1
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Guedeney P, Mesnier J, Michel M, Hauguel-Moreau M, Silvain J, Houde C, Alperi A, Panagides V, Collet JP, Wallet T, Rouanet S, Hammoudi N, Rodes-Cabau J, Montalescot G. Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.
Methods
This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.
Results
A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus <2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.
Conclusion
This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - J Mesnier
- Quebec Heart and Lung Institute , Quebec , Canada
| | - M Michel
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, Cardiology , Boulogne Billancourt , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - C Houde
- Hospital Affiliated with the University of Quebec , Quebec , Canada
| | - A Alperi
- Quebec Heart and Lung Institute , Quebec , Canada
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - T Wallet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | | | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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2
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Zeitouni M, Sulman D, Silvain J, Kerneis M, Guedeney P, Barthelemy O, Procopi N, Collet JP, Montalescot G. Have the ESC guidelines improved the identification and prevention of individuals at risk of premature myocardial infarction? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Over the last 20 years, the proportion of young patients admitted for MI has increased. It is unknown whether the 5-year changes in ESC/EAS guidelines and the new SCORE2 can improve the detection and treatment of individuals at risk of premature MI.
Purpose
To determine how consecutive changes in the ESC/EAS guidelines affected the identification and treatment of young adults premature STEMI.
Methods
Patients admitted for a first STEMI in the ePARIS between 2010 and 2018 were included (n=2757) and stratified by age categories (<55 y-o; 55–65 y-o; >65 y-o). Using baseline characteristics, we evaluated whether patients in each age group would have been detected as high risk and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines (class I, IIA and IIB recommandations). Eligibility for intensive lipid-lowering therapy in secondary prevention according to age was also assessed.
Results
Among the 2757 individuals admitted for a first STEMI, 1253 (45,7%) were <55 y.o, 633 (22.9%) were [55–65] and 871 (31.4%) were >65. Only 17% and 18% of young individuals would have been considered as high risk and eligible for primary prevention statins prior to their first STEMI according to 2016 and 2019 EAS/ESC guidelines respectively, compared with individuals aged 55–65 years (41% and 35%) and >65 years old (21% and 72%), p<0.01. Following 2021 ESC guidelines, 62.5% of individuals aged <55 y.o would have been detected as eligible for primary prevention statins, without difference with individuals aged 55 to 65 years old (61.7%) and >65 y.o (62.1%) (figure). At discharge, based on the expected reduction of baseline LDL-C with maximal dose statins and ezetimibe, 47% of patients with premature STEMI would be eligible for PCSK9i compared with 50% and 37% in individuals aged 55–65 y-o and >65 y-o, respectively.
Conclusions
While 2016 and 2019 ESC guidelines poorly detected young individuals at risk of premature MI, the 2021 ESC guidelines using the new SCORE2 allowed a much better detection of young individuals at risk for a first STEMI. Young patients were also more likely to be eligible for intensive lipid-lowering therapy after their first premature STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere , Paris , France
| | - D Sulman
- Hospital Pitie-Salpetriere , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere , Paris , France
| | - M Kerneis
- Hospital Pitie-Salpetriere , Paris , France
| | - P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | | | - N Procopi
- Hospital Pitie-Salpetriere , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere , Paris , France
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3
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Guedeney P, Roule V, Mesnier J, Chapelle C, Portal JJ, Laporte S, Ollier E, Zeitouni M, Kerneis M, Barthelemy O, Sorrentino S, Silvain J, Vicaut E, Montalescot G, Collet JP. Comparison of the safety and efficacy of antithrombotic regimens following TAVR in patients without having an indication for chronic oral anticoagulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To compare the safety and efficacy of antithrombotic regimens following transcatheter aortic valve replacement (TAVR) in patients without having an indication for chronic oral anticoagulation
Methods and results
We conducted a Prospero-registered systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVR antithrombotic regimens up to March 2021. We estimated the relative risk and 95% confidence intervals using a fixed effect model in a frequentist pairwise and network metanalytic approach. We included 6 studies comprising of 3,777 patients with a mean weighted follow-up of 13.3 months. Single antiplatelet therapy (SAPT) was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95% confidence interval [CI]: 0.28–0.69), apixaban (RR: 0.47, 95% CI 0.26–0.84) and low-dose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI: 0.16–0.57). Risk of all-cause death was significantly reduced with DAPT compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI: 0.41–0.88) and a consistent reduction was observed with SAPT and DAPT compared to apixaban (RR: 0.60, 95% CI: 0.31–1.16 and RR: 0.58, 95% CI: 0.32–1.04, respectively). There were no differences between the various regimens with respect to myocardial infarction and stroke. Apixaban significantly reduced the risk of pulmonary embolism, valve thrombosis and grade 3 or 4 reduced leaflet motion.
Conclusion
Following TAVR in patients without an indication for chronic oral anticoagulant, SAPT was associated with the lowest risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere , Paris , France
| | - V Roule
- University Hospital of Caen, Department of Cardiology , Caen , France
| | - J Mesnier
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Cardiology , Paris , France
| | - C Chapelle
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - J J Portal
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | - S Laporte
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - E Ollier
- University Hospital of Saint-Etienne, Unité de Recherche Clinique Innovation et Pharmacologie , Saint-Etienne , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere , Paris , France
| | - M Kerneis
- Hospital Pitie-Salpetriere , Paris , France
| | | | - S Sorrentino
- Magna Graecia University of Catanzaro, Cardiology , Catanzaro , Italy
| | - J Silvain
- Hospital Pitie-Salpetriere , Paris , France
| | - E Vicaut
- Lariboisiere APHP Site of Saint Louis University Hospital, Unité de Recherche Clinique , Paris , France
| | | | - J P Collet
- Hospital Pitie-Salpetriere , Paris , France
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4
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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Alamowitch S, Sabben C, Deltour S, Benyounes N, Obadia M, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.
Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.
Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.
Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).
Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Laredo
- Hospital Pitie-Salpetriere , Paris , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, cardiology , Boulogne Billancourt , France
| | - T Wallet
- Hospital Pitie-Salpetriere , Paris , France
| | | | - C Sabben
- Fondation Rothschild, Neurology , Paris , France
| | - S Deltour
- Hopital Raymond Poincare, Neurology , Garches , France
| | - N Benyounes
- Fondation Rothschild, Cardiology , Paris , France
| | - M Obadia
- Fondation Rothschild, Neurology , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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5
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Corbeau A, Collet J, Orgeret F, Pistorius P, Weimerskirch H. Fine‐scale interactions between boats and large albatrosses indicate variable susceptibility to bycatch risk according to species and populations. Anim Conserv 2021. [DOI: 10.1111/acv.12676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Corbeau
- Centre d’Études Biologiques de Chizé UMR7372 CNRS‐La Rochelle Université Villiers en Bois France
| | - J. Collet
- Department of Zoology University of Oxford Oxford United Kingdom
| | - F. Orgeret
- DST/NRF Centre of Excellence at the FitzPatrick Institute for African Ornithology Department of Zoology Nelson Mandela University Port Elizabeth South Africa
- Marine Apex Predator Research Unit Institute for Coastal and Marine Research Nelson Mandela University Port Elizabeth South Africa
| | - P. Pistorius
- DST/NRF Centre of Excellence at the FitzPatrick Institute for African Ornithology Department of Zoology Nelson Mandela University Port Elizabeth South Africa
- Marine Apex Predator Research Unit Institute for Coastal and Marine Research Nelson Mandela University Port Elizabeth South Africa
| | - H. Weimerskirch
- Centre d’Études Biologiques de Chizé UMR7372 CNRS‐La Rochelle Université Villiers en Bois France
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6
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Collet J, Engelen NJJA, Schols JMGA, de Vugt ME, Verhey FRJ. [Older people with complex, combined care needs: the need for tailored collaborative care]. Tijdschr Psychiatr 2020; 62:304-308. [PMID: 32388853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Older patients with combined psychiatric, physical and cognitive health problems - patients who need double care - benefit from integrated medical and psychiatric care. The characteristics of these patients, as well as the problems that may exist in offering them adequate integrated care, are illustrated on the basis of a case description. Improvement of existing regional arrangements, premised on a collaborative care model, and involving hospital care, mental health services, nursing home care and community care services, is recommended. In settings that offer 24 hour long-term residential care and treatment, the expertise of mental health services and nursing homes must be structurally combined.
