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Lanhers C, Grolier M, Dutheil F, Gay C, Goldstein A, Mourgues C, Levyckyj C, Pereira B, Coudeyre E. Comparison of self-management and spa therapy for upper-extremity musculoskeletal disorders: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101813. [PMID: 38479114 DOI: 10.1016/j.rehab.2023.101813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. OBJECTIVE To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. METHODS We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. RESULTS In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). CONCLUSIONS This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs. TRIAL REGISTRATION ClinicalTrials.gov (NCT02702466) retrospectively registered.
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Affiliation(s)
- Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France.
| | - Maxime Grolier
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
| | - Frédéric Dutheil
- Service de santé au travail, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, LaPSCo, F-63 000 Clermont-Ferrand, France
| | - Chloé Gay
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F-63 000, Clermont-Ferrand, France
| | - Anna Goldstein
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | - Charline Mourgues
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | | | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, F-63 000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
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Lehut T, Lambert C, Mortier R, Futier E, Chabanne R, Bauer U, Verdier P, Ravan R, Ocquidant P, Mourgues C, Lautrette A. Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study. Eur J Health Econ 2024:10.1007/s10198-024-01686-y. [PMID: 38472725 DOI: 10.1007/s10198-024-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.
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Affiliation(s)
- Timothée Lehut
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Mortier
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Russell Chabanne
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ulrich Bauer
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France
| | - Philippe Verdier
- Intensive Care Unit, Centre Hospitalier de Montluçon, Montluçon, France
| | - Ramin Ravan
- Intensive Care Unit, Centre Hospitalier Jacques Lacarin, Vichy, France
| | | | - Charline Mourgues
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France.
- Intensive Care Medicine, CHU Clermont-Ferrand,Intensive Care Unit, Cancer Centre Jean Perrin, Clermont-Ferrand, 54 rue Montalembert BP69, Cedex 1, 63003, France.
- LMGE (Laboratoire Micro-organismes: Génome et Environnement), UMR CNRS 6023, Université Clermont Auvergne, Clermont-Ferrand, France.
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Bouvier D, Cantais A, Laspougeas A, Lorton F, Plenier Y, Cottier M, Fournier P, Tran A, Moreau E, Durif J, Sarret C, Mourgues C, Sturtz F, Oudart JB, Raffort J, Gonzalo P, Cristol JP, Masson D, Pereira B, Sapin V. Serum S100B Level in the Management of Pediatric Minor Head Trauma: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e242366. [PMID: 38502126 PMCID: PMC10951739 DOI: 10.1001/jamanetworkopen.2024.2366] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/23/2024] [Indexed: 03/20/2024] Open
Abstract
Importance Minor head trauma (HT) is one of the most common causes of hospitalization in children. A diagnostic test could prevent unnecessary hospitalizations and cranial computed tomographic (CCT) scans. Objective To evaluate the effectiveness of serum S100B values in reducing exposure to CCT scans and in-hospital observation in children with minor HT. Design, Setting, and Participants This multicenter, unblinded, prospective, interventional randomized clinical trial used a stepped-wedge cluster design to compare S100B biomonitoring and control groups at 11 centers in France. Participants included children and adolescents 16 years or younger (hereinafter referred to as children) admitted to the emergency department with minor HT. The enrollment period was November 1, 2016, to October 31, 2021, with a follow-up period of 1 month for each patient. Data were analyzed from March 7 to May 29, 2023, based on the modified intention-to-treat and per protocol populations. Interventions Children in the control group had CCT scans or were hospitalized according to current recommendations. In the S100B biomonitoring group, blood sampling took place within 3 hours after minor HT, and management depended on serum S100B protein levels. If the S100B level was within the reference range according to age, the children were discharged from the emergency department. Otherwise, children were treated as in the control group. Main Outcomes and Measures Proportion of CCT scans performed (absence or presence of CCT scan for each patient) in the 48 hours following minor HT. Results A total of 2078 children were included: 926 in the control group and 1152 in the S100B biomonitoring group (1235 [59.4%] boys; median age, 3.2 [IQR, 1.0-8.5] years). Cranial CT scans were performed in 299 children (32.3%) in the control group and 112 (9.7%) in the S100B biomonitoring group. This difference of 23% (95% CI, 19%-26%) was not statistically significant (P = .44) due to an intraclass correlation coefficient of 0.32. A statistically significant 50% reduction in hospitalizations (95% CI, 47%-53%) was observed in the S100B biomonitoring group (479 [41.6%] vs 849 [91.7%]; P < .001). Conclusions and Relevance In this randomized clinical trial of effectiveness of the serum S100B level in the management of pediatric minor HT, S100B biomonitoring yielded a reduction in the number of CCT scans and in-hospital observation when measured in accordance with the conditions defined by a clinical decision algorithm. Trial Registration ClinicalTrials.gov Identifier: NCT02819778.
