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Roche N, Laurendeau C, Raherison C, Fuhrman C, Burgel P. Déterminants de l’épidémiologie future de la BPCO. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.125] [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: 11/28/2022]
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Delmas MC, Guignon N, Leynaert B, Moisy M, Marguet C, Fuhrman C. [Increase in asthma prevalence among young children in France]. Rev Mal Respir 2016; 34:525-534. [PMID: 27919604 DOI: 10.1016/j.rmr.2016.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/02/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Few data on change over time of asthma prevalence in French children are available. METHODS Data from the 2012-2013 national health survey of schoolchildren conducted in a random sample of almost 20,000 children in the last year of nursery school were compared to those which had been collected in 2005-2006 in the same grade level using the same methodology. RESULTS In the 2012-2013 survey, children had a lifetime prevalence of asthma of 11.0% with 11.8% reporting wheezing in the preceding year. Asthma was more frequent and more often uncontrolled in children from families with low socioeconomic status. Compared to the survey conducted in the same grade level in 2005-2006, the prevalence ratios adjusted for children's gender and obesity, family structure, parental unemployment and region were 1.13 [1.05-1.21] for lifetime asthma and 1.12 [1.05-1.17] for past-year wheezing. CONCLUSION In France, the prevalence of asthma in young children increased between 2005 and 2012. The socioeconomic status of children's parents affects both asthma prevalence and control.
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Affiliation(s)
- M-C Delmas
- Direction des maladies non transmissibles et traumatismes, Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | - N Guignon
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), ministère de la Santé, 75007 Paris, France
| | - B Leynaert
- UMR 1152, Inserm, 75890 Paris cedex 18, France; UMR 1152, université Paris-Diderot Paris-7, 75018 Paris, France
| | - M Moisy
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), ministère de la Santé, 75007 Paris, France
| | - C Marguet
- Hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - C Fuhrman
- Direction des maladies non transmissibles et traumatismes, Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
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Le Cossec C, Perrine AL, Beltzer N, Fuhrman C, Carcaillon-Bentata L. Pre-Frailty, Frailty, and Multimorbidity: Prevalences and Associated Characteristics from Two French National Surveys. J Nutr Health Aging 2016; 20:860-869. [PMID: 27709236 DOI: 10.1007/s12603-016-0802-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators. DESIGN Two nationally representative cross-sectional French surveys. SETTINGS Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé - Ménages, HSM) from 2008. PARTICIPANTS Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295). MEASUREMENTS Frailty was assessed using Fried's frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions. RESULTS In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men. CONCLUSION Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.
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Affiliation(s)
- C Le Cossec
- Laure Carcaillon-Bentata, Santé publique France, Agence nationale de santé publique, TSA 50459, 94415 Saint-Maurice Cedex France, Tel : +33 1 55 12 54 35,
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Fuhrman C, Boussac-Zarebska M, Roche N, Delmas MC. [Long-term oxygen therapy in France, 2006-2011]. Rev Mal Respir 2014; 31:421-9. [PMID: 24878158 DOI: 10.1016/j.rmr.2013.06.007] [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: 03/04/2013] [Accepted: 06/30/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aimed to describe the main characteristics of people treated with long-term oxygen therapy (LTOT) and the trends between 2006 and 2011 for prevalence and incidence. METHODS Data were provided from a sample comprising 1/97 of the permanent beneficiaries of the French health insurance. The sample contains anonymous socio-demographic characteristics and data on health care reimbursements. The analyses were carried out among adults aged 20 years and above who had received benefits on account of LTOT. RESULTS In 2011, 2.6% of adults were treated with LTOT, corresponding to around 135,000 people. The crude incidence rate was 0.9‰. The prescription of LTOT included LTOT alone (70%), LTOT associated with assisted ventilation (23%) and LTOT associated with continuous positive airway pressure (7%). About 45% of the patients were supported financially in the long-term illness program of the French Social Security because of severe chronic respiratory failure. Between 2006 and 2011, the age-adjusted prevalence rates increased by 2.9% per year in men and by 6.7% per year in women. The age-adjusted incidence rates remained stable in men (+1.6% per year, P=0.45) but increased in women (+4.7% per year, P=0.04). The median survival was 27 months. CONCLUSION This analysis of the data demonstrates an increasing burden associated with LTOT in France from 2006 to 2011.
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Affiliation(s)
- C Fuhrman
- Institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | - M Boussac-Zarebska
- Institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - N Roche
- Service de pneumologie AP-HP, hôpitaux universitaires Paris-Centre, HIA du Val-de-Grâce, 75005 Paris, France
| | - M-C Delmas
- Institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
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Delmas MC, Marguet C, Raherison C, Nicolau J, Fuhrman C. [Admissions for pediatric asthma in France]. Arch Pediatr 2013; 20:739-47. [PMID: 23731604 DOI: 10.1016/j.arcped.2013.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/08/2013] [Accepted: 04/20/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database. METHODS We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age<15years) between 2002 and 2010 in France (excluding French Guyana). RESULTS In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010. CONCLUSION The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.
