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Jermini M, Fonzo-Christe C, Blondon K, Milaire C, Stirnemann J, Bonnabry P, Guignard B. Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis. Int J Clin Pharm 2024; 46:496-505. [PMID: 38315303 PMCID: PMC10960916 DOI: 10.1007/s11096-023-01683-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review. AIM To develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events. METHOD Two pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated. RESULTS The estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1-1.71. Sensitivity analyses showed that the economic model was robust. CONCLUSION This economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.
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Affiliation(s)
- Mégane Jermini
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Caroline Fonzo-Christe
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
| | - Katherine Blondon
- Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Bertrand Guignard
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
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Krispin E, Javinani A, Odibo A, Carreras E, Emery SP, Sepulveda Gonzalez G, Habli M, Hecher K, Ishii K, Miller J, Papanna R, Johnson A, Khalil A, Kilby MD, Lewi L, Bennasar Sans M, Otaño L, Zaretsky MV, Sananes N, Turan OM, Slaghekke F, Stirnemann J, Van Mieghem T, Welsh AW, Yoav Y, Chmait R, Shamshirsaz AA. Consensus protocol for management of early and late twin-twin transfusion syndrome: Delphi study. Ultrasound Obstet Gynecol 2024; 63:371-377. [PMID: 37553800 DOI: 10.1002/uog.27446] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Fetoscopic laser photocoagulation (FLP) is a well-established treatment for twin-twin transfusion syndrome (TTTS) between 16 and 26 weeks' gestation. High-quality evidence and guidelines regarding the optimal clinical management of very early (prior to 16 weeks), early (between 16 and 18 weeks) and late (after 26 weeks) TTTS are lacking. The aim of this study was to construct a structured expert-based clinical consensus for the management of early and late TTTS. METHODS A Delphi procedure was conducted among an international panel of experts. Participants were chosen based on their clinical expertise, affiliation and relevant publications. A four-round Delphi survey was conducted using an online platform and responses were collected anonymously. In the first round, a core group of experts was asked to answer open-ended questions regarding the indications, timing and modes of treatment for early and late TTTS. In the second and third rounds, participants were asked to grade each statement on a Likert scale (1, completely disagree; 5, completely agree) and to add any suggestions or modifications. At the end of each round, the median score for each statement was calculated. Statements with a median grade of 5 without suggestions for change were accepted as the consensus. Statements with a median grade of 3 or less were excluded from the Delphi process. Statements with a median grade of 4 were modified according to suggestions and reconsidered in the next round. In the last round, participants were asked to agree or disagree with the statements, and those with more than 70% agreement without suggestions for change were considered the consensus. RESULTS A total of 122 experts met the inclusion criteria and were invited to participate, of whom 53 (43.4%) agreed to take part in the study. Of those, 75.5% completed all four rounds. A consensus on the optimal management of early and late TTTS was obtained. FLP can be offered as early as 15 weeks' gestation for selected cases, and can be considered up to 28 weeks. Between 16 and 18 weeks, management should be tailored according to Doppler findings. CONCLUSIONS A consensus-based treatment protocol for early and late TTTS was agreed upon by a panel of experts. This protocol should be modified at the discretion of the operator, according to their experience and the specific demands of each case. This should advance the quality of future studies, guide clinical practice and improve patient care. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Krispin
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Javinani
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - E Carreras
- Maternal-Fetal Medicine Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S P Emery
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - G Sepulveda Gonzalez
- Instituto de Salud Fetal (ISF), Hospital Regional Materno Infantil, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - M Habli
- Department of Pediatric Surgery, Fetal Care Center of Cincinnati, Good Samaritan Hospital, Cincinnati, OH, USA
| | - K Hecher
- Department of Obstetrics and Prenatal Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - K Ishii
- Maternal-Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - J Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | - R Papanna
- Fetal Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - A Johnson
- Fetal Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - M D Kilby
- Fetal Medicine Center, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Illumina UK, Great Abbington, Cambridge, UK
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M Bennasar Sans
- BCNatal, Maternal-Fetal Medicine Center, Hospital Clínic i Hospital Sant Joan de Déu, Barcelona, Spain
| | - L Otaño
- Maternal-Fetal Medicine Unit, Obstetric Division, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - M V Zaretsky
- Colorado Fetal Care Center, Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
| | - N Sananes
- Obstetrics and Gynecology Department, Strasbourg University Hospital, Strasbourg, France
- Inserm 1121 'Biomaterials and Bioengineering', Strasbourg University, Strasbourg, France
| | - O M Turan
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Slaghekke
- Department of Obstetrics, Fetal Medicine Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - T Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - A W Welsh
- Maternal-Fetal Medicine, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Y Yoav
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Chmait
- Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A A Shamshirsaz
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Hofmeister J, Garin N, Montet X, Scheffler M, Platon A, Poletti PA, Stirnemann J, Debray MP, Claessens YE, Duval X, Prendki V. Validating the accuracy of deep learning for the diagnosis of pneumonia on chest x-ray against a robust multimodal reference diagnosis: a post hoc analysis of two prospective studies. Eur Radiol Exp 2024; 8:20. [PMID: 38302850 PMCID: PMC10834924 DOI: 10.1186/s41747-023-00416-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) seems promising in diagnosing pneumonia on chest x-rays (CXR), but deep learning (DL) algorithms have primarily been compared with radiologists, whose diagnosis can be not completely accurate. Therefore, we evaluated the accuracy of DL in diagnosing pneumonia on CXR using a more robust reference diagnosis. METHODS We trained a DL convolutional neural network model to diagnose pneumonia and evaluated its accuracy in two prospective pneumonia cohorts including 430 patients, for whom the reference diagnosis was determined a posteriori by a multidisciplinary expert panel using multimodal data. The performance of the DL model was compared with that of senior radiologists and emergency physicians reviewing CXRs and that of radiologists reviewing computed tomography (CT) performed concomitantly. RESULTS Radiologists and DL showed a similar accuracy on CXR for both cohorts (p ≥ 0.269): cohort 1, radiologist 1 75.5% (95% confidence interval 69.1-80.9), radiologist 2 71.0% (64.4-76.8), DL 71.0% (64.4-76.8); cohort 2, radiologist 70.9% (64.7-76.4), DL 72.6% (66.5-78.0). The accuracy of radiologists and DL was significantly higher (p ≤ 0.022) than that of emergency physicians (cohort 1 64.0% [57.1-70.3], cohort 2 63.0% [55.6-69.0]). Accuracy was significantly higher for CT (cohort 1 79.0% [72.8-84.1], cohort 2 89.6% [84.9-92.9]) than for CXR readers including radiologists, clinicians, and DL (all p-values < 0.001). CONCLUSIONS When compared with a robust reference diagnosis, the performance of AI models to identify pneumonia on CXRs was inferior than previously reported but similar to that of radiologists and better than that of emergency physicians. RELEVANCE STATEMENT The clinical relevance of AI models for pneumonia diagnosis may have been overestimated. AI models should be benchmarked against robust reference multimodal diagnosis to avoid overestimating its performance. TRIAL REGISTRATION NCT02467192 , and NCT01574066 . KEY POINT • We evaluated an openly-access convolutional neural network (CNN) model to diagnose pneumonia on CXRs. • CNN was validated against a strong multimodal reference diagnosis. • In our study, the CNN performance (area under the receiver operating characteristics curve 0.74) was lower than that previously reported when validated against radiologists' diagnosis (0.99 in a recent meta-analysis). • The CNN performance was significantly higher than emergency physicians' (p ≤ 0.022) and comparable to that of board-certified radiologists (p ≥ 0.269).
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Affiliation(s)
- Jeremy Hofmeister
- Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland.
| | - Nicolas Garin
- Division of Internal Medicine, Riviera Chablais Hospital, Rennaz, Switzerland
- Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Xavier Montet
- Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Max Scheffler
- Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandra Platon
- Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jérôme Stirnemann
- Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Pierre Debray
- Department of Radiology, APHP, Hôpital Bichat, University Paris Cité, Inserm UMR1152, Paris, France
| | - Yann-Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, La Colle, Principality of Monaco, Monaco
| | - Xavier Duval
- Department of Epidemiology and Clinical ResearchInserm CIC 1425UMR 1138, APHP, Hôpital BichatUniversity Paris CitéIAME, Paris, France
| | - Virginie Prendki
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
- Division of Infectious Disease, Geneva University Hospital, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.
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Corroenne R, Jacquier M, Stirnemann J, Salomon LJ, Ville Y, Chalouhi G. Evaluation of optical positioning ultrasound simulator for assessment of trainee ability in obstetric ultrasound. Ultrasound Obstet Gynecol 2024; 63:115-116. [PMID: 37329498 DOI: 10.1002/uog.26295] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Affiliation(s)
- R Corroenne
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - M Jacquier
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - J Stirnemann
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - G Chalouhi
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
- Centre SFFERe, Boulogne-Billancourt, France
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Benabdderrahmane K, Stirnemann J, Ramtani S, Falentin-Daudré C. Development of a double-layer electrospun patch as a potential prenatal treatment for myelomeningocele. Wound Repair Regen 2023. [PMID: 37957136 DOI: 10.1111/wrr.13123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/05/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
Myelomeningocele (MMC) is a congenital defect of the spine characterised by meningeal and spinal cord protrusion through the open vertebral arches. This defect causes progressive prenatal damage of the spinal cord, leading to lifelong handicap. Although mid-trimester surgical repair may reduce part of the handicap, an earlier and less invasive approach would further improve the prognosis, possibly minimising maternal and foetal risks. Several studies have proposed an alternative approach to surgical repair by covering the defect with a patch and protecting the exposed neural tissue. Our study aims to elaborate on a waterproof and biodegradable bioactive patch for MMC prenatal foetal repair. We developed a double-layer patch that can provide a waterproof coverage for the spinal cord, with a bioactive side, conducive to cell proliferation, and an antiadhesive side to avoid its attachment to the medulla.
