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Peretti M, Rebaudet S, Chiche L, Pegliasco H, Coquet E. Concerted and multidisciplinary management of COVID-19 drug therapies during the first two epidemic waves in a tertiary hospital in Marseille, France: Results of the PHARMA-COVID study. PLoS One 2023; 18:e0283165. [PMID: 36930624 PMCID: PMC10022761 DOI: 10.1371/journal.pone.0283165] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To evaluate the impact of local therapeutic recommendation updates made by the COVID multidisciplinary consultation meeting (RCP) at the Hôpital Européen Marseille (HEM) through the description of the drug prescriptions for COVID-19 during the first two waves of the epidemic. METHODS This retrospective observational study analysed data from the hospital's pharmaceutical file. We included all patients hospitalized for COVID-19 between February 1, 2020 and January 21, 2021 and extracted specific anti-COVID-19 therapies (ST) from computerized patient record, as well as patients' demographic characteristics, comorbidities and outcome. The evolution of ST prescriptions during the study period was described and put into perspective with the updates of local recommendations made during the first (V1, from 2/24/2020 to 7/27/2020), and second (V2, from 7/28/2020 to 1/21/2021) epidemic waves. RESULTS A total of 607 COVID-19 hospitalized patients, 197 during V1 and 410 during V2. Their mean age was 65 years-old, and they presented frequent comorbidities. In total, 93% of hospitalized patients received ST: anticoagulants (90%), glucocorticoids (39%) mainly during V2 (49% vs 17%, P<0.001), and azithromycin (30%) mainly during V1 (71% vs 10%, P<0.001). Lopinavir/ritonavir and hydroxychloroquine were prescribed to 17 and 7 inpatients, respectively, and only during V1. Remdesivir was never administered. A total of 22 inpatients were enrolled into clinical trials. CONCLUSIONS The effective dissemination of evidence-based and concerted recommendations seems to have allowed an optimized management of COVID-19 drug therapies in the context of this emerging infection with rapidly evolving therapeutic questions.
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Affiliation(s)
| | - Stanislas Rebaudet
- Service d’Infectiologie et de Médecine Interne, Hôpital Européen, Marseille, France
- UMR1252 SESSTIM, Aix-Marseille Univ, Inserm, IRD, ISSPAM, Marseille, France
| | - Laurent Chiche
- Service d’Infectiologie et de Médecine Interne, Hôpital Européen, Marseille, France
- * E-mail:
| | | | - Emilie Coquet
- Service de Pharmacie, Hôpital Européen, Marseille, France
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Derosa L, Alves Costa Silva C, Iebba V, Routy B, Reni A, Audigier-Valette C, Zalcman G, Mazieres J, Friard S, Goldwasser F, Moro-Sibilot D, Scherpereel A, Pegliasco H, Martinez S, Escudier B, Planchard D, Albiges L, Besse B, Barlesi F, Zitvogel L. 259MO A predictive score of cancer immunotherapy responses based on ecological analysis of gut microbiota. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Greillier L, Monville F, Leca V, Vely F, Garcia S, Ciccolini J, Sabatier F, Ferrani G, Boudai N, Ghezali L, Landri M, Marin C, Hamimed M, Arnaud L, Karlsen M, Atsou K, Bokobza S, Fleury P, Boyer A, Audigier-Valette C, Martinez S, Pegliasco H, Ray P, Falchero L, Serre A, Cloarec N, Lebas L, Hominal S, Barre P, Zahi S, Frikha A, Bory P, Ray ML, Laborde L, Martin V, Malkoun R, Roumieux M, Mazieres J, Perol M, Vivier E, Benzekry S, Fieschi J, Barlesi F. Abstract LB120: Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-lb120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Resistance to PD1/L1 immune checkpoint inhibitors (ICIs) in advanced NSCLC patients is observed in about 80% of individuals with no robust predictive biomarker yet. The PIONeeR trial (NCT03493581) aims to predict such resistances through a comprehensive multiparametric biomarkers analysis.
Methodology: Among the >300 advanced NSCLC patients (pts) recruited in PIONeeR, we focused on the first 137 ≥2nd line ECOG PS0-1 pts treated with single-agent nivolumab, pembrolizumab or atezolizumab. Tumor tissue was collected at baseline and pts were re-biopsied at 6 weeks, and blood-sampled every cycle throughout the 24 weeks post C1D1. Response to PD1/L1 ICIs was assessed by RECIST 1.1 every 6 weeks. Immune contexture was characterized in tumor & blood of each pt through FACS for circulating immune cell subtypes quantification and endothelial activation, blood soluble factors dosage, dual- & multiplex IHC/digital pathology to quantify immune cells infiltrating the tumor, WES for TMB & ICI plasma dosage, leading to 331 measured biomarkers in addition to routine clinical parameters. Multivariable (MV) logistic regression was used to examine the association of each biomarker (controlled by sex, age, smoking status, histological type & PDL1+ Tumor Cells) with the risk of Early Progression (EP), i.e. within 3.5 months of treatment. Multivariable Cox regression analysis was conducted for association with PFS and OS.
