24 results on '"Olivier Peyrony"'
Search Results
2. Effect of a delayed admission to the intensive care unit on survival after emergency department visit in patients with cancer: a retrospective observational study
- Author
-
Aude, Lucet, Jessica, Franchitti, Léa, Legay, Hélène, Milacic, Jean-Paul, Fontaine, Sami, Ellouze, and Olivier, Peyrony
- Subjects
Adult ,Intensive Care Units ,Patient Admission ,Neoplasms ,Emergency Medicine ,Humans ,Hospital Mortality ,Emergency Service, Hospital ,Retrospective Studies - Abstract
Delayed admission to the ICU is reported to be associated with worse outcomes in cancer patients.The main objective of this study was to compare the 180-day survival of cancer patients whether they were directly admitted to the ICU from the emergency department (ED) or secondarily from the wards after the ED visit.This was a retrospective observational study including all adult cancer patients that visited the ED in 2018 and that were admitted to the ICU at some point within 7 days from the ED visit.Delayed ICU admission.Survival at day 180 was plotted using Kaplan-Meier curves, and hazard ratio (HR) from Cox proportional-hazard models was used to quantify the association between admission modality (directly from the ED or later from wards) and survival at day 180, after adjustment to baseline characteristics.During the study period, 4560 patients were admitted to the hospital following an ED visit, among whom 136 (3%) patients had cancer and were admitted to the ICU, either directly from the ED in 101 (74%) cases or secondarily from the wards in 35 (26%) cases. Patients admitted to the ICU from the ED had a better 180-day survival than those admitted secondarily from wards (log-rank P = 0.006). After adjustment to disease status (remission or uncontrolled malignancy), survival at day 180 was significantly improved in the case of admission to the ICU directly from the ED with an adjusted HR of 0.50 (95% confidence interval, 0.26-0.95), P = 0.03.In ED patients with cancer, a direct admission to the ICU was associated with better 180-day survival compared with patients with a delayed ICU admission secondary from the wards. However, several confounders were not taken into account, which limits the validity of this result.
- Published
- 2022
3. Impact of Fast SARS-CoV-2 Molecular Point-Of-Care Testing on Patients’ Length of Stay in an Emergency Department
- Author
-
Audrey Baron, Olivier Peyrony, Maud Salmona, Nadia Mahjoub, Sami Ellouze, Maud Anastassiou, Constance Delaugerre, Jean-Paul Fontaine, Sylvie Chevret, Jerome LeGoff, and Linda Feghoul
- Subjects
Adult ,Microbiology (medical) ,General Immunology and Microbiology ,Ecology ,SARS-CoV-2 ,Physiology ,COVID-19 ,Cell Biology ,Length of Stay ,Infectious Diseases ,Point-of-Care Testing ,Genetics ,Humans ,Emergency Service, Hospital ,Pandemics - Abstract
The ID NOW COVID-19 system (IDNOW) is a point-of-care test (POCT) providing results within 15 min. We evaluated the impact of IDNOW use on patient length of stay (LOS) in an emergency department (ED). In the ED of Saint-Louis Hospital, Paris, France, adult patients requiring a rapid diagnosis of SARS-CoV-2 were tested with Cepheid Xpert Xpress SARS-CoV-2 or FilmArray respiratory panel RP2 in the virology laboratory between 18 October and 3 November 2020 (period 1) and with IDNOW between 4 November and 30 November 2020 (period 2). A total of 676 patients participated in the study, 337 during period 1 and 339 during period 2. The median LOS in ED was significantly higher in period 1 than in period 2 (276 versus 208 min
- Published
- 2022
4. Diagnoses in cancer patients presenting to the emergency department with acute thoracic symptoms: a retrospective observational study
- Author
-
Charlotte Lecomte, Jessica Franchitti, Jean-Paul Fontaine, Sami Ellouze, and Olivier Peyrony
- Subjects
Neoplasms ,Emergency Medicine ,Humans ,Emergency Service, Hospital ,Retrospective Studies - Published
- 2022
5. The Response of Emergency Departments (EDs) to the COVID-19 Pandemic: The Experience of 5 EDs in a Paris-Based Academic Hospital Trust
- Author
-
Daniel Aiham Ghazali, Christophe Choquet, Donia Bouzid, Olivier Peyrony, Jean-Paul Fontaine, Curac Sonja, Nicolas Javaud, Patrick Plaisance, Eric Revue, Anthony Chauvin, and Enrique Casalino
- Subjects
Paris ,Health (social science) ,Leadership and Management ,Health Policy ,Humans ,COVID-19 ,Trust ,Emergency Service, Hospital ,Care Planning ,Pandemics ,Hospitals - Abstract
The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.
