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Habermacher C, Lalloué B, Lamouille V, Thilly N, Agrinier N. Family physicians' practices and attitudes towards HPV vaccination since extension of HPV vaccination to males. Infect Dis Now 2023; 53:104669. [PMID: 36736826 DOI: 10.1016/j.idnow.2023.104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/06/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To describe family physicians' (FP) practices and attitudes towards HPV vaccination guidelines since its extension to males in 2021, and to identify levers to promote HPV vaccination in all adolescents. PATIENTS AND METHODS Cross-sectional study among FPs established in France in 2021. We collected sociodemographic data, practices, opinions, and attitudes towards vaccination, and FPs' demands regarding training and information about HPV. We used logistic regression models to identify the variables associated with HPV vaccination proposal. RESULTS Of 530 FPs included, 469 (88.5%) reported that they systematically proposed HPV vaccines to girls vs 335 (63.2%) to boys. A total of 366 (69.0%) FPs reported an increase in HPV vaccines proposal to all adolescents since the extension of HPV vaccination to males recommended by French guidelines. However, factors associated with HPV vaccination proposal differed by target females and target males. Setting and mode of practice, opinion about the number of recommended vaccines and HPV vaccines, and demands of training on HPV vaccines were associated with HPV vaccination proposal to target females. Whereas academic status, opinion about HPV vaccination guidelines extension to males, using continuing medical education as the main source of information on HPV vaccines, and demands for training on HPV vaccines were associated with HPV vaccination proposal to target males. CONCLUSIONS Extension of HPV vaccination to males in French guidelines might have had a favorable impact on HPV vaccination proposal by FPs to adolescents. However, levers to promote HPV vaccination might differ according to the target population sex.
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Affiliation(s)
- C Habermacher
- Université de Lorraine, Faculté de médecine, F-54000 Nancy, France
| | - B Lalloué
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, F-54000 Nancy, France
| | - V Lamouille
- Université de Lorraine, Faculté de médecine, F-54000 Nancy, France
| | - N Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, F-54000 Nancy, France
| | - N Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
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Bocquier A, Bonnay S, Bruel S, Chevreul K, Gagneux-Brunon A, Gauchet A, Giraudeau B, Le Duc-Banaszuc AS, Mueller JE, Thilly N. Codevelopment and evaluation of a multicomponent intervention to improve HPV vaccination in France. Eur J Public Health 2022. [PMCID: PMC9594634 DOI: 10.1093/eurpub/ckac131.340] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. The French authorities launched in 2018 the PrevHPV national research program aimed at codeveloping with stakeholders and evaluating the impact of a multicomponent intervention to improve HPV VC among French adolescents. Methods We identified three components to address main barriers to HPV vaccination in France: adolescents’ and parents’ education and motivation (component 1); general practitioners (GPs)’ training (component 2); and access to vaccination at school (component 3). We developed the intervention using the UK Medical Research Council framework for developing complex interventions as a guide. We used (i) findings from published evidence; (ii) primary data on knowledge, attitudes, behavior and preferences collected through a mixed methods approach (quantitative/qualitative studies, discrete choice experiment); (iii) the advice of stakeholders (e.g., adolescents, parents, school nurses, GPs) involved in working groups. We will evaluate the effectiveness, efficiency and implementation of the components (applied alone or in combination) through a pragmatic cluster randomized controlled trial. The primary endpoint is the HPV VC (≥ 1 dose) among adolescents aged 11-14 years, 2 months after the end of the intervention, at the municipality level. Results Primary data highlighted the need to improve adolescents, parents and school staff knowledge on HPV and to help GPs communicate with patients on this topic. They provided guidance on the most effective communication contents. For each component, we codeveloped tools with a participatory approach (e.g., eHealth tools for adolescents, a decision aid tool for GPs). The trial will end in June 2022; 90 middle schools (i.e., about 40,000 adolescents) and 46 GPs accepted to participate. Conclusions Should the intervention prove effective, results from the implementation evaluation will help us refine it before scaling it up. Key messages • The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • It will add to the small number of studies that compared the effectiveness of various strategies to promote HPV vaccination and will provide key results on cost-effectiveness and implementation.