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7
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McMahon W, Ftouni S, Collet J, Diep C, Rajaratnam S, Maruff P, Drummond S, Anderson C. Task-dependent effects of the wake maintenance zone on cognition and alertness, with and without sleep loss. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Lattuca B, Bouziri N, Portal JJ, Zhou J, Zeitouni M, Kerneis M, Guedeney P, Legrand L, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J. P6454Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs).
Purpose
To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications.
Methods
From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression.
Results
We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT.
Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p<0.031) and a prolonged anticoagulation therapy over 3 months (HR=0.11 [0.05–0.22], p<0.0001).
During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039).
Occurence of mortality (A) and MACE (B)
Conclusions
The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.
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Affiliation(s)
- B Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Bouziri
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J J Portal
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - J Zhou
- Information system department, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - M Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - P Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - L Legrand
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - N Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - R Isnard
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - F Pousset
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J P Collet
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - E Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital (APHP), Paris, France
| | - G Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - J Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
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9
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Guedeney P, Sorrentino S, Giustino G, Chapelle C, Claessen B, Ollier E, Laporte S, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Collet JP, Mehran R, Montalescot G. P5367Indirect comparison of the safety and efficacy of alirocumab and evolocumab: from a comprehensive meta-analysis of 30 randomized controlled trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Alirocumab and evolocumab, two proprotein convertase subtilisin–kexin type 9 inhibitors, have both been associated with improved outcomes in patients with atherosclerotic cardiovascular disease in addition to standard lipid-lowering therapies. However, their comparative safety and efficacy profiles are unknown.
Purpose
To compare the safety and efficacy of alirocumab versus evolocumab.
Methods
We conducted a systematic review and network meta-analysis of placebo-controlled randomized trials available up to November 2018 evaluating the safety and efficacy of alirocumab and evolocumab. We estimated risk ratio and 95% confidence intervals using fixed effect model in a frequentist pairwise and network metanalytic approach. The primary safety endpoints were any adverse events leading to treatment-discontinuation, injection site reaction, systemic allergic reaction, neurocognitive events, ophthalmologic events and new-onset of diabetes mellitus (DM) or worsening of pre-existing DM. The primary efficacy endpoints were all-cause and cardiovascular (CV) death, myocardial infarction (MI) and stroke. This study was registered in PROSPERO (CRD42018090768).
Results
A total of 30 trials, enrolling 59,026 patients were included in this analysis, of whom 13,607 received alirocumab and 17,931 received evolocumab. Mean weighted follow-up time was 2.5 years, with an exposure time of 144,907 patients-years. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. There were no significant differences between alirocumab and evolocumab in terms of safety endpoints, except for injection site reaction with a 27% increased risk of injection site reaction with alirocumab compared to evolocumab (Figure). Compared with evolocumab, alirocumab was associated with a reduction of all-cause death but not CV death. There were no significant differences in MI or stroke between alirocumab and evolocumab.
Conclusion
Alirocumab and evolocumab share a similar safety profile. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to heterogeneity of the studied populations between the two drugs.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - S Sorrentino
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - G Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - C Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - B Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - E Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - S Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie, Universitary Hospital of Saint Etienne, Saint Etienne, France
| | - A Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - D N Kalkman
- University of Amsterdam, Department of Clinical and Experimental Cardiology, Amsterdam, Netherlands (The)
| | - B Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - S De Rosa
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Division of cardiology, Department of Medical and Surgical Science, Catanzaro, Italy
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
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10
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Guedeney P, Huchet F, Manigold F, Rouanet S, Vicaut E, Balagny P, Leprince P, Lebreton G, Letocart V, Barthelemy O, Montalescot G, Guerin P, Collet JP. P3855Incidence, risk factors and impact of readmission for heart failure after successful transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Incidence and correlates of readmission for heart failure in all-comers, after successful transcatheter aortic valve replacement (TAVR) remain unclear.
Objective
We sought to evaluate the incidence, risk factors and clinical impact of readmission for HF after successful TAVR in an unselected patient population.
Methods
All patients who underwent successful TAVR in two high-volume French tertiary centers from February 2010 to December 2016 were prospectively included and followed-up for one year. Cox multivariate model was used to assess risk factors of readmission for heart failure, evaluated a time-updated covariate and mortality.
Results
A total of 1139 patients (mean age 82.4±7.7 years, 52.2% male) were included. Readmission for heart failure occurred in 99 (8.7%) patients. Risk factors of readmission for HF were chronic pulmonary disease (adjHR 1.8; 95% CI [1.2–2.8], p=0.008), chronic kidney disease (adjHR 1.7; 95% CI [1.1–2.6], p=0.01), diabetes mellitus (adjHR 1.7; 95% CI [1.1–2.5], p=0.01), prior atrial fibrillation (adjHR 1.6; 95% CI [1.1–2.4], p=0.02) and post-TAVR left ventricular ejection fraction (LVEF) ≤35% (adjHR 2.1 95% CI 1.2–3.7, p=0.009). Readmission for HF was strongly associated with mortality (Figure) along with increased STS score (adjHR 1.07 95% CI 1.03–1.12, p=0.002), prior atrial fibrillation (adjHR 2.13 95% CI 1.53–2.96, p<0.001) and shock during the index hospitalization (adjHR 2.68 95% CI 1.48–4.87, p=0.001).
Figure 1
Conclusion
Readmission for heart failure occurs in one out of ten patients after successful TAVR and is strong risk factor of mortality. Comorbidities and post-TAVR LVEF≤35% are the main correlates of readmission for heart failure.
Acknowledgement/Funding
ACTION study group
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - F Huchet
- University Hospital of Nantes, Cardiology, Nantes, France
| | - F Manigold
- University Hospital of Nantes, Cardiology, Nantes, France
| | - S Rouanet
- StatEthic, Statistician unit, Levallois Perret, France
| | - E Vicaut
- Action study group, Unité de recherche Clinique, Hôpital Lariboisière, Paris, France
| | - P Balagny
- Hospital Pitie-Salpetriere, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Cardiac Surgery, Paris, France
| | - G Lebreton
- Hospital Pitie-Salpetriere, Cardiac Surgery, Paris, France
| | - V Letocart
- University Hospital of Nantes, Cardiology, Nantes, France
| | | | | | - P Guerin
- University Hospital of Nantes, Cardiology, Nantes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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11
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Danchin N, Puymirat E, Ducrocq G, Henry P, Collet JP, Genee O, Joseph T, Belle L, Naccache N, Ferrieres J, Schiele F, Simon T. P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored.
Aims and methods
Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%.
Results
In patients with HbA1c <7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia <100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia >180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia >180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (<100 mg/dl: 49±14%, >180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c <7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046).
Figure 1. 30-day death
Conclusion
In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c <7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Henry
- Hospital Lariboisiere, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - O Genee
- Clinique de la Reine Blanche, Orleans, France
| | - T Joseph
- Centre Hospitalier, Quimper, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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12
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Zeitouni M, Barthelemy O, Rouanet S, Guedeney P, Hauguel-Moreau M, Hage G, Overtchouk P, Brugier D, Vignolles N, Kerneis M, Silvain J, Collet JP, Vicaut E, Thiele H, Montalescot G. P961Investigator versus Core Lab evaluation of coronary blood flow in PCI of patients in cardiogenic shock: a substudy of the CULPRIT-SHOCK trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Thrombolysis In Myocardial Infarction (TIMI) flow is a prognostic factor which assessment is complex in life-threatening situations. Because TIMI flow evaluation by site investigator (SI) is subject to bias, independent Core-Laboratory (CL) adjudication is the reference standard in clinical trials.
Purpose
To evaluate the concordance between CL and SI in the evaluation of the culprit artery TIMI flow, and the associated prognosis in the CULPRIT-SHOCK trial.
Methods
All patients of the CULPRIT-SHOCK trial with CL adjudications were included in this analysis. CL adjudicators were blinded to patient's characteristics and outcomes: pre and post-PCI TIMI flows were solely evaluated on the basis of coronary angiograms. SI determined the TIMI flow before and immediately after PCI of the culprit lesion. The concordance was determined by Cohen's κ coefficient. A multivariate analysis was used to evaluate 1) factors of discordance 2) the association between each method of evaluation and the mortality at 30 days and 1 year.
