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1. Weaning from mechanical ventilation during myasthenic crisis, a monocentric retrospective study

Author: Aurélien Mazeraud, Sivanthiny Sivanandamoorthy, Rossella Mancusi, Bernard Clair, Diane Friedman, Fouad Fadel, Virginie Maxime, Camille Legouy, David Orlikowski, Tarek Sharshar, Nicholas Heming, and Djillali Annane
Subjects: Medicine, Science
Abstract: Abstract Mechanical ventilation in myasthenic crisis is not standardized and is at high risk of failure. We investigated liberation from mechanical ventilation during myasthenic crisis using a prolonged spontaneous breathing trials (SBT) and sequential pulmonary function tests (PFT). In this retrospective monocenter study, we included patients admitted for a first episode of myasthenic crisis between January 2001 and January 2018. The primary outcome was the incidence of weaning failure upon first extubation in our cohort of patients with MC. Secondary objectives were to determine risk factors and outcome associated with weaning failure upon first extubation in MC. We also compared the characteristics of patients with prolonged weaning. 126 episodes of MC were analyzed. Patient’s age was 64 [42–76] years with 72/126 (56.5%) being women. The median delay between weaning initiation and first extubation was 6 [3–10] days and the median total length of MV was 14 [10–23] days. 118/126 (93.7%) patients underwent prolonged SBT of 8 h or more prior to first extubation. The overall weaning failure rate was 18/126 (14.3%). Extubation was more often successful when the factor precipitating the myasthenic crisis was identified (86/108 (79.6%) vs. 8/18 (44.4%); p = 0.004), whereas PFT was similar in failure or successes. Most weaning failures upon first extubation attempt (11/18; 61%) were attributed to an insufficient stabilization of myasthenia gravis. Duration of mechanical ventilation, an infectious trigger and maximal inspiratory pressure upon intubation were independent risk factors for prolonged weaning. In myasthenic crisis, a standardized protocol including prolonged SBT and respiratory function tests might improve the success of first extubation without prolonging mechanical ventilation. The results of this single center study warrant further evaluation in interventional trials.
Published: 2024
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2. Correction: Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial

Author: Diane Friedman, Lamiae Grimaldi, Alain Cariou, Philippe Aegerter, Stéphane Gaudry, Abdel Ben Salah, Haikel Oueslati, Bruno Megarbane, Nicolas Meunier-Beillard, Jean-Pierre Quenot, Carole Schwebel, Laurent Jacob, Ségloène Robin Lagandré, Pierre Kalfon, Romain Sonneville, Shidasp Siami, Aurelien Mazeraud, and Tarek Sharshar
Subjects: Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Published: 2023
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3. A multicenter cross-sectional French study of the impact of COVID-19 on neuromuscular diseases

Author: Lucie Isoline Pisella, Sara Fernandes, Guilhem Solé, Tanya Stojkovic, Céline Tard, Jean-Baptiste Chanson, Françoise Bouhour, Emmanuelle Salort-Campana, Guillemette Beaudonnet, Louise Debergé, Fanny Duval, Aude-Marie Grapperon, Marion Masingue, Aleksandra Nadaj-Pakleza, Yann Péréon, Frédérique Audic, Anthony Behin, Diane Friedman, Armelle Magot, Jean-Baptiste Noury, Sarah Souvannanorath, Karim Wahbi, Jean-Christophe Antoine, Kévin Bigaut, Jean-Philippe Camdessanché, Pascal Cintas, Rabab Debs, Caroline Espil-Taris, Laurent Kremer, Thierry Kuntzer, Pascal Laforêt, Vincent Laugel, Martial Mallaret, Maud Michaud, Sylvain Nollet, Juliette Svahn, Savine Vicart, Rocio Nur Villar-Quiles, Isabelle Desguerre, David Adams, Sandrine Segovia-Kueny, Géraldine Merret, Elhadi Hammouda, Annamaria Molon, and Shahram Attarian
Subjects: Neuromuscular diseases, COVID-19, Risk factor, Prognosis, Medicine
Abstract: Abstract Background Due to their health condition, patients with neuromuscular diseases (NMD) are at greater risk of developing serious complications with COVID-19. The objective of this study was to analyze the prevalence of COVID-19 among NMD patients and the risk factors for its impact and severity during the first wave of the pandemic. Clinical data were collected from NMD-COVID-19 patients, between March 25, 2020 and May 11, 2020 in an anonymous survey carried out by expert physicians from the French Health Care Network Filnemus. Results Physicians reported 84 patients, including: 34 with myasthenia gravis, 27 with myopathy and 23 with neuropathy. COVID-19 had no effect on NMD for 48 (58%) patients and 48 (58%) patients developed low COVID-19 severity. COVID-19 caused the death of 9 (11%) NMD patients. Diabetic patients were at greater risk of dying. Patients with diabetes, hypertension or severe forms of NMD had a higher risk of developing a moderate or severe form of COVID-19. In our cohort, corticosteroids and other immunosuppressants were not significantly associated with higher COVID-19 severity for acquired NMD. Conclusion During this period, a small percentage of French NMD patients was affected by COVID-19 compared to the general French population and COVID-19 had a limited short-term effect on them. Diabetes, hypertension and a severe degree of NMD were identified as risk factors of unfavorable outcome following COVID-19. Conversely, in our cohort of patients with acquired NMD, corticosteroids or other immunosuppressants did not appear to be risk factors for more severe COVID-19.
Published: 2021
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4. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

Author: Alexandra Laurent, Alicia Fournier, Florent Lheureux, Guillaume Louis, Saad Nseir, Gwenaelle Jacq, Cyril Goulenok, Grégoire Muller, Julio Badie, Bélaïd Bouhemad, Marjolaine Georges, Paul-Michel Mertes, Hamid Merdji, Vincent Castelain, Caroline Abdulmalak, Olivier Lesieur, Gaëtan Plantefeve, Jean-Claude Lacherade, Jean-Philippe Rigaud, Nicholas Sedillot, Damien Roux, Nicolas Terzi, Pascal Beuret, Antoine Monsel, Anne-Laure Poujol, Khaldoun Kuteifan, Thierry Vanderlinden, Anne Renault, Bérengère Vivet, Christophe Vinsonneau, Saber Davide Barbar, Gilles Capellier, Jean Dellamonica, Stephan Ehrmann, Thomas Rimmelé, Julien Bohé, Pierre Bouju, Sébastien Gibot, Bruno Lévy, Johanna Temime, Cyrille Pichot, David Schnell, Diane Friedman, Pierre Asfar, Eddy Lebas, Philippe Mateu, Kada Klouche, Juliette Audibert, Fiona Ecarnot, Nicolas Meunier-Beillard, Mélanie Loiseau, Irène François-Pursell, Christine Binquet, Jean-Pierre Quenot, and PsyCOVID-ICU Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
Subjects: Mental health, Stress factors, ICU, Healthcare professionals, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. Methods This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. Results In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p
Published: 2021
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5. Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial

Author: Diane Friedman, Lamiae Grimaldi, Alain Cariou, Philippe Aegerter, Stéphane Gaudry, Abdel Ben Salah, Haikel Oueslati, Bruno Megarbane, Nicolas Meunier-Beillard, Jean-Pierre Quenot, Carole Schwebel, Laurent Jacob, Ségloène Robin Lagandré, Pierre Kalfon, Romain Sonneville, Shidasp Siami, Aurelien Mazeraud, and Tarek Sharshar
Subjects: Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract: BackgroundCritically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient’s quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. ObjectiveThis multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. MethodsPatients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. ResultsThe study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. ConclusionsThe SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year. Trial RegistrationClinicaltrials.gov NCT01796509; https://clinicaltrials.gov/ct2/show/NCT01796509 International Registered Report Identifier (IRRID)DERR1-10.2196/30496
Published: 2022
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6. Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study

Author: Etienne Gayat, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Charles Damoisel, Qin Lu, Xavier Monnet, Isabelle Rennuit, Elie Azoulay, Marc Léone, Heikel Oueslati, Bertrand Guidet, Diane Friedman, Antoine Tesnière, Romain Sonneville, Philippe Montravers, Sébastien Pili-Floury, Jean-Yves Lefrant, Jacques Duranteau, Pierre-François Laterre, Nicolas Brechot, Karine Chevreul, Morgane Michel, Bernard Cholley, Matthieu Legrand, Jean-Marie Launay, Eric Vicaut, Mervyn Singer, Matthieu Resche-Rigon, and Alexandre Mebazaa
Subjects: Post-intensive care syndrome, Long-term survival, Biomarkers, Score, Discharge, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. Methods FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). Results Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73–4.65), p
Published: 2018
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7. L’équipe, clef de voûte de l’accompagnement des professionnels de santé lors de la sédation d’un patient

Author: Diane Friedman
Subjects: General Nursing
Published: 2023

8. D’une émotion à l’autre, vingtquatre heures dans la vie d’un médecin hospitalier

Author: Diane Friedman
Subjects: General Nursing
Published: 2023

9. Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis

Author: Diane Friedman, Djillali Annane, Guillemette Beaudonnet, Emmanuelle Salort-Campana, Bernard Clair, Jean-Baptiste Chanson, Frédérique Audic, Tiphaine Saulnier, Marco Spinazzi, Louis Carla, Gwendal Le Masson, Stéphane Mathis, Alexandra Foubert-Samier, Aleksandra Nadaj-Pakleza, Antoine Soulages, Shahram Attarian, Fanny Duval, Laurent Kremer, Tanya Stojkovic, Françoise Bouhour, Jean-Christophe Antoine, Pascal Cintas, Céline Tard, Sandrine Segovia-Kueny, Marie-Hélène Violleau, Guilhem Solé, Léa Kern, and Armelle Magot
Subjects: Adult, Male, medicine.medical_specialty, Referral, History, 21st Century, law.invention, Serology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, law, Internal medicine, Myasthenia Gravis, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, SARS-CoV-2, business.industry, COVID-19, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, Intensive care unit, Myasthenia gravis, 3. Good health, Cohort, France, Neurology (clinical), business, 030217 neurology & neurosurgery, Cohort study
Abstract: ObjectiveTo describe the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) among patients with myasthenia gravis (MG) and identify factors associated with COVID-19 severity in patients with MG.MethodsThe CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS (Filière Neuromusculaire) network (between March 1, 2020, and June 8, 2020), including patients with MG with a confirmed or highly suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a PCR test from a nasopharyngeal swab or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology, thoracic CT scan, or typical symptoms. The main outcome was COVID-19 severity based on location of treatment/management (home, hospitalized in a medical unit, or in an intensive care unit). We collected information on demographic variables, general history, and risk factors for severe COVID-19. Multivariate ordinal regression models were used to identify factors associated with severe COVID-19 outcomes.ResultsAmong 3,558 patients with MG registered in the French database for rare disorders, 34 (0.96%) had COVID-19. The mean age at COVID-19 onset was 55.0 ± 19.9 years (mean MG duration: 8.5 ± 8.5 years). By the end of the study period, 28 patients recovered from COVID-19, 1 remained affected, and 5 died. Only high Myasthenia Gravis Foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 (p = 0.004); factors that were not associated included sex, MG duration, and medium MGFA classes (≤IIIb). The type of MG treatment had no independent effect on COVID-19 severity.ConclusionsThis registry-based cohort study shows that COVID-19 had a limited effect on most patients, and immunosuppressive medications and corticosteroids used for MG management are not risk factors for poorer outcomes. However, the risk of severe COVID-19 is elevated in patients with high MGFA classes (odds ratio, 102.6 [4.4–2,371.9]). These results are important for establishing evidence-based guidelines for the management of patients with MG during the COVID-19 pandemic.
Published: 2021

