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L’utilisation correcte des systèmes d’inhalation est un critère d’inclusion de nombreuses études comparatives. Les patients peuvent cependant commettre des erreurs compromettant l’efficacité de leur inhalateur habituel. L’objectif de l’étude est de comparer l’utilisation des systèmes d’inhalation chez des patients souffrant de bronchopneumopathie chronique obstructive (BPCO) [n = 984]. L’évaluation est pratiquée par leurs médecins généralistes, avec une liste de vérifications établie pour chaque modèle (Aerolizer®, Autohaler®, Diskus®, spray ou Turbuhaler®). Seuls 24 % des patients BPCO traités par spray et 34 % à 40 % des patients traités par les systèmes déclenchés par l’inspiration n’ont fait aucune erreur d’utilisation. La fréquence des erreurs majeures varie selon le dispositif : 11,5 % à 14,9 % des sujets traités par Aerolizer®, Autohaler® ou Diskus® versus 37,4 % et 38,1 % des patients traités par spray et Turbuhaler® respectivement. La surestimation d’une technique d’inhalation correcte est plus fréquente avec le Turbuhaler® (24,7 %) par rapport au spray (2,1 %). Ces résultats justifient le développement de programmes d’éducation destinés aux patients BPCO et aux prescripteurs. Mots clés : BPCO, aérosol, inhalation, médecine générale Abstract The correct use of inhalation devices is an inclusion criterion in many comparative studies. However, patients can make errors, thus compromising the effectiveness of their own inhaler. The aim of the study is to evaluate inhaler use by patients with chronic obstructive pulmonary disease (COPD) [n = 984]. General practitioners assessed inhalation technique, using a specific checklist previously established for each inhaler model (Aerolizer®, Autohaler®, Diskus®, a pressurised metered-dose inhaler (pMDI) or a Turbuhaler®). A total of 24% of the patients using a pMDI did not make an error compared with 34-40% of those using breath-actuated devices. The frequency of critical errors varied according to the device: 11.5-14.9% of the subjects using an Aerolizer®, Autohaler® or Diskus® versus 37.4% and 38.1% of the patients using a pMDI and a Turbuhaler®, respectively. The proper use of the Turbuhaler® is often overestimated (24.7%) compared with the pMDI (2.1%). The development of educational programmes for patients and prescribers is needed to improve the management of COPD. Keywords: COPD, device, inhaler, primary care Texte reçu le 29 août 2003 ; accepté le 23 octobre 2003 [ABSTRACT FROM AUTHOR]

Background Imatinib has dramatically improved the prognosis of advanced gastrointestinal stromal tumours (GISTs). Clinical trial data showed that patients with trough imatinib plasma concentrations (Cmin) below 1100 ng/ml (quartile 1) had shorter time to progression, but no threshold has been defined. The main objective of this study was to investigate in advanced GIST whether a Cmin threshold value associated with a longer progression-free survival (PFS) could be specified. This would be the first step leading to therapeutic drug monitoring of imatinib in GIST. Patients and methods Advanced GIST patients (n = 96) treated with imatinib 400 mg/d (41 stomach, 34 small bowel, and 21 other primary site localisations) were prospectively included in this real-life setting study. Routine plasma level testing imatinib (Cmin) and clinical data of were recorded prospectively. Results Small bowel localisation was associated with an increased relative risk of progression of 3.09 versus stomach localisation (p = 0.0255). Mean Cmin (±standard deviation) was 868 (±536) ng/ml with 75% inter-individual and 26% intra-patient variability. A Cmin threshold of 760 ng/ml defined by log-rank test was associated with longer PFS for the whole population (p = 0.0256) and for both stomach (p = 0.043) and small bowel (p = 0.049) localisations when analysed separately. Multivariate Cox regression analysis found that Cmin above 760 ng/ml was associated with 65% reduction risk of progression (p = 0.0271) in the whole population independently of the anatomical localisation. Conclusion Concentration of imatinib significantly influences duration of tumour control treatment in GIST patients with a Cmin threshold of 760 ng/ml associated with prolonged PFS in real-life setting. [ABSTRACT FROM AUTHOR]

Abstract: The aims of the present study were to assess the prevalence and comorbidity of psychiatric disorders in subjects with intentional drug overdose and to explore whether there were gender differences in prevalence and comorbidity. A standardized psychiatric evaluation was performed in 100 randomly selected subjects, 18 years old and older, with intentional drug overdose referred to an emergency department. The prevalences of psychiatric morbidity and comorbidity were very high in both genders: 88% presented with at least one psychiatric diagnosis, and three-quarters presented with comorbid psychiatric disorders. Affective and anxiety disorders were the most prevalent diagnoses. One patient out of three presented with alcohol or substance misuse. Compared to females, males suffered five times more often from substance misuse and three times more often from psychotic syndrome and were three times less likely to present with anxiety disorder. When subjects are referred to hospital for intentional drug overdose, medical management should systematically involve a psychiatric assessment in order to identify not only affective and anxiety disorders, but also alcohol and substance misuse, due to the high prevalence of these disorders, especially in male subjects. [Copyright &y& Elsevier]