Search

Objectives: The objectives of this study were to describe the impact of systemic sclerosis associated interstitial lung disease, on quality of life, to estimate the correlation between quality of life and severity of lung disease and to assess the impact of interstitial lung disease on caregivers. Methods: Seven investigators included systemic sclerosis associated interstitial lung disease patients from December 2019 to April 2020. Sociodemographics and clinical data were collected. Patients reported outcomes and questionnaires were used with 1 generic patients reported outcome (EQ-5D-5L), 1 specific PRO (Brief Interstitial Lung Disease) and 2 self-reported questionnaires on impact of SSc complications and impact on caregivers. The correlation between forced vital capacity and EQ-5D-5L score was estimated with a multivariate linear regression model adjusted on several covariates. Results: In all, 89 patients were included. 26.4% were males, mean age was 58.2 ± 14.5 years. Mean EQ-5D-5L score = 0.79 ± 0.22 (median = 0.85). Mean EQ-5D-5L visual analog scale score = 60.8 ± 20.4 (median = 61.5). Mean King’s Brief Interstitial Lung Disease score = 58.4 ± 12.7 (median = 58.0). After adjustment on covariates, a significant correlation between forced vital capacity and EQ-5D-5L score was found with an increase of 0.003 of the EQ-5D-5L score for a 1% increase of FVC (p = 0.0096). No significant correlation between forced vital capacity and the EQ-VAS and King’s Brief Interstitial Lung Disease score were found. The impact of SSc on other organs was significantly correlated with EQ- 5D-5L score, respectively, for the impact scores on the lung system (p = 0.0003), heart system (p = 0.0182), Raynaud’s syndrome (p = 0.0015), digestive system (p = 0.0032), joints/muscles (p = 0.0003), skin (p < 0.0001), kidney (p = 0.0052) and gastro-oesophageal reflux (p = 0.0063). Significant correlations between King’s Brief Interstitial Lung Disease score and lung system (p < 0.0001), heart system (p < 0.0001), digital ulcers (p = 0.058), digestive system (p < 0.0001), kidney (p = 0.0004), skin (p = 0.0499) and gastro-oesophageal reflux (p = 0.0033) scores were found 68.5% of patients reported their need for a caregiver to help them in their daily life activities. Conclusion: Our study highlighted the strong burden of systemic sclerosis associated interstitial lung disease` for patients, especially with an impact on quality of life, on other organs manifestations and need for caregivers in their daily life.

Objective Our objectives were to describe the basal insulin treatment regimens most widely used in a real-world setting in France and to estimate the associated treatment costs in people with type 2 diabetes mellitus (T2DM). Methods A cross-sectional observational study was conducted (November 2017–February 2018) among adult patients with T2DM requiring basal insulin therapy for their own use in a representative sample of pharmacies. Costs were compared between patients treated with three recently marketed insulins (glargine 300 U/ml [Gla-300], biosimilar glargine 100 U/ml [Gla-100] and a fixed-ratio combination of insulin degludec and liraglutide) and those treated with three established basal or intermediate insulins: branded glargine 100 U/ml, insulin detemir and neutral protamine Hagedorn insulin [NPH]). Results Overall, 1933 patients were analysed. Gla-300 accounted for 59.9% of novel basal insulin prescriptions, and branded Gla-100 accounted for 67.9% of established insulin prescriptions. Recent insulins were more frequently associated with glucagon-like peptide-1 (GLP-1) analogues. Results confirmed a lower rate of severe hypoglycaemia with Gla-300 than with Gla-100. On average, weekly total costs of treatment with all basal insulins were not significantly different, except with detemir, where they were higher. Conclusion New basal insulins are expected to be integrated into clinical practice. This analysis shows that their use does not impact upon the management cost of insulin therapy in people with T2DM. Electronic supplementary material The online version of this article (10.1007/s41669-020-00237-4) contains supplementary material, which is available to authorized users.

