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Biomedical subjects

F Fagnani

Publications and source records attributed to F Fagnani.

At least 73 records · Page 4Linked to original sources
PubMed1988

[The practice of x-ray computed tomography during a period of rapid growth. A survey on the Provence-Alpes-Côte d'Azur region in 1986].

From May to September 1986, a sample of 748 CT-scanner examinations, representative of the total annual activity, has been collected in Provence-Alpes-Côte d'Azur Region. The regional activity of CT-scanner has been estimated to 91,200 examinations in 1986 (total France: 628,500 in 1985) or 22.7 procedures per 1,000 inhabitants (total France: 11,4 in 1985). CT-scanner is now a routine diagnostic imaging device with an annualized average of 6,080 procedures per machine (5,770 in public sector and 8,415 in the for-profit private one). The mean effective utilization time for a machine in one year was 2,700 hours in a regional, public, teaching hospital (PTH) and 3,100 in private, for-profit establishment (PPE). The number of procedures per machine-use hour was 2,4 in PTH and 2.8 PPE. No procedural difference has been observed between the two sectors in carrying out the technique. CT-Scanner diffusion in the private for profit sector has meant: - an increase in the demand from general medical practionners (more than 1/4 examinations); - a larger range of indications concerning less serious health conditions.

France↗
PubMed1987

The diffusion and use of diagnostic imaging equipment in France. The limits of regulation.

The paper presents a French national survey on diagnostic imaging equipment and activity showing that conventional x-ray radiology still dominates and that the rate of diffusion of technological innovations has been very different, being slower than in other industrialized countries for such technologies as CT scanners, nuclear medicine, and magnetic resonance imaging, but on the other hand, very quick for ultrasound and digital angiography. The variety of regulations for this equipment, although it plays an important role, is not sufficient to explain these differences in the rate of diffusion. The paper shows that other explanatory variables must be taken into account, at least in the French context: the situation of the domestic biomedical industry, the relations between private and public sectors of health care delivery, and even the "technical" culture and tradition of French radiologists.

Communication↗
PubMed1986

[Collective radiation dosage due to radiodiagnostic practice in France in 1982. Methodology. 1].

This paper recalls the main concepts of dosimetry which are useful when assessing the collective dose to the patient from medical X-ray examinations. It describes the general protocol which has been followed in measuring dose associated to each x-ray exam (anthropomorphic phantom, in vivo measurement) and gives some results about the variations of parameters such as the mAs, the kVp and the fluoroscopy screening time. As far as the gonadal dose and the effective dose equivalent are concerned a first evaluation is given per type of examination carried out in France in 1982.

Film Dosimetry↗
PubMed1986

[Collective irradiation caused by radio-diagnostic procedures in France in 1982. Results (2)].

This paper gives the most important results of the collective dose received by patients who undergoing diagnostic radiology examinations in France in 1982. It details, per each X-ray examination type, the collective organ dose associated with, and highlights the importance of the radiological procedures (number of X-ray films, fluoroscopy screening time) on the received patient doses. If one takes into account organs for which dosimetric measurements have been carried out, the collective effective dose equivalent per 10(6) inhabitants is 442 man-Sievert; the genetically significant dose reaches 0.295 mSv and finally the collective red bone marrow dose due to 45 million X-ray exams practiced in France (1982) is 40,300 man-Sievert i.e. 0.742 mSv. per inhabitant.

Female↗
PubMed1985

[National survey of radiodiagnosis. Methodological aspects (1)].

A national sample of 386 radiological departments and offices representative of a total set of approximately 5 000 have been involved in a statistical survey during the years 81-82. This survey was first directed to the analysis of the production factors related to radiology (number and characteristics of facilities and equipment; medical and paramedical personnel, ...). The radiological activity has then been observed during one week (in June 82) through systematic questionnaires. The information collected on about 13 000 X-Ray examinations consists in characteristics of the population examined, the aims and results of examination, a technical description of procedures (number and size of films; projection; physical parameters, ...). This survey has excluded X-Ray routine examinations (occupational and others); dental examinations, isolated fluoroscopy and ultrasound practiced by physicians.

France↗
PubMed1985

[National survey on radiodiagnosis. Personnel and equipment (2)].