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Affiliation(s)
- Damien Bouvier
- Department of Biochemistry and Molecular Genetics, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, Reproduction et Développement, Clermont-Ferrand, France
| | - Aymeric Cantais
- Department of Pediatrics, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Fleur Lorton
- Pediatric Emergency Department, Nantes Université, CHU Nantes, INSERM, Centre d’Investigation Clinique 1413, Nantes, France
| | | | - Maria Cottier
- Department of Pediatrics, CHU Montpellier, Montpellier, France
| | | | - Antoine Tran
- Department of Pediatrics, CHU Nice, Nice, France
| | - Emilie Moreau
- Department of Pediatrics, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Julie Durif
- Department of Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Sarret
- Department of Pediatrics, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, SIGMA, Thérapies Guidées par l’Image, Clermont-Ferrand, France
| | - Charline Mourgues
- Biostatistics Unit (Délégation à la Recherche Clinique et à l’Innovation), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Franck Sturtz
- Department of Biochemistry, CHU Limoges, Limoges, France
| | - Jean-Baptiste Oudart
- Faculté de Médecine, Université de Reims Champagne-Ardenne, Matrice Extracellulaire et Dynamique Cellulaire Unit, UMR CNRS 7369, Reims, France
| | | | - Philippe Gonzalo
- Department of Biochemistry and Pharmacology, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Damien Masson
- Department of Biochemistry, CHU Nantes, Nantes, France
| | - Bruno Pereira
- Biostatistics Unit (Délégation à la Recherche Clinique et à l’Innovation), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Biochemistry and Molecular Genetics, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, Reproduction et Développement, Clermont-Ferrand, France
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Mourgues C, Balayssac D, Mulliez A, Planeix CM, Feydel G, Biard A, Alaux-Boïko V, Irthum C, Saroul N, Dang NP. Comparison of the microvascular anastomotic Coupler™ system with hand-sewn suture for end to end veno-venous anastomosis for head and neck reconstruction with free flap transfer: Medico-economic retrospective case-control study. J Craniomaxillofac Surg 2024; 52:291-296. [PMID: 38212165 DOI: 10.1016/j.jcms.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
The aim of this study was to assess the medico-economic impact of the MACD Coupler™ system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective case-control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer. 43 patients per group were analyzed. Rates of initial success, re-intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively K€ 0.7 [0.5; 0.8] and K€ 0.1 [0.5; 0.8] (p = 0.001) and decreased the cost for operating staff with respectively K€ 4.0 [3.4; 5.2] and K€ 5.1 [3.8; 5.4] (p = 0.03). The total management costs were not different between groups with respectively a total median cost of K€ 18.4 [14.3; 27.2] and K€ 17.3 [14.1; 23.7] (p = 0.03). In conclusion, the cost of the Coupler™ is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon.
