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Biomedical subjects

B Chevallier

Publications and source records attributed to B Chevallier.

At least 19 recordsLinked to original sources
PubMed2006

[Medication errors in pediatric inpatients: a multicentric prospective study].

OBJECTIVE: To improve the knowledge of medication errors in paediatrics: rate of occurrence, error characteristics, risk factors. PATIENTS AND METHODS: Our prospective study included nine uninformed teaching paediatric wards (general paediatrics, emergency departments, intensive care units) using a describing questionnaire built from medical reports analysis (event description, medical issues, contributing personal and structural factors) during a two-months period. RESULTS: Seventy-five questionnaires were collected and analysed. Medical errors reported concerned prescription: 21 cases and administration: 45 cases. Ten errors led to adverse effects. An attributable factor was noted in 39 cases. Concerning prescription errors, no respect to protocol: 11 cases, lack of knowledge: 3 cases, personal communication failure: 3 cases were noted. Concerning administration errors, human mistakes (lack of experience, miscommunication, calculation error): 8 cases, unclear prescription: 6 cases and system flaws: 6 cases were noted. Several attribuable causes were reported in 8 cases. CONCLUSIONS: Medication errors in paediatrics inpatients are common and contributing factors intricated. Paediatricians should help hospitals develop effective programs for safety providing medications, reporting medication errors, errors analysis strategy and creating a safe environment of medication for all hospitalised paediatric patients.

Child↗
PubMed2006

[Influenza vaccination coverage rate in children with underlying chronic disorders in 7 French pediatric wards].

UNLABELLED: In France, annual influenza vaccination is recommended and free of charge for children with chronic disease (chronic lung, heart or kidney disease, diabetes, haemoglobinopathy, immune deficiency). The national goal is to reach 75% influenza vaccination coverage by 2008, but data on coverage in high risk children are limited. OBJECTIVES: To estimate the influenza vaccination coverage in children with an underlying chronic health condition in the Paris region, during in- or out-patient visit at hospital. METHODS: A multicentre cross-sectional descriptive study was carried out over 2 months before the 2004-2005 flu vaccination campaign in 7 French paediatric hospitals (Paris region). Inclusion criteria for this survey were: children aged 6 months to 18 years, with an underlying chronic disease requiring annual influenza vaccination, with a vaccination card available, so as to check their vaccination status. Reasons for non vaccination were recorded. RESULTS: Data from 239 children were analysed. 56% of patients were males (mean age: 8.1 years). Two patients had 2 separate underlying chronic disorders; 69% had a haemoglobinopathy, 16.3% had a chronic respiratory disease, and 7.5% had diabetes. The influenza vaccination rate for 2003-2004 was 43.7% (haemoglobinopathy: 55.5%; chronic respiratory diseases: 12.8%). This rate increased from 20.4% to 43.7% between 1999 and 2003. Less than 16% of parents remembered having received a voucher for free vaccination from the National Health Insurance Agency. CONCLUSION: Efforts are still needed to achieve the 2008 objectives of 75% coverage.

Adolescent↗
PubMed2006

Spring-mass model characteristics during sprint running: correlation with performance and fatigue-induced changes.

Spring-mass model properties of eight non-specialized male runners were measured during four straight 100-m sprints on an athletics track. A recently developed simple measurement method allowed to calculate leg and vertical stiffness, vertical displacement of the center of mass, and stride temporal characteristics. Changes in these mechanical parameters were studied and correlated with those of sprint performance. During the first 100 m, forward velocity showed significant variations (mean value of 8.10 +/- 0.31 m x s(-1) over the entire 100-m), while leg and vertical stiffnesses (19.5 +/- 4.3 kN x m(-1) and 93.9 +/- 12.4 kN x m(-1), respectively) remained constant. No significant link was found between mechanical and performance parameters over this first sprint. During the following three sprints, vertical stiffness, step frequency, and contact time significantly decreased (20.6 +/- 7.9%, 8.03 +/- 3.34%, and 14.7 +/- 7.2% of the first 100-m value, respectively) with decreasing maximal and mean velocities (10.9 +/- 2.0% and 7.30 +/- 5.23%, respectively), whereas leg stiffness and maximal force remained constant. Furthermore, changes between these mechanical and performance parameters were significantly related, showing the clear relationship between impairment in spring-mass model properties of the runners' lower limbs and the decrease in performance in fatigue conditions induced by the repetition of these all-out efforts.

