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Merle V, Hallais C, Savoye G, Scotté M, Wurtz B, Blot J, Froment L, Lerebours E, Czernichow P. La revue des réadmissions imprévues permet-elle d’améliorer la qualité des soins ? Étude pilote de faisabilité dans deux services cliniques. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hallais C, Bailly L, Coussens E, Mercier A, Froment L, Merle V, Godard J, Czernichow P. Comment assurer la qualité de surveillance des patients traités pour cancer de la prostate ? Enquête en Haute-Normandie. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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53
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Hallais C, Moreau A, Merle V, Guitard PG, Haghighat S, Thillard D, Tavolacci MP, Veber B, Czernichow P. Évaluation coût–efficacité de l’utilisation de sondes d’intubation à aspiration sous-glottique pour la prévention des pneumopathies sous ventilation. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Merle V, Marini H, Rongère J, Scotté M, Tavolacci MP, Czernichow P. Une plaquette d’information sur les infections du site opératoire (ISO) permet-elle d’améliorer le souvenir de l’information et la satisfaction des patients ? Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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55
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Marini H, Merle V, Frébourg N, Godier S, Bastit D, Benadiba L, Menguy E, Quesney M, Plissonnier D, Czernichow P. Mycoplasma hominis wound infection after a vascular allograft. J Infect 2008; 57:272-4. [PMID: 18649944 DOI: 10.1016/j.jinf.2008.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 05/14/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
Cases of Mycoplasma hominis infections after allograft are rare. We report a case of M. hominis wound infection after a vascular allograft. The allograft was positive before having any contact with the recipient, and our investigation suggests that M. hominis may have been transmitted from the donor to the recipient. It is not clear, however, whether specific diagnosis of M. hominis should be performed on tissue before grafting in order to prevent such donor-to-host transmission.
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Merle V, Hallais C, Wurtz B, Blot J, Daubert H, Froment L, Josset V, Savoye G, Scotté M, Czernichow P. La création du dossier informatisé de séjour avant l’admission est-elle un bon marqueur de programmation des réadmissions ? Étude dans un pôle médical d’activité de CHU. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Carricaburu D, Lhuilier D, Merle V. Quand soigner rend malade : des soignants face au risque infectieux à l'hôpital. SANTE PUBLIQUE 2008. [DOI: 10.3917/spub.080.0057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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58
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Merle V, Tavolacci MP, Moreau A, Dubreuil N, Dollois B, Gray C, Kerleau K, Théry S, Czernichow P. What factors influence healthcare professionals' opinion and attitude regarding information for patients about hospital infection? J Hosp Infect 2007; 66:269-74. [PMID: 17574303 DOI: 10.1016/j.jhin.2007.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 04/26/2007] [Indexed: 11/28/2022]
Abstract
Although informing patients about medical risks is said to decrease the number of malpractice claims, most inpatients receive no information about hospital infection. Using a self-administered questionnaire, we surveyed 1270 healthcare workers randomly selected from 22 French hospitals to assess their opinion on information for patients about hospital infection risks, and their practice of informing patients with, or without, hospital infection. The influence of healthcare worker characteristics on opinion and practice was assessed using logistic regression. Response rate was 87.2%. Although 85.4% supported giving more information, only 17.0% routinely informed non-infected patients and 31.6% informed infected patients about infection. Attitudes were influenced by healthcare worker characteristics and environmental factors. Knowledge of obligations influenced practice when informing non-infected patients, but not those with hospital-acquired infection. Further research is needed to help healthcare professionals improve risk communication and disclosure of hospital infection.
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Tavolacci MP, Marini H, Vanheste S, Merle V, Coulon AM, Micaud G, Czernichow P. A voluntary ingestion of alcohol-based hand rub. J Hosp Infect 2007; 66:86-7. [PMID: 17350719 DOI: 10.1016/j.jhin.2007.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 01/17/2007] [Indexed: 11/23/2022]
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Tavolacci MP, Merle V, Pitrou I, Thillard D, Serra V, Czernichow P. Alcohol-based hand rub: influence of healthcare workers' knowledge and perception on declared use. J Hosp Infect 2006; 64:149-55. [PMID: 16891041 DOI: 10.1016/j.jhin.2006.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
Handrubbing with alcohol-based hand rub (AHR) is a validated alternative to handwashing. The aims of this study were to compare knowledge and declared use of AHR between different categories of healthcare worker (HCW), and to assess factors associated with the use of AHR. A standardized questionnaire was sent to all HCWs in a tertiary care university hospital. The following data were collected for each HCW: job title (physician, nurse, nursing assistant or other), sources of information about AHR; knowledge and perception of AHR and declared use of AHR in daily practice instead of unmedicated or antiseptic soap. Of 5238 questionnaires, 1811 were returned. Physicians had better knowledge about AHR than other HCWs. HCWs' knowledge of AHR efficacy and skin tolerance were independently associated with the use of AHR instead of unmedicated or antiseptic soap. The declared use of AHR differed according to professional category.
