News Article | May 21, 2017
ATS 2017, WASHINGTON, DC -- In a new study that analyzed data from the large French CUB-REA database, high volume intensive care units (ICUs) were found to have lower death rates from acute respiratory distress syndrome (ARDS) than low and moderate volume ICUs. The researchers also found that, overall, among the 35 ICUs in the CUB-REA registry, ICU mortality decreased despite an increase in ARDS severity. The study was presented at the 2017 American Thoracic Society International Conference. ARDS is a common disease affecting 10 percent of patients admitted to ICUs. ARDS occurs when fluid builds up in the tiny, elastic air sacs in the lungs. This buildup reduces oxygen levels in the bloodstream, depriving organs of the oxygen they need to function. "Our study is the first to look at a large and regional database that suggests patients with ARDS admitted to centers caring for large numbers of people with ARDS may have better prognoses than in centers with a lower case volume," said lead author Martin Dres, MD, of the AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumonologie et Réanimation Médicale, Paris, France. "We hope our research fuels further discussion regarding global quality of care and global management in the setting of ARDS." Dr. Dres and colleagues looked at CUB-REA data for 316,000 ICU stays taking place between 2000 and 2014. They assessed the difference in ARDS severity using the SAPS2 scoring method, which measures the severity of disease for patients admitted to the ICU. They also looked at ARDS-related mortality for low, moderate and high patient volume ICUs. They statistically adjusted their analyses to account for severity of illness and other confounding factors. The researchers found that 18,022 ICU stays between 2000 and 2014 were related to ARDS. Overall ICU prevalence of ARDS was 8.3 percent, while its prevalence progressively increased from 6.5 percent in 2000 to 10.5 percent in 2008. Prevalence then decreased to 7.2 percent in 2014. During this time, SAPS2 severity scores increased from an average of 52 to 58 (with 52 representing a predicted 50 percent mortality rate). ICU mortality gradually decreased over these years, from 57.9 percent to 45.5 percent, and hospital mortality decreased from 59.1 percent to 48.4 percent. SAPS2 scores were highest in high-volume ICUs, while high volume ICUs had 51.5 percent mortality; moderate volume ICUs had 54 percent mortality; and low volume ICUs had 55.2 percent mortality rates. Length of stay was also lowest in high volume ICUs. "Further studies are warranted to confirm and delineate our results and determine whether regionalization of patients with ARDS should be recommended," said Dr. Dres. He added: "Since submitting our research abstract, we have confirmed our findings with several methods of case volume calculation for a shorter duration of time (2000-2012). This allowed us to confirm our preliminary results with a more homogeneous population." Effect of High Volume ICUs on Mortality in ARDS Over 15 Years Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common disease affecting 10% of patients admitted in the Intensive Care Unit (ICU) and associated with a crude ICU mortality ranging from 30 to 40% (1). As the management of ARDS patients requires a complex, well organized, and technically sophisticated level of care, we aimed at investigating whether there is or there is not a relationship between patient's outcomes and case-volume ICUs. A secondary objective was to assess trends in patients' characteristics, outcomes, and management between 2000 and 2014. Material and Methods: The French CUB-REA database includes 35 ICUs, which collected 316,000 individual ICUs stays between 2000 and 2014. ARDS were identified from the hospital coding system. We assessed the difference in severity (SAPS2) and ICU mortality between tertiles of case volume. To reach this goal, multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors. Results: Between 2000 and 2014, 18,022 stays were related to ARDS. Overall, ICU prevalence of ARDS was 8.3%. ICU prevalence of ARDS progressively increased from 6.5% in 2000 to 10.5% in 2008 and then decreased to 7.2% in 2014 (p During this period, SAPS II increased from 52 [37-71] to 58 [41-75] (p The three ARDS case volume tertiles were: low volume (?37 admissions per year), moderate volume (38-67), and high volume (>68). SAPS2 was significantly higher in high volume ICUs as compared to low and moderate volume ICUs: 61[43-80] vs. 53 [39-72] and 56 [41-74] respectively (p Conclusion: Between 2000 and 2014, among ICUs of the CUB-REA registry, despite an increase in ARDS severity, ICU mortality decreased. There was a significantly lower ICU mortality in high volume ICUs. 1. Bellani G, Laffey JG, Pham T, et al.: Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016; 315:788-800 Session: A15 Critical Care: The Future of Critical Care? Regionalization and Closing the Gender Gap Abstract Presentation Time: Sunday, May 21, 10 a.m. ET Location: Room 146 C (Middle Bldg, Street Level), Walter E. Washington Convention Center
Habets E.J.J.,Medical Center Haaglanden |
Taphoorn M.J.B.,Medical Center Haaglanden |
Taphoorn M.J.B.,VU University Amsterdam |
Nederend S.,VU University Amsterdam |
And 11 more authors.