10. Les auteurs

Author: Alexandra Benachi, Dominique Luton, Laurent Mandelbrot, Olivier Picone, Hélène Affres, Nadine Ajzenberg, Laurence Amar, Pascale Amate, Djillali Annane, Rana Aoun, Elie Azria, Rakiba Belkhir, Ivan Berlin, Jacques Bernuau, Emmanuel Boleslawski, Claire Bonneau, Marie Bornes, Yoram Bouhnik, Corinne Bouteloup, Elisabeth Bouvet, Dominique Brémond-Gignac, Arnaud Bresset, Florence Bretelle, Léopoldine Bricaire, Marie Bruyère, Julie Carrara, Pierre-François Ceccaldi, Philippe Chanson, Sophie Chauvet, Bernard Clair, Élodie Clouqueur, Sarah Cohen, Chloé Comarmond-Ortoli, Jacqueline Conard, Sophie Conquy, Henri Copin, Anne-Gaël Cordier, Sophie Cordiez, Sarah Coscas, Nathalie Costedoat-Chalumeau, Emile Daraï, Amélie Delabaere, Philippe Deruelle, Marc Dommergues, Anne-Sophie Ducloy-Bouthors, Caroline Dubertret, Hubert Ducou Le Pointe, Bénédicte Dumont, Lise Duranteau, Elisabeth Elefant, Nejla Essafi, Hervé Fernandez, Julia Filippova, Renato Fior, Michael Frank, Jean-Baptiste de Fréminville, Diane Friedman, Frédéric Galacteros, Denis Gallot, Gilles Garcia, Jean-Yves Gauvrit, Anne Gervais, Robert Girot, Bertrand Godeau, Gilles Grangé, Dominique Grenet, Lionel Groussin-Rouiller, Gaëlle Guettrot-Imbert, Stéphanie Guillet, Anoosha Habibi, Smail Hadj-Rabia, Olivier Hermine, Véronique Houfflin-Debarge, Marie Houllier, Lucile Houyel, Marc Humbert, Laurence Iserin, Bernard Iung, Xavier Jaïs, Bérangère Joly, Guillaume Jondeau, Jean-Emmanuel Kahn, Gilles Kayem, Hawa Keita, Valentin Keller, Magalie Ladouceur, Cécile Lavenu-Bombled, Hélène Legardeur, Véronique Le Guern, Claude Lejeune, Claire Le Jeunne, null Lous, null Ray, Aurélien Lorthioir, Lynda Manamani-Bererhi, Isabelle Marie, Grégoire Martin de Frémont, Sophie Matheron, Amandine Maulard, Nadia Merbai, Emmanuel Messas, Sandra de Miranda, Anna Molto, Stéphanie Morgant, Simon Msika, Sophie Nebout, Jacky Nizard, Roseline d'Oiron, Violaine Ozenne, Gabriel Perlemuter, Sandrine Perol, Franck Perrotin, Brigitte Perrouin-Verbe, Edith Peynaud-Debayle, Violaine Peyronnet, Henri-Jean Philippe, Clément Picard, Geneviève Plu-Bureau, Laura Polivka, Brigitte Raccah-Tebeka, Emmanuelle de Raucourt, Jean-Antoine Ribeil, Thomas Ronzière, Valérie Roussel-Robert, Aude Rossi, Lucia Rugeri, David Saadoun, Lise Selleret, Pierre Sellier, Marie-Victoire Sénat, Raphaèle Seror, Damien Subtil, Camille Taillé, Sarah Tebeka, Denis Therby, Ngoc-Tram Tô, Bertrand de Toffol, Nathalie Trillot, Vassilis Tsatsaris, Géraud Tuyeras, Mathieu Uzzan, Morgane Valentin, David Vandendriessche, Roxane Vanspranghels-Gibert, Eric Verspyck, Aurélie Vincent-Rohfritsch, Sandra Vukusic, Bernard Wechsler, Norbert Winer, and Jacques-François Young
Published: 2022

11. One-Year Prognosis of Kidney Injury at Discharge From the ICU

Author: Jean-Marie Launay, Michael Darmon, Qin Lu, Lara Zafrani, Shiro Ishihara, Marie-Céline Fournier, Nicolas Deye, Naoki Sato, Matthieu Legrand, Marc Leone, Romain Sonneville, Xavier Monnet, Jean-Yves Lefrant, Charles Damoisel, Samir Jaber, Haikel Oueslati, Alexandre Mebazaa, Bernard Cholley, Nicolas Bréchot, François Dépret, Philippe Montravers, Bertrand Guidet, Sebastien Pili-Floury, Etienne Gayat, Alexa Hollinger, Antoine Vieillard-Baron, Isabelle Rennuit, Jacques Duranteau, Diane Friedman, Pierre-François Laterre, and Alain Cariou
Subjects: Male, medicine.medical_specialty, Time Factors, Critical Illness, Renal function, Critical Care and Intensive Care Medicine, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Humans, Medicine, Prospective Studies, Prospective cohort study, Survival rate, Aged, Subclinical infection, Creatinine, biology, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, Acute Kidney Injury, Middle Aged, Prognosis, medicine.disease, Patient Discharge, 3. Good health, Survival Rate, Intensive Care Units, 030228 respiratory system, Cystatin C, chemistry, biology.protein, Female, business, Biomarkers, Glomerular Filtration Rate, Kidney disease
Abstract: Objectives The association between outcome and kidney injury detected at discharge from the ICU using different biomarkers remains unknown. The objective was to evaluate the association between 1-year survival and kidney injury at ICU discharge. Design Ancillary investigation of a prospective observational study. Setting Twenty-one ICUs with 1-year follow-up. Patients Critically ill patients receiving mechanical ventilation and/or hemodynamic support for at least 24 hours were included. Interventions Serum creatinine, plasma Cystatin C, plasma neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, plasma Proenkephalin A 119-159, and estimated glomerular filtration rate (on serum creatinine and plasma Cystatin C) were measured at ICU discharge among ICU survivors. Measurements and main results The association between kidney biomarkers at discharge and mortality was estimated using logistic model with and without adjustment for prognostic factors previously identified in this cohort. Subgroup analyses were performed in patients with discharge serum creatinine less than 1.5-fold baseline at ICU discharge. Among 1,207 ICU survivors included, 231 died during the year following ICU discharge (19.2%). Estimated glomerular filtration rate was significantly lower and kidney injury biomarkers higher at discharge in nonsurvivors. The association between biomarker levels or estimated glomerular filtration rate and mortality remained after adjustment to potential cofounding factors influencing outcome. In patients with low serum creatinine at ICU discharge, 25-47% of patients were classified as subclinical kidney injury depending on the biomarker. The association between kidney biomarkers and mortality remained and mortality was higher than patients without subclinical kidney injury. The majority of patients who developed acute kidney injury during ICU stay had elevated biomarkers of kidney injury at discharge even with apparent recovery based on serum creatinine (i.e., subclinical acute kidney disease). Conclusions Elevated kidney biomarkers measured at ICU discharge are associated with poor 1-year outcome, including in patients with low serum creatinine at ICU discharge.
Published: 2019

12. A multicenter cross-sectional French study of the impact of COVID-19 on neuromuscular diseases

Author: Vincent Laugel, Karim Wahbi, Lucie Isoline Pisella, Rabab Debs, Sarah Souvannanorath, Martial Mallaret, Thierry Kuntzer, Sylvain Nollet, Jean-Christophe Antoine, Maud Michaud, Rocío-Nur Villar-Quiles, Aude-Marie Grapperon, Sandrine Segovia-Kueny, Pascal Laforêt, Céline Tard, EL-Hadi Hammouda, Géraldine Merret, Kévin Bigaut, Juliette Svahn, Laurent Kremer, Armelle Magot, Jean-Baptiste Noury, Guillemette Beaudonnet, Louise Debergé, Aleksandra Nadaj-Pakleza, Diane Friedman, Yann Péréon, Emmanuelle Salort-Campana, Pascal Cintas, Sara Fernandes, David H. Adams, Annamaria Molon, Fanny Duval, Anthony Behin, Shahram Attarian, Frédérique Audic, Jean-Philippe Camdessanché, Isabelle Desguerre, Tanya Stojkovic, Françoise Bouhour, Marion Masingue, Guilhem Solé, Caroline Espil-Taris, Savine Vicart, Jean-Baptiste Chanson, Assistance Publique - Hôpitaux de Marseille (APHM), Groupe hospitalier Pellegrin, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de recherche en Myologie – U974 SU-INSERM, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Lille, Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Strasbourg, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Hôpital Bicêtre, Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Raymond Poincaré [AP-HP], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHU Henri Mondor [Créteil], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Bordeaux [Bordeaux], Lausanne University Hospital, Handicap neuromusculaire : Physiopathologie, Biothérapie et Pharmacologies appliquées (END-ICAP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Necker - Enfants Malades [AP-HP], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Association française contre les myopathies (AFM-Téléthon), Admin, Oskar, Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Henri Mondor, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Thérapie des maladies du muscle strié, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Purpan [Toulouse], and CHU Toulouse [Toulouse]
Subjects: medicine.medical_specialty, Cross-sectional study, Population, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal medicine, Health care, medicine, Humans, Pharmacology (medical), Risk factor, education, Myopathy, Pandemics, Genetics (clinical), 030304 developmental biology, 0303 health sciences, education.field_of_study, business.industry, SARS-CoV-2, Research, COVID-19, General Medicine, medicine.disease, Prognosis, Myasthenia gravis, 3. Good health, Neuromuscular diseases, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Cohort, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Background Due to their health condition, patients with neuromuscular diseases (NMD) are at greater risk of developing serious complications with COVID-19. The objective of this study was to analyze the prevalence of COVID-19 among NMD patients and the risk factors for its impact and severity during the first wave of the pandemic. Clinical data were collected from NMD-COVID-19 patients, between March 25, 2020 and May 11, 2020 in an anonymous survey carried out by expert physicians from the French Health Care Network Filnemus. Results Physicians reported 84 patients, including: 34 with myasthenia gravis, 27 with myopathy and 23 with neuropathy. COVID-19 had no effect on NMD for 48 (58%) patients and 48 (58%) patients developed low COVID-19 severity. COVID-19 caused the death of 9 (11%) NMD patients. Diabetic patients were at greater risk of dying. Patients with diabetes, hypertension or severe forms of NMD had a higher risk of developing a moderate or severe form of COVID-19. In our cohort, corticosteroids and other immunosuppressants were not significantly associated with higher COVID-19 severity for acquired NMD. Conclusion During this period, a small percentage of French NMD patients was affected by COVID-19 compared to the general French population and COVID-19 had a limited short-term effect on them. Diabetes, hypertension and a severe degree of NMD were identified as risk factors of unfavorable outcome following COVID-19. Conversely, in our cohort of patients with acquired NMD, corticosteroids or other immunosuppressants did not appear to be risk factors for more severe COVID-19.
Published: 2021

