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Piloquet H, Vrignaud B, Gillaizeau F, Capronnier O, Berding K, Günther J, Hecht C, Regimbart C. Efficacy and safety of a synbiotic infant formula for the prevention of respiratory and gastrointestinal infections: a randomized controlled trial. Am J Clin Nutr 2024; 119:1259-1269. [PMID: 38462218 DOI: 10.1016/j.ajcnut.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Early life nutrition is crucial for the development of the gut microbiota that, in turn, plays an essential role in the maturation of the immune system and the prevention of infections. OBJECTIVES The aim of this study was to investigate whether feeding synbiotic infants and follow-on formulas during the first year of life reduces the incidence rate (IR) of infectious diarrhea compared with standard formulas. Secondary endpoints included the IR of other infectious diseases as well as fecal milieu parameters. METHODS In this double-blind, controlled trial, 460 healthy, 1-mo-old infants were randomly assigned to receive a synbiotic [galacto-oligosaccharides (GOS)/Limosilactobacillus fermentum CECT 5716] (IF, n = 230) or a control formula (CF, n = 230) until 12 mo of age. A reference group of breastfed infants (HM, n = 80) was included. Data on infections were recorded throughout the study period and stool samples were collected at 4 and 12 mo of age. RESULTS IR of infectious diarrhea during the first year of life was 0.60 (CF), 0.56 (IF), and 0.29 (HM), with no statistically significant difference between groups. The IR of lower respiratory tract infections, 1 of the secondary endpoints, however, was lower in IF than in CF [0.79 compared with 1.01, IR ratio = 0.77 (0.60-1.00)]. Additionally, fecal pH was significantly lower at 4 mo (P < 0.0001), whereas secretory IgA was significantly higher at 12 mo of age (P = 0.015) in IF compared with CF. CONCLUSIONS Although no difference is observed in the incidence of diarrhea, consumption of a synbiotic formula containing L. fermentum CECT5716 and GOS in infancy may reduce the incidence of lower respiratory tract infections and affect the immune system and fecal milieu. Additional research is warranted to further investigate the potential interaction of the gut-lung axis. This trial was registered at clinicaltrials.gov as NCT02221687.
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Affiliation(s)
- Hugues Piloquet
- Department of Pediatric Chronic Diseases, University Hospital of Nantes, Nantes, France.
| | - Bénédicte Vrignaud
- Department of Pediatric Chronic Diseases, University Hospital of Nantes, Nantes, France
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2
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Aurousseau A, Moyon L, Gillaizeau F, Douillard B. Visualisation interactive des profils individuels de sujets pour faciliter la revue des données dans le cadre des études cliniques : un outil développé en R Markdown. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.063] [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: 11/16/2022] Open
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3
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Gydé E, Heym B, Gillaizeau F, Marmor S, Boisrenoult P, Amara M. Microbiological Diagnosis of Osteoarticular Infections: Comparison between BacT/Alert Bottles and Schaedler Broth. Microbiol Spectr 2022; 10:e0049822. [PMID: 35412357 PMCID: PMC9045078 DOI: 10.1128/spectrum.00498-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Microbiological diagnosis of osteoarticular infections (OAIs) is based on culture on several media. Experts recommend the use of liquid media, such as Schaedler broth, but many laboratories use blood culture media with automated detection instead for convenience. We aimed to evaluate the performance of culturing in BacT/Alert (bioMérieux) bottles for the microbiological diagnosis of OAI versus culturing in Schaedler broth. This prospective study was conducted on all osteoarticular specimens sent to the microbiology laboratories of the Versailles and Diaconesses Croix Saint-Simon hospitals between October 2016 and February 2017. Each sample was inoculated onto solid agar, into BacT/Alert bottles incubated for 14 days, and into a Schaedler broth incubated for 14 days with daily reading. The gold standard was defined as follow: OAI was diagnosed for a patient if at least two samples were positive for a nonskin microorganism and at least three for a cutaneous species. The times to detection were compared. A total of 1,616 specimens from 349 patients were collected. BacT/Alert bottles were significantly more sensitive than the Schaedler process for OAI diagnosis (114/135 OAI detected by BacT/Alert bottles; 91/135 OAI detected by Schaedler broth; +17.0% [95% confidence interval {CI}, 6.8%, 27.3%]; P = 0.0004). The time to detection was significantly shorter using BacT/Alert bottles (2.0 ± 2.2 days) than using Schaedler broth (4.6 ± 3.6 days, P < 0.0001). The culture of osteoarticular specimens in BacT/Alert bottles allows bacterial enrichment with an automated detection of positivity. Their use decreased detection time and increased sensitivity, making it a useful tool for the diagnosis of OAI that should be included among the recommended media. IMPORTANCE Microbiological diagnosis of OAI is based on culture on several media. French experts recommend the use of liquid media such as Schaedler broth, but many laboratories use blood culture media with automated detection in substitution because it is more convenient. We report here a prospective multicentric study evaluating the performance of culture in BacT/Alert (bioMérieux) bottles for microbiological diagnosis of OAI in comparison with culture in Schaedler broth. A total of 1,616 osteoarticular specimens from 349 patients were collected and inoculated onto agar, into BacT/Alert aerobic and anaerobic bottles, and into a Schaedler broth. BacT/Alert bottles were significantly more sensitive than the Schaedler process for OAI diagnosis (+17.0% [95% CI, 6.8%, 27.3%], P = 0.0004). The time to detection was significantly shorter for the BacT/Alert bottles (2.0 ± 2.2 days) than for Schaedler broth (4.6 ± 3.6 days, P < 0.0001). This study suggests that the use of BacT/Alert bottles should be recommended in microbiological diagnosis of OAI.
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Affiliation(s)
- Esther Gydé
- Centre Hospitalier de Versailles, Service de Biologie, Unité de Microbiologie, Le Chesnay, France
- Centre Hospitalier François Quesnay, Service de Biologie, Mantes La Jolie, France
| | - Béate Heym
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Laboratoire des Centres de Santé et d’Hôpitaux d’Ile de France, Unité de Microbiologie, Paris, France
| | | | - Simon Marmor
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Service d’Orthopédie, Paris, France
| | - Philippe Boisrenoult
- Centre Hospitalier de Versailles, Service d’Orthopédie, Unité Dominique Larrey, Le Chesnay, France
| | - Marlène Amara
- Centre Hospitalier de Versailles, Service de Biologie, Unité de Microbiologie, Le Chesnay, France
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4
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Gillaizeau F, Cambier S, Fournier M, Leuillet S. Prise en compte des événements récurrents dans le cadre des essais cliniques. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.103] [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: 11/27/2022] Open
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5
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Gillaizeau F, Le Gal C, Maudet C, Fournier M, Leuillet S. Méthodes de gestion des valeurs sous des seuils de détection ou de quantification. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.076] [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] Open
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6
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Chatton A, Le Borgne F, Leyrat C, Gillaizeau F, Rousseau C, Barbin L, Laplaud D, Léger M, Giraudeau B, Foucher Y. G-computation, propensity score-based methods, and targeted maximum likelihood estimator for causal inference with different covariates sets: a comparative simulation study. Sci Rep 2020; 10:9219. [PMID: 32514028 PMCID: PMC7280276 DOI: 10.1038/s41598-020-65917-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/26/2020] [Indexed: 12/25/2022] Open
Abstract
Controlling for confounding bias is crucial in causal inference. Distinct methods are currently employed to mitigate the effects of confounding bias. Each requires the introduction of a set of covariates, which remains difficult to choose, especially regarding the different methods. We conduct a simulation study to compare the relative performance results obtained by using four different sets of covariates (those causing the outcome, those causing the treatment allocation, those causing both the outcome and the treatment allocation, and all the covariates) and four methods: g-computation, inverse probability of treatment weighting, full matching and targeted maximum likelihood estimator. Our simulations are in the context of a binary treatment, a binary outcome and baseline confounders. The simulations suggest that considering all the covariates causing the outcome led to the lowest bias and variance, particularly for g-computation. The consideration of all the covariates did not decrease the bias but significantly reduced the power. We apply these methods to two real-world examples that have clinical relevance, thereby illustrating the real-world importance of using these methods. We propose an R package RISCA to encourage the use of g-computation in causal inference.
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Affiliation(s)
- Arthur Chatton
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- A2COM-IDBC, Pacé, France
| | - Florent Le Borgne
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- A2COM-IDBC, Pacé, France
| | - Clémence Leyrat
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- Department of Medical Statistics & Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Florence Gillaizeau
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Chloé Rousseau
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- INSERM CIC1414, CHU Rennes, Rennes, France
| | | | - David Laplaud
- Centre Hospitalier Universitaire de Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie INSERM UMR1064, Université de Nantes, Nantes, France
| | - Maxime Léger
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Bruno Giraudeau
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Université de Nantes, Université de Tours, Nantes, France.
- Centre Hospitalier Universitaire de Nantes, Nantes, France.