Results
Among CULPRIT-SHOCK patients, 663 patients were eligible for this analysis. Of the 214 patients adjudicated TIMI flow 3 by CL before PCI, SI over-estimated the obstruction to TIMI flow 0–1-2 in 121 (56.5%). Of the 139 patients scored TIMI flow 0–1-2 by CL after PCI, SI over-graded their results to TIMI flow 3 in 79 (56.8%). Overall, the K coefficient of agreement was 0.44, 95% CI [0.36; 0.51] before PCI and 0.44, 95% CI [0.35; 0.53] after PCI. Mechanical circulatory support and culprit left main were the main factors of discordance of TIMI flow after PCI. The association between TIMI flow 0–1-2 after PCI and 30-days mortality was significant, whether adjudicated by SI or CL (figure). Post-PCI TIMI-flow 0–1-2 was associated to 1-year mortality only when evaluated by SI (figure).
Association between TIMI and mortality
Conclusions
In comparison to the independant CL evaluation, SI overestimated the severity of coronary slow flow before PCI, and the success of PCI in improving coronary flow. The level of agreement between CL and SI was moderate. While both evaluations predicted 30-days mortality, only SI scoring was associated to 1-year mortality.
Acknowledgement/Funding
European Union Seventh Framework Program, the German Heart Research Foundation, German Cardiac Society.
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Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Rouanet
- StatEthic, Statistician unit, Levallois-Perret, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Hauguel-Moreau
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - G Hage
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - P Overtchouk
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - N Vignolles
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Action Study Group, Unite de Recherche Clinique, Paris, France
| | - H Thiele
- Leipzig University Hospital, Heart center, Leipzig, Germany
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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13
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Procopi A, Procopi N, Collet JP, Barthelemy O, Leprince P, Choussat R, Isnard R. P5575Acute left ventricular mechanics changes after TAVR: the afterload concept revisited. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies have emphasized the prognostic value of mild left ventricular ejection fraction (LVEF) impairment in severe aortic stenosis. However, despite adaptive mechanisms to pressure overload, subtle impaired systolic function could be worsened by increased afterload and partly reversible immediately after its correction.
Objectives
The aim was to evaluate the short terms effects of transcatheter aortic valve replacement (TAVR) on LV systolic function assessed by global longitudinal strain (GLS). We hypothesized that abrupt decrease of LV afterload after TAVR could lead to immediate improvement of LV systolic function.
Methods
Patients referred to our Department for TAVR were included from January 2018 to July 2018 in this observational prospective single center study. Transthoracic echocardiography (TTE) was performed immediately before and 1–5 days after TAVR by the same operator and reviewed in a blind fashion.
Results
35 symptomatic patients with severe aortic stenosis referred for TAVR (age 84±5 y, 18 male, NYHA 2–3, orifice area 0.7±0.2 cm2, LVEF 66±13%, GLS −15.1±4.7%) were included. Only 9/35 (26%) had a LVEF ≤60%. Overall, no significant change in LVEF (65±14%; p=0.55) or GLS (−16.1±4.8%; p=0.11) occurred immediately after TAVR despite a dramatic decrease in transoartic mean pressure gradient (44±15 mm Hg versus 6±3 mmHg; p<0.0001). However in the subgroup of patients with LVEF ≤60%, a significant increase in GLS after TAVR was observed (−9.6±4.1% versus −12.1±3.3%; p=0.0039).
Improvement in GLS according to the LVEF
Conclusion
Following TAVR, an early improvement in LV systolic function assessed by GLS was observed only in patients with pre-existing mild LV systolic dysfunction. Further studies should evaluate whether this improvement is associated with better long term outcome.
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Affiliation(s)
- A Procopi
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - N Procopi
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - R Choussat
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
| | - R Isnard
- Hospital Pitie-Salpetriere, 1Sorbonne Université, ACTION Study Group, ICAN Institute, INSERM UMR_S 1166, Institut de Cardiologie, Paris, France
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14
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Godier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet JP, de Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med 2019; 38:289-302. [DOI: 10.1016/j.accpm.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022]
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15
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Masucci L, Schreiber RA, Kaczorowski J, Collet JP, Bryan S. Universal screening of newborns for biliary atresia: Cost-effectiveness of alternative strategies. J Med Screen 2019; 26:113-119. [DOI: 10.1177/0969141319832039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Biliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and surgical intervention with a Kasai portoenterostomy offers the best chance for long-term patient survival. We conducted a cost-effectiveness analysis to compare no universal screening with screening using either a home-based infant stool colour card with passive card distribution strategy, or conjugated bilirubin testing. Methods A Markov model was developed, with structure, costs, and probabilities informed by the literature and clinical expert opinion, to simulate a newborn cohort over a 10-year time horizon. Health benefits were expressed as life-years gained. This analysis was conducted from the perspective of the Canadian publicly funded health care system (all costs in Canadian dollars). Both deterministic and probabilistic analyses were conducted. Results Screening using a home-based colour card with passive card distribution was a cost-effective option. For a population of 392,902 annual births in Canada, this strategy cost approximately $192,000 more than no universal screening but led to eight life-years gained (incremental cost-effectiveness ratio (ICER) = $24,065 per life-year gained). Screening using conjugated bilirubin testing versus the colour card cost $2,369,199 more and led to five more life-years gained (ICER= $473,840 per life year gained), and so was not cost-effective. Conclusions A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.
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Affiliation(s)
- Lisa Masucci
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Canada
| | - JP Collet
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
- Child and Family Research Institute, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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16
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Zeitouni M, Collet JP, Hulot JS, Silvain J, Kerneis M, Lattuca B, Barthelemy O, Lavie-Badie Y, Esteve JB, Payot L, Brugier D, Galier S, Diallo A, Vicaut E, Montalescot G. P4207The natural history of premature coronary artery disease over 20 years: the AFIJI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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17
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Lattuca B, Cayla G, Cuisset T, Silvain J, Bellemain-Appaix A, Beygui F, Varenne O, Sabouret P, Boueri Z, Motreff P, Bonnet JL, Diallo A, Collet JP, Vicaut E, Montalescot G. 5916Platelet function testing predicts bleeding complications in elderly patients admitted for an acute coronary syndrome: insights from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | | | - F Beygui
- Hospital Cote de Nacre, Cardiology, Caen, France
| | - O Varenne
- Hospital Cochin, Cardiology, Paris, France
| | - P Sabouret
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - Z Boueri
- Hospital of Bastia, Cardiology, Bastia, France
| | - P Motreff
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - J L Bonnet
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - A Diallo
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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18
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Lattuca B, Silvain J, Zeitouni M, Guerin M, Kerneis M, Guedeney P, Collet JP, Lesnik P, Montalescot G. P2708Impact of heterozygous familial hypercholesterolemia on mortality in ST-segment elevation myocardial infarction patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Guerin
- ICAN - Institute of CardioMetabolism and Nutrition, Pitie Salpêtrière Hospital, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - P Lesnik
- ICAN - Institute of CardioMetabolism and Nutrition, Pitie Salpêtrière Hospital, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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19
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Guedeney P, Huchet F, Overtchouk P, Rouanet S, Vicaut E, Manigold T, Letocart V, Balagny P, Leprince P, De Decker L, Lebreton G, Barthelemy O, Montalescot G, Guerin P, Collet JP. P3423Impact of oral anticoagulation on clinical outcomes and hemodynamic parameters after successful transcatheter aortic valve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - F Huchet
- University Hospital of Nantes Nord Laennec, Nantes, France
| | | | | | - E Vicaut
- Lariboisiere hospital, Clinical research unit - ACTION study group, Paris, France
| | - T Manigold
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - V Letocart
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - P Balagny
- Hospital Pitie-Salpetriere, Paris, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Paris, France
| | - L De Decker
- University Hospital of Nantes, Nantes, France
| | - G Lebreton
- Hospital Pitie-Salpetriere, Paris, France
| | | | | | - P Guerin
- University Hospital of Nantes Nord Laennec, Nantes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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Lattuca B, Cayla G, Silvain J, Cuisset T, Leclercq F, Manzo-Silberman S, Saint-Etienne C, Delarche N, El Mahmoud R, Carrie D, Souteyrand G, Diallo A, Collet JP, Vicaut E, Montalescot G. P2245Impact and predictive factors of bleeding complications in elderly patients admitted for an acute coronary syndrome: insights from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - F Leclercq
- Hospital Regional University of Montpellier, Montpellier, France
| | | | | | - N Delarche
- Hospital Center of Pau, Cardiology, Pau, France