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Affiliation(s)
- Charline Mourgues
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France.
| | - David Balayssac
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Claire-Marie Planeix
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Gabrielle Feydel
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Adrien Biard
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Véra Alaux-Boïko
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Charles Irthum
- CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
| | - Nicolas Saroul
- CHU Clermont-Ferrand, Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, INRAE, UNH, Équipe ASMS, 63000, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France; CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
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Mourgues C, Usclade A, Lambert C. Comment on Yang et al. (2022) 'Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial'. Int J Nurs Stud 2024; 150:104650. [PMID: 38052117 DOI: 10.1016/j.ijnurstu.2023.104650] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Charline Mourgues
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, F-63003 Clermont-Ferrand, France.
| | | | - Céline Lambert
- CHU Clermont-Ferrand, DRCI, Biostatistics Unit, F-63003 Clermont-Ferrand, France.
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Debost-Legrand A, Legrand G, Duclos-Médard J, Thomazet J, Pranal M, Langlois E, Mourgues C, Vendittelli F. Opti'care protocol: a randomised control trial to evaluate the impact of a mobile antenatal care clinic in isolated rural areas on prenatal follow-up. BMJ Open 2023; 13:e060337. [PMID: 36797021 PMCID: PMC9936278 DOI: 10.1136/bmjopen-2021-060337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Rural residence appears to be a factor of vulnerability among pregnant women with poor clinical antenatal care. Our principal objective is to assess the impact of an infrastructure for a mobile antenatal care clinic on the completion of antenatal care for women identified as geographically vulnerable in a perinatal network. METHODS AND ANALYSIS Controlled cluster-randomised study in two parallel arms comparing an intervention group with an open-label control group. This study will concern the population of pregnant women who must live in one of the municipalities covered by the perinatal network and considered to be an area of geographic vulnerability. The cluster randomisation will take place according to the municipality of residence. The intervention will be the implementation of pregnancy monitoring by a mobile antenatal care clinic. The completion of antenatal care between the intervention and control groups will be a binary criterion: 1 will be attributed to each antenatal care that includes all visits and supplementary examinations. Sample size has been estimated to be 330 at least with an 80% participation rate.The univariate analyses will compare the follow-up rates (with Fisher's exact test), and all individual characteristics collected (Fisher's exact test, Student's t-test) between the two groups. The multivariate analysis will use a mixed linear model analysis and consider the cluster effect as random; the initial model will include known confounders from the literature, confounders identified in univariate analyses, and the clinically relevant prognostic factors. All of these factors will be taken into account in the model as a fixed effect. ETHICS AND DISSEMINATION The Patient Protection Committee North-West II approved this study on 4 February 2021 (IRB 2020-A02247-32). The results will be the subject of scientific communications and publications. TRIAL REGISTRATION NUMBER NCT04823104.
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Affiliation(s)
- Anne Debost-Legrand
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Legrand
- Centre Hospitalier Sainte Marie de Clermont-Ferrand, Association Hospitalière Sainte-Marie, Chamalieres, France
| | - Julie Duclos-Médard
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Juliette Thomazet
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marine Pranal
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Eric Langlois
- UMR Territoires, AgroparisTech, INRA, Irstea, VetAgro Sup, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - Charline Mourgues
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Françoise Vendittelli
- CHU Clermont-Ferrand, CNRS, Clermont Auvergne INP, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Mourgues C, Usclade A. Assessments of nursing practice: The role of medico-economic analysis. J Adv Nurs 2022; 78:e91-e92. [PMID: 35730983 DOI: 10.1111/jan.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Charline Mourgues
- CHU Clermont-Ferrand, Direction de la Recherche Clinique et des Innovations, Unité de Biostatistiques, Clermont-Ferrand, France