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Affiliation(s)
- K Benabdderrahmane
- LBPS/CSPBAT, UMR CNRS 7244, Institut Galilée, Université Sorbonne Paris Nord, Villetaneuse, France
| | - J Stirnemann
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France
- EA7328 Institut Imagine & Université de Paris-Cité, Paris, France
| | - S Ramtani
- LBPS/CSPBAT, UMR CNRS 7244, Institut Galilée, Université Sorbonne Paris Nord, Villetaneuse, France
| | - C Falentin-Daudré
- LBPS/CSPBAT, UMR CNRS 7244, Institut Galilée, Université Sorbonne Paris Nord, Villetaneuse, France
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Stirnemann J, Besson R, Debavelaere V, Loge F, Amabile C, Migeon P, Curran MA, Fries N, Smith E, Ostermayer E, Bradley KE, Armstrong L, Trychon K, Sheehan K, Flinn M, Rodriguez DA, Spiliopoulos M, Romero V, Jones DA, Allbert JR, Ghulmiyyah L, Spaggiari E, Ville Y. Abstracts of the 33rd World Congress on Ultrasound in Obstetrics and Gynecology, 16-19 October 2023, Seoul, South Korea. Ultrasound Obstet Gynecol 2023; 62 Suppl 1:1-316. [PMID: 37779444 DOI: 10.1002/uog.26321] [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] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | | | - M A Curran
- Division of Maternal-Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - N Fries
- Collège Français d'Echographie Fetale, Paris, France
| | - E Smith
- BovenMaas, Rotterdam, Netherlands
| | - E Ostermayer
- Pränatalmedizin 5-Seen-Land, Seefeld-Hechendorf, Germany
| | - K E Bradley
- Private Practice, Westlake, Village, CA, USA
| | - L Armstrong
- UNC Southeastern Maternal-Fetal Medicine, Lumberton, NC, USA
| | - K Trychon
- Center for Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Sheehan
- Obstetrics and Gynecology, Private Practice, Ridgewood, NJ, USA
| | - M Flinn
- Diagnostic Center of Arizona, Chandler, AZ, USA
| | | | - M Spiliopoulos
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - V Romero
- Maternal-Fetal Medicine, Corewell Health-West, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - D A Jones
- Perinatal Specialists of the Palm Beaches, West Palm Beach, FL, USA
| | - J R Allbert
- Maternal-Fetal Medicine Associates, Charlotte, NC, USA
| | - L Ghulmiyyah
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - E Spaggiari
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
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7
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Nassr AA, Hessami K, Corroenne R, Sanz Cortes M, Donepudi R, Espinoza J, Yamamoto R, Stirnemann J, Ishii K, Belfort MA, Chmait RH, Shamshirsaz AA. Outcome of laser photocoagulation in monochorionic diamniotic twin pregnancy complicated by Type-II selective fetal growth restriction. Ultrasound Obstet Gynecol 2023; 62:369-373. [PMID: 36704956 DOI: 10.1002/uog.26165] [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] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To evaluate the outcome of monochorionic diamniotic (MCDA) twins complicated by Type-II selective fetal growth restriction (sFGR) who underwent fetoscopic laser photocoagulation and to validate a previously proposed subclassification system for Type-II sFGR in a large multicenter cohort. METHODS This retrospective multicenter cohort study included all MCDA twins complicated by Type-II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal-care centers between 2006 and 2020. Cases were subclassified according to a recently proposed system based on Doppler evaluation of the ductus venosus (DV) and middle cerebral artery (MCA) into Type-IIA (normal DV flow and MCA peak systolic velocity (PSV) of the growth-restricted fetus) or Type-IIB (absent or reversed flow in the DV during atrial contraction and/or MCA-PSV ≥ 1.5 multiples of the median of the growth-restricted fetus). Demographic characteristics and pregnancy outcomes were compared between the groups. Data are presented as mean ± SD or n (%) as appropriate. P-values < 0.05 were considered statistically significant. RESULTS A total of 98 patients with MCDA twins met our inclusion criteria, with 56 subclassified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type-IIB cases had a significantly earlier gestational age at diagnosis and at laser surgery, as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth-restricted fetus to 30 days of age was significantly lower in Type-IIB compared to Type-IIA cases (23.8% vs 46.4%; P = 0.034). CONCLUSIONS In MCDA twins complicated by Type-II sFGR and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the DV and MCA helped identify a subset of patients at increased risk of demise of the growth-restricted fetus following intervention. This study provides valuable information for guiding surgical management and patient counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R Corroenne
- Department of Obstetrics and Gynecology, University Paris Descartes, Hopital Necker-Enfants Malades, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R Donepudi
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R Yamamoto
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - J Stirnemann
- Department of Obstetrics and Gynecology, University Paris Descartes, Hopital Necker-Enfants Malades, Paris, France
| | - K Ishii
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - R H Chmait
- Department of Obstetrics and Gynecology, Los Angeles Fetal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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8
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Corroenne R, Grevent D, Kasprian G, Stirnemann J, Ville Y, Mahallati H, Salomon LJ. Corpus callosal reference ranges: systematic review of methodology of biometric chart construction and measurements obtained. Ultrasound Obstet Gynecol 2023; 62:175-184. [PMID: 36864530 DOI: 10.1002/uog.26187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Adequate reference ranges of size of the corpus callosum (CC) are necessary to improve characterization of CC abnormalities and parental counseling. The objective of this study was to evaluate the methodology used in studies developing references charts for CC biometry. METHODS We conducted a systematic review of studies on fetal CC biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. We included observational studies whose primary aim was to create ultrasound or magnetic resonance imaging charts for CC size in a normal population of fetuses. Studies were scored against a predefined set of independently agreed methodological criteria, and an overall quality score was given for each study. RESULTS Twelve studies met the inclusion criteria. Quality scores ranged between 17.4% and 95.7%. The greatest potential for bias was noted for the following items: sample selection and sample-size calculation, as only 17% of the studies were population-based and had consecutive or random recruitment of patients and with a justification of the sample size; number of measurements obtained for CC biometry, as only 17% of the studies performed more than one measurement per fetus and per scan; and description of characteristics of the study population, as only 8% of the studies clearly reported a minimum dataset of demographic characteristics. CONCLUSIONS Our review demonstrates substantial heterogeneity in methods and final biometric values of the fetal CC across the evaluated studies. The use of uniform methodology of the highest quality is essential in order to define a 'short' CC and provide appropriate parental counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - D Grevent
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Stirnemann
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Y Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - H Mahallati
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - L J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
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9
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Marti C, Gaudet-Blavignac C, Martin J, Lovis C, Stirnemann J, Grosgurin O, Novotny F, Iten A, Mendes A, Prendki V, Serratrice C, Farhoumand PD, Abidi N, Vetter P, Carballo S, Reny JL, Berner A, Gayet-Ageron A. Trends in management and outcomes of COVID patients admitted to a Swiss tertiary care hospital. Sci Rep 2023; 13:6013. [PMID: 37045983 PMCID: PMC10096110 DOI: 10.1038/s41598-023-32954-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/05/2023] [Indexed: 04/14/2023] Open
Abstract
Two successive COVID-19 flares occurred in Switzerland in spring and autumn 2020. During these periods, therapeutic strategies have been constantly adapted based on emerging evidence. We aimed to describe these adaptations and evaluate their association with patient outcomes in a cohort of COVID-19 patients admitted to the hospital. Consecutive patients admitted to the Geneva Hospitals during two successive COVID-19 flares were included. Characteristics of patients admitted during these two periods were compared as well as therapeutic management including medications, respiratory support strategies and admission to the ICU and intermediate care unit (IMCU). A mutivariable model was computed to compare outcomes across the two successive waves adjusted for demographic characteristics, co-morbidities and severity at baseline. The main outcome was in-hospital mortality. Secondary outcomes included ICU admission, Intermediate care (IMCU) admission, and length of hospital stay. A total of 2'983 patients were included. Of these, 165 patients (16.3%, n = 1014) died during the first wave and 314 (16.0%, n = 1969) during the second (p = 0.819). The proportion of patients admitted to the ICU was lower in second wave compared to first (7.4 vs. 13.9%, p < 0.001) but their mortality was increased (33.6% vs. 25.5%, p < 0.001). Conversely, a greater proportion of patients was admitted to the IMCU in second wave compared to first (26.6% vs. 22.3%, p = 0.011). A third of patients received lopinavir (30.7%) or hydroxychloroquine (33.1%) during the first wave and none during second wave, while corticosteroids were mainly prescribed during second wave (58.1% vs. 9.1%, p < 0.001). In the multivariable analysis, a 25% reduction of mortality was observed during the second wave (HR 0.75; 95% confidence interval 0.59 to 0.96). Among deceased patients, 82.3% (78.2% during first wave and 84.4% during second wave) died without beeing admitted to the ICU. The proportion of patients with therapeutic limitations regarding ICU admission increased during the second wave (48.6% vs. 38.7%, p < 0.001). Adaptation of therapeutic strategies including corticosteroids therapy and higher admission to the IMCU to receive non-invasive respiratory support was associated with a reduction of hospital mortality in multivariable analysis, ICU admission and LOS during the second wave of COVID-19 despite an increased number of admitted patients. More patients had medical decisions restraining ICU admission during the second wave which may reflect better patient selection or implicit triaging.
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Affiliation(s)
- Christophe Marti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Science, Geneva University Hospitals, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jeremy Martin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Science, Geneva University Hospitals, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Olivier Grosgurin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Fiona Novotny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Anne Iten
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Aline Mendes
- Division of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Darbellay Farhoumand
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Nour Abidi
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Amandine Berner
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Angèle Gayet-Ageron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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10
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Carballo S, Agoritsas T, Berner A, Darbellay Farhoumand P, Grosgurin O, Marti C, Nendaz M, Serratrice J, Stirnemann J, Reny JL. [Advances in hospital based internal medicine]. Rev Med Suisse 2023; 19:172-176. [PMID: 36723641 DOI: 10.53738/revmed.2023.19.812.172] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Hospital based internal medicine has been strongly solicited for over two years with the SARS-CoV-2 epidemic. This epidemic continues to evolve and represents a strain for public health. Numerous studies have addressed issues concerning this epidemic, and multiple novelties concerning other frequent pathologies have also been published. Management strategies of cardiovascular, pulmonary, gastro-intestinal and metabolic diseases are discussed.
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Affiliation(s)
- Sebastian Carballo
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Thomas Agoritsas
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Amandine Berner
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pauline Darbellay Farhoumand
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Olivier Grosgurin
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Christophe Marti
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Mathieu Nendaz
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jacques Serratrice
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jérôme Stirnemann
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jean-Luc Reny
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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11
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Fourgeaud J, Regnault B, Faury H, Da Rocha N, Jamet A, Stirnemann J, Eloit M, Perot P, Leruez-Ville M, Driessen M. Fetal Zika virus infection diagnosed by metagenomic next-generation sequencing of amniotic fluid. Ultrasound Obstet Gynecol 2023; 61:116-117. [PMID: 36102858 DOI: 10.1002/uog.26074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 05/27/2023]
Affiliation(s)
- J Fourgeaud
- Université Paris Cité, FETUS, Paris, France
- Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - B Regnault
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France
| | - H Faury
- Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - N Da Rocha
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France
| | - A Jamet
- Université Paris Cité, FETUS, Paris, France
- Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151, CNRS UMR, 8253, Paris, France
| | - J Stirnemann
- Université Paris Cité, FETUS, Paris, France
- Department of Obstetrics and Fetal Therapy, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - M Eloit
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France
| | - P Perot
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France
| | - M Leruez-Ville
- Université Paris Cité, FETUS, Paris, France
- Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - M Driessen
- Department of Obstetrics and Fetal Therapy, Necker-Enfants Malades Hospital, AP-HP, Paris, France
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Abstract
Vitamin B1 also known as thiamin is an essential vitamin assuring body functioning and comes exclusively from food. Vitamin B1 deficiency is an under-diagnosed disease because it is less frequently suspected in high income countries. However, its risk factors, like alcohol and malnutrition, are common in the general population. Thiamin deficiency can lead to three clinical entities, Gayet-Wernicke encephalopathy, which can progress to Korsakoff encephalopathy, wet Beriberi and its dry form. These diseases are associated with high mortality and heavy long-term sequelae. Rapid diagnosis enables timely treatment.