Objectif : Decrire les pratiques d’auto-surveillance glycemique (ASG) chez les patients diabetiques de type 1 (DT1) ou 2 (DT2) et estimer la proportion de patients realisant une ASG selon la frequence recommandee, la proportion de patients respectant les recommandations de qualite de la mesure. Materiels et methodes : Etude nationale, transversale, conduite aupres de 238 pharmacies. Un questionnaire etait complete avec les patients sur les items suivants : diabetiques adultes, achetant pour eux-memes du materiel d’ASG, utilisant un lecteur depuis au moins six mois, sous insuline ou sulfamide/glinide ± autres antidiabetiques (AD). Resultats : 449 patients ont ete inclus : 85 DT1 et 121 DT2 traites par multi-injections de type basale-bolus ± AD (Groupe A et Groupe B), 123 DT2 par insuline basale ± AD (Groupe C), 102 patients sous un autre schema insulinique ± AD (Groupe D) et 120 DT2 par sulfamides/glinides sans insuline ± autres AD (Groupe E). La frequence recommandee etait suivie respectivement par 29,8 %, 36,4 %, 61,8 % et 69,2 % des patients Groupe A, Groupe B, Groupe C, Groupe E. La qualite de l’auto-mesure restait insuffisante qu’il s’agisse du nettoyage de l’appareil, des conditions de conservation/peremption des bandelettes ou de l’utilisation des solutions de controle. La capacite des patients a prendre une decision face a leur ASG restait faible (Groupe A : 56,5 %, Groupe B : 70,2 %, Groupe C : 49,2 %, Groupe E : 36,0 %) comme leur connaissance de leurs objectifs glycemiques (Groupe A : 81 %, Groupe B : 80,5 %, Groupe C : 68,6 %, Groupe E : 73,7 %). Conclusion : Si des progres restent a faire sur la frequence et la qualite des mesures, professionnels et patients doivent surtout porter leurs efforts sur l’education a l’interpretation des resultats de l’ASG.

Introduction L’objectif principal de cette etude etait de decrire l’impact de la pneumopathie interstitielle diffuse associee a la sclerodermie systemique (PID-ScS) sur la qualite de vie (QdV). Les objectifs secondaires etaient d’etudier la relation entre la QdV et d’autres atteintes d’organes de la ScS et le recours a des aidants par les patients. Materiels et methodes Sept centres investigateurs ont inclus 89 patients atteints de PID-ScS entre decembre 2019 et avril 2020. Des donnees sociodemographiques et cliniques ont ete recueillies. Les patients ont renseigne un questionnaire de QdV generique (EQ-5D-5L), un questionnaire de QdV specifique (K-BILD) et un auto-questionnaire evaluant l’impact de la ScS sur differents organes selon un score variant entre 0 et 100, et le recours a des aidants. Des analyses de regressions lineaires multivariees ont ete conduites entre les scores de QdV, la capacite vitale forcee (CVF) et les scores des atteintes d’organes avec ajustement sur l’âge, le sexe, l’anciennete de la maladie, le type diffus ou non de la ScS et la presence d’auto-anticorps anti-topoisomerase. Resultats Parmi les 89 patients inclus, 73,6 % etaient des femmes. L’âge moyen etait de 58,2 ± 14,5 ans. La CVF moyenne etait de 86,8 ± 24,9 %. Les anticorps detectes etaient majoritairement des anti-topoisomerases (59,0 %). Le score moyen EQ-5D-5L etait de 0,8 ± 0,2 et le score moyen de l’echelle visuelle analogique (EVA) de l’ EQ-5D-5L etait de 60,8 ± 20,4. Le score moyen du K-BILD etait de 58,4 ± 12,7. La regression lineaire multivariee a retrouve une correlation significative entre la CVF et le score EQ-5D-5L avec une augmentation de 0,003 du score EQ-5D-5L pour une augmentation de 1 % de la CVF (p = 0,0096). Aucune correlation significative n’a ete identifiee entre la CVF d’une part et l’EVA de l’EQ-5D-5L ou le score du K-BILD d’autre part. Des correlations significatives ont ete retrouvees par les analyses de regression multivariee entre le score EQ-5D-5L et l’impact de la maladie sur le systeme pulmonaire (p = 0,0003), le systeme cardiaque (p = 0,0018), le syndrome de Raynaud (p = 0,0015), le systeme digestif (p = 0,0032), les articulations/muscles (p = 0,0003), la peau (p Discussion La population incluse presente des caracteristiques similaires aux sujets de la cohorte EUSTAR, ce qui est un gage de sa representativite et les resultats de cette etude sont coherents avec ceux d’autres travaux similaires. Conclusion Cette etude confirme l’impact de la PID-ScS sur la QdV avec la mise en evidence d’une correlation significative entre le score EQ-5D-5L et la CVF, mais egalement avec d’autres atteintes d’organes.