13. Home-based exercise in autoimmune myasthenia gravis: A randomized controlled trial

Author: Simone Birnbaum, Benjamin Rohaut, Judith Mendelson, Francis Bolgert, R. Le Panse, Diane Friedman, Yasmine Domingo, Nicolas Weiss, Bernard Clair, Anthony Behin, Isabelle Ledoux, Frédérique Truffault, Nawal Derridj Ait-Younes, Mélinée Frenkian, Sandra Misdrahi, Guillaume Bassez, Cécilia Orblin Bedos, Jacques Ropers, Tarek Sharshar, B. Eymard, Pierre Portero, S Berrih-Aknin, Sophie Demeret, Philippe Aegerter, Sonia Berrih-Aknin, Estelle Louët, Linda William, Pascal Laforêt, Philippe Thoumie, Raphaël Porcher, Marcela Gargiulo, J.Y. Hogrel, Sylvie Azerad, Elodie Soler, Asmaa Jobic, and Institute of Myology Paris France
Subjects: Adult, Male, Quality of life, medicine.medical_specialty, Randomization, Exacerbation, [SDV]Life Sciences [q-bio], Rowing, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Autoimmune disease, Clinical endpoint, Humans, Medicine, Prospective Studies, Home based exercise, Myasthenia gravis, Exercise, Genetics (clinical), Aged, Exercise Tolerance, business.industry, Middle Aged, medicine.disease, Exercise Therapy, 3. Good health, Neurology, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Physical therapy, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: International audience; The tolerance of exercise and its effects on quality of life in myasthenia gravis are not currently backed up by strong evidence. The aim of this study was to determine whether exercise as an adjunct therapy is well tolerated and can improve health-related quality of life (HRQoL) in stabilized, generalized autoimmune myasthenia gravis (gMG). We conducted a parallel-group, multi-center prospective RCT using computer-generated block randomization. Adults with stabilized, gMG, and no contra-indication to exercise, were eligible. Participants received usual care alone or usual care and exercise. The exercise intervention consisted of 3-weekly 40 min sessions of an unsupervised, moderate-intensity home rowing program over 3 months. The primary endpoint was the change in HRQoL from randomization to postintervention. Assessor-blinded secondary endpoints were exercise tolerance and effects on clinical, psychological and immunological status. Of 138 patients screened between October 2014 and July 2017, 45 were randomly assigned to exercise (n = 23) or usual care (n = 20). Although exercise was well tolerated, the intention-to-treat analysis revealed no evidence of improved HRQoL compared to usual care (MGQOL-15-F; mean adjusted between-groups difference of-0.8 points, 95%CI-5.4 to 3.7). Two patients hospitalized for MG exacerbation were from the usual care group.
Published: 2021

14. Impact of a Postintensive Care Unit Multidisciplinary Follow-up on the Quality of Life (SUIVI-REA): Protocol for a Multicenter Randomized Controlled Trial (Preprint)

Author: Diane Friedman, Lamiae Grimaldi, Alain Cariou, Philippe Aegerter, Stéphane Gaudry, Abdel Ben Salah, Haikel Oueslati, Bruno Megarbane, Nicolas Meunier-Beillard, Jean-Pierre Quenot, Carole Schwebel, Laurent Jacob, Ségloène Robin Lagandré, Pierre Kalfon, Romain Sonneville, Shidasp Siami, Aurelien Mazeraud, and Tarek Sharshar
Abstract: BACKGROUND Critically ill patients are at risk of developing a postintensive care syndrome (PICS), which is characterized by physical, psychological, and cognitive impairments and which dramatically impacts the patient’s quality of life (QoL). No intervention has been shown to improve QoL. We hypothesized that a medical, psychological, and social follow-up would improve QoL by mitigating the PICS. OBJECTIVE This multicenter, randomized controlled trial (SUIVI-REA) aims to compare a multidisciplinary follow-up with a standard postintensive care unit (ICU) follow-up. METHODS Patients were randomized to the control or intervention arm. In the intervention arm, multidisciplinary follow-up involved medical, psychological, and social evaluation at ICU discharge and at 3, 6, and 12 months thereafter. In the placebo group, patients were seen only at 12 months by the multidisciplinary team. Baseline characteristics at ICU discharge were collected for all patients. The primary outcome was QoL at 1 year, assessed using the Euro Quality of Life-5 dimensions (EQ5D). Secondary outcomes were mortality, cognitive, psychological, and functional status; social and professional reintegration; and the rate of rehospitalization and outpatient consultations at 1 year. RESULTS The study was funded by the Ministry of Health in June 2010. It was approved by the Ethics Committee on July 8, 2011. The first and last patient were randomized on December 20, 2012, and September 1, 2017, respectively. A total of 546 patients were enrolled across 11 ICUs. At present, data management is ongoing, and all parties involved in the trial remain blinded. CONCLUSIONS The SUVI-REA multicenter randomized controlled trial aims to assess whether a post-ICU multidisciplinary follow-up improves QoL at 1 year. CLINICALTRIAL Clinicaltrials.gov NCT01796509; https://clinicaltrials.gov/ct2/show/NCT01796509 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30496
Published: 2021

15. Mental health and stress among ICU healthcare professionals in France according to intensity of the COVID-19 epidemic

Author: Gaëtan Plantefève, Pascal Beuret, Khaldoun Kuteifan, Olivier Lesieur, Saad Nseir, Nicholas Sedillot, Kada Klouche, Vincent Castelain, Cyrille Pichot, Jean-Claude Lacherade, Jean Dellamonica, Nicolas Meunier-Beillard, Florent Lheureux, Fiona Ecarnot, Bérengère Vivet, Pierre Bouju, Gilles Capellier, Grégoire Muller, Paul Michel Mertes, Nicolas Terzi, Eddy Lebas, Sébastien Gibot, PsyCOVID-ICU Trial Investigators, Jean-Philippe Rigaud, Diane Friedman, Julio Badie, Jean-Pierre Quenot, Pierre Asfar, Cyril Goulenok, Anne Renault, Anne-Laure Poujol, Irène François-Pursell, Philippe Mateu, David Schnell, Marjolaine Georges, Antoine Monsel, Belaid Bouhemad, Johanna Temime, Hamid Merdji, Christophe Vinsonneau, Thierry Vanderlinden, Alexandra Laurent, Mélanie Loiseau, Juliette Audibert, Alicia Fournier, Caroline Abdulmalak, Christine Binquet, Gwenaëlle Jacq, Stephan Ehrmann, Damien Roux, Bruno Levy, Saber Barbar, Julien Bohé, Guillaume Louis, Thomas Rimmelé, Laboratoire de psychologie : dynamiques relationnelles et processus identitaires [Dijon] (PSY-DREPI), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne (UB), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), CHU Lille, Service de réanimation [CH Versailles], Centre Hospitalier de Versailles André Mignot (CHV), Ramsay Générale de Santé - Hôpital Privé La Louvière, Centre Hospitalier Régional d'Orléans (CHRO), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Service de Pneumologie Soins Intensifs, Appareillage Respiratoire [CHU de Dijon], Les Hôpitaux Universitaires de Strasbourg (HUS), Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil de Strasbourg, Hôpital de Hautepierre [Strasbourg], Fédération de Médecine Translationnelle de Strasbourg (FMTS), Centre Hospitalier Chalon-sur-Saône William Morey, Centre Hospitalier de La Rochelle (CHR), Service de réanimation (CH d'Argenteuil), Centre Hospitalier Victor Dupouy, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Service de Médecine Intensive Réanimation (CH Dieppe), Centre hospitalier de Dieppe, Espace régional de réflexion éthique de Normandie (EREN), Centre hospitalier de Bourg-en-Bresse / Fleyriat (CHBBF), Service des soins intensifs [Hôpital Louis Mourier], Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Centre Hospitalier de Roanne, Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière] (I3), CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'investigation clinique Biothérapie [CHU Pitié-Salpêtrière] (CIC-BTi), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris] (DHU - I2B), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Adaptation, mesure et évaluation en santé. Approches interdisciplinaires (APEMAC), Université de Lorraine (UL), École de Psychologues Praticiens (EPP), Groupe hospitalier de la région de Mulhouse et Sud-Alsace, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), CHRU Brest - Département d'Anesthésie Réanimation (CHU - BREST - DAR), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe Hospitalier de La Haute-Saône, Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Unité de réanimation médicale [CHU de Carémeau, Nîmes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pathologies Respiratoires : Protéolyse et Aérosolthérapie, Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Groupe Hospitalier Bretagne Sud (GHBS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Centre Hospitalier de Lens, Centre Hospitalier Louis Pasteur [Dole], Centre Hospitalier d'Angoulême (CH Angoulême), Hôpital Raymond Poincaré [AP-HP], CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre Hospitalier de Charleville-Mezières, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Service de Réanimation polyvalente [Chartres], Hôpital Louis Pasteur [Chartres], Service de cardiologie [CHRU de Besançon], Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Délégation à la recherche clinique et à l'innovation [CHU Dijon] (DRCI), Service de médecine légale (Institut médico-légal et Unité médico-judiciaire) (CHU de Dijon), Cellule d'urgence médico-psychologique (CUMP), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer (LabEx LipSTIC), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Gustave Roussy (IGR)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Francophone de la Cancérologie Digestive, FFCD-Université de Montpellier (UM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC) (EREBFC)
Subjects: Mediation (statistics), [SDV]Life Sciences [q-bio], Context (language use), Critical Care and Intensive Care Medicine, law.invention, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Environmental health, Intensive care, Healthcare professionals, Health care, Medicine, 030212 general & internal medicine, business.industry, RC86-88.9, Research, Stressor, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Intensive care unit, Mental health, 3. Good health, ICU, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], General Health Questionnaire, business, Stress factors, 030217 neurology & neurosurgery
Abstract: Background We investigated the impact of the COVID-19 crisis on mental health of professionals working in the intensive care unit (ICU) according to the intensity of the epidemic in France. Methods This cross-sectional survey was conducted in 77 French hospitals from April 22 to May 13 2020. All ICU frontline healthcare workers were eligible. The primary endpoint was the mental health, assessed using the 12-item General Health Questionnaire. Sources of stress during the crisis were assessed using the Perceived Stressors in Intensive Care Units (PS-ICU) scale. Epidemic intensity was defined as high or low for each region based on publicly available data from Santé Publique France. Effects were assessed using linear mixed models, moderation and mediation analyses. Results In total, 2643 health professionals participated; 64.36% in high-intensity zones. Professionals in areas with greater epidemic intensity were at higher risk of mental health issues (p p B = 0.13; 95% confidence interval [CI] = 0.08–0.17), having a relative at risk of COVID-19 (B = 0.14; 95%-CI = 0.09–0.18) and working in high-intensity zones (B = 0.11; 95%-CI = 0.02–0.20). Perceived stress mediated the impact of the crisis context on mental health (B = 0.23, 95%-CI = 0.05, 0.41) and the impact of stress on mental health was moderated by positive thinking, b = − 0.32, 95% CI = − 0.54, − 0.11. Conclusion COVID-19 negatively impacted the mental health of ICU professionals. Professionals working in zones where the epidemic was of high intensity were significantly more affected, with higher levels of perceived stress. This study is supported by a grant from the French Ministry of Health (PHRC-COVID 2020).
Published: 2021