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Affiliation(s)
- M-C Delmas
- Département des maladies chroniques, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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Lecomte P, Criniere L, Fagot-Campagna A, Druet C, Fuhrman C. Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007. Diabetes & Metabolism 2013; 39:139-47. [DOI: 10.1016/j.diabet.2012.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
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Delmas MC, Guignon N, Leynaert B, Annesi-Maesano I, Com-Ruelle L, Gonzalez L, Fuhrman C. [Prevalence and control of asthma in young children in France]. Rev Mal Respir 2012; 29:688-96. [PMID: 22682595 DOI: 10.1016/j.rmr.2011.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Few data on regional variations in asthma prevalence are available in France. METHODS The study was carried out during the academic year 2005-2006 in a random sample of around 20,000 children in the last year of nursery school. The lifetime prevalence of asthma and the preceding year prevalences of asthma-like symptoms and treatment for wheezing or asthma attacks were estimated by region. RESULTS Overall, the lifetime prevalence of asthma was 9.8 % and the past-year prevalence of wheezing was 10.7 %. An increasing trend in prevalence was observed from Eastern to Western France and in overseas territories. The regional variations in past-year prevalence of wheezing remained when adjusting for gender, family structure and the number of siblings. Among children who had wheezed or received a treatment in the past year, 42 % had experienced frequent or severe symptoms. CONCLUSION Large regional variations in asthma prevalence among young children in France exist.
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Affiliation(s)
- M-C Delmas
- Départment des maladies chroniques, Institut de veille sanitaire, 12 rue du Val d'Osne, Saint-Maurice cedex, France.
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Fuhrman C, Nguyen X, Fleury B, Delmas MC. Syndrome d’apnées du sommeil : symptômes évocateurs et sous-diagnostic dans la population française. Neurophysiol Clin 2012. [DOI: 10.1016/j.neucli.2012.02.094] [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] Open
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Fuhrman C, Fleury B, Nguyen X, Delmas M. Syndrome d’apnées du sommeil : symptômes évocateurs et sous-diagnostic dans la population française. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.111] [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: 10/14/2022]
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Delmas MC, Marguet C, Raherison C, Nicolau J, Fuhrman C. Readmissions for asthma in France in 2002-2005. Rev Mal Respir 2011; 28:e115-22. [PMID: 22123150 DOI: 10.1016/j.rmr.2011.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/18/2009] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Most admissions for asthma are preventable. The objective of this study was to describe readmissions for asthma. METHODS We used the nationwide hospital database to identify readmissions for asthma in patients aged two to 44 years recorded in metropolitan France between 2002 and 2005. We selected patients having a main diagnosis of asthma or asthma-related acute respiratory failure. Readmission rates at seven days and one year were estimated using the Kaplan-Meier method. RESULTS The 1-year readmission rate was 15.0% and varied with age (being higher in patients aged two to four years and 35-44 years) and sex (being higher in females aged ten to 34 years). The 1-year readmission rate increased with index stay length. The 7-day readmission rate was 1.1% and was higher in patients with shorter index hospital stays. CONCLUSION The rate of readmission of asthma patients is a relevant indicator for monitoring asthma and, more specifically, the clinical management of the disease. In the future, the accumulation of data from consecutive years and the linkage of admission data to asthma medication claims data can be expected to improve our understanding of severe asthma in France.
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Affiliation(s)
- M-C Delmas
- Institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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El Farouki K, Mantey K, Lasalle JL, Fuhrman C, Chiron E, Malfait P. Exhaustivité des signalements de cas graves de grippe A(H1N1)2009 en Provence-Alpes-Côte d’Azur et Corse, France, 2009–2010. Rev Epidemiol Sante Publique 2010. [DOI: 10.1016/j.respe.2010.06.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Delmas MC, Fuhrman C. [Asthma in France: a review of descriptive epidemiological data]. Rev Mal Respir 2010; 27:151-9. [PMID: 20206063 DOI: 10.1016/j.rmr.2009.09.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 09/21/2009] [Indexed: 12/01/2022]
Abstract
This article presents a review of the most recent data on descriptive epidemiology of asthma in France. The latest national surveys show a cumulative prevalence of asthma of more than 10% in children aged 10 years or more and a prevalence of current asthma from 6 to 7% in adults. In 2006, 1038 deaths from asthma were registered (64 deaths among people aged less than 45 years). After the peak observed in the 1980s, mortality from asthma has decreased. The decrease is also observed among children and young adults. According to data from the French discharge database (PMSI), there were 54 130 admissions for asthma (asthma as the principal diagnosis) in 2007. Between 1998 and 2007, the annual rate of admission for asthma decreased. However, no decreasing trend was observed in children and, in adults, admission rates seem to have been stable since 2004. The increase in the rate of admission for acute respiratory failure (ARF) associated with asthma (ARF as the principal diagnosis and asthma as an associated diagnosis) does not compensate for the decrease in the admission rate for asthma that was observed in adults. Data on emergency department visits show evidence of strong seasonal variations in asthma exacerbations.
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Affiliation(s)
- M-C Delmas
- Institut de veille sanitaire, Saint-Maurice, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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Fuhrman C, Delmas MC. Épidémiologie descriptive de la bronchopneumopathie chronique obstructive (BPCO) en France. Rev Mal Respir 2010; 27:160-8. [DOI: 10.1016/j.rmr.2009.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 08/24/2009] [Indexed: 12/22/2022]
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Abstract
BACKGROUND Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma. METHODS Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method. RESULTS The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay. CONCLUSION Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.
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Affiliation(s)
- M-C Delmas
- Institut de veille sanitaire, Saint-Maurice, France.
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Fuhrman C, Bonmarin I, Paty AC, Duport N, Chiron E, Lucas E, Bitar D, Mailles A, Herida M, Vaux S, Lévy-Bruhl D. Severe hospitalised 2009 pandemic influenza A(H1N1) cases in France, 1 July-15 November 2009. ACTA ACUST UNITED AC 2010; 15. [PMID: 20085690 DOI: 10.2807/ese.15.02.19463-en] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [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]
Abstract
From 1 July 2009 to 15 November 2009, 244 patients with 2009 pandemic influenza A(H1N1) were admitted to intensive care unit (ICU) and were compared with 514 cases hospitalised in medical wards in France until 2 November 2009. Detailed case-based epidemiological information and outcomes were gathered for all hospitalised cases. Infants and pregnant women are overrepresented among cases admitted to ICU with seven per cent for both groups respectively, and twenty per cent of ICU cases did not belong to a risk group. Chronic respiratory disease was the most common risk factor among cases but obesity (body mass index >or= 30 Kg/m(2)), chronic cardiac disease and immunosuppression were risk factors associated with severe illness after adjustment for age and for other co-morbidities.