The total projected number of units (including tables and potters) has been estimated at 16 325 in 1982, at the exclusion of radiological dental systems and unit exclusively devoted to mass X-Ray examinations. Almost half of this total equipment is located in public hospitals (including University hospitals), where the departments have a mean size which is markedly greater than the private sector (clinics and physicians' offices). One of the main feature of the French equipment is the high rate of remote controlled machines (almost 40%). The total labor forces involved directly in this activity has been estimated to 46 000; of which 14 580 are physicians (radiologists or not) and 18 680 are radiographers. The mean productivity, computed in annual mean number of examinations per person (medical and para-medical) is estimated at 1 000. These results are examined and compared throughout the different sectors (public and private; hospital, clinic and ambulatory care).

France↗
PubMed1985

[National survey on radiodiagnosis. Comparative analysis of the activity of different sectors (3)].

The survey has estimated the global annual production of radiological procedures in France (1982) at 45,4 millions. The large public hospitals (including University hospitals) produce up to 42% of the total; the mean number of annual procedures by X-Ray unit being 4 000, in this sector. The private sector (including clinics and offices) has a production ratio between 2 350 and 2 800 annual procedures by X-Ray Unit; some type of examinations are over represented as compared with the public sector for example lumbar and dorsal spine and digestive. Specialized procedures such as vascular and neuro-radiological represent a quasi monopoly of the public sector. In term of economic behavior, some differences appear between the public and private sectors in the way to account for the procedures to the Social Security System. These are partly due to differences in the complexity of the procedures (for example in the case of abdomen, stomach and upper G.I., the latter being more often performed in hospitals) and to different medical practices (number of films; utilisation of divided films, etc.). The share of procedures executed under the responsibility of a radiologist yields 88% of the total.

France↗
PubMed1983

[An estimation of the incidence of cerebrovascular accidents in France].

In the absence of epidemiological data concerning France, indirect assessment was undertaken of the incidence and prevalence of cerebrovascular accidents (CVA) at a national level. An international comparison of mortality data concerning diseases of the circulatory system was first made. This analysis reviewed the existence of a certain number of inherent difficulties in the use of available statistics. It is probable that a notable proportion, increasing with age, of cases of CVA, are situated in undefined causes. A similar phenomenon should be noted with regard to cardiac causes (changes in diagnostic practice in the case of ischemic heart disease). Furthermore, mortality data for CVA are very sensitive to the effect of the age and sex structures of the populations considered. Between the years 50 and 80, the absolute number of annual deaths by CVA roughly rose from 60 000 to 70 000 in France. However, after adjustment taking into account changes in numbers, age and sex and undetermined causes, there is a marked decrease in comparative levels (almost 40%). This decrease is of the same order of magnitude as that for mortality of circulatory system diseases taken overall, as well as that of general mortality. CVA remains the 3rd cause of death (in terms of numbers) but it is only in 8th place, in terms of loss of life expectancy. Taking as the reference the American National Survey of Stroke, using a certain number of hypotheses, it is possible to estimate the incidence of CVA in France. This gives an annual number of cases of the order of 140 000, including approximately 100 000 cases of initial CVA. The corresponding prevalence is estimated at 470 000 (mean numbers of individuals suffering one or more CVA).

Age Factors↗
PubMed1982

Phosphofructokinase (PFK) deficiency due to a catalytically inactive mutant M-type subunit.

A case of M-type PFK deficiency due to the synthesis of a structurally abnormal and catalytically inactive M-subunit was reported. PFK activity was reduced (39% of normal) in red cells, normal in leukocytes and platelets, and absent in muscle. The red cell enzyme was not inhibited by antiserum to human muscle PFK and displayed normal biochemical properties (Km for ATP and fructose-6-phosphate, storage stability at +4 degrees C and -80 degrees C, optimum pH, electrophoretic pattern and molecular weight). The complete lack of PFK activity in muscle was confirmed on both histological preparations and muscle extracts. Double immunodiffusion analysis using an antinormal M-PFK serum revealed that the enzyme molecule was present and immunologically identical with normal, although it was catalytically inactive. The muscle abnormality was also confirmed by electromyography, ischemic exercise testing, histochemistry and electron microscopy. Moreover, PFK activity was investigated in myoblast cultures maintained up to 25 days, and it was found to be absent.

Erythrocytes↗
PubMed1981

[Occupational risk and technological innovations. Comparison of conventional and nuclear energy systems (fuel, coal and nuclear) (author's transl)].

The objective is to compare the occupational risks associated to the production of electricity through three alternative technologies: fuel, coal and nuclear (Pressurised Water Reactor). A methodology is proposed in order to integrate the operation and construction activities. The data related to a French scenario have been collected and are presented. The results obtained in the case of nuclear technology correspond to the present French program for 1990 and have in this respect a prospective value.

Accidents, Occupational↗
PubMed1975

Aspartate aminotransferase and alanine aminotransferase activities in plasma: statistical distributions, individual variations, and reference values.