- Published
- 2022
6. Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments : A Retrospective Cohort Study
- Author
-
Donia, Bouzid, Benoit, Visseaux, Christian, Kassasseya, Asma, Daoud, Florent, Fémy, Christelle, Hermand, Jennifer, Truchot, Sebastien, Beaune, Nicolas, Javaud, Olivier, Peyrony, Anthony, Chauvin, Prabakar, Vaittinada Ayar, Arthur, Bourg, Bruno, Riou, Stephane, Marot, Ben, Bloom, Marine, Cachanado, Tabassome, Simon, Yonathan, Freund, and Melkir, Saib
- Subjects
Adult ,Male ,Paris ,SARS-CoV-2 ,Internal Medicine ,COVID-19 ,Humans ,Female ,General Medicine ,Middle Aged ,Emergency Service, Hospital ,Retrospective Studies - Abstract
At the end of 2021, the B.1.1.529 SARS-CoV-2 variant (Omicron) wave superseded the B.1.617.2 variant (Delta) wave.To compare baseline characteristics and in-hospital outcomes of patients with SARS-CoV-2 infection with the Delta variant versus the Omicron variant in the emergency department (ED).Retrospective chart reviews.13 adult EDs in academic hospitals in the Paris area from 29 November 2021 to 10 January 2022.Patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test result for SARS-CoV-2 and variant identification.Main outcome measures were baseline clinical and biological characteristics at ED presentation, intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality.A total of 3728 patients had a positive RT-PCR test result for SARS-CoV-2 during the study period; 1716 patients who had a variant determination (818 Delta and 898 Omicron) were included. Median age was 58 years, and 49% were women. Patients infected with the Omicron variant were younger (54 vs. 62 years; difference, 8.0 years [95% CI, 4.6 to 11.4 years]), had a lower rate of obesity (8.0% vs. 12.5%; difference, 4.5 percentage points [CI, 1.5 to 7.5 percentage points]), were more vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), had a lower rate of dyspnea (26% vs. 50%; difference, 23.6 percentage points [CI, 19.0 to 28.2 percentage points]), and had a higher rate of discharge home from the ED (59% vs. 37%; difference, 21.9 percentage points [-26.5 to -17.1 percentage points]). Compared with Delta, Omicron infection was independently associated with a lower risk for ICU admission (adjusted difference, 11.4 percentage points [CI, 8.4 to 14.4 percentage points]), mechanical ventilation (adjusted difference, 3.6 percentage points [CI, 1.7 to 5.6 percentage points]), and in-hospital mortality (adjusted difference, 4.2 percentage points [CI, 2.0 to 6.5 percentage points]).Patients with COVID-19 illness and no SARS-CoV-2 variant determination in the ED were excluded.Compared with the Delta variant, infection with the Omicron variant in patients in the ED had different clinical and biological patterns and was associated with better in-hospital outcomes, including higher survival.None.
- Published
- 2022
7. Imaging strategies used in emergency departments for the diagnostic workup of COVID-19 patients during the first wave of the pandemic: a cost-effectiveness analysis
- Author
-
Sabrina, Kepka, Kevin, Zarca, Damien, Viglino, Nicolas, Marjanovic, Omide, Taheri, Olivier, Peyrony, Thibaut, Desmettre, Valérie, Wilme, Tania, Marx, Joris, Muller, Sebastien, Harscoat, Pierrick, Le Borgne, Eric, Bayle, Nicolas, Lefebvre, Yves, Hansmann, Samira, Fafi-Kremer, Mickaël, Ohana, Isabelle, Durand Zaleski, and Pascal, Bilbault
- Subjects
Microbiology (medical) ,Infectious Diseases ,Cost-Benefit Analysis ,Humans ,COVID-19 ,General Medicine ,Emergency Service, Hospital ,Pandemics ,Retrospective Studies - Abstract
Emergency departments (EDs) were on the front line for the diagnostic workup of patients with COVID-19-like symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering RT-PCR, which was time-consuming. The objective of our study was to compare the costs and organizational benefits of triage strategies in ED during the first wave of the COVID-19 pandemic.We conducted a retrospective study in five EDs in France, involving 3712 consecutive patients consulting with COVID-like symptoms between 9 March 2020 and 8 April 2020, to assess the cost effectiveness of imaging strategies (chest radiography, chest computed tomography (CT) scan in the presence of respiratory symptoms, systematic ultra-low-dose (ULD) chest CT, and no systematic imaging) on ED length of stay (LOS) in the ED and on hospital costs. The incremental cost-effectiveness ratio was calculated as the difference in costs divided by the difference in LOS.Compared with chest radiography, workup with systematic ULD chest CT was the more cost-effective strategy (average LOS of 6.89 hours; average cost of €3646), allowing for an almost 4-hour decrease in LOS in the ED at a cost increase of €98 per patient. Chest radiography (extendedly dominated) and RT-PCR with no systematic imaging were the least effective strategies, with an average LOS of 10.8 hours. The strategy of chest CT in the presence of respiratory symptoms was more effective than the systematic ULD chest CT strategy, with the former providing a gain of 37 minutes at an extra cost of €718.Systematic ULD chest CT for patients with COVID-like symptoms in the ED is a cost-effective strategy and should be considered to improve the management of patients in the ED during the pandemic, given the need to triage patients.