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Merle V, Germain J, Tavolacci M, Brocard C, Chefson-Girault C, Cyvoct C, De Quin-Gorce M, Édouard S, Guet L, Martin E, Czernichow P. C1-3 - L’indice composite des activités de lutte contre les infections nosocomiales (ICALIN): connaissances et attitude des patients et des usagers. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Germain J, Merle V, Tavolacci M, Astagneau P, Czernichow P. C1-2 - Qualité des données servant au calcul de l’Indice composite des activités de lutte contre les infections nosocomiales (ICALIN). Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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63
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Josset V, Riou F, Moret L, Beuret-Blanquart F, Pascal M, Ferreol S, van Doren C, Berard M, Micaud G, Marc F, Gallien P, Merle V, Petit J, Lombrail P, Czernichow P. P3-5 - Comparaison de « performances » entre équipes d’établissements de santé : exemple des patients admis en soins de suite et de réadaptation (SSR) — Projet INPEC (H). Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Merle V, Tavolacci M, Moreau A, Dubreuil N, Dollois B, Gray C, Kerleau K, Théry S, Czernichow P. C1-4 - Information des patients sur les infections nosocomiales : connaissances, attitudes et opinions des professionnels de santé. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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65
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Ladner J, Delbos V, Dauchet L, Tavolacci M, Merle V, Czernichow P. P9-8 - Un enseignement d’épidémiologie basé sur la lecture critique d’article (LCA) dans le second cycle des études médicales : Expérience à l’UFR de Médecine de Rouen, 2003-2005. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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66
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Tavolacci M, Merle V, Thillard D, Czernichow P. E1-5 - Connaissances et pratiques d’utilisation des Produits hydro-alcooliques (PHA) pour l’hygiène des mains chez les médecins et les soignants dans un Centre Hospitalier Universitaire. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76856-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tavolacci MP, Pitrou I, Merle V, Haghighat S, Thillard D, Czernichow P. Surgical hand rubbing compared with surgical hand scrubbing: comparison of efficacy and costs. J Hosp Infect 2006; 63:55-9. [PMID: 16517006 DOI: 10.1016/j.jhin.2005.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 11/22/2005] [Indexed: 11/16/2022]
Abstract
The aim of this study was to compare the efficacy of surgical hand rubbing (SHR) with the efficacy of surgical hand scrubbing (SHS), and to determine the costs of both techniques for surgical hand disinfection. A review of studies reported in the literature that compared the efficacy of SHS and SHR was performed using MEDLINE. The costs of SHR and SHS were estimated based on standard hospital costs. The literature showed that SHR had immediate efficacy that was similar to that of SHS, but SHR had a more lasting effect. SHR reduced costs by 67%. In conclusion, SHR is a cost-effective alternative to SHS.
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Déchelotte P, Hasselmann M, Cynober L, Allaouchiche B, Coëffier M, Hecketsweiler B, Merle V, Mazerolles M, Samba D, Guillou YM, Petit J, Mansoor O, Colas G, Cohendy R, Barnoud D, Czernichow P, Bleichner G. L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study. Crit Care Med 2006; 34:598-604. [PMID: 16505644 DOI: 10.1097/01.ccm.0000201004.30750.d1] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. DESIGN Prospective, double-blind, controlled, randomized trial. SETTING ICUs in 16 hospitals in France. PATIENTS One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11). INTERVENTIONS Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days. MEASUREMENTS AND MAIN RESULTS Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group. CONCLUSIONS TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
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Merle V, Hallais C, Tavolacci MP, Damm C, Thillard D, Veber B, Czernichow P. Validity of medical staff assessment at admission of patient's risk of nosocomial infection: a prospective study in a surgical intensive care unit. Intensive Care Med 2006; 32:915-8. [PMID: 16601962 DOI: 10.1007/s00134-006-0153-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2005] [Accepted: 03/10/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the ability of a surgical intensive care unit (SICU) medical staff to assess at admission the individual risk of nosocomial infection (NI) during SICU stay in patients admitted for at least 48 h. DESIGN Prospective observational study. SETTING A tertiary-care university hospital. PATIENTS AND PARTICIPANTS 201 admissions to the SICU from November 19, 2003, until April 16, 2004. MEASUREMENTS AND RESULTS Assessment by medical staff at admission of each patient's estimated risk of NI (pneumonia, venous central catheter-related infection, symptomatic urinary tract infection, and bacteremia) during SICU hospitalization, in order to classify patients into four groups: NI risk very low or absent (group 1), low (group 2), high (group 3), very high or certain (group 4). NI was diagnosed via routine surveillance according to Centers for Disease Control case definitions. RESULTS 154 patients were assessed; the percentage of patients with NI increased with estimated risk at admission, from 0% in group 1 to 14.3% in group 4. Positive predictive value of medical assessment varied from 8.4% to 14.5%, according to the cutoff value. Negative predictive value varied from 92.1% to 100%. CONCLUSION Our study suggests that ICU physicians encounter a major difficulty when informing patients or patients' families about the risk of NI occurrence, as they cannot predict this risk accurately. This limitation should be explained to patients and their families.
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Auvin S, Molinié F, Gower-Rousseau C, Brazier F, Merle V, Grandbastien B, Marti R, Lerebours E, Dupas JL, Colombel JF, Salomez JL, Cortot A, Turck D. Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988-1999). J Pediatr Gastroenterol Nutr 2005; 41:49-55. [PMID: 15990630 DOI: 10.1097/01.mpg.0000162479.74277.86] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the incidence and location at diagnosis of inflammatory bowel disease in children and adolescents in northern France between 1988 and 1999. METHODS A 12-year prospective population-based study was conducted by gastroenterologists and pediatric gastroenterologists of northern France (1,312,141 children <17 years of age). RESULTS From 1988 to 1999, 509 cases of childhood inflammatory bowel disease were recorded (7.2% of all inflammatory bowel disease cases in Northern France): 367 Crohn disease, 122 ulcerative colitis and 20 indeterminate colitis. The mean standardized incidence was 3.1/10(5) for inflammatory bowel disease as a whole (2.3 for Crohn disease, 0.8 for ulcerative colitis and 0.12 for indeterminate colitis). Crohn disease location at diagnosis was: small bowel and colon (71%), colon only (10%) and small bowel only (19%). Location of initial ulcerative colitis was: proctitis (11%), left colitis (57%) and pancolitis (32%). Although ulcerative colitis incidence remained stable (0.8), Crohn disease incidence increased from 2.1 in 1988 to 1990 to 2.6 in 1997 to 1999 (P = 0.2). CONCLUSIONS The incidence of Crohn disease in the children of northern France showed an increasing trend (20%; not significant) during the 12-year period while the incidence of ulcerative colitis remained stable. In the entire population(children and adults)the incidence of Crohn disease increased significantly (+23%; P < 0.001), while the incidence of ulcerative colitis decreased (-17%; P < 0.0001).