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Affiliation(s)
- C Fuhrman
- Institut de veille sanitaire, Saint-Maurice, France.
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Ocak I, Raffensperger J, Turkbey B, Fuhrman C. Lipoid pneumonia secondary to Vaseline use in a patient with tympanic membrane perforation. JBR-BTR 2009; 92:280-282. [PMID: 20166495] [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: 05/28/2023]
Abstract
Exogenous lipoid pneumonia is a rare condition caused by aspiration of mineral, vegetable or animal oils. The aspiration of mineral oil is the most common cause of lipoid pneumonia in children. We present a 27-year-old man with a lipoid pneumonia with a history of daily use of Vaseline applied to cotton balls for ear plugging before swimming and shower.
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Affiliation(s)
- I Ocak
- Department of Radiology, Thoracic Imaging Division, University of Pittsburgh Medical Center, Suite E-177 PUH 1st Floor, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Delmas MC, Guignon N, Leynaert B, Com-Ruelle L, Annesi-Maesano I, Herbet JB, Fuhrman C. [Prevalence of asthma among children in France]. Arch Pediatr 2009; 16:1261-9. [PMID: 19625171 DOI: 10.1016/j.arcped.2009.06.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 06/17/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of asthma among children in France. METHODS Data from 3 French national studies were analyzed: the Decennial Health Interview Survey conducted in 2003 among a representative sample of households and 2 surveys conducted among representative samples of schoolchildren from 9(th) grade in 2003-2004 and 5(th) grade in 2004-2005. In the Decennial Health Interview Survey, data on respiratory health were collected using a self-administered questionnaire that was filled in by 1675 children aged 11-14 years living in selected households. For the studies among schoolchildren, 7104 children from 5(th) grade and 7284 from 9(th) grade were interviewed by the school nurse or physician using a standardized questionnaire. RESULTS The cumulative prevalence of asthma varied from 12.3 to 13.4% depending on the survey and the prevalence of current wheeze (wheezing in the past year) varied from 8.3 to 10.1%. The prevalence of current asthma (current wheeze in a child having already had an asthma attack or treatment for wheezing or asthma in the past year) was nearly 9% in 5(th)-grade and 9(th)-grade schoolchildren. Asthma was not controlled (at least 4 attacks, 1 awakening per week, 1 severe attack, 4 unplanned medical visits, or 1 hospitalization in the past year) in 38.5% of the 598 asthmatic teenagers from 9(th) grade, and 29.2% did not declare any anti-inflammatory drug treatment in the past week in spite of the absence of asthma control. CONCLUSION The prevalence of current asthma among children in France is estimated at 9%. Asthma control and treatment remain insufficient. Improving therapeutic and educational management of asthma among children and teenagers is necessary.
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Affiliation(s)
- M-C Delmas
- Institut de veille sanitaire, Saint-Maurice cedex, France.
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Herer B, Fuhrman C, Gazevic Z, Cabrit R, Chouaïd C. Management of nosocomial pneumonia on a medical ward: a comparative study of outcomes and costs of invasive procedures. Clin Microbiol Infect 2009; 15:165-72. [PMID: 19154492 DOI: 10.1111/j.1469-0691.2008.02649.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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
The goal of this study was to compare outcomes and costs of two management strategies for non-ventilator-associated nosocomial pneumonia (NP) in a medical ward. In this single-centre study, NP patients (n = 68) were randomized to receive non-invasive management (NIM) with immediate empirical antibiotic treatment (n = 34), or invasive management (IM) based on protected brush sampling of specimens (n = 34). The economic analysis adopted the hospital's perspective and took into account only direct costs. Baseline characteristics did not differ significantly between the two patient groups. The most frequently isolated organisms were Staphylococcus (25.4%), Streptococcus (23.7%) and Pseudomonas (18.6%) species. The 28-day clinical cure rate did not differ notably between the two groups (NIM, 79.4%; IM, 73.5%). Mortality at 28 days tended to be lower in the NIM group (10.0% vs. 21.8%). Mean antibiotic costs were lower in the IM group (euro194 +/- 355 vs. euro300 +/- 335, p <0.001) but overall management costs were similar (respectively, euro367 +/- 355 and euro346 +/- 363 in the IM and NIM groups, p = 0.08). With respect to both outcome and cost, this study does not support routine management of NP in medical wards using invasive procedures.
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Affiliation(s)
- B Herer
- Centre Médical de Forcilles, Férolles-Attilly, France.