Adaptation, Physiological↗
PubMed2005

[The pediatrician's waiting room: a place for health education?].

OBJECTIVES: To assess the presence and impact of health education messages in pediatricians' waiting rooms. METHODS: In September 2001, 81 pediatricians completed a questionnaire about the furnishings and equipment in their waiting rooms. They also distributed a questionnaire about waiting room health education messages to parents, to be completed at home. RESULTS: The analysis considered 1830 questionnaires. Health education messages were posted in 91% of the waiting rooms and most frequently concerned children's accidents, vaccines, hygiene and nutrition. The best topics that the parents remembered involved child neglect, antibiotic therapy, AIDS and other sexually transmitted diseases, and nutrition. Although memorization of the messages was not influenced by duration of the wait, it was higher among parents who had previously visited the pediatrician. These messages led 14% of the parents to discuss them spontaneously with their pediatrician. CONCLUSION: Health education messages are posted in nearly all the waiting rooms studied; parents remember them in a variable and rather inexplicable order. Posting these messages demonstrates the pediatricians' willingness to be involved - beyond the simple consultation - in the health education of children and families. Identifying the real impact of these messages would require further study.

Humans↗
PubMed2005

[Treatment of exacerbation of asthma: what are today's issues?].

During past decades, major progress has been accomplished in the management of acute asthma. Most recent recommendations include evidence-based rationale. The improved quality of clinical guidelines makes them efficient models for medical education. The pediatric pharmacopoeia provides a great variety of choices of drugs as well as for asthma medical devices. These innovations dramatically facilitated the medical management of asthmatic children, but they did not solve all problems. Physicians now use higher doses of salbutamol, but the early prescription of systemic glucocorticoids for moderate exacerbation of asthma is still underused, given the most recent clinical guidelines and meta-analysis. Furthermore, repeated emergency department visits to the wards and lack of primary care physician should systematically be appraised when evaluating severity, as they are both major risk factors for severe exacerbations, even though they are not considered in acute asthma severity scores. Finally, initiating (or reinforcing) patient education at the time of exacerbation also presents important challenges, as emergency visits are a favorable moment to commence the therapeutic education of the child and his family. Indeed, framing the controller medications and educating families about how to manage the disease and to improve their domestic environment are the genuine tools available for the prevention of asthma exacerbations, and particularly those most severe.

Acute Disease↗
PubMed2005

Respiratory development of 5- to 6- year-old children experiencing a first bronchiolitis episode before age one.

BACKGROUND: The relationship between early infections due to respiratory syncytial virus (RSV), particularly bronchiolitis in infancy, and the subsequent development of asthma, bronchial hyper-responsiveness, and/or other allergic manifestations, seems increasingly certain, even if the mechanisms involved are not yet quite clear. OBJECTIVES: The objectives of this work were to determine the prevalence of, and risk factors for, asthma and allergy in 5 to 6 year-old children who five years previously, had experienced their first episode of bronchiolitis before the age of twelve months, and to define the possible effect of the age at which the bronchiolitis occurred on the subsequent development of asthma. METHOD: A retrospective cohort survey was conducted, based on the registers of two hospital paediatric emergency units (Unit A: the Ambroise Pare teaching hospital at Boulogne, France and unit B: the General Hospital of Cherbourg, France). The cohort comprised 5-6 years old children who had consulted or been admitted to emergency unit A or B between October 1993 and March 1994 for a first attack of bronchiolitis before the age of 12 months. RESULTS: One hundred and twenty eight children were included in the two centres (centre A: 78; centre B: 50). A familial history of allergy was found in 92 children (71.8%). Fifty-two (40.6%) were exposed to tobacco smoke. One hundred and five children (81.2%) had been hospitalised during the first episode of bronchiolitis, but none had been placed in intensive care. Their mean age at admission was 5.1 months, and 29 children were less than three months old. Ninety seven children (75.8%) had experienced at least one episode of wheezing at some time of their life. In the twelve months before the telephone interview, 40 children (31.3%) had had at least one such episode, 47 (36.7%) an attack of asthma, 32 (25.0%) wheezing after an effort, 43 (39.4%) a dry cough at night, 52 children (40.6%) had exhibited allergic rhinitis signs, and 32 (25.0%) eczema. Among the 47 children who had experienced at least one attack of asthma during the previous twelve months, 27 (57.4%) had a history of familial asthma (p<0.04). This was the only significant relationship observed in this study with regard to risk factors for asthma. No relationship was observed between asthma or recent wheezing on the one hand, and on the others age less than three months during the first bronchiolitis episode (p=0.6), initial hospital admission (p=0.6) tobacco smoke exposure (p=0.27), sex (p=0.10) or day care management until age three (p=0.73). DISCUSSION: This study showed a high prevalence of asthma and other allergic manifestations in children who five years previously, had experienced their first bronchiolitis episode before the age of twelve months. The only risk factor for asthma or chest wheezing identified in this study was a familial history of allergy. These data support the idea that for most children, early acute bronchiolitis, even if severe, is a transient event, with no or very few consequences in the middle or long term. Nevertheless it may be the expression of an interaction between viral infection and atopic familial predisposition leading to lasting bronchial hyper-responsiveness.