| | - R El Mahmoud
- University Hospital Ambroise Pare, Cardiology, Boulogne-Billancourt, France
| | - D Carrie
- University Hospital of Toulouse, Cardiology, Toulouse, France
| | - G Souteyrand
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - A Diallo
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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21
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Lattuca B, Yan Y, Kerneis M, Cuisset T, Silvain J, Range G, Elhadad S, Pouillot C, Leclercq F, Manzo-Silberman S, Bellemain-Appaix A, Vicaut E, Cayla G, Collet JP, Montalescot G. P1722Platelet function monitoring for the prediction of clinical outcomes: a pooled analysis of the randomized ARCTIC and ANTARCTIC trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Lattuca
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - Y Yan
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - T Cuisset
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Range
- Hospital Louis Pasteur of Chartres, Cardiology, Chartres, France
| | - S Elhadad
- Hospital of Lagny Marne la Vallée, Cardiology, Jossigny, France
| | - C Pouillot
- Clinic Sainte Clotilde, Cardiology, Saint Denis de la Réunion, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | | | | | - E Vicaut
- Hospital Lariboisiere, Epidemiology and Clinical Research Unit, Paris, France
| | - G Cayla
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Institute of Cardiology, Paris, France
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22
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Collet JP, Zeitouni M, Hulot JS, Silvain J, Barthelemy O, Kerneis M, Lattuca B, Lavie-Badie Y, Payot L, Esteve JB, Brugier D, Galier S, Diallo A, Vicaut E, Montalescot G. P6233Intima-Media thickness to better risk-stratify patients with premature coronary artery disease: an analysis from the AFUI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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Cayla G, Cuisset T, Lattuca B, Silvain J, Leclercq F, Manzo Silberman S, Pouillot C, Carrie D, Beygui F, Vicaut E, Range G, Henry P, Van Belle E, Collet JP, Montalescot G. 5914De-escalation versus escalation of antiplatelet therapy in elderly ACS patients: insight from the ANTARCTIC trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Cayla
- CHU Nimes, ACTION Study Group, Cardiology, Nimes, France
| | - T Cuisset
- AP-HM - Hospital La Timone, Marseille, France
| | - B Lattuca
- University Hospital of Nimes, Cardiology, Nimes, France
| | - J Silvain
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
| | - F Leclercq
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | | | - C Pouillot
- Clinique Sainte Clotilde, Cardiology, Sainte Clotilde, France
| | - D Carrie
- University Hospital of Toulouse, Cardiology, Toulouse, France
| | - F Beygui
- University Hospital of Caen, Cardiology, Caen, France
| | - E Vicaut
- Hospital Lariboisiere, Recherche Clinique, Paris, France
| | - G Range
- Hospital Louis Pasteur of Chartres, Cardiology, Chartres, France
| | - P Henry
- Hospital Lariboisiere, Cardiology, Paris, France
| | - E Van Belle
- Hospital Regional University of Lille - Cardiological Hospital, Lille, France
| | - J P Collet
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
| | - G Montalescot
- AP-HP Hospital Pitie-Salpetriere ACTION Study Group, Cardiology, Paris, France
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Zeitouni M, Collet JP, Silvain J, Hulot JS, Kerneis M, Lavie-Badie Y, Barthelemy O, Payot L, Esteve JB, Lattuca B, Galier S, Brugier D, Diallo A, Vicaut E, Montalescot G. P5400Professional status and long-term prognosis of premature coronary artery disease: the AFIJI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - J S Hulot
- Hospital Pitie-Salpetriere, Institut de cardiologie, Paris, France
| | - M Kerneis
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Cardiac Imaging Center, Toulouse, France
| | - O Barthelemy
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - L Payot
- Centre Hospitalier, Cardiology, Saint-Brieuc, France
| | - J B Esteve
- Protestant Infirmary of Lyon, Cardiology, Caluire et Cuire, France
| | - B Lattuca
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - S Galier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - D Brugier
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
| | - A Diallo
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Unité de Recherche Clinique, Paris, France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6 (UPMC), ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Paris, France
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Overtchouk P, Guedeney P, Montalescot G, Verhoye JP, Koning R, Lefevre TL, Van Belle E, Eltchaninoff H, Gilard M, Leprince P, Iung B, Barthelemy O, Silvain J, Le Breton H, Collet JP. 1213Post-TAVR antithrombotic treatment and one-year survival: insights from the FRANCE TAVI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | | | - J P Verhoye
- University Hospital of Rennes, Rennes, France
| | - R Koning
- Clinic Saint-Hilaire, Rouen, France
| | - T L Lefevre
- Institut Hospitalier Jacques Cartier, Massy, France
| | | | | | - M Gilard
- University Hospital of Brest, Brest, France
| | - P Leprince
- Hospital Pitie-Salpetriere, Paris, France
| | - B Iung
- Hospital Bichat-Claude Bernard, Paris, France
| | | | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | - H Le Breton
- University Hospital of Rennes, Rennes, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
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26
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Collet J, de Vugt ME, Schols JMGA, Engelen GJJA, Winkens B, Verhey FRJ. Well-being of nursing staff on specialized units for older patients with combined care needs. J Psychiatr Ment Health Nurs 2018; 25:108-118. [PMID: 29171899 DOI: 10.1111/jpm.12445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THE SUBJECT Working in long-term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress-related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nurses is unknown. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Nursing staff working on specialized units for patients with combined care needs experience high levels of self-efficacy in combination with strong feelings of self-rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well-being than patient characteristics in specialized settings for combined care needs. WHAT ARE THE IMPLICATIONS FOR PRACTICE Staff well-being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. ABSTRACT Introduction In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well-being of nursing staff is unknown. AIM To investigate whether care characteristics of patients with combined care needs are related to the mental well-being of nursing staff. METHOD Well-being of nursing staff was studied within a larger exploratory observational cross-sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings. RESULTS Nursing staff across settings, with more than 5 years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work-related well-being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout. IMPLICATIONS/CONCLUSION Staff well-being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training.
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Affiliation(s)
- J Collet
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Family Medicine/Elderly Care Medicine and Department of Health Services Research, Maastricht University, Maastricht, Netherlands.,Department of Elderly, Mondriaan Mental Health Care, Heerlen, Netherlands
| | - M E de Vugt
- Alzheimer Center Limburg, School of Mental Health & Neurosciences, Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - J M G A Schols
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Family Medicine/Elderly Care Medicine and Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - G J J A Engelen
- Department of Elderly, Mondriaan Mental Health Care, Heerlen, Netherlands
| | - B Winkens
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | - F R J Verhey
- Alzheimer Center Limburg, School of Mental Health & Neurosciences, Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
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Woolfson JP, Schreiber R, Butler A, MacFarlane J, Kaczorowski J, Collet J, Bryan S. A335 BILIARY ATRESIA HOME SCREENING PROGRAM IN BRITISH COLUMBIA: EVALUATION OF FIRST TWO YEARS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J P Woolfson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - R Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - A Butler
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, BC, Canada
| | - J MacFarlane
- Perinatal Services BC, PHSA, Vancouver, BC, Canada
| | - J Kaczorowski
- Dept of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montreal, QC, Canada
| | - J Collet
- Department of Pediatrics, University of British Columbia, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - S Bryan
- School of Population and Public Health, University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Weimerskirch H, Filippi D, Collet J, Waugh S, Patrick S. Use of radar detectors to track attendance of albatrosses at fishing vessels. Conserv Biol 2018; 32:240-245. [PMID: 28598528 PMCID: PMC5811893 DOI: 10.1111/cobi.12965] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 06/07/2023]
Abstract
Despite international waters covering over 60% of the world's oceans, understanding of how fisheries in these regions shape ecosystem processes is surprisingly poor. Seabirds forage at fishing vessels, which has potentially deleterious effects for their population, but the extent of overlap and behavior in relation to ships is poorly known. Using novel biologging devices, which detect radar emissions and record the position of boats and seabirds, we measured the true extent of the overlap between seabirds and fishing vessels and generated estimates of the intensity of fishing and distribution of vessels in international waters. During breeding, wandering albatrosses (Diomedea exulans) from the Crozet Islands patrolled an area of over 10 million km2 at distances up to 2500 km from the colony. Up to 79.5% of loggers attached to birds detected vessels. The extent of overlap between albatrosses and fisheries has widespread implications for bycatch risk in seabirds and reveals the areas of intense fishing throughout the ocean. We suggest that seabirds equipped with radar detectors are excellent monitors of the presence of vessels in the Southern Ocean and offer a new way to monitor the presence of illegal fisheries and to better understand the impact of fisheries on seabirds.