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Affiliation(s)
- A Bocquier
- APEMAC, Université de Lorraine , Nancy, France
| | - S Bonnay
- APEMAC, Université de Lorraine , Nancy, France
| | - S Bruel
- Département de Médecine Générale, Université Paris , Paris, France
- HESPER EA7425 , Saint-Etienne- , Saint-Etienne, France
- Lyon University , Saint-Etienne- , Saint-Etienne, France
- CIC-INSERM 1408, University Hospital of Saint-Etienne , Saint-Etienne, France
| | - K Chevreul
- Université de Paris ECEVE UMR 1123, , Paris, France
- URC Eco Ile-de-France, Hôpital Robert Debré , Paris, France
| | | | - A Gauchet
- LIP/PC2S, University Savoie Mont Blanc , Chambéry, France
| | - B Giraudeau
- SPHERE U1246, Université de Tours, Université de Nantes, INSERM , Tours, France
- CHRU de Tours INSERM CIC 1415, , Tours, France
| | | | - JE Mueller
- Unité Epidémiologie des Maladies Émergentes, Institut Pasteur , Paris, France
- EHESP French School of Public Health , Rennes, France
| | - N Thilly
- APEMAC, Université de Lorraine , Nancy, France
- Université de Lorraine, CHRU-Nancy Méthodologie, Promotion, Investigation, , Nancy, France
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Bitar S, Thilly N, Agrinier N. Impact pronostic des trajectoires médicamenteuses sur la mortalité à trois ans dans l’insuffisance cardiaque et la fraction d’éjection préservée : résultats de l’étude de cohorte EPICAL2. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.065] [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: 12/01/2022] Open
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Krockow EM, Kurvers RHJM, Herzog SM, Kämmer JE, Hamilton RA, Thilly N, Macheda G, Pulcini C. Harnessing the wisdom of crowds can improve guideline compliance of antibiotic prescribers and support antimicrobial stewardship. Sci Rep 2020; 10:18782. [PMID: 33139823 PMCID: PMC7608639 DOI: 10.1038/s41598-020-75063-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
Antibiotic overprescribing is a global challenge contributing to rising levels of antibiotic resistance and mortality. We test a novel approach to antibiotic stewardship. Capitalising on the concept of "wisdom of crowds", which states that a group's collective judgement often outperforms the average individual, we test whether pooling treatment durations recommended by different prescribers can improve antibiotic prescribing. Using international survey data from 787 expert antibiotic prescribers, we run computer simulations to test the performance of the wisdom of crowds by comparing three data aggregation rules across different clinical cases and group sizes. We also identify patterns of prescribing bias in recommendations about antibiotic treatment durations to quantify current levels of overprescribing. Our results suggest that pooling the treatment recommendations (using the median) could improve guideline compliance in groups of three or more prescribers. Implications for antibiotic stewardship and the general improvement of medical decision making are discussed. Clinical applicability is likely to be greatest in the context of hospital ward rounds and larger, multidisciplinary team meetings, where complex patient cases are discussed and existing guidelines provide limited guidance.
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Affiliation(s)
- Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK.
| | - R H J M Kurvers
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - S M Herzog
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
| | - J E Kämmer
- Center for Adaptive Rationality, Max-Planck Institute for Human Development, Berlin, Germany
- Department of Emergency Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - R A Hamilton
- School of Pharmacy, De Montfort University, Leicester, UK
| | - N Thilly
- Université de Lorraine, APEMAC, Nancy, France
| | - G Macheda
- Université de Lorraine, APEMAC, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France
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Thilly N, Pereira O, Schouten J, Hulscher MEJL, Pulcini C. Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data. JAC Antimicrob Resist 2020; 2:dlaa086. [PMID: 34223041 PMCID: PMC8209962 DOI: 10.1093/jacamr/dlaa086] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
Background We previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications. Objectives To: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population. Methods For all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement. Results We included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs. Conclusions This set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.
