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Thietart S, Boumendil A, Pateron D, Guidet B, Vallet H. Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial. Ann Intensive Care 2022; 12:65. [PMID: 35819563 PMCID: PMC9274629 DOI: 10.1186/s13613-022-01042-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the impact of hospital trajectory on survival and functional decline of older critically ill patients. We evaluate 6-month outcomes after admission to: intensive care units (ICU), intermediate care units (IMCU) or acute medical wards (AMW). Methods Data from the randomised prospective multicentre clinical trial ICE-CUB2 was secondarily analysed. Inclusion criteria were: presenting at emergency departments in critical condition; age ≥ 75 years; activity of daily living (ADL) ≥ 4; preserved nutritional status; and no active cancer. A Cox model was fitted to compare survival according to admission destination adjusting for patient characteristics. Sensitivity analysis using multiple imputation for missing data and propensity score matching were performed. Results Among 3036 patients, 1675 (55%) were women; median age was 85 [81–99] years; simplified acute physiology score (SAPS-3) 62 [55–69]; 1448 (47%) were hospitalised in an ICU, 504 in IMCU (17%), and 1084 (36%) in AMW. Six-month mortality was 629 (44%), 155 (31%) and 489 (45%) after admission in an ICU, IMCU and AMW (p < 0.001), respectively. In multivariate analysis, AMW admission was associated with worse 6-month survival (HR 1.31, 95% CI 1.04–1.63) in comparison with IMCU admission, after adjusting for age, gender, comorbidities, ADL, SAPS-3 and diagnosis. Survival was not significantly different between patients admitted in an ICU and an IMCU (HR 1.17, 95% CI 0.95–1.46). Sensitivity analysis using multiple imputation for missing data and propensity score matching found similar results. Hospital destination was not significantly associated with the composite criterion loss of 1-point ADL or mortality. Physical and mental components of the 12-Item Short-Form Health Survey were significantly lower in the acute medical ward group (34.3 [27.5–41.7], p = 0.037 and 44.3 [38.6–48.6], p = 0.028, respectively) than in the ICU group (34.7 [28.4–45.3] and 45.5 [40.0–50.0], respectively) and IMCU group (35.7 [29.7–43.8] and 44.5 [39.7–48.4], respectively). Conclusions Admission in an AMW was associated with worse 6-month survival in older critically ill patients in comparison with IMCU admission, with no difference of survival between ICU and IMCU admission. There were no clinically relevant differences in quality of life in each group. These results should be confirmed in specific studies and raise the question of dedicated geriatric IMCUs. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01042-4.
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Affiliation(s)
- Sara Thietart
- Department of Intensive Care, APHP, Hôpital Saint-Antoine, Sorbonne Université, 184, rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | | | - Dominique Pateron
- Department of Emergency, APHP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Bertrand Guidet
- Department of Intensive Care, APHP, Hôpital Saint-Antoine, Sorbonne Université, 184, rue du Faubourg Saint-Antoine, 75012, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Saint-Antoine, Paris, France
| | - Hélène Vallet
- Department of Geriatrics, APHP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France.,INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
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Lombart B, Moïsi L, Bellamy V, Landolfini V, Manifacier MJ, Mesnage V, Heilbrunn C, Pateron D, Andro-Melin A, Fain O, Carbonell N, Bourrier A, Thomas C, Libeaut D, Coichard CG, Polomeni A, Guidet B. Multidisciplinary support for ethics deliberations during the first COVID wave. Nurs Ethics 2022; 29:833-843. [PMID: 35240895 DOI: 10.1177/09697330211066575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics-Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. OBJECTIVES The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was to describe the Cell's functions during that period. RESEARCH DESIGN This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient's/designated representative's preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. PARTICIPANTS AND RESEARCH CONTEXT Only our university hospital's clinicians could request EST intervention. ETHICAL CONSIDERATIONS The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. FINDINGS/RESULTS 33 requests (patients' mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. DISCUSSION Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. CONCLUSIONS COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions.
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Affiliation(s)
- Bénédicte Lombart
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Laura Moïsi
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Valérie Bellamy
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Valérie Landolfini
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Marie-Josée Manifacier
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Valérie Mesnage
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Charlotte Heilbrunn
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Dominique Pateron
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Alexandra Andro-Melin
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Olivier Fain
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Nicolas Carbonell
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Anne Bourrier
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Caroline Thomas
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Delphine Libeaut
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Christian-Guy Coichard
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Alice Polomeni
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
| | - Bertrand Guidet
- GH Sorbonne Université, Hôpital Saint-Antoine, 26930APHP, Paris, France; Paris Direction Juridique, 26930APHP, Paris, France; Hôpital Saint-Antoine, 26930APHP, Paris, France
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Riou B, Charpentier S, Chauvin A, Contenti J, Dumas F, Levraut J, Macrez R, Mimoz O, Pateron D. Critères du Conseil national des universités (CNU) de médecine d’urgence pour la nomination des maîtres de conférences et professeurs associés mi-temps. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0377] [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: 11/20/2022]
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Riou B, Nemitz B, Braun F, Tazarourte K, Charpentier S, Pateron D, Carli P. Numéro d’appel d’urgence santé : il faut garantir le respect du secret médical. Ann Fr Med Urgence 2021. [DOI: 10.3166/afmu-2021-0339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Beltramini A, Capitaine AG, De la Dure Molla M, Colon P, Pateron D. Conduite à tenir du médecin urgentiste face aux urgences dentaires. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0231] [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: 11/20/2022]
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Azoulay É, Beloucif S, Guidet B, Pateron D, Vivien B, Le Dorze M. Admission decisions to intensive care units in the context of the major COVID-19 outbreak: local guidance from the COVID-19 Paris-region area. Crit Care 2020; 24:293. [PMID: 32503593 PMCID: PMC7274070 DOI: 10.1186/s13054-020-03021-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
SARS-CoV-2 has caused a global pandemic unprecedented in size, spread, severity, and mortality. The influx of patients with severe or life-threatening disease means that in some cases, the available medical resources are not sufficient to meet the needs of all patients. Hence, healthcare providers may be forced to make difficult choices about which patients should be referred to the ICU. This document is intended to provide conceptual support to all healthcare teams currently engaged in the frontline management of the COVID-19 pandemic. It aims to assist physicians in the decision-making process for ICU admission and to help them provide uninterrupted and high-quality care.