Journal of Neuro-Oncology | Year: 2014
Overall survival of patients with anaplastic oligodendroglial tumors has been improved due to the addition of procarbazine, lomustine and vincristine (PCV) chemotherapy to radiotherapy (RT), especially in 1p/19q-codeleted tumors. With improved survival, quality of survival becomes pivotal. We evaluated cognitive functioning and health-related quality of life (HRQOL) in a cohort of long-term anaplastic oligodendroglioma survivors. Thirty-two out of 37 long-term survivors included in European Organisation for Research and Treatment of Cancer (EORTC) study 26951 in the Netherlands and France participated. Cognition was assessed using neuropsychological tests for 6 domains, and HRQOL with the EORTC Quality of Life Questionnaire (EORTC QLQ-C30) and Brain Cancer Module (EORTC QLQ-BN20). Fatigue and mood were evaluated. Results were compared to healthy controls and to patients' own HRQOL 2.5 years following initial treatment. At the time of assessment, median survival for the patients was 147 months, 27 were still progression-free since initial treatment. Of progression-free patients, 26 % were not, and 30 % were severely cognitively impaired; 41 % were employed and 81 % could live independently. Patients' HRQOL was worse compared to controls, but similar to 2.5 years after initial treatment. Initial treatment (RT versus RT + PCV) was not correlated with cognition or HRQOL. In conclusion, cognitive functioning in long-term anaplastic oligodendroglioma survivors is variable. However, most patients function independently. In progression-free patients, HRQOL is relatively stable during the disease course. In this small sample, no effect of the addition of PCV on cognition or HRQOL was identified. © 2013 Springer Science+Business Media New York.
Tan J.Y.,University of Oxford |
Vance K.W.,University of Oxford |
Varela M.A.,University of Cape Town |
Watson L.M.,University Pierre and Marie Curie |
And 16 more authors.
Nature Structural and Molecular Biology | Year: 2014
What causes the tissue-specific pathology of diseases resulting from mutations in housekeeping genes? Specifically, in spinocerebellar ataxia type 7 (SCA7), a neurodegenerative disorder caused by a CAG-repeat expansion in ATXN7 (which encodes an essential component of the mammalian transcription coactivation complex, STAGA), the factors underlying the characteristic progressive cerebellar and retinal degeneration in patients were unknown. We found that STAGA is required for the transcription initiation of miR-124, which in turn mediates the post-transcriptional cross-talk between lnc-SCA7, a conserved long noncoding RNA, and ATXN7 mRNA. In SCA7, mutations in ATXN7 disrupt these regulatory interactions and result in a neuron-specific increase in ATXN7 expression. Strikingly, in mice this increase is most prominent in the SCA7 disease-relevant tissues, namely the retina and cerebellum. Our results illustrate how noncoding RNA-mediated feedback regulation of a ubiquitously expressed housekeeping gene may contribute to specific neurodegeneration.
