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Touzet S, Buchet-Poyau K, Denis A, Occelli P, Jacquin L, Potinet V, Sigal A, Delaroche-Gaudin M, Fayard-Gonon F, Tazarourte K, Douplat M. Impact of the presence of a mediator on patient violent or uncivil behaviours in emergency departments: a cluster randomised crossover trial. Eur J Emerg Med 2024; 31:201-207. [PMID: 38329117 DOI: 10.1097/mej.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND IMPORTANCE Several studies reported that violent behaviours were committed by patients against healthcare professionals in emergency departments (EDs). The presence of mediators could prevent or resolve situations of tension. OBJECTIVE To evaluate whether the presence of mediators in EDs would have an impact on violent behaviours committed by patients or their relatives against healthcare professionals. Design, settings and participants A 6-period cluster randomised crossover trial was performed in 4 EDs during 12 months. Patients aged ≥18 and their relatives were included. INTERVENTION In order to prevent or resolve situations of tension and conflict, four mediators were recruited.Outcome measure and analysis Using a logistic regression mixed model, the rate of ED visits in which at least one act of violence was committed by a patient or their relatives, reported by healthcare professionals, was compared between the intervention group and the control group. RESULTS A total of 50 429 ED visits were performed in the mediator intervention group and 50 851 in the control group. The mediators reported 1365 interventions; >50% of the interventions were to answer questions about clinical management or waiting time. In the intervention group, 173 acts of violence were committed during 129 ED visits, and there were 145 acts of violence committed during 106 ED visits in the control group. The rate of ED visits in which at least one act of violence was committed, was 0.26% in the intervention group and 0.21% in the control group (OR = 1.23; 95% CI [0.73-2.09]); on a 4-level seriousness scale, 41.6% of the acts of violence were rated level-1 (acts of incivility or rudeness) in the intervention group and 40.0% in the control group. CONCLUSION The presence of mediators in the ED was not associated with a reduction in violent or uncivil behaviours committed by patients or their relatives. However, the study highlighted that patients had a major need for information regarding their care; improving communication between patients and healthcare professionals might reduce the violence in EDs. TRIAL REGISTRATION Clinicaltrials.gov (NCT03139110).
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Affiliation(s)
- Sandrine Touzet
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | | | | | - Pauline Occelli
- Hospices Civils de Lyon, Pôle de Santé Publique
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Véronique Potinet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
| | - Alain Sigal
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | | | - Florence Fayard-Gonon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Accueil des Urgences, Lyon, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Accueil des Urgences
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Coats T, Conroy S, de Groot B, Heeren P, Lim S, Lucke J, Mooijaart S, Nickel CH, Penfold R, Singler K, van Oppen JD, Polyzogopoulou E, Kruis A, McNamara R, de Groot B, Castejon-Hernandez S, Miro O, Karamercan MA, Dündar ZD, van Oppen JD, Pavletić M, Libicherová P, Balen F, Benhamed A, Dubucs X, Hernu R, Laribi S, Singler K, Fraidakis O, Fyntanidou VP, Polyzogopoulou E, Gaal S, Jónsdóttir AB, Kelly-Friel ME, McAteer CA, Sibthorpe LD, Synnott A, Zazzara MB, Coffeng SM, de Groot B, Lucke JA, Smits RAL, Castejon-Hernandez S, Llauger L, Mir SA, Ortiz MS, Padilla EE, Rodeles SC, Rojewski-Rojas W, Fadini D, Jegerlehner NS, Nickel CH, Rezzonico S, Zucconi EC, Cakmak S, Demir HA, Dündar ZD, Güven R, Karamercan MA, Sogut O, Tayfur I, Adams JA, Bernardo J, Brown L, Burton J, Butler MJ, Claassen RI, Compton F, Cooper JG, Heyes R, Ko S, Lightbody CJ, Masoli JAH, McKenzie STG, Mawhinney D, Moultrie NJ, Price A, Raman R, Rothwell LH, Shashikala RP, Smith EJ, Sorice V, van Oppen JD, Wallace JM, Young T, Benvin A, Breški E, Ćefo A, Dumić D, Ferenac R, Jurica I, Otočan M, Zinaić PŠ, Clement B, Jacquin L, Royer B, Apfelbacher SI, Bezati S, Gkarmiri S, Kaltsidou CV, Klonos G, Korka Z, Koufogianni A, Mavros V, Nano A, Ntousopoulos A, Papadopoulos N, Sason R, Zagalioti SC, Hjaltadottir I, Sigurþórsdóttir I, Skuladottir SS, Thorsteinsdottir T, Breslin D, Byrne CP, Dolan A, Harte O, Kazi D, McCarthy A, McMillan SS, Moiloa DN, O’Shaughnessy ÍL, Ramiah V, Williams S, Giani T, Levati E, Montenero R, Russo A, Salini S, van den Berg B, Booijen AM, Sir O, Vermeulen AE, ter Voert MA, Alvarez-Galarraga AC, Azeli Y, Gómez RGG, González González R, Lizardo D, Pérez ML, Madan CN, Medina JÁ, Moreno JS, Patiño EVB, Posada DMC, Rodrigo IC, Vitucci CF, Ballinari M, Dreher T, Gianinazzi L, Espejo T, Hautz WE, Rezzonico S, Bayramoğlu B, Cakmak S, Comruk B, Dogan T, Köse F, Allen TP, Ardley R, Beith CM, Boath KA, Britton HL, Campbell MMF, Capel J, Catney C, Clements S, Collins BP, Compton F, Cook A, Cosgriff EJ, Coventry T, Doyle N, Evans Z, Fasina TA, Ferrick JF, Fleming GM, Gallagher C, Golden M, Gorania D, Glass L, Greenlees H, Haddock ZP, Harris R, Hollas C, Hunter A, Ingham C, Ip SSY, James JA, Kenenden C, Jenkinson GE, Lee E, Lovick SA, McFadden M, McGovern R, Medhora J, Merchant F, Mishra S, Moreland GB, Narayanasamy S, Neal AR, Nicholls EL, Omar MT, Osborne N, Oteme FO, Pearson J, Price R, Sajan M, Sandhu LK, Scott-Murfitt H, Sealey B, Sharp EP, Spowage-Delaney BAC, Stephen F, Stevenson L, Tyrrell I, Ukoh CK, Walsh R, Watson AM, Whiteford JEC, Allston-Reeve C, Barson TJ, Giorgi MG, Godhania YL, Inchley V, Mirkes E, Rahman S. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med 2024; 15:463-470. [PMID: 38340282 PMCID: PMC10997678 DOI: 10.1007/s41999-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. METHODS This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). RESULTS Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. CONCLUSION 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.
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Gibot S, Lafon T, Jacquin L, Lefevre B, Kimmoun A, Guillaumot A, Losser MR, Douplat M, Argaud L, De Ciancio G, Jolly L, Touly N, Derive M, Malaplate C, Luc A, Baumann C, François B. Soluble TREM-1 plasma concentration predicts poor outcome in COVID-19 patients. Intensive Care Med Exp 2023; 11:51. [PMID: 37574520 PMCID: PMC10423708 DOI: 10.1186/s40635-023-00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The immuno-receptor Triggering Expressed on Myeloid cells-1 (TREM-1) is activated during bacterial infectious diseases, where it amplifies the inflammatory response. Small studies suggest that TREM-1 could be involved in viral infections, including COVID-19. We here aim to decipher whether plasma concentration of the soluble form of TREM-1 (sTREM-1) could predict the outcome of hospitalized COVID-19 patients. METHODS We conducted a multicentre prospective observational study in 3 university hospitals in France. Consecutive hospitalized patients with confirmed infection with SARS-CoV-2 were enrolled. Plasma concentration of sTREM-1 was measured on admission and then at days 4, 6, 8, 14, 21, and 28 in patients admitted into an ICU (ICU cohort: ICUC) or 3 times a week for patients hospitalized in a medical ward (Conventional Cohort: ConvC). Clinical and biological data were prospectively recorded and patients were followed-up for 90 days. For medical ward patients, the outcome was deemed complicated in case of requirement of increased oxygen supply > 5 L/min, transfer to an ICU, or death. For Intensive Care Unit (ICU) patients, complicated outcome was defined by death in the ICU. RESULTS Plasma concentration of sTREM-1 at inclusion was higher in ICU patients (n = 269) than in medical ward patients (n = 562) (224 pg/mL (IQR 144-320) vs 147 pg/mL (76-249), p < 0.0001), and higher in patients with a complicated outcome in both cohorts: 178 (94-300) vs 135 pg/mL (70-220), p < 0.0001 in the ward patients, and 342 (288-532) vs 206 pg/mL (134-291), p < 0.0001 in the ICU patients. Elevated sTREM-1 baseline concentration was an independent predictor of complicated outcomes (Hazard Ratio (HR) = 1.5 (1.1-2.1), p = 0.02 in ward patients; HR = 3.8 (1.8-8.0), p = 0.0003 in ICU patients). An sTREM-1 plasma concentration of 224 pg/mL had a sensitivity of 42%, and a specificity of 76% in the ConvC for complicated outcome. In the ICUC, a 287 pg/mL cutoff had a sensitivity of 78%, and a specificity of 74% for death. The sTREM-1 concentrations increased over time in the ConvC patients with a complicated outcome (p = 0.017), but not in the ICUC patients. CONCLUSIONS In COVID-19 patients, plasma concentration of sTREM-1 is an independent predictor of the outcome, although its positive and negative likelihood ratio are not good enough to guide clinical decision as a standalone marker.