| | - Alexandra Usclade
- CHU Clermont-Ferrand, Direction de la Recherche Clinique et des Innovations, Unité de Biostatistiques, Clermont-Ferrand, France
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Dualé C, Mourgues C. The price of pain relief, or should non-invasive medical devices be treated differently in analgesic clinical trials? Eur J Pain 2021; 26:553-554. [PMID: 34845803 DOI: 10.1002/ejp.1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Christian Dualé
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique (INSERM CIC1405), Clermont-Ferrand, France.,INSERM, UMR1107 Neuro-Dol, Clermont-Ferrand, France
| | - Charline Mourgues
- CHU Clermont-Ferrand, Direction de la Recherche Clinique et des Innovations, Unité de Biostatistiques, Clermont-Ferrand, France
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Delabaere A, Chauveau B, Lémery D, Ollier A, Guiguet-Auclair C, Mourgues C, Legrand A. Protocol for the e-POWUS Project: multicentre blinded-randomised controlled trial of ultrasound speed choice to improve sonography quality in pregnant women with obesity. BMJ Open 2021; 11:e038684. [PMID: 34548341 PMCID: PMC8458366 DOI: 10.1136/bmjopen-2020-038684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During pregnancy, maternal obesity increases the risk of fetal abnormalities. Despite advances in ultrasound imaging, the assessment of fetal anatomy is less thorough among these women. Currently, the construction of ultrasound images uses a conventional ultrasound propagation velocity (1540 m/s), which does not correspond to the slower speed of propagation in fat tissue.The main objective of this randomised study is to compare the completeness of fetal ultrasonography according to whether the operator could choose the ultrasound velocity (1420, 1480 or 1540 m/s) or was required to apply the 1540 m/s velocity. METHODS AND ANALYSIS This randomised trial is an impact study to compare a diagnostic innovation with the reference technique. The trial inclusion criteria require that a pregnant woman with obesity be undergoing a fetal morphology examination by ultrasound from 20+0 to 25+0 gestational weeks.Randomisation will allocate women into two groups. The first will be the 'modulable speed' group, in which operators can choose the speed of ultrasound propagation to be considered for the morphological analysis: 1420, 1480 or 1540 m/s. In the second 'conventional speed' group, operators will perform the morphological examination with the ultrasound speed fixed at 1540 m/s. The adjudication committee, two independent experts, will validate the completeness of each examination and the quality of the images. ETHICS AND DISSEMINATION This research protocol does not change the standard management. The only possible impact is an improvement of the ultrasound examination by improving the quality of the image and the completeness of morphological examination. The Agence du Médicament et produits de santé approved this study (2018-A03478-47). The anonymised data will be available on request from the principal investigator. Results will be reported in peer-reviewed journals and at scientific meetings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (http://www.clinicaltrials.gov) Registry (NCT04212234).
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Affiliation(s)
- Amélie Delabaere
- Obstetrics and Gynaecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
- EA 4681, PEPRADE, Clermont University, Auvergne University, Clermont-Ferrand, France
| | - Benoit Chauveau
- Radiology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Didier Lémery
- Obstetrics and Gynaecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
- EA 4681, PEPRADE, Clermont University, Auvergne University, Clermont-Ferrand, France
| | - Amandine Ollier
- CRECHE, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- EA 4681, PEPRADE, Clermont University, Auvergne University, Clermont-Ferrand, France
- Public Health Department, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Charline Mourgues
- EA 4681, PEPRADE, Clermont University, Auvergne University, Clermont-Ferrand, France
- Public Health Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Anne Legrand
- Obstetrics and Gynaecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
- EA 4681, PEPRADE, Clermont University, Auvergne University, Clermont-Ferrand, France