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Affiliation(s)
- Sabrina Silhadi
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Simon Édouard Pinaud
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Mathieu Nendaz
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jérôme Stirnemann
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
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13
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Laux D, Derridj N, Stirnemann J, Lucron H, Stos B, Levy M, Houyel L, Bonnet D. Accuracy and impact of prenatal diagnosis of common arterial trunk. Ultrasound Obstet Gynecol 2022; 60:223-233. [PMID: 35118719 PMCID: PMC9539359 DOI: 10.1002/uog.24873] [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] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Outcome of common arterial trunk (CAT) depends mainly on truncal valve function, presence of coronary artery abnormalities and presence of interrupted aortic arch. The main objective of this study was to evaluate the accuracy of prenatal diagnosis of CAT by analyzing prenatal vs postnatal assessment of: (1) anatomic subtypes and (2) truncal valve function. The secondary objective was to assess the potential impact of prenatal diagnosis of CAT on postnatal mortality and morbidity by comparing prenatally vs postnatally diagnosed patients. METHODS This was a retrospective analysis of all CAT patients diagnosed either prenatally, with postnatal or fetopsy confirmation, or postnatally, from 2011 to 2019 in a single tertiary center. Cohen's kappa statistic was used to evaluate agreement between pre- and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared between prenatally vs postnatally diagnosed CAT patients. RESULTS A total of 84 patients (62 liveborn with prenatal diagnosis, 16 liveborn with postnatal diagnosis and six terminations of pregnancy with fetopsy) met the inclusion criteria. The accuracy of prenatal diagnosis of CAT anatomic subtype was 80.3%, and prenatal and postnatal concordance for subtype diagnosis was only moderate (κ = 0.43), with no patient with CAT Type A3 (0/4) and only half of patients with CAT Type A4 (8/17) being diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence (no agreement; κ = 0.09) and severity (slight agreement; κ = 0.19) of insufficiency. However, four of five cases of postnatally confirmed significant truncal valve stenosis were diagnosed prenatally, with fair agreement for both presence and severity of stenosis (κ = 0.38 and 0.24, respectively). Mortality was comparable in patients with and those without prenatal diagnosis (log-rank P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention (P < 0.001), had shorter intubation time (P = 0.047) and shorter global hospital stay (P = 0.01). CONCLUSIONS The accuracy of prenatal diagnosis of CAT is insufficient to tailor neonatal management and to predict outcome. Fetal assessment of truncal valve dysfunction appears unreliable due to perinatal transition. Improvement is necessary in the fetal diagnosis of anatomic subtypes of CAT requiring postnatal prostaglandin infusion. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Laux
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - N Derridj
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Université́ de Paris, CRESS, INSERM, INRA, Paris, France
| | - J Stirnemann
- Service de Gynécologie-Obstétrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - H Lucron
- Cardiologie Congénitale et Pédiatrique, Centre de Compétence M3C-Antilles-Guyane, CHU de la Martinique, Fort-de-France, Martinique, France
| | - B Stos
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - M Levy
- UE3C-Unité d'Explorations Cardiologiques des Cardiopathies Congénitales, Paris, France
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - L Houyel
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - D Bonnet
- Service de Cardiologie Congénitale et Pédiatrique, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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14
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Martin J, Gaudet-Blavignac C, Lovis C, Stirnemann J, Grosgurin O, Leidi A, Gayet-Ageron A, Iten A, Carballo S, Reny JL, Darbellay-Fahroumand P, Berner A, Marti C. Comparison of prognostic scores for inpatients with COVID-19: a retrospective monocentric cohort study. BMJ Open Respir Res 2022; 9:9/1/e001340. [PMID: 36002181 PMCID: PMC9412043 DOI: 10.1136/bmjresp-2022-001340] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background The SARS-CoV-2 pandemic led to a steep increase in hospital and intensive care unit (ICU) admissions for acute respiratory failure worldwide. Early identification of patients at risk of clinical deterioration is crucial in terms of appropriate care delivery and resource allocation. We aimed to evaluate and compare the prognostic performance of Sequential Organ Failure Assessment (SOFA), Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Uraemia, Respiratory Rate, Blood Pressure and Age ≥65 (CURB-65), Respiratory Rate and Oxygenation (ROX) index and Coronavirus Clinical Characterisation Consortium (4C) score to predict death and ICU admission among patients admitted to the hospital for acute COVID-19 infection. Methods and analysis Consecutive adult patients admitted to the Geneva University Hospitals during two successive COVID-19 flares in spring and autumn 2020 were included. Discriminative performance of these prediction rules, obtained during the first 24 hours of hospital admission, were computed to predict death or ICU admission. We further exluded patients with therapeutic limitations and reported areas under the curve (AUCs) for 30-day mortality and ICU admission in sensitivity analyses. Results A total of 2122 patients were included. 216 patients (10.2%) required ICU admission and 303 (14.3%) died within 30 days post admission. 4C score had the best discriminatory performance to predict 30-day mortality (AUC 0.82, 95% CI 0.80 to 0.85), compared with SOFA (AUC 0.75, 95% CI 0.72 to 0.78), qSOFA (AUC 0.59, 95% CI 0.56 to 0.62), CURB-65 (AUC 0.75, 95% CI 0.72 to 0.78) and ROX index (AUC 0.68, 95% CI 0.65 to 0.72). ROX index had the greatest discriminatory performance (AUC 0.79, 95% CI 0.76 to 0.83) to predict ICU admission compared with 4C score (AUC 0.62, 95% CI 0.59 to 0.66), CURB-65 (AUC 0.60, 95% CI 0.56 to 0.64), SOFA (AUC 0.74, 95% CI 0.71 to 0.77) and qSOFA (AUC 0.59, 95% CI 0.55 to 0.62). Conclusion Scores including age and/or comorbidities (4C and CURB-65) have the best discriminatory performance to predict mortality among inpatients with COVID-19, while scores including quantitative assessment of hypoxaemia (SOFA and ROX index) perform best to predict ICU admission. Exclusion of patients with therapeutic limitations improved the discriminatory performance of prognostic scores relying on age and/or comorbidities to predict ICU admission.
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Affiliation(s)
- Jeremy Martin
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Christophe Gaudet-Blavignac
- Department of Medical Imaging and Medical Information Sciences, Geneva University Hospitals, Geneve, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medical Imaging and Medical Information Sciences, Geneva University Hospitals, Geneve, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Olivier Grosgurin
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Antonio Leidi
- Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Angèle Gayet-Ageron
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Division of Clinical Epidemiology, Geneva University Hospitals, Geneve, Switzerland
| | - Anne Iten
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Infection Control Program, Geneva University Hospitals, Geneve, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Pauline Darbellay-Fahroumand
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Amandine Berner
- Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Christophe Marti
- Faculty of Medicine, University of Geneva, Geneve, Switzerland .,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
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15
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Leidi A, Soret G, Mann T, Koegler F, Coen M, Leszek A, Dubouchet L, Guillermin A, Kaddour M, Rouyer F, Combescure C, Carballo S, Reny JL, Marti C, Stirnemann J, Grosgurin O. Eight versus 28-point lung ultrasonography in moderate acute heart failure: a prospective comparative study. Intern Emerg Med 2022; 17:1375-1383. [PMID: 35181839 PMCID: PMC8856869 DOI: 10.1007/s11739-022-02943-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 10/13/2021] [Accepted: 02/01/2022] [Indexed: 12/26/2022]
Abstract
Lung ultrasonography (LUS) is an accurate method of estimating lung congestion but there is ongoing debate on the optimal number of scanning points. The aim of the present study was to compare the reproducibility (i.e. interobserver agreement) and the feasibility (i.e. time consumption) of the two most practiced protocols in patients hospitalized for acute heart failure (AHF). This prospective trial compared 8- and 28-point LUS protocols. Both were performed by an expert-novice pair of sonographers at admission and after 4 to 6 days on patients admitted for AHF. A structured bio-clinical evaluation was simultaneously carried out by the treating physician. The primary outcome was expert-novice interobserver agreement estimated by kappa statistics. Secondary outcomes included time spent on image acquisition and interpretation. During the study period, 43 patients underwent a total of 319 LUS exams. Expert-novice interobserver agreement was moderate at admission and substantial at follow-up for 8-point protocol (weighted kappa of 0.54 and 0.62, respectively) with no significant difference for 28-point protocol (weighted kappa of 0.51 and 0.41; P value for comparison 0.74 at admission and 0.13 at follow-up). The 8-point protocol required significantly less time for image acquisition at admission (mean time difference - 3.6 min for experts, - 5.1 min for novices) and interpretation (- 6.0 min for experts and - 6.3 min for novices; P value < 0.001 for all time comparisons). Similar differences were observed at follow-up. In conclusion, an 8-point LUS protocol was shown to be timesaving with similar reproducibility when compared with a 28-point protocol. It should be preferred for evaluating lung congestion in AHF inpatients.
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Affiliation(s)
- Antonio Leidi
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Guillaume Soret
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Tamara Mann
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Flora Koegler
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Matteo Coen
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Leszek
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Laetitia Dubouchet
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Alexandre Guillermin
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Myriam Kaddour
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Frédéric Rouyer
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Combescure
- Clinical Research Center and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Jean-Luc Reny
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Jérôme Stirnemann
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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16
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Skalafouris C, Reny JL, Stirnemann J, Grosgurin O, Eggimann F, Grauser D, Teixeira D, Jermini M, Bruggmann C, Bonnabry P, Guignard B. Development and assessment of PharmaCheck: an electronic screening tool for the prevention of twenty major adverse drug events. BMC Med Inform Decis Mak 2022; 22:146. [PMID: 35642053 PMCID: PMC9154036 DOI: 10.1186/s12911-022-01885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Adverse drug events (ADEs) can be prevented by deploying clinical decision support systems (CDSS) that directly assist physicians, via computerized order entry systems, and clinical pharmacists performing medication reviews as part of medical rounds. However, physicians using CDSS are known to be exposed to the alert-fatigue phenomenon. Our study aimed to assess the performance of PharmaCheck—a CDSS to help clinical pharmacists detect high-risk situations with the potential to lead to ADEs—and its impact on clinical pharmacists’ activities.
Methods
Twenty clinical rules, divided into four risk classes, were set for the daily screening of high-risk situations in the electronic health records of patients admitted to our General Internal Medicine Department. Alerts to clinical pharmacists encouraged them to telephone prescribers and suggest any necessary treatment adjustments. PharmaCheck’s performance was assessed using the intervention’s positive predictive value (PPV), which characterizes the proportion of interventions for each alert triggered. PharmaCheck’s impact was assessed by considering clinical pharmacists as a filter for ruling out futile alerts and by comparing the final clinical PPV with a pharmacist (the proportion of interventions that led to a change in the medical regimen) to the final clinical PPV without a pharmacist.
Results
Over 132 days, 447 alerts were triggered for 383 patients, leading to 90 interventions (overall intervention PPV = 20.1%). By risk class, intervention PPVs made up 26.9% (n = 65/242) of abnormal laboratory value alerts, 3.1% (4/127) of alerts for contraindicated medications or medications to be used with caution, 28.2% (20/71) of drug–drug interaction alerts, and 14.3% (1/7) of inadequate mode of administration alerts. Clinical PPVs reached 71.0% (64/90) when pharmacists filtered alerts and 14% (64/242) if they were not doing it.
Conclusion
PharmaCheck enabled clinical pharmacists to improve their traditional processes and broaden their coverage by focusing on 20 high-risk situations. Alert management by pharmacists seemed to be a more effective way of preventing risky situations and alert-fatigue than a model addressing alerts to physicians exclusively. Some fine-tuning could enhance PharmaCheck's performance by considering the information quality of triggers, the variability of clinical settings, and the fact that some prescription processes are already highly secured.
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Malézieux-Picard A, Nascè A, Azurmendi L, Pagano S, Vuilleumier N, Sanchez JC, Reny JL, Zekry D, Roux X, Stirnemann J, Garin N, Prendki V. Kinetics of inflammatory biomarkers to predict one-year mortality in older patients hospitalized for pneumonia: a multivariable analysis. Int J Infect Dis 2022; 122:63-69. [PMID: 35550179 DOI: 10.1016/j.ijid.2022.05.002] [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: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. METHODS Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor-α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. RESULTS In the 133 included patients (median age, 83 years [interquartile range: 78-89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60-0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79-0.96], P-value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00-1.04], P-value=0.02), and higher CRP (1.01 [95% CI 1.00-1.02], P=0.01) at discharge were independently associated with mortality. CONCLUSION Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.
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Affiliation(s)
- Astrid Malézieux-Picard
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland.
| | - Alberto Nascè
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland
| | - Leire Azurmendi
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland
| | - Sabrina Pagano
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland
| | - Nicolas Vuilleumier
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Charles Sanchez
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Xavier Roux
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Intensive Care Division, Geneva University Hospitals, Genève, Switzerland
| | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Nicolas Garin
- Medical Faculty, University of Geneva, Genève, Switzerland; Department of General Internal Medicine, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Genève, Switzerland
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18
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Chauffard A, Bridevaux PO, Carballo S, Prendki V, Reny JL, Stirnemann J, Garin N. Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia. BMC Infect Dis 2022; 22:424. [PMID: 35505308 PMCID: PMC9066797 DOI: 10.1186/s12879-022-07423-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit. METHODS This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity. RESULTS Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2-6.2), heart failure (OR 2.6, 95% CI 1.1-6.1), absence of chest pain (OR 3.0, 95% CI 1.1-8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4-6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3-5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71-0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity. CONCLUSION Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects. TRIAL REGISTRATION NCT00818610.
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Affiliation(s)
- Aline Chauffard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre-Olivier Bridevaux
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Service de Pneumologie, Centre Hospitalier du Valais Romand, Hôpital du Valais, Sion, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nicolas Garin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Division of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. .,Division of Internal Medicine, Hôpital Riviera Chablais, Rennaz, Switzerland. .,Service de Médecine Interne, Centre Hospitalier de Rennaz, Rte du Vieux Séquoia 20, 1847, Rennaz, Switzerland.
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19
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Marti C, Stirnemann J, Lescuyer P, Tonoli D, von Dach E, Huttner A. Therapeutic drug monitoring and clinical outcomes in severely ill patients receiving amoxicillin: a single-center prospective cohort study. Int J Antimicrob Agents 2022; 59:106601. [DOI: 10.1016/j.ijantimicag.2022.106601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022]
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20
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Carballo S, Serratrice J, Marti C, Darbellay Farhoumand P, Grosgurin O, Nendaz M, Agoritsas T, Stirnemann J, Reny JL. [Latest progress in internal medicine]. Rev Med Suisse 2022; 18:107-110. [PMID: 35084135 DOI: 10.53738/revmed.2022.18.766.107] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Internal medicine continues de evolve as a result of further insight and evidence for the efficacy of given interventions. Although numerous studies have addressed issues concerning the SARS-COV-2 epidemic, multiple novelties concerning other frequent pathologies have also been presented. Management strategies of cardiovascular disease, infectious diseases and venous thromboembolism are particularly concerned.
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Affiliation(s)
- Sebastian Carballo
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jacques Serratrice
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Christophe Marti
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Pauline Darbellay Farhoumand
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Olivier Grosgurin
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Mathieu Nendaz
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Thomas Agoritsas
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jérôme Stirnemann
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jean-Luc Reny
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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21
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Leidi A, Saudan A, Soret G, Rouyer F, Marti C, Stirnemann J, Reny JL, Grosgurin O. Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Intern Emerg Med 2022; 17:113-122. [PMID: 34148178 PMCID: PMC8214715 DOI: 10.1007/s11739-021-02781-1] [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] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naïve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.
