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Marseille, France

Cordier C.,University of Strasbourg | Lambert D.,Our Ladys Childrens Hospital | Voelckel M.-A.,La Timone Hospital | Hosterey-Ugander U.,Sahlgrenska University Hospital | Skirton H.,University of Plymouth
Journal of Community Genetics | Year: 2012

Quality genetic healthcare services should be available throughout Europe. However, due to enhanced diagnostic and genetic testing options, the pressure on genetic counselling services has increased. It has been shown in many countries that appropriately trained genetic counsellors and genetic nurses can offer clinical care for patients seeking information or testing for a wide range of genetic conditions. The European Society of Human Genetics is setting up a system of accreditation for genetic counsellors, to ensure safe practice, however there has been little information about the practice and education of non-medical genetic counsellors in Europe. To collect baseline data, we approached key informants (leaders in national genetics organisations or experienced practitioners) to complete an online survey, reporting on the situation in their own country. Twenty-nine practitioners responded, providing data from 18 countries. The findings indicate huge variation in genetic counsellor numbers, roles, and education across Europe. For example, in UK and The Netherlands, there are more than four counsellors per million population, while in Germany, Hungary, Turkey, and Czech Republic, there are no non-medical counsellors. There are specific educational programmes for genetic counsellors in seven countries, but only France has a specific governing legal framework for genetic counsellors. In the post-genomic era, with added pressure on health systems due to increases in availability and use of genetic testing, these disparities are likely to result in inequalities in service provided to European citizens. This study underpins the need for a coherent European approach to accreditation of genetic counsellors. © Springer-Verlag 2011.

Henry J.-M.,La Conception Hospital | Boyer L.,La Timone Hospital | Belzeaux R.,La Conception Hospital | Baumstarck-Barrau K.,Nord Hospital | Samuelian J.-C.,La Conception Hospital
Psychiatric Services | Year: 2010

Objective: The aim of this study was to identify factors associated with homelessness status among patients admitted to the psychiatric emergency ward of a French public teaching hospital over a six-year study period (2001-2006). Methods: The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data that included demographic, financial, clinical, and management information. Results: During this six-year study, the psychiatric service recorded 16,754 care episodes for 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were nonhomeless (93.3%). The mean±SD number of visits to the psychiatric emergency service was higher for homeless patients (4.9±12.3) than for nonhomeless patients (1.7±2.4) (p<.001). A total of 331 homeless patients (56.0%) had more than one care episode, whereas 2,180 (26.4%) of nonhomeless patients had more than one care episode. Factors associated with homelessness included being male, being single, and receiving financial assistance through government social programs. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most common disorders among homeless patients. Aggressive behavior and violence were reported equally among homeless patients (3.5%) and nonhomeless patients (3.2%). Homeless patients were less likely than nonhomeless patients to be hospitalized after receiving care in the emergency ward (47.8% versus 51.1%) (p=.002). Conclusions: Although there is near-universal access to free mental health care in France, study findings suggest that the quality and adequacy of subsequent care are not guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of mental health care for homeless patients.

Puymirat E.,University of Paris Descartes | Taldir G.,University of Paris Descartes | Aissaoui N.,University of Paris Descartes | Lemesle G.,Regional and University Hospital of Lille | And 7 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Objectives: This study sought to assess the impact of invasive strategy (IS) versus a conservative strategy (CS) on in-hospital complications and 3-year outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the FAST-MI (French Registry of Acute Coronary Syndrome). Background: Results from randomized trials comparing IS and CS in patients with NSTEMI are conflicting. Methods: Of the 3,670 patients in FAST-MI, which included patients with acute myocardial infarction (within 48 h) over a 1-month period in France at the end of 2005, 1,645 presented with NSTEMI. Results: Of the 1,645 patients analyzed, 80% had an IS. Patients in the IS group were younger (67 ± 12 years vs. 80 ± 11 years), less often women (29% vs. 51%), and had a lower GRACE (Global Registry of Acute Coronary Events) risk score (137 ± 36 vs. 178 ± 34) than patients treated with CS. In-hospital mortality and blood transfusions were significantly more frequent in patients with CS versus IS (13.1% vs. 2.0%, 9.1% vs. 4.6%). Use of IS was associated with a significant reduction in 3-year mortality and cardiovascular death (17% vs. 60%, adjusted hazard ratio [HR]: 0.44, 95% confidence interval [CI]: 0.35 to 0.55 and 8% vs. 36%, adjusted HR: 0.37, 95% CI: 0.27 to 0.50). After propensity score matching (181 patients per group), 3-year survival was significantly higher in patients treated with IS. Conclusions: In a real-world setting of patients admitted with NSTEMI, the use of IS during the initial hospital stay is an independent predictor of improved 3-year survival, regardless of age. (French Registry of Acute Coronary Syndrome [FAST-MI]; NCT00673036) © 2012 American College of Cardiology Foundation.

Castinetti F.,La Timone Hospital
Discovery medicine | Year: 2010

Pituitary adenomas are benign tumors that can be either secreting (acromegaly, Cushing's disease, prolactinomas) or non-secreting. Transsphenoidal neurosurgery is the gold standard treatment; however, it is not always effective. Gamma Knife radiosurgery is a specific modality of stereotactic radiosurgery, a precise radiation technique. Several studies reported the efficacy and low risk of adverse effects induced by this technique: in secreting pituitary adenomas, hypersecretion is controlled in about 50% of cases and tumor volume is stabilized or decreased in 80-90% of cases, making Gamma Knife a valuable adjunctive or first-line treatment. As hormone levels decrease progressively, the main drawback is the longer time to remission (12-60 months), requiring an additional treatment during this period. Hypopituitarism is the main side effect, observed in 20-40% cases. Gamma Knife is thus useful in the therapeutic algorithms of pituitary adenomas in well-defined indications, mainly low secreting small lesions well identified on magnetic resonance imaging (MRI).

Cuisset T.,La Timone Hospital | Cuisset T.,Aix - Marseille University | Lefevre T.,Institute Cardiovasculaire Paris Sud
EuroIntervention | Year: 2016

Hypertrophic obstructive cardiomyopathy (HOCM) is the most frequent genetic cardiovascular affection and is associated with high mortality and morbidity. Invasive treatment of symptomatic patients with HOCM refractory to drug therapy was limited to surgical myomectomy for years. In the mid 1990s, alcohol septal ablation (ASA) emerged as a new and less invasive option for septal ablation (SA) and is now considered a good alternative with excellent short- And long-term outcomes. Besides ASA, other techniques have been promoted to treat HOCM. The present review aims to summarise current practice and evidence of catheter-based techniques from the treatment of HOCM. We also detail technical points to achieve a safe and effective procedure. © Europa Digital & Publishing 2016. All rights reserved.

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