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Corbeil-Essonnes, France

Charansonney O.L.,Center Hospitalier Sud Francilien | Despres J.-P.,Laval University
Nature Reviews Cardiology | Year: 2010

Obesity is a major health challenge facing the modern world. Some evidence points to obesity itself as the main driver of premature mortality. We propose that this view is oversimplified. For example, high levels of physical activity and cardiorespiratory fitness are associated with lower mortality, even in those who are overweight or obese. To address this issue, we combine epidemiological and physiological evidence in a new paradigm that integrates excess calorie intake, sedentary behavior, and a maladaptive response to stress. Human physiology is optimized to allow large distances to be covered on foot every day in order to find enough food to sustain brain metabolism. Furthermore, when the body is immobilized by an injury, it triggers efficient life-saving metabolic and inflammatory responses. Both these critical adaptations are, however, confounded by a sedentary lifestyle. The implications of these issues for clinical trial design and epidemiologic data analysis are discussed in this article. © 2010 Macmillan Publishers Limited. All rights reserved. Source

Moving from a notion of administration to a real desire to provide support, human resources departments strive to meet as closely as possible the needs of the institute and the staff with the aim of continuously improving global performance. The institute, by developing a feeling of belonging, HR coordination, its jobs and skills forecast management tools and high-quality, constructive dialogue, constitutes a rich triptych for disseminating social responsibility to all the links of the managerial chain. © 2012 Elsevier Masson SAS. Source

Van Bon A.C.,Academic Medical Center Amsterdam | Bode B.W.,Emory University | Sert-Langeron C.,Sanofi S.A. | DeVries J.H.,Academic Medical Center Amsterdam | Charpentier G.,Center Hospitalier Sud Francilien
Diabetes Technology and Therapeutics | Year: 2011

Background: In a previous pilot study comparing insulin glulisine (GLU) with insulin aspart (ASP) administered by continuous subcutaneous insulin infusion (CSII), GLU-treated patients did show a trend toward fewer catheter occlusions compared with ASP-treated patients. Here we performed a randomized open-label, three-way crossover, controlled multicenter study comparing GLU with ASP and insulin lispro (LIS). Methods: Subjects with type 1 diabetes were allocated to one of three treatment orders-GLU-ASP-LIS, ASP-LIS-GLU, or LIS-GLU-ASP-with each insulin used for 13 weeks. The study was designed to demonstrate the superiority of GLU over ASP and LIS on unexplained hyperglycemia and/or perceived infusion set occlusion. A prespecified P value of 0.025 was considered significant to correct for multiple testing. Results: Percentages of subjects with at least one unexplained hyperglycemia and/or infusion set occlusion were not significantly different between GLU and ASP (68.4% [62.7-74.1%] vs. 62.1% [56.2-68.1%], P = 0.04) and GLU and LIS (68.4% [62.7-74.1%] vs. 61.3% [55.4-67.3%], P = 0.03). No differences were seen in hemoglobin A1c at end point, most points of the seven-point glucose curves, severe hypoglycemia, and symptomatic ketoacidosis. The overall rate of hypoglycemia with a plasma glucose level below 70 mg/dL per patient-year was significantly different between GLU and ASP (73.84 vs. 65.01, P = 0.008) and GLU and LIS (73.84 vs. 62.69, P < 0.001). Insulin doses remained unchanged during the trial. Conclusions: GLU was not superior to ASP and LIS with no significant difference seen among GLU, ASP, and LIS in CSII use with respect to unexplained hyperglycemia and/or perceived catheter set occlusion. GLU was associated with a higher frequency of symptomatic hypoglycemia, possibly because of slight overdosing, as previous trials suggested lower insulin requirements when GLU is initiated in type 1 diabetes. © 2011 Mary Ann Liebert, Inc. Source

Franc S.,Center Hospitalier Sud Francilien
Correspondances en MHND | Year: 2016

Telemedical advice: offers that allow the remote interrogation of a doctor from a mobile or web grow rapidely, and they are most often designed to respond to acute problems The National Council of the College of Physicians (CNOM) has just released a report, warning against the "uberisation of healthcare." However most doctors (70 %) deem necessary the integration of digital technology in the organization of care. Many technological tools, either connected or not (apps, etc.), have emerged to facilitate the management of the patient's diabetes, usually without any connection with the caregiver. Telemedicine, which is recognized as a medical procedure per se by the French Medical Council, is the most elaborate form of this integration of digital technology in the organization of care. Source

D'Hubert E.,Center Hospitalier Sud Francilien
Journal of visceral surgery | Year: 2010

Physicians in France have been asked to change their day-to-day medical practice to reduce overall costs. We examine ways to achieve this goal in thyroid surgery. We defined and implemented a clinical pathway to optimize the economic viability of thyroid surgery by increasing revenues and lowering expenses. An increase in revenue was achieved by decreasing patient length of stay (LOS) through the use of a fast-track rehabilitation protocol. Expenses were decreased by performing all pre-operative work-up in the out-patient setting and by decreasing costs in the operating room. For 292 consecutive patients who underwent thyroidectomy, the average LOS has been decreased over time to a mean of 2.03 days in 2008; 96% of patients were discharged on the first postoperative day. These results were primarily achieved by using a fast-track rehabilitation clinical pathway, and no increase in postoperative morbidity was noted. Operating time was decreased by 20% through the use of a second surgical assistant and hemostatic scissors but this improvement did not translate into better daily utilization of the operating room. The economic profitability of thyroid surgery is improved when mean LOS is reduced to 2 days through a fast-track protocol. Decreasing the duration of hospitalization was more effective than decreasing operative duration in controlling overall costs. Copyright © 2010 Elsevier Masson SAS. All rights reserved. Source

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