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Brebion A, Raconnat J, Gagnaire A, Mourgues C, Pereira B, Schmidt J, Henquell C. Impact du diagnostic moléculaire rapide de grippe dans le service d’Accueil des Urgences adultes (2018–2019). Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bouvier D, Balayssac D, Durif J, Mourgues C, Sarret C, Pereira B, Sapin V. Assessment of the advantage of the serum S100B protein biomonitoring in the management of paediatric mild traumatic brain injury-PROS100B: protocol of a multicentre unblinded stepped wedge cluster randomised trial. BMJ Open 2019; 9:e027365. [PMID: 31129587 PMCID: PMC6537998 DOI: 10.1136/bmjopen-2018-027365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION S100B serum analysis in clinical routine could reduce the number of cranial CT (CCT) scans performed on children with mild traumatic brain injury (mTBI). Sampling should take place within 3 hours of trauma and cut-off levels should be based on paediatric reference ranges. The aim of this study is to evaluate the utility of measuring serum S100B in the management of paediatric mTBI by demonstrating a decrease in the number of CCT scans prescribed in an S100B biomonitoring group compared with a 'conventional management' control group, with the assumption of a 30% relative decrease of the number of CCT scans between the two groups. METHODS AND ANALYSIS The protocol is a randomised, multicentre, unblinded, prospective, interventional study (nine centres) using a stepped wedge cluster design, comparing two groups (S100B biomonitoring and control). Children in the control group will have CCT scans or be hospitalised according to the current recommendations of the French Society of Paediatrics (SFP). In the S100B biomonitoring group, blood sampling to determine serum S100B protein levels will take place within 3 hours after mTBI and subsequent management will depend on the assay. If S100B is in the normal range according to age, the children will be discharged from the emergency department after 6 hours' observation. If the result is abnormal, CCT scans or hospitalisation will be prescribed in accordance with current SFP recommendations. The primary outcome measure will be the proportion of CCT scans performed (absence/presence of CCT scan for each patient) in the 48 hours following mTBI. ETHICS AND DISSEMINATION The protocol presented (Version 5, 03 November 2017) has been approved by the ethics committee Comité de Protection des Personnes sud-est 6 (first approval 08 June 2016, IRB: 00008526). Participation in the study is voluntary and anonymous. The study findings will be disseminated in international peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT02819778.
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Affiliation(s)
- Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - David Balayssac
- DRCI, CHU Clermont-Ferrand, Université Clermont-Auvergne, INSERM U1107, NEURO-DOL, Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Catherine Sarret
- Pediatric Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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Abstract
OBJECTIVE The metabolic syndrome (MetS) is responsible for an increased risk of type 2 diabetes, cardiovascular diseases and is associated with all-cause and cardiovascular mortality. Economic and social vulnerability is not an easy concept to grasp, but some studies investigate the association between MetS and socioeconomic and demographic factors, deprivation (more often correlations rather than causal one due to data). This work aims to assess the association between MetS and socio-economic gradient (SEG) in the literature by performing a meta-analysis. DESIGN The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews were followed. SETTING The raw list of studies extracted from PubMed as regard to the inclusion/exclusion criteria was imported in Word. Studies were filed with regard to our three definitions of SEG and their title. PARTICIPANTS Subgroup analysis were performed considering several definitions of Mets: NCEP-ATPIII and IDF2006. RESULTS The overall multivariable-adjusted OR showed that the risk of MetS was significantly increased in association with SEG The results of the subgroup analysis showed an increased risk of MetS in association with SEG when IDF definition was considered. CONCLUSIONS Targeted interventions must be implemented in a specific way as prevention campaigns aimed at the general population are generally not adapted to this particular vulnerable population.
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Affiliation(s)
- M Blanquet
- Service de Santé Publique, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), EA 4681, Université d'Auvergne, Clermont-Ferrand, France
| | - A Legrand
- Service de Santé Publique, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), EA 4681, Université d'Auvergne, Clermont-Ferrand, France
| | - A Pélissier
- LEDi (Laboratoire d'Economie de Dijon), EA 7467, Université Bourgogne Franche-Comté, Dijon, France
| | - C Mourgues
- DRCI (Délégation à la Recherche Clinique et à l'Innovation), Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), EA 4681, Université d'Auvergne, Clermont-Ferrand, France.