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Affiliation(s)
- Élie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Sadek Beloucif
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Anesthesia and Critical Care Department, Avicenne Hospital, Paris, France
| | - Bertrand Guidet
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Medecine Intensive et Réanimation Department, Saint-Antoine Hospital, Paris, France
| | - Dominique Pateron
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Emergency Department, Saint-Antoine Hospital, Paris, France
| | - Benoît Vivien
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Emergency Department, Neckers Hospital, Paris, France
| | - Matthieu Le Dorze
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Anesthesia and Critical Care Department, Lariboisiere Hospital, Paris, France
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Javaud N, Soria A, Maignan M, Martin L, Descamps V, Fain O, Bouillet L, Berard F, Tazarourte K, Roy PM, Fontaine JP, Bagot M, Khellaf M, Goulet H, Lapostolle F, Casalino E, Doutre MS, Gil-Jardine C, Caux F, Chosidow O, Pateron D, Vicaut E, Adnet F. Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial. BMJ Open 2019; 9:e027431. [PMID: 31439599 PMCID: PMC6707704 DOI: 10.1136/bmjopen-2018-027431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/25/2022] Open
Abstract
INTRODUCTION This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria. METHODS AND ANALYSIS This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for >6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks. ETHICS AND DISSEMINATION The protocol has been approved by the Comité de Protection des PersonnesSud-Méditerranée II and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03545464.
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Affiliation(s)
- Nicolas Javaud
- Emergency Department, Hopital Louis-Mourier, Colombes, France
| | | | - Maxime Maignan
- Emergency Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Ludovic Martin
- Service de Dermatologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Olivier Fain
- Internal Medicine, Hopital Saint-Antoine, Paris, France
| | - Laurence Bouillet
- National Reference Centre for Angioedema, Grenoble University Hospital, Grenoble, France
| | | | - Karim Tazarourte
- Emergency Medicine, University Hospital, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory (EA 7425), University Lyon 1, Lyon, France
| | - Pierre-Marie Roy
- Emergency Medicine, University Hospital of Angers, Angers, France
- Institut MITOVASC, Université d'Angers, UFR Santé, Angers, France
| | | | | | | | | | - Frederic Lapostolle
- Urgences-SAMU 93-Unité Recherche-Enseignement-Qualité, APHP, Hôpital Avicenne, Bobigny, France
| | | | - Marie-Sylvie Doutre
- Dermatology, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Cedric Gil-Jardine
- Emergency, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Bordeaux, France
| | | | | | - Dominique Pateron
- Emergency, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Eric Vicaut
- Clinical Research Department, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Frederic Adnet
- Urgences-SAMU 93-Unité Recherche-Enseignement-Qualité, APHP, Hôpital Avicenne, Bobigny, France
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Marçais C, Chetioui A, Yordanov Y, Reuter PG, Raynal PA, Pateron D, Thiebaud PC. Quels médicaments dans nos services mobiles d’urgence et de réanimation ? Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2019-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La dotation médicamenteuse nécessaire lors d’une intervention médicale préhospitalière n’est pas référencée, ce qui laisse chaque structure libre de constituer sa propre pharmacie. L’objectif principal de notre étude était de faire un état des lieux des dotations médicamenteuses des services mobiles d’urgence et de réanimation (Smur).
Méthode : Il s’agit d’une étude observationnelle déclarative, réalisée entre novembre 2017 et avril 2018 auprès de l’ensemble des Smur adultes de France.
Résultats : Sur 402 services sollicités, 191 (48 %) ont répondu et 177 (44 %) inclus. Un Smur disposait en moyenne de 74 ± 9 médicaments. Au total, 231 molécules ont été répertoriées. Parmi elles, 73 (32%) étaient disponibles dans plus de 50%des structures et 94 (41%) dans moins de 5%. Il existait des disparités des dotations médicamenteuses dans l’ensemble des spécialités, plus ou moins importantes selon la classe thérapeutique.
Discussion : La majorité des services dispose des médicaments nécessaires à la prise en charge des urgences les plus graves. Cependant, quelques recommandations ne sont pas toujours respectées. À la vue de nos résultats et des recommandations en vigueur, nous proposons une liste de molécules qui nous semblent être indispensables dans l’arsenal thérapeutique des Smur.
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Rotival J, Yordanov Y, Thiebaud PC, Pelletier-Fleury N, Jacquet E, Debuc E, Pateron D, Naouri D. General practitioner consultation after a visit to the emergency department: an observational study. Fam Pract 2019; 36:132-139. [PMID: 29931110 DOI: 10.1093/fampra/cmy054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some studies have demonstrated an association between poor continuity of care, high likelihood of 'inappropriate' use of emergency departments (EDs) and avoidable hospitalization. However, we lack data concerning primary care use after an ED visit. OBJECTIVE Identify the determinants of a visit to the general practitioner (GP) after an ED visit.Methods. DESIGN Observational study (single-centre cohort). SETTING One emergency department in Paris, France. SUBJECTS All adult patients who presented at the ED and were discharged. MAIN OUTCOME MEASURE We collected data by the use of a standardized questionnaire, patients' medical records and a telephonic follow-up. Descriptive analyses were performed to compare individuals with and without a GP. Then, for those with a GP, multivariate logistic regression was used to identify the determinants of the GP consultation. RESULTS We included 243 patients (mean age 45 years [±19]); 211 (87%) reported having a GP. Among those who reported having a GP, 52% had consulted their GP after the ED visit. Not having a GP was associated with young age, not having complementary health insurance coverage, and being single. GP consultation was associated with increasing age [adjusted odds ratios (aOR) = 1.03], poor self-reported health status (aOR = 2.25), medical complaints versus traumatic injuries (aOR = 2.24) and prescription for sick note (aOR = 5.74). CONCLUSION Not having a GP was associated with factors of social vulnerability such as not having complementary health insurance coverage. For patients with a GP, consultation in the month after an ED visit seems appropriate, because it was associated with poor health status and medical complaints.
