Gouezec H.,Rennes University Hospital Center |
Berger E.,Unite de securite transfusionnelle |
Bergoin-Costello V.,Center hospitalier dAix en Provence |
Betbeze V.,Nantes University Hospital Center |
And 15 more authors.
Transfusion Clinique et Biologique | Year: 2010
The purpose of this retrospective observational multicenter study was to assess appropriateness of red blood cell (RBC) transfusion, according to the French national guidelines (Agence française de sécurité sanitaire des produits de santé) published in 2002. Six hundred and thirty-nine RBC transfusions from nine institutions have been randomly selected and analysed. The data collected are issued from different specialities. Patients' characteristics, occurrences of transfusion, admission, pre-transfusion, post-transfusion and discharge haemoglobin concentrations have been collected. Two physicians (who are in charge) must evaluate the appropriateness of pre-transfusion, discharged haemoglobin concentrations, quantity and quality of transfused RBC. The mean pre-transfusion haemoglobin concentration was 7.89 ± 1.24, the median number of transfused RBC was two (extremes: 1-16), the mean discharge haemoglobin concentration was 10.14 ± 1.30 (-5 days after the end of transfusion). The pre-transfusion and discharge haemoglobin concentrations were higher if the patient presented a co-morbidity factor. Ninety-three percent of pre-transfusion and 79% of discharge haemoglobin concentrations are in accordance with the guidelines. According to the physicians, the RBC transfusions are too " precocious" when pre-transfusion haemoglobin concentration is above nine and the anaemia is asymptomatic. 50% of RBC transfusion with discharge haemoglobin concentration above 10 is not excessive. In case of acute anaemia, the pre-transfusion and discharge haemoglobin concentrations are higher and RBC transfusion excessive. In this study, the trigger haemoglobin concentration is " restrictive" , but the target haemoglobin concentration is " liberal" with a high-discharge haemoglobin concentration. Inappropriate RBC transfusions are mainly due to over-transfusion. © 2010 Elsevier Masson SAS.
Papazian L.,Assistance Publique Hopitaux de Marseille |
Roch A.,Assistance Publique Hopitaux de Marseille |
Charles P.-E.,CHU de Dijon |
Penot-Ragon C.,Assistance Publique Hopitaux de Marseille |
And 16 more authors.
JAMA - Journal of the American Medical Association | Year: 2013
IMPORTANCE: Observational studies have reported that statin use may be associated with improved outcomes of various infections. Ventilator-associated pneumonia (VAP) is the most common infection in the intensive care unit (ICU) and is associated with substantial mortality. OBJECTIVE: To determine whether statin therapy can decrease day-28 mortality in patients with VAP. DESIGN, SETTING, AND PARTICIPANTS: Randomized, placebo-controlled, double-blind, parallelgroup, multicenter trial performed in 26 intensive care units in France from January 2010to March 2013. For power to detect an 8%absolute reduction in the day-28 mortality rate,we planned to enroll 1002 patients requiring invasive mechanical ventilation for more than 2 days and having suspected VAP, defined as a modified Clinical Pulmonary Infection Score of 5 or greater. The futility stopping ruleswere an absolute increase in day-28 mortality of at least 2.7% with simvastatin compared with placebo after enrollment of the first 251 patients. INTERVENTIONS: Participants were randomized to receive simvastatin (60mg) or placebo, started on the same day as antibiotic therapy and given until ICU discharge, death, or day 28, whichever occurred first. MAIN OUTCOMES AND MEASURES: Primary outcomewas day-28 mortality. Day-14, ICU, and hospital mortality rates were determined, as well as duration of mechanical ventilation and Sequential Organ Failure Assessment (SOFA) scores on days 3, 7, and 14. RESULTS: The study was stopped for futility at the first scheduled interim analysis after enrollment of 300 patients, of whom all but 7% in the simvastatin group and 11% in the placebo group were naive to statin therapy at ICU admission. Day-28 mortality was not lower in the simvastatin group (21.2% [95% CI, 15.4% to 28.6%) than in the placebo group (15.2% [95% CI, 10.2% to 22.1%]; P = .10; hazard ratio, 1.45 [95% CI, 0.83 to 2.51]); the between-group difference was 6.0% (95% CI, -3.0% to 14.9%). In statin-naive patients, day-28 mortality was 21.5% (95% CI, 15.4% to 29.1%) with simvastatin and 13.8% (95% CI, 8.8% to 21.0%) with placebo (P = .054) (between-group difference, 7.7% [95% CI, -1.8% to 16.8%). There were no significant differences regarding day-14, ICU, or hospital mortality rates; duration of mechanical ventilation; or changes in SOFA score. CONCLUSIONS AND RELEVANCE: In adults with suspected VAP, adjunctive simvastatin therapy compared with placebo did not improve day-28 survival. These findings do not support the use of statins with the goal of improving VAP outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01057758.
