21 results on '"Pateron D"'
Search Results
2. Comparison of fondaparinux with low molecular weight heparin for venous thromboembolism prevention in patients requiring rigid or semi-rigid immobilization for isolated non-surgical below-knee injury
- Author
-
Samama, C. M, Lecoules, N, Kierzek, G, Claessens, Y. E, Riou, B, Rosencher, N, Mismetti, P, Sautet, A, Barrellier, M. -T, Apartsin, K, Jonas, M, Caeiro, J. R, van der Veen, A. H, Roy, P. -M, Accetta, R, Adnet, F, Akhmetova, I, Banihachemi, J. -J, Barbarash, O. L, Barrelier, M. -T, Belentsov, S. M, Bella, S, Benítez, P. C, Bouget, J, Brassart, C, Brem, M, Brule, K, Caeiro Rey, J. R, Caeiro, R, Caimi, M, Castelli, C, Causero, A, Cebrián, A. F, Chabe, C, Cherny, S, Chernyatina, M, Coletta, S. D, Compagnon, A, Couy, C, Crespo, E. C, D'Errico, A. -M, Dahmen, G. P, Deschamps, P, Detomatis, C, Direr, M. -A, Dominguez, S. S, Dupont, P, Ershova, O. B, Faensen, B, Ferrari, S, Ferrata, P, Fleur, F, Fontanel, A, Foronda, I. E, Fort, P. -A, Fragneaud, C, Franchin, F, Franco, M. L, Froehlich, H, Galdo Pérez, J. M, Gauss, H, Gerisch, S, Girard, P, Gottwalles, Y, Haouas, T, Huber, X, Huther, P, Ibán, M. R, Joly, L. -M, Joseph, A, Kazakov, Y, Koehler, J, Koroteev, R, Kort, N. P, Kotelnikov, M. V, Kuropatkin, G, Lablanche, C, Lahne, U, Le Gall, C, Leizorovicz, A, Leluherne, Y, Lenskaya, L, Louis, K, Lozano Moreno, F. J, Maier-Bosse, I, Mairal, O. M, Mallem, A, Manoukian, A, Martos, T. A, Martínez, A. D, Masmoudi, R, Massè, A, Merah, A, Meyer, V, Nachbaur, G, Namir, N, Navarrete, F. G, Olmeda, A, Orinel, E, Pateron, D, Peidró, L, Plechev, V. V, Poissonnet, M, Popov, A, Potel, G, Preusche, A, Quentzel, S, Quilliec, C, Rabier, P, Ramos, M. M, Rebezov, K, Renaud, B, Roca Ruiz, L. J, Ruppe, U, Saliceto, A, Schluender, M, Schmidt, J, Schulz, A. P, Serikova, S, Sevestre, M. -A, Shvalb, P. G, Smirnov, G, Sokurenko, G. Y, Solodovnikov, A, Soroka, V. V, Subbotin, Y, Suplotova, L, Sánchez, M. C, Testroote, M. J. G, Tyuyushev, I, Vasiliev, A, Vasselle, M, Verleisdonk, E. J. M. M, Voss, G, Wallet, E, Weimar, H, Weisslinger, N, Wetzig, L, Yuzko, T, Zafra Jiménez, J. A, Zgura, V, Zhukov, B. N, Zonova, E, Zubareva, N, Zufferey, P, de Fatima Ouedraogo, M, van Haren-Breure, E, van Olden, G. D. J., Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Hôtel-Dieu [Paris], Service des Urgences ( TOULOUSE - Urgences ), CHU Toulouse [Toulouse], Service des Urgences ( HOTEL DIEU - Urgences ), Assistance publique - Hôpitaux de Paris (AP-HP), Département de Médecine d'Urgence ( MONACO - Urgences ), Princess Grace Hospital Center, Service d'Accueil des Urgences [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [APHP]-Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Saint Etienne, Université Jean Monnet [Saint-Étienne] ( UJM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), Université Jean Monnet [Saint-Étienne] ( UJM ), Service de Chirurgie Orthopédique et Traumatologie [CHU Saint-Antoine], CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP), Service d'Explorations Fonctionnelles, Hôpital côte de nacre, Scientific Center for Reconstructive and Restorative Surgery ( RUSSIE - IRKUTSK - SCRRS ), Academy of Medical Sciences, Sankt-Joseph Hospital ( Sankt-Joseph Hospital ), Sankt-Joseph Hospital, Department of Orthopedic Surgery ( SANTIAGO - Chir Ortho ), Santiago de Compostela University Hospital, Department of Surgery ( EINDHOVEN - Surgery ), Catharina Hospital, Centre de Recherche Clinique ( CRC Angers ), Université d'Angers ( UA ) -CHU Angers, Service des Urgences ( PMR ), CHRU - ANGERS, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des Urgences (TOULOUSE - Urgences), Service des Urgences (HOTEL DIEU - Urgences), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Médecine d'Urgence (MONACO - Urgences), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service des Explorations Fonctionnelles [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Scientific Center for Reconstructive and Restorative Surgery (RUSSIE - IRKUTSK - SCRRS), Sankt-Joseph Hospital (Sankt-Joseph Hospital), Department of Orthopedic Surgery (SANTIAGO - Chir Ortho), Department of Surgery (EINDHOVEN - Surgery), Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), and Service des Urgences (PMR)