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Affiliation(s)
- Antonio Leidi
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Saudan
- grid.8591.50000 0001 2322 4988Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Guillaume Soret
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Rouyer
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Stirnemann
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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22
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Genecand C, Mongin D, Koegler F, Lebowitz D, Regard S, Falcone JL, Nehme M, Braillard O, Grira M, Joubert D, Chopard P, Delaporte E, Stirnemann J, Guessous I, Tardin A, Courvoisier DS. Cohort profile: Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS). BMJ Open 2021; 11:e048946. [PMID: 34848509 PMCID: PMC8634627 DOI: 10.1136/bmjopen-2021-048946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/08/2023] Open
Abstract
PURPOSE The Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020. PARTICIPANTS As of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing. FINDINGS TO DATE ARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection. FUTURE PLANS The data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.
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Affiliation(s)
- Camille Genecand
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Mongin
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Flora Koegler
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Lebowitz
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Simon Regard
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Falcone
- Department of Informatics, University of Geneva, Geneva, Switzerland
| | - Mayssam Nehme
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marwène Grira
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dominique Joubert
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabeth Delaporte
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Aglaé Tardin
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
| | - Delphine S Courvoisier
- Division of General Surgeon, Republic and Canton of Geneva Directorate of Health, Geneva, Switzerland
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
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23
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Leidi A, Karege G, Salamun J, Stirnemann J, Grosgurin O, Leszek A. [Role of point-of-care ultrasonography in the management of heart failure]. Rev Med Suisse 2021; 17:1830-1833. [PMID: 34704679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Heart failure is a common disease and one of the main reasons of hospital admission. It is a rich research field, marked by regular novelties in the management of heart failure. In the last decades point-of-care ultrasonography has been more prominent in internal medicine, particularly for the management of heart failure. A structured training is required to acquire core competencies. In heart failure, this bedside tool includes focused lung, cardiac and vascular ultrasonography. The combination of these modalities raises diagnostic accuracy, reduce time to diagnosis in dyspneic patients and plays a role in adaptation of decongestive therapy.
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Affiliation(s)
- Antonio Leidi
- Service de médecine interne générale, HUG, 1211 Genève 14
| | - Gatete Karege
- Service de médecine interne générale, HUG, 1211 Genève 14
| | - Julien Salamun
- Service de médecine de premier recours, HUG, 1211 Genève 14
| | | | - Olivier Grosgurin
- Service de médecine interne générale, HUG, 1211 Genève 14
- Service des urgences, HUG, 1211 Genève 14
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24
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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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25
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Faure-Bardon V, Fourgeaud J, Stirnemann J, Leruez-Ville M, Ville Y. Secondary prevention of congenital cytomegalovirus infection with valacyclovir following maternal primary infection in early pregnancy. Ultrasound Obstet Gynecol 2021; 58:576-581. [PMID: 33998084 DOI: 10.1002/uog.23685] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) maternal primary infection (MPI) in early pregnancy is the main risk factor for congenital CMV (cCMV) infection with long-term sequelae. Our aim was to evaluate, in a single center offering CMV serology screening at 11-14 gestational weeks, secondary prevention of cCMV by administration of high-dosage maternal oral valacyclovir (VACV) in the first trimester of pregnancy. METHODS This was a case-control study in a longitudinal cohort of pregnancies with CMV-MPI diagnosed prior to 14 weeks of gestation by serology screening (immunoglobulin (Ig) M and IgG measurement and IgG avidity) between 2009 and 2020. From October 2019 onwards, all women presenting at our center with MPI before 14 weeks' gestation were offered treatment with high-dosage oral VACV (8 g/day, 4 g twice/day). We used propensity score matching to compare fetal infection rates in cases treated with maternal oral VACV (8 g/day) with those in untreated controls. Fetal infection was assessed following amniocentesis at 17-22 weeks of gestation, by polymerase chain reaction (PCR) analysis of amniotic fluid for viral DNA. RESULTS Of 310 cases of CMV-MPI identified, 269 underwent amniocentesis for PCR. Of these, 66 were offered, and 65 accepted, treatment with VACV. From the remaining untreated cases, we selected 65 controls, matched for proportion of periconceptional infections and gestational age at amniocentesis. VACV was initiated at a median gestational age of 12.71 (interquartile range (IQR), 10.00-13.86) weeks and the median duration of treatment was 35 (IQR, 26-54) days. On multivariate logistic regression, fetal infection was lower in the treated group (odds ratio, 0.318 (95% CI, 0.120-0.841); P = 0.021). One treated patient developed acute renal failure 4 weeks after initiation of VACV therapy, but this resolved within 5 days after treatment was stopped. CONCLUSION This study confirms the acceptability, tolerance and benefit of secondary prevention by VACV of cCMV infection in a clinical setting with a well-established routine maternal serum screening policy in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Faure-Bardon
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
| | - J Fourgeaud
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
- Virology Laboratory, Associated with the National Herpes Viridae Reference Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - J Stirnemann
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
| | - M Leruez-Ville
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
- Virology Laboratory, Associated with the National Herpes Viridae Reference Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Y Ville
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
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Carballo D, Garin N, Stirnemann J, Mamin A, Prendki V, Meyer P, Marti C, Mach F, Reny JL, Serratrice J, Kaiser L, Carballo S. Prognosis of Laboratory-Confirmed Influenza and Respiratory Syncytial Virus in Acute Heart Failure. J Clin Med 2021; 10:jcm10194546. [PMID: 34640562 PMCID: PMC8509592 DOI: 10.3390/jcm10194546] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Concomitant respiratory viral infections may influence clinical outcomes of acute decompensated heart failure (ADHF) but this association is based on indirect observation. The aim of this study was to evaluate the prevalence and impact of laboratory-confirmed influenza or respiratory syncytial virus (RSV) infection on outcomes in patients hospitalised for ADHF. Prospective cohort of patients hospitalised for ADHF with systematic influenza and RSV screening using real-time PCR on nasopharyngeal swabs. The primary outcome was all-cause mortality or readmission at 90 days. Among 803 patients with ADHF, 196 (24.5%) patients had concomitant flu-like symptoms of influenza. PCR was positive in 45 patients (27 for influenza, 19 for RSV). At 90 days, PCR positive patients had lower rates of all-cause mortality or readmission as compared to patients without flu-like symptoms (HR 0.40, 95% CI 0.18–0.91, p = 0.03), and non-significantly less all-cause mortality (HR 0.30, 95% CI 0.04–2.20, p = 0.24), or HF-related death or readmission (HR 0.36, 95% CI 0.13–0.99, p = 0.05). The prevalence of influenza or RSV infection in patients admitted for ADHF was low and associated with less all-cause mortality and readmission. Concomitant viral infection with ADHF may not in itself be a predictor of poor outcomes. (ClinicalTrials.gov NCT02444416).
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Affiliation(s)
- David Carballo
- Service of Cardiology, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (D.C.); (P.M.); (F.M.)
| | - Nicolas Garin
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
| | - Jérôme Stirnemann
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
| | - Aline Mamin
- Service of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (A.M.); (V.P.); (L.K.)
| | - Virginie Prendki
- Service of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (A.M.); (V.P.); (L.K.)
| | - Philippe Meyer
- Service of Cardiology, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (D.C.); (P.M.); (F.M.)
| | - Christophe Marti
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
| | - Francois Mach
- Service of Cardiology, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (D.C.); (P.M.); (F.M.)
| | - Jean-Luc Reny
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
| | - Jacques Serratrice
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
| | - Laurent Kaiser
- Service of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (A.M.); (V.P.); (L.K.)
| | - Sebastian Carballo
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (N.G.); (J.S.); (C.M.); (J.-L.R.); (J.S.)
- Correspondence:
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Stirnemann J, Massoud M, Fries N, Dumont C, Haddad G, Bessis R, Dhombres F, Salomon LJ. Crown-rump length measurement: a new age for first-trimester ultrasound? Ultrasound Obstet Gynecol 2021; 58:345-346. [PMID: 34131973 DOI: 10.1002/uog.23692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J Stirnemann
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
- EA FETUS, 7328, Université Paris-Descartes, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - M Massoud
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
- Hôpital Femme Mère Enfant et Université Claude Bernard Lyon 1, Bron, France
| | - N Fries
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
| | - C Dumont
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
- CHU de la Réunion, Saint Pierre, France
| | - G Haddad
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
| | - R Bessis
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
| | - F Dhombres
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Sorbonne Université, Paris, France
| | - L J Salomon
- Collège Français d'Echographie Fœtale (CFEF), Paris, France
- EA FETUS, 7328, Université Paris-Descartes, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
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Grosgurin O, Leidi A, Farhoumand PD, Carballo S, Adler D, Reny JL, Bollen Pinto B, Rossel A, Serratrice J, Agoritsas T, Stirnemann J, Marti C. Role of Intermediate Care Unit Admission and Noninvasive Respiratory Support during the COVID-19 Pandemic: A Retrospective Cohort Study. Respiration 2021; 100:786-793. [PMID: 34023830 PMCID: PMC8247832 DOI: 10.1159/000516329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to shortage of intensive care unit (ICU) capacity. We developed a triage strategy including noninvasive respiratory support and admission to the intermediate care unit (IMCU). ICU admission was restricted to patients requiring invasive ventilation. OBJECTIVES The aim of this study is to describe the characteristics and outcomes of patients admitted to the IMCU. METHOD Retrospective cohort including consecutive patients admitted between March 28 and April 27, 2020. The primary outcome was the proportion of patients with severe hypoxemic respiratory failure avoiding ICU admission. Secondary outcomes included the rate of emergency intubation, 28-day mortality, and predictors of ICU admission. RESULTS One hundred fifty-seven patients with COVID-19-associated pneumonia were admitted to the IMCU. Among the 85 patients admitted for worsening respiratory failure, 52/85 (61%) avoided ICU admission. In multivariate analysis, PaO2/FiO2 (OR 0.98; 95% CI: 0.96-0.99) and BMI (OR 0.88; 95% CI: 0.78-0.98) were significantly associated with ICU admission. No death or emergency intubation occurred in the IMCU. CONCLUSIONS IMCU admission including standardized triage criteria, self-proning, and noninvasive respiratory support prevents ICU admission for a large proportion of patients with COVID-19 hypoxemic respiratory failure. In the context of the COVID-19 pandemic, IMCUs may play an important role in preserving ICU capacity by avoiding ICU admission for patients with worsening respiratory failure and allowing early discharge of ICU patients.
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Affiliation(s)
- Olivier Grosgurin
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antonio Leidi
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sebastian Carballo
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Department of Medicine, Division of Lung diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bernardo Bollen Pinto
- Department of Acute Medicine, Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Rossel
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Agoritsas
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Jérôme Stirnemann
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
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Andrey DO, Yerly S, Meyer B, Arm-Vernez I, Roux-Lombard P, Togni G, Guessous I, Spechbach H, Stringhini S, Agoritsas T, Stirnemann J, Reny JL, Siegrist CA, Eckerle I, Kaiser L, Vuilleumier N. Head-to-Head Evaluation of Five Automated SARS-CoV-2 Serology Immunoassays in Various Prevalence Settings. J Clin Med 2021; 10:jcm10081605. [PMID: 33920076 PMCID: PMC8069412 DOI: 10.3390/jcm10081605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose: To assess the diagnostic performances of five automated anti-SARS-CoV-2 immunoassays, Epitope (N), Diasorin (S1/S2), Euroimmun (S1), Roche N (N), and Roche S (S-RBD), and to provide a testing strategy based on pre-test probability. Methods: We assessed the receiver operating characteristic (ROC) areas under the curve (AUC) values, along with the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs), of each assay using a validation sample set of 172 COVID-19 sera and 185 negative controls against a validated S1-immunofluorescence as a reference method. The three assays displaying the highest AUCs were selected for further serodetection of 2033 sera of a large population-based cohort. Results: In the validation analysis (pre-test probability: 48.1%), Roche N, Roche S and Euroimmun showed the highest discriminant accuracy (AUCs: 0.99, 0.98, and 0.98) with PPVs and NPVs above 96% and 94%, respectively. In the population-based cohort (pre-test probability: 6.2%) these three assays displayed AUCs above 0.97 and PPVs and NPVs above 90.5% and 99.4%, respectively. A sequential strategy using an anti-S assay as screening test and an anti-N as confirmatory assays resulted in a 96.7% PPV and 99.5% NPV, respectively. Conclusions: Euroimmun and both Roche assays performed equally well in high pre-test probability settings. At a lower prevalence, sequentially combining anti-S and anti-N assays resulted in the optimal trade-off between diagnostic performances and operational considerations.
