleur thoracique, dyspnée, expectorations ≤ 15 jours), antécédent de tuberculose, radio de thorax normale. L'hémoptysie, classiquement décrite comme un signe de la maladie, était associée avec OR = 0,6 ([0,3-0,9], p = 0,03), suggérant des corrélations avec d'autres variables. Les autres facteurs associés étaient voyage en zone d'endémie, prise d'antibiotiques avant hospitalisation, présence de sueurs nocturnes, diabète, perte de poids (avec une relation dose-effet pour des pertes de poids croissantes), toux prolongée (> 15 jours), et la présence à la radiographie de thorax : d'une caverne (OR = 7,2 [4,3-12,1], p = 5,7e -14 ) et d'une anomalie de localisation apicale (OR = 4,5 [2,2], p = 1,9e -10 ). Ces deux facteurs étant associés, seule la caverne a été retenue dans le modèle. La construction et la validation du score est en cours. Conclusion.-Les analyses descriptives et univariées ajustées sur l'âge ont mis en évidence des facteurs associés classiques de TB. Le modèle final et sa validation seront présentés lors du congrès. http://dx.
The presence of autoantibodies in systemic lupus erythematosus, particularly those of the IgG sub... more The presence of autoantibodies in systemic lupus erythematosus, particularly those of the IgG subclass, have long been associated with disease onset and activity. Here we explored the prevalence of autoreactive IgE in SLE and its relevance to disease in French (n = 79) and United States (US) (n = 117) cohorts with a mean age of 41.5612.7 and 43.6615.3 years and disease duration of 13.568.5 and 16.6611.9 years, respectively. Our findings show that approximately 65% of all SLE subjects studied produced IgE antibodies to the seven autoantigens tested. This positivity was increased to almost 83% when only those subjects with active disease were considered. SLE subjects who were positive for anti-dsDNA, -Sm, and -SSB/La -specific IgE showed a highly significant association in the levels of these antibodies with disease activity similar to that of the corresponding IgG's. A strong association of IgE autoantibodies with active nephritis was also found in the combined cohort analysis. A test of the predictive value of autoreactive IgE's and IgGs for disease activity (SLE Disease Activity Index (SLEDAI) $4) revealed that the best predictors were dsDNA-specific IgE and IgG, and that the age of an SLE subject influenced this predictive model. The finding argue that the overall levels of IgE autoantibodies, independently or in combination with IgG autoantibodies, may serve as indicators of active disease.
Aim: To assess cerebral lesions and other medical as well as social characteristics as predictors... more Aim: To assess cerebral lesions and other medical as well as social characteristics as predictors of risk of mild and severe cognitive deficiencies in very preterm infants.
Background: To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumabradiother... more Background: To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumabradiotherapy for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation.
Background: Legislative measures have been identified as one effective way of changing attitude o... more Background: Legislative measures have been identified as one effective way of changing attitude or behaviour towards health care. The aim of this study was to describe trends in patients' complaints for medical issues; to evaluate the contribution of a law regarding patients' rights, and to identify factors associated to patients' perception of a medical error.
Objective: Neuropathic pain (NP) in acute conditions has been poorly investigated. A diagnostic s... more Objective: Neuropathic pain (NP) in acute conditions has been poorly investigated. A diagnostic score, the DN4 scale (DN4), has been developed to help physicians to detect and treat NP appropriately. DN4 is a 10-item questionnaire. If you have 4 or more positive responses out of 10 items, the answer to the questionnaire is positive and you have a neuropathic pain. We aimed to determine the prevalence of NP in emergency department (ED) patients and to describe this population. Methods: We used the DN4 in the patients with NP visiting the adult ED of a university hospital.
Résumé -Objectif. Évaluer de façon rétrospective la qualité des prescriptions des résidents des é... more Résumé -Objectif. Évaluer de façon rétrospective la qualité des prescriptions des résidents des établissements d'hébergement pour personnes âgées dépendantes (EHPAD) avant la diffusion d'un livret thérapeutique. Méthodes. L'étude a porté sur les prescriptions de 495 résidents de 8 EHPAD, un jour donné. Un score de conformité de prescription a été calculé par rapport au livret à partir de 6 items. Résultats. Le nombre médian de médicaments par ordonnance était de 8,5. Sur 4 311 médicaments prescrits, le score moyen de conformité de la prescription au livret thérapeutique était de 4,96 ± 0,45, (3,4 ± 1,02 pour la prescription manuscrite et 4,54 ± 0,70 pour la prescription informatisée). Parmi ces 4 311 médicaments, 939 (21,8 %) appartenaient à des classes à risque, et devraient être accompagnés d'une surveillance prescrite ; seuls 154 (16,4 %) étaient associés à une prescription de surveillance. Conclusion. Il existe un défaut dans la surveillance des médicaments appartenant aux classes à risque. L'informatisation de la prescription permet d'améliorer la conformité des prescriptions comme le montre le score de conformité.
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