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Affiliation(s)
- H. Weimerskirch
- Centre National de la Recherche Scientifique – Centre d'Etudes Biologiques de Chizé79360 Villiers‐en‐BoisFrance
| | - D.P. Filippi
- Sextant Technology116 Wilton RoadWellington 6012New Zealand
| | - J. Collet
- Centre National de la Recherche Scientifique – Centre d'Etudes Biologiques de Chizé79360 Villiers‐en‐BoisFrance
| | - S.M. Waugh
- Te Papa Museum55 Cable StreetWellington 6011New Zealand
| | - S.C. Patrick
- School of Environmental SciencesUniversity of LiverpoolLiverpool L69 3GPU.K.
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Woolfson J, Schreiber R, Butler A, MacFarlane J, Kaczorowski J, Masucci L, Bryan S, Collet JP. BILIARY ATRESIA HOME SCREENING PROGRAM IN BRITISH COLUMBIA: EVALUATION OF FIRST TWO YEARS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Van Schalkwyk J, Wong F, Prestley N, Dhillon S, Albert A, Collet J, Thomas E, Dewar K, Hippman C, Shaw D, Giesbrecht E, Money D. 2: Improving post-discharge surveillance of surgical site infection following cesarean section. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2015.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nohuz E, Schumacher JC, Collet J, Lenglet Y, Zerr V. [An updated overview of the onco-gynecologic surgery in the French public hospitals: There, we are... but we are here!]. ACTA ACUST UNITED AC 2015; 44:792-4. [PMID: 26142213 DOI: 10.1016/j.jgyn.2015.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/28/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- E Nohuz
- Service d'obstétrique et de gynécologie, hôpital général, route du Fau, 63300 Thiers, France.
| | - J-C Schumacher
- Service d'obstétrique et de gynécologie, hôpital général, route du Fau, 63300 Thiers, France
| | - J Collet
- Service d'obstétrique et de gynécologie, hôpital général, route du Fau, 63300 Thiers, France
| | - Y Lenglet
- Service d'obstétrique et de gynécologie, hôpital général, route du Fau, 63300 Thiers, France
| | - V Zerr
- Service d'obstétrique et de gynécologie, hôpital général, route du Fau, 63300 Thiers, France
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Schreiber RA, Masucci L, Kaczorowski J, Collet JP, Lutley P, Espinosa V, Bryan S. Home-based screening for biliary atresia using infant stool colour cards: a large-scale prospective cohort study and cost-effectiveness analysis. J Med Screen 2014; 21:126-32. [PMID: 25009198 DOI: 10.1177/0969141314542115] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Biliary atresia (BA), a leading cause of paediatric liver failure and liver transplantation, manifests by three weeks of life as jaundice with acholic stools. Poor outcomes due to delayed diagnosis remain a problem worldwide. We evaluated and assessed the cost-effectiveness of methods of introducing a BA Infant Stool Colour Card (ISCC) screening programme in Canada. SETTING AND METHODS A prospective study at BC Women's Hospital recruited consecutive healthy newborns through six incrementally more intensive screening approaches. Under the baseline "passive" strategy, families received ISCCs at maternity, with instructions to monitor infant stool colour daily and return the ISCC by mail at age 30 days. Additional strategies were: ISCC mailed to family physician; reminder letters or telephone calls to families or physicians. Random telephone surveys of ISCC non-returners assessed total card utilization. Primary outcome was ISCC utilization rate expressed as a composite outcome of the ISCC return rate and non-returned ISCC use. Markov modelling was used to predict incremental costs and life years gained from screening (passive and reminder), compared with no screening, over a 10-year time horizon. RESULTS 6,187 families were enrolled. Card utilization rates in the passive screening strategy were estimated at 60-94%. For a Canadian population, the increase in cost for passive screening, compared with no screening, is $213,584 and the gain in life years is 9.7 ($22,000 per life-year gained). CONCLUSIONS A BA ISCC screening programme targeting families of newborns is feasible in Canada. Passive distribution of ISCC at maternity is potentially effective and highly cost-effective.
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Affiliation(s)
- Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition Department of Pediatrics, University of British Columbia, Vancouver, Canada Child and Family Research Institute, Vancouver, Canada
| | - Lisa Masucci
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Institute, BC, Canada
| | - Janusz Kaczorowski
- Dept of Family and Emergency Medicine, Université de Montréal and CRCHUM, Canada
| | - J P Collet
- Department of Pediatrics, University of British Columbia, Vancouver, Canada Child and Family Research Institute, Vancouver, Canada
| | - Pamela Lutley
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Institute, BC, Canada
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Kerneis M, Abtan J, Silvain J, O'Connor SA, Barthelemy O, Vignalou JB, Brugier D, Collet J, Montalescot G. Ticagrelor or prasugrel in STEMI patients: a pharmacodynamic evaluation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Agewall S, Cattaneo M, Collet JP, Andreotti F, Lip GYH, Verheugt FWA, Huber K, Grove EL, Morais J, Husted S, Wassmann S, Rosano G, Atar D, Pathak A, Kjeldsen K, Storey RF. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J 2013; 34:1708-13, 1713a-1713b. [PMID: 23425521 DOI: 10.1093/eurheartj/eht042] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo University, Oslo, Norway.
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Nohuz E, Schumacher JC, Alaboud M, Dalkiliç S, Lenglet Y, Varga J, Ab Der Halden M, Chaumette D, Desroches A, Collet J, Brunel A, Dauptain G, Dognin C, Zerr V. [The obstetrics and gynaecology departments in the French public hospitals: an updated overview]. ACTA ACUST UNITED AC 2012; 41:623-30. [PMID: 23040672 DOI: 10.1016/j.jgyn.2012.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/21/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022]
Abstract
Restructuring the surgery and gynecology-obstetrics departments taking place now raise many interrogations. It appears as a mandatory necessity to some people and as a tribute to financial strategies to others to the detriment of quality and accessibility of care. Its effect is to clarify a good amount of socioeconomical and medical indicators. The plans of perinatality for the obstetrical aspect and the thresholds of activity for the surgical aspect constitute the major lines of these restructurings. A survey soliciting all the French public hospitals was used to assess the state of obstetrics and gynecology departments in the light of these recent restructurings. Medical demography, preserving and improving the quality and continuity of care, efficiency of the technical supports are discriminating criteria of the involved challenges. Such restructurings have an impact on the doctor's lives, which looks globally positive and a good omen to complete this remodeling process. The activity was safeguarded by a redistribution and a refocusing of institutions. One should not minimize the social impact of these changes, with a potential deterioration of working conditions (internal professional reclassifications, mobility obligation towards other sites). It thus appears that the deep changes which affect the small size institutions will be able to achieve well only if they are clearly done (information) and truly integrated in their medical project.
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Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, Thiers, France.
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Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2011; 59:523-30. [PMID: 22206744 DOI: 10.1053/j.ajkd.2011.10.048] [Citation(s) in RCA: 372] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/18/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The development of standardized acute kidney injury (AKI) definitions has allowed for a better understanding of AKI epidemiology, but the long-term renal outcomes of AKI in the pediatric critical care setting have not been well established. This study was designed to: (1) determine the incidence of chronic kidney disease (CKD) in children 1-3 years after an episode of AKI at a tertiary-care pediatric intensive care unit (ICU), (2) identify the proportion of patients at risk of CKD, and (3) compare ICU admission characteristics in those with and without CKD. DESIGN Prospective cohort study. SETTING & PARTICIPANTS Patients admitted to the British Columbia Children's Hospital pediatric ICU from 2006-2008 with AKI, as defined by AKI Network (AKIN) criteria. Surviving patients, most with short-term recovery from their AKI, were assessed at 1, 2, or 3 years after AKI. PREDICTORS Severity of AKI as defined by AKIN and several ICU admission characteristics, including demographics, diagnosis, severity of illness, and ventilation data. OUTCOMES & MEASUREMENTS CKD was defined as the presence of albuminuria and/or glomerular filtration rate (GFR) < 60 mL/min/1.73 m2. Being at risk of CKD was defined as having a mildly decreased GFR (60-90 mL/min/1.73 m2), hypertension, and/or hyperfiltration (GFR ≥ 150 mL/min/1.73 m2). RESULTS The proportion of patients with AKI stages 1, 2, and 3 were 44 of 126 (35%), 47 of 126 (37%), and 35 of 126 (28%), respectively. The number of patients with CKD 1-3 years after AKI was 13 of 126 (10.3% overall; 2 of 44 [4.5%] with stage 1, 5 of 47 [10.6%] with stage 2, and 6 of 35 [17.1%] with stage 3; P = 0.2). In addition, 59 of 126 (46.8%) patients were identified as being at risk of CKD. LIMITATIONS Several patients identified with AKI were lost to follow-up, with the potential of underestimating the incidence of CKD. CONCLUSIONS In tertiary-care pediatric ICU patients, ∼10% develop CKD 1-3 years after AKI. The burden of CKD in this population may be higher with further follow-up because several patients were identified as being at risk of CKD. Regardless of the severity of AKI, all pediatric ICU patients should be monitored regularly for long-term kidney damage.