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Affiliation(s)
- Diego O. Andrey
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva, Switzerland
- Correspondence: ; Tel.: +41-223729800; Fax: +41-223729830
| | - Sabine Yerly
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland; (B.M.); (C.-A.S.)
| | - Isabelle Arm-Vernez
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
| | - Pascale Roux-Lombard
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
- Division of Immunology, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Giuseppe Togni
- Unilabs, Central Laboratory Collection Centers, 1296 Coppet, Switzerland;
| | - Idris Guessous
- Division and Department of Primary Care Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (I.G.); (H.S.); (S.S.)
| | - Hervé Spechbach
- Division and Department of Primary Care Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (I.G.); (H.S.); (S.S.)
| | - Silvia Stringhini
- Division and Department of Primary Care Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (I.G.); (H.S.); (S.S.)
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (T.A.); (J.S.); (J.-L.R.)
| | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (T.A.); (J.S.); (J.-L.R.)
| | - Jean-Luc Reny
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (T.A.); (J.S.); (J.-L.R.)
| | - Claire-Anne Siegrist
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland; (B.M.); (C.-A.S.)
- Department of Childhood and Adolescence, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Isabella Eckerle
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Laurent Kaiser
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, 1211 Geneva, Switzerland; (S.Y.); (I.A.-V.); (P.R.-L.); (L.K.); (N.V.)
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Leruez-Ville M, Ren S, Magny JF, Jacquemard F, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Minodier P, Astruc D, Patural H, Ugolin M, Parat S, Guillois B, Garenne A, Parodi M, Bussières L, Stirnemann J, Sonigo P, Millischer AE, Ville Y. Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long-term sequelae. Ultrasound Obstet Gynecol 2021; 57:97-104. [PMID: 32339337 DOI: 10.1002/uog.22056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the ability of detailed routine ultrasound examination, performed without knowledge of maternal serology and fetal status, with that of targeted prenatal imaging performed in prenatal diagnostic units in cases of known fetal infection to identify cytomegalovirus (CMV)-infected fetuses that will develop long-term sequelae. METHODS All prenatal imaging reports were collected for 255 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All women had undergone detailed routine fetal ultrasound examination at 20-24 and 30-34 weeks as part of routine antenatal care. All cases of known fetal CMV infection had also undergone targeted prenatal ultrasound examination. Postnatal structured follow-up for up to 48 months of age involved clinical, audiological and neurological assessment, including Brunet-Lezine scoring. Long-term sequelae (> 12 months) were considered to be mild in cases with isolated unilateral hearing loss and/or vestibular disorders, and severe in cases with bilateral hearing loss and/or neurological sequelae. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection, searching for reference to findings that were, or could have been, related to fetal infection. Findings were analyzed in relation to whether the cases were diagnosed with CMV in utero or only postnatally. RESULTS There were 237 children with complete follow-up data (> 12 months), for a median of 24 (range, 12-48) months. Of these, 30% (71/237) were diagnosed with CMV prenatally and 70% (166/237) were diagnosed within 3 weeks after birth. 72.5% (29/40) of children with long-term sequelae, including 74% (14/19) with severe long-term sequelae, were not identified in the prenatal period. Among those diagnosed prenatally, the sensitivity of prenatal imaging for predicting long-term sequelae and severe long-term sequelae was 91% and 100%, respectively, while, in the group diagnosed only postnatally, non-specific infection-related ultrasound findings had been reported without raising suspicion in 48% of cases with long-term sequelae and 64% of those with severe long-term sequelae. CONCLUSIONS Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long-term sequelae, in contrast with the high performance of targeted prenatal imaging in known cases of fetal infection. The non-specific nature of ultrasound features of CMV and their evolution, and a lack of awareness of caregivers about congenital CMV, are likely explanations. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester seem key to the performance of prenatal ultrasound. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leruez-Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - S Ren
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - J-F Magny
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Paris, France
| | - F Jacquemard
- American Hospital of Paris, Prenatal Diagnostic Unit, Neuilly, France
| | - S Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - P Garcia
- AP-HM, Hospital La Conception, Neonatology and Intensive Care Department, Marseille, France
| | - A-M Maillotte
- CHU Nice, Hospital L'Archet, Neonatal Intensive Care Unit, Nice, France
| | - M Benard
- Toulouse University Hospital, Department of Neonatology, Toulouse, France
| | - D Pinquier
- Rouen University Hospital, Department of Neonatology, Rouen, France
| | - P Minodier
- AP-HM, Hospital Nord, Emergency Care Department, Marseille, France
| | - D Astruc
- Strasbourg University Hospital, Department of Neonatology, Strasbourg, France
| | - H Patural
- University Hospital, Neonatal Intensive Care Unit, Saint-Etienne, France
| | - M Ugolin
- CHU Rennes and CIC1414, Pediatric Department, Neonatology, Rennes, France
| | - S Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - B Guillois
- CHU de Caen, Department of Neonatology, Caen, France
- Université Caen Normandie, Medical School, Caen, France
| | - A Garenne
- CHRU Brest, Neonatal and Pediatric Intensive Care Unit, Brest, France
| | - M Parodi
- AP-HP, Hospital Necker-E.M., Otology Department, Paris, France
| | - L Bussières
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Clinical Research Unit, Paris, France
| | - J Stirnemann
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
| | - P Sonigo
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - A E Millischer
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
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Vernaz N, Agoritsas T, Calmy A, Gayet-Ageron A, Gold G, Perrier A, Picard F, Prendki V, Reny JL, Samer C, Stirnemann J, Vetter P, Zanella MC, Zekry D, Baggio S. Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs. Swiss Med Wkly 2020; 150:w20446. [PMID: 33382449 DOI: 10.4414/smw.2020.20446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.
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Affiliation(s)
- Nathalie Vernaz
- Medical Directorate, Finance Directorate, Geneva University Hospitals, Geneva University, Switzerland
| | - Thomas Agoritsas
- Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland / Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals, Switzerland
| | - Angèle Gayet-Ageron
- CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Gabriel Gold
- Service of Geriatrics, Department of Internal Medicine Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Switzerland
| | - Arnaud Perrier
- Medical Directorate, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland / Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Fabienne Picard
- Division of Neurology, Department of Clinical Neurosciences, University of Geneva and University Hospitals of Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Jean-Luc Reny
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Switzerland
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospitals, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Switzerland
| | | | - Dina Zekry
- Division of Internal Medicine for the Aged, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland
| | - Stéphanie Baggio
- Division of Prison Health, University of Geneva and University Hospitals of Geneva, Thônex, Switzerland / Office of Corrections, Department of Justice and Home Affairs of the Canton of Zurich, Zurich, Switzerland
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Stirnemann J, Salomon LJ, Papageorghiou AT. INTERGROWTH-21 st standards for Hadlock's estimation of fetal weight. Ultrasound Obstet Gynecol 2020; 56:946-948. [PMID: 32086966 DOI: 10.1002/uog.22000] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 06/10/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics and Maternal-Fetal Medicine, Hopital Necker-Enfants Malades, EHU7328, Université de Paris and Institut Imagine, France
| | - L J Salomon
- Obstetrics and Maternal-Fetal Medicine, Hopital Necker-Enfants Malades, EHU7328, Université de Paris and Institut Imagine, France
| | - A T Papageorghiou
- Nuffield Department of Women's and Reproductive Health and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Hautier S, Kermorvant E, Khen-Dunlop N, de Wailly D, Beauquier B, Corroenne R, Milani G, Bonnet D, James S, Vinit N, Blanc T, Aigrain Y, Colmant C, Salomon L, Ville Y, Stirnemann J. [Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]. ACTA ACUST UNITED AC 2020; 49:172-179. [PMID: 33166705 DOI: 10.1016/j.gofs.2020.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention. METHODS We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies. RESULTS All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far. CONCLUSION The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.
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Affiliation(s)
- S Hautier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - E Kermorvant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Khen-Dunlop
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D de Wailly
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - B Beauquier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - R Corroenne
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - G Milani
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D Bonnet
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - S James
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Vinit
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - T Blanc
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Aigrain
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - C Colmant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - L Salomon
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Ville
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - J Stirnemann
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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Badaoui S, Grevent D, Salomon LJ, Ville Y, Stirnemann J. Magnetic resonance imaging-based three-dimensional modeling of pregnant pelvis for fetoscopic surgical planning. Ultrasound Obstet Gynecol 2020; 56:793-795. [PMID: 32365244 DOI: 10.1002/uog.22067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- S Badaoui
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - D Grevent
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
- Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - L J Salomon
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - Y Ville
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - J Stirnemann
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
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Buchs E, Chalandon Y, Friedlaender A, Stirnemann J, Agoritsas T. [Granulocyte-Colony Stimulating Factors as adjunctive therapy in patients with neutropenic fever]. Rev Med Suisse 2020; 16:1995-2000. [PMID: 33085256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chemotherapy induced neutropenic fever requires a hospitalization in 20-30 % of cases and is then associated with a mortality above 10 %. Hospitalized patients require strict isolation, which sometimes results in a substantial physical and psychological burden. Granulocyte-colony stimulating factors (G-CSF) are established in the primary and secondary prevention of chemotherapy-induced neutropenia. However, their role as adjunctive therapy in patients with neutropenic fever is less clear. This review resumes current best evidence in this area and discusses current recommendations.
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Affiliation(s)
- Elisa Buchs
- Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14
| | - Yves Chalandon
- Service d'hématologie, Département d'oncologie, HUG et Faculté de médecine, Université de Genève, 1211 Genève 4
| | | | - Jérôme Stirnemann
- Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14
| | - Thomas Agoritsas
- Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14
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Stirnemann J, Agoritsas T, Carballo S, Darbellay-Farhoumand P, Grosgurin O, Marti C, Nendaz M, Serratrice J, Reny JL. [Not Available]. Rev Med Suisse 2020; 16:1963. [PMID: 33085250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jérôme Stirnemann
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Thomas Agoritsas
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Sebastian Carballo
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | | | - Olivier Grosgurin
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Christophe Marti
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Mathieu Nendaz
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Jacques Serratrice
- Service de médecine interne générale, Département de médecine, HUG, Genève
| | - Jean-Luc Reny
- Médecin-chef, Service de médecine interne générale, Département de médecine, HUG, Genève
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Meyer B, Torriani G, Yerly S, Mazza L, Calame A, Arm-Vernez I, Zimmer G, Agoritsas T, Stirnemann J, Spechbach H, Guessous I, Stringhini S, Pugin J, Roux-Lombard P, Fontao L, Siegrist CA, Eckerle I, Vuilleumier N, Kaiser L. Validation of a commercially available SARS-CoV-2 serological immunoassay. Clin Microbiol Infect 2020; 26:1386-1394. [PMID: 32603801 PMCID: PMC7320699 DOI: 10.1016/j.cmi.2020.06.024] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [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] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To validate the diagnostic accuracy of a Euroimmun SARS-CoV-2 IgG and IgA immunoassay for COVID-19. METHODS In this unmatched (1:2) case-control validation study, we used sera of 181 laboratory-confirmed SARS-CoV-2 cases and 326 controls collected before SARS-CoV-2 emergence. Diagnostic accuracy of the immunoassay was assessed against a whole spike protein-based recombinant immunofluorescence assay (rIFA) by receiver operating characteristic (ROC) analyses. Discrepant cases between ELISA and rIFA were further tested by pseudo-neutralization assay. RESULTS COVID-19 patients were more likely to be male and older than controls, and 50.3% were hospitalized. ROC curve analyses indicated that IgG and IgA had high diagnostic accuracies with AUCs of 0.990 (95% Confidence Interval [95%CI]: 0.983-0.996) and 0.978 (95%CI: 0.967-0.989), respectively. IgG assays outperformed IgA assays (p=0.01). Taking an assessed 15% inter-assay imprecision into account, an optimized IgG ratio cut-off > 2.5 displayed a 100% specificity (95%CI: 99-100) and a 100% positive predictive value (95%CI: 96-100). A 0.8 cut-off displayed a 94% sensitivity (95%CI: 88-97) and a 97% negative predictive value (95%CI: 95-99). Substituting the upper threshold for the manufacturer's, improved assay performance, leaving 8.9% of IgG ratios indeterminate between 0.8-2.5. CONCLUSIONS The Euroimmun assay displays a nearly optimal diagnostic accuracy using IgG against SARS-CoV-2 in patient samples, with no obvious gains from IgA serology. The optimized cut-offs are fit for rule-in and rule-out purposes, allowing determination of whether individuals in our study population have been exposed to SARS-CoV-2 or not. IgG serology should however not be considered as a surrogate of protection at this stage.
