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Biomedical subjects

F Guillemin

Publications and source records attributed to F Guillemin.

At least 127 records · Page 7Linked to original sources
PubMed1997

The AIMS2-SF: a short form of the Arthritis Impact Measurement Scales 2. French Quality of Life in Rheumatology Group.

OBJECTIVE: To develop a short form of the Arthritis Impact Measurement Scales 2 (AIMS2) questionnaire, preserving content validity as the priority criterion. METHODS: A 2-step reduction procedure was used: 1) Delphi technique, with 1 panel of patients and 1 panel of experts each selecting 1 set of items independently; and 2) nominal group technique, where members of both panels reached consensus on the final selection of items, using information derived from item analysis. Psychometric properties of the AIMS2-Short Form (AIMS2-SF) and AIMS2 were compared using data from a cohort of 127 rheumatoid arthritis patients who completed the AIMS2 twice prior to the initiation of methotrexate (MTX) treatment and 3 months post-initiation of MTX treatment. RESULTS: The 2 panels reached consensus on a 26-item AIMS2-SF (54.4% reduction from the AIMS2). Factor analysis showed preservation of the 5-component structure. Convergent validity (Physical and Symptom components with clinical variables: r = 0.24-0.59), test-retest reproducibility (intraclass correlation coefficient >0.7), and sensitivity to change at 3 months (standardized response mean 0.36-0.8, except Social Interaction component [0.08]) were very close to the values for the original AIMS2. CONCLUSION: The AIMS2-SF is a shorter version of the AIMS2 (i.e., available in 2-page format) and has psychometric properties similar to those of the AIMS2.

Activities of Daily Living↗
PubMed1997

Health-related quality of life in long-term oxygen-treated chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) induces changes in daily activities and mood. Health-related quality of life (HRQL) measures are of particular relevance in the management of such patients, but predictors of HRQL have rarely been investigated. The aim of this study was to seek factors predicting HRQL in severe COPD patients under long term oxygen therapy (LTOT). The pulmonary function parameters at the start of LTOT were studied as potential predictors of future HRQL. HRQL was assessed after an average of 40 months follow-up by the Duke Health Profile (Duke) and by the St. George Respiratory Questionnaire (SGRQ). Sixty-one patients (47 males and 14 females) with a mean age of 66 years were included in the study. Stepwise multiple regression analyses conducted in each HRQL dimension identified few significantly predictive factors. By the Duke, higher Self-esteem scores were associated with higher Pao2 (p < 0.01) and with older age (p < 0.05); higher Social Health scores were associated with older age (p < 0.005), and higher Pain scores were associated with a higher FEV1/FVC ratio (p < 0.05). By the SGRQ, the Activity score correlated with FEV1/FVC (p < 0.05). The proportion of the variance in each score accounted for by covariates in the model did not exceed 10%. No other significant regression models could be identified using the other HRQL dimensions. Our findings demonstrated weak relations between lung function at the start of LTOT and some dimensions of HRQL measured by the Duke and the SGRQ at the end of follow-up.

Aged↗
PubMed1997

Methodological approaches to shortening composite measurement scales.

Composite measurement scales (CMSs) have contributed to improving the measurement of complex medical phenomena such as physical and psychological functioning or health-related quality of life. However, their use in patient care and research is often limited by their length and excessive respondent burden. In such situations, short instruments should be made available. Efforts to develop short instruments have largely focused on shortening existing instruments. To investigate the methodology currently used in the shortening of CMS, we assessed 42 studies reported in medical, psychological, and educational journals between 1984 and 1994. A number of methodological and statistical considerations important in the CMS shortening procedure were found to have been ignored or neglected by authors developing short forms from existing CMS. Serious flaws appear mainly to result from inadequate conceptualization of the shortening process, and inappropriate use and excess credit given to statistical techniques used to select items to be retained in short forms. When performed, the assessment of measurement properties of the short form was often inappropriate, and cross validation studies were seldom conducted. We propose recommendations for shortening existing CMS, to help authors and investigators develop and choose, respectively, shortened measurement instruments. These recommendations address the preliminary choice of the original CMS to be shortened, and the two successive phases to be considered in the development of short forms: the shortening process itself, where items are selected, and the validation of the shortened CMS, which should be conducted independently using independent subject samples.

