Aix-en-Provence, France
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Moreau N.,Aix - Marseille University | Moreau N.,Center hospitalier du Pays dAix | Viallet F.,Aix - Marseille University | Viallet F.,Center hospitalier du Pays dAix | Champagne-Lavau M.,Aix - Marseille University
Ageing Research Reviews | Year: 2013

Theory of mind (TOM) refers to the ability to infer one's own and other's mental states. Growing evidence highlighted the presence of impairment on the most complex TOM tasks in Alzheimer disease (AD). However, how TOM deficit is related to other cognitive dysfunctions and more specifically to episodic memory impairment - the prominent feature of this disease - is still under debate. Recent neuroanatomical findings have shown that remembering past events and inferring others' states of mind share the same cerebral network suggesting the two abilities share a common process .This paper proposes to review emergent evidence of TOM impairment in AD patients and to discuss the evidence of a relationship between TOM and episodic memory. We will discuss about AD patients' deficit in TOM being possibly related to their difficulties in recollecting memories of past social interactions. © 2013 Elsevier B.V.


Viallet F.,Center Hospitalier du Pays dAix | Pitel S.,Qualissima | Lancrenon S.,Sylia Statistics | Blin O.,Marseille University Hospital Center
Current Medical Research and Opinion | Year: 2013

Objective: Rasagiline is a second-generation, irreversible MAO-B inhibitor (MAOB-I) previously shown to be efficacious and well-tolerated compared to placebo in the treatment of early Parkinson's disease (PD). ACTOR (ACceptabilité TOlérance Rasagiline) was a 15-week, multi-center, randomized, double-blind study aimed to assess the safety and tolerability of rasagiline compared to the dopaminergic agonist pramipexole in the treatment of early PD. Methods: Patients with early, untreated idiopathic PD were randomized to receive 1mg rasagiline (n=53) or 1.5mg pramipexole (n=56) daily. The primary outcome was the number of patients experiencing a 'clinically important adverse event' (classified as a serious adverse event, an event leading to withdrawal or severe according to the patient). Safety outcomes were evaluated by the investigator and the patient. Analysis of the primary criterion was a comparative analysis using the chi-squared test. The Wilcoxon Mann-Whitney test was conducted to test the severity of patient-reported adverse events. Other tests performed include a covariance analysis and Student's t-tests. Results: Mean disease duration was 3.4 months, and mean age was 62.6 years. Of patients taking pramipexole, 44.6% reported at least one 'clinically important' adverse event compared to 32.1% of patients taking rasagiline; non-inferiority of rasagiline was reached, with a difference in proportions of-12.6% [confidence interval of-27.8%; 2.6%]. There were no significant differences in clinical effectiveness between the treatments, measured by clinical and patient global impression of improvement (CGI-I, PGI-I) and PDQ-8 scales. A significant decrease in the incidence of gastrointestinal symptoms (p=0.015) and sleep disorders (p=0.027) was reported by physicians in the rasagiline group compared to the pramipexole group; the propensity to sleepiness improved significantly in the rasagiline group (p=0.020), and worsened in the pramipexole group (p=0.042). Limitations: Limitations of this study include the limited sample size due to the lower than anticipated recruitment and the accidental inclusion of a patient who had taken contraindicated medication. Conclusions: In this study, the safety profile of rasagiline had clinically favorable differences in gastrointestinal and sleep adverse events compared to pramipexole, whilst showing comparable clinician and patient-rated clinical effectiveness as a monotherapy for the treatment of early idiopathic PD. © 2013 Informa UK Ltd All rights reserved.


Letanneux A.,Aix - Marseille University | Danna J.,Aix - Marseille University | Velay J.-L.,Aix - Marseille University | Viallet F.,Aix - Marseille University | And 2 more authors.
Movement Disorders | Year: 2014

