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Le Touquet – Paris-Plage, France

Beauvais C.,Hopitaux Universitaires Est Parisi | Rahal A.,Hopitaux Universitaires Paris Center | Hassani K.C.,Hopitaux Universitaires Est Parisien | Pouplin S.,University of Rouen
Education Therapeutique du Patient | Year: 2014

Background: Therapeutic Patient education (TPE) is part of the disease management of inflammatory rheumatic diseases. The detection of unmet educational needs by the rheumatologist may increase the patients' motivation for education.Objectives: (1) Assess the feasibility of a systematic procedure to detect patients educational needs in current practice. (2) Determine the type of patients' needs.Methods: In a pragmatic prospective pilot study, the rheumatologist invited outpatients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to complete a questionnaire of educational diagnosis. The questionnaire was elaborated according to the French National Health Authority guidelines. Six domains were assessed: knowledge and beliefs about disease and treatments, impact on family and social life, impact on professional life, emotional well-being and management by the health care system. For each domain, patients were asked whether they encountered difficulties or needed more information or help.Results: The questionnaire was proposed by the rheumatologist to 68 patients of the 120 outpatients during a 4 month period in hospital or private practice. 53/68 (78%) questionnaires were completed. The reasons of non-distribution were: lack of time (27), severe medical condition (20), oversight (11), literacy or cognitive barriers (6), recent contact with a TPE program (6), other reasons (10). Some patients experiencing language or cultural barriers were subsequently helped by a hospital pharmacist to fulfill the questionnaire. Seventy-four questionnaires were finally analyzed (55 RA and 19 SpA patients, mean age 57 years (24-87)) l'sixty-four percent patients expressed at least one educational need. Patients experienced difficulties or needed information or help in relation to the disease (14%experienced difficulties/55%needed information or help), treatment (respectively 10%/39%), social and family life (33%/35%), professional life (53%/44%), health care system (11%/34%), emotional status (38%/49%).There was no statistical difference between the expression of at least one educational need and age, type of arthritis, duration of disease, hospital or private care, biologic treatment. 61%patients wished to meet another health professional or other patients. The questionnaire was considered helpful by 77%patients. Only 3 patients found the questionnaire too long and none thought it was intrusive.Conclusions: Detection of patients' educational needs in current practice is feasible using a self-administrated questionnaire with good acceptability. This procedure is a first step in an educational process. For some patients having language or cultural barriers, the help of another professional is essential. Educational needs are high in patients with arthritis. They are widely underestimated in routine care and include major socio-professional and psychological issues. © EDP Sciences, SETE, 2014.

Poncelet E.,University of Lille Nord de France | Delpierre C.,University of Lille Nord de France | Kerdraon O.,Lille University Hospital Center | Lucot J.-P.,University of Lille Nord de France | And 2 more authors.
Clinical Radiology | Year: 2013

Aim To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. Materials and methods From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. Results Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. Conclusion TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Perraudin C.,French Institute of Health and Medical Research | Fleury B.,Hopitaux Universitaires Est Parisien | Pelletier-Fleury N.,French Institute of Health and Medical Research
Journal of Sleep Research | Year: 2015

Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti-hypertensive drugs, being overweight (body mass index >25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6-month follow-up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25-4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice. © 2014 European Sleep Research Society.

Guechot J.,Hopitaux Universitaires Est Parisien | Trocme C.,Grenoble University Hospital Center | Renversez J.-C.,Grenoble University Hospital Center | Sturm N.,French Institute of Health and Medical Research | And 3 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2012

Background : The Enhanced Liver Fibrosis (ELF) score combining serum hyaluronan, N-terminal peptide of type III procollagen and tissue inhibitor of metalloproteinase-1, was reported as relevant in predicting liver fibrosis in chronic liver disease and proposed as an alternative to liver biopsy. Methods : We evaluated the ELF score in a cohort of chronic hepatitis C (CHC) patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using commercial reagents, different from those developed by the manufacturer of the Siemens ELF™ test. Results : In 512 CHC, the ELF score, using ROC curves, showed good predictive performances for severe fibrosis [AUROC0.82; 95 confidence interval (CI) 0.780.86]and for cirrhosis (AUROC0.85; 95 CI 0.810.90), but slightly lower for significant fibrosis (AUROC0.78; 95 CI 0.740.82). The Obuchowski measure (0.81) showed that the ELF score globally performed as a marker of liver fibrosis. The ELF score predicted significant fibrosis (cut-off9.0) with a sensitivity of 0.86, a specificity of 0.62, a positive predictive value (PPV) of 0.80 and a negative predictive value (NPV) of 0.70. For extensive fibrosis (cut-off9.33), sensitivity was 0.90, specificity was 0.63, PPV was 0.73 and NPV was 0.85. For cirrhosis (cut-off9.35), sensitivity was 0.83, specificity was 0.75, PPV was 0.44 and NPV was 0.95. Conclusions : This study confirms the ELF score performance as an index to predict liver fibrosis or cirrhosis in CHC. The ELF test, using validated reagents, could be added to the health authorities approved non-invasive tests in assessing fibrosis as surrogate to liver biopsy. © 2012 by Walter de Gruyter Berlin Boston.

Weber-Schoendorfer C.,Charite - Medical University of Berlin | Oppermann M.,Charite - Medical University of Berlin | Wacker E.,Charite - Medical University of Berlin | Bernard N.,Center Regional Of Pharmacovigilance | And 11 more authors.
British Journal of Clinical Pharmacology | Year: 2015

Aims TNF-α inhibitors are considered relatively safe in pregnancy but experience is still limited. The aim of this study was to evaluate the risk of major birth defects, spontaneous abortion, preterm birth and reduced birth weight after first trimester exposure to TNF-α inhibitors. Methods Pregnancy outcomes of women on adalimumab, infliximab, etanercept, certolizumab pegol or golimumab were evaluated in a prospective observational cohort study and compared with outcomes of a non-exposed random sample. The samples were drawn from pregnancies identified by institutes collaborating in the European Network of Teratology Information Services. Results In total, 495 exposed and 1532 comparison pregnancies were contributed from nine countries. The risk of major birth defects was increased in the exposed (5.0%) compared with the non-exposed group (1.5%; adjusted odds ratio (ORadj) 2.2, 95% CI 1.0, 4.8). The risk of preterm birth was increased (17.6%; ORadj 1.69, 95% CI 1.1, 2.5), but not the risk of spontaneous abortion (16.2%; adjusted hazard ratio [HRadj] 1.06, 95% CI 0.7, 1.7). Birth weights adjusted for gestational age and sex were significantly lower in the exposed group compared to the non-exposed cohort (P = 0.02). As a diseased comparison group was not possible to ascertain, the influence of disease and treatment on birth weight and preterm birth could not be differentiated. Conclusions TNF-α inhibitors may carry a risk of adverse pregnancy outcome of moderate clinical relevance. Considering the impact of insufficiently controlled autoimmune disease on the mother and the unborn child, TNF-α inhibitors may nevertheless be a treatment option in women with severe disease refractory to established immunomodulatory drugs. © 2015 The British Pharmacological Society.

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