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Di Fiore F, Lecleire S, Merle V, Hervé S, Duhamel C, Dupas JL, Vandewalle A, Bental A, Gouerou H, Le Page M, Amouretti M, Czernichow P, Lerebours E. Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study. Eur J Gastroenterol Hepatol 2005; 17:641-7. [PMID: 15879726 DOI: 10.1097/00042737-200506000-00008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the main changes in characteristics, practices and outcome between 1996 and 2000 in patients admitted for an acute upper gastrointestinal haemorrhage (AUGIH). PATIENTS AND METHODS All consecutive patients (n=1165) admitted for an AUGIH in four French administrative areas were entered into two separate 6-month studies conducted in 1996 (n=712) and 2000 (n=453). Epidemiological and biological characteristics, endoscopic haemostatic procedures and outcomes were compared. RESULTS Patient characteristics remained unchanged between the two studies; the two main bleeding lesions were peptic ulcer and oesophagogastric varices (30.2 versus 31.1% and 22.5 versus 20.3%). The use of non-steroidal anti-inflammatory drugs or aspirin was more frequent in 2000 (26.5 versus 32.6%; P<0.03). Proton pump inhibitor preventative therapy was administered in less than 15% of patients with a high risk of peptic ulcer bleeding in each period. In patients admitted for varices bleeding, the use of endoscopic haemostatic ligation increased (17.1 versus 40%; P<0.001), with a concomitant decrease in endoscopic sclerotic therapy (76.1 versus 37.5%; P<0.001). We observed a significant decrease in AUGIH mortality in the whole group (11.7 versus 7.2%; P=0.03), and particularly in the subgroup of cirrhotic patients (19.5 versus 11.1%; P=0.05) whatever the source of their bleeding. CONCLUSION Our time-trend evaluation of changes in AUGIH characteristics revealed that peptic ulcer and varices were still the two most frequent bleeding lesions. In patients with varices bleeding, endoscopic ligation became the routine standard treatment instead of varices sclerosis. The mortality rate decreased significantly over the 5-year study period in the whole group and particularly in the subgroup of cirrhotic patients.
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Merle V, Van Rossem V, Tavolacci MP, Czernichow P. Knowledge and opinions of surgical patients regarding nosocomial infections. J Hosp Infect 2005; 60:169-71. [PMID: 15866016 DOI: 10.1016/j.jhin.2004.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Accepted: 09/09/2004] [Indexed: 11/16/2022]
Abstract
UNLABELLED Sixty-five inpatients in various surgery departments were questioned about their knowledge and opinions regarding nosocomial infection, the information they were given on nosocomial infection, and their supposed attitude should they contract a nosocomial infection. RESULTS Seventeen (26%, [16-39%]) were able to describe nosocomial infections as infections acquired in hospital. Identification of nosocomial infections as hospital-acquired infections was significantly associated with a high educational level and with having a member of their own family working in a health-related field. Fifty-two patients (80.0%, [68.2-88.9%]) stated that during their hospitalization they had received no information concerning nosocomial infections and 50 patients (76.9% [64.8-86.5]) mentioned that patients would welcome information about nosocomial infections. Thirty-three patients [50.8, 95% CI(38.6-62.9%)] declared that they would seek legal action against the hospital should they contract a nosocomial infection. There was a trend toward a higher probability of legal action in patients who rated their own risk of nosocomial infection as low or absent versus those who rated their own risk of nosocomial infection as medium or high (58.0% vs. 28.6%, p=0.051). The intention of seeking legal action against the hospital in case of nosocomial infection was not significantly influenced by patients' opinion regarding nosocomial infection preventability.
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Czernichow P, Merle V. [Epidemiology of digestive complications associated with use of low-dose aspirin]. ACTA ACUST UNITED AC 2005; 28 Spec No 3:C37-44. [PMID: 15366673 DOI: 10.1016/s0399-8320(04)95277-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Low-dose aspirin (< 330 mg/d) is recommended for the prevention of myocardial infarction or ischemic stroke. Six to 12% of the general population is exposed to low-dose aspirin. The most frequently studied digestive complications are bleeding peptic ulcers, whose risk is increased twofold by low-dose aspirin treatment, and non-complicated peptic ulcers. History of bleeding or non-complicated peptic ulcer, alcohol intake, concomitant treatment with NSAID or calcic inhibitors are demonstrated risk factors of bleeding ulcer associated with low-dose aspirin. The role of enteric coating, of low-dose aspirin dose, of delay since low-dose aspirin treatment onset, and of Helicobacter pylori infection, remains controversial. Antisecretory drugs (H2 inhibitors, proton pump inhibitors), and nitroglycerin are associated with a decreased risk of bleeding ulcer. The protective effect of COX-2 inhibitors on the risk of bleeding ulcer is suppressed by concomitant treatment with low-dose aspirin. The risk of no- complicated peptic ulcer was increased by low-dose aspirin intake by a factor 2.9 in one study. Low-dose aspirin dose, infection by Helicobacter pylori, NSAID intake, and absence of enteric coating, are possible risk factors for non-complicated peptic ulcer. No association was retrieved with alcohol intake and peptic ulcer history.
