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Marigot-Outtandy D, Beasley V, Mongrenier J, Guérin A, Alexis MA, Crapart S, Avice-Bataille A, Fisher S, Hennechart L, Illien B, Leborgne D, Nahmiash A. Dénutrition hospitalière : les nouvelles recommandations amélioreront-elles le diagnostic ? NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hardy P, Costemale-Lacoste JF, Trichard C, Butlen-Ducuing F, Devouge I, Cerboneschi V, Jacob E, Buferne R, Benyamina A, Cantero A, Gravier V, Ghanem T, Guérin A, Meidinger A, Baleyte JM, Pelissolo A, Corruble E. Comparison of burnout, anxiety and depressive syndromes in hospital psychiatrists and other physicians: Results from the ESTEM study. Psychiatry Res 2020; 284:112662. [PMID: 31703985 DOI: 10.1016/j.psychres.2019.112662] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/26/2022]
Abstract
AIMS To compare prevalence and risk factors for burnout, anxiety and depression among hospital psychiatrists and non-psychiatrists. METHOD Regional online survey of psychiatric and non-psychiatric hospital physicians was performed including: a job-stress scale, the Hospital Anxiety and Depression Scale (HADS), the Copenhagen Burnout Inventory (CBI), a stressful work relationships list and a six items scale about work-related psychosocial risk factors (PRFs). The client-related burnout scale of the CBI has been changed to an interpersonal burnout scale. Cases were defined by a score of 8+ for the HADS-A/HADS-D and 50+ for the three CBI subscales. RESULTS 285 psychiatrists and 326 non-psychiatrists participated. The prevalence of depression, personal burnout and work-related burnout did not differ between physicians. Anxiety was lower in psychiatrists and interpersonal burnout was higher in senior psychiatrists. Multivariate analysis showed two main PRFs, common to both groups of physicians: "work intensity and time" was associated with four of the five syndromes and "emotional demands" with the three burnout syndromes. Interpersonal burnout was associated with stressful relationships with leaders, but not with patients. CONCLUSION Reducing the workload, improving the management of emotions and increasing managerial skills are important approaches for prevention.
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Affiliation(s)
- Patrick Hardy
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, 94270 Le Kremlin-Bicêtre, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France; Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France.
| | - Jean-François Costemale-Lacoste
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, 94270 Le Kremlin-Bicêtre, France; Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Service Hospitalo-Universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpital Corentin-Celton, Hôpitaux Universitaires Paris Ouest, Assistance Publique-Hôpitaux de Paris, 92130 Issy-les-Moulineaux, France
| | - Christian Trichard
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Secteur 91G05, EPS Barthélémy Durand, 91150 Etampes, France
| | - Florence Butlen-Ducuing
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, 94270 Le Kremlin-Bicêtre, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France; Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France
| | - Isabelle Devouge
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Pôle 92G13, Groupe Hospitalier Paul Guiraud, 94800 Villejuif, France
| | - Valérie Cerboneschi
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Secteur 92G18, Groupe Hospitalier Paul Guiraud, 92140 Clamart, France
| | - Elisabeth Jacob
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Unité intersectorielle de réinsertion, EPS Erasme, 92160 Antony, France
| | - Richard Buferne
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; CH Fondation Vallée, 94250 Gentilly, France
| | - Amine Benyamina
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Département de psychiatrie et d'addictologie, Hôpital Paul Brousse, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
| | - Alain Cantero
- Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Pôle 94G16, Hôpitaux de Saint-Maurice, 94410 Saint-Maurice, France
| | - Véronique Gravier
- Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Grand Hôpital de l'Est Francilien, 77100 Meaux, France
| | - Teim Ghanem
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Pôle de psychiatrie d'adultes, GH Nord-Essonne, 91440 Bures-sur-Yvette, France
| | - Agnès Guérin
- Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Pôle 94G05, CH Les Murets, 94510 La Queue-en-Brie, France
| | - Antoine Meidinger
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Clinique L'abbaye (CLINEA), 91170 Viry-Châtillon, France
| | - Jean-Marc Baleyte
- Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Service universitaire de psychiatrie de l'enfant et de l'adolescent, CHI Créteil, 94000 Créteil, France; Faculté de médecine, UPEC, Université Paris-Est, 94000 Créteil, France; INSERM, IMRB, U955, Team 15, 94000 Créteil, France
| | - Antoine Pelissolo
- Dispositif Territorial de Recherche et de Formation (DTRF) Grand Paris Est, 94000 Créteil, France; Faculté de médecine, UPEC, Université Paris-Est, 94000 Créteil, France; Assistance Publique-Hôpitaux de Paris, Pôle de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, 94000 Créteil, France; INSERM, IMRB, U955, Team 15, 94000 Créteil, France
| | - Emmanuelle Corruble
- CESP/UMR-S1178, Equipe "Dépression et Antidépresseurs", Univ Paris-Sud, Faculté de Médecine, INSERM, 94270 Le Kremlin-Bicêtre, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France; Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France
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Beauregard F, Dupont C, Masse V, Planelles S, Guérin A, Pichetto I, Gobyn V, Méric J, Marigot-outtandy D, Le dû D. Impact de la mise en place d’une équipe mobile pluridisciplinaire de vaccination antigrippale dans un hôpital non universitaire. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Guérin A, Bussières JF. [A pilot study of the professional ethical thinking of Quebec hospital pharmacists and pharmacy students]. Ann Pharm Fr 2016; 75:67-76. [PMID: 27659415 DOI: 10.1016/j.pharma.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/09/2016] [Accepted: 07/22/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The main objective was to assess the position of Quebec pharmaceutical community about pharmaceutical ethics statements. The second objective was to compare the level of agreement of pharmacy students and hospitals pharmacists. METHOD Survey conducted one day given in 2012 and 2013 for students in 2013 and from 29/08/2014 to 02/09/2014 for pharmacists. A questionnaire of eight themes and 43 statements was developed: training and education (5 questions), clinical research (7) advertising and marketing (5) evaluation (5) dispensing medication (4), pharmaceutical care (9) economic aspect (6) and code of ethics (2). A Likert scale with four choices was used to measure the level of agreement. The primary outcome was the difference between the level of agreement of pharmacy students and hospital pharmacists. The Chi2 test was used. RESULTS A total of 347 students and 398 pharmacists responded to the survey. There was a statistically significant difference regarding the level of agreement with 28 statements on 43. The differences focused on eight themes of the questionnaire, or training and education (3/5 significantly different questions), clinical research (2/7), advertising and marketing (2/5), Evaluation (4/5) dispensing medication (4/4), pharmaceutical care (5/9), economic aspect (6/6) and ethics (2/2). CONCLUSION This study shows that there is a difference between pharmacists and pharmacy students about pharmaceutical ethics statements.
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Affiliation(s)
- A Guérin
- Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
| | - J-F Bussières
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine (CHUSJ), université de Montréal, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada.