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Deep vein ,[SDV]Life Sciences [q-bio] ,Low molecular weight heparin ,030204 cardiovascular system & hematology ,Fondaparinux ,Asymptomatic ,03 medical and health sciences ,Immobilization ,0302 clinical medicine ,Polysaccharides ,medicine ,Humans ,030212 general & internal medicine ,[ SDV ] Life Sciences [q-bio] ,Heparin ,business.industry ,low molecular weight heparin ,Low-Molecular-Weight ,Anticoagulants ,Hematology ,Venous Thromboembolism ,Bleed ,Heparin, Low-Molecular-Weight ,bleeding ,medicine.disease ,Thrombosis ,3. Good health ,Pulmonary embolism ,Surgery ,fondaparinux ,lower limb ,prophylaxis ,trauma ,venous thromboembolism ,Female ,Leg Injuries ,medicine.anatomical_structure ,Nadroparin ,medicine.symptom ,business ,medicine.drug - Abstract
International audience; BACKGROUND: In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. OBJECTIVES: To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 mL min(-1) ) over nadroparin 2850 anti-factor Xa IU. PATIENTS AND METHODS: In this international, multicenter, randomized, open-label study, patients with an isolated non-surgical unilateral below-knee injury having at least one additional major risk factor for VTE and requiring, in the Investigator's opinion, rigid or semi-rigid immobilization for 21-45 days with thromboprophylaxis up to complete mobilization received subcutaneously once-daily either fondaparinux or nadroparin. The primary efficacy outcome was the composite of VTE (symptomatic or ultrasonographically detected asymptomatic deep vein thrombosis of the lower limb or symptomatic pulmonary embolism) and death up to complete mobilization. The main safety outcome was major bleeding. RESULTS: We randomized 1349 patients (mean age 46 years): 88.7% had a bone fracture, and 83.8% had a plaster cast fitted (mean duration of immobilization, 34 days). The primary efficacy outcome occurred in 15 of 584 patients (2.6%) in the fondaparinux group and 48 of 586 patients (8.2%) in the nadroparin group (odds ratio, 0.30; 95% confidence interval [CI], 0.15-0.54; P
- Published
- 2013
3. 33 Diagnostic accuracy of cardiovascular screening using pocket-size ultrasound in patients with dyspnea in the emergency setting
- Author
-
Poulizac, C., primary, Soulat-Dufour, L., additional, Lang, S., additional, Hermand, C., additional, El Asri, C., additional, Adavane, S., additional, Ederhy, S., additional, Boccara, F., additional, Pateron, D., additional, and Cohen, Ariel, additional
- Published
- 2015
- Full Text
- View/download PDF
4. 30 Pocket-size ultrasound does not alter the diagnosis of the cardiologist in patients admitted for chest pain in a cardiac unit
- Author
-
Soulat-Dufour, L., primary, Lang, S., additional, Rousseau, A. Pasteur, additional, Poulizac, C., additional, Hermand, C., additional, El Asri, C., additional, Boyer-Chatenet, L., additional, Adavane, S., additional, Ederhy, S., additional, Boccara, F., additional, Pateron, D., additional, and Cohen, Ariel, additional
- Published
- 2015
- Full Text
- View/download PDF
5. An unusual aetiology of abdominal pain: the forgotten bullet
- Author
-
Yordanov, Y., primary, Pateron, D., additional, and May, A., additional
- Published
- 2014
- Full Text
- View/download PDF
6. A Simulated Discrete-Event and Queuing Model to Reduce Transfers from the Emergency Department and to Optimize Hospital Bed Management
- Author
-
Wargon, M., primary, Taright, N., additional, Casalino, E., additional, Pateron, D., additional, and Guidet, B., additional