The determination of frequency value (percentile limits) and the classification of the different variation factors allow us to define more and more homogeneous subpopulations as we use these factors for sorting. Using as our study population those persons coming to the Centre for Preventive Medicine, we were able to: (a) Describe and measure the significance and importance of physiological variations or of variations attributed to age--the latter largely related only to excessive weight, which it seems to us is often the case. (b) Establish a classification for variation factors; the recapitulatory table should be useful to clinical chemists in helping physicians interpret a laboratory test result that falls within the zone of incertitude. (c) Suggest a preliminary group of reference values for healthy subjects, to be used in interpreting a laboratory test in this way.

Adolescent↗
PubMedDate not supplied

Economic assessment of a maintenance treatment strategy in prevention of recurrent depressive disorder.

OBJECTIVE: To compare the 12-month cost-effectiveness of milnacipran in maintenance treatment of depression to that of medical follow-up without antidepressant. METHOD: A Markov model with transition probabilities from a double blind clinical trial demonstrating the prophylactic efficacy of milnacipran was used. Other parameters were obtained from published sources. RESULTS: Base-case incremental cost for preventive treatment was 1,191 FF. It was reduced to 685 FF when using a 25% hospitalization rate in case of recurrence. Patients with a high initial response had extra cost of 191 FF and cost-utility was estimated to be 23,875 FF per QALY gained. For those patients, using a 25% hospitalization rate in case of recurrence, costs were lower at 1,174 FF and preventive strategy was dominating. CONCLUSION: Cost of maintenance therapy is partially balanced by the gain from recurrence prevention. It should be focused on patients with few residual symptoms or a high probability of hospitalization in case of recurrence.

Journal Article↗
PubMedDate not supplied

Economic evaluation of enoxaparin vs. placebo for the prevention of venous thromboembolism in acutely ill medical patients.

OBJECTIVES: This paper presents an economic evaluation of a strategy of thromboprophylaxis in acutely ill medical patients with enoxaparin 40 mg vs. no intervention in the context of the French Health System. METHODS: The evaluation used a decision-analysis model to simulate the results of a hypothetical naturalistic, long-term study reflecting the usual care pattern for the patients. The short-term outcomes were derived from an international, double-blind, placebo-controlled randomized clinical study performed in 1102 patients older than 40 years. Treatment was scheduled to last 10 +/- 4 days and primary outcome was venous thromboembolism events rates between days 1 and 14 assessed clinically or through systematic contrast venography. RESULTS: For an hypothetical cohort of 1000 hospitalized medical patients, the model suggested that the prophylaxis strategy would avoid between 1 and 10 deaths (median 4) and between 60 and 127 cases of venous thromboembolism events (median 94). By including or not the costs associated with long-term complications (post-phlebitis syndrome), the net extra cost per patient was estimated as a net saving or 35,857 Euros (Euro), respectively. The corresponding cost-effectiveness ratios in terms of cost per avoided death were a net saving or Euro 8102 (median value), respectively. CONCLUSIONS: Thromboprophylaxis with enoxaparin in hospitalized acutely ill patients over 40 years of age appears to be an efficient strategy using French cost data.

Journal Article↗
PubMedDate not supplied

Cervical smear histories of 585 women with biopsy-proven carcinoma in situ.

OBJECTIVE: To analyze the cervical cytologic smear history of women with carcinoma in situ (CIS). STUDY DESIGN: We examined cytologic smears obtained within the three-year period prior to a histologic diagnosis of CIS in 585 women for whom at least one prebiopsy smear was available. RESULTS: Among 454 patients with only one smear available for review, 9 (2%) had a negative cytologic diagnosis, 58 (13%) had low grade squamous intraepithelial lesion (LSIL), and 387 (85%) had high grade squamous intraepithelial lesion (HSIL). One hundred thirty-one women had two to five smears taken within the previous three years available for review. All the smears taken prior to biopsy showed HSIL. The original diagnosis on the other smears was negative for 78 women (60%), HSIL for 46 (35%) and LSIL for 7 (5%). ALl 132 smears originally classified as negative from 87 of 585 (14.8%) women were reviewed. Twenty-seven (20%) were then classified as showing HSIL, 10 as LSIL, 10 as atypical squamous cells of undetermined significance, 7 as unsatisfactory and 78 (59%) as remaining negative. CONCLUSION: Of smears classified as negative and taken in the three years before biopsy-proven CIS, 41% were reclassified, with half reclassified as showing HSIL.

Adult↗