Data Collection↗
PubMed1997

[Influence of the transfer mode on short-term outcome in neonates with high perinatal risk].

BACKGROUND: Transferring in utero children with high perinatal risk has been widely recommended in France over the last few years. The purpose of this study is to describe the different transfer modes for children less than 32 weeks GA or less than 1,500 g birthweight and analyse their impact on death and severe neurological lesion. POPULATION AND METHODS: This retrospective study concerned live births in a definite geographic area (Lorraine, France). Four hundred and twenty-seven children born alive between 1989 and 1992 and hospitalized in eight neonatology units were recruited. Multivariate analysis (logistic regressions) were performed to assess the influence of transfer mode on death or severe neurological lesion. RESULTS: Sixty-two percent of the children were born in the level 3 maternity, 19% in a level 1 maternity and 19% in a level 2 maternity. One hundred and twenty-one children (28%) were transferred in utero and 116 (27%) were transferred extra muros. Thirty children died during the hospital stay. Multivariate analysis does show that neonatal extra muros transfer plays a significative role on neonatal death after adjustment for other risks factors (OR = 3.3 (1.1-9.91). Thirty-one children presented a severe neurological lesion. In comparison with neonates born in the level 3 maternity without transfer, extra muros transfer appears to be a very significant risk factor (P = 0.0008): OR for transfer from level 2 and level 1 maternity is 15.8 (3.8-66.5), and 5.6 (1.3-24) respectively. There is no significant increased risk for children born after maternal transfer or born in a level 2 maternity without transfer. CONCLUSION: These data are consistent with data from the literature and confirm the risk related to extra muros transfer in premature babies less than 32 weeks GA or less than 1,500 g birthweight.

Female↗
PubMed1997

Differential quantitative blood cultures in the diagnosis of catheter-related sepsis in intensive care units.

The aim of this prospective study was to compare differential blood cultures and quantitative catheter tip cultures for the diagnosis of catheter-related sepsis. Over a period of 2 years, 283 central venous catheters were inserted in 190 adult patients. Catheters were removed when they were no longer needed or when infection was suspected. Immediately before removal of the central venous catheters, blood cultures were performed, with blood drawn simultaneously from the catheter and the peripheral vein. After removal, quantitative catheter culture was performed according to the Brun-Buisson modified Cleri technique. Fifty-five quantitative catheter cultures were positive. They were classified as contaminated (n = 18), colonized (n = 23), or infected (n = 14). Differential blood cultures correctly identified 13 infections. With a catheter/peripheral cfu ratio of 8, differential blood cultures had a sensitivity of 92.8% and a specificity of 98.8%. When the catheters were removed because of suspected infection, differential blood cultures had a sensitivity of 92.8% and a specificity of 100%. Differential blood culture, a technique that does not necessitate catheter removal, seems effective in the diagnosis of catheter-related sepsis in patients in the intensive care unit.

Adult↗
PubMed1997

Life events and disability in rheumatoid arthritis: a European cohort.

The objective was to study the relationship between life events (LE) and the clinical status of patients suffering from recently diagnosed rheumatoid arthritis (RA) in a 2 yr follow-up. As part of a multicentre European cohort study, 370 French and Dutch patients were questioned three times at 1 yr intervals about LE which had occurred in the previous year. Three criteria were used to quantify the degree of disease activity (Ritchie's index), the level of functional disability [Health Assessment Questionnaire (HAQ)] and perceived health [Overall Evaluation of Health (OEH)]. Total LE and desirable LE showed a weak negative correlation with the HAQ scores. On the other hand, death-related LE did not seem to modify patient status. The higher the number of health-associated LE, the greater the deterioration in HAQ and OEH scores. The results indicate that LE do not affect the course of early RA in a spectacular manner.

Adult↗
PubMed1997

Seroreactivity to Borrelia burgdorferi antigens in early rheumatoid arthritis: a case-control study.