Results: Overall, the 137 pts were mainly male (64%), smokers (92%) and <70yrs (68%). Tumors were mainly non-squamous (79%) with >1% PDL1+ TC in 36% of the cases, and 21% of pts were still on treatment at data cut-off. Archived samples were available for 80% of pts at inclusion and re-biopsy was available in 52.9% of these cases. The median follow up was 19.8 months, 22.5% of pts did not progress at data cut-off while 62% presented EP. Tumor Cytotoxic T-cells density, especially PD1+ were lower in EP (MV OR=0.45, p=0.022); conversely, higher proportions of circulating cytotoxic T-cells and activated T-cells (HLA-DR+) were observed in EP (MV OR=3.8, p<0.001). Among other biomarkers, Tregs (MV OR=0.44, p=0.018), NK cell subsets (MV OR≤0.44, p<0.05), albumin (MV OR=0.4, p<0.01) and PDL1 TC % (MV OR=0.27, p<0.01) were decreased whereas alkaline phosphatase was increased (OR=3, p=0.018). >65% inter-pt variability was observed in plasma exposures for all ICIs, with 8-10% of pts displaying trough levels below the target engagement threshold. Data will be presented through unsupervised clustering algorithms & multi-modal supervised learning methods. Changes after 6 weeks of treatment will be analyzed to further investigate drugs mechanisms of action.
Conclusion: The PIONeeR trial provides with the 1st comprehensive biomarkers’ analysis to establish predictive models of resistance in advanced NSCLC pts treated with PD1/L1 ICIs and highlights how tumor and circulating biomarkers are complementary.
Citation Format: Laurent Greillier, Florence Monville, Vanina Leca, Frédéric Vely, Stephane Garcia, Joseph Ciccolini, Florence Sabatier, Gilbert Ferrani, Nawel Boudai, Lamia Ghezali, Marcellin Landri, Clémence Marin, Mourad Hamimed, Laurent Arnaud, Melanie Karlsen, Kevin Atsou, Sivan Bokobza, Pauline Fleury, Arnaud Boyer, Clarisse Audigier-Valette, Stéphanie Martinez, Hervé Pegliasco, Patrice Ray, Lionel Falchero, Antoine Serre, Nicolas Cloarec, Louisiane Lebas, Stephane Hominal, Patricia Barre, Sarah Zahi, Ahmed Frikha, Pierre Bory, Maryannick Le Ray, Lilian Laborde, Virginie Martin, Richard Malkoun, Marie Roumieux, Julien Mazieres, Maurice Perol, Eric Vivier, Sebastien Benzekry, Jacques Fieschi, Fabrice Barlesi. Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB120.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antoine Serre
- 13Institut Cancerologie du Gard, Oncogard, Nimes, France
| | | | - Louisiane Lebas
- 15Centre Hospitalier du Val d'Ariège, St Jean de Verges, France
| | | | | | - Sarah Zahi
- 18Centre Hospitalier de Montauban, Montauban, France
| | | | - Pierre Bory
- 20Centre Hospitalier de Bastia, Bastia, France
| | | | | | | | | | | | | | | | - Eric Vivier
- 24Aix Marseille Université, APHM, Innate Pharma, Marseille, France
| | | | | | - Fabrice Barlesi
- 25Gustave Roussy, Aix Marseille Université, Villejuif, France
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Derosa L, Routy B, Thomas AM, Iebba V, Zalcman G, Friard S, Mazieres J, Audigier-Valette C, Moro-Sibilot D, Goldwasser F, Silva CAC, Terrisse S, Bonvalet M, Scherpereel A, Pegliasco H, Richard C, Ghiringhelli F, Elkrief A, Desilets A, Blanc-Durand F, Cumbo F, Blanco A, Boidot R, Chevrier S, Daillère R, Kroemer G, Alla L, Pons N, Le Chatelier E, Galleron N, Roume H, Dubuisson A, Bouchard N, Messaoudene M, Drubay D, Deutsch E, Barlesi F, Planchard D, Segata N, Martinez S, Zitvogel L, Soria JC, Besse B. Intestinal Akkermansia muciniphila predicts clinical response to PD-1 blockade in patients with advanced non-small-cell lung cancer. Nat Med 2022; 28:315-324. [PMID: 35115705 DOI: 10.1038/s41591-021-01655-5] [Citation(s) in RCA: 214] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
Aside from PD-L1 expression, biomarkers of response to immune checkpoint inhibitors (ICIs) in non-small-cell lung cancer (NSCLC) are needed. In a previous retrospective analysis, we documented that fecal Akkermansia muciniphila (Akk) was associated with clinical benefit of ICI in patients with NSCLC or kidney cancer. In the current study, we performed shotgun-metagenomics-based microbiome profiling in a large cohort of patients with advanced NSCLC (n = 338) treated with first- or second-line ICIs to prospectively validate the predictive value of fecal Akk. Baseline stool Akk was associated with increased objective response rates and overall survival in multivariate analyses, independent of PD-L1 expression, antibiotics, and performance status. Intestinal Akk was accompanied by a richer commensalism, including Eubacterium hallii and Bifidobacterium adolescentis, and a more inflamed tumor microenvironment in a subset of patients. However, antibiotic use (20% of cases) coincided with a relative dominance of Akk above 4.8% accompanied with the genus Clostridium, both associated with resistance to ICI. Our study shows significant differences in relative abundance of Akk that may represent potential biomarkers to refine patient stratification in future studies.