- Published
- 2014
- Full Text
- View/download PDF
7. Variability of intensive care admission decisions for the very elderly
- Author
-
Boumendil, A, Angus, DC, Guitonneau, AL, Menn, AM, Ginsburg, C, Takun, K, Davido, A, Masmoudi, R, Doumenc, B, Pateron, D, Garrouste-Orgeas, M, Somme, D, Simon, T, Aegerter, P, Guidet, B, Boumendil, A, Angus, DC, Guitonneau, AL, Menn, AM, Ginsburg, C, Takun, K, Davido, A, Masmoudi, R, Doumenc, B, Pateron, D, Garrouste-Orgeas, M, Somme, D, Simon, T, Aegerter, P, and Guidet, B
- Abstract
Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear. Trial Registration: ClinicalTrials.gov NCT00912600. © 2012 Boumendil et al.
- Published
- 2012
8. La formation continue en Médecine d'Urgence: table ronde
- Author
-
4èmes Journées Européennes de Médecine d'Urgence (JEMU) (25-27 Nov. 2004: Biarritz), Pateron, D, Lheureux, Philippe, Yersin, B, Williams, D, 4èmes Journées Européennes de Médecine d'Urgence (JEMU) (25-27 Nov. 2004: Biarritz), Pateron, D, Lheureux, Philippe, Yersin, B, and Williams, D
- Abstract
info:eu-repo/semantics/nonPublished
- Published
- 2004
9. Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial.
- Author
-
Thietart S, Boumendil A, Pateron D, Guidet B, and Vallet H
- Abstract
Background: Little is known about the impact of hospital trajectory on survival and functional decline of older critically ill patients. We evaluate 6-month outcomes after admission to: intensive care units (ICU), intermediate care units (IMCU) or acute medical wards (AMW)., Methods: Data from the randomised prospective multicentre clinical trial ICE-CUB2 was secondarily analysed. Inclusion criteria were: presenting at emergency departments in critical condition; age ≥ 75 years; activity of daily living (ADL) ≥ 4; preserved nutritional status; and no active cancer. A Cox model was fitted to compare survival according to admission destination adjusting for patient characteristics. Sensitivity analysis using multiple imputation for missing data and propensity score matching were performed., Results: Among 3036 patients, 1675 (55%) were women; median age was 85 [81-99] years; simplified acute physiology score (SAPS-3) 62 [55-69]; 1448 (47%) were hospitalised in an ICU, 504 in IMCU (17%), and 1084 (36%) in AMW. Six-month mortality was 629 (44%), 155 (31%) and 489 (45%) after admission in an ICU, IMCU and AMW (p < 0.001), respectively. In multivariate analysis, AMW admission was associated with worse 6-month survival (HR 1.31, 95% CI 1.04-1.63) in comparison with IMCU admission, after adjusting for age, gender, comorbidities, ADL, SAPS-3 and diagnosis. Survival was not significantly different between patients admitted in an ICU and an IMCU (HR 1.17, 95% CI 0.95-1.46). Sensitivity analysis using multiple imputation for missing data and propensity score matching found similar results. Hospital destination was not significantly associated with the composite criterion loss of 1-point ADL or mortality. Physical and mental components of the 12-Item Short-Form Health Survey were significantly lower in the acute medical ward group (34.3 [27.5-41.7], p = 0.037 and 44.3 [38.6-48.6], p = 0.028, respectively) than in the ICU group (34.7 [28.4-45.3] and 45.5 [40.0-50.0], respectively) and IMCU group (35.7 [29.7-43.8] and 44.5 [39.7-48.4], respectively)., Conclusions: Admission in an AMW was associated with worse 6-month survival in older critically ill patients in comparison with IMCU admission, with no difference of survival between ICU and IMCU admission. There were no clinically relevant differences in quality of life in each group. These results should be confirmed in specific studies and raise the question of dedicated geriatric IMCUs., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
10. Admission decisions to intensive care units in the context of the major COVID-19 outbreak: local guidance from the COVID-19 Paris-region area.