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Shawky M, Imam A, Rieutord A, Guérin A. OHP-005 Differences in training required for hospital pharmacy practice in france and Egypt. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Li N, Hao Y, Kageleiry A, Peeples M, Fang A, Koo V, Guérin A. Abstract P4-13-14: Time on treatment of everolimus, fulvestrant, and capecitabine for the treatment of HR+/HER2- metastatic breast cancer: A retrospective claims study in the US. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Treatment guidelines for hormone receptor-positive/human epidermal growth factor receptor-2-negative (HR+/HER2-) metastatic breast cancer (mBC) recommend extending the time on treatment (TOT) of endocrine therapy (ET) prior to the initiation of chemotherapy (CT) to avoid its serious side effects and preserve patients' quality of life. Everolimus-based therapy (EVE), fulvestrant monotherapy (FUL mono), and capecitabine monotherapy (CAP mono) are among the latest ET and CT agents approved for the treatment of HR+/HER2- mBC in the US. This retrospective claims analysis compared TOT among HR+/HER2- mBC patients who received EVE versus those who received FUL mono or CAP mono respectively.
Methods:
Postmenopausal women with HR+/HER2- mBC who initiated ≥ 1 new line of therapy for mBC between 7/20/2012 (the approval date of EVE, the latest of all three therapies) and 3/31/2014 (which allowed for ≥ 3 months of potential follow-up) after a non-steroidal aromatase inhibitor were identified from the MarketScan and PharMetrics databases (2002Q1-2014Q2) using an algorithm adapted from the literature. Treatment discontinuation was defined as a treatment gap of ≥ 60 days. Patients' lines of therapies were classified into mutually-exclusive regimen groups (i.e., EVE, FUL mono, and CAP mono) and followed until discontinuation of the line of therapy, end of insurance eligibility, or data cut-off (06/30/2014). Patients who did not discontinue their treatment were censored at the end of follow-up. TOT was compared between EVE versus FUL mono and versus CAP mono using Kaplan-Meier (K-M) analyses with log-rank tests and multivariable Cox models adjusting for the line of therapy and differences in patient characteristics, including age, insurance type, de novo vs non-de-novo mBC, prior use of CT for mBC, sites of metastases (e.g., bone, brain, and visceral), and Charlson comorbidity index.
Results:
Across the first four lines of therapies for mBC, a total of 940 EVE, 953 FUL mono, and 721 CAP mono regimens were included. Based on the different lines of therapies, the K-M estimators of median TOT ranged from 5.5 to 7.2 months for EVE, 4.9 to 8.4 months for FUL mono, and 3.5 to 6.0 months for CAP mono.
Table 1. Comparison of TOT between EVE, FUL mono, and CAP mono by line of therapy Median TOT (months) EVEFUL monoCAP monoLine 16.28.43.5*Line 26.25.64.6*Line 37.25.3*6.0*Line 45.54.95.1**indicates p-value <0.05 for pairwise log-rank tests in comparison with EVE.
Pooling all lines of therapies, EVE was associated with significantly longer TOT compared to FUL mono (multivariable-adjusted hazard ratio [HR] = 0.87, 95% confidence interval [CI]: 0.76-0.99) or CAP mono (multivariable-adjusted HR = 0.73, 95% CI: 0.64-0.83). Similar results were observed in each line of therapy.
Conclusions:
This real-world US claims study of postmenopausal women with HR+/HER2- mBC showed that patients receiving EVE experienced significantly longer TOT than those receiving FUL mono or CAP mono, suggesting a comparative advantage of EVE in extending the duration of ET.
Citation Format: Li N, Hao Y, Kageleiry A, Peeples M, Fang A, Koo V, Guérin A. Time on treatment of everolimus, fulvestrant, and capecitabine for the treatment of HR+/HER2- metastatic breast cancer: A retrospective claims study in the US. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-14.
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Affiliation(s)
- N Li
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - Y Hao
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - A Kageleiry
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - M Peeples
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - A Fang
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - V Koo
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
| | - A Guérin
- Analysis Group, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Montreal, QC, Canada
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Leroux A, Guérin A, Bussières JF, Lebel D, Tremblay S, Roy H, Métras ME, Beauchemin M, Bédard P. [Upgrading a pediatric pharmaceutical care service in Quebec]. Arch Pediatr 2016; 23:117-27. [PMID: 26795358 DOI: 10.1016/j.arcped.2015.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Clinical pharmacy has developed since the 1960s in North America, with large disparities in the presence of decentralized pharmacists in hospital units between healthcare programs. Decentralized pharmacists have been present in pediatrics since the 1970s. The main objective of this study was to describe the steps used to upgrade the pediatrics department's pharmaceutical care. METHODS A descriptive study was conducted to upgrade the pharmaceutical care provided by two full-time equivalents in two pediatric sectors including 81 beds of a tertiary mother-child hospital. The upgrade includes three steps: a structured literature review, a description of the department, and a description of the practice upgrades proposed by the research team, in consensus with the clinical pharmacy team. RESULTS Out of the 236 articles initially identified, 13 relevant articles were found on the role and impact of pharmacists in pediatrics. Nine pharmaceutical activities were supported by high-quality data. Following the literature review and concerted reflection, 15 improvements were identified as feasible without increasing the staff. CONCLUSION There are data on the impact of pharmacists in pediatrics. This descriptive study illustrates a method that was used to upgrade the pediatrics sector in a university mother-child health center.
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Affiliation(s)
- A Leroux
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - A Guérin
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - J-F Bussières
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada; Faculté de pharmacie, université de Montréal, 2940, chemin de la Polytechnique, H3C 3J7 Montréal, Canada
| | - D Lebel
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - S Tremblay
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - H Roy
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - M-E Métras
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - M Beauchemin
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada
| | - P Bédard
- Département de pharmacie, unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada.
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Abstract
OBJECTIVE Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancer-direct healthcare costs to payers and indirect costs to patients, payers, and employers-in the US. METHODS Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (≤30 days prior to first observed lung cancer diagnosis to ≤30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (≤30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation). OUTCOME MEASURES Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers. RESULTS A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers. LIMITATIONS Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage. CONCLUSIONS Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.