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Affiliation(s)
- Lisa Derosa
- Gustave Roussy Cancer Campus, Villejuif, France.,Cancer Medicine Department, Gustave Roussy, Villejuif, France.,Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée, Ligue Nationale contre le Cancer, Villejuif, France.,Université Paris-Saclay, Ile-de-France, France
| | - Bertrand Routy
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Montréal, Quebec, Canada.,Centre de Recherche du CHUM (CRCHUM), Montréal, Quebec, Canada
| | - Andrew Maltez Thomas
- Department CIBIO, University of Trento, Trento, Italy.,European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Valerio Iebba
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gerard Zalcman
- Thoracic Oncology Department-CIC1425/CLIP2 Paris-Nord, Hospital Bichat-Claude Bernard, AP-HP, Université Paris-Diderot, Paris, France
| | - Sylvie Friard
- Pneumology Department, Foch Hospital, Suresnes, France
| | - Julien Mazieres
- Department of Pneumology, Toulouse University Hospital, Toulouse, France
| | | | - Denis Moro-Sibilot
- Department of Thoracic Oncology, Centre Hospitalier Universitaire, Grenoble, France
| | - François Goldwasser
- UPR 4466, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Medical Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Paris, France
| | - Carolina Alves Costa Silva
- Gustave Roussy Cancer Campus, Villejuif, France.,Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | | | | | - Arnaud Scherpereel
- Department of Pulmonary and Thoracic Oncology, University of Lille, University Hospital (CHU), Lille, France
| | | | - Corentin Richard
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Montréal, Quebec, Canada.,Centre de Recherche du CHUM (CRCHUM), Montréal, Quebec, Canada
| | - François Ghiringhelli
- Cancer Biology Transfer Platform, Centre Georges-François Leclerc, Dijon, France.,Centre de Recherche INSERM LNC-UMR1231, Dijon, France.,Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Arielle Elkrief
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Montréal, Quebec, Canada.,Centre de Recherche du CHUM (CRCHUM), Montréal, Quebec, Canada
| | - Antoine Desilets
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Montréal, Quebec, Canada.,Centre de Recherche du CHUM (CRCHUM), Montréal, Quebec, Canada
| | | | - Fabio Cumbo
- Department CIBIO, University of Trento, Trento, Italy
| | - Aitor Blanco
- Department CIBIO, University of Trento, Trento, Italy
| | - Romain Boidot
- Unit of Molecular Biology, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, Dijon, France
| | - Sandy Chevrier
- Unit of Molecular Biology, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, Dijon, France
| | | | - Guido Kroemer
- Gustave Roussy Cancer Campus, Villejuif, France.,UPR 4466, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, INSERM U1138, Equipe labellisée-Ligue contre le cancer, Université de Paris, Institut Universitaire de France, Paris, France.,Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Laurie Alla
- Université Paris-Saclay, INRAE, MGP, Jouy en Josas, France
| | - Nicolas Pons
- Université Paris-Saclay, INRAE, MGP, Jouy en Josas, France
| | | | | | - Hugo Roume
- Université Paris-Saclay, INRAE, MGP, Jouy en Josas, France
| | | | - Nicole Bouchard
- Centre Hospitalier de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Meriem Messaoudene
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Hematology-Oncology Division, Montréal, Quebec, Canada.,Centre de Recherche du CHUM (CRCHUM), Montréal, Quebec, Canada
| | | | - Eric Deutsch
- Gustave Roussy Cancer Campus, Villejuif, France.,Université Paris-Saclay, Ile-de-France, France.,Department of Radiation Oncology, Gustave Roussy, Villejuif, France.,INSERM U1030, Radiothérapie Moléculaire et Innovation Thérapeutique, Villejuif, France
| | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, Villejuif, France.,Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - David Planchard
- Gustave Roussy Cancer Campus, Villejuif, France.,Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy.,European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Stéphanie Martinez
- Service des Maladies Respiratoires, Centre Hospitalier d'Aix-en-Provence, Aix-en-Provence, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus, Villejuif, France. .,Institut National de la Santé Et de la Recherche Médicale (INSERM) U1015, Equipe Labellisée, Ligue Nationale contre le Cancer, Villejuif, France. .,Université Paris-Saclay, Ile-de-France, France. .,Center of Clinical Investigations in Biotherapies of Cancer (BIOTHERIS) 1428, Villejuif, France.