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7
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Pensec C, Gillaizeau F, Guenot D, Bessard A, Carton T, Leuillet S, Campone M, Neunlist M, Blottière HM, Le Vacon F. Impact of pemetrexed chemotherapy on the gut microbiota and intestinal inflammation of patient-lung-derived tumor xenograft (PDX) mouse models. Sci Rep 2020; 10:9094. [PMID: 32499509 PMCID: PMC7272463 DOI: 10.1038/s41598-020-65792-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy remains the gold standard for advanced cancer. Pemetrexed, a chemotherapeutic agent used in non-small cell lung cancer, can induce significant side effects in patients. Although microbiota’s role in the efficacy and/or toxicity of chemotherapy agents has been demonstrated, the impacts of pemetrexed on the gut microbiota and on gastrointestinal inflammation remain unknown. The objective of this study was to evaluate the impact of pemetrexed and the tumor graft on the gut microbiota composition in immunodeficient mice. The faecal microbiota composition was studied with metabarcoding before, 24-h and one week after treatment. The colon epithelial barrier integrity was evaluated by histological examination, intestinal permeability measurement, and selected cytokines quantification. The tumor graft induced some variations in the microbiota composition. Pemetrexed further increased the relative abundance of Enterobacteriaceae and 3 families from the Firmicutes phylum: Enterococcaceae, Lactobacillaceae and Streptococcaceae. Pemetrexed also significantly altered the epithelial barrier integrity, which was associated with early inflammation. This pilot study shows that the association of a lung tumor graft with pemetrexed causes an alteration in the microbiota composition. Such information increases our knowledge about the impact of chemotherapy on the microbiota, which could help to minimize side effects and improve therapeutic effectiveness in the future.
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Affiliation(s)
- Cindy Pensec
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | | | - Dominique Guenot
- IMODI Consortium:.,Université de Strasbourg (Unistra), EA 3430, U1113 IRFAC, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67200, Strasbourg, France
| | - Anne Bessard
- TENS, INSERM U1235, Institut des Maladies de l'Appareil Digestif du CHU de Nantes, Université de Nantes, 44035 Nantes, France
| | - Thomas Carton
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | - Sébastien Leuillet
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | | | - Michel Neunlist
- TENS, INSERM U1235, Institut des Maladies de l'Appareil Digestif du CHU de Nantes, Université de Nantes, 44035 Nantes, France
| | - Hervé M Blottière
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350, Jouy-en-Josas, France.,MetaGenoPolis, INRA, Université Paris-Saclay, 78350, Jouy-en-Josas, France
| | - Françoise Le Vacon
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France. .,IMODI Consortium:, .
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8
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Sénage T, Gillaizeau F, Le Tourneau T, Marie B, Roussel JC, Foucher Y. Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication. J Thorac Cardiovasc Surg 2018; 157:1383-1390.e5. [PMID: 30415900 DOI: 10.1016/j.jtcvs.2018.08.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/14/2017] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Structural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue. METHODS Five hundred sixty-one patients who underwent aortic valve replacement with the aortic Mitroflow valve between 2002 and 2007 were included. We used an illness-death model for interval-censored data. Median follow-up was 6.6 years; 103 cases of SVD were diagnosed. RESULTS The 4-year and 7-year SVD cumulative incidences after the first anniversary of surgery were 15.2% (95% confidence interval, 11.9-19.1) and 31.0% (95% confidence interval, 25.8-37.2), respectively. Female gender, dyslipidemia, chronic obstructive pulmonary disease, and severe patient-prosthesis mismatch were significant risk factors of SVD. The occurrence of SVD was associated with a 2-fold increase in the risk of death. CONCLUSIONS Appropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival.
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Affiliation(s)
- Thomas Sénage
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France.
| | - Florence Gillaizeau
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France; Department of Statistical Science for University College London, London, United Kingdom
| | - Thierry Le Tourneau
- Department of Physiology, Thorax Institute, St Herblain, France; National Center for Scientific Research (CNRS) UMR 6291, for University of Nantes, St Herblain, France
| | - Basile Marie
- Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France
| | | | - Yohann Foucher
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France
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9
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Aurousseau A, Gillaizeau F, Maudet C, Vaissié P, Leuillet S. Tests multiples corrélés et contrôle du « Family-Wise Error Rate » (FWER) dans une application R Shiny interactive. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.296] [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: 10/17/2022] Open
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10
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Gillaizeau F, Sénage T, Le Borgne F, Le Tourneau T, Roussel JC, Leffondrè K, Porcher R, Giraudeau B, Dantan E, Foucher Y. Inverse probability weighting to control confounding in an illness-death model for interval-censored data. Stat Med 2017; 37:1245-1258. [PMID: 29205409 DOI: 10.1002/sim.7550] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/19/2017] [Accepted: 10/09/2017] [Indexed: 11/12/2022]
Abstract
Multistate models with interval-censored data, such as the illness-death model, are still not used to any considerable extent in medical research regardless of the significant literature demonstrating their advantages compared to usual survival models. Possible explanations are their uncommon availability in classical statistical software or, when they are available, by the limitations related to multivariable modelling to take confounding into consideration. In this paper, we propose a strategy based on propensity scores that allows population causal effects to be estimated: the inverse probability weighting in the illness semi-Markov model with interval-censored data. Using simulated data, we validated the performances of the proposed approach. We also illustrated the usefulness of the method by an application aiming to evaluate the relationship between the inadequate size of an aortic bioprosthesis and its degeneration or/and patient death. We have updated the R package multistate to facilitate the future use of this method.
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Affiliation(s)
- Florence Gillaizeau
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,INSERM CR1064, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Statistical Science, University College London, London, U.K
| | - Thomas Sénage
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Thoracic and CardioVascular Surgery, Nantes Hospital University, France
| | - Florent Le Borgne
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,A2COM-IDBC, Nantes, France
| | - Thierry Le Tourneau
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,INSERM UMR1087, CNRS UMR 6291, l'Institut du Thorax, Nantes University, France
| | - Jean-Christian Roussel
- Centre Hospitalier Universitaire de Nantes, Nantes, France.,Department of Thoracic and CardioVascular Surgery, Nantes Hospital University, France
| | - Karen Leffondrè
- ISPED, Centre INSERM U897 Epidemiology and Biostatistics, University of Bordeaux, Bordeaux, France
| | - Raphaël Porcher
- METHODS Team, INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Bruno Giraudeau
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,INSERM CIC1415, CHRU de Tours, Tours, France
| | - Etienne Dantan
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France
| | - Yohann Foucher
- SPHERE, INSERM UMR 1246, Nantes University, Tours University, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France
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11
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Guérin L, Couturaud F, Parent F, Revel MP, Gillaizeau F, Planquette B, Pontal D, Guégan M, Simonneau G, Meyer G, Sanchez O. Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Thromb Haemost 2017; 112:598-605. [DOI: 10.1160/th13-07-0538] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
SummaryChronic thromboembolic pulmonary hypertension (CTEPH) has been estimated to occur in 0.1–0.5% of patients who survive a pulmonary embolism (PE), but more recent prospective studies suggest that its incidence may be much higher. The absence of initial haemodynamic evaluation at the time of PE should explain this discrepancy. We performed a prospective multicentre study including patients with PE in order to assess the prevalence and to describe risk factors of CTEPH. Follow-up every year included an evaluation of dyspnea and echocardiography using a predefined algorithm. In case of suspected CTEPH, the diagnosis was confirmed using right heart catheterisation (RHC). Signs of CTEPH were searched on the multidetector computed tomography (CT) and echocardiography performed at the time of PE. Of the 146 patients analysed, eight patients (5.4%) had suspected CTEPH during a median follow-up of 26 months. CTEPH was confirmed using RHC in seven cases (4.8%; 95%CI, 2.3 – 9.6) and ruled-out in one. Patients with CTEPH were older, had more frequently previous venous thromboembolic events and more proximal PE than those without CTEPH. At the time of PE diagnosis, patients with CTEPH had a higher systolic pulmonary artery pressure and at least two signs of CTEPH on the initial CT. After acute PE, the prevalence of CTEPH appears high. However, initial echocardiography and CT data at the time of the index PE suggest that a majority of patients with CTEPH had previously unknown pulmonary hypertension, indicating that a first clinical presentation of CTEPH may mimic acute PE.