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Affiliation(s)
- A Guérin
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - M Sasane
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Dea
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - J Zhang
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - K Culver
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - R Nitulescu
- a a Analysis Group, Inc. , Montreal , QC , Canada
| | - E Q Wu
- c c Analysis Group, Inc. , Boston , MA , USA
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Guérin A, Bussières JF, Boulkedid R, Bourdon O, Prot-Labarthe S. Erratum to: Development of a consensus-base list of criteria for prescribing medication in a pediatric population. Int J Clin Pharm 2015; 37:895. [PMID: 26362162 DOI: 10.1007/s11096-015-0190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Guérin
- Pharmacy Practice Research Unit, Pharmacy Department, Sainte-Justine University Health Center, 3175, chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - J F Bussières
- Pharmacy Department, Sainte-Justine University Health Center, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - R Boulkedid
- Clinical Epidemiology Unit, APHP, Robert Debré University Health Center, 75019, Paris, France
- INSERM, U 1123 and CIC 1426, Robert Debré University Health Center, 75019, Paris, France
| | - O Bourdon
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- Department of Clinical Pharmacy, Faculty of Pharmacy, Université Paris Descartes, Sorbonne Paris Cité, France
- Laboratory Education and Health Practices EA 3412, Université Paris 13, Sorbonne Paris Cité, France
- French Society of Clinical Pharmacy, Paris, France
| | - S Prot-Labarthe
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- French Society of Clinical Pharmacy, Paris, France
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Guérin A, Sasane M, Wakelee H, Zhang J, Culver K, Dea K, Nitulescu R, Galebach P, Macalalad AR. Treatment, overall survival, and costs in patients with ALK-positive non-small-cell lung cancer after crizotinib monotherapy. Curr Med Res Opin 2015; 31:1587-97. [PMID: 26029864 DOI: 10.1185/03007995.2015.1057115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited post-crizotinib treatment options for ALK-positive non-small cell lung cancer (NSCLC) might lead to poor survival and high economic burden. OBJECTIVE To evaluate real-world treatment patterns, overall survival (OS), and costs following crizotinib discontinuation. METHODS This study used chart review and claims data. First, 27 participating US oncologists reviewed medical records of ALK-positive NSCLC patients who discontinued crizotinib monotherapy and reported patient demographic and clinical information, including post-crizotinib treatment and mortality. OS was estimated using Kaplan-Meier analyses. Second, three large administrative US claims databases were pooled. NSCLC patients were selected if they discontinued crizotinib monotherapy. Post-crizotinib costs were analyzed separately for patients who did or did not discontinue antineoplastic treatment after crizotinib monotherapy. All data were collected prior to ceritinib approval for this patient population. RESULTS A total of 119 ALK-positive NSCLC patients discontinued crizotinib monotherapy. Upon discontinuation, 42% had no additional antineoplastic treatment and 13% received radiation therapy only. The median OS post-crizotinib was 61 days; patients with brain metastases had shorter OS than those who did not (44 vs. 69 days, P = 0.018), and patients without further antineoplastic treatment had shorter OS than those who did (17 vs. 180 days, P < 0.001). From claims data, 305 ALK-positive NSCLC patients discontinued crizotinib monotherapy. After discontinuation, 72% had no additional antineoplastic treatment. Among patients who continued antineoplastic treatment, monthly healthcare costs averaged $22,160, driven by pharmacy ($9202), inpatient ($6419), and outpatient radiotherapy ($2888) and imaging ($1179) costs. Among patients who discontinued any antineoplastic treatment, monthly healthcare costs averaged $3423, mostly driven by inpatient costs ($2074). CONCLUSIONS After crizotinib monotherapy, most patients either received radiotherapy only or discontinued antineoplastic treatment altogether. OS after discontinuing crizotinib was poor and shorter among those with brain metastases than without, and among those without subsequent antineoplastic treatment than with. Patients who continued antineoplastic treatment incurred substantial healthcare costs.
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Affiliation(s)
- A Guérin
- a a Analysis Group Inc. , Boston , MA , United States
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Guérin A, Bussières JF, Boulkedid R, Bourdon O, Prot-Labarthe S. Development of a consensus-base list of criteria for prescribing medication in a pediatric population. Int J Clin Pharm 2015; 37:883-94. [PMID: 26017398 DOI: 10.1007/s11096-015-0139-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although many people are involved in the optimal use of a medication within this process, the use of medications carries risks of adverse events, which are greater in the pediatric population because of many factors. OBJECTIVE In this context, our aim was to develop a consensus-based list of criteria for the safety of the pediatric medication-use process or circuit (referred to from now on as the CIRCUS tool: CIRcuit-of-Child-drug-USe). SETTING Multicenter with a trio of experts from eight university hospitals. METHODS A literature search (1998-2013) was conducted in order to identify the different safety practice domains for the pediatric medication use process. Twenty-six safety practice domains were identified and 48 compliance criteria were formulated. In order to reach a consensus on the most relevant compliance criteria for safety practices, an international 24 French-speaking multidisciplinary panelists (8 doctors, 8 pharmacists and 8 nurses) selected to represent a broad range of experience levels and specialties took part in a two round Delphi survey which was conducted between March and July 2013. Each panelist was asked to rate each proposed criterion on a 1-9 Likert scale in order to show their level of agreement (i.e. 1 reflects strong disagreement and 9 reflects strong agreement). MAIN OUTCOME MEASURE Development of a consensus-base list for safety practices in pediatrics. RESULTS Twenty-two of the 24 professionals invited to take part in this survey (92% participation rate) completed the two Delphi rounds. At the end of the two Delphi rounds, a total of 38/48 (79%) safety practice compliance criteria achieved consensus by the panelists. The criteria were grouped into 23 domains. CONCLUSION This study presents the development of a self-assessment tool for safety practices in the pediatric drug-use process using a Delphi method. This tool may be used in order to record and compare the prevalence of best safety practices in the pediatric drug-use process.
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Affiliation(s)
- A Guérin
- Pharmacy Practice Research Unit, Pharmacy Department, Sainte-Justine University Health Center, 3175, chemin de la Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - J F Bussières
- Pharmacy Department, Sainte-Justine University Health Center, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - R Boulkedid
- Clinical Epidemiology Unit, APHP, Robert Debré University Health Center, 75019, Paris, France
- INSERM, U 1123 and CIC 1426, Robert Debré University Health Center, 75019, Paris, France
| | - O Bourdon
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- Department of Clinical Pharmacy, Faculty of Pharmacy, Université Paris Descartes, Sorbonne Paris Cité, France
- Laboratory Education and Health Practices EA 3412, Université Paris 13, Sorbonne Paris Cité, France
- French Society of Clinical Pharmacy, Paris, France
| | - S Prot-Labarthe
- Pharmacy Department, APHP, Robert Debré University Health Center, Paris, France
- French Society of Clinical Pharmacy, Paris, France
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Guérin A, Tisseyre M, Bussières J. OHP-027 Literature about the role and the impact of pharmacists: perceptions of pharmacy students. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Guérin A, Mody R, Fok B, Lasch KL, Zhou Z, Wu EQ, Zhou W, Talley NJ. Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation. Aliment Pharmacol Ther 2014; 40:83-92. [PMID: 24832002 DOI: 10.1111/apt.12789] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/08/2014] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic constipation (CC) is a highly prevalent health problem, potentially associated with increased risk of colorectal cancer (CRCancer). AIM To investigate the association between CC, its severity, and CRCancer by estimating the relative risk of developing CRCancer and benign colorectal neoplasm (BCN) among severity-stratified patients with and without CC. METHODS Chronic constipation patients from a large retrospective US claims database were matched 1:3 with CC-free controls by demographic characteristics. CRCancer and BCN prevalence were measured over 1 year. In pre-index CRCancer- and BCN-free patients, incidence rate ratios (IRRs) of new CRCancer and BCN were calculated. Multivariate regression models adjusted for comorbidities and family history. CC patients' disease severity was rated based on CC-related resource use. IRRs for new CRCancer and BCN were estimated for CC severity groups and controls. RESULTS Chronic constipation (N = 28,854) and CC-free (N = 86,562) patients had mean age 61.9 years; 66.7% were female. One-year CRCancer prevalence was 2.7% and 1.7%, and BCN prevalence was 24.8% and 11.9% for CC and CC-free patients, respectively. Adjusted IRRs between CC and CC-free patients were 1.59 [95% confidence interval (CI): 1.43-1.78] and 2.60 [95% CI: 1.51-2.70] for CRCancer and BCN, respectively. Patients with severe and very severe CC had significantly greater incidence of CRCancer and BCN. At ≥ 2 and ≥ 5 years of observation, CRCancer and BCN incidence remained consistently and significantly higher for CC patients. CONCLUSIONS Patients with chronic constipation are associated with significantly higher prevalence and incidence of colorectal cancer and benign colorectal neoplasm than matched chronic constipation-free patients. These risks increase with the severity of chronic constipation.