| | | | - Benjamin Besse
- Gustave Roussy Cancer Campus, Villejuif, France.,Cancer Medicine Department, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Ile-de-France, France
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Chiche L, Faralli H, Stavris C, Rebaudet S, Allemand J, Cohen F, Balma D, Pegliasco H, Drouet H, Delord M, Halfon P, Retornaz F. Séquelles physiques et psychiques 3–6 mois après la COVID-19 : premiers résultats de la cohorte prospective ALCOVID. Rev Med Interne 2021. [PMCID: PMC8610705 DOI: 10.1016/j.revmed.2021.10.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Patients et méthodes Résultats Conclusion
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Leca V, Kassambara A, Ghezali L, Outters P, Cotteaux-Lautard C, Arnoux F, Sbarrato T, Monville F, Monville F, Ray ML, Roumieux M, Garcia S, Malkoun R, Resseguier N, Boyer A, Lebas L, Pegliasco H, Barré P, Audigier-valette C, Zahi S, Odier L, Hominal S, Perol M, Mazieres J, Greillier L, Barlesi F, Fieschi-Meric J. 460 Spatial distribution of infiltrating T lymphocytes with Immunoscore® CR T cells exhaustion test helps stratification of NSCLC patients treated with PD1/PDL1 inhibitors in the PIONeeR project. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundPD1/L1 Immune Checkpoint Inhibitors (ICI) have significantly improved long-term outcome in about 20% of advanced Non Small Cells Lung Cancer (NSCLC) patients (pts), but 80% present primary or secondary resistance. The PIONeeR project (NCT03493581) aims to predict the response/resistance to PD1/L1 ICIs in advanced NSCLC pts through a comprehensive agnostic multiparametric and longitudinal biomarkers assessment. Data presented here are a focus on the quantification of tumor infiltration by lymphocytes, their activation as potential markers of the resistance to treatment by ICI.MethodsAdvanced NSCLC pts with available archived tumor tissue at screening visit (VS), treated with standard PD1/L1 ICIs (nivolumab, pembrolizumab or atezolizumab), alone (2nd line or more) or combined with chemotherapy (1st line), were re-biopsied at 6 weeks (V2) of treatment. PD1/L1 ICIs overall response rate (ORR) was assessed by RECIST 1.1 every 6 weeks. The multiplex IHC test ”Immunoscore® CR T Cells Exhaustion” (IS TCE) quantifies cytotoxic lymphocytes expressing three checkpoints: PD1, LAG3, TIM3, extrapolating their exhaustion status, both in the stroma and parenchyma. The unsupervised neural-network-based machine learning algorithm SOM (Self-Organizing Maps) was used to classify samples based on the 27 IS TCE variables. Statistical significance of survival differences between groups was evaluated using the log-rank test.ResultsAmong the first 100 pts, (male (64%), smokers (91,8%), <70yrs (69%), with an ECOG PS0/1 (97%), treated in 2nd line setting (86%)), 79 VS + 30 V2 biopsies were tested with IS TCE. SOM clustering highlighted four distinct clusters: a group with moderate T-cells infiltration (group 1), hot tumors with high T cells infiltration in both stroma and parenchyma (group 2), cold tumors with very low T cells infiltration (group 3), and finally, a highly distinguishable group with important T-cells density in stroma only (group 4). None of the 11 responders was present in the Group 3, ”Cold” cluster. The four groups presented different Progression Free Survival (PFS) rates (p=5,2e-4) with better relapse-free survival Groups 1 and 2. Additionally, V2/VS ratios showed lymphocytes recruitment induced by the treatment in parenchyma only: no significant lymphocytes recruitment was observed in the stromal compartment. Interestingly, the most recruited lymphocyte populations expressed PD1.ConclusionsIS TCE test may help stratifying and predicting responders to anti PD1/L1 therapy through checkpoint expressing lymphocytes quantification and spatial distribution. Additional tests performed on the PIONeeR cohort to explore other aspects of the immune response to cancer should complete these results.AcknowledgementsThis work is supported by French National Research Agency (ANR-17-RHUS-0007), a partnership of AMU, APHM, AstraZeneca, Centre Léon Bérard, CNRS, HalioDx, ImCheck Therapeutics, Innate Pharma, Inserm, Institut Paoli Calmettes and sponsored by AP HM. Drug supply is funded by AstraZeneca. Special thanks to patients and families.Trial RegistrationNCT03493581Ethics ApprovalThe study is conducted in accordance with Good Clinical Practice and the French applicable regulatory requirements (Public Health Code, article L.1121-1/La loi n° 2012–300 du 5 mars 2012 relative aux recherches impliquant la personne humaine (dite loi Jardé), the applicable subject privacy requirements, and the ethical principles that are outlined in the Declaration of Helsinski. The study was approved by the French Ethic Committee, CPP Ouest II - Angers, ref. CPP: 2028/08, Ref ANSM (French competent authority) 2018020500208, 2018072600120, 2019083000148. Freely given written informed consent was signed and obtained from each individual participating in the study, before any study specific procedure was undertaken and after the provision of information about the study by the investigator during a physician-patient consultation and sufficient time for reflection.