16. Comparison of Corticosteroid Tapering Regimens in Myasthenia Gravis: A Randomized Clinical Trial

Author: Diane Friedman, Tarek Sharshar, Bruno Eymard, Aleksandra Nadaj-Pakleza, Marco Spinazzi, Bernard Clair, Simone Birnbaum, Christine Tranchant, Raphaël Porcher, Antoine Gueguen, Lamiae Grimaldi, S. Demeret, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Neuropathologie expérimentale / Experimental neuropathology, Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Hôpital Hôtel-Dieu [Paris], UFR Médecine [Santé] - Université Paris Cité (UFR Médecine UPCité), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Strasbourg, CHU Rothschild [AP-HP], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Novartis Roche Teva Pharmaceutical Industries Ministère des Affaires Sociales et de la Santé, reported receiving nonfinancial support from Allergan and nonfinancial support from Merz outside the submitted work. Dr Gueguen reported receiving grants from French Ministry of Social Affairs and Health during the conduct of the study, has received honoraria and consulting fees from Novartis, Roche, Merck-Serono, Sanofi-Genzyme, Teva, and Mylan, and has received travel funding from Roche, Novartis, Sanofi-Genzyme. A close relative is an Ipsen employee. No other disclosures were reported., Université Paris Cité - UFR Médecine [Santé] (UPCité UFR Médecine), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Rothschild [AP-HP], HAL UVSQ, Équipe, Institut Pasteur [Paris]-Université de Paris (UP), Université de Paris (UP), Université de Paris - UFR Médecine Paris Centre [Santé] (UP Médecine Paris Centre), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de neurologie 1 [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)
Subjects: Pediatrics, medicine.medical_specialty, medicine.drug_class, [SDV]Life Sciences [q-bio], Population, Azathioprine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Prednisone, Interquartile range, law, medicine, 030212 general & internal medicine, 10. No inequality, education, Original Investigation, education.field_of_study, business.industry, 3. Good health, [SDV] Life Sciences [q-bio], Regimen, Relative risk, Corticosteroid, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract: International audience; Importance: The tapering of prednisone therapy in generalized myasthenia gravis (MG) presents a therapeutic dilemma; however, the recommended regimen has not yet been validated. Objective: To compare the efficacy of the standard slow-tapering regimen of prednisone therapy with a rapid-tapering regimen. Design: From June 1, 2009, to July 31, 2013, a multicenter, parallel, single-blind randomized trial was conducted to compare 2 regimens of prednisone tapering. Data analysis was conducted from February 18, 2019, to January 23, 2020. A total of 2291 adults with a confirmed diagnosis of moderate to severe generalized MG at 7 specialized centers in France were assessed for eligibility. Interventions: The slow-tapering arm included a gradual increase of the prednisone dose to 1.5 mg/kg every other day and a slow decrease once minimal manifestation status of MG was attained. The rapid-tapering arm consisted of immediate high-dose daily administration of prednisone, 0.75 mg/kg, followed by an earlier and rapid decrease once improved MG status was attained. Azathioprine, up to a maximum dose of 3 mg/kg/d, was prescribed for all participants. Main Outcomes and Measures: The primary outcome was attainment of minimal manifestation status of MG without prednisone at 12 months and without clinical relapse at 15 months. Intention-to-treat analysis was conducted. Results: Of the 2291 patients assessed, 2086 did not fulfill the inclusion criteria, 87 declined to participate, and 1 patient registered after trial closure. A total of 117 patients (58 in the slow-tapering arm and 59 in the rapid-tapering arm) were selected for inclusion by MG specialists and were randomized. The population included 62 men (53%); median age was 65 years (interquartile range, 35-69 years). The proportion of patients having met the primary outcome was higher in the rapid- vs slow-tapering arm (23 [39%] vs 5 [9%]), with a risk ratio of 3.61 (95% CI, 1.64-7.97; P
Published: 2021

17. DESIGN AND CONDUCT OF A MULTICENTER RANDOMIZED CLINICAL TRIAL ON THE IMPACT OF A POST-INTENSIVE CARE UNIT MULTIDISCIPLINARY FOLLOW-UP ON THE QUALITY OF LIFE (SUIVI-REA) (Preprint)

Author: Diane, Friedman, primary, Grimaldi, Lamiae, additional, Cariou, Alain, additional, Aegerter, Philippe, additional, Gaudry, Stéphane, additional, Ben Salah, Abdel, additional, Oueslati, Haikel, additional, Megarbane, Bruno, additional, Meunier-Beillard, Nicolas, additional, Quenot, Jean-Pierre, additional, Schwebel, Carole, additional, Jacob, Laurent, additional, Robin Lagandré, Ségloène, additional, Kalfon, Pierre, additional, Sonneville, Romain, additional, Siami, Shidasp, additional, Mazeraud, Aurelien, additional, and Sharshar, Tarek, additional
Published: 2021
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18. Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study

Author: Michael Darmon, Jean Reignier, Frédéric Pochard, Virginie Souppart, Alain Combes, Guillaume Geri, François Barbier, Alain Cariou, Danielle Reuter, Fabrice Bruneel, Alexandre Demoule, Bertrand Guidet, Kada Klouche, Matthieu Resche-Rigon, Bruno Mégarbane, Mercé Jourdain, Christophe Guitton, Olivier Guisset, Laurent Papazian, Elie Azoulay, Guillaume Van Der Meersch, Vincent Labbé, Diane Friedman, Achille Kouatchet, Laurent Argaud, Nancy Kentish-Barnes, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Cochin [AP-HP], Centre Hospitalier de Versailles André Mignot (CHV), Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Pneumologie et Réanimation Médicale [CHU Pitié-Salpêtrière] (Département ' R3S '), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital de Corbeil, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de médecine chirurgicale intensive [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital La Source (Orléans), Recherche translationnelle sur le diabète - U 1190 (RTD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Assistance Publique - Hôpitaux de Marseille (APHM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHU Saint-Antoine], 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), Hôpital Ambroise Paré [AP-HP], Groupe hospitalier Saint-André, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Hôpital Avicenne [AP-HP], Centre Hospitalier Le Mans (CH Le Mans), Hôpital Raymond Poincaré [AP-HP], HAL-SU, Gestionnaire, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Sud Francilien, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Pitié-Salpétrière], Hôpital La Source [Orléans] (HLSO), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], CHU Saint-Antoine [AP-HP], and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Stress Disorders, Traumatic, Cross-sectional study, coronavirus, Poison control, Critical Care and Intensive Care Medicine, Hospital Anxiety and Depression Scale, Suicide prevention, 0302 clinical medicine, Surveys and Questionnaires, Prevalence, 030212 general & internal medicine, Depression (differential diagnoses), [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, anxiety, 3. Good health, depression, Anxiety, Female, France, medicine.symptom, Coronavirus Infections, COVID-19/Critical Care, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, Health Personnel, Pneumonia, Viral, Betacoronavirus, 03 medical and health sciences, medicine, Humans, pneumonia, Psychiatry, Pandemics, SARS-CoV-2, business.industry, Editorials, COVID-19, Original Articles, Mental illness, medicine.disease, Mental health, Cross-Sectional Studies, 030228 respiratory system, ICU, business, Stress, Psychological, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity.Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs.Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified.Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42–0.79], 0.57 [95% confidence interval, 0.39–0.82], and 0.49 [95% confidence interval, 0.34–0.72], respectively). HCPs working in non–university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions.Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.
Published: 2020