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Affiliation(s)
- Sébastien Gibot
- Médecine Intensive et Réanimation, Hôpital Central, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
- Service de Médecine Intensive et Réanimation, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035, Nancy Cedex, France.
| | - Thomas Lafon
- Emergency Department, Limoges University Hospital Center, 87000, Limoges, France
- Inserm CIC 1435, Limoges University Hospital Center, 87000, Limoges, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Benjamin Lefevre
- Service des Maladies Infectieuses et Tropicales, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Antoine Kimmoun
- Médecine Intensive et Réanimation, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Anne Guillaumot
- Département de Pneumologie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marie-Reine Losser
- Réanimation Chirurgicale, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud Pierre Benite, 69000, Lyon, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Guillaume De Ciancio
- Département de Cardiologie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Lucie Jolly
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Nina Touly
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Marc Derive
- Inotrem Sa, Faculté de Médecine de Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Catherine Malaplate
- Laboratoire de Biochimie, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
- Centre de Ressources Biologiques Lorraine, CHRU Nancy, Hôpital Brabois, 54500, Vandoeuvre-Les-Nancy, France
| | - Amandine Luc
- Unité de Méthodologie, Data Management et Statistiques, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Cédric Baumann
- Unité de Méthodologie, Data Management et Statistiques, Hôpital Brabois, Université de Lorraine, CHRU-Nancy, 54500, Vandoeuvre-Les-Nancy, France
| | - Bruno François
- Réanimation Polyvalente et Inserm CIC-1435 & UMR-1092, CHU Limoges, 87000, Limoges, France
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Jacquin L, Battault M, Mewton N, Mantout A, Bergerot C, Tazarourte K, Douplat M. Outcome of patients admitted with oxygen mismatch and myocardial injury or infarction in emergency departments. J Cardiovasc Med (Hagerstown) 2023; 24:159-166. [PMID: 36753723 DOI: 10.2459/jcm.0000000000001443] [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: 02/10/2023]
Abstract
AIMS To describe the outcomes and associated factors in a population of patients admitted to emergency departments with at least one condition of oxygen supply/demand imbalance, regardless of the troponin result or restrictive criteria for type 2 myocardial infarction. METHODS We constituted a retrospective cohort of 824 patients. Medical records of patients having undergone a troponin assay were reviewed for selection and classification, and data including in-hospital stay and readmissions were collected. The reported outcomes are in-hospital mortality, 3-year mortality, and major adverse cardiovascular events. RESULTS Patients with myocardial infarction or injury, either chronic or acute, were older, with more history of hypertension and chronic heart or renal failure but not for other cardiovascular risk factors and medical history. Acute myocardial injury and type 2 myocardial infarction were significantly associated with in-hospital mortality [odds ratio (OR) 3.71 95% confidence interval (CI) 1.90-7.33 and OR 3.15 95% CI 1.59-6.28, respectively]. However, the long-term mortality does not differ in comparison with patients presenting chronic myocardial injury or nonelevated troponin, ranging from 26.9 to 34.3%. Patients with chronic myocardial injury and type 2 myocardial infarction had more long-term major cardiovascular events (39.3 and 38.8%), but only for acute heart failure, and none was associated with this outcome after adjustment. CONCLUSION Among patients admitted to emergency departments with an oxygen supply/demand imbalance, acute myocardial injury and type 2 myocardial infarction are strongly associated with in-hospital mortality. However, they are not associated with higher long-term mortality or major cardiovascular events after discharge, which tend to occur in elderly people with comorbidities.
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Affiliation(s)
- Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence.,Université Lyon-1, CarMeN Team 3 Ischemia-Reperfusion Syndromes (IRIS), INSERM UMR 1060
| | - Marion Battault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence
| | - Nathan Mewton
- Université Lyon-1, CarMeN Team 3 Ischemia-Reperfusion Syndromes (IRIS), INSERM UMR 1060.,Hospices Civils de Lyon, Hôpital Louis Pradel, Centre d'investigation clinique, INSERM 1407, Lyon.,Hospices Civils de Lyon, Hôpital Louis Pradel, Service de cardiologie, Bron
| | - Adrien Mantout
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'accueil des urgences, Pierre Bénite
| | - Cyrille Bergerot
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre d'investigation clinique, INSERM 1407, Lyon.,Hospices Civils de Lyon, Hôpital Louis Pradel, Service de cardiologie, Bron
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'accueil des urgence.,Université Lyon-1, Laboratoire Health Services and Performance Research (HESPER) EA 7425, Lyon, France
| | - Marion Douplat
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'accueil des urgences, Pierre Bénite.,Université Lyon-1, Laboratoire Health Services and Performance Research (HESPER) EA 7425, Lyon, France
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Douplat M, Termoz A, Subtil F, Haesebaert J, Jacquin L, Durand G, Potinet V, Hernu R, Nohales L, Mazza S, Berthiller J, Tazarourte K. Changes over time in anxiety, depression, and stress symptoms among healthcare workers in French emergency departments during the first COVID-19 outbreak. J Affect Disord 2022; 316:194-200. [PMID: 35981626 PMCID: PMC9376978 DOI: 10.1016/j.jad.2022.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE Assess the changes in anxiety, depression, and stress levels over time and identify risk factors among healthcare workers in French emergency departments (EDs) during the first COVID-19 outbreak. METHOD A prospective, multicenter study was conducted in 4 EDs and an emergency medical service (SAMU). During 3 months, participants completed fortnightly questionnaires to assess anxiety, depression, and stress using the Hospital Anxiety and Depression and the Chamoux-Simard scale. The changes in anxiety, depression, and stress levels over time were modelled by a linear mixed model including a period effect and a continuous time effect within periods. RESULTS A total of 211 respondents (43.5 %) completed the survey at inclusion. There was a decrease in mean anxiety (from 7.33 to 5.05, p < 0.001), mean depression (from 4.16 to 3.05, p = 0.009), mean stress at work (from 41.2 to 30.2, p = 0.008), and mean stress at home (from 33.0 to 26.0, p = 0.031) at the beginning of each period. The mean anxiety level was higher for administrative staff (+0.53) and lower for paramedics (-0.61, p = 0.047) compared to physicians. The anxiety level increased with the number of day and night shifts (0.13/day, p < 0.001, 0.12/night, p = 0.025) as did stress at work (1.6/day, p < 0.001, 1.1/night, p = 0.007). Reassigned healthcare workers were at higher risk of stress particularly compared to SAMU workers (stress at work: p = 0.015, at home: p = 0.021, in life in general: p = 0.018). CONCLUSION Although anxiety, depression, and stress decreased over time, anxiety was higher among physicians and administrative staff. Reassignment and working hours were identified as potential risk factors for mental health distress in EDs.
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Affiliation(s)
- Marion Douplat
- Hospices Civils of Lyon, Lyon Sud Hospital, Emergency Department, Pierre, Bénite, F-69495, France; UMR ADéS 7268, Aix-Marseille University/EFS/CNRS, Espace éthique méditerranéen, Marseille, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Anne Termoz
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France.
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive, UMR, 5558 Villeurbanne, France.
| | - Julie Haesebaert
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Laurent Jacquin
- Hospices Civils of Lyon, Edouard Herriot Hospital, Emergency Department, Lyon F-69003, France.
| | | | - Veronique Potinet
- Hospices Civils of Lyon, Lyon Sud Hospital, Emergency Department, Pierre, Bénite, F-69495, France.
| | - Romain Hernu
- Hospices Civils of Lyon, Croix Rousse Hospital, Emergency Department, Lyon F-69004, France.
| | - Ludivine Nohales
- Service de Médecine et Santé au Travail, Pôle de Santé Publique, Hospices Civils de Lyon, France.
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
| | - Julien Berthiller
- Pôle de Santé Publique, service de recherche et d'épidémiologie cliniques, Hospices Civils de Lyon, France.
| | - Karim Tazarourte
- Hospices Civils of Lyon, Edouard Herriot Hospital, Emergency Department, Lyon F-69003, France; Hospices Civils of Lyon, Emergency department, Edouard Herriot Hospital, Lyon F-69003, France; Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290 Lyon, France.
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Douplat M, Gavoille A, Subtil F, Haesebaert J, Jacquin L, Durand G, Lega JC, Perpoint T, Potinet V, Berthiller J, Perreton N, Tazarourte K. Management and Outcome of COVID-19 Positive and Negative Patients in French Emergency Departments During the First COVID-19 Outbreak: A Prospective Controlled Cohort Study. West J Emerg Med 2022; 23:897-906. [DOI: 10.5811/westjem.2022.7.57135] [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] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
ntroduction: Few studies have investigated the management of COVID-19 cases from the operational perspective of the emergency department (ED), We sought to compare the management and outcome of COVID-19 positive and negative patients who presented to French EDs.