- Published
- 2022
8. Immune checkpoint blockade toxicity among patients with cancer presenting to the emergency department
- Author
-
Elie Azoulay, Jessica Franchitti, Ivonne Morra, Yoann Tieghem, Olivier Peyrony, Isabelle Madelaine-Chambrin, Sylvie Chevret, Rémi Flicoteaux, Barouyr Baroudjian, Jean-Paul Fontaine, and Sami Ellouze
- Subjects
Male ,Paris ,Abdominal pain ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,Fever ,Vomiting ,Antibodies, Monoclonal, Humanized ,Critical Care and Intensive Care Medicine ,Malignancy ,03 medical and health sciences ,Antineoplastic Agents, Immunological ,0302 clinical medicine ,Neoplasms ,Internal medicine ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Fatigue ,Aged ,Retrospective Studies ,Hepatitis ,business.industry ,Medical record ,Gold standard ,Antibodies, Monoclonal ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,Ipilimumab ,Nivolumab ,030220 oncology & carcinogenesis ,Emergency Medicine ,Female ,medicine.symptom ,Emergency Service, Hospital ,business - Abstract
ObjectivesWe sought to estimate the prevalence of patients with cancer presenting to the emergency department (ED) who are undergoing treatment with immune checkpoint blockade (ICB) therapy; report their chief complaints; describe and estimate the prevalence of immune-related adverse events (IRAEs).MethodsFour abstractors reviewed the medical records of patients with cancer treated with ICB who presented to an ED in Paris, France between January 2012 and June 2017. Chief complaints, underlying malignancy and ICB characteristics, and the final diagnoses according to the emergency physician were recorded. Abstractors noted if an emergency physician identified that a patient was receiving an ICB and if the emergency physician considered the possibility of an IRAE. The gold standard as to whether an IRAE was the cause was the patients’ referring oncologist’s opinion that the ED symptoms were attributed to ICB and IRAE according to post-ED medical records. Descriptive statistics were reported.ResultsAmong the 409 patients treated with ICB at our institution, 139 presented to the ED. Chief complaints were fatigue (25.2%), fever (23%), vomiting (13.7%), diarrhoea (13.7%), dyspnoea (12.2%), abdominal pain (11.5%), confusion (8.6%) and headache (7.9%). Symptoms were due to IRAEs in 20 (14.4%) cases. The most frequent IRAEs were colitis (40%), endocrine toxicity (30%), hepatitis (25%) and pulmonary toxicity (5%). Patients with IRAEs compared with those without them more frequently had melanoma; had received more distinct courses of ICB treatment, an increased number of ICB medications and ICB cycles; and had a shorter time course since the last infusion of ICB. Emergency physicians considered the possibility of an IRAE in 24 (17.3%) of cases and diagnosed IRAE in 10 (50%) of those with later confirmed IRAE. IRAE was more likely to be missed when the referring oncologist was not contacted or when the patient had respiratory symptoms, fatigue or fever.ConclusionsICB exposes patients to potentially severe IRAEs. Emergency physicians must identify patients treated with ICB and consider their toxicity when patients present to the ED with symptoms compatible with IRAEs.
- Published
- 2019
9. Echographie ciblée aux urgences : état des lieux et concept d’implémentation
- Author
-
Kouchiar Azarnoush, Youcef Guechi, Thomas Schmutz, Olivier Peyrony, Thierry Fumeaux, and Vincent Ribordy
- Subjects
General Medicine - Published
- 2019
10. Transfusion globulaire aux urgences. Étude rétrospective multicentrique
- Author
-
Danaé Gamelon, Sonja Curac, Anne-Laure Feral-Pierssens, Barbara Villoing, Sebastien Beaune, Hélène Goulet, Jean-Paul Fontaine, Anne François, France Pirenne, and Olivier Peyrony
- Subjects
Biochemistry (medical) ,Clinical Biochemistry ,Hematology - Abstract
Introduction Les objectifs de cette etude sont de decrire les transfusions en culots globulaires (CG) dans les services d’urgences (SU). Methodes Etude retrospective dans 12 SU incluant tous les patients adultes ayant ete transfuses en CG en janvier et fevrier 2018. Resultats Durant la periode d’inclusion, 529 patients ont ete transfuses en CG. L’âge median etait de 74 [59–85] ans. Ils avaient un antecedent de cancer ou d’hemopathie dans 185 (35,2 %) cas. Un signe de gravite et/ou une tachycardie et/ou un antecedent de cardiopathie ischemique etaient present chez 329 (62,4 %) patients. Un saignement etait objective aux urgences chez 242 (46 %) patients. L’hemoglobinemie (hb) avant transfusion etait de 6,9 [6,0–7,8] g/dL et variait peu qu’il y ait ou pas une hemorragie ou des signes de gravite. Huit (1,5 %) evenements indesirables etaient rapportes (6 OAP, 1 hemolyse, 1 poussee hypertensive). Dans 178 (33,6 %) cas, aucune justification de la transfusion n’etait notee dans le dossier. Trente-trois (6,2 %) patients n’avaient ni cardiopathie ischemique, ni signe de gravite, ni tachycardie, et avaient une hb initiale superieure a 7 g/dL. Cinq cent dix-huit patients (98,1 %) ont ete admis a l’hopital dont 438 (84,6 %) en unite d’hospitalisation de courte duree et, parmi eux, 120 (25,9 %) y sont restes moins de 24 heures. Vingt et un (4,1 %) patients sont decedes a l’hopital au decours de leur admission. Conclusion La transfusion de CG est un acte quasi quotidien dans un SU. Le seuil transfusionnel utilise aux urgences semble plutot bas et en accord avec les recommandations nationales. Une meilleure justification de l’indication de la transfusion dans le dossier medical serait souhaitable.