- Author
-
Azoulay É, Beloucif S, Guidet B, Pateron D, Vivien B, and Le Dorze M
- Subjects
- COVID-19, Humans, Pandemics, Paris epidemiology, Practice Guidelines as Topic, Clinical Decision-Making, Coronavirus Infections epidemiology, Coronavirus Infections therapy, Disease Outbreaks, Intensive Care Units, Patient Admission, Pneumonia, Viral epidemiology, Pneumonia, Viral therapy
- Abstract
SARS-CoV-2 has caused a global pandemic unprecedented in size, spread, severity, and mortality. The influx of patients with severe or life-threatening disease means that in some cases, the available medical resources are not sufficient to meet the needs of all patients. Hence, healthcare providers may be forced to make difficult choices about which patients should be referred to the ICU. This document is intended to provide conceptual support to all healthcare teams currently engaged in the frontline management of the COVID-19 pandemic. It aims to assist physicians in the decision-making process for ICU admission and to help them provide uninterrupted and high-quality care.
- Published
- 2020
- Full Text
- View/download PDF
11. Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial.
- Author
-
Javaud N, Soria A, Maignan M, Martin L, Descamps V, Fain O, Bouillet L, Berard F, Tazarourte K, Roy PM, Fontaine JP, Bagot M, Khellaf M, Goulet H, Lapostolle F, Casalino E, Doutre MS, Gil-Jardine C, Caux F, Chosidow O, Pateron D, Vicaut E, and Adnet F
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Acute Disease, Dose-Response Relationship, Drug, Double-Blind Method, Follow-Up Studies, Glucocorticoids administration & dosage, Histamine H1 Antagonists administration & dosage, Prospective Studies, Quality of Life, Recurrence, Treatment Outcome, Randomized Controlled Trials as Topic, Multicenter Studies as Topic, Cetirizine administration & dosage, Prednisone administration & dosage, Urticaria drug therapy
- Abstract
Introduction: This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria., Methods and Analysis: This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for >6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks., Ethics and Dissemination: The protocol has been approved by the Comité de Protection des Personnes Sud-Méditerranée II and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals., Trial Registration Number: NCT03545464., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
12. General practitioner consultation after a visit to the emergency department: an observational study.
- Author
-
Rotival J, Yordanov Y, Thiebaud PC, Pelletier-Fleury N, Jacquet E, Debuc E, Pateron D, and Naouri D
- Subjects
- Adult, Age Factors, Cohort Studies, Female, Humans, Male, Middle Aged, Paris, Surveys and Questionnaires, Emergency Service, Hospital statistics & numerical data, General Practitioners, Referral and Consultation statistics & numerical data
- Abstract
Background: Some studies have demonstrated an association between poor continuity of care, high likelihood of 'inappropriate' use of emergency departments (EDs) and avoidable hospitalization. However, we lack data concerning primary care use after an ED visit., Objective: Identify the determinants of a visit to the general practitioner (GP) after an ED visit.Methods., Design: Observational study (single-centre cohort)., Setting: One emergency department in Paris, France., Subjects: All adult patients who presented at the ED and were discharged., Main Outcome Measure: We collected data by the use of a standardized questionnaire, patients' medical records and a telephonic follow-up. Descriptive analyses were performed to compare individuals with and without a GP. Then, for those with a GP, multivariate logistic regression was used to identify the determinants of the GP consultation., Results: We included 243 patients (mean age 45 years [±19]); 211 (87%) reported having a GP. Among those who reported having a GP, 52% had consulted their GP after the ED visit. Not having a GP was associated with young age, not having complementary health insurance coverage, and being single. GP consultation was associated with increasing age [adjusted odds ratios (aOR) = 1.03], poor self-reported health status (aOR = 2.25), medical complaints versus traumatic injuries (aOR = 2.24) and prescription for sick note (aOR = 5.74)., Conclusion: Not having a GP was associated with factors of social vulnerability such as not having complementary health insurance coverage. For patients with a GP, consultation in the month after an ED visit seems appropriate, because it was associated with poor health status and medical complaints., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF
13. Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study.