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Affiliation(s)
- N Thilly
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy, Département Méthodologie, Promotion, Investigation, Nancy, France
| | - O Pereira
- Direction Régionale du Service Médical Grand Est, Nancy, France
| | - J Schouten
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Intensive Care Medicine, Nijmegen, The Netherlands
| | - M E J L Hulscher
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
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Bitar S, Thilly N, Agrinier N. L’adhésion continue des prescriptions médicamenteuses aux recommandations européennes dans l’insuffisance cardiaque est associée à une diminution de la mortalité à long terme : cohorte EPICAL2 suivie sur 36 mois. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Baudet A, Kichenbrand C, Pulcini C, Descroix V, Lesclous P, Thilly N, Clément C, Guillet J. Antibiotic use and resistance: a nationwide questionnaire survey among French dentists. Eur J Clin Microbiol Infect Dis 2020; 39:1295-1303. [PMID: 32062724 DOI: 10.1007/s10096-020-03849-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Abstract
The aim of this survey was to describe the attitudes and self-reported practices of French dentists towards antibiotic use and resistance and to compare practices with national guidelines. A nationwide cross-sectional internet-based survey was conducted among the 41,800 French dentists. The online questionnaire was distributed through professional networks from April 2017 to April 2018. Seven-hundred seventy-five dentists participated but only 455 questionnaires were complete enough to be included in the analyses. Amoxicillin was the most frequently prescribed antibiotic (65.8%, 1783/2711), followed by spiramycin + metronidazole fixed-dose combination (11.6%, 312/2711) and amoxicillin-clavulanic acid (10.3%, 279/2711). The main indications for use were abscess (349/423, 82.5%), cervicofacial cellulitis (74.2%, 314/423), and pericoronitis (58.6%, 239/408). Most dentists (90.5%, 381/421) considered that antibiotic resistance is of concern but only half of them (56.3%, 238/423) felt adequately informed about antibiotic use. Many dentists did not comply with the national guidelines: the majority of them declared inappropriate antibiotic prescriptions for 11/17 clinical situations. They did not prescribe antibiotics for 5/6 clinical situations requiring prophylaxis. They reported that the publication of clinical guidelines is the main factor influencing their prescriptions (71.0%, 299/421). They wished to receive regular updates of national guidelines in the form of practical sheets (93.0%, 172/185). French dentists should urgently be targeted by antibiotic stewardship initiatives.
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Affiliation(s)
- A Baudet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Kichenbrand
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - V Descroix
- Hôpital Pitié-Salpêtrière, Service d'Odontologie, F-75013, Paris, France
| | - P Lesclous
- CHU Nantes, Service d'Odontologie, F-44000, Nantes, France
| | - N Thilly
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Département Méthodologie Promotion Investigation, F-54000, Nancy, France
| | - C Clément
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - J Guillet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France.
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France.
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Corbel A, Ladrière M, Le Berre N, Durin L, Rousseau H, Frimat L, Thilly N, Pulcini C. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study. Clin Microbiol Infect 2019; 26:475-484. [PMID: 31382016 DOI: 10.1016/j.cmi.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. METHODS We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. RESULTS Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively). CONCLUSION In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.
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Affiliation(s)
- A Corbel
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France.
| | - M Ladrière
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - N Le Berre
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Durin
- Agence de la Biomédecine, Saint Denis La Plaine, France
| | - H Rousseau
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Frimat
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - N Thilly
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - C Pulcini
- APEMAC, University of Lorraine, Nancy, France; Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France
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Macheda G, Luc A, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies. Med Mal Infect 2019; 49:456-462. [PMID: 31351803 DOI: 10.1016/j.medmal.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 07/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. METHODS We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. RESULTS We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. CONCLUSION The release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.
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Affiliation(s)
- G Macheda
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France
| | - G Béraud
- Médecine interne et maladies infectieuses, CHU de Poitiers, 86021 Poitiers, France; Centre de recherche du CHU de Québec, université Laval, hôpital Saint-Sacrement, chemin Sainte-Foy, Québec, Canada; Hasselt university, interuniversity institute for biostatistics and statistical bioinformatics, Censtat, Hasselt, Belgium
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 20303 Ajaccio, France
| | - R Gauzit
- Équipe mobile d'infectiologie, université Paris Descartes, hôpitaux universitaires Paris centre-site Cochin, AP-HP, 75014 Paris, France
| | - P Lesprit
- Hôpital Foch, 92151 Suresnes, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - N Thilly
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France
| | - C Pulcini
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France.