- Published
- 2021
11. Transfusion plaquettaire aux urgences. Étude rétrospective multicentrique
- Author
-
Romain Brune, Anthony Chauvin, Aiham Ghazali, Youri Yordanov, Aude Arsicaud, Pauline Gilleron, Marie-Caroline Richard, Anne François, France Pirenne, and Olivier Peyrony
- Subjects
Biochemistry (medical) ,Clinical Biochemistry ,Hematology - Published
- 2021
12. The 10 signs telling me that my cancer patient in the emergency department is at high risk of becoming critically ill
- Author
-
Olivier Peyrony and Nathan I. Shapiro
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Critical Care ,business.industry ,Critically ill ,Critical Illness ,Pain medicine ,Cancer ,030208 emergency & critical care medicine ,Emergency department ,Prognosis ,Critical Care and Intensive Care Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,030220 oncology & carcinogenesis ,Anesthesiology ,Practice Guidelines as Topic ,medicine ,Humans ,Medical emergency ,business ,Diagnostic Techniques and Procedures - Published
- 2018
13. Association between benzodiazepine outpatient treatment and risk of early seizure recurrence in emergency patients with seizure: A multicenter retrospective study
- Author
-
Laura Luhmann, Ulysse Hatabian, Valentin Belaud, Christian Kassasseya, Mélanie Roussel, Ben Bloom, Vincent Navarro, Olivier Peyrony, Emmanuel Montassier, Pierrick Le Borgne, Xavier Eyer, Marie Drogrey, Anthony Chauvin, Christophe Choquet, and Yonathan Freund
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Logistic regression ,Seizure recurrence ,03 medical and health sciences ,Benzodiazepines ,0302 clinical medicine ,Recurrence ,Seizures ,Internal medicine ,Outpatients ,medicine ,Clinical endpoint ,Humans ,Retrospective Studies ,Benzodiazepine ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Odds ratio ,Emergency department ,Confidence interval ,Emergency Medicine ,business ,Emergency Service, Hospital - Abstract
Introduction Seizures are one of the most common neurological reasons for emergency department (ED) visits. The benefit of ED-initiated, short-course outpatient benzodiazepine (BZD) treatment to prevent early recurrent seizure is unknown. This study assesses the risk of early seizure recurrence in patients who were or were not started with outpatient BZD in the ED. Methods This was a multicenter retrospective study conducted in eight French EDs between January 1 and December 31, 2019. All patients admitted for seizure were retrospectively screened and those discharged home from the ED were included. Patients with a history of chronic alcohol intoxication or chronic BZD therapy were excluded. Baseline characteristics, type of seizure, and 30-day outcome were retrospectively collected from the electronic health records. The primary endpoint was a return visit for seizure recurrence within 30 days. Independent factors associated with a seizure recurrence were identified using a multivariable binary logistic regression. Results A total of 2,218 patients were included and 1,820 were analyzed. The median age was 39 years and 60% were men. Among them 82% of patients had a generalized tonic-clonic seizure and 47% of seizures were idiopathic. BZD treatment was started in 773 (42%) patients. A total of 154 (8%) patients had an early recurrence at 30 days: 68 (9%) in patients who were treated with BZD versus 86 (8%) in patients who were not (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 0.71 to 1.43). In multivariable analysis, two factors were independently associated with the primary endpoint: chronic epileptic treatment (adjusted OR = 2.58, 95% CI = 1.55 to 4.37) and having had a focal seizure (adjusted OR = 2.16, 95% CI = 1.56 to 4.37). Conclusion BZD therapy was started in 42% of patients who were discharged home after ED visit for a seizure. This treatment was not an independent factor associated with the risk of return visit for seizure recurrence at 30 days.
- Published
- 2021
14. Point-of-care ultrasound with handheld devices in hematology: a monocentric single-stage phase II study
- Author
-
Olivier Peyrony, Rémi Bertinchamp, Simona Pagliuca, P. Bourrier, Cecile Bailly, Etienne Lengliné, Alexis Talbot, and Arben Elezi
- Subjects
Cancer Research ,medicine.medical_specialty ,Standard of care ,Modality (human–computer interaction) ,Single stage ,business.industry ,Point of care ultrasound ,Point-of-Care Systems ,Ultrasound ,Phases of clinical research ,Hematology ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Humans ,Medical physics ,Prospective Studies ,business ,Mobile device ,030215 immunology ,Point of care ,Ultrasonography - Abstract
Point of care ultrasound (PoCUS) with pocket-size devices is an efficient and safe imaging modality that became a standard of care in various clinical settings. However, its implementation in hematology has never been evaluated so far. We conducted a prospective monocentric study aiming to harvest data on its usage and to assess its diagnostic and interventional performance in improving the accuracy of basic physical examination in hematological patients. After a focused training program, six hematologists were trained and conducted this study. Sixty-two patients were included. Only in 19 cases, further specialized imaging was required, whereas, in 43 patients PoCUS was sufficient to address the clinical inquiries. The use of PoCUS devices was assessed for its performance difficulty and usefulness perception with satisfactory outcomes. This study represents a proof-of-concept application of PoCUS in hematology, suggesting benefits over the physical examination.KEY POINTSPoCUS is particularly attractive in a hematological setting because able to improve the accuracy of physical examination.A hematology-focused training in PoCUS using handheld devices can allow hematologists to perform bed-side diagnostic and interventional US-based exams.