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12
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Deltombe C, Gillaizeau F, Anglicheau D, Morelon E, Trébern-Launay K, Le Borgne F, Rimbert M, Guérif P, Malard-Castagnet S, Foucher Y, Giral M. Is pre-transplant sensitization against angiotensin II type 1 receptor still a risk factor of graft and patient outcome in kidney transplantation in the anti-HLA Luminex era? A retrospective study. Transpl Int 2017; 30:1150-1160. [DOI: 10.1111/tri.13009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/08/2016] [Accepted: 07/04/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Clement Deltombe
- Institute for Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
| | - Florence Gillaizeau
- Institute for Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- Inserm U1064; Nantes University Hospital; Nantes France
- EA 4275 SPHERE; Nantes University; Nantes France
- LabEx Transplantex; Nantes France
| | - Daniel Anglicheau
- LabEx Transplantex; Nantes France
- Thematic Research and Care Network RTRS “Centaure”; Université de Strasbourg; Strasbourg France
- Department of Kidney Transplantation; Necker University Hospital; AP-HP; Paris France
| | - Emmanuel Morelon
- Thematic Research and Care Network RTRS “Centaure”; Université de Strasbourg; Strasbourg France
- Department of Transplantation and Clinical Immunology; Hospices Civils de Lyon; Hopital Edouard Herriot; Lyon France
| | - Katy Trébern-Launay
- Institute for Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- Inserm U1064; Nantes University Hospital; Nantes France
- Thematic Research and Care Network RTRS “Centaure”; Université de Strasbourg; Strasbourg France
| | | | - Marie Rimbert
- Plateforme CIMNA; CHU Nantes; Nantes France
- Biotherapy Clinical Investigation; Center Nantes University Hospital; Nantes France
| | - Pierrick Guérif
- Institute for Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
| | | | | | - Magali Giral
- Institute for Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- Inserm U1064; Nantes University Hospital; Nantes France
- EA 4275 SPHERE; Nantes University; Nantes France
- LabEx Transplantex; Nantes France
- Thematic Research and Care Network RTRS “Centaure”; Université de Strasbourg; Strasbourg France
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13
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Le Borgne F, Combescure C, Gillaizeau F, Giral M, Chapal M, Giraudeau B, Foucher Y. Standardized and weighted time-dependent receiver operating characteristic curves to evaluate the intrinsic prognostic capacities of a marker by taking into account confounding factors. Stat Methods Med Res 2017. [PMID: 28633603 DOI: 10.1177/0962280217702416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Time-dependent receiver operating characteristic curves allow to evaluate the capacity of a marker to discriminate between subjects who experience the event up to a given prognostic time from those who are free of this event. In this article, we propose an inverse probability weighting estimator of a standardized and weighted time-dependent receiver operating characteristic curve. This estimator provides a measure of the prognostic capacities by taking into account potential confounding factors. We illustrate the robustness of the estimator by a simulation-based study and its usefulness by two applications in kidney transplantation.
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Affiliation(s)
- Florent Le Borgne
- 1 Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France.,2 IDBC/A2com, Pace, France.,3 ITUN, INSERM U1064, Nantes, France
| | - Christophe Combescure
- 4 CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Florence Gillaizeau
- 1 Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France.,5 Department of Statistical Science, University College London, London, UK
| | - Magali Giral
- 1 Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France.,3 ITUN, INSERM U1064, Nantes, France
| | - Marion Chapal
- 1 Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France.,6 Médecine Néphrologie - Hémodialyse, Centre Hospitalier Départemental Vendée Site de La Roche sur Yon, La Roche-sur-Yon, France
| | - Bruno Giraudeau
- 7 Centre d'Investigation clinique (CIC), INSERM 1415, Tours, France.,8 Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France.,9 CHRU de Tours, Tours, France
| | - Yohann Foucher
- 1 Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France.,10 Nantes University Hospital, Nantes, France
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14
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Le Borgne F, Combescure C, Gillaizeau F, Giral M, Chapal M, Giraudeau B, Foucher Y. Courbes ROC standardisées dépendantes du temps pour évaluer les capacités pronostiques inhérentes à un marqueur en tenant compte des facteurs de confusion. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.007] [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] Open
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15
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Gillaizeau F, Le Borgne F, Rousseau C, Leyrat C, Giral M, Chapal M, Barbin L, Laplaud D, Giraudeau B, Foucher Y. Régression logistique multivariée traditionnelle contre scores de propension : une étude pour mettre fin aux idées préconçues. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.005] [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] Open
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16
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Querard AH, Foucher Y, Combescure C, Dantan E, Larmet D, Lorent M, Pouteau LM, Giral M, Gillaizeau F. Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int 2016; 29:403-15. [PMID: 26756928 DOI: 10.1111/tri.12736] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 10/01/2015] [Revised: 11/03/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
In 2002, the United Network for Organ Sharing proposed increasing the pool of donor kidneys to include Expanded Criteria Donor (ECD). Outside the USA, the ECD definition remains the one used without questioning whether such a graft allocation criterion is valid worldwide. We performed a meta-analysis to quantify the differences between ECD and Standard Criteria Donor (SCD) transplants. We paid particular attention to select studies in which the methodology was appropriate and we took into consideration the geographical area. Thirty-two publications were included. Only five studies, all from the USA, reported confounder-adjusted hazard ratios comparing the survival outcomes between ECD and SCD kidney transplant recipients. These five studies confirmed that ECD recipients seemed to have poorer prognosis. From 29 studies reporting appropriate survival curves, we estimated the 5-year pooled nonadjusted survivals for ECD and SCD recipients. The relative differences between the two groups were lower in Europe than in North America, particularly for death-censored graft failure. It is of primary importance to propose appropriate studies for external validation of the ECD criteria in non-US kidney transplant recipients.
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Affiliation(s)
- Anne-Hélène Querard
- Nephrology, Dialysis, Transplantation, Centre Hospitalier Départemental de Vendée, La Roche sur Yon, France.,EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Yohann Foucher
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Christophe Combescure
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Etienne Dantan
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France
| | - David Larmet
- Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Marine Lorent
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France
| | - Lise-Marie Pouteau
- Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
| | - Magali Giral
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France.,LabEx Transplantex Nantes, Centre d'Investigation Clinique Biothérapie, Nantes, France
| | - Florence Gillaizeau
- EA 4275 SPHERE - bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch, Nantes University, Nantes, France.,Institute for Transplantation, Urology and Nephrology ITUN, CHU Nantes, RTRS 'Centaure', Inserm U1064, Nantes University, Nantes, France
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17
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Le Fur A, Fournier MC, Gillaizeau F, Masson D, Giral M, Cariou B, Cantarovich D, Dantal J. Vitamin D deficiency is an independent risk factor for PTDM after kidney transplantation. Transpl Int 2015; 29:207-15. [DOI: 10.1111/tri.12697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/14/2015] [Accepted: 09/25/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Awena Le Fur
- Institute of Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- INSERM UMR 1064; Nantes University Hospital; Nantes France
| | - Marie-Cécile Fournier
- INSERM UMR 1064; Nantes University Hospital; Nantes France
- EA 4275 - SPHERE Biostatistics, Pharmacoepidemiology, and Human Sciences Research; Nantes University Hospital; Nantes France
| | - Florence Gillaizeau
- Institute of Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- INSERM UMR 1064; Nantes University Hospital; Nantes France
- EA 4275 - SPHERE Biostatistics, Pharmacoepidemiology, and Human Sciences Research; Nantes University Hospital; Nantes France
| | | | - Magali Giral
- Institute of Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- INSERM UMR 1064; Nantes University Hospital; Nantes France
- EA 4275 - SPHERE Biostatistics, Pharmacoepidemiology, and Human Sciences Research; Nantes University Hospital; Nantes France
| | - Bertrand Cariou
- Endocrinology Clinic; Nantes University Hospital; Nantes France
- INSERM UMR 1087; CNRS UMR 6291; Thorax Institute; Nantes University Hospital; Nantes France
| | - Diego Cantarovich
- Institute of Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- INSERM UMR 1064; Nantes University Hospital; Nantes France
| | - Jacques Dantal
- Institute of Transplantation, Urology and Nephrology (ITUN); Nantes University Hospital; Nantes France
- INSERM UMR 1064; Nantes University Hospital; Nantes France
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18
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Caruba T, Boussadi A, Lenain E, Korb-Savoldelli V, Gillaizeau F, Durieux P, Sabatier B. A simulation study of the interception of prescribing errors by clinical pharmacists in an acute hospital setting. J Eval Clin Pract 2015; 21:673-80. [PMID: 25907983 DOI: 10.1111/jep.12363] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To evaluate the performance of several pharmacists in the same department who analysed the same prescriptions in a simulation study. METHODS One hundred prescriptions were retrospectively extracted from the prospective database of our hospital. Five clinical pharmacists working in the same department were asked to analyse individually the order lines of each prescription as if it were part of their routine daily practice. Afterward, an independent committee of five other clinical pharmacists reviewed the same 100 prescriptions. We calculated the sensitivity and the specificity of error detection in a line order by using the results of the committee as the gold standard. RESULTS A total of 908 order lines were analysed (mean 9 ± 3 order lines per prescription). Fifty-one medication errors were identified by the committee (5.6%), including 23 related to laboratory test results: renal failure, or therapeutic concentrations being too low or too high. The sensitivity of the five pharmacists ranged between 19.6% and 56.9% and the specificity between 92.8% and 98.7%. The rates of agreement between each pharmacist and the committee, assessed using kappa coefficient, were between 0.20 and 0.39. The main factors affecting sensitivity and/or specificity in univariate analysis were the number of drugs per prescription, type of drug prescribed (ATC classification) and the glomerular filtration rate. CONCLUSION Discrepancies between the performances of pharmacists exist, as there are between other health care professionals. Pharmacist training, standardization of the pharmaceutical analysis of drug prescription, and implementation of a clinical decision support system allowing biological values to be linked to drug prescriptions could improve individual performance.
