Assistance Publique des Hopitaux de Paris APHP

Paris, France

Assistance Publique des Hopitaux de Paris APHP

Paris, France
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Henn A.,Assistance Publique des Hopitaux de Paris APHP | Michel L.,French Institute of Health and Medical Research | Fite C.,Assistance Publique des Hopitaux de Paris APHP | Fite C.,University of Paris Pantheon Sorbonne | And 16 more authors.
Journal of the American Academy of Dermatology | Year: 2015

Background Sézary syndrome is a cutaneous T-cell lymphoma characterized by erythroderma and leukemic involvement. Objective We sought to define the clinical, biologic, and histopathologic features of Sézary syndrome without erythroderma. Methods Features of patients with Sézary syndrome and normal-appearing skin or stage-T1 patches, fulfilling Sézary syndrome hematologic criteria and with histologically documented disease in normal-appearing skin were collected. Expression of Sézary syndrome molecular biomarkers in peripheral blood and skin lymphocytes were studied. Results Five women and 1 man (median age: 71 years) were all referred for generalized pruritus. Four had no specific lesions; 2 had T1-stage patches. Histologic examination of normal-appearing skin from all patients showed lesions compatible with Sézary syndrome. Peripheral blood lymphocytes from 3 of 4 patients tested strongly expressed PLS3, Twist-1, and KIR3DL2. All normal-appearing skin biopsy specimens expressed programmed death-1. Median follow-up was 9 years. Although no patient developed erythroderma, tumors, or abnormal lymph nodes, specific skin lesions appeared in all patients during follow-up. Only 1 death, unrelated to Sézary syndrome, occurred. Limitations Retrospective design and small sample size are limitations. Conclusion Sézary syndrome without erythroderma is a rare entity that may have a better prognosis than classic Sézary syndrome. © 2014 American Academy of Dermatology, Inc.


Meskine N.,Assistance Publique des Hopitaux de Paris APHP | Vullierme M.-P.,Assistance Publique des Hopitaux de Paris APHP | Zappa M.,Assistance Publique des Hopitaux de Paris APHP | d'Assignies G.,Assistance Publique des Hopitaux de Paris APHP | And 6 more authors.
Academic Radiology | Year: 2011

Rationale and Objectives: Percutaneous liver biopsy for tumors performed under local anesthesia is still a painful procedure. The aim of this study was to evaluate the patient's reaction and the analgesic efficacy and safety of an equimolar mixture of oxygen and nitrous oxide (EMONO) inhalation. Materials and Methods: A monocenter, prospective, randomized and double-blind controlled study was performed including 99 adult patients undergoing ultrasound controlled liver biopsy for tumors. 50 patients received an EMONO and 49 patients received a placebo. Pain was evaluated by patients before and after the procedure using a Visual Analog Scale. Results: Analgesic control, defined by the difference between the final and initial VAS scores (Δ), was significantly better in the EMONO group than in the placebo group (Δ = 17.8 ± 25.5 mm vs 30.1 ± 32.6 mm; P = 045. The number of patients who would agree to undergo another liver biopsy under the same conditions was significantly higher in the EMONO group than the placebo group (92.0% vs 75.5%, P = 026). There were no side-effects from the administration of an EMONO. Conclusion: This study shows that patients receiving an EMONO had a higher analgesic control after percutaneous biopsy of focal liver lesions than patients in the placebo group. Moreover, acceptance of additional biopsies was higher in the EMONO group. © 2011 AUR.


Cristancho-Lacroix V.,Assistance Publique des Hopitaux de Paris APHP | Cristancho-Lacroix V.,University of Paris Descartes | Moulin F.,Assistance Publique des Hopitaux de Paris APHP | Wrobel J.,Assistance Publique des Hopitaux de Paris APHP | And 7 more authors.
Journal of Medical Internet Research | Year: 2014

Background: Web-based programs have been developed for informal caregivers of people with Alzheimer's disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers' correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial. Objective: The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers' stress, and based on the user-centered design approach. Methods: There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire. Results: The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis. Conclusions: Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.


PubMed | Assistance Publique des Hopitaux de Paris APHP
Type: Journal Article | Journal: JMIR research protocols | Year: 2014

Web-based programs have been developed for informal caregivers of people with Alzheimers disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial.The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers stress, and based on the user-centered design approach.There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire.The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis.Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.

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