Methods: We conducted a prospective, multicenter, observational study in four EDs. Included in the study were adult patients (≥18 years) between March 6–May 10, 2020, were hospitalized, and whose presenting symptoms were evocative of COVID-19. We compared the clinical features, management, and prognosis of patients according to their confirmed COVID-19 status.
Results: Of the 2,686 patients included in this study, 760 (28.3%) were COVID-19 positive. Among them, 364 (48.0%) had hypertension, 228 (30.0%) had chronic cardiac disease, 186 (24.5%) had diabetes, 126 (16.6%) were obese, and 114 (15.0%) had chronic respiratory disease. The proportion of patients admitted to intensive care units (ICU) was higher among COVID-19 positive patients (185/760, 24.3%) compared to COVID-19 negative patients (206/1,926, 10.7%; P <0.001), and they required mechanical ventilation (89, 11.9% vs 37, 1.9%; P <0.001) and high-flow nasal cannula oxygen therapy (135, 18.1% vs 41, 2.2%; P < 0.001) more frequently. The in-hospital mortality was significantly higher among COVID-19 positive patients (139, 18.3% vs 149, 7.7%; P <0.001).
Conclusion: Emergency departments were on the frontline during the COVID-19 pandemic and had to manage potential COVID-19 patients. Understanding what happened in the ED during this first outbreak is crucial to underline the importance of flexible organizations that can quickly adapt the bed capacities to the incoming flow of COVID-19 positive patients.
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Affiliation(s)
- Marion Douplat
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Antoine Gavoille
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Fabien Subtil
- Université de Lyon Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
| | - Guillaume Durand
- Villefranche Hospital, Department of Emergency Medicine, Gleize, France
| | - Jean-Christophe Lega
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Internal and Vascular Medicine, Pierre Bénite, France
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse Hospices Civils de Lyon, Lyon, France
| | - Veronique Potinet
- Hospices Civils de Lyon, Lyon Sud Hospital, Department of Emergency Medicine, Pierre Bénite, France
| | - Julien Berthiller
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Nathalie Perreton
- Pôle de Santé Publique, Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Edouard Herriot Hospital, Department of Emergency Medicine, Lyon, France
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Picot S, Perpoint T, Chidiac C, Sigal A, Javouhey E, Gillet Y, Jacquin L, Douplat M, Tazarourte K, Argaud L, Wallon M, Miossec C, Bonnot G, Bienvenu AL. Diagnostic accuracy of fluorescence flow-cytometry technology using Sysmex XN-31 for imported malaria in a non-endemic setting. Parasite 2022; 29:31. [PMID: 35638753 PMCID: PMC9153516 DOI: 10.1051/parasite/2022031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Malaria diagnosis based on microscopy is impaired by the gradual disappearance of experienced microscopists in non-endemic areas. Aside from the conventional diagnostic methods, fluorescence flow cytometry technology using Sysmex XN-31, an automated haematology analyser, has been registered to support malaria diagnosis. The aim of this prospective, monocentric, non-interventional study was to evaluate the diagnostic accuracy of the XN-31 for the initial diagnosis or follow-up of imported malaria cases compared to the reference malaria tests including microscopy, loop mediated isothermal amplification, and rapid diagnostic tests. Over a one-year period, 357 blood samples were analysed, including 248 negative and 109 positive malaria samples. Compared to microscopy, XN-31 showed sensitivity of 100% (95% CI: 97.13–100) and specificity of 98.39% (95% CI: 95.56–100) for the initial diagnosis of imported malaria cases. Moreover, it provided accurate species identification asfalciparumor non-falciparumand parasitaemia determination in a very short time compared to other methods. We also demonstrated that XN-31 was a reliable method for patient follow-up on days 3, 7, and 28. Malaria diagnosis can be improved in non-endemic areas by the use of dedicated haematology analysers coupled with standard microscopy or other methods in development, such as artificial intelligence for blood slide reading. Given that XN-31 provided an accurate diagnosis in 1 min, it may reduce the time interval before treatment and thus improve the outcome of patient who have malaria.
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Affiliation(s)
- Stéphane Picot
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France - Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France
| | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France - CIRI Équipe PH3ID - INSERM - U1111- UCBL Lyon 1 - CNRS - UMR5308 - ENS de Lyon,69007 Lyon,France
| | - Alain Sigal
- Service d'accueil des urgences, Hôpital de la Croix-Rousse, Hospices Civils de Lyon,69004 Lyon,France
| | - Etienne Javouhey
- Service de Réanimation et Urgences Pédiatriques, Hôpital Femme-Mere-Enfant, Hospices Civils de Lyon,69500 Lyon,France
| | - Yves Gillet
- Service de Réanimation et Urgences Pédiatriques, Hôpital Femme-Mere-Enfant, Hospices Civils de Lyon,69500 Lyon,France
| | - Laurent Jacquin
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon,69008 Lyon,France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon,69310 Lyon,France - Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425,69008 Lyon,France
| | - Karim Tazarourte
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon,69008 Lyon,France - Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425,69008 Lyon,France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation,69008 Lyon,France
| | - Martine Wallon
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
| | - Charline Miossec
- Service de Parasitologie et Mycologie Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
| | - Guillaume Bonnot
- Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France
| | - Anne-Lise Bienvenu
- Université de Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246,69100 Villeurbanne,France - Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon,69004 Lyon,France
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8
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Georges M, Perez T, Rabec C, Jacquin L, Finet-Monnier A, Ramos C, Patout M, Attali V, Amador M, Gonzalez-Bermejo J, Salachas F, Morelot-Panzini C. Proposals from a French expert panel for respiratory care in ALS patients. Respir Med Res 2022; 81:100901. [PMID: 35378353 DOI: 10.1016/j.resmer.2022.100901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of death. Non-invasive ventilation (NIV), which is the main recognized treatment for alleviating the symptoms of respiratory failure, prolongs survival and improves quality of life. However, the optimal timing for the initiation of NIV is still a matter of debate. NIV is a complex intervention. Multiple factors influence the efficacy of NIV and patient adherence. The aim of this work was to develop practical evidence-based advices to standardize the respiratory care of ALS patients in French tertiary care centres. METHODS For each proposal, a French expert panel systematically searched an indexed bibliography and prepared a written literature review that was then shared and discussed. A combined draft was prepared by the chairman for further discussion. All of the proposals were unanimously approved by the expert panel. RESULTS The French expert panel updated the criteria for initiating NIV in ALS patients. The most recent criteria were established in 2005. Practical advice for NIV initiation were included and the value of each tool available for NIV monitoring was reviewed. A strategy to optimize NIV parameters was suggested. Revisions were also suggested for the use of mechanically assisted cough devices in ALS patients. CONCLUSION Our French expert panel proposes an evidence-based review to update the respiratory care recommendations for ALS patients in daily practice.
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Affiliation(s)
- M Georges
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France; Centre des Sciences du Goût et de l'Alimentation, UMR 6265 CNRS 1234 INRA, University of Bourgogne Franche-Comté, Dijon, France.
| | - T Perez
- Department of Respiratory Diseases, University Hospital of Lille, Lille, France; Centre for Infection and Immunity of Lille, INSERM U1019-UMR9017, University of Lille Nord de France, Lille, France
| | - C Rabec
- Department of Respiratory Diseases and Intensive Care, Reference Center for Adult Rare Pulmonary Diseases, University Hospital of Dijon-Bourgogne, Dijon, France; University of Bourgogne Franche-Comté, Dijon France
| | - L Jacquin
- Clinical Training Manager for ResMed SAS company, Saint-Priest, France
| | - A Finet-Monnier
- Department of Neuromuscular Disorders and ALS, University Hospital of Timone, Marseille, France
| | - C Ramos
- CRMR SLA-MNM, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - M Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - V Attali
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France
| | - M Amador
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - J Gonzalez-Bermejo
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Salachas
- Neurology Department, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Morelot-Panzini
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Sorbonne Université, Paris, France; Service de Pneumologie (Département R3S), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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9
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Peyrony O, Fontaine JP, Trabattoni E, Nakad L, Charreyre S, Picaud A, Bosc J, Viglino D, Jacquin L, Laribi S, Pereira L, Thiriez S, Paquet AL, Tanneau A, Azoulay E, Chevret S. Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER. J Clin Med 2021; 10:jcm10051145. [PMID: 33803366 PMCID: PMC7967166 DOI: 10.3390/jcm10051145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.
