Center Hospitalier la Chartreuse

Plombières-lès-Dijon, France

Center Hospitalier la Chartreuse

Plombières-lès-Dijon, France
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Berquet A.,CHU Francois Mitterrand | Berquet A.,Stomatologie et odontologie hospitaliere | Louvrier A.,University of Franche Comte | Louvrier A.,Stomatologie et odontologie hospitaliere | And 10 more authors.
Journal of Stomatology, Oral and Maxillofacial Surgery | Year: 2017

Introduction Osteochemonecrosis of the jaw (ONJ) is a chronic ischemic bone exposure. It has an increasing incidence. ONJ is mainly related to bisphosphonate and denosumab therapies in oncologic settings. Healing is considered uncertain ad as occurring slowly. International recommendations suggest to treat ONJ symptomatically in a first attempt. A surgical procedure, potentially aggressive, should be carefully weight up in patients in poor condition and whose life expectancy is often limited. However, surgical treatment seems to allow for a high rate of clinical remission. Postoperative remission periods, when mentioned in the studies, are disparate. The aim of our study was to clarify the remission period of ONJ after surgical management. Method A retrospective study was conducted on all patients operated for an ONJ at stage 2 and 3 in the Department for Oral and Maxillofacial Surgery – University Hospital of Besançon (France) from January 2006 to September 2015. Healing was defined as complete mucosal closure and asymptomatic site. Stage of the disease, the number and the type of surgery and the time between the last operation and the healing was noticed. These data were compared to an exhaustive review of the literature on PubMed with the following key-words: “osteonecrosis” AND “jaw” AND “surgery” AND “management”. Only the articles giving the healing period were included. Results Regarding the single-center retrospective study, the files of 23 patients could be included. Fifteen percent of the patients benefited from several procedures under general anesthesia. Twenty percent had a stage 3 ONJ and 80 % had a stage 2 ONJ. Twenty-five interventions were performed on 23 sites in 20 patients. Immediate healing after surgery occurred in 35 % of the patients. At 6 months after surgery, 57 % of the treated areas were healed. Twenty percent of the patients had died. The healing rate did not improve further after 6 months postoperatively. Regarding the review of the literature, 7 articles could be included. The mean postoperative healing period was 60.7 % at 6 months, 71.1 % at 12 months and 69.5 % at 18 months. Discussion Our study shows that the postoperative healing rate of ONJ lies between 57 and 66.7 % at 6 months and that this rate was optimized in the order of 10 % to 12 months and stable at 18 months postoperatively. The ONJ of our series were partially or fully linked to other drugs than bisphosphonates in 70 % of the cases: 50 % were related to denosumab, alone or in combination and 35 % were related to an association with antiangiogenics, bevacizumab mainly. © 2016 Elsevier Masson SAS


Noblot-Rossignol M.,Center hospitalier La Chartreuse | Vailleau J.-L.,Center hospitalier La Chartreuse | Hamad M.,University of Burgundy | Denis F.,Center hospitalier La Chartreuse | Beye F.,Center hospitalier La Chartreuse
Pharmacien Hospitalier et Clinicien | Year: 2016

Introduction: Setting up a Medication Reconciliation system without extra staffing requires efficiency, notably by defining patient selection criteria. Methodology: An experimental observational single-center study was conducted in a mental health facility to determine eligibility criteria so that reconciliation could be implemented in priority for patients at highest drug-related iatrogenic risk and to enable efficient implementation of the reconciliation process. Potentially relevant general, somatic and psychiatric criteria (n = 6, 14 and 15, respectively) were identified and studied. Results: One or more medication errors were detected in 32 of the 200 patients in whom reconciliation was performed at admission. Thirty-nine of the 53 medication errors were corrected by the physician. A patient interview was carried out in 75 % of cases. Criteria significantly related to risk of medication error were: female gender, admission for agitation/aggressiveness, depressive state, manifest delusional state, alcohol abuse, Quebec score. >. 4, high blood pressure or thyroid dysfunction, and classification as "long-term disease". No psychiatric criteria were significantly associated with risk of medication error. © 2017 Elsevier Masson SAS.