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Affiliation(s)
- Julie Rotival
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France
| | - Youri Yordanov
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie-Curie, Paris, France
| | - Pierre-Clément Thiebaud
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Nathalie Pelletier-Fleury
- CESP - Centre de recherche médecine, sciences, santé, santé mentale, société - UMR 1018, Villejuif, France
| | - Elsa Jacquet
- Département de médecine générale, Université de médecine Paris Sud, Kremlin-Bicetre, France
| | - Erwan Debuc
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Dominique Pateron
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie-Curie, Paris, France
| | - Diane Naouri
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie-Curie, Paris, France
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Pateron D, Raphaël M, Trinh-Duc A. Diarrhée aiguë. Mega-Guide Pratique des Urgences 2019. [PMCID: PMC7152236 DOI: 10.1016/b978-2-294-76093-8.00044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pateron D, Raphaël M, Trinh-Duc A. Pneumopathies infectieuses communautaires. Mega-Guide Pratique des Urgences 2019. [PMCID: PMC7152179 DOI: 10.1016/b978-2-294-76093-8.00014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Daffos Q, Hansconrad E, Plaisance P, Pateron D, Yordanov Y, Chauvin A. Methodological characteristics of randomized controlled trials of ultrasonography in emergency medicine. Am J Emerg Med 2018; 37:338-343. [PMID: 30503277 DOI: 10.1016/j.ajem.2018.11.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Interest in ultrasonography in emergency medicine has increased in recent years, as reflected by a marked increase in publications on the topic. The aim of this study was to 1) describe and evaluate methodological characteristics of randomized controlled trials (RCTs) evaluating an ultrasound intervention in emergency department and 2) estimate whether the reports adequately described the intervention to allow replication. METHODS We searched MEDLINE via PubMed for RCTs published in 2015 assessing an ultrasound intervention, regardless of type, that were performed in an emergency department or evaluated in an emergency situation. Two researchers independently screened titles, abstracts and full texts. Data from all included studies were independently extracted. The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias of reports, and the intervention reporting was evaluated by using the Template for Intervention Description and Replication checklist. RESULTS We identified 11 reports. The most frequent topic was vascular access/identification (n = 4). Random sequence generation and allocation concealment were performed correctly in 55% and 27% trials. Three quarters of reports (73%) showed improper reporting or absence of participant blinding. Risk of bias due to assessor blinding was rated low for 3 RCTs (27%), risk of attrition bias low for all reports, and risk of selective outcome reporting unclear for most reports (n = 10). Only 3 reports (27%) provided an optimal description of the intervention. CONCLUSION The quality of these trials raises questions. In our sample, the authors did not correctly report blinding of participants and assessors or allocation concealment.
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Affiliation(s)
- Quentin Daffos
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France
| | - Erwin Hansconrad
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France
| | - Patrick Plaisance
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France
| | - Dominique Pateron
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
| | - Youri Yordanov
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Pierre et Marie Curie, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
| | - Anthony Chauvin
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France.
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Thiebaud PC, Yordanov Y, Galimard JE, Naouri D, Brigant F, Truchot J, Moustafa F, Pateron D. Suspected lower gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis. Am J Emerg Med 2018; 37:772-774. [PMID: 30154026 DOI: 10.1016/j.ajem.2018.08.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pierre-Clément Thiebaud
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Initiatives de Recherche aux Urgences, SFMU, French Society of Emergency Medicine, France.
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
| | - Jacques-Emmanuel Galimard
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRA Team, Saint-Louis Hospital, Paris, France
| | - Diane Naouri
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, Paris, France
| | - Fabien Brigant
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jennifer Truchot
- Initiatives de Recherche aux Urgences, SFMU, French Society of Emergency Medicine, France; Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Farès Moustafa
- Initiatives de Recherche aux Urgences, SFMU, French Society of Emergency Medicine, France; Emergency department, Hôpital Gabriel-Montpied, Clermont-Ferrand, France
| | - Dominique Pateron
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, Paris, France
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- Initiatives de Recherche aux Urgences, SFMU, French Society of Emergency Medicine, France
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Robert R, Beaussier M, Pateron D, Ecoffey C, Denys F, Honnart D, Misset B, Reignier J, Perrigault PF, Guidet B, Kerever S, Guiot P. Recommandations pour le fonctionnement des unités de surveillance continue dans les établissements de santé. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0067] [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: 11/20/2022]
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Robert R, Beaussier M, Pateron D, Ecoffey C, Denys F, Honnart D, Misset B, Reignier J, Perrigault PF, Guidet B, Kerever S, Guiot P. Recommandations pour le fonctionnement des unités de surveillance continue dans les établissements de santé. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0061] [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: 11/20/2022]
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Naouri D, Lapostolle F, Rondet C, Ganansia O, Pateron D, Yordanov Y. French residents are inadequately trained in the prevention of complications related to air travel. Travel Med Infect Dis 2018; 24:10-11. [DOI: 10.1016/j.tmaid.2018.06.003] [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] [Received: 08/24/2017] [Revised: 10/20/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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Chauvin A, Truchot J, Bafeta A, Pateron D, Plaisance P, Yordanov Y. Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review. Intern Emerg Med 2018; 13:433-444. [PMID: 29147942 DOI: 10.1007/s11739-017-1770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/10/2017] [Indexed: 11/27/2022]
Abstract
The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the "template for intervention description and replication" checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.
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Affiliation(s)
- Anthony Chauvin
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France.
- Faculté de Médecine, Université Diderot, Paris, France.