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Affiliation(s)
- Olivier Peyrony
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-4249-8404
| | - Jean-Paul Fontaine
- Emergency Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
| | | | - Lionel Nakad
- Emergency Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France;
| | - Sylvain Charreyre
- Emergency Department, SAMU de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
- University Claude Bernard Lyon 1, 69007 Lyon, France
| | - Adrien Picaud
- Emergency Department, SAMU, SMUR. Le Mans Hospital, 72181 Le Mans, France;
| | - Juliane Bosc
- Emergency Department, SMUR. Libourne and Sainte Foy la Grande Hospital, 33243 Libourne, France;
| | - Damien Viglino
- Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France;
- HP2 INSERM U 1042 University Grenoble-Alpes, 38043 Grenoble, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civils de Lyon, Edouard Herriot University Hospital, 69622 Lyon, France;
| | - Saïd Laribi
- Emergency Department, Tours University Hospital, 37000 Tours, France;
| | - Laurent Pereira
- Emergency Department, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France;
| | - Sylvain Thiriez
- Emergency Department, SMUR, Victor Provo Hospital, Roubaix Hospital, 59100 Roubaix, France;
| | - Anne-Laure Paquet
- Emergency Department, la Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France;
- Sorbonne-UPMC-Paris VI University, 75005 Paris, France
| | - Alexandre Tanneau
- Emergency Department, SMUR of Lorient and Quimperlé, Bretagne Sud Hospital Group, 56322 Lorient, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, University of Paris, 75006 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
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Charrier P, Occelli P, Buchet-Poyau K, Douplat M, Delaroche-Gaudin M, Fayard-Gonon F, Jacquin L, Potinet V, Sigal A, Tazarourte K, Touzet S. Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study. BMJ Open 2021; 11:e042362. [PMID: 33558353 PMCID: PMC7871700 DOI: 10.1136/bmjopen-2020-042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family. DESIGN Descriptive qualitative study based on 38 semidirective interviews. PARTICIPANTS Doctors, nurses, nursing assistants and administrative staff. SETTING Four emergency departments (EDs) from three French university hospitals. RESULTS According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties. CONCLUSIONS Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03139110).
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Affiliation(s)
- Philippe Charrier
- Centre Max Weber (UMR 5283), University Lumière Lyon 2, F-69007 Lyon, France
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
| | - Pauline Occelli
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
| | | | - Marion Douplat
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | | | | | - Laurent Jacquin
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Véronique Potinet
- Emergency Department, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite, France
| | - Alain Sigal
- Emergency Departement, Croix-Rousse Hospital, F-69004 Lyon, France
| | - Karim Tazarourte
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
- Emergency Department, Edouard Herriot Hospital, F-69008 Lyon, France
| | - Sandrine Touzet
- Public Health Department, Hospices Civils de Lyon, F-69003 Lyon, France
- Health Services and Performance Research Lab (HESPER EA 7425), University Claude Bernard Lyon 1, F-69008 Lyon, France
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11
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Douplat M, Fraticelli L, Claustre C, Peiretti A, Serre P, Bischoff M, Jacquin L, Freyssenge J, Schott AM, Tazarourte K, Frugier S, Khoury CEL, Grezard M, Antoine JD, Dumont O, Lhuillier E, Pierro L, Blain S, Prost C, Sen-Brachet P, Khaldi A. Management of decision of withholding and withdrawing life-sustaining treatments in French EDs. Scand J Trauma Resusc Emerg Med 2020; 28:52. [PMID: 32513282 PMCID: PMC7282105 DOI: 10.1186/s13049-020-00744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Decisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature.
Study objective
We conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France.
Method
In a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process.
Results
There were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives.
Conclusion
The management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.
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Douplat M, Jacquin L, Frugier S, Tazarourte K, Le Coz P. Difficulty of the ethical decision-making process in withholding and withdrawing life-sustaining treatments in French EDs during COVID pandemic. Scand J Trauma Resusc Emerg Med 2020; 28:78. [PMID: 32792005 PMCID: PMC7424240 DOI: 10.1186/s13049-020-00772-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Marion Douplat
- Emergency Department, Lyon Sud Hospital, University Hospital, Hospices Civiles of Lyon, 165 chemin du Grand Revoyet, F-69495, Pierre Bénite, France. .,UMR ADéS 7268, Aix-Marseille University/ EFS / CNRS, Espace éthique méditerranéen, Timone Adulte's Hospital, Marseille, France.
| | - Laurent Jacquin
- Emergency Department, Édouard-Herriot Hospital, Lyon University Hospital, Hospices Civiles of Lyon, 5 place d'Arsonval, F-69003, Lyon, France
| | - Soizic Frugier
- Emergency Department, Lyon Sud Hospital, University Hospital, Hospices Civiles of Lyon, 165 chemin du Grand Revoyet, F-69495, Pierre Bénite, France
| | - Karim Tazarourte
- Emergency Department, Édouard-Herriot Hospital, Lyon University Hospital, Hospices Civiles of Lyon, 5 place d'Arsonval, F-69003, Lyon, France
| | - Pierre Le Coz
- UMR ADéS 7268, Aix-Marseille University/ EFS / CNRS, Espace éthique méditerranéen, Timone Adulte's Hospital, Marseille, France
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13
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Charrier P, Buchet-Poyau K, Delaroche-Gaudin M, Douplat M, Jacquin L, Occelli P, Fayard-Gonon F, Potinet V, Tazarourte K, Touzet S. [Mediators in emergency services: what missions according to the staff?]. Sante Publique 2020; 31:797-807. [PMID: 32550662 DOI: 10.3917/spub.196.0797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Violence in emergency services has become a central issue in the daily work of hospital employees. While the use of video surveillance and the training of professionals in conflict management are the most common methods used, there are few cases using the setting up of a third part such as a mediator. We conducted a qualitative study with professionals to examine their representations associated with mediation. METHOD Semi-directive interviews were conducted with professionals from four emergency units. The topics discussed in interviews were the definition of mediation and the missions that the mediators should fulfil. The content of 38 semi-directive interviews was analysed according to the inductive approach of the grounded theory. A content analysis was made, followed by an analysis aiming to bring out types and convergences/divergences. RESULTS Professionals were not aware of the definition of mediation and of its missions. They linked to it an instrumental theme, making mediation a tool for conflict prevention and management, a tool for communication with patients about their care, and about the organisation of emergency unit. The upcoming presence of mediators was seen as an help. A potential competition between professionals and mediators in the tasks performed was identified. CONCLUSION The study shows a favourable opinion towards mediation. It has allowed to identify obstacles to the well-functioning of the missions assigned to mediators. One of the challenges is the integration of this new actor, the mediator.
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Douplat M, Daoud K, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments. J Gen Intern Med 2020; 35:177-181. [PMID: 31686289 PMCID: PMC6957665 DOI: 10.1007/s11606-019-05464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires. OBJECTIVE To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED. DESIGN Prospective observational multicenter study. PATIENTS We included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner. MAIN MEASURES GPs were interviewed about their perception of end of life patient's management and the communication with ED and families. KEY RESULTS There were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient's associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to "always" participate in end of life decisions despite the fact that they usually don't participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated. CONCLUSIONS GPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making. NIH TRIAL REGISTRY NUMBER NCT02844972.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Khadidja Daoud
- Hôpital de Vienne, Service d’Accueil des urgences, Montée du Dr Chapuis, 38209 Vienne, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
| | - Pierre Le Coz
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
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Douplat M, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Difficulty of the decision-making process in emergency departments for end-of-life patients. J Eval Clin Pract 2019; 25:1193-1199. [PMID: 31287201 DOI: 10.1111/jep.13229] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life-sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision-making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. AIM The purpose of this study is to describe the decision-making process of withholding and withdrawing life-sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients. DESIGN We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017. RESULTS We included 109 patients in the study. Fifty-eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life-sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision-making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died. CONCLUSION There is little anticipation in end-of-life decisions. Discussion with patients concerning their end-of-life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France.,UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France
| | - Pierre Le Coz
- UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Karim Tazarourte
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
| | - Laurent Jacquin
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
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Douplat M, Jacquin L, Tazarourte K, Le Coz P. Answer to the reply letter to: Physician's experience in decisions of withholding, withdrawing life-sustaining treatments: A multicentre survey in emergency departments. Anaesth Crit Care Pain Med 2019; 38:519-520. [PMID: 30807877 DOI: 10.1016/j.accpm.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Marion Douplat
- Hospices civils de Lyon, hôpital Lyon Sud, service d'accueil des urgences, 65, chemin du Grand Revoyet, Pierre-Bénite 69495, France; UMR 7268 ADéS, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine, 27, boulevard Jean-Moulin, Marseille 13005, France.
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard-Herriot, Service d'Accueil des urgences, 5, place d'Arsonval, Lyon 69003, France.
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard-Herriot, Service d'Accueil des urgences, 5, place d'Arsonval, Lyon 69003, France.
| | - Pierre Le Coz
- UMR 7268 ADéS, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine, 27, boulevard Jean-Moulin, Marseille 13005, France.