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Hill R, Fuhrman C. Presence of Family Members During Resuscitation. Ann Emerg Med 2008; 52:309-10. [DOI: 10.1016/j.annemergmed.2008.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 11/25/2022]
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Caillaud D, Sarter H, Thibaudon M, Lecadet J, Zeghnoun A, Delmas M, Fuhrman C. Exposition aux pollens et consommation de médicaments antiallergiques. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.allerg.2008.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zempolich K, Fuhrman C, Milash B, Flinner R, Greven K, Ryu J, Forbes A, Kerlin K, Nichols RC, Gaffney DK. Changes in gene expression induced by chemoradiation in advanced cervical carcinoma: a microarray study of RTOG C-0128. Gynecol Oncol 2008; 109:275-9. [PMID: 18299147 DOI: 10.1016/j.ygyno.2008.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 01/15/2008] [Accepted: 01/22/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate gene expression patterns in patients with advanced cervix cancer before and during chemoradiation in a multi-institutional cooperative group setting. METHODS RTOG C0128 was designed as a Phase II trial of radiation therapy with concomitant chemotherapy and Celecoxib at 400 mg twice daily for one year. Tumor samples were obtained for microarray gene expression analysis before treatment and at the time of the first implant (paired sample). RNA was extracted, linearly amplified, and purity was assessed by gel electrophoresis. Each sample was hybridized against a universal RNA mixture on a customized spotted array consisting of >10,000 genes. Gene expression pre-treatment was compared with clinical characteristics. Changes in gene expression following radiation were assessed within the paired samples (same patient) and then compared across all paired samples. Data were normalized using the AROMA software, and clustering analysis was performed using Ward's method in Spotfire. Differences in paired samples were calculated with Significance Analysis of Microarrays (SAM). RESULTS From August 2001 to March 2004, 84 patients were accrued to the trial. Tissue was obtained prior to initiation of therapy from 34 patients (40%). FIGO stages of the patients providing tissue were IB (23%), II (57%), and IIIA-IVA (20%). RNA quality was sufficient in 22 pre-treatment and 14 post-treatment samples. Among pre-treatment samples, no significant differences in gene expression were observed by FIGO stage, age, or race. However, between comparison of histologic subtypes (adenocarcinoma, n=5; squamous cell carcinoma, n=17) demonstrated 45 genes differentially expressed with a false discovery rate of 0.018. Cluster analysis segregated unpaired samples into 2 groups: 18/22 comprising pre-treatment samples and 10/14 in group 2 representing post-treatment samples. In all 13 paired samples, gene expression after chemoradiation was significantly upregulated in 91 genes and downregulated in 251 genes (false discovery rate of 0.0018). Genes significantly upregulated included bax, cdk inhibitor 1, MMP2, and adhesion molecules PECAM1, VCAM1, and ICAM2. Genes significantly downregulated included topoisomerase II alpha, myc, H2AX, MSH2, RAD51, RAD53, PCNA, and cell cycle-regulating molecules chk1, CDK2, cyclinB1, cyclin D3, cdc2, and cdc25. CONCLUSIONS Microarray analysis was successfully performed in a multi-institutional cooperative group trial. Gene expression significantly correlated with histology, but not stage, age or race. Cluster analysis identified two groups of gene expression profiles correlating with pre or post-treatment acquisition of tissue. Notably, paired samples showed significant changes in gene expression following chemoradiation, including several downregulated radiation response genes. Further analysis comparing gene expression to clinical outcomes, acute and late toxicities awaits maturation of clinical data. Hopefully, this data will lead to the development of molecularly based therapies.
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Affiliation(s)
- K Zempolich
- University of Utah and Huntsman Cancer Institute, USA
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Abstract
BACKGROUND As the quality of asthma care influences hospital admission rates, we described hospitalizations for asthma and studied trends in admission rates in France from 1998 to 2002. METHODS Using data from the French hospital information system, admissions for asthma were defined by the J45 or J46 codes (ICD-10) as primary diagnosis, and admissions for acute respiratory failure (ARF) associated with asthma by the J96.0 code as primary diagnosis and the J45 or J46 codes as an associated diagnosis. Annual rates of admission adjusted for age and sex were calculated. RESULTS During the study period, the adjusted asthma admission rate decreased by 5% per year (from 10.8/10,000 in 1998 to 8.6/10,000 in 2002). A significant decrease was observed in children aged 10-14 years (-5%/year) and in older people (from -7%/year in 15-19 years old to -9%/year in people aged 50 years or more), whereas no significant decrease was seen in youngest children (-2%/year in children aged 0-1 or 5-9 years, +0.1%/year in those aged 2-4 years). Although not statistically significant, an increase in admission rate for ARF associated with asthma was observed (+5%/year). CONCLUSION Admission rates for asthma decreased between 1998 and 2002 in people aged 10 years and older. However, changes in coding practices or admission policies cannot be excluded and the extent to which the observed trends reflect changes in preventive care among patients with asthma remains to be assessed.
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Affiliation(s)
- L Pascal
- Institut de veille sanitaire, Saint-Maurice, France
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Abstract
Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. An ambassador program and expanded visiting hours turned the waiting room into part of the therapeutic environment. New palliative order sets and practice guidelines were introduced. Interdisciplinary care planning was guided by a family communication record. Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.
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Affiliation(s)
- Daniel Ray
- Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
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Mularski RA, Curtis JR, Billings JA, Burt R, Byock I, Fuhrman C, Mosenthal AC, Medina J, Ray DE, Rubenfeld GD, Schneiderman LJ, Treece PD, Truog RD, Levy MM. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med 2007; 34:S404-11. [PMID: 17057606 DOI: 10.1097/01.ccm.0000242910.00801.53] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [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: 11/26/2022]
Abstract
For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill. We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care. Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and enhancement.