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Affiliation(s)
- Cherry Mammen
- Department of Pediatrics, Division of Nephrology, Child & Family Research Institute, University of British Columbia, Vancouver, Canada.
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Boustière C, Veitch A, Vanbiervliet G, Bulois P, Deprez P, Laquiere A, Laugier R, Lesur G, Mosler P, Nalet B, Napoleon B, Rembacken B, Ajzenberg N, Collet JP, Baron T, Dumonceau JM. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2011; 43:445-61. [PMID: 21547880 DOI: 10.1055/s-0030-1256317] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two tables are included for quick reference.
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Affiliation(s)
- C Boustière
- Department of Digestive Endoscopy, Hôpital Saint Joseph, Marseille, France
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Collet J, Tharaud O, Legrand C, Chapoton A, Vuillaume D. Performances of Sexithiophene Based Thin-Film Transistor Using Self-Assembled Monolayers. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-488-407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractHigh performance thin-film transistors (TFT) made of conducting oligomers are obtained when the organic films are well ordered at a molecular level. Highly ordered films are obtained provided that oligomers have a sufficient mobility on the substrate surface during film formation. One possible way to fulfill such a condition is to evaporate oligomers on heated substrates [1,2]. In this work, we suggest that a high surface mobility is obtained by a chemical functionalization of the silicon dioxide surface, and the corresponding improvements of the TFT performances are evidenced. A self-assembled monolayer of octadecyltrichlorosilane (OTS) was deposited on the SiO2 by chemisorption from solution before the evaporation of sexithiophene film. Room temperature current-voltage measurements indicate that the presence of the OTS monolayer improves TFT performances : threshold voltage is decreased, subthreshold slope is decreased, a high current ratio Ion/Ioff is obtained for a reduced gate voltage excursion, the fieldeffect mobility is slightly increased. We have also fabricated and characterized a nanometer scale organic FET (gate length = 50 nm) made of 6T films and only with a self-assembled monolayer as the insulating film between the degenerated silicon substrate (gate) and the conducting channel (no thick SiO2, we call it « oxide-free » organic FET). Performances of this nanometer size organic FETs are the following : subthreshold slope of 0.35V/dec, threshold voltage of −1.3V, effective mobility of 2×10−4 cm2/V.s.
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Fanello S, Parat-Pateu V, Dagorne C, Hitoto H, Collet J, Routiot T, Baron C, Fournié A. [Postpartum contraception: medical guidelines, women's point of view]. ACTA ACUST UNITED AC 2007; 36:369-74. [PMID: 17544012 DOI: 10.1016/j.jgyn.2006.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 11/23/2006] [Accepted: 12/12/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Postpartum contraception is subjected to specific medical guidelines related to the suckling mode. The practitioner must conciliate prescription rules with women's expectations. The purpose of this work was to estimate the medical practice in the maternity centre at a local hospital and the actual practice of women at home, in immediate postpartum and during the year that followed the childbirth. METHOD One hundred and four new mothers from the maternity centre, in September 2004, took the survey. During their stay after birth, they filled a questionnaire on contraception. Various data have been collected from their obstetrical file. The analysis allowed the synthesis of medical guidelines on postpartum contraception. One year later, patients answered a telephone survey about their contraceptive practice. RESULTS In our survey, two-third of the new mothers (61.5%) chose breast-feeding. Seventy percent of them received progestins as contraceptives. Three out of four women (78%) followed this prescription after they left the hospital. Two-third (62.5%) of the women who had chosen artificial suckling received a prescription of estroprogestin. The majority of them (96%) used it after their return home. A high number of women (87.5%) estimated that these contraceptions were efficient, but more than a third of them thought they were uneasy to use (38.9%). Half of the women (52.8%) forgot their contraception during postpartum and the majority of them (86%) changed it within a year. A quarter (23.1%) of the contraception follow-up during this time was made by a general practitioner. CONCLUSION The practice in the maternity centre generally follows medical guidelines. However, it seems important to adapt postpartum contraception to the real practice of women. The general practitioner plays a major role in this management, especially during well-baby visits.
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Affiliation(s)
- S Fanello
- Département universitaire de santé publique, UFR de médecine, CHU d'Angers, 49045 Angers cedex 01, France.
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Lachaine J, Gordon A, Choinière M, Collet JP, Dion D, Tarride JE. Painful neuropathic disorders: an analysis of the Régie de l'Assurance Maladie du Québec database. Pain Res Manag 2007; 12:31-7. [PMID: 17372632 PMCID: PMC2670723 DOI: 10.1155/2007/713835] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE Painful neuropathic disorders (PNDs) refer to neurological disorders involving nerves in which pain is a predominant symptom. In most cases, PNDs involve the peripheral nerves. Treatment of PNDs is likely to use large health care resources. However, little is known about the economic burden of PNDs in Canada. METHOD The present study was performed using data from a random sample of patients covered by the Régie de l'Assurance Maladie du Quebec drug plan. Subjects with a diagnosis of a peripheral PND were identified. Comorbidities, pain-related medication use and resource utilization were compared between PND patients and control patients without PNDs matched for age and sex in a 1:1 ratio. RESULTS A total of 4912 patients with PNDs were identified. A higher level of comorbidities was found in the PND group (Von Korff chronic disease score 3.91 versus 2.54; P<0.001). The proportion of users of pain-related medications was significantly higher in the PND cohort than in the control group (chi-squared; P<0.001). The average annual number of physician visits was also significantly higher in the PND group than in the control group (14.7 versus 6.4; P<0.001). From a health ministry perspective, costs of health care resources were significantly higher in the PND group (4,163 dollars versus 1,846 dollars; P<0.001). The proportion of potentially inappropriate medications was 34% among those 65 years of age or older. CONCLUSIONS PNDs are associated with a higher level of comorbidities, higher medical resources utilization and higher health care costs than non-PND conditions.
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Affiliation(s)
- J Lachaine
- University of Montreal, Montreal, Quebec, Canada.
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Raymond J, Meder JF, Molyneux AJ, Fox AJ, Johnston SC, Collet JP, Rouleau I. Trial on endovascular treatment of unruptured aneurysms (TEAM): study monitoring and rationale for trial interruption or continuation. J Neuroradiol 2007; 34:33-41. [PMID: 17316800 DOI: 10.1016/j.neurad.2007.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Preventive treatment of unruptured intracranial aneurysms is often performed but has never been proved beneficial as compared to conservative management. In a context of uncertainty, the 'best treatment' that can be offered to each individual is a chance to be treated and thus to be protected from rupture of the aneurysm, and an equal chance not to be treated, and hence to be exempted from possible immediate complications, using randomization. Such action is optimal unless or until an independent committee with privileged access to data judges that, given the comparative outcome of the 2 groups, preventive treatment or conservative management, is generally warranted. Potential reasons to interrupt such a study are reviewed, including insufficient recruitment, poor compliance, excessive cross-overs, unacceptable iatrogenia, and treatments being convincingly different or equivalent. We conclude that insufficient recruitment is the sole realistic event that could lead to premature interruption. This review may provide a deeper understanding of the principles justifying the necessity of the study.