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Affiliation(s)
- A Guérin
- Analysis Group, Inc., Boston, MA, USA
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Guérin A, Lebel D, Marando N, Prot-Labarthe S, Bourdon O, Bussières JF. [Determinants of the evolution of hospital pharmacy in France and Quebec: Perception of hospital pharmacists]. Ann Pharm Fr 2014; 72:202-15. [PMID: 24780836 DOI: 10.1016/j.pharma.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/02/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital pharmacy practice has evolved differently between France and Quebec. While this development is part of broader systems, French and Quebec hospitals have undergone significant changes over the years to cope with challenges, among others, the economic and demographic realities. PURPOSE The main objective is to evaluate and compare the perception of French and Quebec hospital pharmacists about the factors that have contributed to the evolution of pharmacy practice in their respective context. METHODS This is a descriptive cross-sectional study. The study focuses on a sample of experienced hospital pharmacists in France and Quebec. We targeted a convenience sample of 50 respondents per country. An online questionnaire with 15 pharmaceutical activities to which are connected nine factors that may have influenced the implementation of each of these activities in each country was used. The mean score was calculated for each of the nine factors for each activity. The perception of French and Quebec hospital pharmacists was then compared. A P value less than 0.05 was considered statistically significant. RESULTS Two hundred and sixty hospital pharmacists were directly contacted in France and 79 in Quebec. Seventy-eight French pharmacists and 77 Quebec pharmacists responded to the survey, that is a respective response rate of 30% and 97%, respectively. The hierarchy of factors that contributed to the evolution of pharmacy practice was similar between the two countries, legislative and regulatory factors as well as the concern for risk management and quality dominate; scientific human, economic factors and training have a relatively similar position. For cons, the news factor (6th in France against the 10th position in Quebec) and the academic factor (10th position in France against the 6th position in Quebec) obtained inverse scores between France and Quebec. CONCLUSION There are few data on the determinants of the evolution of hospital pharmacy in France and Quebec. The hierarchy of factors that contributed to the evolution of pharmacy practice is similar between the two countries, although differences of rank were found for the news and academic factors. Further studies are needed to better understand the factors that influence the evolution of pharmacy practice in health care institutions.
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Affiliation(s)
- A Guérin
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - D Lebel
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - N Marando
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - S Prot-Labarthe
- Département de pharmacie, hôpital Robert-Debré, AP-HP, 48, boulevard Serurier, 75019 Paris, France
| | - O Bourdon
- Département de pharmacie, hôpital Robert-Debré, AP-HP, 48, boulevard Serurier, 75019 Paris, France; Faculté de pharmacie, université Paris Descartes, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France; Éducation et pratiques de santé EA 3412, université Paris Nord-13, 74, rue Marcel-Cachin, 93017 Bobigny cedex, France
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada; Faculté de pharmacie, université de Montréal, 2900, Édouard Montpetit, Montréal, Québec H3T 1J4, Canada.
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Guérin A, Thibault M, Nguyen C, Lebel D, Bussières JF. [Steps aimed at upgrading a pharmaceutical care sector: the case of surgery]. Ann Pharm Fr 2014; 72:267-86. [PMID: 24997888 DOI: 10.1016/j.pharma.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND While the concept of clinical pharmacy was developed in the 1960s, clinical programs are characterized by their great variety and disparity when it comes to the presence of pharmacists in healthcare sectors. PURPOSE This article aims to describe a method in which pharmaceutical care sectors in healthcare facilities can be upgraded. METHODS This is a descriptive study supporting the upgrade of pharmaceutical care practiced in the surgery sector of a 500-bed mother-child university hospital center, the CHU Sainte-Justine. The pharmacy department employs more than 70 healthcare professionals. The study involved these proposed upgrading steps: firstly, a review of the literature; secondly, a description of the profile of the sector; thirdly, a description of the upgrading of pharmacist practice in surgery. RESULTS A total of 137 articles were compiled, seven of which were selected to evaluate the impact and eight a description of the pharmacist's role in surgery. The authors did not identify any particular pharmaceutical activity based on very good quality data (A). However, there were five based on good quality data (B) and seven that lacked adequate proof (C, D) in relation to the practice of surgery. Nevertheless, a number of other authors described the development of the pharmacist's clinical role in surgery. CONCLUSION There are few data on the impact of pharmacists in surgery. This descriptive study proposes a number of steps aimed at upgrading pharmaceutical care within a Quebec university hospital center.
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Affiliation(s)
- A Guérin
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - M Thibault
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - C Nguyen
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - D Lebel
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - J-F Bussières
- Département de pharmacie et unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada; Faculté de pharmacie, université de Montréal, 2900, Édouard Montpetit, H3T 1J4 Montréal, Québec, Canada.