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Affiliation(s)
- Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Herer B, Fuhrman C, Gazevic Z, Cabrit R. 56 Comparaison de deux stratégies de prise en charge des pneumopathies nosocomiales chez le malade non ventilé. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72431-2] [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: 11/30/2022]
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Abstract
BACKGROUND A study was undertaken of deaths with an underlying or associated cause of chronic obstructive pulmonary disease (COPD), and trends in COPD mortality from 1979 to 2002 in France were analysed. METHODS Data were obtained from the Centre of Epidemiology on the Medical Causes of Death (CépiDc) for individuals aged 45 years and over. Owing to implementation of ICD-10 in 2000 for recording causes of death, two separate periods were analysed (1979-99 and 2000-2). RESULTS In 2000-2, COPD was the underlying cause of 1.4% of deaths (deaths from COPD) and was mentioned on the death certificate in 3.0% (deaths with COPD). The other main underlying causes in these cases were cardiovascular diseases (32.0%) and cancers (24.5%). In 1979-99, age standardised rates of death with COPD remained stable in men (-0.01%/year) and increased in women (+1.7%/year). The mean annual rates of death with COPD per 100 000 were 84 for men and 19 for women in 2000-2. CONCLUSION Multiple cause analysis improved the estimate of COPD related mortality. In 1979-99, COPD related mortality rates in France were stable in men but increased in women. Implementation of ICD-10 in 2000 introduced substantial discontinuities in mortality trends.
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Affiliation(s)
- C Fuhrman
- Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
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Zempolich K, Milash B, Fuhrman C, Robert F, Greven K, Ryu J, Forbes A, Kerlin K, Nichols R, Gaffney D. Changes in Gene Expression Induced by Chemoradiation in Advanced Cervical Carcinoma: A Microarray Study of RTOG C-0128. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ray DE, Fuhrman C, Arnold D, Masiado T, Geracci J, Wasser T, Kruklitis R, Deitrick L. CORRELATION OF THE QUALITY OF DYING AND DEATH QUESTIONNAIRE AND THE CRITICAL CARE FAMILY SATISFACTION SURVEY IN A MULTI-SPECIALTY INTENSIVE CARE UNIT. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.186s-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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31
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Gaffney DK, Winter K, Fuhrman C, Flinner R, Greven K, Ryu J, Forbes A, Kerlin K, Nichols RC, Zempolich K. Feasibility of RNA collection for micro-array gene expression analysis in the treatment of cervical carcinoma: a scientific correlate of RTOG C-0128. Gynecol Oncol 2005; 97:607-11. [PMID: 15863167 DOI: 10.1016/j.ygyno.2005.01.014] [Citation(s) in RCA: 7] [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] [Received: 12/02/2004] [Revised: 01/08/2005] [Accepted: 01/11/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the feasibility of RNA collection in a multi-institutional cooperative group setting to be utilized for micro-array gene expression analysis, and to describe the methodology. METHODS RTOG C0128, a phase I-II, protocol was designed to look at the safety and efficacy of external beam radiation therapy to 45 Gy with concomitant 5-FU and cisplatin chemotherapy, brachytherapy to deliver 85 Gy to point A, and Celecoxib at 400 mg twice daily for 1 year. Patients had the option of participating in a tissue collection portion of the protocol to be utilized for micro-array gene expression analysis before treatment and at the time of the first implant. RNA quality was determined by two parameters: the absorbance ratio at 260 nm/280 nm, and by the ratio of the integrated peak of 28S RNA to 18S RNA after gel electrophoresis. RESULTS From August 2001 to March 2004, 84 patients were accrued to the trial, and tissue was obtained prior to initiation of therapy on 34 patients (40%). FIGO stages for the patients who provided tissue were IB (23%), II (57%), and IIIA-IVA (20%). Additionally, biopsies were obtained at the time of the first implant from 22 of the accrued patients making paired samples available on 26% for RNA extraction and micro-array gene expression analysis. The mean +/- SEM amount of tissue obtained pretreatment was 97 +/- 13 mg compared with 51 +/- 8 mg for tissue obtained at the time of the first implant (P = 0.009). The mean total RNA extracted from the samples prior to treatment was 119 +/- 19 microg versus 35 +/- 6 microg at the time of the first procedure (P = 0.001). The RNA quality was assessed via the absorbance ratio at 260 nm divided by 280 nm. The mean values pretreatment and at first implant were 1.87 +/- 0.07 versus 1.66 +/- 0.11, respectively (P = 0.002); however, the integrated peak of 28S RNA to 18S RNA after gel electrophoresis was not significantly different (P = 0.26). CONCLUSIONS RNA extraction for gene expression analysis can be successfully performed in the multi-institutional cooperative group setting. Fresh tissue samples were obtained on 40% of accrued patients prior to treatment. The amount of biopsy material and the quantity of RNA extracted were greater prior to treatment compared with the first implant. The quality of RNA was superior prior to treatment as measured by the ratio of absorbance at 260/280 nm. These results indicate that gene expression analysis is feasible in the cooperative group setting utilizing amplification techniques for the RNA. Hopefully, this will allow for improvement in prognosis, therapeutic development, and correlation with acute and late toxicities in patients with cancer.
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Affiliation(s)
- D K Gaffney
- University of Utah and Huntsman Cancer Institute, Salt Lake City, UT 84108, USA.
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Belani C, Fuhrman C, Wilson D, Fisher S, Sciurba F, Luketich J, Weissfeld J, Siegfried J. P-238 Two-year outcomes from lung cancer screening with low-dose helical computed tomography. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80732-9] [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: 11/28/2022]
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33
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Abstract
The intensive care unit (ICU) waiting room is a dynamic place that influences the satisfaction of families of critically ill patients. Waiting-room comfort and amenities are important, because families often spend a great deal of nonvisiting time there. A quality improvement evaluation of the ICU waiting room at Lehigh Valley Hospital, Allentown, PA, was conducted. Methods included distribution of an 18-item family survey, ethnographic observations, interviews, and assessment of the physical environment. Findings suggest that the role of the receptionist and access to food and other services were important to families and influenced their assessment of the quality of services provided by the ICU.