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France.
| | - Jennifer Truchot
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
- Ilumens Simulation Department, Paris Descartes University, 45 rue des Saint Pères, 75006, Paris, France
| | - Aida Bafeta
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
| | - Dominique Pateron
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Service des Urgences-Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Patrick Plaisance
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
| | - Youri Yordanov
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Service des Urgences-Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Guidet B, Pateron D, Boumendil A. ICU Admission and Mortality Among Elderly Adults-Reply. JAMA 2018. [PMID: 29536093 DOI: 10.1001/jama.2017.21680] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bertrand Guidet
- AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | | | - Ariane Boumendil
- AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
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Riou B, Carli P, Charpentier S, de La Coussaye JE, Dumas F, Gueugniaud PY, Maignan M, Pateron D, Pelaccia T. Modalités de fonctionnement du Conseil national des universités (CNU) de médecine d'urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Leblanc J, Hejblum G, Costagliola D, Durand-Zaleski I, Lert F, de Truchis P, Verbeke G, Rousseau A, Piquet H, Simon F, Pateron D, Simon T, Crémieux AC. Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Ann Emerg Med 2017; 72:41-53.e9. [PMID: 29092761 DOI: 10.1016/j.annemergmed.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. METHODS In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. RESULTS During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. CONCLUSION The combined strategy of targeted screening and diagnostic testing was effective.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, URC Eco Île-de-France, Paris, France, and Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Santé publique, Créteil, France
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Villejuif, France
| | - Pierre de Truchis
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Infectious Diseases Department, Garches, France
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, and UHasselt, Hasselt, Belgium
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris, Paris, France
| | - Hélène Piquet
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - François Simon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Louis, Microbiology Department, INSERM U941, Paris, France
| | - Dominique Pateron
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, and Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, Paris, France
| | - Anne-Claude Crémieux
- Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Infectious Diseases Department, Université Paris Diderot, Univ Paris 07, Paris, France
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Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, Maignan M, Yordanov Y, Delerme S, Doumenc B, Fartoukh M, Charestan P, Trognon P, Galichon B, Javaud N, Patzak A, Garrouste-Orgeas M, Thomas C, Azerad S, Pateron D, Boumendil A. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA 2017; 318:1450-1459. [PMID: 28973065 PMCID: PMC5710364 DOI: 10.1001/jama.2017.13889] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE The high mortality rate in critically ill elderly patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission and to a variable ICU use among this population. OBJECTIVE To determine whether a recommendation for systematic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster-randomized clinical trial of 3037 critically ill patients aged 75 years or older, free of cancer, with preserved functional status (Index of Independence in Activities of Daily Living ≥4) and nutritional status (absence of cachexia) who arrived at the emergency department of one of 24 hospitals in France between January 2012 and April 2015 and were followed up until November 2015. INTERVENTIONS Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n=1519 participants) or to follow standard practice (n=1518 participants). MAIN OUTCOMES AND MEASURES The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life (12-Item Short Form Health Survey, ranging from 0 to 100, with higher score representing better self-reported health) at 6 months. RESULTS One patient withdrew consent, leaving 3036 patients included in the trial (median age, 85 [interquartile range, 81-89] years; 1361 [45%] men). Patients in the systematic strategy group had an increased risk of death at 6 months (45% vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments for baseline characteristics, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups. CONCLUSIONS AND RELEVANCE Among critically ill elderly patients in France, a program to promote systematic ICU admission increased ICU use but did not reduce 6-month mortality. Additional research is needed to understand the decision to admit elderly patients to the ICU. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01508819.
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Affiliation(s)
- Bertrand Guidet
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR S 1136, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
| | - Guillaume Leblanc
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
- Department of Anesthesiology and Critical Care, Université Laval, Québec City, Québec, Canada
| | - Tabassome Simon
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- AP-HP, Hôpital Saint-Antoine, Department of Pharmacology and Unité de Recherche Clinique de l’Est Parisien, Paris, France
| | - Maguy Woimant
- AP-HP, Hôpital Avicenne, Service d’Accueil des Urgences (SAU), Bobigny, France
| | - Jean-Pierre Quenot
- CHU de Dijon, Service de Réanimation Médicale, Dijon, France
- Equipe LIPNESS, INSERM UMR 866, Université de Bourgogne Franche Comté, Dijon, France
| | | | | | | | | | | | | | | | | | | | | | - Anabela Patzak
- AP-HP, Hôpital européen Georges-Pompidou, SAU, Paris, France
| | | | - Caroline Thomas
- AP-HP, Hôpital Saint-Antoine, Service de Gériatrie Aiguë, Paris, France
| | - Sylvie Azerad
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique Paris Île-de-France Ouest, Boulogne-Billancourt, 92104, France
| | - Dominique Pateron
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
- AP-HP, Hôpital Saint-Antoine, SAU, Paris, France
| | - Ariane Boumendil
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
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Abstract
Pain in children is underestimated and undertreated because of lack of pain assessment tools. Pain assessment depends on the cognitive development of the child being tested, clinical context, and pain typology. For children older than age 6 years, pain assessment is based on a self-report. For children younger than age 6 years, behavioral pain scales are needed to assess pain. Numerous pain scales exist. Many are reliable and some are recommended, but all have specific conditions for their use. In this article, we review the available pain scales for children from birth to adolescence. We provide the validity criteria of each pain scale to help caregivers use the adapted tools. We then propose a synthesis of the reliable tools to use based on the pain context. [Pediatr Ann. 2017;46(10):e387-e395.].
