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Aix-en-Provence, France

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. Source

Worbe Y.,University Pierre and Marie Curie | Mallet L.,University Pierre and Marie Curie | Golmard J.-L.,Assistance Publique Hopitaux de Paris | 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. Source

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. Source

Michallet M.,Center Hospitalier Lyon Sud | Luporsi E.,Center Alexis Vautrin | Soubeyran P.,Institute Bergonie | Amar N.A.,Center Hospitalier Of Troyes | And 11 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. Source

Lebdai S.,Angers University Hospital Center | Rahmene Azzouzi A.,Angers University Hospital Center | Delongchamps N.B.,Service durologie | Benchikh A.,University Paris Diderot | And 12 more authors.
Progres en Urologie | Year: 2015

Introduction: 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. Material and methods: A questionnaire has been distributed by email to 1141urologists members of the French Association of Urologists in November2013. Results: 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. Conclusion: 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. Level of evidence: 4. © 2014 Elsevier Masson SAS. Source

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