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Affiliation(s)
- J Raymond
- Department of Radiology, Interventional Neuroradiology Research Unit (INRU), Université de Montréal, CHUM Notre-Dame Hospital, 1560 Sherbrooke East, suite M-8203, H2L 4M1, Montreal, Quebec, Canada
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Thomas D, Collet JP, Cottin Y, Cournot M, Ducimetière P, Ferrières J, Paillard F, Valensi P, Zeller M, Cambou JP. [The best of epidemiology and cardiovascular prevention in 2006]. Arch Mal Coeur Vaiss 2007; 100 Spec No 1:57-64. [PMID: 17405566] [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: 05/14/2023]
Abstract
The recent analysis of the French MONICA registries report a reduction in the incidence of fatal MI related to improvement of care whereas the overall incidence of coronary events remain stable, suggesting the need for a better primary prevention. The extensive review of the death certificates and the analysis of the death classification from the same registries indicate an under estimation of MI-related death in the national death registry. It is also confirmed that instead of 50%, approximately 80% of coronary death are explained by the four major risk factors including smoking, hypercholesterolemia, hypertension and diabetes. The international REACH registry has enrolled more than 67 000 individuals including patients with symptomatic atherothrombotic disease and patients with multiple risk factors. The analysis of baseline characteristics and of the one year FU shows a high residual risk and a lack of efficacy of secondary prevention. The existence of a symptomatic disease and the number of symptomatic localization of atherothrombosis are critical factors to predict recurrence of major vascular events Secondary analysis of the INTERHEART study provide the essence of what should any physician know about the relationship between coronary heart disease and smoking, either active or passive. Prevention with respect to this risk factor remains very insufficient. Varenicline, a new nicotinic receptor partial agonist, should help patients involved in smoking cessation program. The established detrimental effects of perioperative smoking represent a unique opportunity to promote smoking cessation in individuals scheduled for surgery. The major cardiovascular impact of second hand smoking has been recently demonstrated by the short-term effects of banning smoking in public places on the incidence of acute coronary events. The SPARCL study has demonstrated the benefit of high dose of atorvastatine to prevent recurrent acute ischemic cerebrovascular event in patients with a prior history of stroke or TIA. In the open ASTEROID study, high doses of rosuvastatine confirm the possibility of reducing the volume of coronary atheroma analyzed by IVUS. The expected benefit of glitazones to reduce the incidence of death, MI and stroke in diabetes patients with a prior history of vascular event has been confirmed in the PROactive study. Pioglitazone provided a clear reduction of recurrent vascular events in diabetes patient with a prior MI at a cost of a significant increase of the risk of heart failure. In the DREAM study, neither ramipril nor rosiglitazone have reduced the incidence of cardiovascular events significantly. The moderate benefit of the fenofibrate to prevent cardiovascular events in the FIELD study, which was carried out in diabetics mostly in primary prevention, needs to be considered after adjustment on statin use in a higher proportion of patients of the placebo group. Postprandial hyperglycaemia, analyzed by the peak of glycaemia after a load in glucose, has been confirmed as a more powerful independent predictive factor of the risk of cardiovascular event than fasting glycaemia. The systematic screening postprandial hyperglycaemia represents an interesting strategy for primary prevention which warrants further investigation. If obesity is a risk factor whose impact on morbi-mortality is well established, a French study shows that body mass index has an unfavourable influence on the cognitive functions in middle-aged men and women.
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Affiliation(s)
- D Thomas
- Groupe épidémiologie et prévention de la Société française de cardiologie. institut de cardiologie, groupe hospitalier Pitié-Salpêtriere, 47, boulevard de l'Hôpital. 75651 Paris Cedex 13.
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Trosini-Désert V, Vergnon JM, Collet JP, Montalescot G, Similowski T. [Fibreoptic bronchoscopy and anti-platelet agents: a risk-benefit analysis]. Rev Mal Respir 2007; 24:48-56. [PMID: 17268365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Respiratory physicians are confronted increasingly often by patients, in whom a fibreoptic bronchoscopy (FB) is planned, who are taking anti-platelet agents (APAs) prescribed by their cardiologist. It is necessary therefore to weigh the indications for bronchoscopy and the subsequent benefits against the risks, not only of haemorrhage, but of thrombosis if the APAs are withdrawn. METHODS/RESULTS In the absence of agreed guidelines on the subject this article reviews the literature and reports the results of a survey conducted among 138 members of the French Respiratory Endoscopy Group. Five questions were considered: 1) what is the risk of haemorrhage during the procedure? 2) what are the pharmacological characteristics of current APAs? 3) what is the risk of thrombosis on withdrawal of APAs? 4) what are the circumstances in which the FB may be delayed? 5) what should be the therapeutic strategy if the APAs are withdrawn? CONCLUSIONS While awaiting clinical studies that will allow a better understanding of these questions, and the subsequent publication of practice guidelines, it is crucial that respiratory physicians are aware of the need, prior to FB, to inquire routinely about treatment with APAs, to identify the indication, and never to interrupt such treatment without consulting the prescriber.
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Affiliation(s)
- V Trosini-Désert
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation, Paris, France. /fr
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Raymond J, Meder JF, Molyneux AJ, Fox AJ, Johnston SC, Collet JP, Rouleau I. Unruptured intracranial aneurysms: the unreliability of clinical judgment, the necessity for evidence, and reasons to participate in a randomized trial. J Neuroradiol 2006; 33:211-9. [PMID: 17041525 DOI: 10.1016/s0150-9861(06)77266-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J Raymond
- Interventional Neuroradiology Research Unit, Department of Radiology, Université de Montréal, CHUM Notre-Dame Hospital, Montreal, Canada.
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Collet JP, Allali Y, Lesty C, Tanguy ML, Silvain J, Ankri A, Blanchet B, Dumaine R, Gianetti J, Payot L, Weisel JW, Montalescot G. Altered Fibrin Architecture Is Associated With Hypofibrinolysis and Premature Coronary Atherothrombosis. Arterioscler Thromb Vasc Biol 2006; 26:2567-73. [PMID: 16917107 DOI: 10.1161/01.atv.0000241589.52950.4c] [Citation(s) in RCA: 251] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Hypofibrinolysis promotes atherosclerosis progression and recurrent ischemic events in premature coronary artery disease. We investigated the role of fibrin physical properties in this particular setting. METHODS AND RESULTS Biomarkers of recurrent thrombosis and premature coronary artery disease (CAD) were measured in 33 young post-myocardial infarction patients with angiographic-proven CAD and in 33 healthy volunteers matched for age and sex. Ex vivo plasma fibrin physical properties were assessed by measuring fibrin rigidity and fibrin morphological properties using a torsion pendulum and optical confocal microscopy. The fibrinolysis rate was derived from continuous monitoring of the viscoelastic properties after addition of lytic enzymes. Young CAD patients had a significant increase in plasma concentration of fibrinogen, von Willebrand factor, plasminogen activator inhibitor type 1, and lipoprotein(a) as compared with controls (P<0.05). Fibrin of young CAD patients was stiffer (P=0.002), made of numerous (P=0.002) and shorter fibers (P=0.04), and lysed at a slower rate than that of controls (P=0.03). Fibrin stiffness was an independent predictor for both premature CAD and hypofibrinolysis. CONCLUSIONS This first detailed study of clot properties in such a group of patients demonstrated that abnormal plasma fibrin architecture is an important feature of both premature CAD and fibrinolysis rate. The determinants of this particular phenotype warrant further investigation.
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Affiliation(s)
- J P Collet
- Department of Cardiology, Pitié-Salpêtrière University Hospital, Paris, France.
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Phélippeau G, Le Feuvre C, Helft G, Beygui F, Collet JP, Choussat R, Montalescot G, Metzger JP. [The value of active stents for coronary angioplasty in patients with chronic renal failure]. Arch Mal Coeur Vaiss 2006; 99:791-7. [PMID: 17067097] [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: 05/12/2023]
Abstract
UNLABELLED The risk of intra-stent restenosis has diminished considerably with the advent of endoprostheses which actively release sirolimus or paclitaxel. Patients with chronic renal failure constitute a high cardiovascular risk population, in whom the incidence of coronary heart disease is particularly high, representing one of the principal causes of death. The aim of this study, which included 152 patients, was to quantify the value of active stents for coronary angioplasty in patients with chronic renal failure. Thirty eight patients with chronic renal failure who underwent angioplasty with active stents were matched for age, sex and the presence of diabetes with 3 other groups of patients: one group with active stents but without renal failure, one group with inactive stents and no renal failure, and one group with inactive stents and chronic renal failure. The average follow up was 16 +/- 5 months. The acute stent thrombosis rate (2%) was not elevated in cases of renal failure nor after active stent implantation. Chronic renal failure significantly increased the mortality rate 16 months after angioplasty, whichever type of stent was used: 8 versus 2% deaths in patients with an inactive stent (p = 0.001). In renal failure, the risk of death was lower with an active stent (8 vs 26% with an inactive stent, p<0.05). Similarly, there was a non-significant trend towards a lower risk of death and/or infarction in renal failure after active stents (8 vs 21% with an inactive stent, NS). CONCLUSIONS In this study, coronary angioplasty with an active stent in patients with chronic renal failure was associated with a lower mortality rate compared with inactive stents, with no increase in the risk of acute thrombosis.