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Guérin A, Tanguay C, Lebel D, Bourdon O, Bussières JF. OHP-015 Clinical Research in France and Quebec. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Guérin A, Merger D, Courbon E, Métras ME, Lebel D, Bussières JF. OHP-023 Differences in Training Required For Hospital Pharmacy Practise in France and Quebec. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Guérin A, Tanguay C, Lebel D, Prot-Labarthe S, Bourdon O, Bussières JF. OHP-060 Paediatric Clinical Research: Current Situation and Pharmaceutical Constraints in France and Canada. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Guérin A, Caron E, Lebel D, Bussières JF. GRP-147 Pre-Post Study of Interruptions in a Pharmacy Department. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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20
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Strober BE, Sobell JM, Duffin KC, Bao Y, Guérin A, Yang H, Goldblum O, Okun MM, Mulani PM. Sleep quality and other patient-reported outcomes improve after patients with psoriasis with suboptimal response to other systemic therapies are switched to adalimumab: results from PROGRESS, an open-label Phase IIIB trial. Br J Dermatol 2012; 167:1374-81. [PMID: 22897348 DOI: 10.1111/bjd.12000] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psoriasis is associated with poor health-related quality of life, including sleep impairment. OBJECTIVE To assess the extent of sleep impairment, the effect of adalimumab on sleep and other patient-reported outcomes, and correlations between changes in these outcomes and sleep quality in patients with psoriasis. METHODS Patients in the 16-week, open-label, Phase IIIb PROGRESS trial had chronic plaque psoriasis and suboptimal response to prior therapy (etanercept, methotrexate or narrowband ultraviolet B phototherapy). Adalimumab was self-injected subcutaneously (80 mg at week 0, then 40 mg every other week from week 1). The focus for this analysis was the Medical Outcomes Study Sleep Scale. Other patient-reported outcomes included the Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), Physician's Global Assessment, a visual analogue scale for psoriasis/psoriatic arthritis (PsA) pain, and the Work Productivity and Activity Index Questionnaire-Specific Health Problems. RESULTS Patients with psoriasis had impaired sleep at baseline. The degree of sleep impairment was significantly associated with the extent of work productivity for all sleep measures and, for some sleep measures, was associated with DLQI impairment, clinical severity measured by PASI, the presence of PsA, and depression. Adalimumab treatment significantly improved sleep quality by 15% from baseline, as well as DLQI score, pain and work productivity. The improvement in sleep was partially explained (R(2 ) = 0·16, P < 0·001) by improvements in the objectively measured psoriasis signs in PASI. CONCLUSIONS Adalimumab treatment improved sleep outcomes and other patient-reported outcomes including health-related quality of life, work productivity, daily activity and disease-related pain.
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Affiliation(s)
- B E Strober
- Dermatology Associates, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Marret H, Bleuzen A, Guérin A, Lauvin-Gaillard MA, Herbreteau D, Patat F, Tranquart F. Résultats préliminaires de la destruction des fibromes utérins par ultrasons focalisés contrôlée par résonance magnétique. ACTA ACUST UNITED AC 2011; 39:12-20. [DOI: 10.1016/j.gyobfe.2010.08.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
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Kimball AB, Guérin A, Tsaneva M, Yu AP, Wu EQ, Gupta SR, Bao Y, Mulani PM. Economic burden of comorbidities in patients with psoriasis is substantial. J Eur Acad Dermatol Venereol 2010; 25:157-63. [DOI: 10.1111/j.1468-3083.2010.03730.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Morgan JA, Guo A, Williams D, Guérin A, Latremouille-Viau D, Tsaneva M, Yu AP, Wu E, Signorovitch J, Demetri GD. Real world treatment patterns of gastrointestinal stromal tumor patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15602 Background: Imatinib is accepted as the standard first-line therapy to treat gastrointestinal stromal tumor (GIST) in patients with unresectable or metastatic disease. In the case of disease progression, physicians may consider increasing imatinib dose or switching to another second-line agent, such as sunitinib. The aim of this study was to analyze the real-world long term treatment patterns of GIST patients. Methods: Two large claims databases from 01/1999 to 03/2008 were combined (MarketScan and Ingenix Impact) to extract patients diagnosed with GIST who initiated on imatinib ≥400 mg/day. Patients were followed from the first observed imatinib prescription to the end of data availability. Patients who dose increased during the study period were defined as dose escalators, while patients who later switched to sunitinib with or without dose escalation were defined as switchers. Kaplan Meier analyses were used to estimate the rate of treatment changes over time including imatinib discontinuation, defined as a lack of imatinib supply for ≥60 days, and switching back to initial treatment. Results: Among the 1,508 GIST patients who initiated on imatinib, 253 patients had a dose increase and 153 patients switched to sunitinib during the study period. 20.1% patients on imatinib discontinued by the end of the first year, and 43.0% discontinued by the end of the third year. Among the 153 switchers, 61 patients had a dose escalation prior to the switch, of which 82.0% reached 800 mg before switching. Among all the switchers, 20.3% switched back to imatinib within 6 months. Conclusions: These claims-based findings on the duration of first-line imatinib therapy of GIST patients supports data on imatinib efficacy in treating GIST from formal clinical research studies. Most of GIST patients who initiated imatinib continued on this therapy without undergoing dose increase or switch to sunitinib. Among switchers, most did not dose escalate before switching and many eventually switched back to imatinib. It appears that physicians tend to not always follow clinical practice guidelines developed based on expert consensus, with respect to decision rules for dose escalation, or for the appropriate time to change kinase inhibitor therapy. [Table: see text]
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Affiliation(s)
- J. A. Morgan
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - A. Guo
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - D. Williams
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - A. Guérin
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - D. Latremouille-Viau
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - M. Tsaneva
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - A. P. Yu
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - E. Wu
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - J. Signorovitch
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
| | - G. D. Demetri
- Dana-Faber Cancer Institute, Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Analysis Group, Inc., Boston, MA
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Wu E, Guo A, Williams D, Guérin A, Yu AP, Latremouille-Viau D, Tsaneva M, Signorovitch J, Griffin JD, Bollu V. Adverse events associated with escalating imatinib versus switching to dasatinib in patients with chronic myelegenous leukemia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7092 Background: After initial therapy with imatinib, some chronic myelegenous leukemia (CML) patients may require dose escalation or switching to another BCR/ABL kinase inhibitor to achieve the desired response. This study compared adverse events associated with either escalation of imatinib or switching to dasatinib. Methods: Two large administrative claims databases were combined (MarketScan and Ingenix Impact) to extract deidentified information on 17,382 patients diagnosed with CML (ICD-9 code: 205.1) from January 1999 to March 2008. 474 patients (dose escalators) had their dose of imatinib increased at some point to >400 mg/day but were never given dasatinib, while 175 patients were switched to dasatinib with or without dose escalation of imatinib (switchers). Patients were followed from the index date to treatment discontinuation or end of eligibility. Cox proportional-hazard models were used to compare the risk of common adverse events (AEs) associated with escalation or switching to dasatinib, controlling for demographics, imatinib treatment patterns, and prior therapies at baseline. Patients with the studied AEs at baseline were excluded from analyses of the corresponding AEs. Results: Switchers experienced significantly higher risk of the following AEs than escalators: fluid retention (HR 3.22 p < 0.0001), pleural effusion (HR 4.90 p < 0.0001), thrombocytopenia (HR 3.25 p = 0.0044), neutropenia (HR 3.40 p = 0.0009), and some non-hematologic adverse events (HR 2.38 p < 0.0001), dyspnea (HR 4.02 p < 0.0001), constipation (HR 5.79 p = 0.0041), nausea and vomiting (HR 2.40 p = 0.0100), and congestive heart failure (HR 5.01 p < 0.0001). No statistically significant differences in risk of other common AEs associated with imatinib and dasatinib were identified. Conclusions: 15.4% of CML patients treated with ≤400mg of imatinib initially either had dose escalation or switch to dasatinib. Significantly more AEs were associated to those who switched to dasatinib than those who dose escalated. Further study is warranted to examine the causality of the difference in these AEs. [Table: see text]