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Affiliation(s)
- B Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - G Torriani
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland
| | - S Yerly
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - L Mazza
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - A Calame
- Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland
| | - I Arm-Vernez
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - G Zimmer
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland; Department of Infectious Diseases and Pathobiology (DIP), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - T Agoritsas
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - J Stirnemann
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - H Spechbach
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - I Guessous
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - S Stringhini
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - J Pugin
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - P Roux-Lombard
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - L Fontao
- Division of Dermatology and of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - C-A Siegrist
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - I Eckerle
- Department of Microbiology and Molecular Medicine, University of Geneva, Geneva, Switzerland; Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - N Vuilleumier
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Geneva University, Geneva, Switzerland; Division of Laboratory Medicine, Department of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - L Kaiser
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
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Aubert CE, Schnipper JL, Fankhauser N, Marques-Vidal P, Stirnemann J, Auerbach AD, Zimlichman E, Kripalani S, Vasilevskis EE, Robinson E, Metlay J, Fletcher GS, Limacher A, Donzé J. Patterns of multimorbidity in medical inpatients: a multinational retrospective cohort study. Intern Emerg Med 2020; 15:1207-1217. [PMID: 32180102 DOI: 10.1007/s11739-020-02306-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Abstract
Multimorbidity is frequent and represents a significant burden for patients and healthcare systems. However, there are limited data on the most common combinations of comorbidities in multimorbid patients. We aimed to describe and quantify the most common combinations of comorbidities in multimorbid medical inpatients. We used a large retrospective cohort of adults discharged from the medical department of 11 hospitals across 3 countries (USA, Switzerland, and Israel) between 2010 and 2011. Diseases were classified into acute versus chronic. Chronic diseases were grouped into clinically meaningful categories of comorbidities. We identified the most prevalent combinations of comorbidities and compared the observed and expected prevalence of the combinations. We assessed the distribution of acute and chronic diseases and the median number of body systems in relationship to the total number of diseases. Eighty-six percent (n = 126,828/147,806) of the patients were multimorbid (≥ 2 chronic diseases), with a median of five chronic diseases; 13% of the patients had ≥ 10 chronic diseases. Among the most frequent combinations of comorbidities, the most prevalent comorbidity was chronic heart disease. Other high prevalent comorbidities included mood disorders, arthropathy and arthritis, and esophageal disorders. The ratio of chronic versus acute diseases was approximately 2:1. Multimorbidity affected almost 90% of patients, with a median of five chronic diseases. Over 10% had ≥ 10 chronic diseases. This identification and quantification of frequent combinations of comorbidities among multimorbid medical inpatients may increase awareness of what should be taken into account when treating such patients, a growth in the need for special care considerations.
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Affiliation(s)
- Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jeffrey Lawrence Schnipper
- BWH Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA
| | - Eduard Eric Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville, TN, USA
| | | | - Joshua Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA
| | - Grant Selmer Fletcher
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Andreas Limacher
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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Prendki V, Malézieux-Picard A, Azurmendi L, Sanchez JC, Vuilleumier N, Carballo S, Roux X, Reny JL, Zekry D, Stirnemann J, Garin N. Accuracy of C-reactive protein, procalcitonin, serum amyloid A and neopterin for low-dose CT-scan confirmed pneumonia in elderly patients: A prospective cohort study. PLoS One 2020; 15:e0239606. [PMID: 32997689 PMCID: PMC7526885 DOI: 10.1371/journal.pone.0239606] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/09/2020] [Indexed: 01/16/2023] Open
Abstract
Objective The diagnosis of pneumonia based on semiology and chest X-rays is frequently inaccurate, particularly in elderly patients. Older (C-reactive protein (CRP); procalcitonin (PCT)) or newer (Serum amyloid A (SAA); neopterin (NP)) biomarkers may increase the accuracy of pneumonia diagnosis, but data are scarce and conflicting. We assessed the accuracy of CRP, PCT, SAA, NP and the ratios CRP/NP and SAA/NP in a prospective observational cohort of elderly patients with suspected pneumonia. Methods We included consecutive patients more than 65 years old, with at least one respiratory symptom and one symptom or laboratory finding suggestive of infection, and a working diagnosis of pneumonia. Low-dose CT scan and comprehensive microbiological testing were done in all patients. The index tests, CRP, PCT, SAA and NP, were obtained within 24 hours. The reference diagnosis was assessed a posteriori by a panel of experts considering all available data, including patients’ outcome. We used area under the curve (AUROC) and Youden index to assess the accuracy and obtain optimal cut-off of the index tests. Results 200 patients (median age 84 years) were included; 133 (67%) had pneumonia. AUROCs for the diagnosis of pneumonia was 0.64 (95% CI: 0.56–0.72) for CRP; 0.59 (95% CI: 0.51–0.68) for PCT; 0.60 (95% CI: 0.52–0.69) for SAA; 0.41 (95% CI: 0.32–0.49) for NP; 0.63 (95% CI: 0.55–0.71) for CRP/NP; and 0.61 (95% CI: 0.53–0.70) for SAA/NP. No cut-off resulted in satisfactory sensitivity or specificity. Conclusions Accuracy of traditional (CRP, PCT) and newly proposed biomarkers (SAA, NP) and ratios of CRP/NP and SAA/NP was too low to help diagnosing pneumonia in the elderly. CRP had the highest AUROC. Clinical Trial Registration NCT 02467092
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Affiliation(s)
- Virginie Prendki
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Medical Faculty, Geneva, Switzerland
| | - Astrid Malézieux-Picard
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- * E-mail:
| | - Leire Azurmendi
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Vuilleumier
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
- Diagnostic Department, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Xavier Roux
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Department of Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dina Zekry
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Medical Faculty, Geneva, Switzerland
| | - Jérôme Stirnemann
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Garin
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of General Internal Medicine, Division of General Internal Medicine, Riviera Chablais Hospitals, Rennaz, Switzerland
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Blanchet B, Jallouli M, Allard M, Ghillani-Dalbin P, Galicier L, Aumaître O, Chasset F, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Goulvestre C, Hulot JS, Amoura Z, Vidal M, Piette JC, Jourde-Chiche N, Costedoat-Chalumeau N. Hydroxychloroquine levels in patients with systemic lupus erythematosus: whole blood is preferable but serum levels also detect non-adherence. Arthritis Res Ther 2020; 22:223. [PMID: 32977856 PMCID: PMC7517694 DOI: 10.1186/s13075-020-02291-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/13/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022] Open
Abstract
Background Hydroxychloroquine (HCQ) levels can be measured in both serum and whole blood. No cut-off point for non-adherence has been established in serum nor have these methods ever been compared. The aims of this study were to compare these two approaches and determine if serum HCQ cut-off points can be established to identify non-adherent patients. Methods HCQ levels were measured in serum and whole blood from 573 patients with systemic lupus erythematosus (SLE). The risk factors for active SLE (SLEDAI score > 4) were identified by multiple logistic regression. Serum HCQ levels were measured in 68 additional patients known to be non-adherent, i.e. with whole-blood HCQ < 200 ng/mL. Results The mean (± SD) HCQ levels were 469 ± 223 ng/mL in serum and 916 ± 449 ng/mL in whole blood. The mean ratio of serum/whole-blood HCQ levels was 0.53 ± 0.15. In the multivariate analysis, low whole-blood HCQ levels (P = 0.023), but not serum HCQ levels, were independently associated with active SLE. From the mean serum/whole-blood level ratio, a serum HCQ level of 106 ng/mL was extrapolated as the corresponding cut-off to identify non-adherent patients with a sensitivity of 0.87 (95% CI 0.76–0.94) and specificity of 0.89 (95% CI 0.72–0.98). All serum HCQ levels of patients with whole-blood HCQ below the detectable level (< 20 ng/mL) were also undetectable (< 20 ng/mL). Conclusions These data suggest that whole blood is better than serum for assessing the pharmacokinetic/pharmacodynamic relation of HCQ. Our results support the use of serum HCQ levels to assess non-adherence when whole blood is unavailable.
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Affiliation(s)
- Benoit Blanchet
- AP-HP, Hôpital Cochin, Biologie du médicament - Toxicologie, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Moez Jallouli
- Service de Médecine interne, Hôpital Hédi Chaker, Sfax, Tunisie
| | - Marie Allard
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Pascale Ghillani-Dalbin
- AP-HP, Hôpital Pitié-Salpêtrière, Département d'immunologie, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Lionel Galicier
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Saint Louis, service d'immunologie clinique, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Olivier Aumaître
- Université de Clermont-Ferrand, 63003, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de médecine interne, 58 rue Montalembert, 63003, Clermont-Ferrand cedex1, France
| | - François Chasset
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Tenon, service de dermatologie allergologie, 4 rue de la Chine, 75020, Paris, France
| | - Véronique Le Guern
- AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Frédéric Lioté
- Université de Paris, F-75205, Paris, France.,AP-HP, Hôpital Lariboisière, service de rhumatologie, DMU Locomotion, 2 rue Ambroise Paré, 75010, Paris, France
| | - Amar Smail
- CHU Amiens, Hôpital Nord, service de médecine interne, Place Victor Pauchet, 80000, Amiens, France
| | - Nicolas Limal
- AP-HP, Hôpital Henri Mondor, service de médecine interne, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France
| | - Laurent Perard
- Centre Hospitalier Saint Joseph Saint Luc, service de médecine interne, 20 quai Claude Bernard, 69007, Lyon, France
| | - Hélène Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, 5 place d'Arsonval, 69003, Lyon, France
| | - Du Le Thi Huong
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence pour le Lupus Systémique et le syndrome des Antiphospholipides, service de médecine interne, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Bouchra Asli
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Saint Louis, service d'immunologie clinique, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jean-Emmanuel Kahn
- Servie de Médecine Interne, Hôpital Ambroise Paré, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France
| | - Laurent Sailler
- Université Paul-Sabatier, Toulouse, France.,CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac, F-31059, Toulouse, France
| | - Félix Ackermann
- Hôpital Foch, Service de médecine interne, 92150, Suresnes, France
| | - Thomas Papo
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Karim Sacré
- Université Paris-Diderot, Sorbonne Paris-Cité, F-75205, Paris, France.,AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, 46 rue Henri-Huchard, 75018, Paris, France
| | - Olivier Fain
- Sorbonne Université, Hôpital Saint Antoine, APHP, service de médecine interne, F 75012, Paris, France
| | - Jérôme Stirnemann
- Hôpitaux Universitaires de Genève, Service de Médecine interne Générale, Avenue Gabrielle Perret Gentil 4, CH-1211, Geneva, Switzerland
| | - Patrice Cacoub
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gaelle Leroux
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Judith Cohen-Bittan
- AP-HP, Hôpital Pitié-Salpêtrière, service de gériatrie, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Jérémie Sellam
- AP-HP, Hôpital Saint Antoine, Service de Rhumatologie, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Xavier Mariette
- Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, AP-HP, Université Paris-Sud, INSERM UMR 1184, Paris, France
| | - Claire Goulvestre
- AP-HP, Hôpital Cochin, service d'immunologie biologique, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Zahir Amoura
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence pour le Lupus Systémique et le syndrome des Antiphospholipides, service de médecine interne, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Michel Vidal
- AP-HP, Hôpital Cochin, Biologie du médicament - Toxicologie, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.,UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jean-Charles Piette
- UPMC, Université Paris 6, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne 2, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | | | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260 ; AP-HM, Centre de Néphrologie et Transplantation Rénale, Marseille, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, service de médecine interne, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Université Paris-Descartes, Paris, France. .,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
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41
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Aubert CE, Schnipper JL, Fankhauser N, Marques-Vidal P, Stirnemann J, Auerbach AD, Zimlichman E, Kripalani S, Vasilevskis EE, Robinson E, Metlay J, Fletcher GS, Limacher A, Donzé J. Association of patterns of multimorbidity with length of stay: A multinational observational study. Medicine (Baltimore) 2020; 99:e21650. [PMID: 32846776 PMCID: PMC7447409 DOI: 10.1097/md.0000000000021650] [Citation(s) in RCA: 3] [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] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify the combinations of chronic comorbidities associated with length of stay (LOS) among multimorbid medical inpatients.Multinational retrospective cohort of 126,828 medical inpatients with multimorbidity, defined as ≥2 chronic diseases (data collection: 2010-2011). We categorized the chronic diseases into comorbidities using the Clinical Classification Software. We described the 20 combinations of comorbidities with the strongest association with prolonged LOS, defined as longer than or equal to country-specific LOS, and reported the difference in median LOS for those combinations. We also assessed the association between the number of diseases or body systems involved and prolonged LOS.The strongest association with prolonged LOS (odds ratio [OR] 7.25, 95% confidence interval [CI] 6.64-7.91, P < 0.001) and the highest difference in median LOS (13 days, 95% CI 12.8-13.2, P < 0.001) were found for the combination of diseases of white blood cells and hematological malignancy. Other comorbidities found in the 20 top combinations had ORs between 2.37 and 3.65 (all with P < 0.001) and a difference in median LOS of 2 to 5 days (all with P < 0.001), and included mostly neurological disorders and chronic ulcer of skin. Prolonged LOS was associated with the number of chronic diseases and particularly with the number of body systems involved (≥7 body systems: OR 21.50, 95% CI 19.94-23.18, P < 0.001).LOS was strongly associated with specific combinations of comorbidities and particularly with the number of body systems involved. Describing patterns of multimorbidity associated with LOS may help hospitals anticipate resource utilization and judiciously allocate services to shorten LOS.