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Halfon P, Penaranda G, Khiri H, Garcia V, Drouet H, Philibert P, Psomas C, Delord M, Retornaz F, Charpin C, Gonzales T, Pegliasco H, Allardet-Servent J. An optimized stepwise algorithm combining rapid antigen and RT-qPCR for screening of COVID-19 patients. PLoS One 2021; 16:e0257817. [PMID: 34555117 PMCID: PMC8460002 DOI: 10.1371/journal.pone.0257817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background & aim We investigated the combination of rapid antigen detection (RAD) and RT-qPCR assays in a stepwise procedure to optimize the detection of COVID-19. Methods From August 2020 to November 2020, 43,399 patients were screened in our laboratory for COVID-19 diagnostic by RT-qPCR using nasopharyngeal swab. Overall, 4,691 of the 43,399 were found to be positive, and 200 were retrieved for RAD testing allowing comparison of diagnostic accuracy between RAD and RT-qPCR. Cycle threshold (Ct) and time from symptoms onset (TSO) were included as covariates. Results The overall sensitivity, specificity, PPV, NPV, LR-, and LR+ of RAD compared with RT-qPCR were 72% (95%CI 62%–81%), 99% (95% CI95%–100%), 99% (95%CI 93%–100%), and 78% (95%CI 70%–85%), 0.28 (95%CI 0.21–0.39), and 72 (95%CI 10–208) respectively. Sensitivity was higher for patients with Ct ≤ 25 regardless of TSO: TSO ≤ 4 days 92% (95%CI 75%–99%), TSO > 4 days 100% (95%CI 54%–100%), and asymptomatic 100% (95%CI 78–100%). Overall, combining RAD and RT-qPCR would allow reducing from only 4% the number of RT-qPCR needed. Conclusions This study highlights the risk of misdiagnosing COVID-19 in 28% of patients if RAD is used alone. A stepwise analysis that combines RAD and RT-qPCR would be an efficient screening procedure for COVID-19 detection and may facilitate the control of the outbreak.
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Affiliation(s)
- Philippe Halfon
- Laboratoire Alphabio, Marseille, France
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
- * E-mail:
| | | | | | | | - Hortense Drouet
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Patrick Philibert
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Christina Psomas
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Marion Delord
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Frédérique Retornaz
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Caroline Charpin
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
| | - Thomas Gonzales
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Européen Marseille, Marseille, France
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Grimaud F, Penaranda G, Stavris C, Retornaz F, Brunel V, Cailleres S, Pegliasco H, Le Treut J, Grisoni V, Coquet E, Chiche L, Rognon A. Adverse Events Induced by PD-1/PD-L1 Inhibitors: A Real-World Single-Centre Experience with a Management-Based Approach. Ther Clin Risk Manag 2021; 17:669-677. [PMID: 34234443 PMCID: PMC8256379 DOI: 10.2147/tcrm.s308194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 01/11/2023] Open
Abstract
AIM To assess the efficacy and tolerance of programmed death-1 (PD-1) and PD-ligand 1 (PD-L1) inhibitors and the impact of a standardised management-based protocol in a real-world setting. PATIENTS AND METHODS Data from patients who had received anti-PD-(L)1 were collected from our pharmacy database. Clinical response and toxicity were assessed using RECIST criteria and CTCAE version 5.0, respectively. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method. Potential prognostic factors were identified using Cox's model. RESULTS A total of 196 patients and 201 lines of treatment were included (median age: 66 (range: 38-89) years). Types of cancer included non-small cell lung cancer (73%), transitional cell carcinoma (10%), renal cell carcinoma (6%), small cell lung cancer (5%), head and neck squamous cell carcinoma (4%) and classical Hodgkin's lymphoma (1%). Twenty-five (12%) patients had pre-existing autoimmune conditions. Our standardised management-based protocol included 129 (64%) patients. Objective response rate was 29%, median OS was 10 months (IQR: 7-15) and median PFS was 5 months (IQR: 1-22). Patients with an abnormal baseline complete blood count had a worse OS (HR=2.48 [95% CI: 1.24-4.96]; p=0.0103). Thirty-three (16%) patients experienced severe (grade 3 or 4) immune-related adverse event (irAE). There were three (1%) irAE-related deaths. AEs resolved faster when patients were assessed by an internist before anti-PD-(L)1 initiation (p=0.0205). CONCLUSION PD-1 and PD-L1 inhibitors are effective and safe in a real-world setting. Implementation of a standardised management-based protocol with internal medicine specialists is an effective way to optimise irAE management.
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Affiliation(s)
- Fabien Grimaud
- Department of Pharmacy, Hôpital Européen, Marseille, France
| | | | - Chloé Stavris
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | | | - Véronique Brunel
- Department of Haemato-Oncology, Hôpital Européen, Marseille, France
| | - Sylvie Cailleres
- Department of Haemato-Oncology, Hôpital Européen, Marseille, France
| | - Hervé Pegliasco
- Department of Pulmonology, Hôpital Européen, Marseille, France
| | | | | | - Emilie Coquet
- Department of Pharmacy, Hôpital Européen, Marseille, France
| | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | - Amélie Rognon
- Department of Pharmacy, Hôpital Européen, Marseille, France
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9
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Cohen F, Chiche L, Rebaudet S, Pegliasco H, Brunel V. [Incidental pneumonia on PET imaging]. Rev Med Interne 2020; 42:225-226. [PMID: 33160705 PMCID: PMC7642736 DOI: 10.1016/j.revmed.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/03/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Affiliation(s)
- F Cohen
- Service de radiologie, hôpital Européen, Marseille, France
| | - L Chiche
- Service de médecine interne, oncohématologie et maladies infectieuses, hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France.