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Affiliation(s)
- G Phélippeau
- AP-HP, département de cardiologie médicale, institut de cardiologie, groupe hospitalier la Pitié-Salpêtrière, Paris
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Muller-Bolla M, Collet JP, Ducruet T, Robinson A. Side effects of hyperbaric oxygen therapy in children with cerebral palsy. Undersea Hyperb Med 2006; 33:237-44. [PMID: 17004410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND This article reports the side effects observed in a double-blind placebo-controlled multi-center randomized clinical trial carried out to assess the efficacy and safety of hyperbaric oxygen (HBO2) therapy in children with cerebral palsy. Intention-to-treat analysis did not prove to have a beneficial effect. MATERIAL AND METHODS 111 children aged 3 to 12 years were included and followed for 8 weeks. They all received 40 compressions of 1 hour (5 days per week). In the treated group (n=57), HBO2 sessions consisted of an exposure to 100% oxygen at 1.75 atmosphere absolute (atm abs) while children in the control group (n=54) received air at 1.3 atm abs. A physician carried out a general health surveillance including an ear examination prior to and immediately following each session. All clinical events occurring during the course of the study were recorded. FINDINGS Events were classified in 3 categories: Events related to pressure/volume changes, events related to oxygen toxicity, and other events. No events due to oxygen toxicity were noted. Only middle ear barotrauma significantly differed according to the groups (50% in HBO2 session group versus 27.8% in control group). Other events were rare and equivalent in both groups. CONCLUSION Short-term exposure to HBO2 at medium level pressure (1.75 atm abs) was responsible for a significant increase of middle ear barotrauma compared to children that received very low external pressure (1.3 atm abs).
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Affiliation(s)
- M Muller-Bolla
- Centre for Clinical Epidemiology and Community Studies, Randomized Clinical Trial Unit, Jewish General Hospital, McGill University, Montreal, Canada
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Tagalakis V, Tamim H, Collet J, Kahn SR, Blostein M, Hanley JA. The effect of warfarin on the risk of prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14524 Background: The anticancer activity of oral anticoagulants has been a matter of debate for several years. Recent evidence suggests that prolonged treatment with warfarin may be associated with a reduced incidence of newly diagnosed urogenital cancer during long-term follow-up of patients with venous thromboembolism. The aim of this study was to assess whether exposure to warfarin was associated with reduced risk of prostate cancer in a large population-based cohort. Methods: We conducted a matched case-control study nested within the population of beneficiaries of the Saskatchewan Prescription Drug Plan aged 50 years and older from 1981–2002 with no history of cancer since 1967. New cases of prostate cancer diagnosed between 1981 and 2002 were identified using the linked Saskatchewan Cancer Agency registry. Six controls per case matched on age, gender, and sampling time were randomly selected. The cumulative exposure to warfarin in the five years preceding the cancer diagnosis was assessed. Prescription counts were used to define warfarin exposure. Exposure in the year immediately preceding the cancer diagnosis was excluded to control for detection bias. Conditional logistic regression analysis was used to assess confounding by other drugs such as nonsteroidal anti-inflammatory medications. Results: Among 11502 cases and 69012 controls, 7.4% of cases and 7.1% of controls had a history of any warfarin use. Compared to men who had never used warfarin, adjusted odds ratio (OR) for prostate cancer among ever-users in the 5 year period was 0.94 (95% confidence interval (CI), 0.86–1.03). In those who accumulated 1, 2, 3 and 4 years of warfarin use, the adjusted ORs were 1.01 (95% CI, 0.89–1.16), 1.00 (95% CI, 0.82–1.23), 0.81 (95% CI, 0.60–1.09), and 0.80 (95% CI, 0.65–0.99), respectively (p-trend=0.03). Conclusion: Our results suggest that cumulative use of warfarin of at least 4 years may be associated with a reduced risk of prostate cancer. However, confounding by other determinants of prostate cancer associated with warfarin use is possible. Nonetheless, confirmation of these findings by prospective studies may provide the evidence necessary to consider the use of warfarin in prostate cancer prevention. No significant financial relationships to disclose.
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Affiliation(s)
- V. Tagalakis
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
| | - H. Tamim
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
| | - J. Collet
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
| | - S. R. Kahn
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
| | - M. Blostein
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
| | - J. A. Hanley
- SMBD-Jewish General Hospital, Montreal, Quebec, PQ, Canada; McGill University, Montreal, PQ, Canada
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Corcos J, Collet JP, Shapiro S, Herschorn S, Radomski SB, Schick E, Gajewski JB, Benedetti A, MacRamallah E, Hyams B. Multicenter randomized clinical trial comparing surgery and collagen injections for treatment of female stress urinary incontinence. Urology 2005; 65:898-904. [PMID: 15882720 DOI: 10.1016/j.urology.2004.11.054] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 11/29/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare, in a multicenter, randomized clinical trial, collagen injections versus surgery with regard to efficacy, quality of life, satisfaction, and complications. METHODS Of 133 women with stress urinary incontinence, 66 were randomized to collagen injection and 67 to surgery (6 needle bladder neck suspensions, 19 Burch, and 29 slings). After randomization, 15 women refused their allocated treatment. "Intent-to-treat" and "per protocol" analyses were applied. Women assigned to collagen injection could receive up to three injections before it was considered a failure. A "top-up" injection was allowed within 3 months after cure. Success as the primary outcome at 12 months was defined as a dry 24-hour pad test (2.5 g or less of urine) after having received only the allocated intervention. RESULTS The per protocol analysis showed that the success rate 12 months after collagen injections (53.1%) was much lower than that after surgery (72.2%). The difference was 19.1% (95% confidence interval -36.2% to -2%). The general and disease-specific quality-of-life scores measured by the Rand Medical Outcomes Study 36-item Health Survey and Incontinence Impact Questionnaire were similar in the two groups (P = 0.306). Women treated by surgery were, on average, more satisfied (79.6%) than those treated by collagen injection (67.2%), but the difference was not significant (P = 0.228). Finally, complications were less frequent and severe with collagen injection: 36 events in 23 subjects for collagen injection versus 84 events in 34 subjects for surgery (P = 0.03). CONCLUSIONS One year after intervention, the success rate of collagen injection as a treatment for stress urinary incontinence was about 19% lower than that after surgery. This has to be tempered by the similar changes in quality of life and satisfaction in both groups and that the number and severity of complications were much greater after surgery than after collagen injection. The results of this study indicate that collagen injections might be a worthwhile alternative to surgery for the treatment of stress urinary incontinence.
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Affiliation(s)
- J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Ecollan P, Siami S, Boon G, Fievet ML, Collet JP, Haas R, Montalescot G. [Value of biochemistry performed in pre-hospital cardiology]. Arch Mal Coeur Vaiss 2005; 98:1111-7. [PMID: 16379107] [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: 05/05/2023]
Abstract
For a long time, the diagnosis of an acute myocardial infarction (AMI) seen in outdoor patients, was only relying on ECG findings. For that reason a certain amount of patients suffering from an AMI showing an atypical or not contributive ECG had not been identified as such and in consequence did not benefit from any prehospital treatment or had not been admitted in coronary care unit (CCU). With the arrival of the biological bed side monitoring in the SAMU, it became possible to measure via TRIAGE Cardiac the biological parameters of an AMI (myoglobin, troponin Ic and CKMB) and so confirm or exclude the diagnosis in certain cases. Other markers became measurable, such as BNP (brain natriuretic protein) a marker for early detection of heart failure. This natriuretic peptide is used during hospitalisation as a prognostic value in acute coronary syndrome with no cardiac insufficiency associated. More recently a semi quantitative test CardioDetect using the early release of h-FABP (heart fatty acid binding) showed a better sensibility in the first hours after chest-pain onset in out-door patients. The experience of the use of these biological bed side tests in the prehospital phase is only recent, but already permits a better management of out door patients. The future of there employ is promising. The combined use of these different markers in out door patients will probably allow in the near future identifying high risk patients.
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Affiliation(s)
- P Ecollan
- Département d'anesthésie, SMUR, DAR.
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