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Affiliation(s)
- Thibaut Caruba
- Service de Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Abdelali Boussadi
- Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris 5 et 6, Paris, France
| | - Emilie Lenain
- Unité d'Epidémiologie et de Recherche Clinique, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Virginie Korb-Savoldelli
- Service de Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Florence Gillaizeau
- Unité d'Epidémiologie et de Recherche Clinique, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Pierre Durieux
- Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris 5 et 6, Paris, France
| | - Brigitte Sabatier
- Service de Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris 5 et 6, Paris, France
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19
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Abstract
Medical researchers are often interested to investigate the relationship between explicative variables and times-to-events such as disease progression or death. Such multiple times-to-events can be studied using multistate models. For chronic diseases, it may be relevant to consider semi-Markov multistate models because the transition intensities between two clinical states more likely depend on the time already spent in the current state than on the chronological time. When the cause of death for a patient is unavailable or not totally attributable to the disease, it is not possible to specifically study the associations with the excess mortality related to the disease. Relative survival analysis allows an estimate of the net survival in the hypothetical situation where the disease would be the only possible cause of death. In this paper, we propose a semi-Markov additive relative survival (SMRS) model that combines the multistate and the relative survival approaches. The usefulness of the SMRS model is illustrated by two applications with data from a French cohort of kidney transplant recipients. Using simulated data, we also highlight the effectiveness of the SMRS model: the results tend to those obtained if the different causes of death are known.
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Affiliation(s)
- Florence Gillaizeau
- EA 4275 – SPHERE – bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch team, Université de Nantes, Nantes, France
- INSERM CR1064 Centre pour la Recherche en Transplantation et Immunointervention (CRTI), Institut Transplantation-Urologie-Néphrologie (ITUN), Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Etienne Dantan
- EA 4275 – SPHERE – bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch team, Université de Nantes, Nantes, France
| | - Magali Giral
- EA 4275 – SPHERE – bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch team, Université de Nantes, Nantes, France
- INSERM CR1064 Centre pour la Recherche en Transplantation et Immunointervention (CRTI), Institut Transplantation-Urologie-Néphrologie (ITUN), Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Yohann Foucher
- EA 4275 – SPHERE – bioStatistics, Pharmacoepidemiology and Human sciEnces REsearch team, Université de Nantes, Nantes, France
- INSERM CR1064 Centre pour la Recherche en Transplantation et Immunointervention (CRTI), Institut Transplantation-Urologie-Néphrologie (ITUN), Nantes, France
- Centre Hospitalier Universitaire de Nantes, Nantes, France
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20
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Gillaizeau F, Sénage T, Le Tourneau T, Roussel JC, Foucher Y. La détérioration de bioprothèse valvulaire : un problème majeur de santé publique largement sous-estimé par la non-prise en compte de la censure par intervalle et l’évolution multi-états de la maladie. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.031] [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] Open
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21
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Ismael S, Savalle M, Trivin C, Gillaizeau F, D'Auzac C, Faisy C. The consequences of sudden fluid shifts on body composition in critically ill patients. Crit Care 2014; 18:R49. [PMID: 24666889 PMCID: PMC4057272 DOI: 10.1186/cc13794] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/13/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Estimation of body composition as fat-free mass (FFM) is subjected to many variations caused by injury and stress conditions in the intensive care unit (ICU). Body cell mass (BCM), the metabolically active part of FFM, is reported to be more specifically correlated to changes in nutritional status. Bedside estimation of BCM could help to provide more valuable markers of nutritional status and may promote understanding of metabolic consequences of energy deficit in the ICU patients. We aimed to quantify BCM, water compartments and FFM by methods usable at the bedside for evaluating the impact of sudden and massive fluid shifts on body composition in ICU patients. METHODS We conducted a prospective experimental study over an 6 month-period in a 18-bed ICU. Body composition of 31 consecutive hemodynamically stable patients requiring acute renal replacement therapy for fluid overload (ultrafiltration ≥5% body weight) was investigated before and after the hemodialysis session. Intra-(ICW) and extracellular (ECW) water volumes were calculated from the raw values of the low- and high-frequency resistances measured by multi-frequency bioelectrical impedance. BCM was assessed by a calculated method recently developed for ICU patients. FFM was derived from BCM and ECW. RESULTS Intradialytic weight loss was 3.8 ± 0.8 kg. Percentage changes of ECW (-7.99 ± 4.60%) and of ICW (-7.63 ± 5.11%) were similar, resulting ECW/ICW ratio constant (1.26 ± 0.20). The fall of FFM (-2.24 ± 1.56 kg, -4.43 ± 2.65%) was less pronounced than the decrease of ECW (P < 0.001) or ICW (P < 0.001). Intradialytic variation of BCM was clinically negligible (-0.38 ± 0.93 kg, -1.56 ± 3.94%) and was significantly less than FFM (P < 0.001). CONCLUSIONS BCM estimation is less driven by sudden massive fluid shifts than FMM. Assessment of BCM should be preferred to FFM when severe hydration disturbances are present in ICU patients.
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22
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Gillaizeau F, Chan E, Trinquart L, Colombet I, Walton RT, Rège-Walther M, Burnand B, Durieux P. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev 2013:CD002894. [PMID: 24218045 DOI: 10.1002/14651858.cd002894.pub3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost-effective fashion. This is an updated version of an earlier Cochrane systematic review, first published in 2001 and updated in 2008. OBJECTIVES To assess whether computerized advice on drug dosage has beneficial effects on patient outcomes compared with routine care (empiric dosing without computer assistance). SEARCH METHODS The following databases were searched from 1996 to January 2012: EPOC Group Specialized Register, Reference Manager; Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Ovid; EMBASE, Ovid; and CINAHL, EbscoHost. A "top up" search was conducted for the period January 2012 to January 2013; these results were screened by the authors and potentially relevant studies are listed in Studies Awaiting Classification. The review authors also searched reference lists of relevant studies and related reviews. SELECTION CRITERIA We included randomized controlled trials, non-randomized controlled trials, controlled before-and-after studies and interrupted time series analyses of computerized advice on drug dosage. The participants were healthcare professionals responsible for patient care. The outcomes were any objectively measured change in the health of patients resulting from computerized advice (such as therapeutic drug control, clinical improvement, adverse reactions). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. We grouped the results from the included studies by drug used and the effect aimed at for aminoglycoside antibiotics, amitriptyline, anaesthetics, insulin, anticoagulants, ovarian stimulation, anti-rejection drugs and theophylline. We combined the effect sizes to give an overall effect for each subgroup of studies, using a random-effects model. We further grouped studies by type of outcome when appropriate (i.e. no evidence of heterogeneity). MAIN RESULTS Forty-six comparisons (from 42 trials) were included (as compared with 26 comparisons in the last update) including a wide range of drugs in inpatient and outpatient settings. All were randomized controlled trials except two studies. Interventions usually targeted doctors, although some studies attempted to influence prescriptions by pharmacists and nurses. Drugs evaluated were anticoagulants, insulin, aminoglycoside antibiotics, theophylline, anti-rejection drugs, anaesthetic agents, antidepressants and gonadotropins. Although all studies used reliable outcome measures, their quality was generally low.This update found similar results to the previous update and managed to identify specific therapeutic areas where the computerized advice on drug dosage was beneficial compared with routine care:1. it increased target peak serum concentrations (standardized mean difference (SMD) 0.79, 95% CI 0.46 to 1.13) and the proportion of people with plasma drug concentrations within the therapeutic range after two days (pooled risk ratio (RR) 4.44, 95% CI 1.94 to 10.13) for aminoglycoside antibiotics;2. it led to a physiological parameter more often within the desired range for oral anticoagulants (SMD for percentage of time spent in target international normalized ratio +0.19, 95% CI 0.06 to 0.33) and insulin (SMD for percentage of time in target glucose range: +1.27, 95% CI 0.56 to 1.98);3. it decreased the time to achieve stabilization for oral anticoagulants (SMD -0.56, 95% CI -1.07 to -0.04);4. it decreased the thromboembolism events (rate ratio 0.68, 95% CI 0.49 to 0.94) and tended to decrease bleeding events for anticoagulants although the difference was not significant (rate ratio 0.81, 95% CI 0.60 to 1.08). It tended to decrease unwanted effects for aminoglycoside antibiotics (nephrotoxicity: RR 0.67, 95% CI 0.42 to 1.06) and anti-rejection drugs (cytomegalovirus infections: RR 0.90, 95% CI 0.58 to 1.40);5. it tended to reduce the length of time spent in the hospital although the difference was not significant (SMD -0.15, 95% CI -0.33 to 0.02) and to achieve comparable or better cost-effectiveness ratios than usual care;6. there was no evidence of differences in mortality or other clinical adverse events for insulin (hypoglycaemia), anaesthetic agents, anti-rejection drugs and antidepressants.For all outcomes, statistical heterogeneity quantified by I(2) statistics was moderate to high. AUTHORS' CONCLUSIONS This review update suggests that computerized advice for drug dosage has some benefits: it increases the serum concentrations for aminoglycoside antibiotics and improves the proportion of people for which the plasma drug is within the therapeutic range for aminoglycoside antibiotics.It leads to a physiological parameter more often within the desired range for oral anticoagulants and insulin. It decreases the time to achieve stabilization for oral anticoagulants. It tends to decrease unwanted effects for aminoglycoside antibiotics and anti-rejection drugs, and it significantly decreases thromboembolism events for anticoagulants. It tends to reduce the length of hospital stay compared with routine care while comparable or better cost-effectiveness ratios were achieved.However, there was no evidence that decision support had an effect on mortality or other clinical adverse events for insulin (hypoglycaemia), anaesthetic agents, anti-rejection drugs and antidepressants. In addition, there was no evidence to suggest that some decision support technical features (such as its integration into a computer physician order entry system) or aspects of organization of care (such as the setting) could optimize the effect of computerized advice.Taking into account the high risk of bias of, and high heterogeneity between, studies, these results must be interpreted with caution.