Vambergue A.,Service de Diabetologie |
Perimenis P.,Groupe Hospitalier
Correspondances en MHND | Year: 2015
The intra uterine diabetic environment affects the fetoplacental unit. The fetoplacental unit has to adapt itself to an influx of nutriments (glucose, amino acids, lipids) in excess. In case of maternal diabetes, the placenta sets up hormonal, infl ammatory and immune adaptative mechanisms. In case of maternal diabetes, the PPARs (peroxisome proliferatoractivated receptors) are involved in the placentation, in the modifi cation of the mediators of the infl ammation, and in the lipid metabolism. These adaptative mechanisms have for consequence a modifi cation of transfers, immune responses and angiogenesis associated with an oxidative stress. These placental adaptative mechanisms will have consequences in clinical practice, as abnormalities of growth, macrosomia or intra-uterine growth restriction (IUGR).
Nae I.-C.,Groupe hospitalier |
Chevet J.-B.,Groupe hospitalier |
Delaporte B.,Groupe hospitalier
Archives de Pediatrie | Year: 2011
Postnatal urinary ascites is a rare occurrence compared with other causes of peritoneal effusion at this age and its frequency in prenatal diagnosis. Spontaneous rupture of the bladder was diagnosed in a premature male infant presenting with postnatal ascites and anuric renal insufficiency. Surgical repair was required. No predisposing factor was associated with this rare complication. The urinary origin of the ascites was diagnosed based on the biochemical composition, allowing us to understand its mechanism and to treat it. © 2010 Elsevier Masson SAS.
Reyes S.,University Paris Diderot |
Kurtz A.,University Paris Diderot |
Herve D.,University Paris Diderot |
Tournier-Lasserve E.,Groupe Hospitalier |
Chabriat H.,University Paris Diderot
Journal of Neurology | Year: 2012
Genetic counselling has been poorly investigated in cerebrovascular diseases. Characteristics, motivations and long-term outcome of presymptomatic tests (PT) in subjects at risk of CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) were investigated at the National Centre for Rare Vascular Diseases of the Brain and/or Retina (CERVCO). Sociodemographic, motivational and psychological variables were collected between 2003 and 2010 for PT applicants. Multidisciplinary consultations (with a geneticist, neurologist and psychologist) were proposed over a 6 month period. When PT showed a deleterious mutation of the NOTCH3 gene, cognitive performances, mood, autonomy and quality of life were also assessed. Over 7 years, only 33 subjects asked for a PT of CADASIL. They were predominantly women, lived as a couple, had children and were of high sociocultural level. The dropout rate after the first step of the procedure was 63%. The characteristics of the 11 subjects who reached the end of the procedure did not differ from the 22 who dropped out. Six were carriers of the deleterious mutation and were still asymptomatic after a mean follow-up of 19 months. They did not experience any particular negative event and all of them indicated a high score of overall quality of life. Indeed, two carriers gave birth to their first child. These initial data in CADASIL show that PT is rarely requested and that there is a high dropout rate. Our study also highlights that a multidisciplinary and multistep procedure in genetic counselling testing appears useful to obtain minimal harmful consequences of genetic testing. © Springer-Verlag 2012.
Verny M.,Groupe hospitalier |
Berrut G.,Nantes University Hospital Center
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2012
The definition of normal pressure hydrocephalus (NPH), in adults, associates clinical signs (Adams and Hakim triad) involving gait disorders, urinary incontinence and dementia, associated with aspects on brain imaging that are consistent with this hypothesis and also normal or slightly increased intracranial pressure. The aim of this study was to clarify the techniques and methods facilitating the diagnosis of NPH. The literature review has been conducted from the Medline database without date limitation including the keywords "normal pressure hydrocephalus" and "diagnosis." They should appear in the article title. From the 43 initially sorted, only 13 have been selected using exclusion criteria. The proposed methods are very sparse and focused on the improvement after surgical shunt. This focus is independent from the diagnosis criteria proposed in 2005. This introduces an ambiguity in the interpretation of the results. In practice, the diagnosis of NPH is more difficult in the elderly population where differential diagnoses are frequent, particularly vascular lesions (notably microangiopathy) and Alzheimer's disease. The more invasive techniques as continuous spinal drainage (usually during 3 days) or some features of CSF dynamics (Rout, compliance) seem to be the best predictors of after shunt improvement. However, these techniques are difficult to use in routine in the elderly. The combination of Evans index and corpus callosum angle on MRI is very useful to improve the differential diagnosis with cerebral atrophy. Spinal tap test (lumbar puncture with the removal of 40 mL of CSF) can be repeated two or three times for consecutive days to improve the predictive value before shunting. Gait and balance often improve after shunt, more than cognition and bladder disorders. In the elderly population, the prognosis after 3 years is non conclusive despite initial improvement. Poor prognosis seems to be due to associated pathologies in particular neurodegenerative diseases. This should be considered in decision-making of CSF shunt.