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Chauvin A, Hutin A, Leredu T, Plaisance P, Pateron D, Yordanov Y. Accidental blood exposures among emergency medicine residents and young physicians in France: a national survey. Intern Emerg Med 2017; 12:221-227. [PMID: 27179649 DOI: 10.1007/s11739-016-1458-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to investigate the epidemiological characteristics of blood or fluid exposure (BFE) and occupational infection risk among emergency medicine (EM) residents and young physicians (<35 years old) in France. We led a cross-sectional, anonymous, online survey. 1779 participants were contacted with a response rate of 36 % (n = 633). Among the respondents, 459 (72 %) reported at least one BFE. Among participants with at least one BFE, 35 % (n = 163) never reported the exposure to the relevant medical authorities or support. Among participants who reported exposure, 63 % (n = 232) did it immediately. Among participants who never or not systematically reported their BFE, most of them (62 %, n = 181/289) did not do so because the procedure was too long, and 28 % (n = 82/289) estimated the risk as low even if only one-third (n = 166/458) checked their HIV status even though the BFE was at a transmission risk. Circumstances in which the participants had the most BFE were: suturing 57 % (n = 262/457) and when making precipitated gestures 24 % (n = 111/457). The latest exposures were caused by a solid needle in 42 % (n = 191/455) or hollow-bore needle in 27 % (n = 123/455). Post-exposure reporting rates were low. Reporting procedure itself and self-management were the main reasons for BFE underreporting. Simplifying procedures might increase BFE reporting, and allow appropriate post-exposure counseling and/or prophylaxis.
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Affiliation(s)
- Anthony Chauvin
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Faculté de Médecine, Université Diderot, Paris, France.
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France.
- Hospital Lariboisière, Service d'Accueil des Urgences, 2, rue Ambroise Pare, 75010, Paris, France.
| | - Alice Hutin
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
- Emergency Département, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Descartes, Paris, France
| | - Thomas Leredu
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
- Emergency Département, Hôpital Mignot, Versailles, France
| | - Patrick Plaisance
- Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
| | - Dominique Pateron
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
| | - Youri Yordanov
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
- AJMU, Association des Jeunes Médecins Urgentistes, Paris, France
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Leung I, Casalino E, Pateron D, Grateau G, Garandeau E, de Stampa M. [Participation of general practitioners in the management of their “hospital at home” patients]. Sante Publique 2016; 28:499-504. [PMID: 28155754] [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: 06/06/2023]
Abstract
Objectives: Hospital at home (HAH) care is becoming increasingly popular in France and requires the involvement of general practitioners (GPs) in the care of their patients. The objective of this study was to identify the incentives and barriers to the involvement of general practitioners in HAH. Materials and methods: A qualitative study was carried out using semi-structured interviews during a focus group with 12 GPs. All interviews were recorded and then transcribed verbatim and data analysis used the grounded theory method. Results: General practitioners appeared to be familiar with the indications and places of care for HAH, but they highlighted the difficulties associated with the HAH request circuit. GPs identified difficulties determining their exact role in HAH, which were improved by their clinical expertise in home visits. Doctors stressed the complexity of home care, but they were assisted by the coordinating physician and they requested specific training. Conclusion: We identified incentives and barriers to the participation of GPs in HAH. The request circuit needs to be simplified, home visits need to be strengthened and support must be provided to GPs in their management of complex care.
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Naouri D, Lapostolle F, Rondet C, Ganansia O, Pateron D, Yordanov Y. Prevention of Medical Events During Air Travel: A Narrative Review. Am J Med 2016; 129:1000.e1-6. [PMID: 27267286 PMCID: PMC7093858 DOI: 10.1016/j.amjmed.2016.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 01/23/2023]
Abstract
Prior to traveling, and when seeking medical pretravel advice, patients consult their personal physicians. Inflight medical issues are estimated to occur up to 350 times per day worldwide (1/14,000-40,000 passengers). Specific characteristics of the air cabin environment are associated with hypoxia and the expansion of trapped gases into body cavities, which can lead to harm. The most frequent medical events during air travel include abdominal pain; ear, nose, and throat pathologies; psychiatric disorders; and life-threatening events such as acute respiratory failure or cardiac arrest. Physicians need to be aware of the management of these conditions in this unusual setting. Chronic respiratory and cardiovascular diseases are common and are at increased risk of acute exacerbation. Physicians must be trained in these conditions and inform their patients about their prevention.
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Affiliation(s)
- Diane Naouri
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Frederic Lapostolle
- SAMU 93, Hopital Avicenne, Assistance Publique des Hôpitaux de Paris, Bobigny, France; Faculté de Médecine, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Claire Rondet
- Faculté de Médecine, Université Pierre et Marie-Curie, Departement de Médecine Générale, Paris, France
| | - Olivier Ganansia
- Service des Urgences, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Dominique Pateron
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Pierre et Marie-Curie, Paris, France and NOT Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Youri Yordanov
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Pierre et Marie-Curie, Paris, France and NOT Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Centre de Recherche Epidémiologie et Statistique, INSERM U1153, Paris, France.