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Affiliation(s)
- Florence Gillaizeau
- French Cochrane Center, Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, Paris, France, 75004
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23
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Berdot S, Gillaizeau F, Caruba T, Prognon P, Durieux P, Sabatier B. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013; 8:e68856. [PMID: 23818992 PMCID: PMC3688612 DOI: 10.1371/journal.pone.0068856] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. OBJECTIVES We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. DATA SOURCES Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. STUDY SELECTION Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. DATA EXTRACTION Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. RESULTS Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. CONCLUSIONS Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.
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Affiliation(s)
- Sarah Berdot
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
| | | | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Laboratoire Interdisciplinaire de Recherche en Economie de Santé, EA4410, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Patrice Prognon
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- Université Paris-Sud 11, Chatenay-Malabry, France
| | - Pierre Durieux
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
- INSERM, Centre d’Investigation Épidémiologique 4, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Brigitte Sabatier
- Department of Pharmacy, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
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Oudard S, Gillaizeau F, Peyrard S, Latorzeff I, Beuzeboc P, Sevin E, Rolland F, Mourey L, Priou F, Culine S. Effect of addition of docetaxel (D) to hormonal therapy (HT) versus HT alone on quality of life: Results from a phase III study in non-metastatic high-risk prostate cancer (PC) patients (pts) with a rising PSA status. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e16009] [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
e16009 Background: Around 75% of non-metastatic high risk PC pts undergo PSA recurrence within 2 years after local therapy. Effect of D in addition to HT on Quality Of Life (HRQoL) was assessed using QLQ-C30. Methods: HRQoL was assessed every 3months: baseline, 3m, 6m, 9m and 12m for this multicenter, randomized phase III study comparing arm A: HT+D (70 mg/m2 Q3W, 6 cycles) and arm B: HT (triptorelin) every 3m for 1 year in non-metastatic PC pts at high-risk of recurrence after radical prostatectomy (RP) and/or radiotherapy (RT). Stratification factors (SF) were RP vs RT and PSA-doubling time < or >6m. Inclusion criteria were at least 1 of: Gleason >8, PSA-DT <6m, positive surgical margins, PSA velocity >0.75ng/mL/year, pathological pelvic lymph nodes, time from RP/RT to inclusion < 12m. Primary endpoint was PSA PFS (ASCO2011, abs 84423); secondary endpoints: PSA response, time to metastasis, overall survival, QoL and safety. Treatment effect on QoL was analyzed using 1) linear (L) and non-linear (NL) mixed models with continuous and discrete time points from baseline to 12m. Covariates were: SF, an interaction term between time and treatment and 2) time to 20% degradation of QoL upon Cox regression model. Results: Included =254, ITT=251. Arm A (125) vs B (126): median age(y) 64 vs 66, time(m) initial diagnosis to inclusion 35 vs 34, ECOG=0: 96% vs 93%, Gleason score (%) >8: 32 vs 27, RP (%): 69.6 vs 71.4, RT (%): 37.6 vs 38.1, PSA-DT (%) <6m: 53.6 vs 53.2, respectively. At baseline, mean (SD) Global Health status was 76.8 (19.4) and 81.6 (16.9) for arm A and B respectively (p=0.10). Fatigue dimension score was different at 3M (p<0.0001). Upon linear and non-linear longitudinal analysis, addition of D to HT had no effect on QoL (L: p=0.29; NL: p=0.25). Time to 20% QoL degradation was not significantly different between the 2 arms (p=0.44). Conclusions: Addition of docetaxel to hormonotherapy at an early stage after local therapy in non-metastatic high-risk PC pts with a rising PSA status does not significantly impact QoL during the first 12 months.
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Affiliation(s)
- Stephane Oudard
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | | | - Severine Peyrard
- Hôpital européen Georges-Pompidou, Unité d'Epidémiologie et de Recherche Clinique, Paris, France
| | | | | | | | | | - Loic Mourey
- Institut Claudius Regaud, Service D'Oncologie Médicale, Toulouse, France
| | - Franck Priou
- Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France
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Essalhi M, Gillaizeau F, Chevallier JM, Ducloux R, Chevalier-Bidaud B, Callens E, Graba S, Gillet-Juvin K, Altman JJ, Louis B, Mahut B, Delclaux C. Cross-sectional assessment of the roles of comorbidities in resting and activity-related dyspnea in severely obese women. J Asthma 2013; 50:565-72. [PMID: 23550628 DOI: 10.3109/02770903.2013.790420] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma. METHODS Severely obese (body mass index (BMI) > 35 kg m(-2)) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled. RESULTS Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints. CONCLUSIONS In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.
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Affiliation(s)
- Mohamed Essalhi
- AP-HP, Hôpital Européen Georges-Pompidou, Service de Physiologie - Clinique de la Dyspnée, Paris, France
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Fron Chabouis H, Chabouis F, Gillaizeau F, Durieux P, Chatellier G, Ruse ND, Attal JP. Randomization in clinical trials: stratification or minimization? The HERMES free simulation software. Clin Oral Investig 2013; 18:25-34. [DOI: 10.1007/s00784-013-0949-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
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Ladouceur M, Gillaizeau F, Redheuil A, Iserin L, Bonnet D, Boudjemline Y, Mousseaux E. Optimal follow-up in adult patients with congenital heart disease and chronic pulmonary regurgitation: Towards tailored use of cardiac magnetic resonance imaging. Arch Cardiovasc Dis 2013; 106:27-35. [DOI: 10.1016/j.acvd.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/28/2012] [Accepted: 10/09/2012] [Indexed: 11/26/2022]
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Bats AS, Mathevet P, Buenerd A, Orliaguet I, Mery E, Zerdoud S, Le Frère-Belda MA, Froissart M, Querleu D, Martinez A, Leblanc E, Morice P, Daraï E, Marret H, Gillaizeau F, Lécuru F. The sentinel node technique detects unexpected drainage pathways and allows nodal ultrastaging in early cervical cancer: insights from the multicenter prospective SENTICOL study. Ann Surg Oncol 2012; 20:413-22. [PMID: 22911367 DOI: 10.1245/s10434-012-2597-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy may improve nodal staging in cervical cancer. The aims of this study are to determine the rate of unusual patterns of cervical lymphatic drainage, to determine the rates of micrometastases and isolated tumor cells (ITCs) in SLNs, and to assess the clinical impact of SLN biopsy. METHODS Multicenter prospective study conducted between January 2005 and June 2007 in women undergoing laparoscopic surgery for early cervical cancer. Combined technetium/Patent Blue labeling was used. Lymphoscintigraphy was performed before surgery. SLN location was recorded, and factors associated with location were explored. SLNs underwent step sectioning ± immunohistochemistry. RESULTS 145 patients were enrolled and 139 included in a modified intention-to-diagnose analysis. Although 80.6 % of SLNs were in external iliac and interiliac areas, 38.2 % of patients had at least one SLN in an unexpected area and 5.1 % had SLNs only in unexpected areas. In unexpected areas, the number of SLNs per patient was not significantly different between lymphoscintigraphy and intraoperative detection (0.79 [0.62-1.02] versus 0.50 [0.37-0.68]; P = 0.096). In expected locations, there were significantly more blue and hot SLNs per patient than blue or hot SLNs (1.70 [1.45-1.99], 0.42 [0.30-0.57], 0.52 [0.39-0.69]). Of 28 metastatic SLNs, 17 contained micrometastases or ITCs. SLN involvement was found only by immunohistochemistry in 39.1 % of patients with positive nodes, and involved SLNs were located in unexpected areas in 17 % of those patients. CONCLUSIONS Sentinel lymph node biopsy detects unusual drainage pathways and micrometastases in a substantial proportion of patients, thus improving nodal staging.