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Bitar S, Agrinier N, Alla F, Rossignol P, Mebazaa A, Thilly N. Adhésion des prescriptions médicamenteuses aux recommandations de la société européenne de cardiologie, après une hospitalisation pour insuffisance cardiaque : résultats de la cohorte Epical2. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nguyen-Huu N, Thilly N, Rossignol P, Alla F, Mebazaa A, Girerd N, Agrinier N. Impact des profils phénotypiques identifiés à partir des caractéristiques cliniques sur la mortalité à un an chez les patients hospitalisés pour aggravation de leur insuffisance cardiaque à fraction d’éjection préservée : cohorte EPICAL2. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.023] [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: 11/26/2022] Open
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12
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Nguyen-Huu NH, Thilly N, Rossignol P, Alla F, Mebazaa A, Girerd N, Agrinier N. Impact des profils phénotypiques identifiés à partir des caractéristiques cliniques sur la mortalité à un an chez les patients hospitalisés pour aggravation de leur insuffisance cardiaque à fraction d’éjection préservée : cohorte EPICAL2. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Lévin C, Thilly N, Dousak M, Beraud G, Klesnik M, Uhan S, Nathwani D, Beovic B, Pulcini C. Perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance. Med Mal Infect 2018; 49:241-249. [PMID: 30266431 DOI: 10.1016/j.medmal.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/08/2017] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. METHOD European junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences. RESULTS The questionnaire was completed by 641 junior physicians: family medicine (37%), other medical specialties (e.g., pediatrics, internal medicine, neurology: 45%), surgical specialties (11%), and anesthesiology-intensive care specialty (7%). Most respondents (93%) declared being aware of the risk of bacterial resistance and 41% acknowledged prescribing antibiotics more often than necessary. Two factors were independently associated with appropriate prescription practices: a high perceived level of education on antibiotic use (OR=1.51; 95% CI [1.01-2.30]) and a medical specialty (OR=1.69; 95% CI [1.16-2.46]). Factors independently associated with taking into account adverse events of antibiotics were a good perceived knowledge of antibiotics (OR=3.71; 95% CI [2.09-6.61]), and a high perceived education level on antibiotics (OR=1.70; 95% CI [1.11-2.58]). CONCLUSION Our data can help better define interventions targeting junior physicians in antibiotic stewardship programs.
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Affiliation(s)
- C Lévin
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France.
| | - N Thilly
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France; Centre hospitalier universitaire de Nancy, plateforme d'aide à la recherche clinique, 54000 Nancy, France
| | - M Dousak
- Faculty of Social Sciences, University of Ljubljana, Slovenia
| | - G Beraud
- Santé des populations et pratiques optimales en santé, centre de recherche du CHU de Québec-Université Laval, hôpital Saint-Sacrement, Québec, Canada; Service de médecine interne et maladies infectieuses, centre hospitalier universitaire de Poitiers, 86021 Poitiers, France; Censtat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgique
| | - M Klesnik
- Department of Infectious Disease, University Medical Centre, Ljubljana, Slovenia
| | - S Uhan
- Faculty of Social Sciences, University of Ljubljana, Slovenia
| | - D Nathwani
- Infection Unit, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - B Beovic
- Department of Infectious Disease, University Medical Centre, Ljubljana, Slovenia
| | - C Pulcini
- EA 4360 APEMAC, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Fôret-de-Haye, BP 20199, 54505 Nancy, France; Service de maladies infectieuses et tropicales, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
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Thilly N, Pulcini C. Reliability of self-reported recent antibiotic use among the general population: a cross-sectional study: author's response. Clin Microbiol Infect 2018; 24:87-88. [DOI: 10.1016/j.cmi.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
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Vial F, Hime N, Feugeas J, Thilly N, Guerci P, Bouaziz H. Ultrasound assessment of gastric content in the immediate postpartum period: a prospective observational descriptive study. Acta Anaesthesiol Scand 2017; 61:730-739. [PMID: 28653359 DOI: 10.1111/aas.12930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/16/2017] [Accepted: 06/04/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pulmonary aspiration of gastric contents in pregnant women undergoing general anesthesia or sedation/analgesia in the peripartum period is a feared complication in obstetric anesthesia. We assessed the changes in antral cross-sectional area (CSA) with ultrasonography in laboring women and in the immediate postpartum period. PATIENTS AND METHODS In an observational study in a university-affiliated maternity, gastric ultrasonography examinations were performed in non-consecutive laboring women, after epidural analgesia insertion and after childbirth. Assessment of antral CSA, difficulty of performance on a numerical scale, and factors that could influence gastric content were noted. A cut-off value of 381 mm2 was taken for the diagnosis of empty stomach. RESULTS One hundred women were enrolled in the study. Median antral CSA was 469 mm2 [25th-75th] [324-591] after epidural insertion and 427 mm2 [316-574] after delivery. Antral CSA was ≥ 381 mm2 in 59 of 90 women (65%) after epidural insertion vs. 48 of 100 women (48%) after delivery (P = 0.59). Median variation of antral CSA between two measurements was 36 mm2 [-42 to 114]. Gastric ultrasonography was significantly more difficult to perform during labor than immediately post-delivery (median difficulty score 5 [2-7] vs. 2 [1-4], P < 0.0001). No risk factors (pain, anxiety, diabetes, smoking) were significantly associated with the occurrence of full stomach post-delivery. CONCLUSION This study demonstrated that 48% of parturients in the immediate postpartum period presented an antral CSA ≥ 381 mm2 , cut-off being accepted for diagnosis of empty stomach and emphasizes the need for re-assessing before any general anesthetic procedure.