Yellow jacket venom immunotherapy: The influence of maintenance dose on the immunologic response [Immunothérapie allergénique au venin de guêpe: Influence de la dose d'entretien sur la réponse immunologique]
Roussel C.,Service de pneumologie et immuno allergologie |
Birnbaum J.,Center hospitalier dAix en Provence |
Bourrain J.-L.,Grenoble University Hospital Center |
Demoly P.,Montpellier University Hospital Center |
And 2 more authors.
Revue Francaise d'Allergologie | Year: 2015
Objective.- Specific immunotherapy is the only curative treatment of hymenoptera venom allergy. Currently, there is no consensus on the maintenance dose to be used. The objective of this study was to evaluate the influence of maintenance dose (100 μg versus 200 μg) on the immunologic response after 5 years of vespula venom immunotherapy. Patients and method.- During the first year, all patients received 100 μg/month. According to the dose received for pursuit of immunotherapy, patients were distributed, afterward, in 2 groups. Group 200 (n = 41): progressive increase of the maintenance dose until 200 μg/month. Group 100 (n = 48): constant dose of 100 μg/month. Immunologic response was evaluated on evolution of skin tests (modification of positivity level) and vespula specific IgE (percentage of decrease) between 0 and 5 years. Improvement of skin tests was defined by positivity with a more important venom concentration after 5 years compared with initial skin tests. Results.- After 5 years, proportion of patients presenting an improvement of skin tests positivity level was more important (p = 0.003) in group 200 (90.2%) than group 100 (74.4%). Vespula specific IgE, initially higher in group 200, became identical to that of the other group after 5 years (p = 0.1). Global decrease of vespula specific IgE was similar between 2 groups after 5 years (p = 0.1). Conclusion.- The increase of venom dose at 200 μg is associated with a more important improvement of immunological response than the preservation of 100 μg.
Michallet M.,Center Hospitalier Lyon Sud |
Luporsi E.,Center Alexis Vautrin |
Soubeyran P.,Institute Bergonie |
Amar N.A.,Center Hospitalier Of Troyes |
And 13 more authors.
BMC Cancer | Year: 2014
Background: The approval of epoetin biosimilars in the European Union requires extensive scientific evaluation and stringent regulatory procedures, including post-marketing studies. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study was an observational, longitudinal, multicentre study performed in France to evaluate the efficacy and safety of biosimilar epoetins for the treatment of chemotherapy-induced anaemia (CIA) in the clinical setting.Methods: Patients >18 years with CIA (haemoglobin [Hb] <11 g/dL) in association with solid tumours, lymphoma or myeloma and eligible for treatment with an epoetin biosimilar were included in this study. Patient characteristics were recorded at baseline along with anaemia-related information, such as observed and target Hb (as chosen by the treating clinician), brand and dose of epoetin biosimilar prescribed, and details of any other treatments. Patients were then followed-up at 3 and 6 months. The primary endpoint was Hb response (defined as Hb reaching ≥10 g/dL, an increase of Hb ≥1 g/dL since inclusion visit or reaching physician-defined target Hb, with no blood transfusions in the 3 weeks prior to measurement). Other endpoints included adverse events, achievement of target Hb and associated treatments.Results: Overall, 2333 patients >18 years (mean age 66.5 years) with CIA (haemoglobin [Hb] <11 g/dL) in association with solid tumours, lymphoma or myeloma and eligible for biosimilar epoetin treatment were included. 99.9% of patients received epoetin zeta (median dose 30,000 IU/week). Mean baseline Hb was 9.61 g/dL, with 35.6% of patients having moderate anaemia (Hb 8-9.5 g/dL). Hb response was achieved in 81.6% and 86.5% of patients at 3 and 6 months, respectively. Overall mean change in Hb level was 1.52 ± 1.61 and 1.72 ± 1.61 g/dL at 3 and 6 months, respectively. Transfusion and thromboembolic event rates were 9.4% and 2.4% at 3 months, and 5.8% and 1.5% at 6 months, respectively.Conclusions: Epoetin zeta was effective and well tolerated in the management of CIA in patients with solid tumours, lymphoma and myeloma.Trial registration: Trial registration number: NCT02140736 (date of registration: 14 May 2014). © 2014 Michallet et al.; licensee BioMed Central Ltd.
Khachab H.,Center hospitalier dAix en Provence |
Rahal Y.,Center hospitalier dAix en Provence |
Boulain L.,Center hospitalier dAix en Provence |
Barnay C.,Center hospitalier dAix en Provence |
And 4 more authors.