PubMed | Unite dangiologie et dexplorations fonctionnelles vasculaires, University of Bergen, Center Hospitalier Of Cahors and Center hospitalier La Chartreuse
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2013

Using a questionnaire, we have evaluated how VKA and INR are handled by medical doctors in Quercy-Rouergue. This evaluation is part of an international post-analytical quality assessment survey in laboratory medicine supervised by Noklus (http://www.noklus.no/). The original questionnaire designed by Noklus has been adapted to our local practices in replacing warfarin by fluindione. The Centre de rfrence et dducation aux antithrombotiques dIle de France (Creatif) also participated. Of 282 medical doctors who were sent the questionnaire 109 filled it in, 62% of them being general practitioners. For a target INR at 2.5, the thresholds used to change the dose of VKA range between 1.3 and 2.3 for low values, and between 2.8 and 4 for high values. The bleeding or ischemic risks of being under VKA, versus of not being under VKA, are largely overestimated. INR measurements also tend to be too frequent in stable, and even more so in overdosed, patients. In case of INR at 4.8 only 59% of the participants implement the recommendation of la Haute autorit de sant (HAS) and le Groupe dtude sur lhmostase et la thrombose (GEHT) which consists of skipping one dose of VKA, and the attitudes also diverge regarding the importance of the VKA dose reduction, and the number of days under reduced dose before the next INR measurement, the attitude of the Creatif being barely predominant among the participants, and slightly different from that recommended by the HAS and the GEHT. In conclusion, despite the limitations of our methods (the analysis of a questionnaire being less close to the truth than an analysis of actual practices), our evaluation points to the heterogeneity in the knowledge about, and in handling, VKA and INR regarding more particularly management of overdosing, and the estimation of bleeding or ischemic risks, despite the availability of supposedly clear and simple practice guidelines.


Grimaldi-Bensouda L.,LA SER | Grimaldi-Bensouda L.,French National Conservatory of Arts and Crafts | Grimaldi-Bensouda L.,French Institute of Health and Medical Research | Alperovitch A.,French Institute of Health and Medical Research | And 70 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Background: Gout therapy includes xanthine oxidase inhibitors (XOI) and colchicine, which have both been associated with decreased cardiovascular risk. However, their effects on major cardiac events, such as myocardial infarction (MI), need to be investigated further. Objectives: To investigate whether XOIs and colchicine are associated with decreased risk of MI. Methods: This case-control study compared patients with first-ever MI and matched controls. Cases were recruited from the Pharmacoepidemiological General Research on MI registry. Controls were selected from a referent population (n=8444) from general practice settings. Results: The study sample consisted of 2277 MI patients and 4849 matched controls. Use of allopurinol was reported by 3.1% of cases and 3.8 of controls, and 1.1% of cases and controls used colchicine. The adjusted OR (95% CI) for MI with allopurinol use was 0.80 (0.59 to 1.09). When using less stringent matching criteria that allowed for inclusion of 2593 cases and 5185 controls, the adjusted OR was 0.73 (0.54 to 0.99). Similar results were found on analysis by sex and hypertension status. Colchicine used was not associated with a decreased risk of MI (aOR=1.17 (0.70 to 1.93)). Conclusions: Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.


Grimaldi-Bensouda L.,LA SER | Grimaldi-Bensouda L.,French National Conservatory of Arts and Crafts | Grimaldi-Bensouda L.,French Institute of Health and Medical Research | Alperovitch A.,French Institute of Health and Medical Research | And 72 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Background: Gout therapy includes xanthine oxidase inhibitors (XOI) and colchicine, which have both been associated with decreased cardiovascular risk. However, their effects on major cardiac events, such as myocardial infarction (MI), need to be investigated further. Objectives: To investigate whether XOIs and colchicine are associated with decreased risk of MI. Methods: This case-control study compared patients with first-ever MI and matched controls. Cases were recruited from the Pharmacoepidemiological General Research on MI registry. Controls were selected from a referent population (n=8444) from general practice settings. Results: The study sample consisted of 2277 MI patients and 4849 matched controls. Use of allopurinol was reported by 3.1% of cases and 3.8 of controls, and 1.1% of cases and controls used colchicine. The adjusted OR (95% CI) for MI with allopurinol use was 0.80 (0.59 to 1.09). When using less stringent matching criteria that allowed for inclusion of 2593 cases and 5185 controls, the adjusted OR was 0.73 (0.54 to 0.99). Similar results were found on analysis by sex and hypertension status. Colchicine used was not associated with a decreased risk of MI (aOR=1.17 (0.70 to 1.93)). Conclusions: Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect. © 2014 BMJ Publishing Group Ltd & European League Against Rheumatism.