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Maignan M, Viglino D, Collomb Muret R, Vejux N, Wiel E, Jacquin L, Laribi S, N-Gueye P, Joly LM, Dumas F, Beaune S. Intensity of care delivered by prehospital emergency medical service physicians to patients with deliberate self-poisoning: results from a 2-day cross-sectional study in France. Intern Emerg Med 2019; 14:981-988. [PMID: 31104303 DOI: 10.1007/s11739-019-02108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Emergency management of deliberate self-poisoning (DSP) by drug overdose is common in emergency medicine. There is a paucity of data about the prehospital care of these patients. The principal aim was to describe the intensity of care received by patients with DSP who were managed by prehospital emergency medical service (EMS) physicians. A 48-h cross-sectional study was conducted in 319 EMS and emergency units in France. Patient and poisoning characteristics and treatments administered were recorded. Complications of poisoning, hospitalization, intensive care unit admission and death were recorded until day 30. The primary endpoint was the probability of receiving prehospital intensive care, including fluid resuscitation, vasopressor therapy, invasive ventilation, or antidotal treatments, depending whether prehospital treatment was carried out by an EMS physician or not. Data from 703 patients (median age was 43 [30-52] years, 288 (40%) men) were analyzed. One hundred and fifteen (16%) patients were attended by an EMS physician. Patients attended by EMS physicians were more likely to receive intensive treatment in the prehospital setting [odds ratio (OR) 7.4, 95% confidence interval 4.3-12.9]. These patients had more severe poisoning as suggested mainly by a lower Glasgow Coma Score (13 [8-15] vs. 15 [15-15]; p < 0.001) and a higher rate of admission to an intensive care unit [29 (25%) vs. 15 (2%), p < 0.001]. Patients with DSP attended by prehospital EMS physicians frequently received intensive care. The level of care seemed appropriate for the severity of the poisoning.
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Affiliation(s)
- Maxime Maignan
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France.
| | - Damien Viglino
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Nathan Vejux
- Emergency Department, CHU Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble cedex 9, France
| | - Eric Wiel
- Emergency Department and SAMU 59, Lille University Hospital, Inserm UMR1011 and UDSL, Institut Pasteur de Lille, EGID, Lille, France
| | - Laurent Jacquin
- Emergency Department, Hospices Civiles de Lyon, Lyon, France
| | - Said Laribi
- Emergency Department, Tours University Hospital, 37044, Tours, France
- INSERM, U942, BIOmarkers in CArdioNeuroVAScular Diseases, Paris, France
| | - Papa N-Gueye
- Emergency Department, APHP Hôpital Lariboisière, Paris, France
| | - Luc-Marie Joly
- Emergency Department, Charles Nicolle Hospital, Rouen, France
| | - Florence Dumas
- Emergency Department, APHP Hôpital Cochin, Sudden Death Expertise Center, Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
| | - Sebastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, APHP, University Paris Diderot, INSERM UMR-S 1144, Paris, France
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Jacquin L, Gandar A, Aguirre-Smith M, Perrault A, Hénaff ML, Jong LD, Paris-Palacios S, Laffaille P, Jean S. High temperature aggravates the effects of pesticides in goldfish. Ecotoxicol Environ Saf 2019; 172:255-264. [PMID: 30711860 DOI: 10.1016/j.ecoenv.2019.01.085] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
In human-altered rivers, fish are often conjointly exposed to an increase in water temperature due to global warming and to a contamination by organic pollutants such as pesticides, but their combined effects are still elusive. Thermal and chemical stressors could potentially interact because high temperature increases metabolism and toxicant uptake, and can alter the ability of organisms to set up adequate stress responses and to maintain homeostasis. These combined stressors could thus potentially result in higher level of molecular and cellular damage, and stronger effects on behavior and physiology, but experimental evidence across biological levels is still scarce. In this study, goldfish Carassius auratus were experimentally exposed to an environmentally realistic cocktail of pesticides (S-metolachlor, isoproturon, linuron, atrazine-desethyl, aclonifen, pendimethalin and tebuconazol) commonly found in rivers of South-West of France at low or high dose in two different thermal conditions: a common summer temperature (22 °C) or a high temperature recorded during heat waves (32 °C). Results showed that high temperature alone caused behavioral and physiological changes (increased swimming activity, increased hepatosomatic index, decreased reproductive index) but limited cellular damage. However, high temperature aggravated the effects of pesticides at the molecular and cellular level. Indeed, pesticide exposure resulted in higher genotoxic effects (micronuclei rate) and irreversible cellular damage of the gills and liver (apoptosis, inflammation, necrosis) at 32 °C compared to 22 °C. This suggests potential synergistic effects of climate change and pollution, and highlights the need for multiple stress approaches to better predict the impacts of human activities on aquatic wildlife.
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Affiliation(s)
- L Jacquin
- Laboratoire Evolution & Diversité Biologique EDB, UMR 5174, Université de Toulouse, UPS, CNRS, IRD, Toulouse, France.
| | - A Gandar
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - M Aguirre-Smith
- Laboratoire Evolution & Diversité Biologique EDB, UMR 5174, Université de Toulouse, UPS, CNRS, IRD, Toulouse, France; Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - A Perrault
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - M Le Hénaff
- Bordeaux Science Agro, 1 cours du Général De Gaulle, CS 40201, 33175 Gradignan, France
| | - L De Jong
- Aix Marseille Université, Avignon Université, CNRS, IRD, IMBE, 3 place Victor Hugo, 13331 Marseille, France
| | - S Paris-Palacios
- UMR-I02 SEBIO Unité Stress Environnementaux et BIOsurveillance des milieux aquatiques, Université de Reims Champagne-Ardenne, Faculté des Sciences, Campus du Moulin de la Housse, BP1039 51687 Reims cedex 2, France
| | - P Laffaille
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
| | - S Jean
- Laboratoire Ecolab, Université de Toulouse, UPS, CNRS, INPT, ENSAT, route de l'Agrobiopole, 31326 Castanet-Tolosan, France
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Côte J, Boniface A, Blanchet S, Hendry AP, Gasparini J, Jacquin L. Melanin-based coloration and host-parasite interactions under global change. Proc Biol Sci 2019; 285:rspb.2018.0285. [PMID: 29848644 DOI: 10.1098/rspb.2018.0285] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/02/2018] [Indexed: 12/21/2022] Open
Abstract
The role of parasites in shaping melanin-based colour polymorphism, and the consequences of colour polymorphism for disease resistance, remain debated. Here we review recent evidence of the links between melanin-based coloration and the behavioural and immunological defences of vertebrates against their parasites. First we propose that (1) differences between colour morphs can result in variable exposure to parasites, either directly (certain colours might be more or less attractive to parasites) or indirectly (variations in behaviour and encounter probability). Once infected, we propose that (2) immune variation between differently coloured individuals might result in different abilities to cope with parasite infection. We then discuss (3) how these different abilities could translate into variable sexual and natural selection in environments varying in parasite pressure. Finally, we address (4) the potential role of parasites in the maintenance of melanin-based colour polymorphism, especially in the context of global change and multiple stressors in human-altered environments. Because global change will probably affect both coloration and the spread of parasitic diseases in the decades to come, future studies should take into account melanin-based coloration to better predict the evolutionary responses of animals to changing disease risk in human-altered environments.
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Affiliation(s)
- J Côte
- Laboratoire Évolution & Diversité Biologique EDB, UMR 5174, UPS; CNRS; ENSFEA; IRD, Université Toulouse 3 Paul Sabatier, Toulouse, France
| | - A Boniface
- Department of Biology & Redpath Museum, McGill University, Montréal, Québec, Canada
| | - S Blanchet
- Station d'Ecologie Théorique et Expérimentale SETE, UMR 5321, UPS, CNRS, Moulis, France
| | - A P Hendry
- Department of Biology & Redpath Museum, McGill University, Montréal, Québec, Canada
| | - J Gasparini
- Sorbonnes Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de Paris, 75005, Paris, France
| | - L Jacquin
- Laboratoire Évolution & Diversité Biologique EDB, UMR 5174, UPS; CNRS; ENSFEA; IRD, Université Toulouse 3 Paul Sabatier, Toulouse, France
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Douplat M, Jacquin L, Tazarourte K, Michelet P, Le Coz P. Physicians' experience in decisions of withholding and withdrawing life-sustaining treatments: A multicenter survey into emergency departments. Anaesth Crit Care Pain Med 2018; 37:633-634. [PMID: 30268527 DOI: 10.1016/j.accpm.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Marion Douplat
- Hospices civils de Lyon, hôpital Lyon sud, service d'accueil des urgences, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; UMR 7268 ADéS Aix-Marseille université, EFS, CNRS, efaculté de médecine de Marseille , hôpital adultes La Timone, 27, boulevard Jean-Moulin 13005 Marseille, France.
| | - Laurent Jacquin
- Hospices civils de Lyon, hôpital Édouard-Herriot, service d'accueil des urgences, 5, place d'Arsonval, 69003 Lyon, France.
| | - Karim Tazarourte
- Hospices civils de Lyon, hôpital Édouard-Herriot, service d'accueil des urgences, 5, place d'Arsonval, 69003 Lyon, France.
| | - Pierre Michelet
- Assistance publique-Hôpitaux de Marseille, hôpital de la Timone, service d'accueil des urgences, 265, rue Saint-Pierre, 13005 Marseille, France.
| | - Pierre Le Coz
- UMR 7268 ADéS Aix-Marseille université, EFS, CNRS, efaculté de médecine de Marseille , hôpital adultes La Timone, 27, boulevard Jean-Moulin 13005 Marseille, France.