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Lecleire S, Di Fiore F, Merle V, Hervé S, Duhamel C, Rudelli A, Nousbaum JB, Amouretti M, Dupas JL, Gouerou H, Czernichow P, Lerebours E. Acute upper gastrointestinal bleeding in patients with liver cirrhosis and in noncirrhotic patients: epidemiology and predictive factors of mortality in a prospective multicenter population-based study. J Clin Gastroenterol 2005; 39:321-7. [PMID: 15758627 DOI: 10.1097/01.mcg.0000155133.50562.c9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS To assess epidemiologic features and predictive factors of mortality of acute upper gastrointestinal bleeding (UGIB). STUDY During a 6-month period, a prospective population-based study including all the UGIB occurring in a geographic area of 3 million people was conducted. Data from cirrhotic patients were compared with those of noncirrhotic patients. RESULTS A total of 2,133 UGIB were recorded, 21.9% in cirrhotic patients (n = 468). Endoscopic hemostasis was performed in 46.5% and 8.3% in cirrhotic and noncirrhotic patients, respectively (P < 0.001). Mortality during hospitalization was 23.5% in cirrhotic patients and 11.2% in noncirrhotic patients (P < 0.001). Six independent predictive factors of mortality were observed in both patient groups: a prothrombin level less than 40%, an UGIB occurring in inpatients, a concomitant digestive carcinoma, a hematemesis revealing the UGIB, a recent use of steroid drugs, and age over 60 years. Four other predictive factors of mortality were also identified in noncirrhotic patients. CONCLUSIONS Although epidemiologic features, clinical course, management, and prognosis of UGIB were quite different in cirrhotic and noncirrhotic patients, the majority of predictive factors of mortality were the same in both patient groups. These data underline the major role of debilitated status and hepatic failure in the prognosis of UGIB in cirrhotic patients.
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Baron S, Turck D, Leplat C, Merle V, Gower-Rousseau C, Marti R, Yzet T, Lerebours E, Dupas JL, Debeugny S, Salomez JL, Cortot A, Colombel JF. Environmental risk factors in paediatric inflammatory bowel diseases: a population based case control study. Gut 2005; 54:357-63. [PMID: 15710983 PMCID: PMC1774426 DOI: 10.1136/gut.2004.054353] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Environmental exposures in early life have been implicated in the aetiology of inflammatory bowel disease. OBJECTIVE To examine environmental risk factors prior to the development of inflammatory bowel disease in a paediatric population based case control study. METHODS A total of 222 incident cases of Crohn's disease and 60 incident cases of ulcerative colitis occurring before 17 years of age between January 1988 and December 1997 were matched with one control subject by sex, age, and geographical location. We recorded 140 study variables in a questionnaire that covered familial history of inflammatory bowel disease, events during the perinatal period, infant and child diet, vaccinations and childhood diseases, household amenities, and the family's socioeconomic status. RESULTS In a multivariate model, familial history of inflammatory bowel disease (odds ratio (OR) 4.3 (95% confidence interval 2.3-8)), breast feeding (OR 2.1 (1.3-3.4)), bacille Calmette-Guerin vaccination (OR 3.6 (1.1-11.9)), and history of eczema (OR 2.1 (1-4.5)) were significant risk factors for Crohn's disease whereas regular drinking of tap water was a protective factor (OR 0.56 (0.3-1)). Familial history of inflammatory bowel disease (OR 12.5 (2.2-71.4)), disease during pregnancy (OR 8.9 (1.5-52)), and bedroom sharing (OR 7.1 (1.9-27.4)) were risk factors for ulcerative colitis whereas appendicectomy was a protective factor (OR 0.06 (0.01-0.36)). CONCLUSIONS While family history and appendicectomy are known risk factors, changes in risk based on domestic promiscuity, certain vaccinations, and dietary factors may provide new aetiological clues.
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Tavolacci MP, Merle V, Dupuis M, Van Doren C, Josset V, Houdent G, Lemeland JF, Czernichow P. Choix d’une stratégie de dépistage du Staphylococcus aureus résistant à la méticilline à l’admission en service de soins de suite et de réadaptation. Presse Med 2004; 33:1575-8. [PMID: 15685108 DOI: 10.1016/s0755-4982(04)98995-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To identify a strategy of MRSA screening (methicillin-resistant Staphylococcus aureus) on admission to geriatric rehabilitation units, which would lead to acceptable efficacy and cost compared with a reference maximaliste strategy combining all six sampling sites. Method MRSA screening was conducted prospectively for 3 months in all the patients admitted to a geriatric follow-up and rehabilitation unit, using samples from the nostrils, armpits, urine scars cutaneous ulcers and sores. Six strategies were defined combing different sampling sites. Their efficacy and cost were compared with those of a maximaliste strategy combining the 6 sampling sites. RESULTS Combined screening of all six sites was the most effective but also the most expensive strategy. The least expensive strategy used only samples from ulcers and sores, but its efficacy was of only 45%. The strategy with the lowest loss of efficacy compared to the reference strategy combined the sampling of ulcers and sores and sampling from the nostrils: it was efficient in 91% and its cost was 2.5 fold lower than the cost of the reference strategy. DISCUSSION A preliminary, short term study established an MRSA screening strategy adapted to the specificities of a geriatric rehabilitation unit and its recruitment. The ability to define the optimal strategy for MRSA screening in a geriatric rehabilitation and follow-up unit may be an important factor in controlling the diffusion of MRSA.
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Josset V, Chamouni P, Tavolacci MP, Merle V, Delbos V, Froment L, Ladner J, Ounnoughene N, Czernichow P. [Efficiency of hepatitis C virus screening before and after blood transfusion]. Transfus Clin Biol 2004; 11:186-91. [PMID: 15564099 DOI: 10.1016/j.tracli.2004.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED Efficiency of a viral hepatitis C screening strategy before and after blood transfusion has to be evaluated. METHODS Four screening strategies were virtually applied to the population of transfused patients at Rouen University Hospital during 1996 and then compared : the first without any systematic HCV screening test; the second with systematic testing both before and 3 months after transfusion; the third with systematic testing both before and 6 months after transfusion ; the last defined as systematic testing before transfusion only. The efficacy (i.e. number of positive tests), the efficiency (i.e. average cost per positive test) and the marginal costs of moving from a strategy to another one were assessed using decision analysis. RESULTS The efficacy of systematic screening test before transfusion only (361 per positive test), systematic testing both before and three months after (523 per positive test) or six months after (488 per positive test) transfusion was similar, but the efficacy of the strategy without any systematic screening test (385 per positive test) was lower. The systematization of screening test both before, and three months, or 6 months after transfusion lead to a marginal cost of 619 , and 559 per positive test respectively. The systematization of testing before transfusion only lead to a marginal cost of 343 per positive test. Adding systematic testing after transfusion lead to a marginal cost of 5824 per positive test. CONCLUSION Systematic screening tests before transfusion only can be considered as the most efficient strategy.