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Boumendil A, Woimant M, Quenot JP, Rooryck FX, Makhlouf F, Yordanov Y, Delerme S, Takun K, Ray P, Kouka MC, Poly C, Garrouste-Orgeas M, Thomas C, Simon T, Azerad S, Leblanc G, Pateron D, Guidet B. Designing and conducting a cluster-randomized trial of ICU admission for the elderly patients: the ICE-CUB 2 study. Ann Intensive Care 2016; 6:74. [PMID: 27473119 PMCID: PMC4967062 DOI: 10.1186/s13613-016-0161-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/21/2016] [Indexed: 11/15/2022] Open
Abstract
Background
The benefit of ICU admission for elderly patients remains controversial. This report highlights the methodology, the feasibility of and the ethical and logistical constraints in designing and conducting a cluster-randomized trial of intensive care unit (ICU) admission for critically ill elderly patients. Methods
We designed an interventional open-label cluster-randomized controlled trial in 24 centres in France. Clusters were healthcare centres with at least one emergency department (ED) and one ICU. Healthcare centres were randomly assigned either to recommend a systematic ICU admission (intervention group) or to follow standard practices regarding ICU admission (control group). Clusters were stratified by the number of ED annual visits (<44,616 or >44,616 visits), the presence or absence of a geriatric ward and the geographical area (Paris area vs other regions in France). All elderly patients (≥75 years of age) who got to the ED were assessed for eligibility. Patients were included if they had one of the pre-established critical conditions, a preserved functional status as assessed by an ADL scale ≥4 (0 = very dependent, 6 = independent), a preserved nutritional status (subjectively assessed by physicians) and without active cancer. Exclusion criteria were an ED stay >24 h, a secondary referral to the ED and refusal to participate. The primary outcome was the mortality at 6 months calculated at the individual patient level. Secondary outcomes were ICU and hospital mortality, as well as ADL scale and quality of life (as assessed by the SF-12 Health Survey) at 6 months. Results
Between January 2012 and April 2015, 3036 patients were included in the trial, 1518 patients in 11 clusters allocated to intervention group and 1518 patients in 13 clusters allocated to standard care. There were 51 protocol violations. Conclusions The ICE-CUB 2 trial was deemed feasible and ethically acceptable. The ICE-CUB 2 trial will be the first cluster-randomized trial to assess the benefits of ICU admission for selected elderly patients on long-term mortality. Trial registration Clinical trials.gov identifier: NCT01508819 Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0161-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariane Boumendil
- Hôpital Saint-Antoine, Service de Réanimation Médicale (Intensive Care Unit - ICU), Assistance Publique - Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Maguy Woimant
- Hôpital Avicenne, Service d'Accueil des Urgences (SAU, Emergency Department), AP-HP, 93009, Bobigny, France
| | | | | | | | | | - Samuel Delerme
- Hôpital Pitié Salpétrière, SAU, AP-HP, 75013, Paris, France
| | - Khalil Takun
- Hôpital Cochin, SAU, AP-HP, 75014, Paris, France
| | - Patrick Ray
- Hôpital Tenon, SAU, AP-HP, 75020, Paris, France
| | | | - Claire Poly
- SAU, Hôpital Robert Ballanger, 93602, Aulnay-Sous-Bois, France
| | | | - Caroline Thomas
- Hôpital Saint-Antoine, Acute Geriatric Ward, AP-HP, 75012, Paris, France
| | - Tabasome Simon
- Hôpital Saint-Antoine, URC Est, AP-HP, 75012, Paris, France
| | - Sylvie Azerad
- Hôpital Ambroise Paré, URC Ouest, AP-HP, 92104, Boulogne-Billancourt, Paris, France
| | - Guillaume Leblanc
- Department of Anesthesiology and Critical Care, Université Laval, Québec, QC, Canada
| | - Dominique Pateron
- Hôpital Saint-Antoine, SAU, AP-HP, 75012, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Bertrand Guidet
- Hôpital Saint-Antoine, Service de Réanimation Médicale (Intensive Care Unit - ICU), Assistance Publique - Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,UPMC Univ Paris 06, Sorbonne Universités, Paris, France. .,UMR_S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, INSERM, 75013, Paris, France.
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Pateron D, Raphaël M, Trinh-Duc A. Pneumopathies infectieuses communautaires. Méga-Guide Pratique des Urgences 2016. [PMCID: PMC7167520 DOI: 10.1016/b978-2-294-74748-9.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yordanov Y, Pateron D. Re: Not Another Boring Lecture: Let's Be the Guide on the Side. J Emerg Med 2015; 49:710-711. [PMID: 26277196 DOI: 10.1016/j.jemermed.2014.12.096] [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: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Youri Yordanov
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Centre de Recherche Epidémiologie et Statistique, INSERM, Paris, France
| | - Dominique Pateron
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Pierre et Marie Curie, Paris, France
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Poulizac C, Soulat-Dufour L, Lang S, Hermand C, El Asri C, Adavane S, Ederhy S, Boccara F, Pateron D, Cohen A. 33 Diagnostic accuracy of cardiovascular screening using pocket-size ultrasound in patients with dyspnea in the emergency setting. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Soulat-Dufour L, Lang S, Rousseau AP, Poulizac C, Hermand C, El Asri C, Boyer-Chatenet L, Adavane S, Ederhy S, Boccara F, Pateron D, Cohen A. 30 Pocket-size ultrasound does not alter the diagnosis of the cardiologist in patients admitted for chest pain in a cardiac unit. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alves M, Janneau-Magrino L, Legendre N, Pateron D, Guidet B, Yordanov Y. Human immunodeficiency virus post-exposure prophylaxis: primum non nocere. Am J Med 2015; 128:e3-4. [PMID: 25486450 DOI: 10.1016/j.amjmed.2014.10.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Mikael Alves
- Intensive Care Unit, Centre Hospitalier Intercommunal Poissy Saint Germain en Laye, Poissy, France
| | - Laurène Janneau-Magrino
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Legendre
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Pateron
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Pierre et Marie Curie, Paris, France.
| | - Bertrand Guidet
- Faculté de Médecine, Université Pierre et Marie Curie, Paris, France; Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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32
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Yordanov Y, Beltramini A, Debuc E, Pateron D. [Improving emergency department organisation]. Rev Prat 2015; 65:41-46. [PMID: 25842427] [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: 06/04/2023]
Abstract
Emergency departments use has been constantly increasing over the world. Overcrowding is defined as a situation which compromises patient safety because of delayed cares. This situation is often reached. Emergency departments have to continuously improve their organization to be able to ensure the same quality of care to a higher number of patients. Thus a good organization is essential: it doesn't always avoid overcrowding. The rest of the hospital has to be involved in this process to ensure efficiency. We examine the various interventions and procedures that can be found in medical literature for improving patients flow and management in emergency departments.
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Affiliation(s)
- Youri Yordanov
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Pateron
- Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adrien May
- Service de Pédiatrie, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
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Guidet B, Thomas C, Pateron D, Pichereau C, Bigé N, Boumendil A, Garrouste-Orgeas M, N’guyen YL. Personnes âgées et réanimation. Réanimation 2014. [DOI: 10.1007/s13546-013-0814-4] [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: 10/26/2022]
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d'Almeida KW, Pateron D, Kierzek G, Renaud B, Semaille C, de Truchis P, Simon F, Leblanc J, Lert F, Le Vu S, Crémieux AC. Understanding providers' offering and patients' acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France. PLoS One 2013; 8:e62686. [PMID: 23638133 PMCID: PMC3639277 DOI: 10.1371/journal.pone.0062686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/22/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We assessed the EDs’ characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France’s new HIV cases are diagnosed annually. Methods EDs nurses offered testing to all patients 18–64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS’ characteristics collected included structural characteristics (location, type, size), daily workload (patients’ number and severity, length of stay in hours), staff’s participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling. Results Indigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773–0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581–0.667) and decreased over time (OR = 0.978, 95% CI = 0.975–0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623–0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142–2.038). The EDs’ characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate. Conclusion Our findings suggest the need for taking into account EDs’ characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources’ utilization such as HIV targeted screening in the EDs might be privileged.