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Ben Hassen M, Cao TV, Bartholomé J, Orasen G, Colombi C, Rakotomalala J, Razafinimpiasa L, Bertone C, Biselli C, Volante A, Desiderio F, Jacquin L, Valè G, Ahmadi N. Rice diversity panel provides accurate genomic predictions for complex traits in the progenies of biparental crosses involving members of the panel. Theor Appl Genet 2018; 131:417-435. [PMID: 29138904 PMCID: PMC5787227 DOI: 10.1007/s00122-017-3011-4] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/04/2017] [Indexed: 05/25/2023]
Abstract
KEY MESSAGE Rice breeding programs based on pedigree schemes can use a genomic model trained with data from their working collection to predict performances of progenies produced through rapid generation advancement. So far, most potential applications of genomic prediction in plant improvement have been explored using cross validation approaches. This is the first empirical study to evaluate the accuracy of genomic prediction of the performances of progenies in a typical rice breeding program. Using a cross validation approach, we first analyzed the effects of marker selection and statistical methods on the accuracy of prediction of three different heritability traits in a reference population (RP) of 284 inbred accessions. Next, we investigated the size and the degree of relatedness with the progeny population (PP) of sub-sets of the RP that maximize the accuracy of prediction of phenotype across generations, i.e., for 97 F5-F7 lines derived from biparental crosses between 31 accessions of the RP. The extent of linkage disequilibrium was high (r 2 = 0.2 at 0.80 Mb in RP and at 1.1 Mb in PP). Consequently, average marker density above one per 22 kb did not improve the accuracy of predictions in the RP. The accuracy of progeny prediction varied greatly depending on the composition of the training set, the trait, LD and minor allele frequency. The highest accuracy achieved for each trait exceeded 0.50 and was only slightly below the accuracy achieved by cross validation in the RP. Our results thus show that relatively high accuracy (0.41-0.54) can be achieved using only a rather small share of the RP, most related to the PP, as the training set. The practical implications of these results for rice breeding programs are discussed.
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Affiliation(s)
- M Ben Hassen
- Department of Agriculture and Environmental Sciences, University of Milan, Via Giovanni Celoria, 2, 20133, Milan, Italy
| | - T V Cao
- Cirad, UMR AGAP, Avenue Agropolis, 34398, Montpellier Cedex 5, France
| | - J Bartholomé
- Cirad, UMR AGAP, Avenue Agropolis, 34398, Montpellier Cedex 5, France
| | - G Orasen
- Department of Agriculture and Environmental Sciences, University of Milan, Via Giovanni Celoria, 2, 20133, Milan, Italy
| | - C Colombi
- Fondazione Parco Tecnologico Padano, Via Einstein, Loc. Cascina Codazza, 26900, Lodi, Italy
| | | | | | - C Bertone
- Department of Agriculture and Environmental Sciences, University of Milan, Via Giovanni Celoria, 2, 20133, Milan, Italy
| | - C Biselli
- CREA-Council for Agricultural Research and Economics, Research Center for Genomics and Bioinformatics, Via S. Protaso 302, 29017, Fiorenzuola d'Arda, PC, Italy
| | - A Volante
- CREA-Council for Agricultural Research and Economics, Research Center for Cereal and Industrial Crops, S. S. 11 to Torino Km 2.5, 13100, Vercelli, Italy
| | - F Desiderio
- CREA-Council for Agricultural Research and Economics, Research Center for Genomics and Bioinformatics, Via S. Protaso 302, 29017, Fiorenzuola d'Arda, PC, Italy
| | - L Jacquin
- Cirad, UMR AGAP, Avenue Agropolis, 34398, Montpellier Cedex 5, France
| | - G Valè
- CREA-Council for Agricultural Research and Economics, Research Center for Cereal and Industrial Crops, S. S. 11 to Torino Km 2.5, 13100, Vercelli, Italy
| | - N Ahmadi
- Cirad, UMR AGAP, Avenue Agropolis, 34398, Montpellier Cedex 5, France.
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Ponce C, Kaczorowski F, Perpoint T, Miailhes P, Sigal A, Javouhey E, Gillet Y, Jacquin L, Douplat M, Tazarourte K, Potinet V, Simon B, Lavoignat A, Bonnot G, Sow F, Bienvenu AL, Picot S. Diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for screening patients with imported malaria in a non-endemic setting. ACTA ACUST UNITED AC 2017; 24:53. [PMID: 29251261 PMCID: PMC5734902 DOI: 10.1051/parasite/2017054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Sensitive and easy-to-perform methods for the diagnosis of malaria are not yet available. Improving the limit of detection and following the requirements for certification are issues to be addressed in both endemic and non-endemic settings. The aim of this study was to test whether loop-mediated isothermal amplification of DNA (LAMP) may be an alternative to microscopy or real-time PCR for the screening of imported malaria cases in non-endemic area. RESULTS 310 blood samples associated with 829 suspected cases of imported malaria were tested during a one year period. Microscopy (thin and thick stained blood slides, reference standard) was used for the diagnosis. Real-time PCR was used as a standard of truth, and LAMP (Meridian Malaria Plus) was used as an index test in a prospective study conducted following the Standards for Reporting Diagnosis Accuracy Studies. In the 83 positive samples, species identification was P. falciparum (n = 66), P. ovale (n = 9), P. vivax (n = 3) P. malariae (n = 3) and 2 co-infections with P. falciparum + P.malariae. Using LAMP methods, 93 samples gave positive results, including 4 false-positives. Sensitivity, specificity, positive predictive value and negative predictive value for LAMP tests were 100%, 98.13%, 95.51%, and 100% compared to PCR. CONCLUSION High negative predictive value, and limit of detection suggest that LAMP can be used for screening of imported malaria cases in non-endemic countries when expert microscopists are not immediately available. However, the rare occurrence of non-valid results and the need for species identification and quantification of positive samples preclude the use of LAMP as a single reference method.
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Affiliation(s)
- Camille Ponce
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Flora Kaczorowski
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Alain Sigal
- Service d'accueil des Urgences, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Etienne Javouhey
- Service d'accueil des Urgences Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, 69677 Bron, France
| | - Yves Gillet
- Service d'accueil des Urgences Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, 69677 Bron, France
| | - Laurent Jacquin
- Service d'accueil des urgences, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Marion Douplat
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Hôpital Lyon Sud, 69310 Pierre-Bénite, France
| | - Karim Tazarourte
- Service des urgences/SAMU 69, Hospices Civils de Lyon, Lyon, 69003, France - Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
| | - Véronique Potinet
- Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Hôpital Lyon Sud, 69310 Pierre-Bénite, France
| | - Bruno Simon
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Adeline Lavoignat
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Guillaume Bonnot
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Fatimata Sow
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
| | - Anne-Lise Bienvenu
- Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France - Laboratoire d'Hématologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Stéphane Picot
- Institute of Parasitology and Medical Mycology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France - Malaria Research Unit, SMITh, ICBMS, UMR 5246 CNRS-INSA-CPE-University Lyon1, 69100 Villeurbanne, France
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Beaune S, Dumas F, Jacquin L. Prix, contrats et bourses de recherche décernés par la Société Française de Médecine d’Urgence en 2016. Ann Fr Med Urgence 2017. [DOI: 10.1007/s13341-017-0714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Maternal antibodies (MatAb) are known to provide passive protection early in life for young vertebrates but their effects on the development of offspring immune response across generations are still unknown. Here, we investigated the effects of antigen exposure (keyhole limpet haemocyanin, KLH) experienced by urban pigeon (Columba livia) females on the amount of antigen-specific antibodies (Abs) transferred into the egg yolk of their daughters and on the humoural immune response towards this same antigen in their grandchildren. We found that chicks from KLH-injected maternal grandmothers had a higher humoural response than chicks from sham-injected grandmothers. However, we did not detect a significant effect of female KLH exposure on the ability of their daughters to transmit anti-KLH Abs into their eggs. These results suggest that antigen exposure at one generation may shape the immune profile of offspring over two next generations, although the underlying mechanisms remain to be investigated.
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Affiliation(s)
- A Ismail
- Sorbonne Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de, Paris, F-75005, Paris, France
| | - L Jacquin
- Sorbonne Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de, Paris, F-75005, Paris, France CNRS, ENFA, UMR 5174 EDB (Laboratoire Évolution & Diversité Biologique), Université Toulouse 3 Paul Sabatier, Toulouse 31062, France
| | - C Haussy
- Sorbonne Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de, Paris, F-75005, Paris, France
| | - S Perret
- Centre d'Ecologie Expérimentale et Prédictive CEREEP-Ecotron Ile-De-France CNRS ENS, UMS 3194, Ecole Normale Supérieure, St-Pierre-lès-Nemours, France
| | - J Gasparini
- Sorbonne Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de, Paris, F-75005, Paris, France
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Scriba MF, Gasparini J, Jacquin L, Mettke-Hofmann C, Rattenborg NC, Roulin A. The effect of food quality during growth on spatial memory consolidation in adult pigeons. ACTA ACUST UNITED AC 2016; 220:573-581. [PMID: 27913599 DOI: 10.1242/jeb.152454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/21/2016] [Indexed: 11/20/2022]
Abstract
Poor environmental conditions experienced during early development can have negative long-term consequences on fitness. Animals can compensate for negative developmental effects through phenotypic plasticity by diverting resources from non-vital to vital traits such as spatial memory to enhance foraging efficiency. We tested in young feral pigeons (Columba livia) how diets of different nutritional value during development affect the capacity to retrieve food hidden in a spatially complex environment, a process we refer to as 'spatial memory'. Parents were fed with either high- or low-quality food from egg laying until young fledged, after which all young pigeons received the same high-quality diet until memory performance was tested at 6 months of age. The pigeons were trained to learn a food location out of 18 possible locations in one session, and then their memory of this location was tested 24 h later. Birds reared with the low-quality diet made fewer errors in the memory test. These results demonstrate that food quality during development has long-lasting effects on memory, with a moderate nutritional deficit improving spatial memory performance in a foraging context. It might be that under poor feeding conditions resources are redirected from non-vital to vital traits, or pigeons raised with low-quality food might be better in using environmental cues such as the position of the sun to find where food was hidden.