19. Efficacy of Rituximab in Refractory Generalized anti-AChR Myasthenia Gravis

Author: Olivier Boyer, Yves Allenbach, Océane Landon-Cardinal, Lucienne Chatenoud, Emmanuelle Salort-Campana, Bruno Eymard, Olivier Benveniste, Nicholas Heming, Diane Friedman, Pascal Laforêt, Marguerite Guiguet, Tarek Sharshar, Fabienne Jouen, Institut de Myologie, Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Association française contre les myopathies (AFM-Téléthon)-Sorbonne Université (SU), Hôpital Raymond Poincaré [AP-HP], Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie et biothérapies des maladies inflammatoires et autoimmunes, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Thérapie des maladies du muscle strié, Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Necker Enfants-Malades (INEM - UM 111 (UMR 8253 / U1151)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Association française contre les myopathies (AFM-Téléthon)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Pierre et Marie Curie - Paris 6 (UPMC), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de recherche en Myologie – U974 SU-INSERM, Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), AP-HP Hôpital Raymond Poincaré [Garches], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Adult, Male, Vital capacity, medicine.medical_specialty, Exacerbation, [SDV]Life Sciences [q-bio], Health Status, Pilot Projects, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Refractory, Internal medicine, Myasthenia Gravis, medicine, Clinical endpoint, Humans, Immunologic Factors, Receptors, Cholinergic, Respiratory system, ComputingMilieux_MISCELLANEOUS, Acetylcholine receptor, Autoantibodies, Muscle Weakness, business.industry, Middle Aged, medicine.disease, Myasthenia gravis, 3. Good health, Respiratory Function Tests, 030104 developmental biology, Treatment Outcome, Neurology, Quality of Life, Rituximab, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: Background Several retrospective case series have suggested rituximab (RTX) might improve patients with refractory Myasthenia Gravis (MG). Objective In this study, we aimed to evaluate prospectively the efficacy of RTX on muscle function in refractory generalized anti-acetylcholine receptor (AChR) MG patients. Methods Enrolled patients received 1 g of RTX at day 0, day 14, and 6-month follow-up (M6). The primary endpoint was improvement of muscle function at 12-month (M12) based on myasthenic muscle score (MMS). Secondary endpoints were an improvement of the MG Foundation of America Postintervention Status (MGFA-PIS), respiratory forced vital capacity, occurrences of acute MG exacerbation and requirement of associated immunosuppressants and immunomodulatory agents. Results Twelve patients were enrolled, and 11 completed the study. Only a single patient presented an improvement of at least 20 points on MMS at M12, although 2 patients displayed an increase of at least 18 points at M12. MGFA-PIS had improved in 55% of patients by M12. The clinical improvement was not associated with a reduction of immunosuppressant burden. Conclusions These results provide data on the effect of RTX in patients with severe, refractory anti-AChR Abs generalized MG. Even though primary outcome was only reached in a single patient at M12, a beneficial effect of RTX on muscle function was seen in half of the patients at M12 and persisted in a third of patients at M18.
Published: 2018

20. Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study

Author: Morgane Michel, Jean-Marie Launay, Jacques Duranteau, Marc Leone, Alexandre Mebazaa, Bernard Cholley, Philippe Montravers, Jean-Yves Lefrant, Qin Lu, Matthieu Legrand, Charles Damoisel, Xavier Monnet, Matthieu Resche-Rigon, Bertrand Guidet, Karine Chevreul, Elie Azoulay, Isabelle Rennuit, Mervyn Singer, Nicolas Bréchot, Heikel Oueslati, Samir Jaber, Pierre-François Laterre, Diane Friedman, Romain Sonneville, Sebastien Pili-Floury, Nicolas Deye, Eric Vicaut, Etienne Gayat, Antoine Vieillard-Baron, Alain Cariou, Antoine Tesniere, Département d'Anesthésie Réanimation SMUR [Paris], 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), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4)-Centre National de la Recherche Scientifique (CNRS), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Unité de Soins Intensifs [Saint-Louis], Hôpital Raymond Poincaré [AP-HP], Service d'Anesthésie Réanimation, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Bichat - Claude Bernard, Département d'Anesthésie Réanimation [CHU Bichat-Claude-Bernard], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'anesthésie et soins intensifs [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie et réanimation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Université Catholique de Louvain = Catholic University of Louvain (UCL), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Département de la Recherche Clinique et du Développement [AP-HP Hôtel Dieu] (DRCD-URC Eco), Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Psychiatrie et Neurologie personnalisées [AP-HP Hôpital Henri-Mondor] (DHU PePsy), Hôpital Henri Mondor, Service de RadioBiologie et d'Epidémiologie (IRSN/DRPH/SRBE), Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Service d'Anesthésie-Réanimation [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service d'Anesthésie et Soins Intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Université Paris Diderot - Paris 7 (UPD7), Unité de Recherche Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Fernand-Widal, Département de l'information médicale et de la biostatistique [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Ambroise Paré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Radiobiologie et épidémiologie (DRPH/SRBE), UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), COMBE, Isabelle, and Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris]
Subjects: Male, Time Factors, Outcome Assessment, health care facilities, manpower, and services, 030204 cardiovascular system & hematology, Cardiovascular, Critical Care and Intensive Care Medicine, Medical and Health Sciences, law.invention, Cohort Studies, 0302 clinical medicine, Belgium, law, Outcome Assessment, Health Care, Odds Ratio, Medicine, Vasoconstrictor Agents, Hospital Mortality, Prospective Studies, Survivors, Prospective cohort study, education.field_of_study, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Score, Middle Aged, Intensive care unit, 3. Good health, Hospitalization, Intensive Care Units, Heart Disease, Artificial, Female, Patient Safety, France, Cohort study, medicine.medical_specialty, Critical Illness, Population, Post-intensive care syndrome, 03 medical and health sciences, Long-term survival, Clinical Research, Intensive care, Humans, education, Aged, business.industry, Research, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Odds ratio, Length of Stay, medicine.disease, Comorbidity, Emergency & Critical Care Medicine, Respiration, Artificial, Health Care, Good Health and Well Being, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, Discharge, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Biomarkers
Abstract: Background Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. Methods FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). Results Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73–4.65), p
Published: 2018

21. StO2 guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial

Author: Gwenhael Colin, Jerome Aboab, Virginie Maxime, Diane Friedman, Andrea Polito, David Orlikowski, Tarek Sharshar, Bernard Clair, Djillali Annane, and Olivier Nardi
Subjects: Resuscitation, medicine.medical_specialty, Surviving Sepsis Campaign, Septic shock, business.industry, Central venous pressure, Health Informatics, Critical Care and Intensive Care Medicine, medicine.disease, Intensive care unit, law.invention, Surgery, Sepsis, Anesthesiology and Pain Medicine, Randomized controlled trial, law, Anesthesia, medicine, SOFA score, business
Abstract: The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO2) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. Subjects were randomly assigned to a 6 h resuscitation strategy following the Surviving Sepsis Campaign guidelines with (experimental) or without (control) StO2. StO2 was measured over several muscles (masseter, deltoid and pectoral or thenar muscles), and a StO2 above 80 % over at least 2 muscles was the therapeutic goal. The primary outcome was evaluated as follows: 7-day mortality or worsening of SOFA score between day 7 and study onset, i.e., DSOFA > 0). Thirty subjects were included in the study over a period of 40 weeks. Fifteen subjects were included in each group. Monitoring of StO2 over three areas was performed in the experimental group. However, measures over the pectoral muscle provided poor results. At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA > 0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA > 0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO2 as a treatment goal. However, the protocol showed no clear trend for or against targeting StO2.
Published: 2013

22. ICU physicians' and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study

Author: Maité Garrouste-Orgeas, Arnaud Desachy, Laetitia Contentin, Ségolène Robin, Rebecca Hamidfar-Roy, Juliette Audibert, René Robert, Paul Morin-Longuet, Antoine Roquilly, Nicolas Lerolle, Amélie Seguin, M. Feissel, Jérôme Devaquet, Philippe Mateu, Patrice Tirot, Bruno Mégarbane, Guillaume Grillet, Patrick Bardou, Amélie Le Gouge, Christophe Guitton, Nathalie Embriaco, Didier Thevenin, Jonathan Messika, Mélanie Adda, Emmanuelle Mercier, Jean-Pierre Quenot, Bénédicte Philippon-Jouve, Béatrice Eon, Nancy Kentish-Barnes, Fabien Lion, Daniel Da Silva, Simon Bourcier, Frédérique Ganster, François Barbier, Diane Friedman, Sebastien Jochmans, Alice Cottereau, Olivier Guisset, Emmanuel Canet, Alexandre Lautrette, Alexandre Boyer, Jean Reignier, Olivier Lesieur, François Brenas, Mercé Jourdain, Xavier Repessé, Jean-Philippe Rigaud, Anne-Claire Hyacinthe, Vincent Das, and Anne Renault
Subjects: Adult, Male, medicine.medical_specialty, Poor compliance, Attitude of Health Personnel, Icu nurses, Nursing Staff, Hospital, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Nursing, law, Anesthesiology, Physicians, Surveys and Questionnaires, Weaning, Medicine, Humans, Questionnaire study, business.industry, 030208 emergency & critical care medicine, Exploratory analysis, Middle Aged, Intensive care unit, Respiration, Artificial, Intensive Care Units, 030228 respiratory system, Nurses perceptions, Family medicine, Airway Extubation, Female, France, business
Abstract: Terminal extubation (TE) and terminal weaning (TW) are the methods available for withdrawing mechanical ventilation. Perceptions of TE and TW by intensive care unit (ICU) staff may influence bedside practices and the feasibility of studies comparing these methods. From January to June 2013, 5 nurses and 5 physicians in each of 46 (out of 70, 65.7 %) French ICUs completed an anonymous self-questionnaire. Clusters of staff members defined by perceptions of TE and TW were identified by exploratory analysis. Denominators for computing percentages were total numbers of responses to each item; cases with missing data were excluded for the relevant item. Of the 451 (98 %) participants (225 nurses and 226 physicians), 37 (8.4 %) had never or almost never performed TW and 138 (31.3 %) had never or almost never performed TE. A moral difference between TW and TE was perceived by 205 (45.8 %) participants. The exploratory analysis identified three clusters defined by personal beliefs about TW and TE: 21.2 % of participants preferred TW, 18.1 % preferred TE, and 60.7 % had no preference. A preference for TW seemed chiefly related to unfavorable perceptions or insufficient knowledge of TE. Staff members who preferred TE and those with no preference perceived TE as providing a more natural dying process with less ambiguity. Nearly two-fifths of ICU nurses and physicians in participating ICUs preferred TW or TE. This finding suggests both a need for shared decision-making and training before performing TE or TW and a high risk of poor compliance with randomly allocated TW or TE.
Published: 2016

23. Soins palliatifs : comment « faire collège » autour de la parole du malade ?

Author: Delphine Prenat-Molimard, Sophie Chrétien, Cécile Prigent, Jean-Philippe Louvel, Serge Laouenan, Diane Friedman, and Charles Joussellin
Published: 2016