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Josset V, Chamouni P, Merle V, Tavolacci MP, Froment L, Daubert H, Ladner J, Czernichow P. [Survival after blood transfusion: a study at Rouen university hospital]. Transfus Clin Biol 2004; 11:199-204. [PMID: 15564101 DOI: 10.1016/j.tracli.2004.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED The aim of this study was to estimate short term survival rate after blood transfusion according to various criteria. PATIENTS AND METHODS Patients admitted and transfused from January, 1 until June, 30 1996 at Rouen university hospital were retrospectively included, and their status (alive or dead) was determined. The characteristics of patients admitted and transfused were compared to the overall population of inpatients. Independent factors associated with mortality six months after blood transfusion were evaluated using Cox model. RESULTS During the study period, 1887 patients were transfused. These patients were older, more often admitted in surgical or in intensive care units, and had a longer duration of stay, than the overall inpatients population. The survival rate at six months in transfused patients was 76.1%. Mortality rate at six months was independently higher in patients aged 75 and older, in men, in patients admitted in intensive care units, or transfused with homologous fresh-frozen plasma or packed platelet blood cells. Mortality rate was lower in patients who underwent a surgical procedure, in children under 16, and in patients whose stay was classified in "Circulatory system disorders", "Musculoskeletal system and connective tissues disorders or trauma", or "Injuries, allergy or poisoning". CONCLUSION In this study implemented in a teaching hospital inpatients receiving blood transfusion, the survival was mainly associated with the severity and characteristics of the diseases requiring transfusion.
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Josset V, Torre JP, Tavolacci MP, Van Rossem-Magnani V, Anselme K, Merle V, Godart J, Libert A, Ladner J, Czernichow P. Efficiency of hepatitis C virus screening strategies in general practice. ACTA ACUST UNITED AC 2004; 28:351-7. [PMID: 15146150 DOI: 10.1016/s0399-8320(04)94935-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Hepatitis C viral infection (HCV) is a frequent and severe disease; screening strategies to-date remain insufficient. OBJECTIVE To assess the efficiency of HCV screening of high-risk groups among patients consulting general practitioners. METHODS A cost-effectiveness analysis was performed involving general medicine screening practices recorded during a survey of 127 practitioners (10,041 patients) conducted in 1997. A reference strategy, defined as HCV screening for illicit drug users and transfused patients, and five extended strategies, where the screening population was broadened to include other risk groups as well, were considered. Average cost and marginal cost-effectiveness ratios were determined for each extended strategy and compared with those observed for the reference strategy. The sensitivity of HCV screening to funding modalities, HCV seroprevalence and proportion of HCV high-risk groups among patients attending general practitioners was studied. RESULTS The reference strategy was the most cost-effective method irrespective of the funding modality considered. Fixed practitioner payment was the least efficient funding modality. The average cost of one positive test was sensitive to variations of HCV seroprevalence in the high-risk group as well as the proportion of high-risk patients among the general practitioners' patients. CONCLUSION Extension of hepatitis C screening to risk groups other than transfused patients and illicit drug users implies a substantial increase in healthcare costs as well as social consensus for such expenditures.
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Merle V, Moret L, Josset V, Pidhorz L, Piétu G, Gouin F, Riou F, Chassagne P, Petit J, Lombrail P, Czernichow P, Dujardin F. Facteurs de qualité de la prise en charge des sujets âgés opérés d’une fracture de l’extrémité supérieure du fémur. ACTA ACUST UNITED AC 2004; 90:504-16. [PMID: 15672917 DOI: 10.1016/s0035-1040(04)70424-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hip fractures are one of the leading causes for admission of elderly subjects to healthcare facilities. Because of population aging, the incidence of hip fractures has increased considerably over the last years and will continue to increase in industrialized countries. Hip fracture in an elderly subject may be life threatening and has a significant functional and social impact not only because of the fracture itself, but also because of the risk of complications related to the patient's health status and the long hospital stay. The purpose of this work was to identify in the published literature professional practices, excepting the surgical procedure, associated with better early and long-term outcome in elderly patients with hip fracture. Questions raised concerning the patient's hospital stay include factors related to the preoperative phase (time to surgery, usefulness of traction), the operation itself (antibiotic prophylaxis, anesthesia technique), and the postoperative phase (prevention of venous thrombosis, malnutrition, episodes of confusion, duration of indwelling bladder catheter, correction of anemia, geriatric care during the stay in the orthopedic ward, early and intense rehabilitation, prevention of recurrence). Among these factors, several appear to be associated with better outcome, including long-term outcome--surgery as early as possible in light of the patient's general status, antibiotic prophylaxis in accordance with standard recommendations (SFAR), prevention of venous thrombosis with low-molecular-weight heparin initiated at admission and associated with elastic contention. Oral nutritional support is probably beneficial and should be proposed for all patients. Particular attention must be given to prevention of confusion in order to reduce the rate of institutionalization. The rythm of rehabilitation exercises should be at least five sessions per week. Finally, there are several methods, which are effective in preventing recurrence, taking into account osteoporosis, risk of falls. Preventive measures should be instituted for all patients undergoing surgery for hip fracture.