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Affiliation(s)
- M F Scriba
- Avian Sleep Group, Max Planck Institute for Ornithology, Eberhard-Gwinner-str.5, Seewiesen 82319, Germany .,Department of Ecology and Evolution, University of Lausanne, Lausanne 1015, Switzerland
| | - J Gasparini
- Sorbonne Universités, UPMC Univ Paris 06, UPEC, Paris 7, CNRS, INRA, IRD, Institut d'Ecologie et des Sciences de l'Environnement de Paris, Paris F-75005, France
| | - L Jacquin
- Laboratoire Evolution & Diversité Biologique (EDB), Université Toulouse 3 Paul Sabatier, UPS; CNRS; ENFA, 118 route de Narbonne, Toulouse 31062, France
| | - C Mettke-Hofmann
- School of Natural Sciences and Psychology, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
| | - N C Rattenborg
- Avian Sleep Group, Max Planck Institute for Ornithology, Eberhard-Gwinner-str.5, Seewiesen 82319, Germany
| | - A Roulin
- Department of Ecology and Evolution, University of Lausanne, Lausanne 1015, Switzerland
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Jacquin L, Dybwad C, Rolshausen G, Hendry AP, Reader SM. Evolutionary and immediate effects of crude-oil pollution: depression of exploratory behaviour across populations of Trinidadian guppies. Anim Cogn 2016; 20:97-108. [DOI: 10.1007/s10071-016-1027-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/21/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
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Jacquin L, Reader SM, Boniface A, Mateluna J, Patalas I, Pérez-Jvostov F, Hendry AP. Parallel and nonparallel behavioural evolution in response to parasitism and predation in Trinidadian guppies. J Evol Biol 2016; 29:1406-22. [PMID: 27086945 DOI: 10.1111/jeb.12880] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 01/18/2023]
Abstract
Natural enemies such as predators and parasites are known to shape intraspecific variability of behaviour and personality in natural populations, yet several key questions remain: (i) What is the relative importance of predation vs. parasitism in shaping intraspecific variation of behaviour across generations? (ii) What are the contributions of genetic and plastic effects to this behavioural divergence? (iii) And to what extent are responses to predation and parasitism repeatable across independent evolutionary lineages? We addressed these questions using Trinidadian guppies (Poecilia reticulata) (i) varying in their exposure to dangerous fish predators and Gyrodactylus ectoparasites for (ii) both wild-caught F0 and laboratory-reared F2 individuals and coming from (iii) multiple independent evolutionary lineages (i.e. independent drainages). Several key findings emerged. First, a population's history of predation and parasitism influenced behavioural profiles, but to different extent depending on the behaviour considered (activity, shoaling or boldness). Second, we had evidence for some genetic effects of predation regime on behaviour, with differences in activity of F2 laboratory-reared individuals, but not for parasitism, which had only plastic effects on the boldness of wild-caught F0 individuals. Third, the two lineages showed a mixture of parallel and nonparallel responses to predation/parasitism, with parallel responses being stronger for predation than for parasitism and for activity and boldness than for shoaling. These findings suggest that different sets of behaviours provide different pay-offs in alternative predation/parasitism environments and that parasitism has more transient effects in shaping intraspecific variation of behaviour than does predation.
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Affiliation(s)
- L Jacquin
- Laboratoire Évolution & Diversité Biologique (EDB UMR 5174), Université de Toulouse, CNRS, ENFA, UPS, Toulouse, France.,Redpath Museum & Department of Biology, McGill University, Montréal, QC, Canada.,ECOBIOP, INRA, Univ. Pau & Pays Adou, Saint-Pée-sur-Nivelle, France
| | - S M Reader
- Department of Biology, McGill University, Montréal, QC, Canada
| | - A Boniface
- Redpath Museum & Department of Biology, McGill University, Montréal, QC, Canada
| | - J Mateluna
- Department of Biology, McGill University, Montréal, QC, Canada
| | - I Patalas
- Department of Biology, McGill University, Montréal, QC, Canada
| | - F Pérez-Jvostov
- Department of Biology, McGill University, Montréal, QC, Canada.,Institute of Parasitology, McGill University, Saint-Anne-de-Bellevue, QC, Canada
| | - A P Hendry
- Redpath Museum & Department of Biology, McGill University, Montréal, QC, Canada
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Muscat C, Jacquin L, Le Loch JB, Picardo T, Tazarourte K. Épiglottite aiguë de l’adulte : une série de cas. Ann Fr Med Urgence 2015. [DOI: 10.1007/s13341-015-0544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Trace metals produced by anthropogenic activities are of major importance in urban areas and might constitute a new evolutionary force selecting for the ability to cope with their deleterious effects. Interestingly, melanin pigments are known to bind metal ions, thereby potentially sequestering them in inert body parts such as coat and feathers, and facilitating body detoxification. Thus, a more melanic plumage or coat coloration could bring a selective advantage for animals living in polluted areas. We tested this hypothesis by investigating the link between melanin-based coloration and zinc and lead concentrations in feathers of urban feral pigeons, both at capture time and after one year of captivity in standardized conditions. Results show that differently coloured pigeons had similar metal concentrations at capture time. Metal concentrations strongly decreased after one year in standardized conditions, and more melanic pigeons had higher concentrations of zinc (but not lead) in their feathers. This suggests that more melanic pigeons have a higher ability to store some metals in their feathers compared with their paler counterparts, which could explain their higher success in urbanized areas. Overall, this work suggests that trace metal pollution may exert new selective forces favouring more melanic phenotypes in polluted environments.
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Affiliation(s)
- M Chatelain
- UPMC Univ Paris 06, Institut d'Ecologie et des Sciences de l'Environnement, , Paris, France
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Gasparini J, Jacquin L, Laroucau K, Vorimore F, Aubry E, Castrec-Rouëlle M, Frantz A. Relationships between metals exposure and epidemiological parameters of two pathogens in urban pigeons. Bull Environ Contam Toxicol 2014; 92:208-212. [PMID: 24322059 DOI: 10.1007/s00128-013-1172-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 11/28/2013] [Indexed: 06/03/2023]
Abstract
Human activities often generate or increase concentration of chemical compounds including pesticides, hydrocarbons and metals that can potentially affect ecological interactions. We found that elevated levels of zinc in pigeon feathers were associated with both low prevalence of Chlamydiaceae (ornithosis disease) and low intensity of blood pathogens (Haemosporidian parasites). In contrast, high levels of lead in pigeon feathers were associated with high blood pathogens intensities. Our results suggest that metals linked to human activities in cities such as zinc and lead may play a significant role in the ecology of host-parasite interactions and could potentially affect the epidemiology of diseases in the urban environment.
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Affiliation(s)
- J Gasparini
- Laboratoire Ecologie et Evolution (EcoEvo) UMR 7625, CNRS, 75005, Paris, France,
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Soulleihet V, Nicoli F, Trouve J, Girard N, Jacquin L. Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns. Am J Emerg Med 2013; 32:225-32. [PMID: 24361139 DOI: 10.1016/j.ajem.2013.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 07/15/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs. METHOD Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized. RESULTS In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively). CONCLUSION Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems.
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Affiliation(s)
- Valéry Soulleihet
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, SAMU 13, 13005 Marseille, France
| | - François Nicoli
- OLEA Medical, 13600 La Ciotat, France; Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service d'urgences neurovasculaires, 13005 Marseille, France
| | - Jacques Trouve
- Centre Hospitalier Henri Duffaut, SAMU 84, 84903 Avignon cedex 09, France
| | - Nadine Girard
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service de Neuroradiologie, 13005 Marseille, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences Médicales, 69003 Lyon, France.
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Jacquin L, Franceschi F, By Y, Durand-Gorde JM, Condo J, Deharo JC, Michelet P, Fenouillet E, Guieu R, Ruf J. Search for adenosine A2A spare receptors on peripheral human lymphocytes. FEBS Open Bio 2012; 3:1-5. [PMID: 23847753 PMCID: PMC3668538 DOI: 10.1016/j.fob.2012.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 12/20/2022] Open
Abstract
Some ligand–receptor couples involve spare receptors, which are apparent when a maximal response is achieved with only a small fraction of the receptor population occupied. This situation favours cross-reactions with low-affinity ligands, which may be detrimental for cell signaling. In the case of the adenosine A2A receptors (A2AR), which have an immunosuppressive effect on lymphocytes through cAMP production, the presence of spare A2AR remains to be established. We examined the situation using patients over-expressing lymphocyte A2AR and an agonist-like mAb to A2AR. We found that maximal mAb binding and functional response varied among the patients whereas the dissociation constant and half-maximal effective concentration had similar mean values (0.19 and 0.18 μM, respectively). Lymphocyte A2AR expression was correlated to plasma adenosine level and A2AR occupation but not to A2AR response. These results are consistent with a lack of a reserve of functional A2AR on human lymphocytes as a general rule and suggest that the amount and functional state of the expressed A2AR determine the maximal level of the lymphocyte response to adenosine.