- Author
-
Thiebaud PC, Yordanov Y, Galimard JE, Raynal PA, Beaune S, Jacquin L, Ageron FX, and Pateron D
- Subjects
- Adult, Aged, Aged, 80 and over, Female, France, Gastrointestinal Hemorrhage therapy, Humans, Male, Middle Aged, Prospective Studies, Symptom Assessment, Emergency Service, Hospital, Endoscopy, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology
- Abstract
Background: Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective. We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes., Method: This was a prospective, observational, multicenter study covering 4 consecutive days in November 2013. Participating EDs were part of the Initiatives de Recherche aux Urgences network coordinated by the French Society of Emergency Medicine. All patients with suspected UGB in these EDs were included., Results: In total, 110 EDs participated, including 194 patients with suspected UGB (median age 66 years [Q1-Q3: 51-81]). Overall, 104 patients (54%) had hematemesis and 75 (39%) melena. Endoscopy revealed lesions in 121 patients, mainly gastroduodenal ulcer or ulcerations (41%) or bleeding lesions due to portal hypertension (20%). The final diagnosis of UGB was reversed by endoscopy in only 3% of cases. Overall, 67 patients (35%) had at least one severity sign. Twenty-one patients died (11%); 40 (21%) were hospitalized in intensive care units and 126 (65%) in medicine departments; 28 (14%) were outpatients. Mortality was higher among patients with clinical and biological severity signs., Conclusion: Most of the UGB cases in EDs are revealed by hematemesis. The emergency physician diagnosis of UGB is rarely challenged by the endoscopic findings.
- Published
- 2017
- Full Text
- View/download PDF
14. Designing and conducting a cluster-randomized trial of ICU admission for the elderly patients: the ICE-CUB 2 study.
- Author
-
Boumendil A, Woimant M, Quenot JP, Rooryck FX, Makhlouf F, Yordanov Y, Delerme S, Takun K, Ray P, Kouka MC, Poly C, Garrouste-Orgeas M, Thomas C, Simon T, Azerad S, Leblanc G, Pateron D, and Guidet B
- Abstract
Background: The benefit of ICU admission for elderly patients remains controversial. This report highlights the methodology, the feasibility of and the ethical and logistical constraints in designing and conducting a cluster-randomized trial of intensive care unit (ICU) admission for critically ill elderly patients., Methods: We designed an interventional open-label cluster-randomized controlled trial in 24 centres in France. Clusters were healthcare centres with at least one emergency department (ED) and one ICU. Healthcare centres were randomly assigned either to recommend a systematic ICU admission (intervention group) or to follow standard practices regarding ICU admission (control group). Clusters were stratified by the number of ED annual visits (<44,616 or >44,616 visits), the presence or absence of a geriatric ward and the geographical area (Paris area vs other regions in France). All elderly patients (≥75 years of age) who got to the ED were assessed for eligibility. Patients were included if they had one of the pre-established critical conditions, a preserved functional status as assessed by an ADL scale ≥4 (0 = very dependent, 6 = independent), a preserved nutritional status (subjectively assessed by physicians) and without active cancer. Exclusion criteria were an ED stay >24 h, a secondary referral to the ED and refusal to participate. The primary outcome was the mortality at 6 months calculated at the individual patient level. Secondary outcomes were ICU and hospital mortality, as well as ADL scale and quality of life (as assessed by the SF-12 Health Survey) at 6 months., Results: Between January 2012 and April 2015, 3036 patients were included in the trial, 1518 patients in 11 clusters allocated to intervention group and 1518 patients in 13 clusters allocated to standard care. There were 51 protocol violations., Conclusions: The ICE-CUB 2 trial was deemed feasible and ethically acceptable. The ICE-CUB 2 trial will be the first cluster-randomized trial to assess the benefits of ICU admission for selected elderly patients on long-term mortality. Trial registration Clinical trials.gov identifier: NCT01508819.