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Basuyau F, Josset V, Merle V, Czernichow P. Case fatality and health care costs in HIV-infected patients: evolution from 1992 to 2000 at Rouen University Hospital, France. Int J STD AIDS 2004. [DOI: 10.1258/0956462041944420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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82
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Hallais C, Merle V, Tavolacci M, Damm C, Thillard D, Veber B, Czernichow P. P8-5 Peut-on prédire le risque individuel d’infection nosocomiale pendant un séjour en réanimation chirurgicale ? Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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83
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Merle V, Moret L, Graveleau S, Petit J, Lombrail P, Czernichow P. P17-17 Modalités de diffusion des référentiels de bonne pratique de prise en charge : exemple des fractures de l’extrémité supérieure du fémur. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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84
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Tavolacci M, Ladner J, Menard J, Kerdiles M, Delbos V, Merle V, Czernichow P. P17-12 Comparaison de l’évaluation par les étudiants et les enseignants d’un enseignement d’épidémiologie fondé sur la lecture critique d’article (LCA). Expérience à l’UFR de Médecine de Rouen, 2003-04. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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85
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Merle V, Moret L, Graveleau S, Petit J, Lombrail P, Czernichow P. P16-4 Facteurs pronostiques chez les malades de 65 ans et plus opérés d’une fracture de l’extrémité supérieure du fémur (FESF). Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99378-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Hallais C, Ladner J, Tavolacci M, Kerdiles M, Merle V, Czernichow P. P17-6 Évaluation d’un enseignement de santé publique fondé sur la lecture critique et l’analyse d’article : expérience à l’UFR de Médecine, Rouen, 2002-03. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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87
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Herault T, Delbos V, Tavolacci M, Josset V, Froment L, Merle V, Nouvet G, Muir J, Ladner J, Czernichow P. P5-15 Impact de la première hospitalisation sur la prise en charge de patients atteints de bronchopneumopathie chronique obstructive : étude dans deux services de Pneumologie d’un CHU. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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88
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Molinié F, Gower-Rousseau C, Yzet T, Merle V, Grandbastien B, Marti R, Lerebours E, Dupas JL, Colombel JF, Salomez JL, Cortot A. Opposite evolution in incidence of Crohn's disease and ulcerative colitis in Northern France (1988-1999). Gut 2004; 53:843-8. [PMID: 15138211 PMCID: PMC1774088 DOI: 10.1136/gut.2003.025346] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND Northern France was characterised by a high incidence of Crohn's disease (CD) and a low incidence of ulcerative colitis (UC) according to the first inquiry undertaken in the late 1980s. AIMS To assess the trends in the incidence of inflammatory bowel disease (IBD) over a 12 year period (1988-1999) in the same area of Northern France. PATIENTS Patients living in Northern France (Nord, Pas-de-Calais, Somme, and Seine Maritime--total of 5,790,526 inhabitants) between 1988 and 1999 were included in the study. Case ascertainment was established according to methodology previously described. METHODS Trends in incidence were studied using a Poisson regression model in four three year periods (1988-90, 1991-93, 1994-96, and 1997-99) adjusted for age at diagnosis and sex. Incidence rates were standardised for age with the European standard population. RESULTS During 1988-99, 7066 cases of IBD were recorded (56.8% CD, 37.7% UC, and 5.5% indeterminate colitis). Mean annual incidence rate of CD increased from 5.2/100,000 inhabitants in 1988-90 to 6.4 in 1997-99 (adjusted p for trend <0.001). In contrast, the incidence of UC decreased from 4.2 to 3.5 (adjusted p for trend <0.001). The ileocolonic subtype of CD increased by 25% even though median age at diagnosis and frequency of digestive investigations were not different. CONCLUSIONS Contrary to what has been reported in other countries in Northern Europe, the incidence of CD increased by 23% in 12 years in Northern France while that of UC decreased by 17% during the same period. This indicates that some factors which influence IBD frequency (in both directions) are still at work in this area of Europe, and that further studies aimed at identifying these should be performed. The rising incidence of CD could enhance the burden of this disease on the public health system in France.
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Merle V, Thiéfin G, Czernichow P. Épidémiologie des complications gastro-duodénales associées aux anti-inflammatoires non stéroïdiens. ACTA ACUST UNITED AC 2004; 28 Spec No 3:C27-36. [PMID: 15366672 DOI: 10.1016/s0399-8320(04)95276-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nonsteroidal anti-inflammatory agents (NSAIDs) are among the most widely prescribed drugs worldwide. In France, about 25% of individuals aged 40 years or older are treated with NSAIDs at least one week in the year. Although the therapeutic benefits of these drugs are substantial, their use is limited by their gastroduodenal toxicity. Dyspepsia occurs in about 30% of patients receiving NSAIDs, an approximately two-fold enhancement of risk compared with control subjects. Asymptomatic endoscopic lesions are observed in 20 to 80% of patients, depending on population characteristics, individual NSAIDs and definitions of endoscopic lesions. The risk of symptomatic ulcer, complicated ulcer (haemorrhage, perforation, stenosis) and death related to ulcer complication is multiplied by 4 in patients treated with NSAIDs. Established risk factors for NSAID-induced gastroduodenal complications are age, ulcer history, heavy alcohol consumption, individual NSAIDs, dose, association with corticoid or aspirin or anticoagulants (ulcer haemorrhage) while the role of treatment duration and Helicobacter pylori infection are controversial.
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Tavolacci MP, Merle V, Josset V, Bouchart F, Litzler PY, Tabley A, Bessou JP, Czernichow P. Mediastinitis after coronary artery bypass graft surgery: influence of the mammary grafting for diabetic patients. J Hosp Infect 2003; 55:21-5. [PMID: 14505605 DOI: 10.1016/s0195-6701(03)00116-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mediastinitis is a severe complication of coronary artery bypass graft surgery (CABG) particularly when harvesting internal mammary arteries (IMA). CABG in diabetic patients often uses two IMA because the saphenous graft is damaged. To our knowledge this risk of mediastinitis has not previously been reported in diabetic patients. All consecutive diabetic patients undergoing CABG over a three-year period from 1998 to 2000 were included in the study. Data recorded were: age, sex, duration of stay, whether one or two IMA were used, diagnosis of mediastinitis. Calculation of relative risk and analysis of trends by chi2 trend tests was also performed. In total 256 diabetic patients were included in the cohort. The incidence of mediastinitis was 4.3% (11/256). The risk of mediastinitis was higher in patients with two IMA than in patients with one IMA (relative risk 5.97, 95 CI 1.63-21.93, P=0.004). Age and sex were not confounding factors. No patients with mediastinitis died. Bilateral IMA grafting is associated with higher risk of mediastinitis in diabetic patients. The authors suggest that the risk of mediastinitis in diabetic patients should be taken into consideration when cardiac surgeons choose unilateral or bilateral IMA harvesting for surgery.