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Affiliation(s)
- F. Vial
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - N. Hime
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - J. Feugeas
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - N. Thilly
- Clinical Epidemiology and Evaluation; University Hospital of Nancy; Nancy France
| | - P. Guerci
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
- Department of Anesthesiology and Critical Care Medicine; University Hospital of Nancy; Nancy France
- University of Lorraine; Nancy France
| | - H. Bouaziz
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
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Diallo K, Kern W, Béraud G, Giannella M, Kofteridis D, Kostyanev T, Pardo J, Retamar P, Thilly N, Pulcini C. Prise en charge des bactériémies/fongémies : une enquête européenne. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.155] [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: 11/30/2022]
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Collette C, Frimat L, Ayav C, Clerc-Urmes I, Martin A, Agrinier N, Laborde-Castérot H, Peters N, Thilly N. Risque hémorragique associé aux pratiques de prescription des antiagrégants plaquettaires et des anticoagulants oraux chez les hémodialysés chroniques. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.215] [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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Martin A, Thilly N, Ayav C, Clerc-Urmes I, Held P, Frimat L, Peters N. Étude T2HD, anticoagulants oraux et antiagrégants plaquettaires : pratiques, bénéfices et risques chez l’hémodialysé chronique. Données observationnelles. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Faivre JC, Agopiantz M, Loeb E, Cassinari K, Wack M, Catoire P, Braun M, Thilly N, Coudane H. [Evaluation of the theoretical teaching of postgraduate medical students in France]. Rev Med Interne 2015; 36:579-87. [PMID: 25980929 DOI: 10.1016/j.revmed.2015.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 12/13/2014] [Accepted: 02/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In France, medical students regularly complain about the shortcomings of their theoretical training and the necessity of its adaptation to better fit the needs of students. The goal was to evaluate the theoretical teaching practices in postgraduate medical studies by: 1) collecting data from medical students in different medical faculties in France; 2) comparing this data with expected practices when it is possible; 3) and proposing several lines of improvement. METHODS A survey of theoretical practices in the 3rd cycle of medical studies was conducted by self-administered questionnaires which were free of charge, anonymous, and administered electronically from July 3 to October 31, 2013 to all medical students in France. RESULTS National, inter-regional, regional and field internship educational content was absent in respectively 50.5%, 42.8%, 26.0% and 30.2% of cases. Medical students follow complementary training due to insufficient DES and/or DESC 2 training in 43.7% of cases or as part of a professional project in 54.9% of cases. The knowledge sought by medical students concerns the following crosscutting topics: career development (58.9%), practice management (50.7%), medical English (50.4%) and their specialty organization (49.9%). Fifty-four point one percent would like to be evaluated on their theoretical training on an annual basis. CONCLUSION The results of this first national survey give insights into the theoretical teaching conditions in postgraduate medical education in France and the aspirations of medical students.
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Affiliation(s)
- J-C Faivre
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Département universitaire de radiothérapie, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, CS 30519, 54511 Vandœuvre-lès-Nancy cedex, France; Inter syndicat national des internes, 75005 Paris, France.