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Affiliation(s)
- Laurent Jacquin
- Aix-Marseille Université, UMR MD2, Faculté de Médecine Nord, Marseille, France
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Bonello L, Berbis J, Laine M, Armero S, Bessereau J, Jacquin L, Bonello C, Camillieri E, Barragan P, Dignat-George F, Paganelli F, Camoin-Jau L. Biological efficacy of a 600 mg loading dose of clopidogrel in ST-elevation myocardial infarction. Thromb Haemost 2012; 108:101-6. [PMID: 22535315 DOI: 10.1160/th12-02-0125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/29/2012] [Indexed: 01/08/2023]
Abstract
Optimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600 mg loading dose (LD) of clopidogrel. We performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50 ± 23% with a large inter-individual variability (range: 1-94%). Patients with a VASP index ≥50% were significantly older (p= 0.03), with a higher body mass index (BMI) (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an acute coronary syndrome (ACS) and with a high fibrinogen level compared to good responders (VASP <50%). In multivariate analysis BMI, omeprazole use, ACS and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 -3.5; p=0.003). In conclusion, STEMI is associated with high on-treatment platelet reactivity following 600 mg of clopidogrel. The present results suggest that 600 mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred.
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Affiliation(s)
- Laurent Bonello
- Département de Cardiologie, Hôpital Universitaire Nord, Aix-Marseille University, Marseille, France.
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By Y, Jacquin L, Franceschi F, Durand-Gorde JM, Condo J, Michelet P, Guieu R, Ruf J. Fall in oxygen tension of culture medium stimulates the adenosinergic signalling of a human T cell line. Purinergic Signal 2012; 8:661-7. [PMID: 22331499 DOI: 10.1007/s11302-012-9295-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/01/2012] [Indexed: 10/28/2022] Open
Abstract
We examined the short-course expression of various parameters involved in the adenosinergic signalling of a human T cell line during in vitro decrease of the medium culture oxygen tension mimicking in vivo hypoxia. Fall of 92 mmHg in oxygen tension of culture medium induced in CEM, a CD4+ human T cell line, a continuous production of hypoxia-inducing factor-1α with a plateau value at 9 h, a rapid increase in adenosine production peaking at 3 h and a decrease in adenosine deaminase peaking at 6 h. The adenosine A(2A) receptor (A(2A)R) protein level of CEM cells was enhanced with a peak at 6 h. Intracellular 3',5'-cyclic adenosine monophosphate accumulated in CEM cells with a maximal level at 9 h. These results show that a human-cultured T cells line can upregulate its own adenosine production and A(2A)R expression during exposure to acute hypoxia. Hypoxia-increased stimulation of the adenosinergic signalling of T cells may have immunosuppressive properties and, consequently, A(2A)R agonists may have therapeutic relevance.
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Affiliation(s)
- Youlet By
- UMR MD2 P2COE, Aix-Marseille Univ, Faculté de Médecine, Timone, 27, Boulevard Jean Moulin, F-13385, Marseille Cedex 5, France
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Jacquin L, Récapet C, Bouche P, Leboucher G, Gasparini J. Melanin-based coloration reflects alternative strategies to cope with food limitation in pigeons. Behav Ecol 2012. [DOI: 10.1093/beheco/ars055] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
P2Y12-ADP receptor antagonist use has been critical in the development of percutaneous coronary intervention, dramatically reducing the rate of early stent thrombosis. However, it recently was observed that a significant proportion of patients do not achieve optimal platelet reactivity inhibition after clopidogrel loading dose. The large interindividual variability in clopidogrel responsiveness is related to several factors, including the genetic polymorphism of hepatic cytochrome P450 2C19 (CYP2C19*2), which recently has been highlighted by a warning from the U.S. Food and Drug Administration. Of importance, patients exhibiting reduced clopidogrel metabolism and/or low clopidogrel responsiveness (ie, high on-treatment platelet reactivity) have an increased rate of thrombotic events after percutaneous coronary intervention. This review summarizes the current knowledge on this important clinical issue. While the future of genetic testing remains undetermined, several trials are underway to demonstrate the potential utility of platelet reactivity testing with P2Y12-ADP receptor antagonists.
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Affiliation(s)
- Elise Camilleri
- Service de Cardiologie, Hôpital de Martigues, Martigues, France
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Jacquin L, Michelet P, Brocq FX, Houel JG, Truchet X, Auffray JP, Carpentier JP, Jammes Y. Short-term spirometric changes in wildland firefighters. Am J Ind Med 2011; 54:819-25. [PMID: 22006591 DOI: 10.1002/ajim.21002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The short-term effects of smoke inhalation have been little studied in European wildland firefighters, especially in an intra-individual design. Our purpose is to study the spirometric changes from the early stage during a wildland fire season and to compare smokers and non-smokers. METHODS A population of 108 firefighters from a Civil Security Unit, based in Corsica, was tested immediately after having been exposed to the smoke of coniferous trees. RESULTS Out of 108 people, 59 were smokers and 49 were non-smokers without any acute or chronic pulmonary disease. Compared to baseline values, a decrease of spirometric parameters was observed immediately after the end of exposure and an even greater decrease was seen after 24 hr (FEV1 -0.53 L; FVC -0.59 L; PEF -53 L min(-1), P < 0.05 for each). None of the participants complained of respiratory symptoms. Three months after the end of the season, a final test was given which revealed a persistent decrease in spirometric parameters in comparison with baseline values (FEV1 -0.28 L; FVC -0.34 L; PEF -45 L min(-1), P < 0.05 for each). Comparison of smoking and non-smoking groups did not show any noteworthy difference for each parameter or the importance of their decline. CONCLUSIONS The findings show that firefighters are likely to develop respiratory impairments after wood smoke exposure. We did not observe any statistical differences between smokers and non-smokers.
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Affiliation(s)
- Laurent Jacquin
- Centre Hospitalier Universitaire Timone Adultes, Pôle Réanimation, Urgences, SAMU and Hyperbarie, Marseille, France.
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Gasparini J, Erin N, Bertin C, Jacquin L, Vorimore F, Frantz A, Lenouvel P, Laroucau K. Impact of urban environment and host phenotype on the epidemiology of Chlamydiaceae in feral pigeons (Columba livia). Environ Microbiol 2011; 13:3186-93. [DOI: 10.1111/j.1462-2920.2011.02575.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grandet P, Fourrier L, Guerot E, Jacquin L, Maréchal M. Référentiel de compétences et d’aptitudes du masseur-kinésithérapeute de réanimation (MKREA) en secteur adulte. Introduction et sommaire. Réanimation 2011. [DOI: 10.1007/s13546-011-0229-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bessereau J, Coulange M, Jacquin L, Fournier M, Michelet P. Endotracheal tube intracuff pressure during helicopter transport. Ann Emerg Med 2010; 56:583-4; author relply 584. [PMID: 21036300 DOI: 10.1016/j.annemergmed.2010.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 04/09/2010] [Accepted: 04/16/2010] [Indexed: 11/26/2022]
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Barbagallo A, Sipp D, Jacquin L, Schmid P. Control of an Incompressible Cavity Flow using a Reduced Model Based on Global Modes. 5th AIAA Theoretical Fluid Mechanics Conference 2008. [DOI: 10.2514/6.2008-3904] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
| | - Denis Sipp
- Office National d'Etudes et Recherches Aerospatiales
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Cathébras P, Jacquin L, le Gal M, Fayol C, Bouchou K, Rousset H. Correlates of somatic causal attributions in primary care patients with fatigue. Psychother Psychosom 1995; 63:174-80. [PMID: 7624463 DOI: 10.1159/000288956] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Researchers in the field of chronic fatigue in tertiary care found that patients' somatic (e.g. viral) explanations for their condition may lead to chronicity of symptoms. We studied the influence of a somatic attributional bias on outcome and reported symptoms in primary care patients with fatigue. We compared fatigue scores on a specific scale, and number of presented symptoms, in two groups of primary care patients with 'functional' fatigue: 75 with a high score on the somatic subscale of the Fatigue Attribution Scale (S-FAS), and 95 with a low score on the S-FAS. At the index visit, patients with low and high scores on the S-FAS were not different for age, sex, fatigue scores, and levels of depressive symptoms. Patients with high scores on the S-FAS presented significantly more somatic and psychological symptoms-a total of 36 symptoms for 24 patients (25.3%) in the low-score group, and a total of 52 symptoms for 31 patients (41.3%) in the high-score group. Forty-two days later, at the follow-up visit, the fatigue scores were similar in both groups. In primary care patients with fatigue not due to somatic illness or major depression, the tendency to attribute fatigue to somatic causes is not associated with a worse outcome, but with a higher number of reported symptoms.
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Affiliation(s)
- P Cathébras
- Service de Médecine Interne, Hôpital Nord, CHU de Saint-Etienne, France
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