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B Grandbastien

Publications and source records attributed to B Grandbastien.

35 records · Page 2Linked to original sources
PubMed1998

Early onset pneumonia in neurosurgical intensive care unit patients.

To investigate early onset pneumonia in a neurosurgical intensive care unit, we studied a cohort of patients over a 13-month period and compared neurotrauma (T) with non-neurotrauma (NT) patients. Data were abstracted from the infection surveillance database. Five hundred and sixty-five adults were hospitalized in the neurosurgical intensive care unit. 57.9% had trauma and 129 patients developed 152 episodes of pneumonia. Incidence rates, restricted to the 129 first episodes of pneumonia, were 20.1 versus 15.7/1000 patient days and 34.2 versus 27.9/1000 ventilation days, in the T and NT groups respectively. In both groups, the distribution of risk stratified by hospital days was bimodal, being highest during the first three days. However, the risk was higher for T patients (at day 3, 20/1000 ventilation days versus 10.2/1000 ventilation days). The daily risk peaked again at days 5 and 6, and thereafter remained low. Pneumonia occurring within the first three days, or early onset pneumonia (EOP), was associated with trauma (P = 0.036) and, in the NT group only, with a Glasgow coma scale score lower than 9 (P = 0.062). EOP was caused by Staphylococcus aureus (33%), Haemophilus spp. (23%), other Gram-positive cocci (22%), and other Gram-negative bacilli (GNB) (19%); whereas after the third day GNB other than Haemophilus spp. accounted for 45.4% of isolates (P = 0.11). This large series confirms the high incidence of EOP in neurosurgical intensive care units, particularly among trauma patients, in relation to risk factors different from those seen in other intensive care patients. Further studies are needed to elaborate specific preventive measures during early care.

Adult↗
PubMed1998

No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d'Urgences Pédiatriques.

OBJECTIVE: To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death. DESIGN: A 4-month prospective cohort study. SETTING: Nine French multidisciplinary paediatric intensive care units. PATIENTS: All patients who died in PICUs, except premature babies. MAIN RESULTS: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months). CONCLUSIONS: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.

Brain Death↗
PubMed1998

Handwashing quality: impact of a special program.

To evaluate the impact of a program on basic handwashing quality, a before-after audit was performed in a university hospital. We defined a 13-step protocol to describe a proper basic handwash (BHW). The proportion of BHW that satisfied this checklist increased significantly, from 4.2% before the program to 18.6% after, but these low proportions suggest that simpler alternatives to BHW should be studied.

Cross Infection↗
PubMed1998

Anti-Saccharomyces cerevisiae mannan antibodies in familial Crohn's disease.

OBJECTIVE: Anti-Saccharomyces cerevisiae mannan antibodies (ASCA) are associated with Crohn's disease. The aim of this study was to determine the prevalence of ASCA in families in which at least two members were affected with Crohn's disease. METHODS: A total of 20 families including two (n=15) or more (n=5) patients with Crohn's disease were tested for ASCA with use of an ELISA method. Overall, 51 affected members, 66 healthy first degree relatives, and 163 healthy control subjects were studied. RESULTS: ASCA were detected in 35 of 51 (69%) patients with Crohn's disease and in 13 of 66 (20%) healthy relatives versus one of 163 healthy control subjects (p < 0.0001 and p < 0.001). ASCA-positive relatives were distributed in 12 of 20 families. ASCA were present in eight healthy parents and four healthy siblings. The prevalence of ASCA in relatives did not depend on the ASCA status of affected members. CONCLUSION: ASCA in 20% of healthy first degree relatives of patients with Crohn's disease suggest that these antibodies might be a subclinical marker for Crohn's disease in families. Whether ASCA reflect environmental or genetic factors or a combination of both is unknown.

Adolescent↗
PubMed1998

Anticipation in familial Crohn's disease.