| | - M Agopiantz
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Inter syndicat national des internes, 75005 Paris, France; Département d'endocrinologie et de gynécologie médicale, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - E Loeb
- Inter syndicat national des internes, 75005 Paris, France; Université de Caen Basse-Normandie, 14000 Caen, France; Département de psychiatrie, CHU de Caen, 14000 Caen, France
| | - K Cassinari
- Inter syndicat national des internes, 75005 Paris, France; Université de Rouen, 76000 Rouen, France; CHU de Rouen, 76000 Rouen, France
| | - M Wack
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Service d'épidémiologie et évaluation cliniques, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - P Catoire
- Université de Lille 2 droit et santé, 59000 Lille, France; Association nationale des étudiants en médecine de France, 75020 Paris, France
| | - M Braun
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Département de neuroradiologie, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - N Thilly
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Service d'épidémiologie et évaluation cliniques, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - H Coudane
- Université de Lorraine, 54511 Vandœuvre-lès-Nancy, France; Département de médecine légale, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France; Conférence des doyens des facultés de médecine, 75006 Paris, France
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Agrinier N, Schockmel M, Thilly N, Laborde-Castérot H, Jourdain P, Leclercq C, Dany F, Druelle J, Mulak G, Juillière Y. Efficacité d’un programme d’éducation thérapeutique sur la survie des patients insuffisants cardiaques à fraction d’éjection préservée. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.120] [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: 11/30/2022] Open
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Bonsergent E, Agrinier N, Thilly N, Legrand K, Lecomte E, Briançon S. Prévention du surpoids et de l’obésité des adolescents en milieu scolaire : résultats d’un essai contrôlé, randomisé en grappe. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Affiliation(s)
- N Thilly
- Clinical Epidemiology and Evaluation, CIC-EC CIE6 Inserm, University Hospital of Nancy, Nancy, France
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Jacques V, Vial F, Lerintiu M, Thilly N, Mc Nelis U, Raft J, Bouaziz H. Réhabilitation périopératoire des césariennes programmées non compliquées en France : enquête de pratique nationale. ACTA ACUST UNITED AC 2013; 32:142-8. [DOI: 10.1016/j.annfar.2013.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Bevilacqua S, Demoré B, Boschetti E, Doco-Lecompte T, May I, May T, Rabaud C, Thilly N. 15 years of antibiotic stewardship policy in the Nancy Teaching Hospital. Med Mal Infect 2011; 41:532-9. [PMID: 21907511 DOI: 10.1016/j.medmal.2011.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/04/2011] [Accepted: 08/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The authors report the results of a 15-year antibiotic stewardship policy in the Nancy Teaching Hospital and assess the impact of reinforcing this policy on antibiotic consumption. METHODS Antibiotic stewardship policy was initiated in the mid 90s and then reinforced from 2006 onwards. It was completed by prescription guidelines, nominative prescription of antibiotics, and an operational infectious diseases team (OIDT). The objectives were to promote antibiotic stewardship and decrease the use of extended broad spectrum or costly molecules and intravenous administration. Antibiotics consumption, as defined daily dose per 1000 patient days (DDD/1000PD) and in euros, was monitored from 2005 onwards. RESULTS Between 2005 and 2008, overall yearly cost of antibiotics dropped by 34% (-€1,308,902) and consumption in DDD/1000PD by 10%. This drop in consumption concerned all antibiotic classes. Teicoplanin prescription dropped by more than 50% and use of fluoroquinolone IV decreased by 15% in 3years. The operational team's interventions were effective since nearly 80% of suggested prescription amendments were accepted by prescribers. CONCLUSIONS This experiment shows that it is possible to implement antibiotic stewardship policy. Our results prove a significant decrease in overall consumption of antibiotic, a change in prescribing patterns, with a shift towards the use of cheaper antibiotics.
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Affiliation(s)
- S Bevilacqua
- Service des maladies infectieuses et tropicales, CHU Nancy, hôpitaux de Brabois, bâtiment P. Canton, rue du Morvan, Vandœuvre-Lès-Nancy, Nancy, France.
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Legrand K, Latarche C, Bonsergent E, Empereur F, Collin JF, Thilly N, Briançon S. Détermination d’une dose d’intervention reçue dans les essais non médicamenteux. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Abstract
Kidney transplantation is the treatment of choice to enhance survival, morbidity and quality of life perceived by the patient. Despite improvements in short-term outcomes, a gap persists comparing with health of general population. A stringent collaboration between the family physician, the community nephrologists, the transplant center and others specialists is required. Recent recommendations have been published in France.
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Affiliation(s)
- L Frimat
- Service de néphrologie, CHU Nancy, France; Nancy-Université, EA 4003, Nancy, France.