Kristoffersen A.H.,University of Bergen | Kristoffersen A.H.,Haraldsplass Deaconess Hospital | Ajzner E.,Central University of Costa Rica | Rogic D.,Clinical Hospital Center | And 7 more authors.
Thrombosis Research | Year: 2016

Introduction Clinical algorithms consisting of pre-test probability estimation and D-dimer testing are recommended in diagnostic work-up for suspected venous thromboembolism (VTE). The aim of this study was to explore how physicians working in emergency departments investigated patients suspected to have VTE. Materials and methods A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to physicians in six European countries. The physicians were asked to estimate pre-test probability of VTE, and indicate their clinical actions. Results In total, 487 physicians were included. Sixty percent assessed pre-test probability of PE to be high in Case A, but 7% would still request only D-dimer and 11% would exclude PE if D-dimer was negative, which could be hazardous. Besides imaging, a D-dimer test was requested by 41%, which is a "waste of resources" (extra costs and efforts, no clinical benefit). For Case B, 92% assessed pre-test probability of DVT to be low. Correctly, only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer, which is a "waste of resources". Conclusions These results should encourage scientific societies to improve the dissemination and knowledge of the current recommendations for the diagnosis of VTE. © 2016 Elsevier Ltd. All rights reserved.


PubMed | Clinical Hospital Center Zagreb, National Health Institute Dr Ricardo Jorge, University of Bergen, Ege University and 4 more.
Type: | Journal: Thrombosis research | Year: 2016

Clinical algorithms consisting of pre-test probability estimation and D-dimer testing are recommended in diagnostic work-up for suspected venous thromboembolism (VTE). The aim of this study was to explore how physicians working in emergency departments investigated patients suspected to have VTE.A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to physicians in six European countries. The physicians were asked to estimate pre-test probability of VTE, and indicate their clinical actions.In total, 487 physicians were included. Sixty percent assessed pre-test probability of PE to be high in Case A, but 7% would still request only D-dimer and 11% would exclude PE if D-dimer was negative, which could be hazardous. Besides imaging, a D-dimer test was requested by 41%, which is a waste of resources (extra costs and efforts, no clinical benefit). For Case B, 92% assessed pre-test probability of DVT to be low. Correctly, only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer, which is a waste of resources.These results should encourage scientific societies to improve the dissemination and knowledge of the current recommendations for the diagnosis of VTE.


Kristoffersen A.-H.,University of Bergen | Thue G.,University of Bergen | Ajzner E.,Josa Andras Teaching Hospital | Claes N.,Hasselt University | And 15 more authors.
Thrombosis Research | Year: 2012

Introduction: Standardisation of treatment with vitamin K antagonists (VKAs) is still an issue after 60 years of use. The study aimed to explore aspects of VKA monitoring in primary and secondary care. Methods: Two case histories were distributed to physicians in 13 countries. Case history A focused on a patient with atrial fibrillation on stable anticoagulation (latest INR 2.3). Physicians were asked about frequency of INR measurement, when to change the VKA dose, and the patient's annual risk of ischemic stroke and bleeding. Case history B focused on a patient with an unexpected INR of 4.8, asking for the patient's 48-hour bleeding risk, the immediate dose reduction and time until a repeat INR. Results: Altogether, 3016 physicians responded (response rate 8 - 38%), of which 82% were from primary care and 18% from secondary care. Answers varied substantially within and between countries regardless of level of care and VKA used. Median number of weeks between INR measurements was 4 - 6 weeks. Median threshold INR for increasing or decreasing the VKA dose was 1.9 and 3.1, respectively. Risk of ischemic stroke and bleeding were overestimated 2 - 3 times. In case history B, the median dose reduction the two first days was 75% for GPs and 55% for specialists, irrespective of estimates of bleeding risk; with one week to a repeat INR. Conclusion: Variation in VKA monitoring is substantial implying clinical consequences. Guidelines seem either unknown or may be considered impracticable. Further efforts towards standardisation of VKA management are needed. © 2012 Elsevier Ltd.

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