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Fuhrman C, Chouaid C, Herigault R, Housset B, Adnot S. Comparison of four demand oxygen delivery systems at rest and during exercise for chronic obstructive pulmonary disease. Respir Med 2004; 98:938-44. [PMID: 15481269 DOI: 10.1016/j.rmed.2004.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to assess the performance of four demand oxygen delivery systems (DODS) in improving oxygenation and effort tolerance, at rest and during exercise, in chronic obstructive pulmonary disease (COPD) patients. MATERIALS AND METHODS Thirteen COPD patients were prospectively included. Four DODS (Oxiclip, Versatile, Venture and Impulse) were compared with continuous-flow oxygen (CFO). Nine of these patients performed 6-min walking tests on room air and on 3 l/min oxygen by DODS and CFO; Oxygen saturation, walking distance and the Borg dyspnea score were recorded. RESULTS With all four DODS devices arterial oxygenation was improved with lower oxygen flow rates than with CFO. Oxygen economy was best with Impulse, but at a cost of less satisfactory oxygenation. Exercise desaturation was similar with CFO, Oxiclip, Venture, and Impulse but significantly higher with Versatile (P < 0.05). Borg dyspnea scores were similar with CFO, Oxiclip, Venture, and Versatile but worse with Impulse (P < 0.05). There was no significant difference in walking distances. CONCLUSIONS All four DODS improved oxygen saturation and saved oxygen. However, performance was better with the two devices (Oxiclip and Venture) that deliver a bolus of oxygen at inspiration onset.
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Affiliation(s)
- C Fuhrman
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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35
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Fuhrman C, Veziris N, Herer B, Bonnaud F. [What attitude to adopt before the sequellae of tuberculosis are evident on chest x-ray? Risk of progression and role of chemoprophylaxis before the images of inactive tuberculosis depending on prior treatment and course]. Rev Mal Respir 2004; 21:S65-73. [PMID: 15344273 DOI: 10.1016/s0761-8425(04)71389-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- C Fuhrman
- Service de pneumologie, Centre Hospitalier Intercommunal de Créteil, France
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Gaffney D, Winter K, Fuhrman C, Flinner R, Greven K, Ryu J, Forbes A, Kerlin K, Nichols R, Karen Z. Feasibility of rna collection for micro-array gene expression analysis in the treatment of cervical carcinoma: A scientific correlate of RTOG c-0128. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.402] [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: 11/24/2022]
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37
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Beigelman C, Fuhrman C, Veziris N, Herer B, Bonnaud F. Quelles attitudes adopter devant des séquelles de tuberculose mises en évidence sur une radiographie thoracique ? Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71387-x] [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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Affiliation(s)
- C Fuhrman
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, France
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39
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Atassi K, Mangiapan G, Fuhrman C, Lasry S, Onody P, Housset B. 255 Intérêt du mélange équimolaire protoxyde d’azote/oxygène 50 %-50 % au cours de l’endoscopie bronchique chez l’adulte. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71881-1] [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: 11/26/2022]
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Zahreddine I, Atassi K, Fuhrman C, Febvre M, Maitre B, Housset B. [Impact of prior biological assessment of coagulation on the hemorrhagic risk of fiberoptic bronchoscopy]. Rev Mal Respir 2003; 20:341-6. [PMID: 12910108] [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] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION The goals of the study were to test the value of coagulation tests to predict bleeding events during fiberoptic bronchoscopy (FOB) and to identify risk factors. METHODS A monocentric prospective study of 426 procedures performed by one physician was realized. A standardized questionnaire and coagulation tests including prothrombine time, activated cephaline time and platelets counts were performed before the procedure. Bleeding events, defined by a loss of more than 50 ml of blood, were recorded for all patients. RESULTS 44 patients (10.3%) had bleeding events, modifying the procedure in 19 cases. No death occurred following FOB during the study. Among the 17 patients with abnormalities on coagulation test before FOB, only one had significant bleeding. Two risk factors were found as predictors of bleeding events: nose or gum bleeding (OR=4.99, CI (95%) [2.6-9.5]; p<0.001) and left cardiac failure (OR=4.53, CI (95%) [1.7-12.1]; p<0.01). CONCLUSION This study shows that abnormalities on coagulation tests are not predictive for bleeding events. Nose or gum bleeding and left cardiac failure may be risk factors for bleeding events during FOB.
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Affiliation(s)
- I Zahreddine
- Service de Pneumologie, Hôpital intercommunal de Créteil, Université Paris XII
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41
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Housset B, Fuhrman C. Les enjeux du traitement de la tuberculose. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00065-9] [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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42
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Fuhrman C, Nutt M, Vichtovonga K, Coleman MR. Effect of thermal hysteresis on the gas permeation properties of 6FDA-based polyimides. J Appl Polym Sci 2003. [DOI: 10.1002/app.13189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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43
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Fuhrman C, Parrot A, Wislez M, Prigent H, Boussaud V, Bernaudin JF, Mayaud C, Cadranel J. Spectrum of CD4 to CD8 T-cell ratios in lymphocytic alveolitis associated with methotrexate-induced pneumonitis. Am J Respir Crit Care Med 2001; 164:1186-91. [PMID: 11673207 DOI: 10.1164/ajrccm.164.7.2010120] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 11/16/2022] Open
Abstract
The present study was conducted to confirm the presence of severe lymphocytic alveolitis and to determine the factors responsible for the very different alveolar CD4 to CD8 T-cell ratios (CD4/ CD8) described in methotrexate-induced pneumonitis (MTX-pneumonitis). Clinical and radiologic findings, as well as bronchoalveolar lavage (BAL) data, including CD4 and CD8 subset analysis, were retrospectively reviewed for patients hospitalized between 1985 and 2000 for MTX-pneumonitis. BAL cell counts from patients with MTX-pneumonitis (cases) were compared with those from patients receiving MTX but who did not have evidence of MTX toxicity (MTX-exposed patients) and those from healthy subjects (control subjects). Nineteen BAL were performed in 14 consecutive cases of MTX-pneumonitis. MTX was given for various underlying diseases. All cases presented a subacute diffuse interstitial pneumonitis that recovered, with MTX discontinuation and/or initiation of adjunctive steroid therapy. At the time of diagnosis, BAL cell counts in MTX-pneumonitis indicated severe lymphocytic alveolitis when compared with MTX-exposed patients and control subjects and moderate neutrophil alveolitis compared with control subjects. The lymphocytic alveolitis resulted from an increase in both CD4 and CD8 lymphocyte cell counts. Nevertheless, alveolar CD4/ CD8 T-cell ratios ranged from 0.4 to 9.6. CD4/CD8 values correlated positively with lymphocyte counts but negatively with time elapsed between last MTX administration and BAL and with steroid cumulative dose received by the patients. Severe lymphocytic alveolitis was confirmed in our series of MTX-pneumonitis. The between-patient variation in CD4/CD8 T-cell ratios may reflect the large range of time intervals between last MTX administration and BAL evaluation and the use of adjunctive steroid therapy.