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Affiliation(s)
- Carole E. Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey L. Schnipper
- BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Pedro Marques-Vidal
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Andrew D. Auerbach
- Division of Hospital Medicine, University of California, San Francisco, CA
| | | | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health Vanderbilt University, Nashville, TN
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN
| | - Eduard E. Vasilevskis
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health Vanderbilt University, Nashville, TN
- VA Tennessee Valley, Geriatric Research, Education and Clinical Center, Nashville, TN
| | | | - Joshua Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Grant S. Fletcher
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Andreas Limacher
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Harvard Medical School, Boston, MA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
- Department of Internal Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
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42
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Serratrice C, Stirnemann J, Berrahal A, Belmatoug N, Camou F, Caillaud C, Billette de Villemeur T, Dalbies F, Cador B, Froissart R, Masseau A, Brassier A, Hivert B, Swiader L, Bertchansky I, de Moreuil C, Chabrol B, Durieu I, Leguy Seguin V, Astudillo L, Humbert S, Pichard S, Marcel C, Hau Rainsard I, Bengherbia M, Yousfi K, Berger MG. A Cross-Sectional Retrospective Study of Non-Splenectomized and Never-Treated Patients with Type 1 Gaucher Disease. J Clin Med 2020; 9:jcm9082343. [PMID: 32708003 PMCID: PMC7464688 DOI: 10.3390/jcm9082343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 01/16/2023] Open
Abstract
Patients with type 1 Gaucher disease (GD1) present thrombocytopenia, anemia, organomegaly, and bone complications. Most experts consider that the less aggressive forms do not require specific treatment. However, little is known about the disease course of these forms. The objective of this cross-sectional retrospective study was to compare the clinical, radiological, and laboratory characteristics of patients with less severe GD1 at diagnosis and at the last evaluation to identify features that might lead to potential complications. Non-splenectomized and never-treated patients (19 women and 17 men) were identified in the French Gaucher Disease Registry (FGDR). Their median age was 36.6 years (2.4–75.1), and their median follow-up was 7.8 years (0.4–32.4). Moreover, 38.7% were heterozygous for the GBA1 N370S variant, and 22.6% for the GBA1 L444P variant. From diagnosis to the last evaluation, GD1 did not worsen in 75% of these patients. Some parameters improved (fatigue and hemoglobin concentration), whereas platelet count and chitotriosidase level remained stable. In one patient (2.7%), Lewy body dementia was diagnosed at 46 years of age. Bone lesion onset was late and usually a single event in most patients. This analysis highlights the genotypic heterogeneity of this subgroup, in which disease could remain stable and even improve spontaneously. It also draws attention to the possible risk of Lewy body disease and late onset of bone complications, even if isolated, to be confirmed in larger series and with longer follow-up.
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Affiliation(s)
- Christine Serratrice
- Department of Internal Medicine for the Aged, Geneva University Hospitals, 1226 Thonex- Geneva, Switzerland
- Correspondence: ; Tel.: +4179-873-1474
| | - Jérôme Stirnemann
- Department of Internal Medicine, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Amina Berrahal
- University Hospital of Clermont Ferrand, Hematology Biology Department, 63000 Clermont-Ferrand, France; (A.B.); (M.G.B.)
| | - Nadia Belmatoug
- Department of Internal Medicine, Centre de Référence des Maladies Lysosomales, AP-HP.Nord, Site Beaujon, Paris University, 92110 Clichy, France; (N.B.); (C.M.); (M.B.); (K.Y.)
| | - Fabrice Camou
- Intensive Care Unit, Hôpital Saint-André, CHU Bordeaux, 33000 Bordeaux, France;
| | - Catherine Caillaud
- Biochemistry, Metabolomics, and Proteomics Department, Necker Enfants Malades University Hospital, AP-HP. Center-Paris University, 75015 Paris, France;
| | | | - Florence Dalbies
- Institute of Cancerology and Hematology, CHRU Morvan, 29200 Brest, France;
| | - Bérengère Cador
- Department of Internal Medicine, CHU Pontchaillou, 35000 Rennes, France;
| | - Roseline Froissart
- Biochemical and Molecular Biology Department, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France;
| | - Agathe Masseau
- Department of Internal Medicine, CHU Hôtel Dieu, 44093 Nantes, France;
| | - Anaïs Brassier
- Reference Centre for Hereditary Metabolic Diseases, Hôpital Necker-Enfants Malades, AP-HP, IHU Institut Imagine, 75015 Paris, France;
| | - Bénédicte Hivert
- Department of Clinical Hematology, Hôpital Saint Vincent de Paul, Groupement des Hôpitaux de l’Institut Catholique de Lille, 59800 Lille, France;
| | - Laure Swiader
- Department of Internal Medicine, CHU Timone, 13005 Marseille, France;
| | - Ivan Bertchansky
- Department of Internal Medicine, Saint-Eloi Hospital, CHU Montpellier, 34000 Montpellier, France;
| | - Claire de Moreuil
- Department of Internal Medicine, Hôpital de la Cavale Blanche, CHRU de Brest, 29200 Brest, France;
| | - Brigitte Chabrol
- Department of Pediatric Neurology, CHU Timone, 13005 Marseille, France;
| | - Isabelle Durieu
- Department of Internal Medicine, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 69495 Pierre-Bénite, France;
| | - Vanessa Leguy Seguin
- Department of Internal Medicine and Clinical Immunology, CHU F. Mitterrand, 21000 Dijon, France;
| | | | - Sébastien Humbert
- Department of Internal Medicine, Besancon University Hospital, 25000 Besancon, France;
| | - Samia Pichard
- Service of Metabolic Diseases, Hôpital Robert Debré, 75019 Paris, France;
| | - Catherine Marcel
- Department of Internal Medicine, Centre de Référence des Maladies Lysosomales, AP-HP.Nord, Site Beaujon, Paris University, 92110 Clichy, France; (N.B.); (C.M.); (M.B.); (K.Y.)
| | | | - Monia Bengherbia
- Department of Internal Medicine, Centre de Référence des Maladies Lysosomales, AP-HP.Nord, Site Beaujon, Paris University, 92110 Clichy, France; (N.B.); (C.M.); (M.B.); (K.Y.)
| | - Karima Yousfi
- Department of Internal Medicine, Centre de Référence des Maladies Lysosomales, AP-HP.Nord, Site Beaujon, Paris University, 92110 Clichy, France; (N.B.); (C.M.); (M.B.); (K.Y.)
| | - Marc G. Berger
- University Hospital of Clermont Ferrand, Hematology Biology Department, 63000 Clermont-Ferrand, France; (A.B.); (M.G.B.)
- University Clermont Auvergne, EA 7453 CHELTER, 63000 Clermont-Ferrand, France
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43
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Berger J, Vigan M, Pereira B, Nguyen TT, Froissart R, Belmatoug N, Dalbiès F, Masseau A, Rose C, Serratrice C, Pers YM, Bertchansky I, Camou F, Bengherbia M, Bourgne C, Caillaud C, Pettazzoni M, Berrahal A, Stirnemann J, Mentré F, Berger MG. Intra-monocyte Pharmacokinetics of Imiglucerase Supports a Possible Personalized Management of Gaucher Disease Type 1. Clin Pharmacokinet 2020; 58:469-482. [PMID: 30128966 DOI: 10.1007/s40262-018-0708-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Intravenous imiglucerase enzyme replacement therapy for Gaucher disease type 1 administered every 2 weeks is at variance with the imiglucerase plasma half-life of a few minutes. We hypothesized that studying the pharmacokinetics of imiglucerase in blood Gaucher disease type 1 monocytes would be more relevant for understanding enzyme replacement therapy responses. METHODS Glucocerebrosidase intra-monocyte activity was studied by flow cytometry. The pharmacokinetics of imiglucerase was analyzed using a population-pharmacokinetic model from a cohort of 31 patients with Gaucher disease type 1 who either started or were receiving long-term treatment with imiglucerase. RESULTS A pharmacokinetic analysis of imiglucerase showed a two-compartment model with a high peak followed by a two-phase exponential decay (fast phase half-life: 0.36 days; slow phase half-life: 9.7 days) leading to a median 1.4-fold increase in glucocerebrosidase intra-monocyte activity from the pre-treatment activity (p = 0.04). In patients receiving long-term treatment, for whom the imiglucerase dose per infusion was chosen on the basis of disease aggressiveness/response, imiglucerase clearance correlated with the administered dose. However, the residual glucocerebrosidase intra-monocyte activity value was dose independent, suggesting that the maintenance of imiglucerase residual activity is patient specific. Endogenous pre-treatment glucocerebrosidase intra-monocyte activity was the most informative single parameter for distinguishing patients without (n = 10) and with a clinical indication (n = 17) for starting enzyme replacement therapy (area under the receiver operating characteristic curve: 0.912; 95% confidence interval 0.8-1; p < 0.001), as confirmed also by a factorial analysis of mixed data. CONCLUSION This study provides novel pharmacokinetic data that support current imiglucerase administration regimens and suggests the existence of a glucocerebrosidase activity threshold related to Gaucher disease type 1 aggressiveness. These findings can potentially improve Gaucher disease type 1 management algorithms and clinical decision making.
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Affiliation(s)
- Juliette Berger
- Hématologie Biologique, CHU Clermont-Ferrand, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
- Université Clermont Auvergne, Equipe d'Accueil 7453 CHELTER, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
- CHU Clermont-Ferrand, CHU Estaing, CRB Auvergne, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Marie Vigan
- INSERM and University Paris Diderot, IAME, UMR 1137, Paris, France
- AP-HP, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, 75018, Paris, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, DRCI, CHU Montpied, 58 rue Montalembert, 63003, Clermont-Ferrand Cedex 1, France
| | - Thu Thuy Nguyen
- INSERM and University Paris Diderot, IAME, UMR 1137, Paris, France
| | - Roseline Froissart
- Hospices Civils de Lyon, Centre de Biologie et de Pathologie Est, Unité des Maladies Héréditaires du Métabolisme et Dépistage Néonatal, Service de Biochimie et Biologie Moléculaire Grand Est, 69677, Bron, France
| | - Nadia Belmatoug
- Médecine Interne, AP-HP, Hôpital Beaujon, 100 boulevard Général Leclerc, 92110, Clichy, France
| | - Florence Dalbiès
- Hématologie, CHRU Brest site Hôpital Morvan, 5 avenue Maréchal Foch, 29200, Brest, France
| | - Agathe Masseau
- Médecine Interne, CHU de Nantes, Hôtel-Dieu, 44093, Nantes, France
| | - Christian Rose
- Onco-Hématologie, Hôpital Saint-Vincent de Paul, boulevard de Belfort, 59000, Lille, France
| | - Christine Serratrice
- Hôpitaux Universitaires de Genève, Département de Médecine Interne, Hôpital des Trois-Chêne, Chemin du Pont-Bochet 3, Thônex, 1226, Geneva, Switzerland
| | - Yves-Marie Pers
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, 371 avenue du Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - Ivan Bertchansky
- INSERM U1183, Saint-Eloi University Hospital, Montpellier, France
| | - Fabrice Camou
- Service de Médecine Interne et Maladies Infectieuses, CHU Bordeaux, Groupe Hospitalier Sud, avenue Magellan, 33604, Pessac Cedex, France
| | - Monia Bengherbia
- Médecine Interne, AP-HP, Hôpital Beaujon, 100 boulevard Général Leclerc, 92110, Clichy, France
| | - Céline Bourgne
- Hématologie Biologique, CHU Clermont-Ferrand, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
- Université Clermont Auvergne, Equipe d'Accueil 7453 CHELTER, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Catherine Caillaud
- INSERM U1151, Institut Necker Enfants Malades, Université Paris Descartes, Paris, France
- AP-HP, Hôpital Universitaire Necker Enfants Malades, Laboratoire de Biochimie, Métabolomique et Protéomique, 149 rue de Sèvres, 75005, Paris, France
| | - Magali Pettazzoni
- Hospices Civils de Lyon, Centre de Biologie et de Pathologie Est, Unité des Maladies Héréditaires du Métabolisme et Dépistage Néonatal, Service de Biochimie et Biologie Moléculaire Grand Est, 69677, Bron, France
| | - Amina Berrahal
- Hématologie Biologique, CHU Clermont-Ferrand, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Jérôme Stirnemann
- Département de Médecine Interne, Hôpitaux Universitaires de Genève, Gabrielle Perret Gentil 4, 1211, Geneva, Switzerland
| | - France Mentré
- INSERM and University Paris Diderot, IAME, UMR 1137, Paris, France
- AP-HP, Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, 75018, Paris, France
| | - Marc G Berger
- Hématologie Biologique, CHU Clermont-Ferrand, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France.