24. Sepsis-associated encephalopathy and its differential diagnosis

Author: Djillali Annane, Andrea Polito, Shidasp Siami, Anthony Checinski, Diane Friedman, and Tarek Sharshar
Subjects: medicine.medical_specialty, Neurology, business.industry, Internal medicine, parasitic diseases, medicine, Neurology (clinical), Differential diagnosis, Sepsis-Associated Encephalopathy, business, Gastroenterology
Abstract: Sepsis-associated encephalopathy (SAE) is defined as a diffuse cerebral dysfunction resulting from the systemic inflammatory response to an infection without direct infestation of the CNS. Although the pathophysiology of SAE is as yet unknown, some mechanisms have been suggested that involve BBB disruption as a consequence of proinflammatory mediators’ effects on endothelial cells. This leads to an increased passage of neurotoxic and proinflammatory mediators into the brain parenchyma, as well as an impairment of the movements of oxygen and metabolites through the BBB. Both neurons and glial cells are affected, resulting in neural functioning and neurotransmission impairment. The clinical translation of this process is an alteration of consciousness and awareness. SAE is a frequent condition in septic patients. Despite being considered reversible, SAE appears to be associated with long-term cognitive impairment. Detection and diagnosis can be challenging; it requires daily neurological assessment with the assistance of clinical scores. Use of biomarkers and neurophysiological testing is discussed. The aim of this article is to provide practical tools for detection of SAE, as well as an updated overview of its pathophysiology and therapeutic perspectives.
Published: 2010

25. Sepsis-associated encephalopathy and its differential diagnosis

Author: Emanuele Iacobone, Andrea Polito, Juliette Bailly-Salin, Robert Stevens, Diane Friedman, and Tarek Sharshar
Subjects: Pathology, medicine.medical_specialty, Critical Care, Critical Illness, Encephalopathy, Central nervous system, Critical Care and Intensive Care Medicine, Blood–brain barrier, Proinflammatory cytokine, Diagnosis, Differential, Sepsis, Risk Factors, Intensive care, parasitic diseases, medicine, Humans, Neurologic Examination, Brain Diseases, Brain Mapping, Wernicke–Korsakoff syndrome, Brain Diseases, Metabolic, business.industry, Electroencephalography, Sepsis-Associated Encephalopathy, medicine.disease, Intensive Care Units, medicine.anatomical_structure, Blood-Brain Barrier, Brain Injuries, Immunology, Encephalitis, business
Abstract: Sepsis is often complicated by an acute and reversible deterioration of mental status, which is associated with increased mortality and is consistent with delirium but can also be revealed by a focal neurologic sign. Sepsis-associated encephalopathy is accompanied by abnormalities of electroencephalogram and somatosensory-evoked potentials, increased in biomarkers of brain injury (i.e., neuron-specific enolase, S-100 beta-protein) and, frequently, by neuroradiological abnormalities, notably leukoencephalopathy. Its mechanism is highly complex, resulting from both inflammatory and noninflammatory processes that affect all brain cells and induce blood-brain barrier breakdown, dysfunction of intracellular metabolism, brain cell death, and brain injuries. Its diagnosis relies essentially on neurologic examination that can lead one to perform specific neurologic tests. Electroencephalography is required in the presence of seizure; neuroimaging in the presence of seizure, focal neurologic signs or suspicion of cerebral infection; and both when encephalopathy remains unexplained. In practice, cerebrospinal fluid analysis should be performed if there is any doubt of meningitis. Hepatic, uremic, or respiratory encephalopathy, metabolic disturbances, drug overdose, withdrawal of sedatives or opioids, alcohol withdrawal delirium, and Wernicke's encephalopathy are the main differential diagnoses of sepsis-associated encephalopathy. Patient management is based mainly on controlling infection, organ system failure, and metabolic homeostasis, at the same time avoiding neurotoxic drugs.
Published: 2009

26. Irwin Hirsch: Coasting in the Countertransference: Conflicts of Self Interest between Analyst and Patient

Author: Diane Friedman
Subjects: Psychiatry and Mental health, Clinical Psychology, Psychotherapist, Psychoanalysis, media_common.quotation_subject, Self-interest, Psychoanalytic theory, Countertransference, Psychology, media_common
Published: 2009

27. Chapitre 11. Confusion en réanimation

Author: Guy Moneger, Diane Friedman, and Tarek Sharshar
Published: 2015

28. Mitochondrial Diseases

Author: Djillali Annane and Diane Friedman
Published: 2014

29. Liste des collaborateurs

Author: Hélène Affres, Laurence Amar, Pascale Amate, Djillali Annane, Elie Azria, Alexandra Benachi, Ivan Berlin, Jacques Bernuau, Guillaume Bobrie, Emmanel Boleslawski, Claire Bonneau, Marie Bornes, Yoram Bouhnik, Corinne Bouteloup, Elisabeth Bouvet, Dominique Brémond-Gignac, Arnaud Bresset, Florence Bretelle, Léopoldine Bricaire, Marie Bruyere, Pierre-François Ceccaldi, Philippe Chanson, Sophie Chauvet, Bernard Clair, Élodie Clouqueur, Sarah Cohen, Jacqueline Conard, Cloé Comarmond, Sophie Conquy, Henri Copin, Anne-Gaël Cordier, Sophie Cordiez, Nathalie Costedoat-Chalumeau, Emile Daraï, Amélie Delabaere, Philippe Deruelle, Marc Dommergues, Marie Dreyfus, Caroline Dubertret, Lê Thi Huong Du-Boutin, Guillaume Ducarme, Anne-Sophie Ducloy-Bouthors, Hubert Ducou Le Pointe, Lise Duranteau, Fadi Fakhouri, Hervé Fernandez, Hélène Ferrand, Julia Filippova, Renato Fior, Michael Frank, Diane Friedman, Frédéric Galacteros, Denis Gallot, Gilles Garcia, Jean-Yves Gauvrit, Anne Gervais, Robert Girot, Bertrand Godeau, Gilles Grangé, Dominique Grenet, Lionel Groussin, Gaëlle Guettrot-Imbert, Anoosha Habibi, Smail Hadj-Rabia, Olivier Hermine, Véronique Houfflin-Debarge, Lucile Houyel, Justine Hugon-Rodin, Marc Humbert, Laurence Iserin, Bernard Iung, Xavier Jaïs, Bérangère Joly, Guillaume Jondeau, Jean-Emmanuel Kahn, Gilles Kayem, Hawa Keita, Valentin Keller, Magalie Ladouceur, Hélène Legardeur, Véronique Le Guern, Claude Lejeune, Claire Le Jeunne, Camille Le Ray, Dominique Luton, Lynda Manamani-Bererhi, Laurent Mandelbrot, Isabelle Marie, Sophie Matheron, Amandine Maulard, Nadia Merbai, Emmanuel Messas, Sandra De Miranda, Stéphanie Morgant, Simon Msika, Sophie Nebout, Sophie Nedellec, Jacky Nizard, Roseline d'Oiron, Violaine Ozenne, Gabriel Perlemuter, Brigitte Perrouin-Verbe, Franck Perrotin, Edith Peynaud-Debayle, Henri-Jean Philippe, Clément Picard, Olivier Picone, Marie Pigeyre, Pierre-François Plouin, Geneviève Plu-Bureau, Laura Polivka, Patrice Poulain, Marie de Pradier, Brigitte Raccah-Tebeka, Jean-Antoine Ribeil, Roman Rouzier, Thomas Ronziere, Aude Rossi, David Saadoun, Lise Selleret, Pierre Sellier, Marie-Victoire Sénat, Damine Subtil, Camille Taillé, Denis Therby, Ngoc-Tram Tô, Bertrand de Toffol, Nathalie Trillot, Vassilis Tsatsaris, Géraud Tuyeras, Morgane Valentin, Anne Vambergue, David Vandendriessche, Eric Verspyck, Aurélie Vincent-Rohfritsch, Marie-Catherine Voltzenlogel, Sandra Vukusic, Bernard Wechsler, Norbert Winer, and Jacques-François Young
Published: 2014

30. Retroperitoneal fibrosis presenting as bilateral leg swelling resulting from compression of the inferior vena cava: A case study and review

Author: Karla M. Anderson, Harjit Singh, and Diane Friedman
Subjects: medicine.medical_specialty, Leg swelling, business.industry, fungi, Nursing support, food and beverages, Retroperitoneal fibrosis, Compression (physics), Inferior vena cava, Surgery, Medical–Surgical Nursing, Autonomic nervous system, medicine.vein, Retroperitoneal structures, medicine, Disease process, medicine.symptom, business
Abstract: Bilateral lower extremity swelling can have several causes. Several of these causes can be present in the same patient at the same time. Retroperitoneal fibrosis, a rare cause of compression of retroperitoneal structures, is incompletely understood. It most commonly produces compression of the ureters but, more rarely, it can cause compression of the inferior vena cava, gonadal veins, lymphatics, or autonomic nervous system. Nursing support and coordination can have a positive impact on helping the patient and family cope with this difficult disease process. This article will review a case report with patient care implications. (J Vasc Nurs 2000;18:88-96)
Published: 2000

31. StO₂ guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial

Author: Olivier, Nardi, Andrea, Polito, Jérôme, Aboab, Gwenhael, Colin, Virginie, Maxime, Bernard, Clair, Diane, Friedman, David, Orlikowski, Tarek, Sharshar, and Djillali, Annane
Subjects: Adult, Male, Spectroscopy, Near-Infrared, Resuscitation, Pilot Projects, Middle Aged, Shock, Septic, Oxygen Consumption, Sepsis, Humans, Female, Muscle, Skeletal, Algorithms, Aged, Monitoring, Physiologic
Abstract: The scientific community has agreed upon developing accurate monitoring of tissue perfusion and oxygenation to improve the management of subjects with sepsis. This pilot study aimed to investigate the feasibility of targeting tissue oxygen saturation (StO₂) in addition to the currently recommended resuscitation goals, central venous pressure, mean arterial pressure and central venous oxygen saturation, in patients with severe sepsis or septic shock. A pilot, single-centre, randomised, non-blinded trial recruited 30 subjects with severe sepsis upon intensive care unit admission at an academic medical centre in France. Subjects were randomly assigned to a 6 h resuscitation strategy following the Surviving Sepsis Campaign guidelines with (experimental) or without (control) StO₂. StO₂ was measured over several muscles (masseter, deltoid and pectoral or thenar muscles), and a StO₂ above 80 % over at least 2 muscles was the therapeutic goal. The primary outcome was evaluated as follows: 7-day mortality or worsening of SOFA score between day 7 and study onset, i.e., DSOFA0). Thirty subjects were included in the study over a period of 40 weeks. Fifteen subjects were included in each group. Monitoring of StO₂ over three areas was performed in the experimental group. However, measures over the pectoral muscle provided poor results. At study day 7, there were 5/15 (33.3 %) subjects who died or had a DSOFA0 in the experimental arm and 4/15 (26.6 %) who died or had a DSOFA0 in the control arm (p = 1.00). This pilot study was the first randomised controlled trial using an algorithm derived from the SSC recommendations, which included StO₂ as a treatment goal. However, the protocol showed no clear trend for or against targeting StO₂.
Published: 2012