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Affiliation(s)
- Anne-Sophie Bats
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
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Savalle M, Gillaizeau F, Maruani G, Puymirat E, Bellenfant F, Houillier P, Fagon JY, Faisy C. Assessment of body cell mass at bedside in critically ill patients. Am J Physiol Endocrinol Metab 2012; 303:E389-96. [PMID: 22649067 DOI: 10.1152/ajpendo.00502.2011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 02/07/2023]
Abstract
Critical illness affects body composition profoundly, especially body cell mass (BCM). BCM loss reflects lean tissue wasting and could be a nutritional marker in critically ill patients. However, BCM assessment with usual isotopic or tracer methods is impractical in intensive care units (ICUs). We aimed to modelize the BCM of critically ill patients using variables available at bedside. Fat-free mass (FFM), bone mineral (Mo), and extracellular water (ECW) of 49 critically ill patients were measured prospectively by dual-energy X-ray absorptiometry and multifrequency bioimpedance. BCM was estimated according to the four-compartment cellular level: BCM = FFM - (ECW/0.98) - (0.73 × Mo). Variables that might influence the BCM were assessed, and multivariable analysis using fractional polynomials was conducted to determine the relations between BCM and these data. Bootstrap resampling was then used to estimate the most stable model predicting BCM. BCM was 22.7 ± 5.4 kg. The most frequent model included height (cm), leg circumference (cm), weight shift (Δ) between ICU admission and body composition assessment (kg), and trunk length (cm) as a linear function: BCM (kg) = 0.266 × height + 0.287 × leg circumference + 0.305 × Δweight - 0.406 × trunk length - 13.52. The fraction of variance explained by this model (adjusted r(2)) was 46%. Including bioelectrical impedance analysis variables in the model did not improve BCM prediction. In summary, our results suggest that BCM can be estimated at bedside, with an error lower than ±20% in 90% subjects, on the basis of static (height, trunk length), less stable (leg circumference), and dynamic biometric variables (Δweight) for critically ill patients.
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Korb-Savoldelli V, Gillaizeau F, Caruba T, Tauckoor A, Prognon P, Durieux P, Sabatier B. Information about medication in HIV-infected patients and its relation to adherence. Swiss Med Wkly 2012; 142:w13642. [PMID: 22836790 DOI: 10.4414/smw.2012.13642] [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: 11/19/2022] Open
Abstract
QUESTIONS UNDER STUDY In HIV-infected patients, comprehension of medication instructions is an essential condition for adherence to Highly Active Antiretroviral Therapy (HAART). In this study, we used a self-reported questionnaire to know which sources of medication information HIV-infected patients used and their impact on adherence. In secondary objectives, we determined profiles of non-adherent patients and specified the role of the pharmacist. METHODS A cross-sectional, observational study was conducted in one community pharmacy and one French university hospital pharmacy, in HAART-naïve or not patients, from April to June 2009. RESULTS During the 3-month study period, 233 HIV-infected patients were included. The majority of patients sought information about their HAART treatments from the hospital physician (79.8%), the community physician (74.2%), and patient information leaflets (73.8%). The community and hospital pharmacists were consulted by respectively 16.3% and 3.4% of patients. According to multivariate regression analysis, adherence seemed to be associated with the sources of information "community physician", "hospital physician", "internet", and the potential support of patient associations. A total of 65.7% of patients were considered to be adherent. CONCLUSIONS In our study, among sources used by HIV-infected outpatients, their physicians are the most helpful sources of information about HAART. Regarding practice implications, the key role of the pharmacist is underutilised, indicating the need for improved communication between the pharmacist and outpatients.
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Fournier S, Brossier F, Fortineau N, Gillaizeau F, Akpabie A, Aubry A, Barbut F, Chedhomme FX, Kassis-Chikhani N, Lucet JC, Robert J, Seytre D, Simon I, Vanjak D, Zahar JR, Brun-Buisson C, Jarlier V. Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience. Euro Surveill 2012. [DOI: 10.2807/ese.17.30.20229-en] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- S Fournier
- Direction de la Politique Médicale (Directorate of Medical Politics), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Brossier
- Bacteriology laboratory, Université Pierre et Marie CURIE – Paris 6, Hôpital Pitié-Salpêtrière, Assistance publique – Hôpitaux de Paris, Paris, France
| | - N Fortineau
- Bicêtre Hospital, Assistance publique – Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - F Gillaizeau
- Departement of hospital informatics, European hospital Georges Pompidou, Assistance publique – Hôpitaux de Paris, Paris, France
| | - A Akpabie
- Emile Roux Hospital, Assistance publique – Hôpitaux de Paris, Limeil-Brévannes, France
| | - A Aubry
- Charles Foix Hospital, Assistance publique – Hôpitaux de Paris, Ivry-Sur-Seine, France
| | - F Barbut
- Saint Antoine Hospital, Assistance publique – Hôpitaux de Paris, Paris, France
| | - F X Chedhomme
- La Collégiale Hospital, Assistance publique – Hôpitaux de Paris, Paris, France
| | - N Kassis-Chikhani
- Paul Brousse Hospital, Assistance publique – Hôpitaux de Paris, Villejuif, France
| | - J C Lucet
- Bichat-Claude Bernard Hospital, Assistance publique – Hôpitaux de Paris, Paris, France
| | - J Robert
- Bacteriology laboratory, Université Pierre et Marie CURIE – Paris 6, Hôpital Pitié-Salpêtrière, Assistance publique – Hôpitaux de Paris, Paris, France
| | - D Seytre
- Avicenne Hospital, Assistance publique – Hôpitaux de Paris, Bobigny, France
| | - I Simon
- Sainte Périne Hospital, Assistance publique – Hôpitaux de Paris, Paris, France
| | - D Vanjak
- Beaujon Hospital, Assistance publique – Hôpitaux de Paris, Beaujon, France
| | - J R Zahar
- Necker Hospital, Assistance publique – Hôpitaux de Paris, Paris, France
| | - C Brun-Buisson
- Henri Mondor Hospital, Assistance publique – Hôpitaux de Paris, Créteil, France
| | - V Jarlier
- Bacteriology laboratory, Université Pierre et Marie CURIE – Paris 6, Hôpital Pitié-Salpêtrière, Assistance publique – Hôpitaux de Paris, Paris, France
- Direction de la Politique Médicale (Directorate of Medical Politics), Assistance Publique-Hôpitaux de Paris, Paris, France
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Fournier S, Brossier F, Fortineau N, Gillaizeau F, Akpabie A, Aubry A, Barbut F, Chedhomme FX, Kassis-Chikhani N, Lucet JC, Robert J, Seytre D, Simon I, Vanjak D, Zahar JR, Brun-Buisson C, Jarlier V. Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience. Euro Surveill 2012; 17:20229. [PMID: 22856512] [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: 06/01/2023] Open
Abstract
Repeated outbreaks of vancomycin-resistant Enterococcus faecium (VRE) occurred between 2004 and 2010 in Assistance Publique--Hôpitaux de Paris (AP-HP), a 23,000-bed multi-hospital institution. From August 2004 to December 2005, the French guidelines for preventing cross-transmission of multiresistant bacteria were applied. Because the number of VRE cases continued to increase, an institutional control programme was implemented from January 2006 onwards: it foresees stopping transfer of VRE and contact patients, separating VRE and contact patients in distinct cohorts, intervention of a central infection control team to support local teams, and quick application of measures as soon as first VRE cases are identified. Between August 2004 and December 2010, 45 VRE outbreaks occurred in 21 of the 38 AP-HP hospitals, comprising 533 cases. Time series analysis showed that the mean number of cases increased by 0.8 cases per month (95% confidence interval (CI): 0.3 to 1.3, p=0.001) before, and decreased by 0.7 cases per month after implementation of the programme (95% CI: -0.9 to -0.5, p<0.001), resulting in a significant trend change of -1.5 cases per month (95% CI: -2.1 to -0.9, p<0.001). The number of cases per outbreak was significantly lower after implementation of the programme. A sustained and coordinated strategy can control emerging bacteria at the level of a large regional multihospital institution.
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Affiliation(s)
- S Fournier
- Direction de la Politique Medicale-Directorate of Medical Politics, Assistance Publique-Hopitaux de Paris, Paris, France.
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Colombet I, Montheil V, Durand JP, Gillaizeau F, Niarra R, Jaeger C, Alexandre J, Goldwasser F, Vinant P. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care 2012; 2:239-47. [DOI: 10.1136/bmjspcare-2011-000157] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Korb-Savoldelli V, Gillaizeau F, Pouchot J, Lenain E, Postel-Vinay N, Plouin PF, Durieux P, Sabatier B. Validation of a French Version of the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults. J Clin Hypertens (Greenwich) 2012; 14:429-34. [DOI: 10.1111/j.1751-7176.2012.00634.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [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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Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P, Durieux P. Evaluation of drug administration errors in a teaching hospital. BMC Health Serv Res 2012; 12:60. [PMID: 22409837 PMCID: PMC3364158 DOI: 10.1186/1472-6963-12-60] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 03/12/2012] [Indexed: 11/10/2022] Open
Abstract
Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.