- Published
- 2016
- Full Text
- View/download PDF
15. Emergency medicine as a primary specialty-French emergency medicine residents' attitudes.
- Author
-
Yordanov Y, Sobotka J, Dahan B, Jacquin L, Kalpokdjian A, and Pateron D
- Subjects
- Cross-Sectional Studies, France, Humans, Attitude of Health Personnel, Emergency Medicine education, Internship and Residency, Physicians
- Abstract
Emergency medicine (EM) has been a fellowship program (supra-specialty) in France since 2004. Even though the program can be accessed after completion of one of several primary specialties, the vast majority (97%) of its residents enter the program after having completed training in family medicine. A change to develop a primary EM specialty is being discussed. Our objective was to assess French residents and young EM physicians' attitudes toward EM as a primary specialty. We conducted a brief cross-sectional online survey among young EM physicians and trainees in November and December 2012. There were 288 respondents to the survey. Forty-nine percent (n=142) of respondents would have chosen EM if it was a primary specialty, but 73% (n=209) prefer maintaining the status quo, offering EM training as a supra-specialty fellowship program. Work-related quality of life was the main reason for those not choosing EM as a primary specialty.
- Published
- 2015
- Full Text
- View/download PDF
16. An unusual aetiology of abdominal pain: the forgotten bullet.
- Author
-
Yordanov Y, Pateron D, and May A
- Subjects
- Abdominal Pain etiology, Adolescent, Female, Firearms, Foreign Bodies etiology, Humans, Abdominal Pain diagnosis, Foreign Bodies diagnosis, Wounds, Gunshot complications
- Published
- 2014
- Full Text
- View/download PDF
17. Understanding providers' offering and patients' acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France.
- Author
-
d'Almeida KW, Pateron D, Kierzek G, Renaud B, Semaille C, de Truchis P, Simon F, Leblanc J, Lert F, Le Vu S, and Crémieux AC
- Subjects
- Adolescent, Adult, France, HIV enzymology, HIV Reverse Transcriptase analysis, Humans, Middle Aged, Young Adult, Emergency Service, Hospital statistics & numerical data, HIV Infections diagnosis, Health Personnel statistics & numerical data, Mass Screening statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Objective: We assessed the EDs' characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually., Methods: EDs nurses offered testing to all patients 18-64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS' characteristics collected included structural characteristics (location, type, size), daily workload (patients' number and severity, length of stay in hours), staff's participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling., Results: Indigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773-0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581-0.667) and decreased over time (OR = 0.978, 95% CI = 0.975-0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623-0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142-2.038). The EDs' characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate., Conclusion: Our findings suggest the need for taking into account EDs' characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources' utilization such as HIV targeted screening in the EDs might be privileged.
- Published
- 2013
- Full Text
- View/download PDF
18. Variability of intensive care admission decisions for the very elderly.
- Author
-
Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, Davido A, Masmoudi R, Doumenc B, Pateron D, Garrouste-Orgeas M, Somme D, Simon T, Aegerter P, and Guidet B
- Subjects
- Aged, 80 and over, Emergency Medical Services statistics & numerical data, Female, Humans, Male, Triage statistics & numerical data, Decision Making, Intensive Care Units statistics & numerical data, Patient Admission statistics & numerical data
- Abstract
Unlabelled: Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED) of 15 hospitals in the Paris (France) area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91) were included in the study. 94% of participants completed follow-up (n = 2495). 12.4% (n = 329) of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717) and 50.7% (n = 1264). At six months, 57.5% (n = 1433) of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear., Trial Registration: ClinicalTrials.gov NCT00912600.