Background Clostridium difficile infection (CDI) is associated with a substantial Quality of life impact on patients that has not been so far measured with a generic validated instrument. Methods A prospective study was performed in 7 French acute-care settings in patients presenting with a bacteriologically-confirmed CDI. The EQ-5D-3 L was filled in by patients at 7 ± 2 days after CDI diagnosis to describe their state of health at that date as well as their state of health immediately before the CDI episode (baseline). Individual utility decrement was obtained by subtracting the corresponding utilities. The Quality Adjusted Life Year (QALY) loss was calculated by multiplying the days spent from baseline to the date of the interview, by the decrement of utility. A multivariate analysis of variance of the utility decrement according to CDI and patients characteristics was performed. Results Eighty patients were enrolled (mean age: 69.4 years, 55% females). The utility scores dropped from a mean 0.542 (SD: 0.391) at baseline to 0.050 (SD: 0.404) during the CDI episode with a mean adjusted utility decrement of 0.492 (SD: 0.398) point. This decrement increased significantly with CDI severity (Zar score ≥ 3) (p = 0.001), in patients with a positive baseline utility (p = 0.032), in women as compared to men (p = 0.041) and in patients aged more than 65 years (p = 0.041). No association with the Charlson index was found. The associated QALY loss not integrating the excess mortality was 0.028 (SD: 0.053). Conclusions The impact on quality of life of CDI episodes is major and translates in a substantial QALY loss despite their short duration. Electronic supplementary material The online version of this article (10.1186/s12955-019-1081-5) contains supplementary material, which is available to authorized users.

Objectives: To describe Self-Monitoring of Blood Glucose (SMBG) practices in France in patients with type 1 (T1DM) or type 2 (T2DM) diabetes, by estimating the proportion of patients performing SMBG at the recommended testing frequency and the proportion of patients complying with the current quality control guidelines on SMBG. Materials and methods: National cross-sectional study conducted in 238 pharmacies. A questionnaire was completed with adult diabetic patients buying SMBG devices or reagent strips for themselves, using a blood glucose meter for at least 6 months, treated with insulin or sulfonylurea/glinides ± other oral hypoglycaemic agents (HA). Results: Data from 449 patients were analysed: 85 T1DM and 121 T2DM patients treated by multiple basal-bolus injections ± HA (Group A and Group B), 123 T2DM patients treated by basal insulin ± HA (Group C), 102 patients treated by other insulin regimens ± HA (Group D) and 120 T2DM patients treated by sulfonylurea / glinides without insulin ± other HA (Group E). The recommended test frequency was observed by 29.8%, 36.4%, 61.8% and 69.2% of patients in Group A, Group B, Group C, and Group E, respectively. The quality of self-monitoring was insufficient in terms of device cleaning, storage conditions/expiry date of reagent strips, or use of control solutions. Patients displayed a limited capacity to take decisions in relation to their SMBG results (Group A: 56.5%, Group B: 70.2%, Group C: 49.2%, Group E: 36.0%) and limited knowledge about their glucose targets (Group A: 81%, Group B: 80.5%, Group C: 68.6%, Group E: 73.7%). Conclusion: SMBG use and compliance with quality guidelines must be improved, but healthcare professionals and patients must also focus their efforts on education to interpret SMBG results.