Annales de Cardiologie et d'Angeiologie | Year: 2013
Introduction: Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention. Methods and results: To discuss these specificities, we realized a retrospective study involving patients aged more than 75. years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P = 0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS). Discussion and conclusion: Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent. © 2013 Elsevier Masson SAS.
Pouessel G.,Service de pediatrie |
Pouessel G.,Lille University of Science and Technology |
Deschildre A.,Lille University of Science and Technology |
Beaudouin E.,Center hospitalier Durkheim |
And 6 more authors.
Revue Francaise d'Allergologie | Year: 2016
The Personalized care project (PCP) for allergic emergencies was designed to improve the management in schools of children with a chronic illness, such as allergies. It was derived from official judiciary and administrative files, including the inter-ministerial document of 25 June 2001 and the document No. 2003-135 of 8 September 2003. French recommendations on the establishment of PCPs, first for food allergic children, had been provided by a tripartite commission in 2003. In 2014, a task force on anaphylaxis of the European Academy of allergy and clinical immunology (EAACI) had prepared guidelines for the management of anaphylaxis, with indications for the use of adrenaline autoinjectors in allergic children. The tripartite "Anaphylaxis", "Food allergy" and "Stinging insects" working groups of the French allergology society provided critical comments and finally validated these European guidelines. These different working groups now propose realization of these recommendations which should lead to the establishment of a PCP in schools where the daily management of allergic children is necessary, taking into account the conclusions of the tripartite commission, as well as the evolution of allergy nomenclature, of data in medical journals and of the EAACI recommendations of 2014. The aim of this paper was to update these recommendations and finally provide a position statement from the French allergology society. © 2016 Elsevier Masson SAS.
Cassir N.,Service de maladies infectieuses et tropicales |
Di Marco J.-N.,Center hospitalier dAix en Provence |
Poujol A.,Center hospitalier dAix en Provence |
Lagier J.-C.,Service de maladies infectieuses et tropicales
Archives de Pediatrie | Year: 2012
Context: The judicious prescription of antibiotics has become a central focus of professional and public-health measures to combat the spread of resistant organisms. It also seems important to consider the other impacts and determinants of antibiotic misuse. Objective: Evaluating the ambulatory antibiotic prescription for common infections in patients secondarily hospitalized as well as the consequences and determinants of this prescription. Patients and methods: Study conducted over a period of 6 months between May and November 2008, during which 52 children aged between 3 months and 15 years, hospitalized in the pediatric hospital of Aix-en-Provence, were recruited. The reason for the pediatric emergency department visit was persistent symptoms or new symptoms over 48. h of ambulatory antibiotic prescription. The ambulatory antibiotic prescription was compared with current practice guidelines, and clinical progression after hospitalization was also analyzed. Afterwards, the determinants of this overprescription in ambulatory practice were investigated through a telephone questionnaire. Results: Seventy-five percent of the antibiotic prescriptions were inappropriate, 60 % of which could potentially have been avoided with had an adequate and recommended practices been followed. Only 25 % of the children were prescribed ambulatory diagnostic exams, whereas these exams confirmed the diagnosis at the hospital for 71 % of them. In addition, 15 % of the children presented secondary effects of the antibiotics at their admission. Among practitioners, 84 % recognized having difficulties on reevaluation of the antibiotic prescription at 48. h. A high proportion of them (71 %) believe that antibiotics should be initiated precociously in patients with underlying conditions such as diabetes. Furthermore, 33 % recognized that the perceived parents' expectation could be a determinant of prescription. Otherwise, 22 % of them had attended an antibiotic prescription educational program during the past year. Discussion: Antibiotic prescription for children's common infections remains a difficult decision for practitioners. This could partly be explained by atypical clinical symptoms and the risk of rapid progression in pediatric medicine. However, the rate of inappropriate prescription of antibiotics is high in this population. Among the main consequences of this practice, one may note the appearance of antibiotic resistance, the occurrence of side effects, and delayed diagnoses as well as preventable hospitalizations. Although certain considerations, such as the problems re-evaluating the patient after 48. h, must be taken into account, better use of paraclinical examinations in general practice could help to reduce inappropriate antibiotic prescriptions. Further large-scale, prospective studies should be conducted on the existing practices and beliefs concerning ambulatory antibiotic prescription in order to adjust prevention strategies. © 2012 Elsevier Masson SAS.
Worbe Y.,University Pierre and Marie Curie |
Mallet L.,University Pierre and Marie Curie |
Golmard J.-L.,Groupe Hospitalier Pitie Salpetriere |
Behar C.,University Pierre and Marie Curie |
And 20 more authors.