Age of Onset↗
PubMed2003

[How are personal child health records completed? A multicentric evaluation study].

OBJECTIVE: To evaluate the completeness of personal child health record in France. PATIENTS AND METHODS: Cross-sectional multicentric study, based on child health records analysed and parents' interviews; 1685 children were included: 863 infants aged from 12 to 18 month and 822 children aged from three and a half to four and a half years. RESULTS: One Apgar score was recorded in 96% of cases; the sitting position's acquisition was registered in 91%; the age of walk in 81%. Growth curves were plotted in 64% of cases for weight and in 62% for height in infant's records and 22% of cases for both in older children's records. Ten per cent of the last visit to a physician were not recorded in infants health records, 19% in those of children; as well an hospitalisation for respectively 1,5% and 3,3% and a performed operation for 1,8% and 5,1% respectively. Immunization batches were exhaustively indicated in 68% and 50% of the records. CONCLUSION: Many important data for medical follow-up are missing in the child health records, especially for the oldest children. Physicians and parents should be incited to a better use of the personal record.

Apgar Score↗
PubMed2003

[Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities].

BACKGROUND: The home delivery of counseling and devices intended to prevent child injuries could help parents to adopt safe behavior more efficiently. The aim of the present study was to adapt and test in France a safety kit designed and used in Quebec (Canada). The intervention program (kit delivery and counseling) was assessed by measuring 6 to 8 weeks after a first home visit the percentage of safety changes adopted by the families included in the survey, compared with the pre-intervention situation; and by evaluating the satisfaction of families with their participation in the survey, and the satisfaction of nurses with the use of this new tool. POPULATION AND METHOD: One hundred families from 4 towns in the Hauts-de-Seine department in the Paris suburbs (Boulogne, Chaville, Sèvres, Ville d'Avray) were selected by the social services for home visits by nurses or doctors, when their child reached the age of 6 to 9 months. Selection criteria were usually primipara, medical problem, psychological and/or socio-economic difficulties. During the first visit, 49 families (group 1) (1 family lost for follow-up) received the usual informative and preventive counseling, and a kit including preventive devices and pamphlets about indoor injuries and ways of avoiding them. The other 50 families (group 2) received counseling but not the kit. Between 6 and 8 weeks later, a second home visit was paid to all selected families. RESULTS: Between the first and the second visits, the percentage of safety improvement was significantly higher in group 1 (with the kit) than in group 2 (without the kit). This improvement mainly related to the risk of fall (P < 0.02), fire and burns (P < 0.001), poisoning (P < 0.01) and suffocation (P < 0.001). When the analysis was focused on safety improvement related to devices provided in the kit, the difference between the 2 groups was significant: 67.8% of safety improvement in group 1 vs 38.1% in group 2 (P < 0.001). The relative risk (RR) was 1,78 (95% confidence interval (CI): 1,18-2,68). Even for items not related to the devices provided, the difference remained significant: 48.6% in group 1 vs 28.8% in group 2 (P < 0.001); RR =1,31 (95% CI: 1,23-1,40). The perceived usefulness of the kit was discussed in a focus group with all nurses and doctors. On the whole, the judgment was very positive, mainly because the kit facilitated the introduction of the notion of accident prevention in the discussion at home. CONCLUSION: As in the canadian survey, our results indicate that routine home visits by the social services offer a good opportunity to introduce the subject of child injury prevention. Free delivery of prevention kit and simple counseling allow often deprived families to modify their behavior and to arrange their apartments so as to reduce risks.

Accident Prevention↗
PubMed2003

[Telephone activity in outpatient pediatric practice].