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Affiliation(s)
- E. Wu
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - A. Guo
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - D. Williams
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - A. Guérin
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - A. P. Yu
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - D. Latremouille-Viau
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - M. Tsaneva
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - J. Signorovitch
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - J. D. Griffin
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - V. Bollu
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
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Guérin A, Guo A, Williams D, Yu AP, Wu E, Latremouille-Viau D, Tsaneva M, Signorovitch J, Griffin JD. Treatment patterns of chronic myelogenous leukemia patients with suboptimal responses to imatinib. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7090 Background: Imatinib is the first-line therapy for Philadelphia chromosome-positive chronic myelogenous leukemia (CML). Patients with suboptimal responses may have the dose of imatinib escalated or may be switched to an alternative kinase inhibitor such as dasatinib. The aim of this study is to examine the real-world treatment patterns of imatinib and dasatinib in CML patients. Methods: Two large U.S. administrative claims databases from January 1999 to March 2008 were combined (MarketScan and Ingenix Impact) to extract de-identified information of patients diagnosed with CML (ICD-9 code: 205.1) who were initiated on imatinib. Patients were followed from the first observed imatinib prescription to the end of data availability. Patients who increased imatinib dose to >400 mg/day were defined as dose escalators, while patients who initiated on imatinib and further switched to dasatinib were considered as switchers. Rates of imatinib dose escalation and switching to dasatinib were estimated. Kaplan-Meier (KM) survival analyses were used to estimate the rate of imatinib discontinuation, defined as a lack of imatinib supply for at least 90 days. Among switchers, the rate of switching back to imatinib was also estimated using KM survival analysis. Results: Among the 5,159 CML patients initiated with imatinib, 1,144 patients either had dose escalation of imatinib (839) or were switched to dasatinib (305) during the study period. Of the 5,159 patients, 12.1% patients discontinued imatinib by the end of the first year, and 25.4% discontinued by the end of the third year. Among the 305 switchers, 115 (37.7%) had an imatinib dose increase prior to the switch, and 66 (21.6%) were escalated to 800 mg of imatinib before switching. 51 patients (16.7%) had used imatinib for <6 months before switching, and 17.1% switched back to imatinib within 6 months of dasatinib treatment. Conclusions: This study showed that great variability was observed in the real world treatment pattern of CML patients. Most CML patients who initiated on imatinib did not dose increase or switch during the study period. Of those who switched to dasatinib, most did not attempt to increase the dose before switching, and a sizeable portion of patients had to switch back to imatinib. [Table: see text]
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Affiliation(s)
- A. Guérin
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - A. Guo
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - D. Williams
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - A. P. Yu
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - E. Wu
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - D. Latremouille-Viau
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - M. Tsaneva
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - J. Signorovitch
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
| | - J. D. Griffin
- Analysis Group, Inc., Boston, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Dana-Farber Cancer Institute, Boston, MA
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Abstract
OBJECTIVES The primary objective was to investigate whether nonadherence to antiepileptic drugs (AEDs) is associated with increased mortality and the secondary objective to examine whether nonadherence increases the risk of serious clinical events, including emergency department (ED) visits, hospitalizations, motor vehicle accident (MVA) injuries, fractures, and head injuries. METHODS A retrospective open-cohort design was employed using Medicaid claims data from Florida, Iowa, and New Jersey from January 1997 through June 2006. Patients aged > or =18 years with > or =1 diagnosis of epilepsy by a neurologist and > or =2 AED pharmacy dispensings were selected. Medication possession ratio (MPR) was used to evaluate AED adherence on a quarterly basis with MPR > or =0.80 considered adherent and <0.80 nonadherent. The association of nonadherence with mortality was assessed using a time-varying Cox regression model adjusting for demographic and clinical confounders. Incidence rates for serious clinical events were compared between adherent and nonadherent quarters using incidence rate ratios (IRRs) with 95% CIs calculated based on the Poisson distribution. RESULTS The 33,658 study patients contributed 388,564 AED-treated quarters (26% nonadherent). Nonadherence was associated with an over threefold increased risk of mortality compared to adherence (hazard ratio = 3.32, 95% CI = 3.11-3.54) after multivariate adjustments. Time periods of nonadherence were also associated with a significantly higher incidence of ED visits (IRR = 1.50, 95% CI = 1.49-1.52), hospital admissions (IRR = 1.86, 95% CI = 1.84-1.88), MVA injuries (IRR = 2.08, 95% CI = 1.81-2.39), and fractures (IRR = 1.21, 95% CI = 1.18-1.23) than periods of adherence. CONCLUSION These findings suggest that nonadherence to antiepileptic drugs can have serious or fatal consequences for patients with epilepsy.
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Affiliation(s)
- E Faught
- UAB Epilepsy Center, Civitan International Research Center 312, 1719 6th Avenue South, Birmingham, AL 35294, USA.
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Pannier B, Guérin A, London G, Asmar R, Safar M. [Combination of low-dose perindopril/indapamide versus atenolol in the hypertensive patient. Effects on systolic pressure and arterial hemodynamics. REASON Study]. Arch Mal Coeur Vaiss 2002; 95 Spec No 6:11-6. [PMID: 12407781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
In hypertension, consideration of systolic blood pressure (SBP) and pulse pressure (PP) is now well recognized from epidemiological and therapeutical points of view, after numerous years of interest in only diastolic blood pressure. SBP, and also PP, are tightly linked to mechanical properties of large arteries. It is now possible to investigate precisely, with very good repeatability, these mechanic properties. The REASON study is an international multicenter randomised, controlled, parallel-groups study in essential hypertensives. The very low dose perindopril/indapamide combination (Per/Ind: 2 mg/0.625 mg) was compared with atenolol (50 mg) for a 12-month active treatment period in terms of blood pressure reduction efficiency and change in large artery hemodynamics to attempt to relate changes in pressure and changes in arterial mechanics. 471 patients suffering from hypertension were included, 406 benefitted from the treatment for one year (per-protocol analysis) and 96 benefitted from arterial investigations (pulse wave velocity and aortic wave reflection with applanation tonometry). Changes in brachial and central SBP and PP were higher with Per/ind than with atenolol. The reduction in pulse wave velocity was similar with both drugs, but aortic wave reflections were more reduced with Per/Ind than with atenolol. The very low dose perindopril/indapamide decreases SBP and PP to a larger extent than does a betablocker after a 12-month treatment. Changes in arterial mechanics, non invasively measured, were the same (pulse wave velocity) or in favour of Per/Ind vs atenolol (higher reduction in aortic wave reflection, with higher reductions in central systolic and pulse pressures).