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Roque I, Hochain P, Merle V, Lerebours E, Hecketsweiler P, Ducrotté P. [Assessment of the quality and psychological impact of information delivered using official consent forms in digestive endoscopy]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2003; 27:17-21. [PMID: 12594361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
AIM To test the impact of information brochures and informed consent forms in patients undergoing digestive endoscopy procedures. METHOD All patients undergoing digestive endoscopy procedures during a two-month period were given information about the procedure to be performed by delivery of an information form produced by the French Endoscopy and Gastroenterology Societies. The patients were then asked to sign an inform consent form. A questionnaire about the informed consent form and the consent experience was given to all patients after the endoscopic procedure. RESULTS The questionnaire was completed by 108 consecutive patients. The informed consent form was completely read by 96.3% and understood by 95%. Sixteen percent asked for complementary information, all about complications. Twenty percent were distressed by the explanations. Receiving written information was surprising for 22.2% of the patients, and distressing for 18.5% mainly when endoscopy was planned without general anesthesia (P=0.01 versus general anesthesia). Obtaining informed consent was qualified as a normal procedure for 47.2%, but distressing for 19.4%. It was considered by 41.1% as a way for doctors to be discharged from their obligations. CONCLUSION The informed consent forms written by scientific societies are easy to understand. One third of the patients were distressed or surprised to be given oral or written information. To sign a written consent form before an endoscopy procedure is considered to be a means of discharging practitioners from their responsibilities for 30% of the patients.
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Chamouni P, Lenain P, Buchonnet G, Merle V, Bourgain C, Boyer A, Girault C, Czernichow P. Difficulties in the management of an incomplete form of refractory thrombotic thrombocytopenic purpura, the usefulness of vincristine. TRANSFUSION SCIENCE 2000; 23:101-6. [PMID: 11035270 DOI: 10.1016/s0955-3886(00)00073-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although several etiologies can be identified in thrombotic thrombocytopenic purpura (TTP), idiopathic cases are still frequent. Incomplete forms are more rare. Currently, the diagnosis may be made in cases of thrombocytopenia and microangiopathic hemolytic anemia. According to the literature, mortality and morbidity are significantly improved with plasma exchange. However, treatment in refractory forms remains problematic. CASE REPORT A 33-year old woman presented with an incomplete form of TTP, refractory to a combination of therapeutics. The patient underwent plasma infusion, plasma exchange, and then was started on corticosteroids. She also received intravenous immunoglobulins and antiplatelet agents in close proximity to vincristine (Oncovin) infusion. The main biological indicators used were the platelet count, hematocrit, LDH, and the presence of schistocytes. Following vincristine treatment, the patient's condition rapidly improved. CONCLUSION Vincristine administered after the failure of standard therapeutics was effective in this refractory form of TTP.
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Merle V, Germain JM, Chamouni P, Daubert H, Froment L, Michot F, Teniere P, Czernichow P. Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol. Am J Infect Control 2000; 28:109-15. [PMID: 10760218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections. AIM OF THE STUDY To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS. METHODS Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated. RESULTS The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor. CONCLUSION Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.
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Kraenkel RA, Manna MA, Merle V. Nonlinear short-wave propagation in ferrites. PHYSICAL REVIEW. E, STATISTICAL PHYSICS, PLASMAS, FLUIDS, AND RELATED INTERDISCIPLINARY TOPICS 2000; 61:976-979. [PMID: 11046355 DOI: 10.1103/physreve.61.976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/1999] [Indexed: 05/23/2023]
Abstract
In this paper we discuss the propagation of nonlinear electromagnetic short waves in ferromagnetic insulators. We show that such propagation is perpendicular to an externally applied field. In the nonlinear regime we determine various possible propagation patterns: an isolated pulse, a modulated sinusoidal wave, and an asymptotic two-peak wave. The mathematical structure underlying the existence of these solutions is that of the integrable sine-Gordon equation.
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Roque I, Goria O, Merle V, Bord S, Janvresse C, Czernichow P, Colin R. [Hepatitis C screening in an anonymous and free screening center in Rouen]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:1397-8. [PMID: 10642626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Michel P, Merle V, Chiron A, Ducrotte P, Paillot B, Hecketsweiler P, Czernichow P, Colin R. Postoperative management of stage II/III colon cancer: a decision analysis. Gastroenterology 1999; 117:784-93. [PMID: 10500059 DOI: 10.1016/s0016-5085(99)70335-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Two separate decisions must be made for the management of patients with resected stage II/III colon cancer: whether to begin adjuvant chemotherapy and whether patients should be included in a follow-up protocol consisting of regular monitoring of carcinoembryonic antigen level and of colonoscopy and imaging. The standard management for these patients is adjuvant chemotherapy for stage III patients and follow-up for stage II/III patients with resected colon cancer. METHODS Decision analysis was used to compare the effectiveness (5-year survival rate) and cost-effectiveness ratio of 7 strategies of treatment and follow-up. RESULTS The most cost-effective strategies were adjuvant chemotherapy for all patients with stage II/III resected colon cancer, with either no follow-up or follow-up only for patients aged less than 75 years with a seric preoperative carcinoembryonic antigen level of >5 ng/mL (5-year survival, 62.3% or 62.7%; cost per surviving patient, $8254 or $8657, respectively). The order of efficacy of the strategies was insensitive to changes in the values of the studied variables. The method of follow-up does little to improve 5-year survival but adds substantial cost. CONCLUSIONS The current standard strategy may not be the most cost-effective strategy for the management of patients with resected colon cancer.