BACKGROUND: Offspring with a family history of Crohn's disease have an earlier age of onset than their parents. This might be due to genetic anticipation, characterised by earlier and/or more severe disease in subsequent generations. AIMS: To investigate the possibility of genetic anticipation in affected parent-child pairs with Crohn's disease from France and Belgium. PATIENTS AND METHODS: In a cohort of 160 multiply affected families with Crohn's disease, 57 parent-first affected child pairs were detected. Clinical characteristics (age at diagnosis, disease extent, and type) of both parents and children were registered and compared. RESULTS: Children were younger than their parents at diagnosis in 48/57 (84%) pairs. The median age at diagnosis was 16 years younger in children than in parents (p < 0.0001). However, the difference was related to the age at diagnosis in the parents and was not present in 12 parent-child pairs with an early age at diagnosis for the parents. In most cases, disease extent and type were not considered more severe in children than in parents. Parental sex affected neither age at diagnosis nor extent and type of disease in children. CONCLUSION: Patients in the second affected generation acquire their disease at an earlier time in life in some but not all familial cases of Crohn's disease. Several explanations including genetic anticipation and environmental factors might explain this phenomenon.

Adolescent↗
PubMed1998

Anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease: prevalence and diagnostic role.

BACKGROUND: Perinuclear antineutrophil cytoplasmic autoantibodies (pANCA) are a well recognised marker for ulcerative colitis. Antibodies to oligomannosidic epitopes of the yeast Saccharomyces cerevisiae (ASCA) are a new marker associated with Crohn's disease. AIMS: To assess the value of detecting pANCA and/or ASCA for the diagnosis of ulcerative colitis and Crohn's disease. METHODS: Serum samples were obtained from 100 patients with Crohn's disease, 101 patients with ulcerative colitis, 27 patients with other miscellaneous diarrhoeal illnesses, and 163 healthy controls. Determination of pANCA and ASCA was performed using the standardised indirect immunofluorescence technique and an ELISA, respectively. RESULTS: The combination of a positive pANCA test and a negative ASCA test yielded a sensitivity, specificity, and positive predictive value of 57%, 97%, and 92.5% respectively for ulcerative colitis. The combination of a positive ASCA test and a negative pANCA test yielded a sensitivity, specificity, and positive predictive value of 49%, 97%, and 96% respectively for Crohn's disease. Among patients with miscellaneous non-inflammatory bowel disorders, three were ASCA positive and two were pANCA positive. One control was ASCA positive. The presence of ASCA in patients with Crohn's disease was associated with small bowel involvement. CONCLUSION: ASCA and pANCA are strongly associated with Crohn's disease and ulcerative colitis, respectively. Combination of both tests could help the diagnosis of inflammatory bowel disease.

Adult↗
PubMed1997

[Characteristics of patients and use of resource in French pediatric intensive care units. Le groupe francophone de Rèanimation et urgences pédiatriques].

UNLABELLED: Evaluation of case-mix and resource consumption in pediatric intensive care units (ICU) is required. AIMS: This study describes the patterns of pediatric ICU resource consumption, determines the impact of primary clinical characteristics (particularly severity of illness) on resource utilization, and analyses medical efficiency with the frequency of inappropriate stays in French pediatric ICU. METHODS: Prospective study in nine French volunteer multidisciplinary pediatric ICUs from December 1993 to April 1994. Premature neonates were excluded. Resource consumption was expressed using the Omega system and length of stay, from which total Omega per admission, and average daily Omega (total Omega/length of stay) were obtained. RESULTS: Seven hundred and twelve patients were eligible. Twenty-five percent were full-term neonates, 30% infants (1 month to 1 year), and 45% children. Surgical patients constituted 22% of the population. A chronic disease was present in 45% of infants and children. Immunodeficiency was present in 10% of patients. The median length of stay was 4 days (range: 1-155). The mean Omega scores per admission were: total Omega = 92 +/- 124, Omega/day = 14 +/- 9. Sixty-four percent required mechanical ventilation and 37% during more than 2 days. Forty-two percent had a central venous access, and 23% an arterial line. The resource consumption was greater in non-survivors, surgical patients, neonates, and immunosuppressed patients. The mean PRISM score was 9 +/- 9. Mortality was 13%. The Omega/day and the PRISM score correlated. The frequency of inappropriate stays was 7.6% and accounted for 1.0% of the overall Omega activity. CONCLUSIONS: The results of this study can be used for interinstitutional comparison and a broader appraisal of pediatric intensive care. They illustrate the relationship between severity of illness and resource consumption. French pediatric ICU efficiency seems to be high, as compared to North American and Dutch results.