Micrographia, an abnormal reduction in writing size, is a specific behavioral deficit associated with Parkinson's disease (PD). In recent years, the availability of graphic tablets has made it possible to study micrographia in unprecedented detail. Consequently, a growing number of studies show that PD patients also exhibit impaired handwriting kinematics. Is micrographia still the most characteristic feature of PD-related handwriting deficits? To answer this question, we identified studies that investigated handwriting in PD, either with conventional pencil-and-paper measures or with graphic tablets, and we reported their findings on key spatiotemporal and kinematic variables. We found that kinematic variables (velocity, fluency) differentiate better between control participants and PD patients, and between off- and on-treatment PD patients, than the traditional measure of static writing size. Although reduced writing size is an important feature of PD handwriting, the deficit is not restricted to micrographia stricto sensu. Therefore, we propose the term PD dysgraphia, which encompasses all deficits characteristic of Parkinsonian handwriting. We conclude that the computerized analysis of handwriting movements is a simple and useful tool that can contribute to both diagnosis and follow-up of PD. © 2014 International Parkinson and Movement Disorder Society .


Moreau C.,University of Lille Nord de France | Pennel-Ployart O.,University of Lille Nord de France | Pinto S.,CNRS Speech and Language Laboratory | Plachez A.,University of Lille Nord de France | And 5 more authors.
Movement Disorders | Year: 2011

Background: Parkinsonian dysarthria (as typically characterized by hypophonia, monotony of pitch, and rhythm abnormalities) is often accompanied by gait disturbances. The long-term effect of subthalamic nucleus deep brain stimulation (STN DBS) on dysarthria remains unclear. Methods: Given STN DBS's known improvement of gait disorders, we analyzed speech intelligibility and aerodynamic and acoustic parameters in 11 advanced PD patients in three double-blind, randomized conditions: "defined Off," 60 Hz STN DBS and 130 Hz STN DBS. Results: An improvement in aerodynamic speech parameters during 60 Hz STN DBS was accompanied by significant clinical benefit. Conclusions: Chronic treatment with low-frequency STN DBS may have a beneficial impact on dysarthropneumophonia, even in advanced PD patients. © 2011 Movement Disorder Society.


In health facilities, the supporting palliative care is an integral part of taking comprehensive care of patients with potentially lethal diseases. One of the tasks of mobile teams of palliative care is to assist the teams in place in some complex situations. To achieve this, the mobile team of palliative care may need to be creative: the Palliative Care Resource Group has been designed for such purposes by an intra-hospital mobile team of palliative care. The group aims at: (1) providing care applicants a space for dialogue in which clinical palliative experiences are discussed; (2) comprehending complex situations together and co-constructing a reflection about the palliative practice adapted to the specificities of medical field. In these groups are pooled knowledge, and know-how between " experts" of curative medicine and those of palliative medicine. These exchange time co-facilitated by members of the mobile team of palliative care, use the group dynamics. They are open to all staff in care services and surrounding structures. Palliative Care Resource Groups are now being extended to more services for care of Pays-d'Aix hospital and beyond. Interests are shared between care teams and the mobile team of palliative care. The principle of these groups is applicable in all care services that receive palliative patients in its goals, its operations and its positioning. The common interest is to practice palliative care in health facilities in continuity beyond the dividing lines. © 2011 Elsevier Masson SAS.


Mimoz O.,University of Poitiers | Auquier P.,University of Monastir | Loundou A.,Unite dAide Methodologique A la Recherche Clinique et Epidemiologique | Gauzit R.,Unite de Reanimation Chirurgicale | And 5 more authors.
Intensive Care Medicine | Year: 2010

Purpose: To develop and validate the IPREA (Inconforts des Patients de REAnimation) questionnaire for the assessment of discomfort perceived by patients related to their intensive care unit (ICU) stay. Methods: This was a two step-study comprising a phase of item generation conducted in one ICU and a phase of psychometric evaluation during a multicenter prospective cohort study in 14 ICUs. Patients were unselected consecutive adult surviving ICU patients. On the day of ICU discharge, a nurse asked patients to rate the severity of 16 discomfort sources, from 0 to 100. Ten percent of patients were randomly chosen to be questioned again to assess the reproducibility. Results: Of 1,380 eligible patients, 1,113 survived and 868 patients could be questioned. The highest scores were for sleep deprivation (35 ± 33), being restrained by tubing, wires, and cables (33 ± 30), pain (32 ± 30), and thirst (32 ± 34). No multidimensional structure was identified. The mean overall score of discomfort was 22 ± 14. Internal consistency was satisfactory using Cronbach's alpha coefficient (0.78). The test-retest reliability study found average measure intraclass correlations ranging from 0.70 to 0.92. The mean duration of the questionnaire administration was 10 ± 7 min. Conclusion: The psychometric properties and acceptability of the IPREA questionnaire make it a potential instrument for measuring discomfort perceived by unselected ICU patients. © 2010 jointly held by Springer and ESICM.