| | - S Rebaudet
- Service de médecine interne, oncohématologie et maladies infectieuses, hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - H Pegliasco
- Service de pneumologie, hôpital européen, Marseille, France
| | - V Brunel
- Service de médecine interne, oncohématologie et maladies infectieuses, hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
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10
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Tamisier R, Treptow E, Joyeux-Faure M, Levy P, Sapene M, Benmerad M, Bailly S, Grillet Y, Stach B, Muir JF, Pegliasco H, Pépin JL. Impact of a Multimodal Telemonitoring Intervention on CPAP Adherence in Symptomatic OSA and Low Cardiovascular Risk. Chest 2020; 158:2136-2145. [DOI: 10.1016/j.chest.2020.05.613] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
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11
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Dalon F, Roche N, Belhassen M, Nolin M, Pegliasco H, Deslée G, Housset B, Devillier P, Van Ganse E. Dual versus triple therapy in patients hospitalized for COPD in France: a claims data study. Int J Chron Obstruct Pulmon Dis 2019; 14:1839-1854. [PMID: 31692478 PMCID: PMC6708389 DOI: 10.2147/copd.s214061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Purposes Following a hospitalization for COPD, dual and triple therapies were compared in terms of persistence and relations with outcomes (exacerbations, health care resource use and costs). Methods This was a historical observational database study. All patients aged ≥45 hospitalized for COPD between 2007 and 2015 were identified in a 1/97th random sample of French claims data. Patients receiving dual therapy within 60 days after hospitalization were compared to patients receiving triple therapy, after propensity score matching on disease severity. Results Of the 3,089 patients hospitalized for COPD, 1,538 (49.8%) received either dual or triple therapy in the 2 months following inclusion, and 1,500 (48.6%) had at least 30 days of follow-up available; 846 (27.4%) received dual therapy, and 654 (21.2%) received triple therapy. After matching, the number of exacerbations was 2.4 per year in the dual vs 2.3 in the triple group (p=0.45). Among newly treated patients (n=206), persistence at 12 months was similar in the dual and triple groups (48% vs 41%, respectively, p=0.37). As compared to patients on dual therapy, more patients on triple therapy received oral corticosteroids (49.1 vs 40.4%, p=0.003) or were hospitalized for any reason (67% vs 55.8%, p=0.0001) or for COPD (35.3 vs 25.1%, p=0.0002) during follow-up. Cost of care was higher for patients on triple than for those on dual therapy (€11,877.1 vs €9,825.1, p=0.01). Conclusion Following hospitalizations for COPD, patients on dual and triple therapy experienced recurrent exacerbations, limited adherence to therapies and high cost of care. Patients on triple therapy appeared more severe than those on dual therapy, as reflected by exacerbations and health care resource use.
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Affiliation(s)
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, AP-HP and Paris Descartes University (EA2511), Sorbonne Paris Cité, Paris, France
| | | | - Maëva Nolin
- Pharmacoepidemiology Department, PELyon, Lyon, France
| | | | - Gaëtan Deslée
- Pulmonary Department, INSERM U1250, Maison Blanche University Hospital, Reims, France
| | - Bruno Housset
- Pulmonary Department, CHI de Créteil, University Paris Est Créteil, Créteil, France
| | - Philippe Devillier
- Department of Airway Diseases, UPRES EA 220, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Eric Van Ganse
- Pharmacoepidemiology Department, PELyon, Lyon, France.,EA 7425 Hesper Health Services and Performance Research, Claude-Bernard University, Lyon, France.,Respiratory Medicine, Croix-rousse Hospital, Lyon, France
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12
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Raherison C, Didier A, Prud’homme A, Pegliasco H, Zard E, Sail L, Eid Antoun Z, Spinu L. Prise en charge de l’asthme et perception des médecins généralistes : données françaises de l’enquête internationale « GAPS » auprès des médecins (The Global Asthma Physician Survey). Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.013] [Citation(s) in RCA: 1] [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] [Indexed: 10/18/2022]
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13
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Stavris C, Charpin C, Halfon P, Retornaz F, Coquet E, Rognon A, Pegliasco H, Chiche L. Dépistage et prise en charge multidisciplinaire des complications auto-immunes de l’immunothérapie du cancer : une expérience monocentrique avec évaluation interniste systématique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.416] [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: 10/18/2022]
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14
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Palot A, Pegliasco H, Recorbet G, Conil P, Desruelles T, Charpin D, Donio V, Lacoste L, Briand Y, Chevalier E. Profil R′ : programme pluridisciplinaire de repérage de patients à risque de BPCO en pratique ambulatoire : impacts et enseignements. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.640] [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: 10/22/2022]
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15
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Fleury B, Cohen-Levy J, Lacassagne L, Buchet I, Geraads A, Pegliasco H, Gagnadoux F. [Treatment of obstructive sleep apnea syndrome using a mandibular advancement device]. Rev Mal Respir 2011; 27 Suppl 3:S146-56. [PMID: 21129623 DOI: 10.1016/s0761-8425(10)70020-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- B Fleury
