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Cergy-Pontoise, France

Dohner H.,University of Ulm | Lubbert M.,Albert Ludwigs University of Freiburg | Fiedler W.,University of Hamburg | Fouillard L.,Center Hospitalier Rene Dubos | And 14 more authors.
Blood | Year: 2014

Treatment outcomes for older patients with acute myeloid leukemia (AML) have remained dismal. This randomized, phase 2 trial in AML patients not considered suitable for intensive induction therapy compared low-dose cytarabine (LDAC) with orwithout volasertib, a highly potent and selective inhibitor of polo-like kinases. Eighty-seven patients (median age 75 years) received LDAC 20mg twice daily subcutaneously days 1-10 or LDAC + volasertib 350 mg IV days 1 + 15 every 4 weeks. Response rate (complete remission and complete remission with incomplete blood count recovery)was higher for LDAC+volasertib vs LDAC (31.0% vs 13.3%; odds ratio, 2.91; P = .052). Responses in the LDAC + volasertib arm were observed across all genetic groups, including 5 of 14 patients with adverse cytogenetics. Median event-free survival wassignificantly prolonged by LDAC+ volasertib comparedwith LDAC (5.6 vs 2.3 months; hazard ratio, 0.57; 95% confidence interval, 0.35-0.92; P = .021); median overall survival was 8.0 vs 5.2 months, respectively (hazard ratio, 0.63; 95% confidence interval, 0.40-1.00; P5.047). LDAC+ volasertib led to an increased frequency of adverse events that was most pronounced for neutropenic fever/infections and gastrointestinal events; there was no increase in the death rate at days 60 + 90. This study was registered at www.clinicaltrials.gov as #NCT00804856. © 2014 by The American Society of Hematology. Source

Beranger A.,University of Paris Descartes | Boize P.,Center Hospitalier Rene Dubos | Viallard M.-L.,University of Paris Descartes
Archives de Pediatrie | Year: 2014

Introduction: Prematurity is one of the etiologies for severe neurological complications. Decisions to withdraw therapeutics, including artificial nutrition and hydration (ANH), are sometimes discussed. But can one withdraw ANH if the patient is a child suffering from severe neurological conditions, based on his best interests? The aim of this study was to further the understanding of the complexity of the withdrawal of ANH and its implementation in the neonatal intensive care unit (NICU). Method: This qualitative preliminary study based on a questionnaire was conducted on the staff in the NICU of the Pontoise medical center (France) in February 2012. The results were compared with the current knowledge on this issue and sociological data. Results: Ten of the hospital staff members responded to the questionnaire: 60% considered ANH as a treatment, but the status of ANH (i.e., treatment or care) remained undefined for several respondents. Comparison with the withdrawal of mechanical ventilation or adult practices seemed to be inadequate. The staff had little experience in the domain and therefore few certainties on practices. Half of the respondents indicated that terminal sedation needed to be used. For the other half, it depended on the patient's pain. Timing was also an important notion given that the newborn is a being developing and evolving each in its own way. Conclusion: The withdrawal of ANH remains controversial in the NICU. Humanity, culture, and the relationship to others are ever present in the decision-making process, creating a moral opposition above and beyond ethical reflection. © 2013 Elsevier Masson SAS. Source

Broughton A.,Catholic University of Louvain | Verger C.,Center Hospitalier Rene Dubos | Goffin E.,Catholic University of Louvain
Seminars in Dialysis | Year: 2010

Infectious peritonitis is still a major concern in peritoneal dialysis (PD). Standard antibiotic regimens target common causative microorganisms such as Staphylococcus aureus and epidermidis or Pseudomonas aeruginosa. When the infection does not respond, unusual infective agents are to be considered including zoonoses-infections with an animal source. Companion animals or occupations involving animal contact favor the development of zoonoses, especially for immunocompromised patients such as those with end-stage renal disease. We reviewed the literature for all animals-related peritonitis in PD and analyzed data from our own PD unit and from the French-speaking registry for peritoneal dialyis (RDPLF) to assess both the frequency and the potential risk for PD patients in owning a pet or to working with animals. In a literature search, we identified 124 cases of PD peritonitis caused by 12 different zoonotic agents. Animals were involved in 24% of the cases. Overall mortality rate was 13.5% and Tenckhoff catheters had to be removed in 27% of the cases. The results from RDPLF analysis show that zoonotic microorganisms were responsible for 0.54% of the peritonitis episodes (51 out of a total of 9433 during a 9-year period). In our unit, zoonotic microorganisms were responsible for 0.03% of the peritonitis episodes (four out of a total of 128 during a 9-year period). Considering those results, some specific treatment recommendations can be made, but the major factor still remains prevention, by insisting on strict hygenic measures when a PD patient owns a pet. © 2010 Wiley Periodicals, Inc. Source

Devalois B.,Center Hospitalier Rene Dubos | Puybasset L.,Hopital Pitie Salpetriere
Presse Medicale | Year: 2016

New French 2016' Act recognizes 3 new rights for patients at the end of their life: right to dead without futilities, right to have their wishes respected and right to be comfortable in all circumstances.Medical acts must not be continued in an unreasonable way. Futility is defined by useless, disproportionate or without another aim that an artificial life sustaining acts.For patients who cannot tell their wishes, a withdrawing or withholding decision of life sustaining treatments can be taken with a collegiate process.Doctors must always care about patient comfort with palliative care. Artificial hydration and nutrition can be considered as futile.Patients can write advanced directives or design confidence person to attest their wishes if they should be unable to do it.Doctors must respect advanced directives, except in emergency cases or if there are inappropriate. In such cases, the decision not to respect advanced directives must be taken collegially.Sedation is a therapeutic solution to alleviate refractory suffering for patients at the end of life, even if there is a risk to shorten their life, if the aim is to make patient comfortable and if it is the only way to achieve this goal.A specific right to deep and continuous sedation until death is created, only for patients with a short life prognosis (for. hours to days). It is an exceptional practice with very strict conditions including a collegiate deliberation including non-medical team members.If they wish, patients at the end of life should be cared at home with comfort treatments if needed. Referent doctor must inform patients about their rights. An initial and continuous formation on this field is required.For every decision, it is important to keep a record in the patient chart. If not, it will be a fault. © 2016 Elsevier Masson SAS. Source

The increasing activity of mental health centres for children and adolescents and longer waiting times in obtaining a first appointment have led an area of child psychiatry to question the organisation of new consultation applications. Two CMP in the sector had a waiting period of over 40 days for half of the patients. Two improvement actions were implemented: the implementation of organisation and reception nurses and the development of a new applications management process. The evaluation after one year showed a decrease of half of the appointment waiting time without changing the non showed up rate. © 2014 Elsevier Masson SAS. Source

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