32. Masseter tissue oxygen saturation predicts normal central venous oxygen saturation during early goal-directed therapy and predicts mortality in patients with severe sepsis

Author: Virginie Maxime, Djillali Annane, Olivier Nardi, Bernard Clair, Tarek Sharshar, Diane Friedman, Andrea Polito, David Orlikowski, Gwenhael Colin, and Jerome Aboab
Subjects: Male, Resuscitation, Surviving Sepsis Campaign, Central Venous Pressure, Critical Care, Critical Illness, Deltoid curve, Early goal-directed therapy, Critical Care and Intensive Care Medicine, Risk Assessment, law.invention, Cohort Studies, Oxygen Consumption, law, Predictive Value of Tests, Sepsis, medicine, Humans, Hospital Mortality, Prospective Studies, Aged, Monitoring, Physiologic, Aged, 80 and over, Academic Medical Centers, Spectroscopy, Near-Infrared, Septic shock, business.industry, Masseter Muscle, Area under the curve, Deltoid Muscle, Middle Aged, medicine.disease, Intensive care unit, Shock, Septic, Survival Analysis, Intensive Care Units, ROC Curve, Anesthesia, Female, Saturation (chemistry), business, Follow-Up Studies
Abstract: OBJECTIVE This study aimed to investigate, in patients with severe sepsis, the correlation between central venous oxygen saturation and tissue oxygen saturation at different levels. DESIGN Prospective observational study. SETTING General intensive care unit at an academic medical center in France. PATIENTS Thirty-eight patients with underresuscitated severe sepsis and septic shock on intensive care unit admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During early resuscitation according to the 6-hr bundles of the Surviving Sepsis Campaign guidelines, tissue oxygen saturation was recorded every other hour at the level of the thenar, masseter, and deltoid muscles along with central hemodynamics, arterial lactate concentrations, and central venous oxygen saturation. Over the 6-hr resuscitation period, thenar tissue oxygen saturation was consistently higher than masseter tissue oxygen saturation (p = .04) and deltoid tissue oxygen saturation (p = .002), and masseter tissue oxygen saturation was consistently higher than deltoid tissue oxygen saturation (p = .04). Receiver operating characteristic curves analyses showed that masseter tissue oxygen saturation was better predictor of central venous oxygen saturation >70% than thenar tissue oxygen saturation (area under the curve, 0.80; 95% confidence interval 0.71-0.89 vs. 0.67; 95% confidence interval 0.56-0.77; p = .02). The crude 28-day mortality was 36.8%. Receiver operating characteristic curve analysis showed that masseter tissue oxygen saturation (area under the curve 0.87; 0.75-0.98) and deltoid tissue oxygen saturation (area under the curve 0.88; 0.77-0.98) but not thenar tissue oxygen saturation (area under the curve 0.66; 0.46-0.86) or central venous oxygen saturation (area under the curve 0.56; 0.38-0.80) were strong predictors of 28-day mortality. CONCLUSIONS This study suggested that in the early 6-hr resuscitation period, masseter tissue oxygen saturation accurately identified patients with severe sepsis and central venous oxygen saturation >70%. Both masseter tissue oxygen saturation and deltoid tissue oxygen saturation but not central venous oxygen saturation or thenar tissue oxygen saturation are strong predictors of 28-day mortality.
Published: 2011

33. Maladie mitochondriale

Author: Diane Friedman and Djillali Annane
Published: 2010

34. PULLING TOGETHER: Building a Community DEBRIEFING TEAM

Author: Diane Friedman and Marcie Clark
Subjects: Emergency Medical Services, business.industry, Health Personnel, Debriefing, education, Applied psychology, Critical Incident Stress Debriefing, medicine.disease, Nursing, Adaptation, Psychological, Incident stress, Psychotherapy, Group, Workforce, medicine, Humans, Illinois, Pshychiatric Mental Health, Group intervention, business, Burnout, Professional, General Nursing
Abstract: 1. Research shows that many emergency workers are affected physically and emotionally by critical incident stress. 2. Debriefings conducted by trained team members are an effective method to mitigate the impact of critical incident stress. A debriefing is a structured, time-limited group intervention. 3. Cooperation among community agencies is essential for the development and effective functioning of a critical incident stress debriefing team. 4. Several teams in Illinois have organized to form a Critical Incident Stress Debriefing Network. The Illinois network is part of an international organization composed of critical incident stress debriefing providers.
Published: 1992

35. Risk factors and outcomes following revascularization for chronic mesenteric ischemia

Author: Robert G. Atnip, Karla M. Anderson, Diane Friedman, John Blebea, and Todd K. Kihara
Subjects: Male, medicine.medical_specialty, Visceral artery, medicine.medical_treatment, Arterial reconstruction, Revascularization, Blood Vessel Prosthesis Implantation, Sex Factors, Celiac Artery, Mesenteric Artery, Superior, Risk Factors, Internal medicine, Mesenteric Vascular Occlusion, medicine, Humans, Life Tables, Clinical efficacy, Graft Type, Vascular Patency, Proportional Hazards Models, Retrospective Studies, business.industry, Angioplasty, General Medicine, Middle Aged, Surgery, Chronic mesenteric ischemia, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Abdominal surgery
Abstract: Revascularization for chronic mesenteric ischemia is an infrequent vascular procedure whose objective long-term patency results have been described in relatively few patients. We reviewed our experience with such procedures and report on the objective and symptomatic long-term results. We retrospectively reviewed a consecutive series of 42 patients who underwent mesenteric arterial reconstruction of 66 vessels during an 11-year period from 1986 to 1997. All patients were treated for symptomatic chronic mesenteric ischemia. The results support the clinical efficacy and durability of visceral artery bypass procedures for patients with symptomatic chronic mesenteric ischemia. Patency rates for females were better than for males independent of graft type.
Published: 1999

36. Relevance of anxiety in clinical practice of Guillain-Barré syndrome: a cohort study

Author: Marie-Christine Durand, Marie-Hélène Marcadet, Raphaël Porcher, Takoua Merhbene, Djillali Annane, Diane Friedman, Tarek Sharshar, Andrea Polito, David Orlikowski, Morgane Blanc, and Marion Antona
Subjects: Weakness, medicine.medical_specialty, medicine.medical_treatment, Intensive care, medicine, Intubation, Cognitive decline, Guillain-Barre syndrome, Adult intensive & critical care, business.industry, Research, Intensive Care, General Medicine, Neuromuscular disease, medicine.disease, Neurology, Respiratory failure, Physical therapy, Anxiety, medicine.symptom, business, Intensive & Critical Care, Cohort study
Abstract: Objectives Illness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent need for intubation in Guillain-Barre syndrome (GBS). Design Incident case-cohort study. Setting Acute secondary care in a teaching hospital (France) from 2006 to 2010. Participants 110 adult GBS patients. Either language barrier or cognitive decline that precluded understanding was considered as exclusion criteria. Primary outcome Acute respiratory failure. Interventions At admission, anxiety and clinical factors (including known predictors of respiratory failure: delay between GBS onset and admission, inability to lift head, vital capacity (VC)) were assessed and related to subsequent need for mechanical ventilation (MV). Anxiety was assessed using a Visual Analogical Scale (VAS), the State Anxiety Inventory form Y1 (STAI-Y1) score and a novel-specific questionnaire, evaluating fears potentially triggered by GBS. Patients were asked to choose which they found most stressful from weakness, pain, breathlessness and uncertainty. Results 23 (22%) were subsequently ventilated. Mean STAI-Y1 was 47.2 (range 22–77) and anxiety VAS 5.2 (range 0–10). STAI was above 60/80 in 22 (21%) patients and anxiety VAS above 7/10 in 28 (27%) patients. Fear of remaining paralysed, uncertainty as to how the disease would progress and fear of intubation were the most stressful. Factors significantly associated with anxiety were weakness and bulbar dysfunction. STAI-Y1 was higher and uncertainty more frequent in subsequently ventilated patients, who had shorter onset-admission delay and greater weakness but not a lower VC. Uncertainty was independently associated with subsequent MV. Conclusions Early management of patients with GBS should evaluate anxiety and assess its causes both to adjust psychological support and to anticipate subsequent deterioration.
Published: 2012

37. Psychogenic seizures in children and adolescents: outcome after diagnosis by ictal video and electroencephalographic recording

Author: Elaine Wyllie, Diane Friedman, A. David Rothner, Hans Luders, Dudley Dinner, Harold Morris, Robert Cruse, Gerald Erenberg, and Prakash Kotagal
Subjects: Adolescent, Seizures, Pediatrics, Perinatology and Child Health, Video Recording, Humans, Electroencephalography, Child, Prognosis, Psychomotor Performance, Follow-Up Studies
Abstract: Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring, with unresponsiveness. Ictal and interictal electroencephalograms showed no abnormalities after antiepileptic medication was discontinued. Fifteen patients had psychogenic seizures spontaneously during recording, and six had seizures in response to suggestion and intravenous saline injection. After the video-electroencephalographic evaluation, patients and families were told that the episodes were emotional in origin. All patients but 1 agreed to remain without antiepileptic medication, and 16 patients (76%) agreed to begin psychiatric treatment. At 6 to 66 (mean 30) months' follow-up, 14 of 18 (78%) were free of episodes. These data indicate that the majority of young patients with psychogenic seizures have a good outcome. A firm diagnosis is critical so that the episodes can be classified and emphasized as medically not worrisome, permitting a shift away from antiepileptic medication and toward psychiatric treatment.
Published: 1990

38. Surgery for intractable epilepsy: Clinicopathologic correlates in 60 cases

Author: Diane Friedman, Dudley S. Dinner, Alden W. Dudley, Joseph F. Hahn, Harold H. Morris, Ronald P. Lesser, Melinda L. Estes, Elaine Wyllie, and Hans Lüders
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, business.industry, Intractable epilepsy, Electroencephalography, Seizure reduction, General Medicine, Temporal Lobe, Temporal lobe, Surgery, Epilepsy, Temporal Lobe, Child, Preschool, medicine, Humans, Female, Epilepsy surgery, Epilepsies, Partial, Child, business
Abstract: The pathologic findings in 60 consecutive patients with intractable epilepsy who consecutively underwent surgery at The Cleveland Clinic Foundation (1979-1984) were analyzed in an attempt to define pathologic findings influencing surgical outcome. Statistically significant predictors of outcome were sought from variables including macroscopic lesions, microscopic abnormalities, and the absence of significant pathologic findings. A higher percentage of patients (82%) with macroscopic temporal lobe lesions had an excellent result (seizure reduction >90%) than did the group with no significant pathologic findings (60%), but the differences were not statistically significant. The authors also found that the group of patients who had only temporal lobe resections had a higher percentage of excellent results (70%) than did the group of patients having epilepsy surgery for other areas of the brain (42.5%). This difference, however, was not statistically significant (P = .10).
Published: 1988