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Affiliation(s)
- Sarah Berdot
- Department of pharmacy, Hôpital européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Mole B, Gillaizeau F, Carbonnel E, Pierre I, Brazille P, Grataloup C, Mercier S, Duracinsky M, Weiss L, Piketty C. Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: results of the LIPOPHILL open-label study. AIDS Res Hum Retroviruses 2012; 28:251-8. [PMID: 21801082 DOI: 10.1089/aid.2011.0042] [Citation(s) in RCA: 14] [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: 11/12/2022] Open
Abstract
Combination antiretroviral therapy (cART) can cause potentially stigmatizing facial lipoatrophy. Encouraging preliminary results have been reported with 2.5% polyacrylamide hydrogel for facial reconstruction. The aim of this multicenter, open-label noncomparative pilot study was to evaluate the efficacy and safety of intradermal facial injections of polyacrylamide hydrogel in HIV-infected patients with severe facial lipoatrophy. The patients received between two and six injections every 4 weeks, according to the aesthetic results. Clinical efficacy was evaluated by means of facial ultrasonography and photography at baseline and months 6, 12, and 24. Adverse events, patient satisfaction, and quality of life were also assessed. One hundred and eleven patients were enrolled and received at least one injection. Mean cheek skin thickness was 9.7 mm [95% CI: 9.1 to 10.2] at baseline. It rose by an average of 4.4 mm [95% CI: 3.9 to 4.9; p<0.001] at month 12 and a further 0.87 mm [95% CI: 0.52 to 1.23; p<0.001] at month 24. The Overall Treatment Satisfaction scale showed an improvement in more than 88% of patients at all visits, based on the appreciations of the patients, their close relatives and physicians, and on independent assessment of facial photographs. Quality of life improved significantly over time, as shown by the lipodystrophy-specific ABCD scale. No severe adverse effects related to the polyacrylamide hydrogel were noted. Polyacrylamide hydrogel injections were well tolerated and significantly improved the aesthetic aspect and quality of life of HIV-infected patients with facial lipoatrophy.
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Affiliation(s)
- Bernard Mole
- APHP, Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France
| | - Florence Gillaizeau
- APHP, Hôpital Européen Georges Pompidou, Unité d'Epidémiologie et de Recherche Clinique, Paris, France
- INSERM, Centre d'Investigation Epidémiologique 4, Paris, France
| | | | - Isabelle Pierre
- APHP, Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France
| | - Patricia Brazille
- Service des Maladies Infectieuses, Hôpital de St-Germain-en-Laye, St-Germain-en-Laye, France
| | - Christine Grataloup
- APHP, Service de Radiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Sylvie Mercier
- Service de Radiologie, Hôpital Edouard Herriot, Lyon, France
| | - Martin Duracinsky
- APHP, Service de Médecine Interne, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurence Weiss
- APHP, Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Piketty
- APHP, Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France
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Bats AS, Buénerd A, Querleu D, Leblanc E, Daraï E, Morice P, Marret H, Gillaizeau F, Mathevet P, Lécuru F. Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: A prospective, multicenter study. Gynecol Oncol 2011; 123:230-5. [DOI: 10.1016/j.ygyno.2011.08.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/09/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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Le Frère-Belda MA, Bats AS, Gillaizeau F, Poulet B, Clough KB, Nos C, Peoc'h M, Seffert P, Bouteille C, Leroux A, Guillemin F, Blanc-Fournier C, Crouet H, Arnould L, Cuisenier J, Penault-Llorca F, Gimbergues P, Jacquemier J, Houvenaeghel G, Chatellier G, Lécuru F. Diagnostic performance of one-step nucleic acid amplification for intraoperative sentinel node metastasis detection in breast cancer patients. Int J Cancer 2011; 130:2377-86. [PMID: 21780107 DOI: 10.1002/ijc.26291] [Citation(s) in RCA: 50] [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] [Received: 02/02/2011] [Revised: 05/19/2011] [Accepted: 06/07/2011] [Indexed: 11/10/2022]
Abstract
The purpose of this prospective multicenter study was to assess one-step nucleic acid amplification (OSNA) for intraoperative sentinel lymph node (SLN) metastasis detection in breast cancer patients, using final histology as the reference standard. OSNA results were also compared to intraoperative histology SLN evaluation and to standard clinicopathological risk markers. For this study, fresh SLNs were cut in four blocks, and alternate blocks were used for OSNA and histology. CK19 mRNA copy number was categorized as strongly positive, positive or negative. Positive histology was defined as presence of macrometastasis or micrometastasis. When discrepancies occurred, the entire SLNs were subjected to histological studies and the node lysates to additional molecular studies. Five hundred three SLN samples from 233 patients were studied. Mean time to evaluate two SLNs was 40 min. Sensitivity per patient was 91.4% (95% CI, 76.9-98.2%), specificity 93.3% (95% CI, 88.6-96.6%), positive likelihood ratio 13.7 and negative likelihood ratio 0.1. Sensitivity was 63.6% for frozen sections and 47.1% for touch imprint cytology. Both methods were 100% specific. Positive histology and positive OSNA were significantly associated with highest clinical stage, N1 status and vascular invasion; and OSNA results correlated with HER2/neu status and benefited patients with negative histology. These findings show that OSNA assay can allow detection of SLN metastasis in breast cancer patients intraoperatively with a good sensitivity, thus minimizing the need for second surgeries for axillary lymph node detection.
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Lécuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Daraï E, Marret H, Magaud L, Gillaizeau F, Chatellier G, Dargent D. Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 2011; 29:1686-91. [PMID: 21444878 DOI: 10.1200/jco.2010.32.0432] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Sentinel lymph node (SLN) biopsy may be used to target lymph node metastases in patients with early cervical cancer. Whether SLN biopsy only is acceptable in the staging and surgical management of early cervical cancer remains unknown. This prospective multicenter study (SENTICOL [Ganglion Sentinelle dans le Cancer du Col]) assessed the sensitivity and negative predictive value (NPV) of SLN biopsy. PATIENTS AND METHODS Adults with cervical carcinoma who met the International Federation of Gynecology and Obstetrics criteria for stage IA1 with lymphovascular space invasion to stage IB1 underwent technetium 99 lymphoscintigraphy and Patent Blue injection followed by laparoscopic lymph node mapping, SLN removal, and lymph node dissection. Only surgeons trained in SLN biopsy in cervical carcinoma participated in the study. SLNs and nonsentinel lymph nodes underwent routine staining. Negative SLNs were subjected to ultrastaging. The reference method was pelvic and/or para-aortic lymphadenectomy with histologic examination of all nodes. RESULTS One hundred forty-five patients were enrolled, and 139 were included in a modified intention-to-diagnose analysis. Intraoperative radioisotope-blue dye mapping detected at least one SLN in 136 patients (97.8%; 95% CI, 93.8% to 99.6%), 23 of whom had true-positive results and two who had false-negative results, yielding 92.0% sensitivity (23 of 25; 95% CI, 74.0% to 99.0%) and 98.2% NPV (111 of 113; 95% CI, 74.0% to 99.0%) for node metastasis detection. No false-negative results were observed in the 104 patients (76.5%) in whom SLN were identified bilaterally. CONCLUSION Combined labeling for node mapping was associated with high rates of SLN detection and with high sensitivity and NPV for metastasis detection. However, SLN biopsy was fully reliable only when SLNs were detected bilaterally.
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Affiliation(s)
- Fabrice Lécuru
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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Korb-Savoldelli V, Sabatier B, Gillaizeau F, Guillemain R, Prognon P, Bégué D, Durieux P. Non-adherence with drug treatment after heart or lung transplantation in adults: a systematic review. Patient Educ Couns 2010; 81:148-54. [PMID: 20627643 DOI: 10.1016/j.pec.2010.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 04/06/2010] [Accepted: 04/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Heart or lung transplantation is a complex intervention requiring medication adherence. The objective of this systematic review is to estimate the prevalence of non-adherence (NA) with post-transplantation medication in heart or lung recipients and to assess its clinical impact. We examined in the selected studies if the authors considered the patient's perspective in their evaluations. METHODS The electronic database MEDLINE, EMBASE and The Cochrane Central Register were searched. Only studies that reported the number of non-adhere subjects were eligible. The different methods of measurement, the ways in which authors defined NA and if authors had integrated patient's perspective in their secondary objectives were also assessed. RESULTS The range frequency of NA was 1-42.9% for all drugs. Non-adherent patients tend to experience worse outcomes compared to adherent patients. The patient's perception of drug side-effects is the most reported patient-related factor for impairing adherence. CONCLUSION NA after heart or lung transplantation is an important issue and concerns not only immunosuppressant treatments. The main striking point of the selected studies is the lack of patient perspective and the omission of patients-healthcare providers' relationship. PRACTICE IMPLICATIONS Future research must focus on patients' motivation for the medication-taking behaviour.
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Affiliation(s)
- V Korb-Savoldelli
- Pharmacy Department, AP-HP Georges Pompidou European Hospital, Paris, France.