This study investigates the seroreactivity to Borrelia burgdorferi antigens of patients suffering from rheumatoid arthritis (RA) for < 5 yr. Subjects were matched with controls for age, sex and area of residence in order to minimize the risk of differential exposure to B. burgdorferi. A total of 57 pairs were tested by immunofluorescence assay (IFA) and Western blotting. Only two RA patients showed positive IFA results, and another was positive by Western blot analysis. No significant difference in Lyme seropositivity was detected between cases and controls using either serological test. Furthermore, no significant difference in antibody response was observed to specific or non-specific proteins (e.g. Osp C, 93 kDa protein, flagellin, heat shock proteins). These results do not support the previous suggestions that B. burgdorferi may be involved in the aetiology of RA, or that RA favours the production of antibodies that cross-react with B. burgdorferi proteins.

Adult↗
PubMed1997

Determination of the maximal tumor/normal skin ratio after HpD or m-THPC administration in hairless mouse (SKh-1) by fluorescence spectroscopy--a non-invasive method.

Two major steps in our study on the treatment of skin tumors by photochemotherapy (PCT) were the development of a skin tumor model in hairless mice by chemical carcinogenesis and by the use fluorescence spectroscopy, a semi-quantitative and non-invasive method, to determine the time after i.p. injection of photosensitizer when the tumor/normal skin ratio is the highest. Carcinogenesis provided mice bearing many benign papillomas and these were used to determine the tumor/normal skin ratios of two photosensitizers by fluorescence spectroscopy. Hematoporphyrin derivative (HpD) (5 mg/kg body weight) and m-tetra(hydroxyphenyl)-chlorin (m-THPC) (0.3 mg/kg body weight) were injected, and fluorescence measured at 4, 8, 24, 48, 72 and 96 h after injection. The tumor/normal skin ratio was 6.2 for HpD and 5.1 for m-THPC. The times required to reach these ratios were 48 h for HpD and 72 h for m-THPC. Published reports indicate that m-THPC gives a much higher tumor/normal skin ratio than HpD. These results must be confirmed by organic extraction. Photodynamic therapy with the same doses of HpD and m-THPC used in this pharmacokinetic study must also be carried out to compare the toxicities of the two photosensitizers and to determine which is best for this type of tumor.

Animals↗
PubMed1997

Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus--a meta-analysis.

OBJECTIVE: To describe the relative risk for venous thrombosis (VT) associated with antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE). DESIGN: Systematic review and meta-analysis of 26 articles that examined the association between aPL and VT in SLE. SETTING: Mostly secondary and tertiary referral centres. PATIENTS: 2249 patients with SLE, 1120 tested for LA (lupus anticoagulant) and 1563 tested for aCL (anticardiolipin antibodies). MAIN OUTCOME MEASURES: A summary of study characteristics and a critical appraisal of study quality were done. Two statistical combinations of 18 primary studies that examined the association of VT and LA and of 14 studies that examined the association of VT and aCL were performed to estimate the risk for VT associated with aPL. RESULTS: The odds ratios of the risk of VT related to the LA summarized from 18 studies were 5.61 [95% CI; 3.80-8.27] overall, 6.32 [CI; 3.71-10.78] for deep venous thrombosis and pulmonary embolism, 11.6 [3.65-36.91] for recurrent venous thrombosis after the first event. The odds ratios of the risk of VT related to aCL summarized from 14 studies were 2.17 [95% CI; 1.51-3.11] overall, 2.50 [CI; 1.51-4.14] for deep venous thrombosis and pulmonary embolism, 3.91 [1.14-13.38] for recurrent venous thrombosis after the first event. CONCLUSIONS: Patients with SLE and LA are at approximately six times greater risk for VT than patients without LA, whereas patients with SLE and aCL are approximately two times greater risk for VT than patients without aCL. We have identified important methodologic limitations and differences in study characteristics. Other risk factors for VT have not been thoroughly evaluated in these studies. Further studies are needed that provide an accurate estimate of the absolute risk for aPL related VT.

Antibodies, Anticardiolipin↗
PubMed1997

[The DUKE health profile: a generic instrument to measure the quality of life tied to health].