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Pateron D. Une organisation des flux au sein des urgences. Ann Fr Med Urgence 2013. [DOI: 10.1007/s13341-013-0294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, Guidet B. Variability of intensive care admission decisions for the very elderly. PLoS One 2012; 7:e34387. [PMID: 22509296 PMCID: PMC3324496 DOI: 10.1371/journal.pone.0034387] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 03/02/2012] [Indexed: 11/18/2022] Open
Abstract
Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83–91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear.
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Affiliation(s)
- Ariane Boumendil
- Unité de Recherche en Épidémiologie Systèmes d'Information et Modélisation U707, Institut national de la santé et de la recherche médicale, Paris, France.
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Croguennec Y, Braun F, Fréchard S, Ricard-Hibon A, Dhers M, Pateron D. L’infi rmier(ère) diplomé(e) d’état seul(e) devant une situation de détresse médicale. Ann Fr Med Urgence 2012. [DOI: 10.1007/s13341-012-0151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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d'Almeida KW, Kierzek G, de Truchis P, Le Vu S, Pateron D, Renaud B, Semaille C, Bousquet V, Simon F, Guillemot D, Lert F, Crémieux AC. Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments. ACTA ACUST UNITED AC 2011; 172:12-20. [PMID: 22025095 DOI: 10.1001/archinternmed.2011.535] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To lower the number of undiagnosed infections and to improve early detection, international health agencies have promoted nontargeted human immunodeficiency virus (HIV) screening in health care settings, including emergency departments (EDs). This strategy remains controversial and has yet to be tested on a large scale. We assessed the public health impact of nontargeted HIV-rapid test (RT) screening among ED patients in the metropolitan area of Paris (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually. METHODS During a randomly assigned 6-week period for each of the 29 participating EDs, 18- to 64-year-old patients who were able to provide consent for HIV testing were offered a fingerstick whole-blood HIV RT. Main outcome measures were the number of patients tested for HIV and their characteristics vs those of the general metropolitan Paris population and the proportion of newly diagnosed HIV-positive patients among those tested and their characteristics vs those from the national HIV case surveillance. RESULTS Among 138,691 visits, there were 78,411 eligible patients, 20,962 of whom (27.0%) were offered HIV RT; 13,229 (63.1%) accepted testing and 12,754 (16.3%) were tested. The ED patients' characteristics reflected the general population distribution. Eighteen patients received new HIV diagnoses (0.14%; 95% confidence interval, 0.08%-0.22%). Like national HIV case surveillance patients, they belonged to a high-risk group (n = 17), were previously tested (n = 12), and were either symptomatic or had a CD4 lymphocyte count lower than 350/μL, suggesting late-stage infections (n = 8); 12 patients were linked to care. CONCLUSIONS Nontargeted HIV testing in EDs was feasible but identified only a few new HIV diagnoses, often at late stages, and, unexpectedly, most patients belonged to a high-risk group. Our findings do not support the implementation of nontargeted screening of the general population in EDs.
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Affiliation(s)
- Kayigan Wilson d'Almeida
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Centre de Recherche en Épidémiologie et Santé des Populations, Villejuif, France
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Nemitz B, Carli P, Carpentier F, Ducassé JL, Giroud M, Pateron D, Pelloux P, Riou B, Schmidt J. Référentiel métier-compétences pour la spécialité de médecine d’urgence. Ann Fr Med Urgence 2011. [DOI: 10.1007/s13341-011-0124-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Pateron D, Vicaut E, Debuc E, Sahraoui K, Carbonell N, Bobbia X, Thabut D, Adnet F, Nahon P, Amathieu R, Aout M, Javaud N, Ray P, Trinchet JC. Erythromycin Infusion or Gastric Lavage for Upper Gastrointestinal Bleeding: A Multicenter Randomized Controlled Trial. Ann Emerg Med 2011; 57:582-9. [DOI: 10.1016/j.annemergmed.2011.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/15/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
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Perruche F, Elie C, d'Ussel M, Ray P, Thys F, Bleichner G, Roy PM, Schmidt J, Gayet A, Pateron D, Le Joubioux E, Porcher N, Gamand P, Claessens YE. Anxiety and depression are unrecognised in emergency patients admitted to the observation care unit. Emerg Med J 2010; 28:662-5. [DOI: 10.1136/emj.2009.089961] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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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Somme D, Boumendil A, Garrouste-Orgeas M, Pateron D, Aegerter P, Simon T, Guidet B. Quelles sont les indications pertinentes de recours à la réanimation pour les personnes âgées? Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Capolaghi B, Charbonnier B, Dumontet M, Hennache B, Henninot J, Laperche T, Lavoinne A, Lefèvre G, Morin C, Pateron D. [Prescription, assay and interpretation of cardiac troponins tests: guidelines from SFBC-CNBC troponin working group]. Ann Biol Clin (Paris) 2005; 63:245-61. [PMID: 15951257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 03/16/2005] [Indexed: 05/02/2023]
Abstract
Troponin (I or T) has become the gold-standard marker in acute coronary syndromes during the last few years, as confirmed by a national survey realized within french clinical chemists, cardiologists and emergency practitioners. The importance of this marker and the heterogeneousness of circulating forms of troponin after myocardial necrosis fully justify international studies about standardization of this assay, which is a central bulk to reach a global market coherence. Checking analytical problems, although necessary, must be absolutely associated with an informed clinical interpretation. The knowledge of the crucial thresholds of each assay, the kinetic curves and the specificity limits of troponin assays allow the best use of their potential in diagnosis and prognosis together with an optimal patient care in very different clinical settings, in addition to others clinical and technical arguments. The quality improvement through successive generations of assay kits must nowadays persuade the physicians never to ignore a significant and valid troponin increase, which mainly reveals a cardiac injury, whatever its origin.