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Mourgues C, Rossi A, Favre N, Delabaere A, Roszyk L, Sapin V, Debost-Legrand A, Gallot D. Fetal fibronectin test for threatened preterm delivery 48h after admission: Cost-effectiveness study. Eur J Obstet Gynecol Reprod Biol 2019; 234:75-78. [PMID: 30660942 DOI: 10.1016/j.ejogrb.2018.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this work was to assess the cost-effectiveness of the fetal fibronectin (fFN) test at 48 h after admission for threatened preterm delivery to promote early discharge. STUDY DESIGN Before-and-after study to calculate the incremental cost-effectiveness ratio (ICER). Patients were enrolled 48 h after admission in a tertiary care centre for threatened preterm delivery between 24+0 and 34+6 weeks. fFN testing was performed. During the first period, physician was blinded to fFN test and discharge occurred after apparent reduced symptomatology at physician's discretion. During the second period, fFN test was revealed to physician and discharge was immediately proposed to negative test patients. The costs considered in this analysis were the direct medical costs from the hospital perspective: costs of hospitalisation, treatment, and imaging procedures. The efficacy criterion selected was the number of deliveries at 7 and at 14 days after admission for threatened preterm delivery. RESULTS The study included 178 pregnant patient, 99 during the first period (July 2008-October 2009) and 79 during the second (March 2010-February 2012). The lengths of hospital stays were shorter during the second period, with more than 50% of women discharged home between 48 and 72 h (p < 0.0001) resulting in a cost-saving of 76 051 euros. The number of deliveries at 7 and at 14 days was similar between the two periods. CONCLUSION The fFN test at 48 h after admission supported early discharge and was safe and cost-effective.
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Affiliation(s)
- Charline Mourgues
- Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France
| | - Amélie Rossi
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Favre
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amélie Delabaere
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France; Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurence Roszyk
- Laboratoire de Biochimie Médicale et Biologie Moléculaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Sapin
- Laboratoire de Biochimie Médicale et Biologie Moléculaire, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, équipe PEPRADE, Clermont-Ferrand, France; Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Pôle Femme Et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France.
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Gay C, Guiguet-Auclair C, Mourgues C, Gerbaud L, Coudeyre E. Physical activity level and association with behavioral factors in knee osteoarthritis. Ann Phys Rehabil Med 2019; 62:14-20. [DOI: 10.1016/j.rehab.2018.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/03/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022]
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Mourgues C, Blanquet M, Gerbaud L, Soubrier M, Dougados M. Economic analysis of a nurse-led programme for comorbidities management of rheumatoid arthritis patients. Joint Bone Spine 2018; 85:573-576. [DOI: 10.1016/j.jbspin.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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Mourgues C, Themista A, Eljezi V. Economic evaluation of bilateral sternal local anaesthetic infusions via multi-hole catheters after cardiac surgery. Eur J Anaesthesiol 2018; 35:402-404. [PMID: 29601421 DOI: 10.1097/eja.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Charline Mourgues
- From the Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont Ferrand, France
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Ory J, Mourgues C, Raybaud E, Chabanne R, Jourdy JC, Belard F, Guérin R, Cosserant B, Faure JS, Calvet L, Pereira B, Guelon D, Traore O, Gerbaud L. Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia. Clin Oral Investig 2017; 22:1945-1951. [PMID: 29189950 DOI: 10.1007/s00784-017-2289-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. MATERIALS AND METHODS In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). RESULTS A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. CONCLUSION AND CLINICAL RELEVANCE Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. TRIAL REGISTRATION NCT02400294.
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Affiliation(s)
- Jérôme Ory
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France.