- Published
- 2021
15. Surfaces and equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the emergency department at a university hospital
- Author
-
I. Brindel Berthon, P. Le Guen, Lionel Ades, D. Bouda, C. Mehlman, Lionel Galicier, Constance Delaugerre, Jean Paul Fontaine, A. Lebel M Baye, M. T. Tremorin, Louise Bondeelle, J. D. Bouaziz, R. Peffault de la Tour, D. Farge-Blancel, N. De Castro, E. De Kerviler, Sylvie Chevret, C. De Margerie-Mellon, A. Tazi, Linda Feghoul, B. Plaud, S. Cassonnet, Sami Ellouze, Olivier Peyrony, A. Benattia, Séverine Mercier-Delarue, D. Feyeux, J. Garestier, A. L. Jegu, Nadia Mahjoub, E. Kozakiewicz, K. Celli Lebras, C. Fauvaux, E. Brugnet, S. Maylin, J. M. Molina, G. Liegeon, M. Rouveau, B. Denis, H. Fenaux, J. Chabert, M. L. Chaix, Etienne Lengliné, C. Davoine, S. Caillat Zucman, Jérôme Le Goff, L. Aguinaga, I. Madelaine Chambrin, Juliette Soret, F. Depret, V. Fremeaux-Bacchi, Y. Achili, Rémi Bertinchamp, Micheline Thegat-Le Cam, David Boutboul, Eric Oksenhendler, F. Morin, E. Feredj, G. Martin de Frémont, M. Meunier, C. Dupin, M. Clément, J. Saussereau, L. Djaghout, G. Lorillon, Stephanie Harel, Anne Bergeron, G. Archer, B. Bercot, Maud Salmona, Audrey Gabassi, N. Schnepf, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Paris (UP), Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Génomes, biologie cellulaire et thérapeutiques (GenCellDi (UMR_S_944)), and Collège de France (CdF (institution))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)
- Subjects
medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Equipment ,010501 environmental sciences ,medicine.disease_cause ,01 natural sciences ,Article ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Contamination ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Personal protective equipment ,0105 earth and related environmental sciences ,Coronavirus ,Transmission (medicine) ,business.industry ,SARS-CoV-2 ,Emergency department ,Public Health, Environmental and Occupational Health ,Outbreak ,virus diseases ,COVID-19 ,3. Good health ,Surfaces ,Emergency medicine ,Equipment Contamination ,RNA, Viral ,business ,Emergency Service, Hospital - Abstract
Objectives Environmental contamination by patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through respiratory droplets suggests that surfaces and equipment could be a medium of transmission. We aimed to assess the surface and equipment contamination by SARS-COV-2 of an emergency department (ED) during the coronavirus infectious disease-2019 (COVID-19) outbreak. Methods We performed multiple samples from different sites in ED patients care and non-patient care areas with sterile premoistened swabs and used real-time reverse transcriptase polymerase chain reaction (RT-PCR) to detect the presence of SARS-CoV-2 ribonucleic acid (RNA). We also sampled the personal protective equipment (PPE) from health care workers (HCWs). Results Among the 192 total samples, 10 (5.2%) were positive. In patient care areas, 5/46 (10.9%) of the surfaces directly in contact with COVID-19 patients revealed the presence of SARS-CoV-2 RNA, and 4/56 (7.1%) of the surfaces that were not directly in contact with COVID-19 patients were positive. SARS-CoV-2 RNA was present only in the patients’ examination and monitoring rooms. Before decontamination SARS-CoV-2 RNA was present on the saturation clip, the scuff for blood pressure measurement, the stretcher, the plastic screens between patients and the floor. After decontamination, SARS-CoV-2 RNA remained on the scuff, the stretcher and the trolleys. All samples from non-patient care areas or staff working rooms were negative. Only one sample from the PPE of the HCWs was positive. Conclusions Our findings suggest that surfaces and equipment contamination by SARS-CoV-2 RNA in an ED during the COVID-19 outbreak is low and concerns exclusively patients’ examination and monitoring rooms, preserving non-patient care areas.
- Published
- 2020
16. Impact of panelists' experience on script concordance test scores of medical students
- Author
-
Jennifer Truchot, Sylvie Chevret, Pierre-Emmanuel Cailleaux, Jonathan Messika, Mariana Mirabel, Victoria Tea, Alice Hutin, David Calvet, Raphael Borie, Yousrah Baadj, Adrien Albaladejo, David Lebeaux, Martin Flamant, Alexandre Meunier, Xavier Treton, Damien Roux, Olivier Peyrony, and Clémence Martin
- Subjects
Medical knowledge ,medicine.medical_specialty ,Students, Medical ,020205 medical informatics ,Wilcoxon signed-rank test ,Concordance ,lcsh:Medicine ,02 engineering and technology ,Statistics, Nonparametric ,Education ,03 medical and health sciences ,0302 clinical medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,030212 general & internal medicine ,Experience level ,Medical student ,Median score ,Medical education ,lcsh:LC8-6691 ,Script concordance test ,lcsh:Special aspects of education ,business.industry ,lcsh:R ,Clinical reasoning ,Uncertainty ,General Medicine ,Panelist ,Test (assessment) ,Large cohort ,Physical therapy ,Clinical Competence ,Educational Measurement ,business ,Research Article - Abstract
Background The evaluation process of French medical students will evolve in the next few years in order to improve assessment validity. Script concordance testing (SCT) offers the possibility to assess medical knowledge alongside clinical reasoning under conditions of uncertainty. In this study, we aimed at comparing the SCT scores of a large cohort of undergraduate medical students, according to the experience level of the reference panel. Methods In 2019, the authors developed a 30-item SCT and sent it to experts with varying levels of experience. Data analysis included score comparisons with paired Wilcoxon rank sum tests and concordance analysis with Bland & Altman plots. Results A panel of 75 experts was divided into three groups: 31 residents, 21 non-experienced physicians (NEP) and 23 experienced physicians (EP). Among each group, random samples of N = 20, 15 and 10 were selected. A total of 985 students from nine different medical schools participated in the SCT examination. No matter the size of the panel (N = 20, 15 or 10), students’ SCT scores were lower with the NEP group when compared to the resident panel (median score 67.1 vs 69.1, p p N = 15 and 67.7 vs 68.4, p N = 10) and with EP compared to NEP (65.4 vs 67.1, p p p Conclusions Even though student SCT scores differed statistically according to the expert panels, these differences were rather weak. These results open the possibility of including less-experienced experts in panels for the evaluation of medical students.