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Kraenkel RA, Manna MA, Merle V. Long-wave and short-wave asymptotics in nonlinear dispersive systems. PHYSICAL REVIEW. E, STATISTICAL PHYSICS, PLASMAS, FLUIDS, AND RELATED INTERDISCIPLINARY TOPICS 1999; 60:2418-20. [PMID: 11970044 DOI: 10.1103/physreve.60.2418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/1998] [Revised: 04/07/1999] [Indexed: 11/07/2022]
Abstract
In this paper we study the interplay between short- and long-space scales in the context of conservative dispersive systems. We consider model systems in (1+1) dimensions that admit both long- and short-wavelength solutions in the linear regime. A nonlinear analysis of these systems is constructed, making use of multiscale expansions. We show that the equations governing the lowest order involve only short-wave properties and that the long-wave effects to leading order are determined by a secularity elimination procedure.
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Rolland N, Grandbastien B, Merle V, Gower-Rousseau C, Yzet T, Marti R, Lerebours E, Dupas JL, Czernichow P, Salomez JL, Lebrun T, Cortot A. [Cost of early management of chronic inflammatory intestinal disease]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:483-8. [PMID: 10416112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVES The aim of this study was to assess the cost of the first management of inflammatory bowel disease (IBD) from the onset of first symptoms until 6 weeks after the diagnosis. This cost was calculated in French francs (FF) for all IBD and namely for Crohn's disease (CD), ulcerative colitis (UC), and ulcerative proctitis (UP). MATERIAL AND METHODS Data concerning 258 patients were collected by the mean of a standardized questionnaire from 3 different sources: the patient, his general practitioner, and his gastroenterologist. RESULTS Two hundred and fifty eight patients were included: 144 CD (55.8%), 76 UC (29.5%), 30 UP (11.6%), and 8 chronic unclassifiable colitis (CUC) (3.1%). The mean direct costs of the diagnosis (m +/- SD) were 23,116 +/- 40,820 FF for CD, 10,628 +/- 17,316 FF for UC and 3,451 +/- 2,743 FF for UP. Although unplanned hospitalizations occurred in only 38% of the patients (98/258), they represented the 3/4 of the mean costs: 78.2% for CD and 64% for UC. Indirect costs generated by days off work were 4,719 +/- 6,610 FF for CD, 2,996 +/- 6,897 FF for UC and 1,230 +/- 3,622 FF for UP. CONCLUSION The first management of a patient with CD was twice more expensive than the one with UC and 6.5 times than the one with UP.
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Merle V, Goria O, Gourier-Frery C, Benguigui C, Michel P, Huet P, Czernichow P, Colin R. [Risk factors of contamination by hepatitis C virus. Case-control study in the general population]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:439-46. [PMID: 10416106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
UNLABELLED In 30% of patients with hepatitis C virus, the source of infection is unknown. OBJECTIVE To identify the risk factors of infection by hepatitis C virus in a case-control study. METHODS Cases had positive hepatitis C virus serology, and were living in Fecamp (Normandy, France). Controls (2 for each case) were age and sex-matched subjects with negative hepatitis C virus serology, living in Fecamp. Demographic, medical, professional, and environmental data were collected. Statistical analysis included chi 2 or Fisher's exact test and multiple logistic regression. RESULTS The risk factors of hepatitis C virus by univariate analysis were: history of transfusion, high number of sexual partners, hepatitis C virus infection in a relative, history of digestive or genitourinary surgery, an invasive medical procedure, digestive endoscopy, biopsy, lumbar or pleural puncture, medical care after an accident, injections, multiple deliveries or abortion. Risk factors of hepatitis C virus infection by multivariate analysis: hepatitis C virus infection in a relative (Odds ratio: 4.58), history of transfusion (Odds ratio: 2.32), of a surgical procedure (Odds ratio: 2.50), of medical care after an accident (Odds ratio: 1.51), of injections (Odds ratio: 2.24). CONCLUSION Our results suggest the possible nosocomial transmission of hepatitis C virus. Intrafamilial transmission is also possible.
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Paillot B, Czernichow P, Michel P, Merle V, Queuniet AM, Duval C, Daubert H. Incidence of rectosigmoid adenomatous polyps in subjects without prior colorectal adenoma or cancer: a prospective cohort study. Gut 1999; 44:372-6. [PMID: 10026323 PMCID: PMC1727427 DOI: 10.1136/gut.44.3.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Subjects without known colorectal adenomas or cancer constitute a large majority of the population where 85% of all cases of colorectal cancer are thought to occur. Consequently these people should be considered for screening to decrease mortality from colorectal cancer in the general population. AIMS To estimate the incidence rate of rectosigmoid adenomas in these subjects. METHODS Subjects without adenomas or cancer at a previous examination which had visualised the rectosigmoid underwent a fibre endoscopy every three years. Endoscopic data and population characteristics were collected prospectively. RESULTS A total of 450 subjects fulfilled the selection criteria; 287 (64%) underwent at least two examinations, and 163 had three or more. At the second examination, with a mean delay of 39 months, the incidence rate of rectosigmoïd adenomas was 1.50% per patient year. The rate was 1.75% per patient year (95% CI 0.80-3.33) at the third endoscopy with an additional mean delay of 38 months. The cumulative incidence rate at six years was 7.3% (95% CI 4.3-10.3), representing a mean of 1.2% per patient year. This rate increased with age and was higher for men than for women after age adjustment (p< 0.03). CONCLUSIONS The incidence rates are very low compared with those of patients with prior adenomas. These results should be considered in establishing rectosigmoid adenoma screening strategies.
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