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Thilly N, Boini S, Kessler M, Briancon S, Frimat L. Management and control of hypertension and proteinuria in patients with advanced chronic kidney disease under nephrologist care or not: data from the AVENIR study (AVantagE de la Nephroprotection dans l'Insuffisance Renale). Nephrol Dial Transplant 2008; 24:934-9. [DOI: 10.1093/ndt/gfn566] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Thilly N, Boini S, Kessler M, Briançon S, Frimat L. Les pratiques thérapeutiques mises en place avant la dialyse sont bénéfiques pour la qualité de vie des patients insuffisants rénaux chroniques terminaux. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.03.056] [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: 11/30/2022] Open
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Frimat L, Thilly N, Boini S, Loos-Ayav C, Kessler M, Briançon S. Insuffisance rénale chronique terminale traitée : gestion du patient non planifié. Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78752-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thilly N, Boini S, Loos-Ayav C, Kessler M, Briançon S, Frimat L. Factors associated with anemia among incident pre-dialysis patients managed within a French care network. Clin Nephrol 2007; 67:81-8. [PMID: 17338427 DOI: 10.5414/cnp67081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Despite guidelines concerning the management of renal anemia, the international literature reports that a large proportion of pre-dialysis patients have hemoglobin values lower than the recommended level. The present study analyzed the evolution of pre-dialysis Hb levels and erythropoietin use over a 4-year period and investigated factors associated with anemia. METHODS A total of 1315 patients initiating dialysis in Lorraine, France, were enrolled since 2001-2004. For each year, anemia, defined by Hb <11 g/dl, and erythropoietin use were investigated in three groups: all patients, patients whose dialysis was planned and patients whose dialysis was unplanned. RESULTS At initiation of dialysis, all groups showed increases over time in mean hemoglobin levels, proportion of patients without anemia and with erythropoietin therapy. Among patients whose first dialysis was planned in 2004, 43.8% had anemia and 67.9% had received erythropoietin, compared with 75.4% and 29.4%, respectively, when dialysis was unplanned. Patients receiving unplanned dialysis were more likely to have anemia (odds ratio (OR) = 2.6), as were those with a serum albumin level < 3.5 g/dl (OR = 2.1), body mass index < 30 kg/m2 (OR = 1.9) (all p < 0.001) or glomerular filtration rate < 10 ml/min/1.73 m2 (OR = 1.4, p = 0.04). The year of dialysis initiation was also associated with anemia (p = 0.024). CONCLUSION The proportion ofpatients starting dialysis with anemia might be reduced by earlier nephrology referral leading to erythropoietin administration, planned first dialysis while residual renal function remains, and greater attention to nutritional status.
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Affiliation(s)
- N Thilly
- Department of Clinical Epidemiology and Evaluation, CEC-CIE6 Inserm (EA 4003), Nancy, France.
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Thilly N, Boini S, Kessler M, Briançon S, Frimat L. P11-12 - Suivi néphrologique et qualité de la prise en charge thérapeutique des insuffisants rénaux chroniques. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Thilly N, Pierson H, Collard C, Lecompte T, Dufay E. [Prophylaxis of venous thromboembolism in medical patients: from medical decision tools to the use of low molecular weight heparin]. Therapie 1998; 53:579-86. [PMID: 10070237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In France, low molecular weight heparins are largely used for prophylaxis of venous thromboembolic disease in medical patients. Although clinical trials show their efficacy in some particular clinical situations, there is no consensus about their use in non-surgical patients. A consequence is a wide disparity of prophylaxis of venous thromboembolic disease regimens: such a situation was observed during a practice survey in two medical units of the general hospital of Lunéville. So, prior assessment for pharmacists and physicians was carried out to determine tools which guide decision-making. These comprise clinical practice guidelines, a record card which allows the scoring of risk for venous thromboembolic disease and a clinical algorithm leading to the appropriate prescription according to the risk and the haematological results. A second concomitant practice survey was organized in the same two units in order to measure the appropriateness of the decision-making tools in medical practice. The four-month study included 108 medical patients. The process was successful because: (1) validated practices are improved, particularly in respect of biological monitoring during treatment, and (2) the disparity of therapeutic strategies is highly reduced, the clinical practice guidelines being followed in 81 per cent of all cases. Despite the lack of consensus, heightened awareness of the attendant risk in many medical conditions allows appropriate prophylactic measures to be taken. These measures need decision-making tools that are easy to use and that improve heparin prescribing and thus healthcare quality.
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Affiliation(s)
- N Thilly
- Service de pharmacie, centre hospitalier de Lunéville, France
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