- Published
- 2020
17. Accuracy of Emergency Department Clinical Findings for Diagnostic of Coronavirus Disease-2019
- Author
-
Arben Elezi, Léa Legay, Clémentine Rivière, Carole Marbeuf-Gueye, Alessandra Principe, Marie Simonetta, Marion Giroud, Vy Truong, P. Taboulet, Mathieu Tourdjman, Khalil Khenissi, Olivier Peyrony, Sami Ellouze, and Carl Ogereau
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Anosmia ,Physical examination ,Emergency department ,Lung ultrasound ,Internal medicine ,medicine ,Medical history ,In patient ,medicine.symptom ,business - Abstract
Objective: We sought to describe the medical history and clinical findings of patients attending the ED with suspected COVID-19 and estimate the diagnostic accuracy of patients’ characteristics for predicting COVID-19. Methods: We prospectively enrolled all patients tested for SARS-CoV-2 by RT-PCR in our ED from March 9, 2020 to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (“low”, “moderate”, “high”) rated by emergency physicians depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios (LR+/LR-). Results: We included 391 patients of whom 225 tested positive for SARS-CoV-2. RT-PCR was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when she or he thought that clinical probability was high. Patient-reported anosmia and the presence of bilateral B-lines on lung ultrasound had the highest LR+ for the diagnosis of COVID-19 (7.58; 95% CI 2.36–24.36 and 7.09; 95% CI 2.77–18.12 respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B-lines on lung ultrasound had the lowest LR- for the diagnosis of COVID-19 (0.33; 95% CI 0.25–0.43 and 0.26; 95% CI 0.15–0.45 respectively). Conclusions: Anosmia, emergency physician estimate of high clinical probability and bilateral B-lines on lung ultrasound increased the likelihood of identifying COVID-19 in patients presenting to the ED.
- Published
- 2020
18. Central venous oxygen saturation is not predictive of early complications in cancer patients presenting to the emergency department
- Author
-
Matthieu Resche-Rigon, Alessandra Principe, Ariane Gillet, Léa Legay, Marie Simonetta, Hélène Milacic, Jessica Franchitti, Jean-Paul Fontaine, Jihed Amami, Adélia Bragança, Elie Azoulay, Guillaume Dumas, Olivier Peyrony, and Anne Verrat
- Subjects
Male ,Catheterization, Central Venous ,Paris ,medicine.medical_specialty ,Prognostic factor ,Neutropenia ,Central Venous Pressure ,030204 cardiovascular system & hematology ,law.invention ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,law ,Neoplasms ,Internal medicine ,Internal Medicine ,medicine ,Humans ,In patient ,Oximetry ,Prospective Studies ,030212 general & internal medicine ,Aged ,business.industry ,Cancer ,Emergency department ,Middle Aged ,medicine.disease ,Intensive care unit ,Triage ,Oxygen ,ROC Curve ,Area Under Curve ,Emergency Medicine ,Female ,Emergency Service, Hospital ,business - Abstract
Central venous oxygen saturation (ScvO2) is easily observable in oncology patients with long-term central venous catheters (CVC), and has been studied as a prognostic factor in patients with sepsis. We sought to investigate the association between ScvO2 and early complications in cancer patients presenting to the ED. We prospectively enrolled adult cancer patients with pre-existing CVC who presented to the ED. ScvO2 was measured on their CVC. The outcome was admission to the intensive care unit (ICU) or mortality by day 7. ScvO2 was first studied as a continuous variable (%) with a ROC analysis and as a categorical variable (cut-off at 1 and a performance status > 2 (OR 4.76; 95% CI 1.81–12.52 and OR 6.23, 95% CI 2.40–16.17, respectively). This study does not support the use of ScvO2 to risk stratify cancer patients presenting to the ED.