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Affiliation(s)
- B Pannier
- Service de médecine, hôpital Manhès, 8 Grande-rue, 91712 Fleury-Mérogis Cedex, France
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Guérin A, Marchais S, Pannier B, London G. [Cardiac anomalies in chronic renal failure]. Presse Med 2000; 29:274-80. [PMID: 10701411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
PRINCIPAL CARDIOVASCULAR COMPLICATIONS IN END STAGE RENAL DISEASE: Cardiovascular diseases are the leading causes of morbidity and mortality in end stage renal disease patients. Very often, complications observed are left ventricular hypertrophy and various forms of arterial degenerative lesions involving coronary arteries, less frequently pericarditis and calcifying valvulopathy are diagnosed. THE REASONS ARE COMPLEX: Risk factors can be either specific of uremia per se such as anemia, overhydration, fistula or the same as in the general population. Hemodynamic alterations including tensile stress or blood flow play a major role associated to various locally or generally generated substances whose role remains currently to be determined. THEIR TREATMENTS: Treatments of cardiovascular complications are not specific in this end stage renal disease population but are more often the treatment of the etiology: reduction of fistula blood flow, increase of hemoglobin, best control of weight gain between two hemodialysis sessions or blood pressure control.
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Affiliation(s)
- A Guérin
- Service de Néphrologie et d'Hémodialyse, Centre hospitalier F.H. Manhes, Fleury Mérogis
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London GM, Guérin A. Influence of arterial pulse and reflective waves on systolic blood pressure and cardiac function. J Hypertens Suppl 1999; 17:S3-6. [PMID: 10465060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Hypertension is a cardiovascular risk factor classically attributed to a reduction in the calibre and/or number of small arteries and arterioles resulting in increased peripheral vascular resistance. The definition of blood pressure as a product of total peripheral resistance (TPR) and cardiac output, however, does not take into account the fluctuation of blood pressure and flow during the cardiac cycle, with systolic and diastolic blood pressure representing the extremes of pulse pressure fluctuations. Diastolic blood pressure is closer to mean blood pressure (and therefore to TPR) than systolic blood pressure, and as such has been used as a marker for the diagnosis of hypertension. However, this approach has no rational basis and was challenged by the Framingham Heart Study which demonstrated that systolic rather than diastolic blood pressure is a better risk marker for stroke and coronary artery disease in subjects aged 45 years and older. This view has subsequently been confirmed by several epidemiological and interventional studies. Systolic blood pressure is closely associated with pulse pressure and is determined by the pattern of left ventricular ejection, arterial stiffness and timing of arterial wave reflections, i.e. the geometrical and viscoelastic properties of large conduit arteries. In humans, with ageing and hypertension, the arteries stiffen as a result of progressive degeneration of the arterial media, increased collagen and calcium content, and dilation and hypertrophy of large arteries and the aorta. Thus, the increase in systolic blood pressure (as a result of arterial damage) increases the fatigue of arterial walls and accelerates arterial damage, producing a self-perpetuating cycle.
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Affiliation(s)
- G M London
- Cêntre Hospitalier FH Manhès, Fleury-Merogis, France
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Pannier B, Slama M, Guérin A, Martel E, London G, Safar M, Cuche JL. Further study on the carotid baroreflex system in the cardiovascular deconditioning induced by head-down tilt. Aviat Space Environ Med 1998; 69:904-10. [PMID: 9737764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
HYPOTHESIS The responses of the carotid baroreflex and of the peripheral sympathetic system to stimulations induced by either lower body negative pressure (LBNP -40 mmHg) or cold pressor test were investigated in eight volunteers before and after 48 h in the -6 degrees head-down tilt (HDT). METHODS Geometry (diastolic diameter and pulsatile distention) and dynamics (cross-sectional compliance and tangential tension) of the bulb and the common carotid artery were investigated using ultrasonic devices, echotracking and aplanation tonometry. The activity of the sympathetic system was evaluated through measurements of plasma concentrations of catecholamines (CAs) and 3,4-dihydroxyphenyl glycol (DHPG). RESULTS During LBNP -40 mmHg, the pulsed tangential tension was decreased and the pressure amplification, induced by the reflexion of the pressure wave, was increased with no difference between before and after HDT. Since cross-sectional compliance and distensibility coefficient remained unchanged and the carotid contour of the waveform unaltered, it is concluded that the carotid reflexogenic area reads the same message during LBNP whether the cardiovascular system was deconditioned or not. Nonetheless, during LBNP after 48 h HDT, the heart rate accelerated faster and CAs and DHPG concentrations increased out of proportion, suggesting that the peripheral sympathetic activity was more reactive after HDT than before. Finally, forearm vascular resistances were measured in response to cold pressor test; they increased in the same proportion after HDT when compared with before. CONCLUSION Results indicate that the carotid baroreflex and the peripheral sympathetic system were not deficient after 48 h HDT.
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Affiliation(s)
- B Pannier
- Department of Internal Medicine, Hôpital Manhes, Fleury-Merogis, France
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32
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Guérin A. [Home hospitalization in psychiatry. Care adapted to the patient]. Rev Infirm 1998:46-8. [PMID: 9653353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Paulmyer-Lacroix O, Mollé L, Noizet A, Guérin A, Mollar M, Gamerre M, Grillo JM. [Intrauterine insemination with the husband's sperm: conclusions of five years experience]. Contracept Fertil Sex 1998; 26:300-6. [PMID: 9622965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We analyzed retrospectively 936 intrauterine insemination (IUI) cycles with husband's sperm (384 couples). Superovulation and induction monitoring occurred in the majority of cases; IUI was timed 36-40 h after ovulatory hCG. The overall pregnancy rate per cycle (PR/C) was 11.4% (107/936). Data analysis demonstrated that PR/C decreased with infertility duration, woman's age (especially after 38 years old) and number of attempts (significantly after the 4 th cycle). Superovulation (in particular by antiestrogens) and induction monitoring seemed to provide an increase in cycle pregnancy rate. Highest PR/C were observed in dysovulation and male infertility groups. In cases of sperm defects, our data showed that 2 parameters had a significant influence on pregnancy outcome: the number of motile progressive inseminated spermatozoa (> 300,000) and the spermatozoa survival rate after 24 h (> 50%). As a conclusion, intrauterine insemination can be proposed as a satisfying treatment of infertility, if precise protocol is followed and its indications well-defined.