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Niès J, Colombet I, Zapletal E, Gillaizeau F, Chevalier P, Durieux P. Effects of automated alerts on unnecessarily repeated serology tests in a cardiovascular surgery department: a time series analysis. BMC Health Serv Res 2010; 10:70. [PMID: 20298618 PMCID: PMC2848138 DOI: 10.1186/1472-6963-10-70] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 03/19/2010] [Indexed: 11/28/2022] Open
Abstract
Background Laboratory testing is frequently unnecessary, particularly repetitive testing. Among the interventions proposed to reduce unnecessary testing, Computerized Decision Support Systems (CDSS) have been shown to be effective, but their impact depends on their technical characteristics. The objective of the study was to evaluate the impact of a Serology-CDSS providing point of care reminders of previous existing serology results, embedded in a Computerized Physician Order Entry at a university teaching hospital in Paris, France. Methods A CDSS was implemented in the Cardiovascular Surgery department of the hospital in order to decrease inappropriate repetitions of viral serology tests (HBV). A time series analysis was performed to assess the impact of the alert on physicians' practices. The study took place between January 2004 and December 2007. The primary outcome was the proportion of unnecessarily repeated HBs antigen tests over the periods of the study. A test was considered unnecessary when it was ordered within 90 days after a previous test for the same patient. A secondary outcome was the proportion of potentially unnecessary HBs antigen test orders cancelled after an alert display. Results In the pre-intervention period, 3,480 viral serology tests were ordered, of which 538 (15.5%) were unnecessarily repeated. During the intervention period, of the 2,095 HBs antigen tests performed, 330 unnecessary repetitions (15.8%) were observed. Before the intervention, the mean proportion of unnecessarily repeated HBs antigen tests increased by 0.4% per month (absolute increase, 95% CI 0.2% to 0.6%, p < 0.001). After the intervention, a significant trend change occurred, with a monthly difference estimated at -0.4% (95% CI -0.7% to -0.1%, p = 0.02) resulting in a stable proportion of unnecessarily repeated HBs antigen tests. A total of 380 unnecessary tests were ordered among 500 alerts displayed (compliance rate 24%). Conclusions The proportion of unnecessarily repeated tests immediately dropped after CDSS implementation and remained stable, contrasting with the significant continuous increase observed before. The compliance rate confirmed the effect of the alerts. It is necessary to continue experimentation with dedicated systems in order to improve understanding of the diversity of CDSS and their impact on clinical practice.
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Affiliation(s)
- Julie Niès
- Centre de Recherche des Cordeliers, INSERM, U872 Eq, 20, Paris, F-75006 France.
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Caruba T, Colombet I, Gillaizeau F, Bruni V, Korb V, Prognon P, Bégué D, Durieux P, Sabatier B. Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis. BMC Health Serv Res 2010; 10:13. [PMID: 20067620 PMCID: PMC2820036 DOI: 10.1186/1472-6963-10-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 01/12/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most predictive of their reproduction the next day despite pharmacist's alert (i.e. override the alert). METHODS We prospectively collected all medication order lines and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described and modelled the errors rate according to the chronology of hospital stay. We performed a classification and regression tree analysis to find which characteristics of alerts were predictive of their overriding (i.e. prescribing error repeated). RESULTS 12 533 order lines were reviewed, 117 errors (errors rate 0.9%) were observed and 51% of these errors occurred on the first day of the hospital stay. The risk of a prescribing error decreased over time. 52% of the alerts were overridden (i.e error uncorrected by prescribers on the following day. Drug omissions were the most frequently taken into account by prescribers. The classification and regression tree analysis showed that overriding pharmacist's alerts is first related to the ward of the prescriber and then to either Anatomical Therapeutic Chemical class of the drug or the type of error. CONCLUSIONS Since 51% of prescribing errors occurred on the first day of stay, pharmacist should concentrate his analysis of drug prescriptions on this day. The difference of overriding behavior between wards and according drug Anatomical Therapeutic Chemical class or type of error could also guide the validation tasks and programming of electronic alerts.
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Affiliation(s)
- Thibaut Caruba
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- Laboratoire Interdisciplinaire de Recherche en Economie de Santé, Paris, France
| | - Isabelle Colombet
- Department of Hospital Informatics, Evaluation and Public Health, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- INSERM, UMR S 872, Equipe 20, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
- INSERM, Centre D'investigation Épidémiologique 4, Paris, France
| | - Florence Gillaizeau
- Department of Hospital Informatics, Evaluation and Public Health, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- INSERM, UMR S 872, Equipe 20, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
- INSERM, Centre D'investigation Épidémiologique 4, Paris, France
| | - Vanida Bruni
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
| | - Virginie Korb
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
| | - Patrice Prognon
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
| | - Dominique Bégué
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- Laboratoire Interdisciplinaire de Recherche en Economie de Santé, Paris, France
| | - Pierre Durieux
- Department of Hospital Informatics, Evaluation and Public Health, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- INSERM, UMR S 872, Equipe 20, Paris, France
- Centre de Recherche des Cordeliers, Université Paris Descartes, Paris, France
- INSERM, Centre D'investigation Épidémiologique 4, Paris, France
| | - Brigitte Sabatier
- Department of pharmacy, APHP, Georges Pompidou European Hospital, 75015 Paris, France
- Université Paris Descartes, INSERM U765, 4 avenue de l'Observatoire, 75006 Paris, France
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Fron H, Durieux P, Chatellier G, Gillaizeau F, Attal J. Choosing the allocation method for clinical trials in restorative dentistry. Dent Mater 2010. [DOI: 10.1016/j.dental.2010.08.067] [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: 10/19/2022]
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Roy PM, Durieux P, Gillaizeau F, Legall C, Armand-Perroux A, Martino L, Hachelaf M, Dubart AE, Schmidt J, Cristiano M, Chretien JM, Perrier A, Meyer G. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med 2009; 151:677-86. [PMID: 19920268 DOI: 10.7326/0003-4819-151-10-200911170-00003] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. OBJECTIVE To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department. DESIGN Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032). SETTING 20 emergency departments in France. PATIENTS 1103 and 1768 consecutive outpatients with suspected pulmonary embolism. INTERVENTION After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients). MEASUREMENTS Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome). RESULTS The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001). LIMITATION The study was not designed to show a difference in the clinical outcomes of patients during follow-up. CONCLUSION A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.
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Affiliation(s)
- Pierre-Marie Roy
- Centre Hospitalier Universitaire d'Angers and Université d'Angers, Angers, France.
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Caruba T, Havard L, Gillaizeau F, Guérot E, Prognon P, Pineau J. Évaluation des régulateurs de débit passifs utilisés pour la perfusion intraveineuse. ACTA ACUST UNITED AC 2009; 28:936-42. [DOI: 10.1016/j.annfar.2009.09.009] [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: 04/10/2008] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
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Colombet I, Sabatier B, Gillaizeau F, Prognon P, Begué D, Durieux P. Long-term effects of a multifaceted intervention to encourage the choice of the oral route for proton pump inhibitors: an interrupted time-series analysis. Qual Saf Health Care 2009; 18:232-5. [PMID: 19468008 DOI: 10.1136/qshc.2007.023887] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PROBLEM Drugs are often given intravenously even when the patient is able to swallow and when an oral form would be more cost-effective. DESIGN Evaluation of the impact of a multifaceted intervention on the early switch from intravenous to oral administration of proton pump inhibitors (PPI) in a hospital setting. The interrupted time series of intravenous PPI consumption was analysed. BACKGROUND AND SETTING At a French University Hospital, the Drug Committee, composed of multidisciplinary pharmacy and medical staff, addressed the issue of increasing consumption of intravenous PPI drugs (May 2003). STRATEGY FOR CHANGE Letters to department heads, academic analyses from members of the Drug Committee, paper reminders at the point of care and audit-feedbacks by pharmacists. Monitoring of consumption and repeated reminder letters were planned. EFFECT OF CHANGE: The consumption of PPI was stable before the first intervention (mean level: 954 units/month). An immediate decrease occurred after the first Drug Committee letter (30% relative reduction, 95% CI -16% to -46%; p<0.001) with a significant trend change during the first multifaceted intervention (-24 units/month, 95% CI -42 to -7; p = 0.007). After the end of the outreach visits (July 2004), the consumptions increased (+32 units/month, 95% CI: 14 to 50, p<0.001). The second intervention had no significant impact. LESSONS LEARNT A complex intervention (audit, feedbacks, outreach visits) had an effect on practice. It was not sustained even after a less resource-intensive intervention. Other types of interventions are needed that could be continuously implemented to improve ordering practices long term.
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Duclos A, Gillaizeau F, Colombet I, Coste J, Durieux P. Health staff perception regarding quality of delivered information to inpatients. Int J Qual Health Care 2007; 20:13-21. [DOI: 10.1093/intqhc/mzm063] [Citation(s) in RCA: 6] [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] [Indexed: 11/13/2022] Open
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