- Université Clermont Auvergne, Equipe d'Accueil 7453 CHELTER, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France.
- CHU Clermont-Ferrand, CHU Estaing, CRB Auvergne, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France.
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44
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Colmant C, Lapillonne A, Stirnemann J, Belaroussi I, Leroy-Terquem E, Kermovant-Duchemin E, Bussieres L, Ville Y. Impact of different prenatal management strategies in short- and long-term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases. BJOG 2020; 128:401-409. [PMID: 32416618 DOI: 10.1111/1471-0528.16318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review perinatal and neurodevelopmental outcome (NDO) following selective fetoscopic laser coagulation (SFLC), cord coagulation (CC) or expectant management of monochorionic diamniotic twin pregnancies complicated with selective intrauterine growth restriction (sIUGR) and absent or reverse end-diastolic flow (AREDF) in the umbilical arteries (UA). DESIGN AND SETTING Single-centre retrospective observational study. POPULATION 108 cases of sIUGR diagnosed before 26+6 weeks' gestation with AREDF in the UA. METHODS Survival rate and potential risk factors were analysed. NDO was assessed using parental questionnaires. MAIN OUTCOMES MEASURES Survival, gestational age at delivery and NDO. RESULTS SFLC, CC and EM were performed in 13, 50 and 45 cases, respectively, with an overall survival of 23.1, 40 and 77.8% and intrauterine demise of the co-twin of 30.8, 10 and 6.7% respectively. Intrauterine demise of the sIUGR twin occurred in 76.9 and 17.8% following SFLC and EM, respectively. The discordance in EFW at diagnosis was higher and absent/negative a-wave in the ductus venosus (DV) was more prevalent in the surgical groups. NDO in survivors at follow up was abnormal in 0 and 18% in the smaller twin following SFLC and EM, respectively, and in 25, 24 and 21% in the larger twin following SFLC, CC and EM, respectively. CONCLUSION SFLC yielded a poor result. EM seems a valid option when EFW discordance is <30% and a-wave in DV is positive. Otherwise, CC should be considered to protect the AGA co-twin. The long-term outcome of both small and large twins seems unaffected by the choice in primary prenatal management strategy. TWEETABLE ABSTRACT In type II sIUGR in MC twins, long-term neurodevelopment is normal in over 80% of the survivors.
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Affiliation(s)
- C Colmant
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - A Lapillonne
- EA7328 and PACT, Université Paris Descartes, Paris, France.,Neonatology and Intensive Care Unit, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - J Stirnemann
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
| | - I Belaroussi
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | | | - E Kermovant-Duchemin
- EA7328 and PACT, Université Paris Descartes, Paris, France.,Neonatology and Intensive Care Unit, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - L Bussieres
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
| | - Y Ville
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
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45
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Carballo S, Stirnemann J, Garin N, Darbellay Farhoumand P, Serratrice J, Carballo D. Prognosis of patients eligible for dapagliflozin in acute heart failure. Eur J Clin Invest 2020; 50:e13245. [PMID: 32306388 DOI: 10.1111/eci.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, was shown in the DAPA-HF study to reduce the risk of worsening heart failure or death in symptomatic patients with left ejection fraction <40%, irrespective of diabetes. The aim of this study was to evaluate eligibility status for dapagliflozin in non-selected patients hospitalized for acute decompensated heart failure (ADHF), as well as prognostic implications of this status. MATERIALS AND METHODS Analysis of 815 patients recruited in a prospective cohort of acute heart failure at the University Hospitals of Geneva, consisting of consecutive patients admitted with ADHF. Eligibility for dapagliflozin was determined using criteria described DAPA-HF. RESULTS Of 815 patients, 220 (27%) were eligible for dapagliflozin treatment. In survival analysis, patients who were eligible for dapagliflozin had better clinical outcomes with respect to all-cause mortality and rehospitalization as compared to those who were not eligible. In multivariate analysis, the hazard ratio for all-cause mortality or readmission in patients eligible for dapagliflozin was 0.82 (95% CI 0.68-0.999, P = .049) as compared to the non-eligible. CONCLUSIONS Using DAPA-HF criteria, only 27% of non-selected patients admitted for ADHF are theoretically eligible for dapagliflozin. This eligibility for dapagliflozin is associated with better outcomes. Further evaluation of the benefits of dapagliflozin in selected HF patients may be of interest. This may have implications for selection criteria in future randomized effectiveness studies.
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Affiliation(s)
- Sebastian Carballo
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Stirnemann
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Garin
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jacques Serratrice
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Carballo
- Service of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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46
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Nguyen Y, Stirnemann J, Belmatoug N. [Gaucher disease]. Rev Prat 2020; 70:416-420. [PMID: 32877100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gaucher disease. Gaucher disease is a rare lysosomal autosomal recessive disease, caused by a deficiency of glucocerebrosidase, a lysosomal enzyme. The most frequent symptoms are cytopenia, splenomegaly, hepatomegaly, and potentially severe bone involvement (bone infarcts, avascular osteonecrosis, and pathological fractures). Neurological involvement may occur in type 2 and type 3 Gaucher disease. Patients with type 1 Gaucher disease have an increased risk of Parkinson disease, some solid cancers, and some hematologic malignancies including multiple myeloma. Patients often experience delays before their disease is being diagnosed. Thus, there is a need for physicians to recognize Gaucher disease symptoms to reduce the risk of irreversible complications.
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Affiliation(s)
- Yann Nguyen
- Service de médecine interne, centre de référence des maladies lysosomales, AP-HP Nord, Université de Paris, hôpital Beaujon, Clichy, France
| | - Jérôme Stirnemann
- Service de médecine interne générale, hôpitaux universitaires de Genève, Genève, Suisse
| | - Nadia Belmatoug
- Service de médecine interne, centre de référence des maladies lysosomales, AP-HP Nord, Université de Paris, hôpital Beaujon, Clichy, France
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47
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Carballo D, Stirnemann J, Garin N, Marti C, Serratrice J, Carballo S. Eligibility for sacubitril-valsartan in patients with acute decompensated heart failure. ESC Heart Fail 2020; 7:1282-1290. [PMID: 32167679 PMCID: PMC7261587 DOI: 10.1002/ehf2.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/30/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Large‐scale clinical trials have demonstrated clinical benefits of sacubitril–valsartan in symptomatic heart failure with reduced ejection fraction patients (PARADIGM‐HF), with potential benefits in patients hospitalized for acute decompensated heart failure (ADHF) (PIONEER‐HF) and fewer benefits in patients with heart failure with preserved ejection fraction (PARAGON‐HF). The aim of this study was to evaluate eligibility for sacubitril–valsartan using criteria described in PIONNER‐HF in non‐selected patients hospitalized for ADHF. Methods and results Between November 2014 and May 2019, 799 patients were recruited in a prospective registry of acute heart failure at the University Hospitals of Geneva (http://ClinicalTrials.gov: NCT02444416). The cohort consists of consecutive patients admitted to the Department of Medicine with ADHF. Eligibility for sacubitril–valsartan was determined using criteria described in PIONEER‐HF, including left ventricular ejection fraction, clinical parameters, and co‐morbidities. Of 799 patients, 123 (15.39%) were eligible for sacubitril–valsartan treatment. Clinical outcomes including all‐cause mortality and readmission were similar in eligible and non‐eligible groups, hazard ratio 1.02 (95% confidence interval 0.81–1.29, P = 083). Conclusions Using current criteria from randomized controlled trials, only 15% of non‐selected patients admitted for ADHF are theoretically eligible for sacubitril–valsartan. Eligibility for sacubitril–valsartan using published criteria is not associated with worse outcome, suggesting that further evaluation of benefits of sacubitril–valsartan in heart failure patients based on parameters other than left ventricular ejection fraction may be of interest.
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Affiliation(s)
- David Carballo
- Service of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Stirnemann
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Garin
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Chistophe Marti
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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48
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Carballo S, Stirnemann J, Marti C, Darbellay Farhoumand P, Nendaz M, Serratrice J. [Novelties in internal medicine]. Rev Med Suisse 2020; 16:113-116. [PMID: 31967752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This selective overview of articles describes new concepts, therapeutic measures and pharmacological agents that may modify current practice in internal medicine. Implications for management of cardiovascular disease, such as heart failure, diabetes and infectious diseases figure prominently.
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Affiliation(s)
| | | | | | | | - Mathieu Nendaz
- Service de médecine interne générale, HUG, 1211 Genève 14
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49
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Aubert CE, Schnipper JL, Roumet M, Marques-Vidal P, Stirnemann J, Auerbach AD, Zimlichman E, Kripalani S, Vasilevskis EE, Robinson E, Fletcher GS, Aujesky D, Limacher A, Donzé J. Best Definitions of Multimorbidity to Identify Patients With High Health Care Resource Utilization. Mayo Clin Proc Innov Qual Outcomes 2020; 4:40-49. [PMID: 32055770 PMCID: PMC7011007 DOI: 10.1016/j.mayocpiqo.2019.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To compare different definitions of multimorbidity to identify patients with higher health care resource utilization. Patients and Methods We used a multinational retrospective cohort including 147,806 medical inpatients discharged from 11 hospitals in 3 countries (United States, Switzerland, and Israel) between January 1, 2010, and December 31, 2011. We compared the area under the receiver operating characteristic curve (AUC) of 8 definitions of multimorbidity, based on International Classification of Diseases codes defining health conditions, the Deyo-Charlson Comorbidity Index, the Elixhauser-van Walraven Comorbidity Index, body systems, or Clinical Classification Software categories to predict 30-day hospital readmission and/or prolonged length of stay (longer than or equal to the country-specific upper quartile). We used a lower (yielding sensitivity ≥90%) and an upper (yielding specificity ≥60%) cutoff to create risk categories. Results Definitions had poor to fair discriminatory power in the derivation (AUC, 0.61-0.65) and validation cohorts (AUC, 0.64-0.71). The definitions with the highest AUC were number of (1) health conditions with involvement of 2 or more body systems, (2) body systems, (3) Clinical Classification Software categories, and (4) health conditions. At the upper cutoff, sensitivity and specificity were 65% to 79% and 50% to 53%, respectively, in the validation cohort; of the 147,806 patients, 5% to 12% (7474 to 18,008) were classified at low risk, 38% to 55% (54,484 to 81,540) at intermediate risk, and 32% to 50% (47,331 to 72,435) at high risk. Conclusion Of the 8 definitions of multimorbidity, 4 had comparable discriminatory power to identify patients with higher health care resource utilization. Of these 4, the number of health conditions may represent the easiest definition to apply in clinical routine. The cutoff chosen, favoring sensitivity or specificity, should be determined depending on the aim of the definition.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jeffrey L Schnipper
- BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Marie Roumet
- CTU Bern and Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | | | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospital, Switzerland
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, Sheba Medical Center, Tel HaShomer, Israel
| | | | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health and Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN
| | - Eduard E Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville
| | | | - Grant S Fletcher
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Limacher
- CTU Bern and Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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50
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Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, Donzé J. Multimorbidity and healthcare resource utilization in Switzerland: a multicentre cohort study. BMC Health Serv Res 2019; 19:708. [PMID: 31623664 PMCID: PMC6798375 DOI: 10.1186/s12913-019-4575-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/29/2019] [Accepted: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients. METHODS We performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques. RESULTS Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases). CONCLUSIONS Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | | | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | | | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.,Division of General Medicine, BWH Hospitalist Service, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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