Adolescent↗
PubMed1997

[Evaluation of the ambulatory treatment of acute diarrhea in infants. Réseau interhospitalier d'evaluation des pratigues médicales dans les affections courantes de l'enfant].

BACKGROUND: Gastroenteritis remains a common and expensive illness. Oral rehydration solutions (ORS) have been shown to be effective in the prevention and treatment of dehydration, the prime cause for diarrhea-related morbidity and mortality. OBJECTIVE: To evaluate the ambulatory management of acute gastroenteritis in infants, and particularly practices concerning oral fluid therapy. METHODS: This prospective, multicenter study included 326 infants (mean age: 10 +/- 6 months), examined in a hospital for acute gastroenteritis, with or without dehydration. RESULTS: Before admission, 81% had previously been examined by a practitioner, and 89% of these practitioners had written a prescription. This prescription included ORS in 35% and was not different according to the age of the infant. Pediatricians prescribed ORS more frequently than general practitioners (respectively 58% vs 29%; P < 0.001). The failure rate of ORS prescription was 25% (two parents did not observe, ten children refused to drink, and eight stopped treatment because of vomiting). Lactose-free milks were prescribed in 46% of infants and the observance was 82%. At least one drug was prescribed in 94% of infants, with a mean of 2.6 drugs per infant; one antibiotic was prescribed in 33% of infants. Infants were admitted to hospital without any previous consultation in 18%, on the parents' initiative but after at least one previous medical examination in 52%, and on the physician's initiative in 30%. Thirty-three percent were dehydrated; one infant died and two had sequellae. CONCLUSION: The use of ORS remains insufficient. Efforts to improve use of ORS should be expanded beyond physician education.

Acute Disease↗
PubMed1996

Clinical characteristics of Crohn's disease in 72 families.

BACKGROUND & AIMS: Familial aggregation argues for genetic susceptibility to Crohn's disease. The aim of this study was to compare the age of onset and the clinical features of Crohn's disease between patients with familial disease and those with sporadic disease and investigate the concordance for disease location and type among relatives with Crohn's disease. METHODS: Seventy-two families with 2 (n = 55), 3 (n = 8), 4 (n = 6), and 5 or more (n = 3) affected first-degree relatives were selected for the study. A population of 1377 patients with sporadic nonfamilial Crohn's disease was used for comparison. RESULTS: Clinical data were obtained from 176 patients with familial Crohn's disease (79 men and 97 women). Median age at onset was younger in familial Crohn's disease than in sporadic cases: 22 vs. 26.5 years (P < 0.01). In familial cases, fewer patients had exclusively colonic involvement and more patients had both small bowel and colonic involvement. Among relatives of families with 2 affected members, 56% were concordant for disease location and 49% for disease type. These percentages reached 83% and 76%, respectively, within families with more than 2 affected members. CONCLUSIONS: Patients with familial Crohn's disease are characterized by an early age at onset with more extensive disease and may represent a homogeneous clinical subgroup with a particularly strong genetic influence.

Adolescent↗
PubMed1994

[Nosocomial risk].

The risks of hospital-acquired infection were, for many years, not seriously considered. However, current conditions increase risk, and the intense media and legal interest have led to the issue becoming a major medical concern. Hospital-acquired infections can be considered from four angles: the clinical dimension is the most obvious. It involves hospitalized patients, and to an increasing degree, hospital staff; the economic impact although difficult to assess, is a largely underestimated drain on hospital budgets; the legal problems have been recently highlighted by developments in jurisprudence; finally, there are ethical considerations associated with the behaviour sometimes found among health care workers, as a consequence of workplace risks. In this article we try to define and assess the significance of the major factors. We discuss the validity of various epidemiological and economic tools, and thus highlight the role of hospital-acquired infections in the working of hospitals.