International audience; AbstractBackgroundFibrodysplasia ossificans progressiva (FOP) is a rare, severely disabling, and life-shortening genetic disorder that causes the formation of heterotopic bone within soft connective tissue. Previous studies found that the FOP prevalence was about one in every two million lives. The aim of this study is to estimate the FOP prevalence in France by probabilistic record-linkage of 2 national databases: 1) the PMSI (Programme de médicalisation des systèmes d’information), an administrative database that records all hospitalization activities in France and 2) CEMARA, a registry database developed by the French Centres of Reference for Rare Diseases.ResultsUsing a capture-recapture methodology to adjust the crude number of patients identified in both data sources, 89 FOP patients were identified, which results in a prevalence of 1.36 per million inhabitants (CI95% = [1.10; 1.68]). FOP patients’ mean age was 25 years, only 14.9% were above 40 years, and 53% of them were males. The first symptoms – beside toe malformations- occurred after birth for 97.3% of them. Mean age at identified symptoms was 7 years and above 18 years for only 6.9% of patients. Mean age at diagnosis was 10 years, and above 18 years for 14.9% of the patients. FOP patients were distributed across France.ConclusionsDespite the challenge of ascertaining patients with rare diseases, we report a much higher prevalence of FOP in France than in previous studies elsewhere. We suggest that efforts to identify patients and confirm the diagnosis of FOP should be reinforced and extended at both national and European level.

Objectif Evaluer les consequences sur la qualite de vie d’un episode d’infection a Clostridium difficile (ICD) chez des patients hospitalises en court sejour. Materiel et methodes Une etude observationnelle prospective a ete conduite en 2016 dans sept centres hospitaliers francais chez des patients presentant une ICD confirmee microbiologiquement. L’auto-questionnaire EQ-5D-3L a ete complete par les patients pour decrire leur etat de sante percu, a deux reprises : a 7 (± 2) jours apres le diagnostic d’ICD ainsi que de facon retrospective pour decrire leur etat avant l’episode infectieux. Les decrements d’utilite correspondants (avant et pendant l’episode) ont ete calcules en appliquant les valeurs de reference francaises [1] . Le score obtenu variait entre −1 et 1, 1 etant la meilleure qualite de vie possible. Le calcul des QALYs a ete effectue a partir de l’EQ-5D et des durees moyennes observees des episodes dans les etudes publiees. La perte de QALY a ete estimee en multipliant la perte incrementale d’utilite par la duree moyenne d’un episode. Une analyse de la variance des decrements d’utilite en fonction de la severite de l’ICD et des caracteristiques des patients a ete realisee. Resultats Au total, 80 patients ont ete inclus et disposaient de donnees exploitables ; 45 % des patients inclus etaient des hommes et l’âge median a l’inclusion etait de 71 ans (min/max : 30/98). La duree d’hospitalisation moyenne etait de 30 jours (± 29). Le score moyen de Charlson etait de 5,1 (± 2,8). Les scores d’utilite etaient negatifs chez 14 patients (18 %) avant l’episode d’ICD et chez 43 patients (54,4 %) pendant l’episode. Le score moyen EQ-5D est passe de 0,542 (± 0,391) avant l’episode infectieux a 0,050 (±0,404) pendant l’episode, avec une perte d’utilite moyenne ajustee de 0,482 points (±0,4). Le decrement d’utilite etait significativement plus important en fonction de la severite de l’ICD (score Zar ≥ 3) (p = 0,001), pour les patients avec un score d’utilite positif avant l’episode (p = 0,032), pour les femmes (p = 0,041) et pour les patients âges de 65 ans ou plus (p = 0,041). Aucune association avec le score de Charlson n’a ete mise en evidence. La perte de QALY associee en l’absence de deces etait de 10,22 QALD (« Quality-Adjusted Life Days ») (± 19,44) soit 0,028 QALY (± 0,052). Conclusion Les consequences sur la qualite de vie des episodes d’ICD, en dehors des consequences en termes de mortalite plus elevee, sont importantes et se traduisent en une perte significative de QALY malgre leur courte duree.