Larger E.,Groupe Hospitalier |
Lemoine A.-Y.,University of Paris Descartes |
Faucher P.,University of Paris Descartes
Medecine des Maladies Metaboliques | Year: 2015
The long-term follow-up of the patients having participated to glucose trials in diabetes have shown diverging trajectories with regards to diabetes-specific complications, according to the intervention group patients had been randomized to during the intervention phases of the trials. Group-specific risk in the incidence of complication has been observed although blood glucose levels have been largely similar during the long-term follow-up. The long-term persistence of differences has been called metabolic memory. The present manuscript presents the long-term, 30 years, results of the Diabetes control and complications trial (DCCT) and the molecular basis of the metabolic memory, based on several experimental models. © 2015 Elsevier Masson SAS.
El Rachkidi R.,Groupe Hospitalier |
Sari-Leret M.-L.,Groupe Hospitalier |
Wolff S.,Groupe Hospitalier
Spine | Year: 2011
Study Design: A case report with review of the literature. Objective: To present a first case of an atraumatic bilateral pedicle fracture of L5 in a patient with long-term risedronate therapy and without any previous history of surgery or fracture. Summary of Background Data: A few cases of bilateral osteoporotic pedicle fractures have been reported. All were associated with previous or concomitant corporeal compression fractures. Atypical femoral fractures were recently described with long-term bisphosphonate treatment. To our knowledge, there are no previous reports of isolated bilateral pedicle fracture associated with prolonged bisphosphonate therapy. Methods: A 66-year-old woman treated with risedronate for 10 years and without any history of trauma presented with exacerbation of low back pain. No fracture was noted in her past medical history. Results: A complete workup showed an isolated bilateral recent fracture of the L5 pedicles without evident etiology. Consolidation was achieved after 3 months of bracing. Conclusion: We reported the first case of isolated bilateral pedicle fracture in a patient treated with risedronate for 10 years. This may be another atypical fracture in long-term bisphosphonate treatment. © 2011 Lippincott Williams & Wilkins.
Training on health dispensed at the hospital: A medicine chest simulation for the safe use of drugs at home [Education pour la santéreáliseé à lhôpital: une simulation darmoire à pharmacie pour sécuriser lusage des médicaments au domicile]
Laincer A.,Groupe Hospitalier |
Lukat S.,Groupe Hospitalier |
Dalle-Pecal M.,Groupe Hospitalier |
Divine C.,Groupe Hospitalier
Pharmacien Hospitalier et Clinicien | Year: 2016
Introduction. As part of 2014 patient security week, a medicine chest simulation took place at the hospital in order to communicate on correct storage and use of drugs at home. Method. A home medicine chest has been reproduced in the hospital hall and then within the cardiac re-adaptation hospital day. The medicine chest included seventeen products such as drugs and medical devices, of which eleven purposely contained errors. The objective for the attendees (patients, visitors and hospital staff) consisted in identifying mistakes. Results. Thirty-six people took part in this event. Average number of mistakes was eight (between two and eleven). The three most notified errors were the presence of a cleaning product bottle (100 %), unable to identify loose pills (97 %) and single dose kept after opening (86 %). Ninety-four percent of attendees consider that they have learnt useful information and 53 % of them claim that they are willing to change organization of their own medicine chest. Conclusion. The home medicine chest simulation is a tool to educate in an enjoyable way on health topics and is interesting to set up within health institutions. © 2015 Elsevier Masson SAS.