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Affiliation(s)
- B Capolaghi
- Laboratoire de biochimie, Hôpital Bel Air, CHR Metz-Thionville
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Abstract
INTRODUCTION The "Collégiale des radiologistes" of the Paris public hospital system (Assistance Publique-Hôpitaux de Paris, AP-HP) has participated since 1998 in a collaborative quality improvement program for the 49 radiology departments. They work together with the AP-HP college of emergency physicians on one part of this program, which focuses on emergency radiologic work-ups. Analysis of the dysfunctions in this sector underlined the lack of agreement between clinicians and radiologists on the examinations required. OBJECTIVE The aim of this project was to establish operational and consensual guidelines for physicians, radiologists and emergency teams for the use of diagnostic radiology in emergency situations in adults. METHOD The working group of radiologists and emergency physicians drafted this document, largely from documentary sources. A large panel of physicians validated the draft during successive review sessions, and the two colleges then approved them. RESULTS The guidelines are presented in 3 columns: clinical situations, quality aims (type of imaging, time within which the examination should be performed) and comments. The clinical situations were regrouped by anatomical area or system: head, neck, thorax, heart, gynecology, abdomen, urinary, non-traumatic bone and spine disorders, multiple trauma, and isolated trauma of the spine and limbs and of the head, trunk, abdomen, and pelvis. CONCLUSION These guidelines based on consensus within the institution make it possible to harmonize the requests for and practices of radiologic examinations in emergency situations. Their implementation is an integral part of the ongoing development of operating agreements between the radiology and emergency departments.
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Affiliation(s)
- Dominique Pateron
- Service Médical d'Accueil, Fédération des Urgences Médico-Chirurgicales, CHU Jean Verdier, avenue du 14 Juillet, 93140 Bondy
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Abstract
OBJECTIVES Little is known about the epidemiology of acute upper gastrointestinal haemorrhage hospitalized in Emergency Departments. Most of the studies concerning digestive bleeding have been carried out by Gastroenterology Departments. This multicentre study included consecutive patients with acute upper gastrointestinal haemorrhage hospitalized after an initial management at Emergency Departments in France, to describe the initial medical management and to determine the causes of acute upper gastrointestinal haemorrhage. We also studied the relationship between the use of non-steroidal anti-inflammatory drugs or aspirin and the occurrence of an acute upper gastrointestinal haemorrhage by a case-control comparison. RESULTS A total of 180 patients (112 men, 59+/-18 years) were included during 23 days, and 353 controls (222 men, 57+/-13 years) were selected at the same time. The delay between the first clinical signs of acute upper gastrointestinal haemorrhage and arrival at the Emergency Department was 33+/-42 h, and endoscopy was performed 14+/-16 h after admission to the Emergency Department. Sixty-six percent of patients with cirrhosis could benefit from a specific vasoactive treatment. Endoscopy was performed in 160 patients. Bleeding was caused by ulcers and gastritis in 88 patients (49%) and portal hypertension in 59 (32%). The relationship between the use of non-steroidal anti-inflammatory drugs or aspirin and acute upper gastrointestinal haemorrhage was confirmed, odds ratio, (OR) 1.69 [95% confidence interval (CI) 1.15-2.33], but not among cirrhotic patients, odds ratio 1.12 (95% CI 0.65-1.86). CONCLUSION Hospitalized acute upper gastrointestinal haemorrhage in Emergency Departments in France is more often caused by cirrhosis than in other countries. Decreasing the delay between the first signs of bleeding and arrival at the Emergency Department is the main challenge in the management of acute upper gastrointestinal haemorrhage.
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Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, Batallan A, Bernot B, Pateron D, Stimemann J, Thomas M. Valeur du symptôme PICA pour le diagnostic de carence martiale. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tazi KA, Barrière E, Moreau R, Heller J, Sogni P, Pateron D, Poirel O, Lebrec D. Role of shear stress in aortic eNOS up-regulation in rats with biliary cirrhosis. Gastroenterology 2002; 122:1869-77. [PMID: 12055594 DOI: 10.1053/gast.2002.33586] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS In rats with portal vein stenosis, the initial cause of aortic nitric oxide (NO) overproduction might be overactivation of endothelial NO synthase (eNOS) related to increased shear stress. Cardiac output is higher in cirrhosis than in extrahepatic portal hypertension. The aims of this study were to evaluate the role of shear stress, vascular endothelial growth factor (VEGF), and cytokines in aortic eNOS up-regulation in rats with biliary cirrhosis and to compare these results with those in rats with portal vein stenosis. METHODS NOS activities, NOS protein, heat shock protein (Hsp) 90, and VEGF expressions were studied in rat aortas. Propranolol was administered to rats with cirrhosis to reduce cardiac output and thus shear stress. RESULTS In cirrhotic rats, the aortic eNOS protein was 3.0 and 1.7 times higher than in control and portal vein-stenosed rats, respectively. In cirrhotic rats, the Hsp90 content was 3.2 and 2.2 times higher than in control and portal vein-stenosed rats, respectively. Propranolol decreased NOS activity by 47% and eNOS and Hsp90 expression by 75% and 72%, respectively. Aortic VEGF expression was decreased in cirrhotic rats. VEGF-induced stimulation of NOS activity was greater in aortas from control rats than in aortas from portal vein-stenosed or cirrhotic rat aortas. eNOS expression was up-regulated after VEGF incubation. After lipopolysaccharide administration, eNOS expression did not change in portal vein-stenosed or cirrhotic rats. CONCLUSIONS This study shows that in aortas from rats with biliary cirrhosis, systemic vasodilation depends mainly on eNOS up-regulation related to shear stress.
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Affiliation(s)
- Khalid A Tazi
- Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, INSERM U-481, Hôpital Beaujon, Clichy, France.
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