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Affiliation(s)
- C Fuhrman
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon, AP-HP, Paris, France
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Delacourt C, Lorino H, Fuhrman C, Herve-Guillot M, Reinert P, Harf A, Housset B. Comparison of the forced oscillation technique and the interrupter technique for assessing airway obstruction and its reversibility in children. Am J Respir Crit Care Med 2001; 164:965-72. [PMID: 11587980 DOI: 10.1164/ajrccm.164.6.2010153] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [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: 11/16/2022] Open
Abstract
The forced oscillation technique (FOT) and interrupter technique are particularly attractive for pediatric use as they require only passive cooperation from the patient. We compared the sensitivity and specificity of these methods for detecting airway obstruction and its reversibility in 118 children (3-16 yr) with asthma or chronic nocturnal cough. FOT (R(0) and R(16)) and interruption (Rint) parameters were measured at baseline and after bronchodilator inhalation (n = 94). Rint was significantly lower than R(0), especially in children with high baseline values. Baseline parameters were normalized for height and weight [R(SD)]. In children able to perform forced expiratory maneuvers (n = 93), the best discrimination between those with baseline FEV(1) < 80% or > or = 80% of predicted values was obtained with R(0)(SD). At a specificity of 80%, R(0)(SD) yielded 66% sensitivity, whereas Rint(SD) yielded only 33% sensitivity. Similarly, postbronchodilator changes in R(0)(SD) [DeltaR(0)(SD)] yielded the best discrimination between children with and without significant reversibility in FEV(1). At a specificity of 80%, DeltaR(0)(SD) yielded 67% sensitivity and DeltaRint(SD) yielded 58% sensitivity. In children unable to perform forced expiratory maneuvers (n = 25), FOT, contrary to the interrupter technique, clearly identified a subgroup of young children with high resistance values at baseline, which returned to normal after bronchodilation. We conclude that, in asthmatic children over 3 yr old, FOT measurements provide a more reliable evaluation of bronchial obstruction and its reversibility compared with the interrupter technique, especially in young children with high baseline values.
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Affiliation(s)
- C Delacourt
- Service de Pédiatrie and Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France.
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Herer B, Fuhrman C, Demontrond D, Gazevic Z, Housset B, Chouaïd C. Diagnosis of nosocomial pneumonia in medical ward: repeatability of the protected specimen brush. Eur Respir J 2001; 18:157-63. [PMID: 11510788 DOI: 10.1183/09031936.01.99097901] [Citation(s) in RCA: 9] [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: 11/05/2022]
Abstract
The aims of this study were to assess the repeatability of two pairs of protected specimen brushes (PSB) done successively in the same lung area and either processed at the bedside or in the laboratory, and to provide a description of the bacteriological findings in 39 cases of suspected nosocomial pneumonia occurring in nonventilated patients. Four PSB were divided into two pairs. One pair of brushes (PB) was prepared at bedside and then sent to the laboratory; the other pair (PL) was immediately sent to the laboratory for complete processing. According to a 10(3) colony forming units (cfu) x mL(-1) threshold, 49% out of 156 PSB were positive. Using the 10(3) cfu x mL threshold, the PL brushes were 89.7% concordant while the PB brushes were 76.9% concordant. The repeatability as expressed by K-value of the cultures of PSB was higher for PL brushes than for PB brushes (K-values of 0.795 and 0.537 respectively, p=0.12). Bacterial species were isolated in 58.3% of 156 PSB (176 isolates). In 14 cases, cultures of PSB disclosed more than one micro-organism in a concentration > 10(3) cfu x mL(-1). The most frequently isolated organisms were Pseudomonas spp. (23.9%), Enterobacteriaceae (23.3%), Streptococcus spp. (21.6%) and Staphylococcus spp. (13.1%). Polymicrobial cultures were more frequent if the patient had a tracheostomy (seven out of the nine patients with a tracheostomy versus seven out of the 30 patients without a tracheostomy, p<0.01). Bacteriological discrepancies leading to a potential troublesome choice in antibiotherapy were observed in 31.8% of the patients for PL brushes and 56.5% of the patients for PB brushes. There is a low degree of repeatability of protected specimen brushes outside intensive care units which seem dependent on sampling processing. The distribution of pathogens found in case of suspicion of nosocomial pneumonia in nonventilated patients appears to be similar to that obtained in ventilator-associated pneumonia.