- Service de Pneumologie, Hôpital Saint-Antoine, Groupement hospitalier, universitaire Est, Paris, France
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16
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Peretti-Watel P, Bendiane MK, Galinier A, Lapiana JM, Favre R, Pegliasco H, Obadia Y. Opinions toward pain management and palliative care: Comparison between HIV specialists and oncologists. AIDS Care 2010; 16:619-27. [PMID: 15223531 DOI: 10.1080/09540120410001716414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the introduction of HAART, pain is still a common symptom in people living with HIV/AIDS. For these persons, pain management supplied by palliative care teams may support standard HIV care. This study compares opinions toward palliative care of 83 HIV specialists and 217 oncologists (French national survey: Palliative Care 2002). Data were collected by phone questionnaire. A cluster analysis was carried out in order to identify contrasted profiles of opinions toward palliative care. A logistic regression was performed to test the relationships between identified clusters and physicians' characteristics. With a two-cluster partition, we observed a profile corresponding to a restrictive conception of palliative care. Within this profile, physicians were more prone to consider that palliative care should be used only for terminally-ill patients, and only after all curative treatments have failed, with a restrained prescriptive power for physicians providing palliative care. This conception was associated with reluctance toward morphine analgesia. Once controlled for other physicians' characteristics, HIV specialists were more likely than oncologists to endorse this restrictive conception (OR=1.9, CI 95% [1.1; 3.3]). Thus French HIV specialists should be more informed about the utility of providing palliative care, even for patients who are not in terminal stage.
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Affiliation(s)
- P Peretti-Watel
- Regional Centre for Disease Control of South-Eastern France, and Health and Medical Research National Institute, Research Unit 379, Social Sciences Applied to Medical Innovation, Institut Paoli Calmettes, Marseilles, France.
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17
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Charpin D, Gouitaa M, Dron-Gonzalvez M, Fardeau MF, Massabie-Bouchat YP, Hugues B, Fabre C, Vivinus S, Pegliasco H, André C. Immunotherapy with an Aluminum Hydroxide-Adsorbed Juniperus ashei Foreign Pollen Extract in Seasonal Indigenous Cypress Pollen Rhinoconjunctivitis. Int Arch Allergy Immunol 2007; 143:83-91. [PMID: 17228169 DOI: 10.1159/000098656] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/05/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The efficacy of standardized Juniperus ashei extract was assessed in patients with allergic rhinoconjunctivitis due to European cypress pollens. METHODS Forty adults with European cypress-allergic rhinoconjunctivitis were randomized to receive immunotherapy or a matched placebo. Specific immunotherapy was performed with a standardized, aluminum hydroxide-adsorbed J. ashei extract with a potency of 100 IR (arbitrary index of reactivity) containing 54 microg of Jun a 1/ml (Alustal, Stallergenes, France). Subcutaneous injections started in October 2000. The maintenance dose was 0.30 ml of the 100-IR concentration per month. Rhinitis and conjunctivitis symptoms were rated according to a 4-point score. RESULTS Seventeen patients from the treated group and 15 patients from the placebo group completed year 2001; 14 in each group completed year 2002. A statistically significant improvement (41%, p < 0.02) in the conjunctivitis symptom score was observed in actively treated patients compared to the placebo group at the peak of the 2001 pollen season. Improvement in rhinitis (17%) was not significant. This significant improvement was greater at the peak of the 2002 pollen season (63%, p < 0.01). CONCLUSIONS This study therefore indirectly validates the concept of treatment by major allergen because J. ashei is absent from the region in which this study was conducted.
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Affiliation(s)
- D Charpin
- Service de Pneumologie, Hôpital Nord, Marseille, France
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18
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Surpas P, Pradal M, Pegliasco H. Cas clinique : régression spontanée d’une bulle géante, un effet inattendu de la réhabilitation ? Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)71635-7] [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: 10/22/2022]
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19
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Ben Diane MK, Galinier A, Pegliasco H, Lapiana JM, Favre R, Peretti-Watel P, Obadia Y. [Doctors' opinions on palliative care: results from a French survey on physicians attitudes and practices]. Sante Publique 2005; 17:75-85. [PMID: 15835217 DOI: 10.3917/spub.051.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine practitioners' opinions on palliative care. METHOD Statistical analyses were carried out on data collected from 1000 physicians recruited to participate in a study on knowledge, attitudes and practices with respect to palliative care ("Palliative Care 2002"). A cluster analysis (CAH) was conducted based on responses to nine questions in order to identify homogeneous and contrasting profiles of opinions on palliative care. RESULTS Two distinctly different categories of profiles emerged. The first one had a restrictive approach to palliative care (n = 387; 38.7%), while the second one supported its expansion (n = 613; 61.3%). CONCLUSION A newly revised communication campaign which favoured and recognised palliative care could assist in the dissemination of related practices among physicians.