Objective: To compare the incidence of Nd:YAG laser treatment following 3 square-edged intraocular lenses (IOLs) of different composition implanted during cataract surgery. Design: Patient chart analysis. Participants: Patients aged 50-85 years and given a hydrophobic acrylic IOL (either SA60AT or AR40E) or hydro-philic acrylic IOL (XL-Stabi) were included. Analysis was conducted of 767 eyes treated with SA60AT ( n = 250), AR40E ( n = 254), or XL-Stabi ( n = 263). Methods: This retrospective study involved patients who had undergone cataract surgery between 2001 and 2002. Ophthalmology centres were accepted into the study if they used at least 2 of the IOLs being investigated. The medical files of patients fulfilling the inclusion criteria were listed, and eligible cases were selected randomly. Patients' characteristics were obtained from their medical files. Data on postsurgical complications and Nd:YAG laser treatment over 3 years were also extracted. Follow-up data were obtained from the medical files and the patients' ophthalmologists. Time to Nd:YAG laser treatment was analysed using Kaplan-Meier survival curves adjusted with a Cox model. Results: After 3 years' follow-up the proportions of patients who had not received Nd:YAG laser treatment were 87.0% with SA60AT, 76.6% with AR40E, and 54.6% with XL-Stabi ( p p p Conclusions: Of the 3 square-edged lenses studied, the SA60AT was associated with a lower incidence of Nd:YAG laser treatment than either AR40E or XL-Stabi.

The aim of this study was to confirm randomized clinical trial results showing that a fixed timolol/travoprost combination (TT; DuoTrav) controls intraocular pressure (IOP) better than a fixed timolol/latanoprost combination (TL; Xalacom) in everyday ophthalmic practice, when measured in the morning and24 hours after instillation.Patients with ocular hypertension or primary open angle glaucoma stabilized on TT or TL were included in this retrospective cross-sectional study. Data on demographics, medical history and previous treatments were extracted from the patients' medical records. Last treatment instillation times and IOP values were recorded at clinic visits. Treatments were compared by analyses of variance, logistic regressions and propensity scores adjusted for confounding factors.Out of 316 patients included, 124 instilled TT, 192 instilled TL and 266 (84.2%) overall had instilled their eye drops within 24 hours. The patients' mean age was 64.5 years and 51.6% were female. Treatment groups were comparable except for longer disease and treatment durations in TL recipients. Worse eye mean IOPs were 25.8 mmHg at diagnosis and 21.9 mmHg on starting their designated fixed combination treatment. The best IOP control was provided by TT instillations (mean IOP 17.1 and 19.0 mmHg in the TT and TL groups, respectively; p0.001). This difference was reinforced by results in the subgroup of patients who instilled treatment24 hours prior to IOP measurement (mean IOP 17.0 and 20.3 mmHg in the TT and TL groups, respectively; p0.004). Also, 82.6% of TT patients satisfied their ophthalmologists' IOP targets versus 51.1% of TL patients (p0.001). All significant differences persisted after adjustment for confounding factors.This study, conducted in routine ophthalmic practice, confirmed published clinical trial results showing that TT provides better IOP control than TL when measured in the morning, and that travoprost has longer-lasting residual effects than latanoprost when IOP is measured24 hours after instillation. However, readers should interpret these findings in the context of a cross-sectional observational study conducted in a naturalistic setting.