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Affiliation(s)
- B Herer
- Centre Médical de Forcilles, Férolles-Attilly, France
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Lavole A, Abd Alsamad I, Mangiapan G, Bassinet L, Monnet I, Housset B, Fuhrman C. [Primary pleural lymphoma: a rare complication of tuberculosis pleural sequelae]. Rev Mal Respir 2001; 18:72-4. [PMID: 14639182] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We report two cases of malignant lymphoma of B phenotype occurring after therapeutic pneumothorax for tuberculosis. In both cases, outcome was fatal without time for specific treatment. Mainly reported in Japan, this pathology seems to be less frequent in western countries. As for B phenotype lymphoma associated with immunodeficiency, association with Epstein Barr virus is reported. Definite diagnosis is difficult and requires surgical biopsy. Prognosis remains poor with a survival ranging from 3 to 6 month.
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MESH Headings
- Aged
- Aged, 80 and over
- Biopsy
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/pathology
- Fatal Outcome
- Female
- Humans
- Lung/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasm Invasiveness/pathology
- Pleura/pathology
- Pleural Neoplasms/diagnosis
- Pleural Neoplasms/pathology
- Pneumothorax, Artificial
- Tuberculosis, Pleural/complications
- Tuberculosis, Pleural/pathology
- Tuberculosis, Pleural/therapy
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Affiliation(s)
- A Lavole
- Service de pneumologie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94010 Créteil Cedex
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Legrand Cattan K, Chouaïd C, Monnet I, Atassi K, Bassinet L, Dhissi G, Fuhrman C, Lebargy F, L'Huillier JP, Maitre B, Mangiapan G, Roos F, Bignon J, Housset B, Pairon JC. [Evaluation of occupational exposures in lung cancer]. Rev Mal Respir 2000; 17:957-62. [PMID: 11131874] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Occupational lung cancers are underestimated by the number of cases compensated in the French National Insurance System. Rules of compensation of occupational diseases were recently modified in France. Therefore a study was conducted on incident cases of lung cancer in a general hospital in the Paris area. The aim was to evaluate the exposure to carcinogens using data of a detailed specific occupational questionnaire, and to determine the number of cases who could receive compensation. Two hundred and seven subjects (171 males, 36 females, mean age = 64.5 years) were eligible in 1996, and 122 had an occupational questionnaire. Definite exposure to one or more occupational carcinogens in at least one job was identified in 50 subjects, the most frequent agent was asbestos (42 subjects). Claim for compensation was done in 32 subjects, mainly for asbestos (30 subjects). This study emphasizes the frequency of occupational exposure to carcinogens, and the usefulness of systematic occupational questionnaire in subjects having lung cancer. Social and financial consequences are important for these subjects. Further studies are needed, with recruitement of control subjects to allow calculation of the attributable risk to occupational factors in lung cancer.
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Affiliation(s)
- K Legrand Cattan
- Service de Pneumologie et Pathologie Professionnelle, Centre Hospitalier Intercommunal, 40, avenue de Verdun, 94000 Créteil
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Fuhrman C, Duche JC, Chouaid C, Abd Alsamad I, Atassi K, Monnet I, Tillement JP, Housset B. Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies. Clin Biochem 2000; 33:405-10. [PMID: 11018693 DOI: 10.1016/s0009-9120(00)00157-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/18/2022]
Abstract
STUDY OBJECTIVE The aim of the study was to assess diagnosis value of tumor markers for differential diagnosis between mesothelioma and other pleural tumors. DESIGN AND METHODS Prospective study of 85 patients attending our hospital with malignant pleural effusion. The diagnostic approach involved routine pleurocentesis followed by pleural needle. When precise diagnosis was not achieved, thoracoscopy with pleural biopsies was performed. Carcinoembryonic antigen (CEA), hyaluronic acid, tissue polypeptide antigen and cyfra 21 to 1 were measured in serum and pleural fluid. RESULTS By using receiver operating characteristics curves and area under curves, the best diagnostic characteristics were obtained with pleural and serum CEA concentrations. The area under the curve was larger for pleural ACE than for serum ACE. The sensitivity and specificity of a pleural CEA level exceeding 3 ng/mL for ruling out the diagnosis of mesothelioma were 100% and 77%, respectively. CONCLUSION A CEA level above 3 ng/mL in pleural fluid eliminated the diagnosis of mesothelioma, whereas the other markers were not sufficiently discriminant. However, despite a negative predictive value of 100% at a cutoff of 3 ng/mL, CEA assay in pleural fluid only avoids a small number of diagnostic thoracoscopies.
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Affiliation(s)
- C Fuhrman
- Service de Pneumologie, Hôpital Intercommunal de Créteil, Créteil, France.
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Iglesias E, Fuhrman C, Chouaid C, Monnet I, Hagege H, Housset B. [Unusual cause of severe alveolar hypoventilation]. Rev Mal Respir 2000; 17:119-20. [PMID: 10756566] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Mesenteric panniculitis is a rare disease of the adipose tissue of mesentery. Ascites is an unusual presentation. We report a case of panniculitis whose initial presentation was an obesity-hypoventilation syndrome with pulmonary hypertension. Respiratory disorders were related to abundant ascites. Panniculitis cure and ascites disappearance allowed return to normal pulmonary function and pulmonary artery pressure.
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Affiliation(s)
- E Iglesias
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil
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50
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Abstract
Antiarrhythmic agents can cause pneumonitis. Flecainide is a rare cause of hypersensitivity pneumonitis, and few cases have been reported. We describe a case of interstitial hypoxaemiant pneumonitis probably related to flecainide in a patient with the LEOPARD syndrome, a rare congenital disorder.
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Affiliation(s)
- A Robain
- Department of Pulmonary Disease, Hôpital Intercommunal de Creteil, France
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