PubMed | Center Hospitalier du Pays dAix, Sandoz Biopharmaceuticals, Center dHemato Cancerologie Praz Coutant, Center Paul Strauss and Center Hospitalier
Type: Journal Article | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2016

Chemotherapy-induced neutropenia is a serious and potentially life-threatening consequence of cancer treatment. Prophylactic treatment with granulocyte-colony stimulating factor (G-CSF) decreases the incidence of febrile neutropenia, the rate of hospitalization, and the use of antibiotics in patients at risk. The aim of this study was to assess efficacy, safety, and use of Zarzio()-biosimilar of Neupogen() (G-CSF; filgrastim)-in prophylaxis of chemotherapy-induced neutropenia in current practice in cancer patients.We conducted an observational, prospective, longitudinal, and multicentric study in France. The incidence of neutropenia was evaluated at each cycle of chemotherapy.One hundred eighty-four patients (women, 64.7 %; mean age, 61.7 years) with solid tumor (89.7 %; breast cancer, 50.5 %) or non-Hodgkin lymphoma (10.3 %) were included. The risk of febrile neutropenia based on chemotherapy regimen was >20 % for 32.1 % of patients. No case of febrile neutropenia was reported. Neutropenia was the cause of hospitalization and/or antibiotic therapy in 10 patients. The most frequent adverse events related to Zarzio() were pain, in particular bone pain. No serious adverse event related to Zarzio() was reported.The results obtained in real-life conditions confirm that Zarzio() is efficient and well tolerated in cancer patients.


PubMed | Center Hospitalier du Pays dAix, Bristol Myers Squibb, HEVA and Estaing University Hospital Center
Type: Journal Article | Journal: Clinics and research in hepatology and gastroenterology | Year: 2016

This retrospective hospital database analysis aimed to determine the burden and cost of hospitalisations related to chronic hepatitis C (CHC) infections in France in 2012.All hospital stays with CHC (ICD-10 code B18.2) coded as the principal, related or significantly associated diagnosis were extracted from the French National Hospital database 2012 (PMSI). Hospitalisations not directly related to CHC were excluded. Patients were assigned to a liver disease stage, namely non-cirrhotic liver disease, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma or post-liver transplantation. Costing was performed using French national tariffs and expressed in 2013 Euros. We documented 22,056 hospital stays involving 12,040 patients who were considered to be directly related to CHC. Of these stays, 11,779 (53.4%) were documented in patients with severe complications (decompensated cirrhosis, hepatocellular carcinoma or liver transplantation).The mean number and duration of hospital stays increased with disease severity. Overall, 1181 patients (9.8%) died during hospitalisation. The total cost of hospital stays for CHC was estimated to be 61 million, of which 26.4% were attributable to hepatocellular carcinoma, 32.5% to post-liver transplantation and 21.0% to decompensated cirrhosis. Compared with a previous analysis in 2009, the number of patients hospitalised fell by 22%, although the patients hospitalised were overall more severely ill. The total cost of hospitalisation decreased by 8%, with a notably marked reduction in the number of biopsies performed (32%). This study illustrates the persistently high burden of CHC infections in France.


PubMed | Center Hospitalier du Pays dAix and IAI
Type: Journal Article | Journal: Journal of clinical microbiology | Year: 2016

Disk diffusion testing is widely used to detect methicillin resistance in staphylococci, and cefoxitin is currently considered the best marker for mecA-mediated methicillin resistance. In low-inoculum diffusion testing (colony suspension at 10


PubMed | Center hospitalier du pays dAix and Center hospitalier dAvignon
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2016

The acute heart failure generates a very important number of hospitalizations for a high cost. A recent reflection on optimizing its management is ongoing, based on the fastest management in the emergency department, with a distinction between which patient should remain and who returns at home, and under what conditions, allowing to limit the number of hospitalizations. It will require a reorganization of emergency department and updating of decision algorithms and new guidelines of care.

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