- Published
- 2018
19. Monitoring Personalized Learning Curves for Emergency Ultrasound With Risk-adjusted Learning-curve Cumulative Summation Method
- Author
-
Arben Elezi, Anne Verrat, Olivier Peyrony, Matthieu Resche-Rigon, Kouchiar Azarnoush, Adélia Bragança, Jihed Amami, Léa Legay, Hélène Milacic, Ivonne Morra, P. Bourrier, Jean-Paul Fontaine, Pierre Taboulet, Jessica Franchitti, and Ariane Gillet
- Subjects
medicine.medical_specialty ,Image quality ,business.industry ,Brief Contributions ,education ,030208 emergency & critical care medicine ,CUSUM ,Personalized learning ,030204 cardiovascular system & hematology ,Emergency Nursing ,Inferior vena cava ,Session (web analytics) ,Education ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.vein ,Learning curve ,Emergency Medicine ,medicine ,Emergency ultrasound ,Medical physics ,business ,Risk adjusted - Abstract
Background Ultrasound (US) has been a regular practice in emergency departments for several decades. Thus, train our students to US is of prime interest. Because US image acquisition ability can be very different from a patient to another (depending on image quality), it seems relevant to adapt US learning curves (LCs) to patient image quality using tools based on cumulative summation (CUSUM) as the risk-adjusted LC CUSUM (RLC). Objectives The aim of this study was to monitor LC of medical students for the acquisition of abdominal emergency US views and to adapt these curves to patient image quality using RLC. Methods We asked medical students to perform abdominal US examinations with the acquisition of 11 views of interest on emergency patients after a learning session. Emergency physicians reviewed the student examinations for validation. LCs were plotted and the student was said proficient for a specific view if his LC reached a predetermined limit fixed by simulation. Results Seven students with no previous experience in US were enrolled. They performed 19 to 50 examinations of 11 views each. They achieve proficiency for a median of 9 (6-10) views. Aorta and right pleura views were validated by seven students; inferior vena cava, right kidney, and bladder by six; gallbladder and left kidney by five; portal veins and portal hilum by four; and subxyphoid and left pleura by three. The number of US examinations required to reach proficiency ranged from five to 41 depending on the student and on the type of view. LC showed that students reached proficiency with different learning speeds. Conclusions This study suggests that, when monitoring LCs for abdominal emergency US, there is some heterogeneity in the learning process depending on the student skills and the type of view. Therefore, rules based on a predetermined number of examinations to reach proficiency are not satisfactory.
- Published
- 2017
20. Bacterial Pneumonias in Immunocompromised Patients
- Author
-
Elie Azoulay, Andry Van de Louw, Adrien Mirouse, Virginie Lemiale, and Olivier Peyrony
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,Immunocompromised Host ,0302 clinical medicine ,Cancer Survivors ,law ,Risk Factors ,Epidemiology ,medicine ,Pneumonia, Bacterial ,Humans ,Intensive care medicine ,education ,education.field_of_study ,Cross Infection ,business.industry ,Bacterial pneumonia ,Immunosuppression ,medicine.disease ,Intensive care unit ,Review article ,Anti-Bacterial Agents ,Pneumonia ,030228 respiratory system ,Respiratory failure ,business - Abstract
With the overall improvement in survival of cancer patients and the widespread use of novel immunotherapy drugs for malignant as well as nonmalignant diseases, the prevalence of immunosuppression is rising in the population. Immunocompromised patients are particularly exposed to pulmonary infections which remain a leading cause for acute hypoxic respiratory failure and intensive care unit admission. Although fungal or opportunistic infections are always a concern, bacterial pneumonia remains the most common cause of pulmonary infection, is associated with a significant mortality, and has some specificity in this population. Adequate and timely prevention, diagnosis, and management of bacterial pneumonias require knowledge about the complex interplay between host factors (type and severity of immunosuppression) and bacterial pathogenesis, to improve the outcome. We provide an overview of bacterial pneumonias in immunocompromised patients including their epidemiology, risk factors with respect to the pattern of immunosuppression, microbiological characteristics, diagnostic approach, management, and prevention.
- Published
- 2019
21. Fulminant diabetes due to immune checkpoint inhibitors in the emergency department
- Author
-
Olivier Peyrony, Jean-Paul Fontaine, Lara Zafrani, Sami Ellouze, and Inna Mohamadou
- Subjects
medicine.medical_specialty ,Diabetic ketoacidosis ,business.industry ,Fulminant ,Cancer ,030208 emergency & critical care medicine ,General Medicine ,Pembrolizumab ,Emergency department ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Emergency Medicine ,medicine ,Intensive care medicine ,Complication ,Adverse effect ,business - Abstract
Immune checkpoint inhibitors (ICIs) are of growing importance in new cancer therapies, exposing patients to various and potentially severe immune-related adverse events and placing emergency physicians on the front line when they occur. If endocrine toxicity is a well-known complication of ICIs, fulminant diabetes with diabetic ketoacidosis is exceptional. We present a case of fulminant diabetes after only two cycles of pembrolizumab in a 53-year-old man with a history of metastatic lung cancer who presented to our emergency department with coma and acidosis revealing diabetic ketoacidosis. The patient was rehydrated and treated with insulin and recovered quickly. Lung toxicity was also suspected on CT-scan findings. This rare and life-threatening complication that developed unusually early during the treatment course may be challenging in a cancer patient. Therefore, emergency physicians should investigate symptoms in patients treated with checkpoint inhibitors and consider toxicity when they present to the ED with complaints compatible with an immune-related adverse event.