- Published
- 2012
- Full Text
- View/download PDF
19. Role of shear stress in aortic eNOS up-regulation in rats with biliary cirrhosis.
- Author
-
Tazi KA, Barrière E, Moreau R, Heller J, Sogni P, Pateron D, Poirel O, and Lebrec D
- Subjects
- Animals, Aorta metabolism, Constriction, Pathologic, Endothelial Growth Factors metabolism, Endothelial Growth Factors pharmacology, HSP90 Heat-Shock Proteins metabolism, Lymphokines metabolism, Lymphokines pharmacology, Male, Nitric Oxide Synthase Type III, Portal Vein enzymology, Rats, Rats, Sprague-Dawley, Reference Values, Stress, Mechanical, Up-Regulation, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factors, Aorta enzymology, Liver Cirrhosis, Biliary enzymology, Nitric Oxide Synthase metabolism
- Abstract
Background & Aims: In rats with portal vein stenosis, the initial cause of aortic nitric oxide (NO) overproduction might be overactivation of endothelial NO synthase (eNOS) related to increased shear stress. Cardiac output is higher in cirrhosis than in extrahepatic portal hypertension. The aims of this study were to evaluate the role of shear stress, vascular endothelial growth factor (VEGF), and cytokines in aortic eNOS up-regulation in rats with biliary cirrhosis and to compare these results with those in rats with portal vein stenosis., Methods: NOS activities, NOS protein, heat shock protein (Hsp) 90, and VEGF expressions were studied in rat aortas. Propranolol was administered to rats with cirrhosis to reduce cardiac output and thus shear stress., Results: In cirrhotic rats, the aortic eNOS protein was 3.0 and 1.7 times higher than in control and portal vein-stenosed rats, respectively. In cirrhotic rats, the Hsp90 content was 3.2 and 2.2 times higher than in control and portal vein-stenosed rats, respectively. Propranolol decreased NOS activity by 47% and eNOS and Hsp90 expression by 75% and 72%, respectively. Aortic VEGF expression was decreased in cirrhotic rats. VEGF-induced stimulation of NOS activity was greater in aortas from control rats than in aortas from portal vein-stenosed or cirrhotic rat aortas. eNOS expression was up-regulated after VEGF incubation. After lipopolysaccharide administration, eNOS expression did not change in portal vein-stenosed or cirrhotic rats., Conclusions: This study shows that in aortas from rats with biliary cirrhosis, systemic vasodilation depends mainly on eNOS up-regulation related to shear stress.
- Published
- 2002
- Full Text
- View/download PDF
20. Role of aortic nitric oxide synthase 3 (eNOS) in the systemic vasodilation of portal hypertension.
- Author
-
Pateron D, Tazi KA, Sogni P, Heller J, Chagneau C, Poirel O, Philippe M, Moreau R, and Lebrec D
- Subjects
- Adrenergic beta-Antagonists pharmacology, Animals, Antihypertensive Agents pharmacology, Atenolol pharmacology, Constriction, Pathologic, In Vitro Techniques, Male, Nitric Oxide Synthase genetics, Nitric Oxide Synthase Type III, Portal Vein physiopathology, Propranolol pharmacology, RNA, Messenger metabolism, Rats, Rats, Sprague-Dawley, Reference Values, Vasodilator Agents pharmacology, Aorta enzymology, Hypertension, Portal physiopathology, Nitric Oxide Synthase physiology, Vasodilation physiology
- Abstract
Background & Aims: In portal hypertension, the mechanisms responsible for nitric oxide (NO) overproduction and vasodilation have not yet been clearly identified. One hypothesis is that NO synthase (NOS) 3 is overactivated because of shear stress in endothelial cells caused by hyperkinetic circulation. The aim of this study was to evaluate aortic NOS3 after a reduction of blood flow by long-time beta-adrenoceptor antagonist administration., Methods: Propranolol or atenolol was administered by gavage in portal vein-stenosed and sham-operated rats. The vascular reactivity of thoracic aortic rings to phenylephrine, total aortic NOS activity, and aortic NOS3 messenger RNA and protein expressions were studied., Results: After propranolol or atenolol administration, the aortic hyporesponse returned to normal in portal vein-stenosed rats. Total aortic NOS activity was higher in portal vein-stenosed aortas and significantly decreased after beta-blocker administration. Aortic NOS3 expressions were more marked in portal vein-stenosed aortas than in controls, but NOS3 expressions were reduced after propranolol administration., Conclusions: In portal hypertension, aortic NOS3 activity and expressions are enhanced but return to normal after beta-blocker administration. These results suggest that in portal hypertension, increased shear stress, related to high blood flow, induces enhanced aortic NOS3.
- Published
- 2000
- Full Text
- View/download PDF
21. High prevalence of serum antibodies to hepatitis C virus in patients with Hashimoto's thyroiditis.
- Author
-
Duclos-Vallée JC, Johanet C, Trinchet JC, Deny P, Laurent MF, Duron F, Valensi P, Weil B, Homberg JC, and Pateron D
- Subjects
- Enzyme-Linked Immunosorbent Assay, Female, Hepatitis C Antibodies, Humans, Immunoblotting, Male, Hepacivirus immunology, Hepatitis Antibodies blood, Thyroiditis, Autoimmune immunology
- Published
- 1994
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.