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Affiliation(s)
- O Paulmyer-Lacroix
- CHU La Conception, Centre de procréation médicalement assistée, Marseille
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Guérin A, Resplandy G, Marchais S, Taillard F, London G. The effect of haemodialysis on the pharmacokinetics of perindoprilat after long-term perindopril. Eur J Clin Pharmacol 1993; 44:183-7. [PMID: 8453964 DOI: 10.1007/bf00315478] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have studied the pharmacokinetics of perindoprilat, the active metabolite of perindopril, in 7 hypertensive patients undergoing haemodialysis after short-term and long-term (1 month) perindopril. We also measured angiotensin-converting enzyme activity. Each subject took 2 mg of perindopril after a 4-hour haemodialysis. Serial blood samples were obtained each hour during dialysis and between dialysis (7 samples over 44 h). Perindoprilat steady state was reached within 5 haemodialysis sessions. There was a high degree of angiotensin converting enzyme inhibition after the first dose. Administration for 1 month did not modify the time to peak perindoprilat concentration but significantly increased the mean maximal concentration: 10.2 versus 26.8 ng.ml-1. The mean accumulation ratio was 3.5. The mean reduction in perindoprilat concentration after dialysis was greater than 50%. Perindoprilat haemodialysis clearance was 62 ml.min-1 after the first administration and 72 ml.min-1 after 1 month. Tolerance of perindopril was good throughout the study. Treatment can be begun with 2 mg of perindopril after haemodialysis in hypertensive patients undergoing haemodialysis.
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Affiliation(s)
- A Guérin
- Centre Hospitalier Médical F. H. Manhès, Fleury Mérogis, France
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Olivier C, Guérin A, Cataldi M. [Acute adrenal failure. Physiopathology, diagnosis, prevention, emergency treatment with posology]. Rev Prat 1992; 42:1969-72. [PMID: 1485097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Olivier
- Laboratoire de neuroendocrinologie expérimentale, Inserm U 297, faculté de médecine Nord, Marseille
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Ondongh-Essalt E, Freyssenet MG, Guérin A, Erangah-Ipendo I. [The waterfall of frontiers. Voyage into the heart of an exile]. Soins 1992:4-6. [PMID: 1290103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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37
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London G, Guérin A, Marchais S, Levy B. [Evaluation of arterial compliance in renal insufficiency]. Arch Mal Coeur Vaiss 1991; 84 Spec No 3:63-6. [PMID: 1953287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pulse wave velocity (PWV) of the aorta, of the arm, of the leg, was measured in 90 normal subjects (N) and 92 dialysis patients (D) of the same age and blood pressure status. All patients underwent blood biochemistry, especially serum liquid concentrations, and aortic ultra-sonography. Aortic calcifications were diagnosed by echo and radiologic examination. Aortic PWV was significantly higher in D (1,113 +/- 319 cm/s) than in N (965 +/- 216 cm/s) (p = 0.0016). The aortic diameters were greater in D both at the aortic root and at the bifurcation. The pulse pressure was higher in D (76.6 +/- 23.7 vs 63.9 +/- 2 mmHg, p = 0.007). In both populations, the PWV increased with age and blood pressure but aortic calcification was only weakly correlated with this increase. These results indicate that the compliance of the aortic wall is reduced in D and leads to an increase in the pulsatile component of the blood pressure and thereby to an increase in left ventricular afterload.
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Affiliation(s)
- G London
- Centre hospitalier F. H. Manhès, Fleury-Mérogis
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Jutten C, Guérin A, Hérault J. Simulation machine and integrated implementation of neural networks. Neural Netw 1990. [DOI: 10.1007/3-540-52255-7_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Aortic and brachial pulse wave velocity were measured in 26 haemodialysis patients in order to assess the effect of uraemic waste-product retention on arterial compliance. Dialysis with a 'low-calcium' dialysate (1.50 mmol/l) did not change the pulse wave velocity, but dialysis with a 'high-calcium' dialysate (1.75 mmol/l) induced a significant increase in both aortic and brachial pulse wave velocity. The results indicate that (1) waste-product retention is not responsible for the increased arterial pulse wave velocity observed in uraemic patients and (2) the increase in serum ionized calcium decreases arterial compliance.
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Habibi B, Blériot JP, Pinsard D, Bretagne Y, Guérin A, Carlet J. [Acute anuric hemolysis caused by antiajmaline antibodies]. Presse Med 1983; 12:513-5. [PMID: 6219361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In a 32-year old woman under ajmaline therapy for cardiac arrhythmia, a sudden episode of acute haemolytic anaemia and renal failure led to the identification of a potent agglutinating, haemolysing and lymphocytotoxic antibody specific to ajmaline and cross-reacting with quinine and quinidine. The immunological features of the antibody and the pathophysiological mechanism of blood cell destruction are presented, together with a brief synopsis of drugs incriminated so far in the induction of specific antibody formation and immune haemolytic anaemia.
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Schortgen G, Daubresse D, Guérin A. [Anuria after accidental perfusion of hemoglobin. 2 cases]. Nouv Presse Med 1980; 9:3625-6. [PMID: 6937074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Delas N, Bousquet O, Launay P, Saigot T, Merland JJ, Guérin A, Sarrazin A. [Therapeutic embolization in gastrointestinal bleeding due to Rendu-Osler disease (author's transl)]. Gastroenterol Clin Biol 1978; 2:399-403. [PMID: 307506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Veyssière J, Guérin A. [Note on the dosimetric study of the 60Co moving strip technique (author's transl)]. Ann Radiol (Paris) 1977; 20:227-32. [PMID: 879646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cohadon F, Guérin A, Castel JP, Leifer C, Caillé M, Leman P. [Pseudo-tumorous softening of the cerebellum]. Bord Med 1970; 3:285-97. [PMID: 5425867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bourguet J, Lefranc J, Bagot P, Guérin A, Jézéquel J, Bourdiniere J. [Treatment of various ocular complications of zygomato-malar fractures]. Rev Otoneuroophtalmol 1968; 40:271-8. [PMID: 5746529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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46
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Guérin A. [Apropos of a case of ecmnesia]. J Med Bord 1967; 144:427-429. [PMID: 5609716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Bourguet J, Ragot P, Guérin A. [Nasopharyngeal fibroma. Apropos of 15 patients and 20 operations]. Ann Otolaryngol Chir Cervicofac 1965; 82:987-94. [PMID: 5856777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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48
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Arné L, Guérin A, Julien J, Vital C. [On a case of subacute leukoencephalopathy in a patient having presented a thrombophlebitis of the lower extremities]. Rev Neurol (Paris) 1965; 112:560-2. [PMID: 5856210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bourguet J, Bagot P, Guérin A. [Statistical study of 121 ethmoido-maxillary malignant tumors]. Rev Laryngol Otol Rhinol (Bord) 1965; 86:457-73. [PMID: 5837978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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