OBJECTIVES: To assess the amount of telephone activity in outpatient pediatric practice. METHODS: Seventy-nine pediatricians belonging to a continuing medical education group (Arepege) prospectively recorded data about all the telephone calls they took personally for 3 days, from 4 to 6 December 2000. They noted the number of calls each day and their duration, the caller, the reason for and the response to each call. RESULTS: In 3 days, the 79 pediatricians received 4413 calls, for a mean of 19 calls daily for each practitioner. The calls were brief, 86% of them lasting less than 2 min; each pediatrician spent an average of 26 min a day on the telephone; most calls (82%) came from children's mothers. The reasons for the calls were: request for appointment (1035 calls, 23.5%), request for advice not associated with an acute disease (1416 calls, 32%), the onset of acute symptoms (1961 calls, 44.5%). An appointment was made in 26% of the cases for which the reason for the call was illness. CONCLUSION: Pediatric private practice involves substantial telephone activity, which generates no healthcare costs, but does present risks that might be attenuated by the use of appropriate algorithms for conducting these telephone interviews.

Adult↗
PubMed2003

Doxorubicin versus doxorubicin and cisplatin in endometrial carcinoma: definitive results of a randomised study (55872) by the EORTC Gynaecological Cancer Group.

BACKGROUND: Combination chemotherapy yields better response rates which do not always lead to a survival advantage. The aim of this study was to investigate whether the reported differences in the efficacy and toxicity of monotherapy with doxorubicin (DOX) versus combination therapy with cisplatin (CDDP) in endometrial adenocarcinoma lead to significant advantage in favour of the combination. PATIENTS AND METHODS: Eligible patients had histologically-proven advanced and/or recurrent endometrial adenocarcinoma and were chemo-naïve. Treatment consisted of either DOX 60 mg/m(2) alone or CDDP 50 mg/m2 added to DOX 60 mg/m2, every 4 weeks. RESULTS: A total of 177 patients were entered and median follow-up is 7.1 years. The combination DOX-CDDP was more toxic than DOX alone. Haematological toxicity consisted mainly of white blood cell toxicity grade 3 and 4 (55% versus 30%). Non-haematological toxicity consisted mainly of grade 3 and 4 alopecia (72% versus 65%) and nausea/vomiting (36 % versus 12%). The combination DOX-CDDP provided a significantly higher response rate than single agent DOX (P <0.001). Thirty-nine patients (43%) responded on DOX-CDDP [13 complete responses (CRs) and 26 partial responses (PRs)], versus 15 patients (17%) on DOX alone (8 CR and 7 PR). The median overall survival (OS) was 9 months in the DOX-CDDP arm versus 7 months in the DOX alone arm (Wilcoxon P = 0.0654). Regression analysis showed that WHO performance status was statistically significant as a prognostic factor for survival, and stratifying for this factor, treatment effect reaches significance (hazard ratio = 1.46, 95% confidence interval 1.05-2.03, P = 0.024). CONCLUSIONS: In comparison to single agent DOX, the combination of DOX-CDDP results in higher but acceptable toxicity. The response rate produced is significantly higher, and a modest survival benefit is achieved with this combination regimen, especially in patients with a good performance status.

Adenocarcinoma↗
PubMed2003

Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial.

OBJECTIVES: Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada). DESIGN AND SUBJECTS: One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties. INTERVENTIONS: During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later. MAIN OUTCOME MEASURES: The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers. RESULTS: Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93). CONCLUSION: Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.

Accidents, Home↗
PubMed2003

[Marfan syndrome].

Marfan's syndrome is a monogenetic disease with an autosomal dominant transmission generally accompanied by type I fibrillin abnormality. This widely-distributed molecule participates in the structure of connective tissues so that any aberration may result in disease of many systems: skeletal morphology, dislocation of the lens, neurological or cutaneous signs and dilatation of the aorta predisposing to dissection, mitral valve prolapse being a common association. The diagnosis, clinical because of the size of the culprit gene and the multiplicity of the possible mutations, is sometimes difficult, and diagnostic criteria have been proposed. It is important to make the diagnosis because treatment is based on the restriction of violent exercise, betablocker therapy and regular echocardiographic monitoring of the ascending aorta, the region at highest risk of dilatation and dissection. A family enquiry is essential to make the diagnosis before the onset of complications in pauci-symptomatic patients (great intra-familial variability). Pregnancy poses special problems in these patients.

Adult↗