39. 3/ The Development of Professional Identity in Psychotherapists

Author: Nadine J. Kaslow and Diane Friedman
Subjects: media_common.quotation_subject, education, Professional development, Collegiality, humanities, Education, Developmental psychology, Craft, Psychiatry and Mental health, Clinical Psychology, Psychology, Competence (human resources), Parallels, Individuation, Social psychology, Identity formation, Autonomy, media_common
Abstract: It is our view that the processes which psychothera- ists undergo as they both learn their craft and develop a sense of professions identity conform to the developmental sequelae which lead to individuation and identity formation in human beings in general. In this chapter we highlight parallels in the developmental processes and delineate guidelines for supervisory practice which they imply. We have identified six stages in the learning and supervisory processes of psychotherapists-in-training and of new professionals. We describe the new trainee's diffuse anxiety, excitement, and dependency on the supervisor in the earliest stares, his or her increasing sense of confidence, competence and autonomy as they emerge in the middle stages, and, his or her emergent stability as a psychotherapist and collegiality both with peers and senior staff during the last stage.
Published: 1986

40. Basal Temporal Subdural Electrodes in the Evaluation of Patients with Intractable Epilepsy

Author: George Skipper, Harold H. Morris, Diane Friedman, Ronald P. Lesser, Joseph F. Hahn, Lee Friedman, Dudley S. Dinner, Elaine Wyllie, and Hans Lüders
Subjects: Physics, Surgical resection, Epileptogenic focus, Brain Mapping, medicine.medical_specialty, Temporal lobectomy, business.industry, Complex partial seizures, Intractable epilepsy, Action Potentials, Electroencephalography, Temporal Lobe, Electrodes, Implanted, Surgery, Resection, Epilepsy, Temporal Lobe, Neurology, medicine, Humans, Neurology (clinical), Surgical treatment, Nuclear medicine, business, Subdural electrodes
Abstract: Summary: In evaluation of patients with complex partial seizures who are candidates for surgical treatment, exact definition of the epileptogenic focus is essential for a good surgical outcome. We report a new technique which permits detailed mapping of the epileptogenic activity in the basal temporal lobe and the convexity of the temporal lobe. The technique consists of placement of at least 16 basal temporal electrodes and an additional 64 electrodes covering the temporal convexity. This extensive coverage permits accurate definition of the limits of the epileptogenic focus and also of adjacent functional areas and therefore allows more significant determination than have previous techniques of the ideal extent of the surgical resection. This accuracy cannot be achieved with depth electrodes or the limited coverage provided by previously reported epidural or subdural electrode techniques. RESUME Dans le bilan de patients presentant des crises partielles complexes et qui sont candidats a un traitement chirurgical, une definition exact du foyer epileptogene est essentielle dans la perspective d'un bon resultat post-operatoire. Les auteurs rappor-tent une nouvelle technique qui permet d'etablir une topographie detaillee de l'activite paroxystique dans la region basale et la convexite du lobe temporal. Cette technique consiste a placer un minimum de 16 electrodes temporales basales et 64 electrodes supplementaires sur la convexite temporale. Cette large couverture permet de defiinir precisement les limites du foyer ṕileptogene et des regions fonctionnelles adjacentes; elle permet done de determiner avec une precision superieure a celle des techniques anterieures l'extension ideale de la resection chirurgicale. Cette precision ne peut etre obtenue par des electrodes pro-fondes ou par la couverture limitee fournie par les techniques anterieurement decrites utilisant des electrodes epi- ou sous-durales. RESUMEN En la evaluacion de enfermos con ataques parciales comple-jos, considerados como candidates para tratamiento quirurgico, resulta esencial la definiciom del foco epileptogenico para consequir unos resultados quirurgicos de buena calidad. Se presenta una tecnica nueva que permite conseguir un mapa detallado de la actividad epileptogenica en la region basal y en la convexidad del lobulo temporal. Esta tecnica consiste en la colocacion de, al menos, 16 electrodos basales temporales y de 64 electrodos que cubren la convexidad del lobulo temporal. Esta amplia cobertura permite una valida definicion de los limites de los focos epilep-togenicos y tambien de las areas funcionales adyacentes que, por lo tan to, permite determinar con precision, mas fiable que con tecnicas previas, la amplitud ideal de la reseccion quirurgica. Esta exactitud no puede consequirse con electrodos profundos ni con el emplazamiento de electrodos epi o subdurales como ha sido previamente publicado. ZUSAMMENFASSUNG Bei der Untersuchung der Patienten mit komplexen Partialan-fallen, die moglicherweise fur eine chirurgische Behandlung in Frage kommen, ist eine genaue Abgrenzung des epileptogenen Fokus' unabdingbar fur einen guten Operationserfolg. Wir be-richten uber eine neue Technik, welche ein detailliertes Mapping der epileptogenen Aktivitat uber der Basis und der Konvexitat des Temporallappens erlaubt. Die Technik umfaβt die Plazierung von wenigstens 16 basalen Elektroden und Weiteren 64 Konvex-itatselektroden. Diese dichte Besetzung erlaubt die akkurate Abgrenzung der Fokusregion sowie angrenzender funktioneller Ge-biete. Damit laβt sich mit signifikant besserer Zuverlassigkeit das Ausmaβ der vorgesehenen Resektion fest bestimmen. Die Genauigkeit kann weder mit Tiefenelektroden noch mit be-grenzten Ableitungen–wie kurzhch berichtet–durch epi- oder subdurale Elektroden-Technik erreicht werden.
Published: 1989

41. Subdural Electrodes in the Evaluation for Epilepsy Surgery in Children and Adults

Author: Elaine Wyllie, H. Lüders, H. Morris III, R. Lesser, D. Dinner, A. Rothner, G. Erenberg, R. Cruse, Diane Friedman, J. Hahn, and Melinda Estes
Subjects: Adult, Pediatrics, medicine.medical_specialty, Adolescent, Electroencephalography, Epilepsy, medicine, Humans, Epilepsy surgery, Good outcome, Child, Electrodes, Monitoring, Physiologic, medicine.diagnostic_test, business.industry, Incidence (epidemiology), General Medicine, medicine.disease, Temporal Lobe, medicine.anatomical_structure, El Niño, Child, Preschool, Anesthesia, Scalp, Pediatrics, Perinatology and Child Health, Neurology (clinical), business, Subdural electrodes, Follow-Up Studies
Abstract: To evaluate the utility and safety of chronic extraoperative subdural EEG and functional localization studies in children compared to adults, we studied 61 patients each of whom had similar evaluations for epilepsy surgery, regardless of age. The 23 children and adolescents (3 to 18 years old) and the 38 adults (20 to 41 years old) each had several days and nights of extraoperative EEG from scalp and chronically-implanted subdural electrodes, and the same percentage of children and adults also had functional localization studies including cortical electrical stimulation. The methods and results of these studies and of the subsequent resections did not differ between the two groups, and they both had similar rate of complications and similar incidence of good outcome. The subdural technique was as effective and well-tolerated in children and adolescents as in adults. Other invasive EEG techniques have not yet been systematically compared between children and adults, but the subdural technique, at least, appears to be suitable for patients over a wide age range.
Published: 1988

42. Use of a holding technique to control the violent behavior of seriously disturbed adolescents

Author: Diane Friedman, Mark C. Walker, and Derek M. Miller
Subjects: Restraint, Physical, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Poison control, Psychiatric Department, Hospital, Violence, Social Environment, Suicide prevention, Occupational safety and health, Intervention (counseling), Injury prevention, medicine, Humans, Psychiatry, Patient Care Team, business.industry, Mental Disorders, Social environment, medicine.disease, Psychiatry and Mental health, Crisis Intervention, Medical emergency, Seclusion, business, Crisis intervention
Abstract: Therapeutic holding is a treatment technique in which a violent patient is physically contained by people rather than by mechanical or chemical restraints or seclusion. Episodes of therapeutic holding that took place on an inpatient adolescent psychiatric unit over an 18-month period were examined retrospectively through chart review and review of written audits of each episode. During that period, 22.8 percent of the patient population experienced at least one episode of therapeutic holding. Patients requiring this intervention were more likely to be younger and, when day at risk were controlled, to be male and to have had longer stays on the unit. The technique enabled patients to regain behavioral control after a mean of 21.2 minutes, a much shorter period of containment than the four to 16 hours reported in studies of seclusion.
Published: 1989

43. Clinical outcome after complete or partial cortical resection for intractable epilepsy

Author: Diane Friedman, A. D. Rothner, Robert P. Cruse, Joseph F. Hahn, Gerald Erenberg, Elaine Wyllie, Ronald P. Lesser, Melinda L. Estes, Hans Lüders, Harold H. Morris, and Dudley S. Dinner
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Intractable epilepsy, Electroencephalography, Resection, Epilepsy, Postoperative Complications, Medicine, Humans, Surgical Wound Infection, Ictal, Epilepsy surgery, Child, Electrocorticography, Cerebral Cortex, medicine.diagnostic_test, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Evaluation Studies as Topic, Scalp, Child, Preschool, Female, Neurology (clinical), business, Follow-Up Studies
Abstract: This is the first epilepsy surgery series to analyze the definition of “completeness” of resection, based solely on results of chronic scalp and subdural EEG recording. When patients had complete removal of all cortical areas with ictal and interictal epileptiform discharges, the clinical outcome was usually good. When areas with epileptiform discharges were left behind, good outcome was significantly less frequent. This correlation between complete resection and good outcome was independent of the presence or absence of CT-detected structural lesions or sharp waves on post-resection electrocorticography. These results support completeness of resection, defined by prolonged extraoperative EEG, as an important factor in seizure surgery.
Published: 1987

44. Book Reviews

Author: DIANE FRIEDMAN
Subjects: Psychiatry and Mental health, General Medicine, Pshychiatric Mental Health, Pediatrics
Published: 1989

45. Guide to Clinical Studies and Developing Protocols

Author: Diane Friedman
Subjects: Pharmacology, Pharmacology (medical)
Published: 1985

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