Introduction La fibrodysplasie ossifiante progressive (FOP) est une affection autosomique dominante rare, caracterisee par l’association d’anomalies congenitales des extremites et la survenue d’episodes successifs et cumulatifs d’ossifications musculaires irreversibles, conduisant a une ankylose progressive de l’axe vertebral et des membres. Objectifs La prevalence de la FOP est mal connue, evaluee de facon variable par deux etudes a 0,36 et 0,61 par million d’habitants. L’objectif de ce travail est d’estimer la prevalence a partir de deux systemes de collecte de donnees nationaux complementaires en France : donnees provenant soit de registres (CEMARA et MOC) soit medico-administratives (PMSI) afin notamment d’evaluer les patients non presents dans les registres. Methodes Cette etude a ete realisee a partir du croisement de CEMARA, base de donnees des centres maladies rares, existant depuis 2007 (integrant les patients FOP du registre local du centre de reference MOC etablit en 1990, apres accord des patients et des professionnels les prenant en charge) et du PMSI, base du programme de medicalisation des systemes d’information (donnees de 2006 a 2012). La date choisie pour l’estimation de la prevalence etait le 1er janvier 2012. Les patients decedes avant cette date ont ete exclus de l’etude. Resultats Les resultats preliminaires sont presentes ci-dessous. Les resultats du croisement des deux bases ne seront analyses qu’apres accord de la CNIL en attente. CEMARA et registre du CR MOC : au 01/01/2012, 85 patients vivants sont identifies FOP dans CEMARA et resident en France. Pour 63, le diagnostic avait ete confirme a cette date, 10 avaient deja des symptomes mais sans diagnostic confirme. Pour le reste (12), ces donnees sont manquantes. La prevalence est donc de 1,3 cas par million. Parmi ces 85 patients, 52 % sont des hommes, l’âge moyen est de 29 ans, 44 % ont moins de 20 ans, 48 % entre 20 et 60 ans et 8 % plus de 60 ans. PMSI : au 01/01/2012, 242 patients sont identifies dans le PMSI comme ayant ete hospitalises avec un code diagnostique CIM10 de FOP avant cette date et non decedes a cette date. La prevalence estimee est de 3,7 par million. Il est probable que certains de ces patients aient eu ce code diagnostique par exces. Ce point sera examine apres : (1) appariement des donnees avec la base CEMARA et (2) examen plus precis des donnees issues du PMSI sur ces hospitalisations (autres diagnostics, hospitalisations ulterieures). Parmi ces 242 patients, 44 % sont des hommes, l’âge moyen est de 42 ans, 18 % ont moins de 20 ans, 60 % entre 20 et 60 ans et 22 % plus de 60 ans. Conclusion Cette etude preliminaire permet de montrer pour cette pathologie une prevalence superieure aux etudes anterieures. Elle montre la pertinence du reseau CEMARA ainsi que le potentiel d’exploitation couple aux donnees medico-administratives en France pour les maladies rares. L’etude d’appariement avec le PMSI permettra d’affiner la precision de l’etude qui se situera probablement au-dessus de 1,3 cas par million en France (soit 1/770 000 residents).

A water soluble and hydrolysable polyester derived from malic acid has been synthesized by copolymerization of three different malolactonic acid esters. Functional pendant groups have been selected to interact with and protect heparin binding growth factors (HBGF). Three β-substituted β-lactones have been synthesized by using aspartic acid as a chiral precursor and benzyl, allyl and butyl alcohols in the formation of the ester pendant groups. The terpolymer has been subjected to three consecutive different chemical modifications. This modified terpolymer, able to induce new bone formation in an in vivo model, has the same property as carboxymethyl benzylamide sulfonate dextrans (CMDBS). Consequently, the distribution of the lateral functional groups is more essential than the glucidic nature of the backbone to acquire biological efficiency.