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Affiliation(s)
- M K Ben Diane
- Observatoire Régional de la Santé Provence Alpes-Côte-d'Azur, 23, rue Stanislas Torrents, 13006 Marseille, France
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20
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Peretti-Watel P, Bendiane MK, Obadia Y, Lapiana JM, Galinier A, Pegliasco H, Favre R, Moatti JP. Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians. J Palliat Med 2005; 8:280-90. [PMID: 15890039 DOI: 10.1089/jpm.2005.8.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disclosure of the prognosis to terminally ill patients is a strong prerequisite for integrating the physical, psychological, spiritual, and social aspects of end-of-life care. OBJECTIVE This study aimed to assess French physicians' general attitudes and effective practices (with patients followed up to death recently) toward such disclosure. DESIGN/SUBJECTS We used data from a cross-sectional survey conducted among a national sample of 917 French general practitioners, oncologists, and neurologists. RESULTS A majority of respondents opted for prognosis disclosure only at patients' request, very few opted for systematic disclosure without patient's request, and a significant minority opted for systematic concealment. Concerning deceased patients described by respondents, 44.5% of competent patients were informed of prognosis by their physician, 27.3% were informed by someone else, 9.0% refused to be informed, and 19.2% were simply not informed. Concealment was more frequent for older patients, and physicians involved in a nongovernmental organization (NGO) for patients' support were more likely to disclose the prognosis, even without patient's request. CONCLUSIONS Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.
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Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 23 rue Stanislas Torrents, 13006 Marseille, France.
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21
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Ben Diane MK, Peretti-Watel P, Lapiana JM, Favre R, Galinier A, Pegliasco H, Obadia Y. [Opinion of general and specialized physicians toward euthanasia. Results from the French survey on attitudes and practices against palliative care, 2002]. Ann Med Interne (Paris) 2003; 154:441-7. [PMID: 14732835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES To evaluate opinion of physicians about the legalization of euthanasia according to their professional characteristics, their attitudes toward morphine, their attitudes toward communication with end-of-life patients, and their perception of specific types of terminal care. METHOD Univariate and multivariate analyses were carried out from data collected among 1.000 general practitioners, oncologists, neurologists and HIV specialists (French cross-sectional survey on palliative care, 2002). RESULTS 42.5% of physicians agreed with the statement that euthanasia should be legalized as it is already the case in the Netherlands. Inadequate prescription of morphine and calling terminal sedation as active euthanasia were associated with a favorable opinion toward legalization of euthanasia. CONCLUSION Specific training on pain management and terminal sedation would help physicians to have a better view of the problem of euthanasia.
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Affiliation(s)
- Marc K Ben Diane
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 23, rue Stanislas-Torrents, 13006 Marseille.
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22
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Peretti-Watel P, Bendiane MK, Pegliasco H, Lapiana JM, Favre R, Galinier A, Moatti JP. Doctors' opinions on euthanasia, end of life care, and doctor-patient communication: telephone survey in France. BMJ 2003; 327:595-6. [PMID: 12969926 PMCID: PMC194087 DOI: 10.1136/bmj.327.7415.595] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Peretti-Watel
- Regional Center for Disease Control of South-Eastern France, 13006 Marseille, France.
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23
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Ben Diane MK, Pegliasco H, Galinier A, Lapiana JM, Favre R, Peretti-Watel P, Obadia Y. [Terminal care of patients by the general practitioner and the specialist. Results of a French survey "Attitudes and practices in palliative treatment--2002"]. Presse Med 2003; 32:488-92. [PMID: 12733386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE Assess the attitude of the practitioners with regard to the management of patients at the end of their lives, depending on the physician/patient communication and treatment of pain. Method Statistical analysis of the data collected among 1,000 practitioners recruited for a survey on knowledge, attitudes and practices regarding palliative care in 2002. RESULTS The practitioners who felt "ill at ease" in the management of patients at the end of their life often had a poor opinion regarding morphine and did not systematically their patients of the therapeutic aims. CONCLUSION Greater awareness by the practitioners of palliative care would help to improve the quality of care supplied to terminally ill patients.
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Affiliation(s)
- M K Ben Diane
- Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Unité 379 de I'INSERM, Marseille (13).
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24
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Serrano E, Demoly P, Pegliasco H, Percodani J. [Why is allergic rhinitis currently at the centre of a debate?]. Rev Laryngol Otol Rhinol (Bord) 2003; 124:269-75. [PMID: 15038572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
MESH Headings
- Adolescent
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Asthma/complications
- Child
- Histamine H1 Antagonists/therapeutic use
- Humans
- Incidence
- Inflammation
- Prevalence
- Prognosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Terminology as Topic
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Affiliation(s)
- Elie Serrano
- CHU Toulouse, Hôpital Larrey, Service d'ORL et de Chirurgie Cervico-Faciale, TSA 30030, F-31059 Toulouse 9, France
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25
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Pegliasco H. [Compliance: challenges in asthma management?]. Rev Pneumol Clin 2002; 58:1S17-1S18. [PMID: 12458321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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