- Published
- 2020
22. Abdominal aortic occlusion due to acute thrombosis
- Author
-
Olivier Peyrony, Jean-Paul Fontaine, Léa Legay, and Patricia Refinetti
- Subjects
Male ,medicine.medical_specialty ,Aorta ,business.industry ,Aortic occlusion ,MEDLINE ,Arterial Occlusive Diseases ,Thrombosis ,Middle Aged ,Internal medicine ,medicine.artery ,Emergency Medicine ,Internal Medicine ,Cardiology ,Humans ,Medicine ,Aorta, Abdominal ,Acute thrombosis ,business - Published
- 2019
23. Acute Respiratory Failure in Patients with Hematologic Malignancies
- Author
-
Lara Zafrani, Elie Azoulay, Virginie Lemiale, Anne-Sophie Moreau, and Olivier Peyrony
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,High-resolution computed tomography ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Case fatality rate ,medicine ,Humans ,In patient ,Acute respiratory failure ,030212 general & internal medicine ,Intensive care medicine ,Respiratory Distress Syndrome ,medicine.diagnostic_test ,business.industry ,Organ dysfunction ,Middle Aged ,Intensive care unit ,Intensive Care Units ,Bronchoalveolar lavage ,030228 respiratory system ,Hematologic Neoplasms ,Acute Disease ,Female ,medicine.symptom ,business ,Respiratory care - Abstract
Acute respiratory failure occurs in up to 50% of patients treated for hematologic malignancies and is associated with a high case fatality rate. Because of residual organ dysfunction and time spent receiving respiratory care, underlying disease control is affected. Early admission to an intensive care unit for acute respiratory failure has proven benefit because it is the best place for rapid implementation of noninvasive diagnostic and therapeutic strategies. This article reviews the clinical approach and diagnostic strategies for acute respiratory failure in patients with hematologic malignancies.
- Published
- 2017
24. Utility of adding Pneumocystis jirovecii DNA detection in nasopharyngeal aspirates in immunocompromised adult patients with febrile pneumonia
- Author
-
Olivier Peyrony, Alexandre Alanio, Samia Hamane, Nathalie De Castro, Stéphane Bretagne, Nicolas Guigue, Jérôme LeGoff, Jean Menotti, Université Paris Diderot - Paris 7 (UPD7), Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris], Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Mycologie moléculaire, Service de maladies infectieuses et tropicales [Saint-Louis], Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des urgences, Hopital Saint-Louis [AP-HP] (AP-HP), Laboratoire de microbiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), AP-HP Hôpital Saint-Louis, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
- Subjects
Male ,[SDV]Life Sciences [q-bio] ,Pneumocystis pneumonia ,Pneumocystis carinii ,0302 clinical medicine ,Nasopharynx ,Pneumocystosis ,80 and over ,030212 general & internal medicine ,Fever of unknown origin ,DNA, Fungal ,Pneumocystis jirovecii ,Aged, 80 and over ,0303 health sciences ,biology ,medicine.diagnostic_test ,nasopharyngeal aspirates ,General Medicine ,Middle Aged ,3. Good health ,Infectious Diseases ,Real-time polymerase chain reaction ,Fungal ,Molecular Diagnostic Techniques ,Female ,Original Article ,influenza ,Adult ,Adolescent ,Lymphoproliferative disorders ,Real-Time Polymerase Chain Reaction ,DNA, Ribosomal ,Fever of Unknown Origin ,03 medical and health sciences ,Young Adult ,stomatognathic system ,medicine ,Humans ,quantitative real-time PCR ,Aged ,Ribosomal ,030306 microbiology ,DNA ,Pneumonia ,medicine.disease ,biology.organism_classification ,Virology ,Bronchoalveolar lavage ,RNA, Ribosomal ,Immunology ,RNA ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Detection of viral and bacterial DNA in nasopharyngeal aspirates (NPAs) is now a routine practice in emergency cases of febrile pneumonia. We investigated whether Pneumocystis jirovecii DNA could also be detected in these cases by conducting retrospective screening of 324 consecutive NPAs from 324 adult patients (198 or 61% were immunocompromised) admitted with suspected pulmonary infections during the 2012 influenza epidemic season, using a real-time quantitative polymerase chain reaction (PCR) assay (PjqPCR), which targets the P. jirovecii mitochondrial large subunit ribosomal RNA gene. These NPAs had already been tested for 22 respiratory pathogens (18 viruses and 4 bacteria), but we found that 16 NPAs (4.9%) were PjqPCR-positive, making P. jirovecii the fourth most prevalent of the 23 microorganisms in the screen. Eleven of the 16 PjqPCR-positive patients were immunocompromised, and five had underlying pulmonary conditions. Nine NPAs were also positive for another respiratory pathogen. Six had PjqPCR-positive induced sputa less than 3 days after the NPA procedure, and five were diagnosed with pneumocystis pneumonia (four with chronic lymphoproliferative disorders and one AIDS patient). In all six available pairs quantification of P. jirovecii DNA showed fewer copies in NPA than in induced sputum and three PjqPCR-negative NPAs corresponded to PjqPCR-positive bronchoalveolar lavage fluids, underscoring the fact that a negative PjqPCR screen does not exclude a diagnosis of pneumocystosis. Including P. jirovecii DNA detection to the panel of microorganisms included in screening tests used for febrile pneumonia may encourage additional investigations or support use of anti-pneumocystis pneumonia prophylaxis in immunocompromised patients.
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.