Objectif Decrire les pratiques d’autosurveillance glycemique (ASG) en France chez les patients diabetiques de type 1 (DT1) ou 2 (DT2) en particulier : – estimer la proportion de patients realisant une ASG selon la frequence recommandee en fonction du traitement recu ; – estimer la proportion de patients pratiquant cette ASG conformement aux recommandations en matiere de qualite de la mesure. Materiels et methodes Etude nationale, transversale, conduite aupres de 238 pharmacies. Un questionnaire etait complete avec les patients : – diabetiques adultes ; – venu acheter pour eux-memes du materiel d’ASG ; – utilisant un lecteur depuis au moins 6 mois ; – traites par insuline ou par sulfamide/glinide ± autres antidiabetiques (AD). Le recrutement etait concu afin d’obtenir 4 groupes (n = 120 par groupe) se differenciant par leur traitement hypoglycemiant. Resultats Les donnees de 449 patients ont ete analysees : 85 DT1 et 121 DT2 traites par multi-injections de type basale-bolus ± AD (G1 et G2), 123DT2 par insuline basale ± AD (G3) et 120DT2 par sulfamides/glinides sans insuline ± autres AD (G4). La frequence recommandee est suivie par respectivement 29,8 %, 36,4 %, 61,8 % et 72,4 % des patients G1, G2, G3, G4. La qualite de mesure est insuffisante en matiere de nettoyage de l’appareil, peremption et conservation des bandelettes (de 20 % a 35 % des patients ne verifient jamais cette derniere) ou utilisation des solutions de controle (seulement 8 % a 22 % les utilisent). La capacite des patients a prendre une decision therapeutique face a leur ASG reste faible (G1 : 43,5 %, G2 : 29,8 %, G3 : 50,8 %, G4 : 64,0 %), et la connaissance des objectifs de glycemie a jeun (G1 : 19 %, G2 : 19,5 %, G3 : 31,4 %, G4 : 26,3 %) ou d’HbA1c (G1 : 29,6 %, G2 : 46,2 %, G3 : 45,8 %, G4 : 40,3 %) est insuffisante. Conclusion Si des progres restent a faire sur le suivi des recommandations et la qualite de mesure de l’ASG, professionnels de sante et patients doivent porter des efforts sur l’education a l’interpretation des resultats des mesures.

Purpose. To determine the prevalence of ocular surface diseases and identify risk factors in a population of patients receiving antiglaucomatous eyedrops over the long term. Methods. An observational cross-sectional study was designed to investigate ocular surface signs and symptoms using simple clinical tools. An ocular surface disease intensity score was calculated based on 10 questions regarding ocular surface symptoms and signs with a 4-grade scale. Patients were classified into 3 groups (A, B, and C) according to this total score. A multinomial logistic regression was performed in order to identify risk factors for surface disease. Results. In an overall population of 516 patients, 49% belonged to group A, 30% to group B, and 21% to group C. The multivariate analysis showed that the following factors were correlated with the severity of ocular surface disease: patient age, number of daily eyedrops, past topical treatment changes for ocular intolerance (found in the history of 40% of the patients), intraocular pressure (found to be significantly higher in patients with more severe ocular surface disease), and glaucoma severity. Conclusions. Patients treated for primary open-angle glaucoma or ocular hypertension often have ocular surface diseases, more often and more severely in older patients receiving more drugs and presenting with more severe glaucoma. These high prevalence values might therefore have consequences on the burden of the disease in terms of adherence to treatment and quality of life.

Jean-Philippe Nordmann1, Christophe Baudouin1, Jean-Paul Renard2, Philippe Denis3, Antoine Lafuma4, Caroline Laurendeau4, Viviane Jeanbat4, Gilles Berdeaux5,61Hôpital des Quinzes-Vingt, Paris, France; 2Hôpital du Val de Grâce, Paris, France; 3Hôpital Edouard Herriot, Lyon, France; 4Cemka, Bourg-la-Reine, France; 5Alcon France, Rueil-Malmaison, France; 6Conservatoire National des Arts et Métiers, Paris, FranceObjective: To identify and characterize treatment compliance profiles of glaucoma patients and evaluate the association with intraocular pressure (IOP).Methods: A computerized device (Travalert®) that recorded daily instillation times and eye-drop counts was given for 3 months. Patients were declared compliant when at least 2 drops were instilled per day. Compliance rates were calculated for weekdays and weekends, separately, over 8 consecutive weeks. A principal components analysis (PCA) was followed by an ascendant hierarchical classification (AHC) to identify compliance groups.Results: 140 patients were recruited (mean age 65.5 years; 51.8% female) of whom 83.6% had primary open-angle glaucoma with mean IOP 23.9 mmHg before Travalert® use. 60.7% were treated with DuoTrav® (travoprost timolol fixed combination) and 39.3% with ­travoprost. The PCA identified two axes (compliance and treatment weeks). The AHC identified 3 ­compliance groups: ‘high’ (56.6%, approx. 80% compliance), ‘medium’ (21.2%, approx. 50% compliance), and ‘low’ (22.1%, approx. 20% compliance). Demographics and glaucoma parameters did not predict low compliance. Final mean IOP was 16.1 mmHg, but higher in the low compliance group (17.7 mmHg, P = 0.02).Conclusions: Compliance measurement by a medical device showed compliance rates