PLoS ONE | Year: 2010
Background: Repetitive behaviours (RB) in patients with Gilles de la Tourette syndrome (GTS) are frequent. However, a controversy persists whether they are manifestations of obssessive-compulsive disorder (OCD) or correspond to complex tics. Methods: 166 consecutive patients with GTS aged 15-68 years were recruited and submitted to extensive neurological, psychiatric and psychological evaluations. RB were evaluated by the YBOCS symptom checklist and Mini International Neuropsychiatric Interview (M.I.N.I), and classified on the basis of a semi-directive psychiatric interview as compulsions or tics. Results:RB were present in 64.4% of patients with GTS (107/166) and categorised into 3 major groups: a 'tic-like' group (24.3%-40/166) characterised by RB such as touching, counting, 'just right' and symmetry searching; an 'OCD-like' group (20.5%-34/166) with washing and checking rituals; and a 'mixed' group (13.2%-22/166) with both 'tics-like' and 'OCD-like' types of RB present in the same patient. In 6.3% of patients, RB could not be classified into any of these groups and were thus considered 'undetermined'. Conclusions:The results confirm the phenomenological heterogeneity of RB in GTS patients and allows to distinguish two types: tic-like behaviours which are very likely an integral part of GTS; and OCD-like behaviours, which can be considered as a comorbid condition of GTS and were correlated with higher score of complex tics, neuroleptic and SSRIs treatment frequency and less successful socio-professional adaptation. We suggest that a meticulous semiological analysis of RB in GTS patients will help to tailor treatment and allow to better classify patients for future pathophysiologic studies. © 2010 Worbe et al.
PubMed | Center hospitalier dAix en Provence
Type: Comparative Study | Journal: Annales de cardiologie et d'angeiologie | Year: 2013
Cardiovascular causes are the first causes of death in elderly patients. Nevertheless, elderly patients are underrepresented in randomized studies of acute coronary syndromes although treatment of ACS for elderly patients has specificities that need special attention.To discuss these specificities, we realized a retrospective study involving patients aged more than 75years old and admitted for ACS in the cardiology department of Aix-en-Provence General Hospital in the first six months of 2010 (Group A) and 2012 (Group B) which we compared. Initial presentation was chest pain in only 78.6% of Group A versus 81.6% in Group B (NS), renal insufficiency was found in 41.4% of the patients of Group A versus 50.5% of the patients in Group B (NS), anaemia was found in 34.3% of Group A patients versus 40.2% of Group B (NS), invasive strategy is less systematic with 74.2% of Group A patients having a revascularization versus 73.6% of Group B (NS), Drug Eluting Stents were less frequently used with 14.3% of Group A patients versus 14.7% of Group B (NS), radial access was used for angioplasty in 61.2% of Group A patients versus 80.2% of Group B (P=0.02), unfractioned heparin was used in 74.3% of the cases in Group A versus 68% in Group B (NS).Acute coronary syndrome of the elderly patients has numerous specificities, first there are frequent unusual presentation making diagnosis more difficult, second they have frequent co morbidities making them frail patients with higher risk of hemorrhagic complications and lesser tendency to invasive evidence based treatment. In the absence of specific recommendations, their treatment should not differ from younger patients. This work allowed us also to evaluate our professional practices in order to improve them; we note a positive evolution with the significant raise in the use of radial access, invasive strategy though should be more systematic and use of low molecular weight heparin and Fondaparinux should be more frequent.
PubMed | Service durologie, Clinique mutualiste Beausoleil, Limoges University Hospital Center, Angers University Hospital Center and 5 more.
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2014
The French guidelines on the management of benign prostatic hyperplasia (BPH) have been published in 2012 by the LUTS committee of the French Urological Association. The aim of this study was to evaluate the impact of these guidelines on the BPH management by French urologists.A questionnaire has been distributed by email to 1141urologists members of the French Association of Urologists in November2013.We collected 222responses (response rate: 19%). The guidelines have been read by 73% of the urologists. The guidelines were followed most of the time by 76% of them, 11% followed them systematically and 4.5% did not follow them. The new terminology was used by 28 to 52% according to the items. The symptoms were evaluated by the IPSS score (33%), by interrogatory alone (64%) or by neither of them (3%). Prostate volume was not systematically taken for account in the treatment strategy by 57% of the urologists. Sexual function was assessed systematically by 28% of the urologists, 11% used a questionnaire (IIEF: 92%). PSA was tested respectively by 70 and 51% of the urologists at the initial evaluation and the follow-up. After introduction of a monotherapy, 56% of the urologists evaluated the efficacy at 3months.The French guidelines for the management of benign prostatic hyperplasia (BPH) by the LUTS committee of the French Urological Association were well known and used by French urologists. Some improvements can be expected for the use of the IPSS score, the evaluation of the sexual function, and the use of the new terminology.4.