Cross Infection↗
PubMed1993

[Value of continuous passive motion in the early rehabilitation of total knee arthroplasty. Prospective study apropos of 120 medical records].

The purpose of our study was to evaluate the interest of passive motion rehabilitation with an automatic device. Our protocol has been made of 120 TKA performed in the same surgical department between february 1987 to June 1990. We draw lots, a group "RC" with usual rehabilitation program and a second group "AM" with the same program added with passive motion two hours per day. The passive motion device was Toronto Mobilimb. Passive range of motion (ROM) of flexion and extension, pain level, deep venous thrombosis existence, volume of blood postop drainage, mobilisation under anaesthesia, device tolerance were studied. The results showed a flexion ROM average of 86.7 degrees in the RC group at discharge and 90 degrees in the AM group. This difference is statistically significant and evokes the efficacy of passive motion. At the term of one year postop, the flexion averages reaches 108 degrees in both groups. The extension lag falls from 8.2 degrees and 9.2 degrees average in AM and RC group at discharge to 3 degrees and 3.7 degrees in the same groups at one year. The mean of blood postop drainage by suction was very different in the RC group than AM group (1149ml-968ml). In conclusion, we can say that passive motion device is useful to reach enough flexion in the first days after surgical day and may give some comfort. In our experience the classical rehabilitation program with physiotherapist must be continued.

Aged↗
PubMed1991

[The social protection of pregnant women and young mothers in Europe].

Through the study of perinatal legislation in 24 European countries, the authors have analyzed Social Protection for pregnant women and young mothers. For maternity leave, the durations of pre- and post-natal leaves were compared, including its possible variations according to the obstetrical pathology and the number of births in different countries. Maternity benefits vary from 50 to 100% of the previous salary and a payment curve shows considerable differences in salaries or the global benefits attributed. Parental leave, which has only recently been created in some countries, is subject to great variations from one country to another and sometimes even within the same country, according to the public or private sectors of activity. Protection of the single parent and the benefits or allowances at birth are studied as well as benefits for infants. The latter were pioneered by France and have not been emulated in many other countries. In the discussion the authors try to establish the motivations leading to the various perinatal measures in Europe, be they social, medical or demographic. They consider the possibility of harmonization, but homogeneity, which has to respect existing sociological, cultural and ideological particularities. This work continues according to the guidelines laid down by the European Parliament, which could, in due course, comprise the whole continent, bearing in mind the probable transfer of populations expected in the last years of this century.

Employment↗
PubMedDate not supplied

Development of a pediatric multiple organ dysfunction score: use of two strategies.

BACKGROUND: An organ dysfunction (OD) scoring system for critically ill children is not yet available, and the method for developing such a system is not well defined. The aim of this study was to compare two developmental methods for assessing OD in critically ill children. METHODS: Consecutive admissions between January and May 1997 in three French and Canadian pediatric intensive care units (PICUs) were studied prospectively. Physiologic data were selected using a Delphi method; the most abnormal values during PICU stay were recorded. The outcome measure was the vital status at PICU discharge. Six organ systems were studied: hepatic, cardiovascular, renal, hematologic, respiratory, and neurologic. For each of the six organ systems, the PEdiatric Multiple OD (PEMOD) system included one variable and the PEdiatric Logistic OD (PELOD) system included several variables. Severity levels and relative weights of ODs were determined according to the mortality rate (PEMOD) or by logistic regression (PELOD). RESULTS: There were 594 admissions, including 51 deaths (9%). Severity levels and relative weights of ODs were: four levels graded from 1 to 4 for the PEMOD system and three levels with scores of 1, 10, and 20 for PELOD system. For both systems, calibrations were good (p = 0.23 and p = 0.44 respectively). The PELOD system was more discriminant than the PEMOD system (areas under the ROC curves 0.98 and 0.92, respectively, p < 10(-5)). Moreover, with the PEMOD system, four ODs did not contribute significantly to the prediction of PICU outcome. CONCLUSIONS: The PELOD system was more discriminant and had the advantage of taking into account both the relative severities among ODs and the degree of severity of each OD.

Adolescent↗