Catherine Boureau1, Antoine Lafuma2, Viviane Jeanbat2, Andrew F Smith3, Gilles Berdeaux41Clinique Geoffroy St Hilaire, Paris, France; 2Cemka-Eval, Bourg la Reine, France; 3Alcon Laboratories Ltd, Hemel Hempstead, UK and Nuffield Laboratory of Ophthalmology, University of Oxford, UK; 4Alcon France, Rueil Malmaison, France; Conservatoire National des Arts et Métiers, Paris, FranceBackground: Posterior capsule opacification is one of the most frequent adverse events following cataract surgery. This manuscript reports the lifetime cost of complications linked to posterior capsule opacification using three types of intraocular lens with square edges.Methods: Costs were estimated from a retrospective study of patients who underwent cataract surgery and data from the literature. The lenses studied were hydrophobic acrylic (SA60AT and AR40E) and hydrophilic acrylic (XL-Stabi) lenses with square edges. The frequency of Nd-Yag laser capsulotomies after 4 years’ survival was estimated by two methods: the first involved linear adjustment of the rate at 5 and 6 years follow-up and then application of a constant rate after 6 years; the second involved linear adjustment after 5 years follow-up. The economic perspective was that of the French Sickness Fund.Results: After 3 years’ follow-up the percentage of patients who had not undergone laser Nd-Yag capsulotomy was 86.9% with SA60AT, 76.6% with AR40E and 54.6% with XL-Stabi lenses (p

With multifocal intraocular lenses, the majority of the patients do not wear glasses after cataract surgery which is a potential source of savings.To collect data in four European countries on the associated costs for society of wearing spectacles after cataract surgery and the patient willingness to pay to be free of spectacles.Cross-sectional survey of centers that recruited patients who wore refractive spectacles after cataract surgery. Costs were expressed in 2006 Euros Results: 408 patients were recruited by 22 centers. Patients with a mean age of 68.5 years underwent cataract surgery about 3 years prior to recruitment. In all countries, prescribed lenses were mainly mono-focal and the mean cost of spectacles was EUR366.3. Half the patient population with private health insurance was reimbursed for spectacles at a level of 50%, except Spanish patients who were reimbursed at only 5.3%. However, a large part of the cost was directly paid by the patients. Out of a total mean cost of EUR354.9, patients paid EUR285.2 and health insurances only EUR69.7. More than half the patients were willing to pay at least 0.5EUR/day to be free of spectacles.Large differences were found among the 4 countries. Almost half of all subjects had private health insurance. The total cost of refraction includes a variety of resources not limited to spectacles. A large part of the cost was borne by patients and there is a high patient willingness to pay to be free of spectacles in this population.

A bioactive poly(beta-hydroxyalkanoate) derived from malic acid was prepared and tested on bone repair and muscle regeneration. This functionalized and hydrolyzable polymer was obtained after several steps, the first one being the anionic copolymerization of three malolactonic acid esters. Chemical modifications were carried out on the terpolymer to turn benzyl-protecting groups into carboxyl groups and allyl groups into sulfonate groups. The resulting polymer bore carboxylate, sulfonate, and sec-butyl pendent groups in 65/25/10 molar proportions and were aimed at interacting with heparan binding growth factors. This polymer did not present any toxic effect in cell viability of HepG2 cells, over a large range of concentrations (0.01-0.25 mgl(-1)). Its ability to improve wound healing was tested in vivo and positive results are reported. Furthermore, the bioactivity of this polymer was evaluated using the regeneration model of Extensor digitorum longus (EDL) rat muscle. The study displayed a significant increase in the muscle regeneration and maturation.