| | - Charline Mourgues
- Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Evelyne Raybaud
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France
| | - Russell Chabanne
- Réanimation Neurochirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Réanimation Médico-Chirurgicale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | - Fabien Belard
- Département de l'Information Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Renaud Guérin
- Réanimation Médico-Chirurgicale Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bernard Cosserant
- Réanimation Cardio Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Laure Calvet
- Réanimation Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Dominique Guelon
- Réanimation Médico-Chirurgicale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Ousmane Traore
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France
| | - Laurent Gerbaud
- Santé Publique, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Ory J, Raybaud E, Chabanne R, Cosserant B, Faure JS, Guérin R, Calvet L, Pereira B, Mourgues C, Guelon D, Traore O. Comparative study of 2 oral care protocols in intensive care units. Am J Infect Control 2017; 45:245-250. [PMID: 28341071 DOI: 10.1016/j.ajic.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. MATERIAL/METHODS This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. RESULTS A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). CONCLUSIONS Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
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Perbet S, Blanquet M, Mourgues C, Delmas J, Bertran S, Longère B, Boïko-Alaux V, Chennell P, Bazin JE, Constantin JM. Cost analysis of single-use (Ambu ® aScope™) and reusable bronchoscopes in the ICU. Ann Intensive Care 2017; 7:3. [PMID: 28050896 PMCID: PMC5209315 DOI: 10.1186/s13613-016-0228-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 04/20/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Flexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes. Methods The study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions. Results At a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu® aScope™. Conclusions The cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Perbet
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France. .,Réanimation Médico-Chirugicale, Pôle de Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand Cedex, France.
| | - M Blanquet
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C Mourgues
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - J Delmas
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - S Bertran
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Longère
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Boïko-Alaux
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Chennell
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-E Bazin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-M Constantin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
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Zenasni F, Mourgues C, Nelson J, Muter C, Myszkowski N. How does creative giftedness differ from academic giftedness? A multidimensional conception. Learning and Individual Differences 2016. [DOI: 10.1016/j.lindif.2016.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mourgues C, Soubrier M, Pereira B, Vorilhon P, Mathieu S. AB0829 2012 American Guidelines for The Management of Gout as Seen by Family Doctors in France. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gay C, Gerbaud L, Auclair C, Mourgues C, Coudeyre E. How physical activity level for patients with knee osteoarthritis. Epidemiological study on spa therapy. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.228] [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: 10/23/2022]
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Mourgues C, Henquell C, Nourisson C, Kubandova-Tatar S, Pereira B, Tournadre A, Soubrier M, Couderc M. SAT0184 Monitoring of EBV/CMV/VZV Load in Patients Receiving Tocilizumab for Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lelong A, Jiroff L, Mourgues C, Leymarie M, Gerbaud L, Lémery D, Vendittelli F. Social deprivation in perinatal period: case study of women from Clermont-Ferrand area in 2007. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marconi Tassara J, Diaz JP, Mourgues C. [An integrated program for psychosis]. Acta Psiquiatr Psicol Am Lat 1980; 26:211-22. [PMID: 7348056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The reciprocal balance between the cognitive normal awareness of reality and the cognitive psychotic awareness of reality in schizophrenia, is proposed, on the basis of the structural psychopathological theory of psychoses of the author. This balance points to the dominance of the operant conditioning of psychotic reality over normal reality during the invasion period of the disease, an equilibrium of both aspects during the steady period, and a dominance of normal reality during the residual period. A comprehensive program for secondary and terciary prevention of schizophrenia is outlined, with five levels of function delegation: D1, psychiatrists and psychologists; D2, nurses and social workers; D3, auxiliary nurses; D4, family co-therapist; D5, patients and other relatives. The functions delegated to D5 include the recognition of symptoms, causes and course, and attitudes conducing to secondary handicaps in patients. To D4, are delegate the administration of psychotropic drugs at home and technique for reinforcing normal reality. To D3, are delegated notions on epidemiology, the supervision of the psychopharmacological treatment and of reinforcement programs for normal reality, attitudes and its change, and notions of urgencies in psychosis. The D2 and D1 levels indicate treatment at all levels and treat the more complicated cases in institutions. The efficacy of the program in 36 cases, after a year, indicates a reduction of acute psychotic productivity from 72 to 6% of the patients, and a rate of hospitalization of only 8%.
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Legay JM, Mourgues C. [On the role of the maximum inheritance of a group of characteristics in the development of these characteristics]. C R Acad Hebd Seances Acad Sci D 1966; 262:1979-81. [PMID: 4956744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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