To adapt the DUKE Health Profile, a 17-item self-report generic health related quality of life measure cross-culturally in french. A multidisciplinary expert committee was provided with three translations independent of each other, each backtranslated to the original language, and produced a synthesis version equivalent to the original. A cohort of 963 persons from the general population filled in the questionnaire twice in three months. The internal consistency was acceptable (Cronbach's alpha = 0.63-0.81) except in social dimension. Convergent validity was evidenced by a significant correlation with overall health. The test-retest reproducibility in stable subjects (601) was satisfactory (intraclass coefficient correlation r = 0.63-0.78) except in pain and disability dimensions. There was a significant modification of scores in the same direction as overall health change in subjects improved (n = 128) or worsened (n = 187). Age-adjusted scores were lower in females, in subjects with lower education, urban residency, unemployed and living alone and in subjects reporting a chronic disease. This short form questionnaire similar to the original version proved simple to use in the general population.

Health Status↗
PubMed1997

[Measurement of functional inability and quality of life in cardiac failure. Transcultural adaptation and validation of the Goldman, Minnesota and Duke questionnaires].

Cardiac failure has a big impact on the daily life of patients and this can be evaluated using quality of life questionnaires. The aim of this study was to translate and adapt for the French population and test the validity of two quality of life self-administered-questionnaires: the Duke health Profile, the Minnesota Quality of Life Questionnaire in Cardiac Failure and one function capacity questionnaire, the Goldman Specific Activity Scale. The questionnaires were translated and retranslated then submitted to a committee of experts: the final version was presented to 30 patients. The study of the quantitative properties of the three instruments was performed on a sample of 74 patients with cardiac failure to assess their validity and 26 stable patients after cardiac transplantation to test reproducibility. The results of this study show that these three instruments are valid and reproducible and are comparable to the original documents: Cronbach's Alpha ranging from 0.54 to 0.78 for the Duke, except for the social dimension, and from 0.73 to 0.93 for the Minnesota, except for its incapacity dimension, intraclass correlation coefficient > 0.6 in all dimensions. The validity of convergence with LVEF and the NYHA measured during hospitalisation for decompensation was poor, except for the Goldman. The three instruments provided coherent information. The authors conclude that a structured method allows transcultural adaptation of instruments of evaluation of quality of life, the French version having comparable properties to the original documents: they may be used for clinical research.

Activities of Daily Living↗
PubMed1996

Intraoperative radiation therapy in recurrent carcinoma of the uterine cervix: report of the French intraoperative group on 70 patients.

PURPOSE: To evaluate the feasibility and oncologic results of intraoperative radiation therapy (IORT) for recurrent uterine cervical carcinoma in a cohort of patients treated in seven French institutions. METHODS AND MATERIALS: From 1985 to 1993, 70 patients with pelvic recurrences underwent IORT with/ without external radiation therapy (ERT) and chemotherapy (CT). Treatment modalities for recurrence were IORT alone (40 out of 70), IORT + ERT (30 out of 70), additional chemotherapy (20 out of 70). Gross complete resection (CR) was performed in 30 out of 70 cases, partial resection (PR) in 37 out of 70, and unspecified surgery in 3 out of 70. Sixty-five patients had electron beam IORT and 5, 100 KV photon IORT. Mean IORT cone size, electron beam energy, and dose (calculated at the 90% isodose line) were, respectively, 75 mm (40 to 90), 12 MeV (6 to 20), and 18 Gy (10 to 25) after CR and 80 mm (45 to 100), 15 MeV (7 to 24), and 19 Gy (10 to 30) after PR. RESULTS: Mean follow-up after IORT was 15 months (2 to 69). One, 2- and 3-year overall survival rates were 47, 17, and 8%, respectively; median survival was 11 months and local control, 21%. Median survival and local control rates increased after CR (13 months, 27%) vs. PR (10 months, 17%) and when initial treatment consisted of surgery (S) alone (15 months, 25%) vs. radiation therapy (RT +/- S) (10 months, 16%). However, these differences were not statistically significant. No death-related toxicity was observed. Grade 2 or 3 toxicity was observed in 19 out of 70 patients (27%), including 9 not directly IORT-related complications (13%) (three digestive tract fistulas, one rectal stricture, three urinary fistulas, two infections) and 10 directly IORT-related complications (14%) (five neuropathies, four ureteral obstructions, and one rectal stricture). CONCLUSION: This retrospective study demonstrates the feasibility of IORT. The usefulness of IORT still needs to be evaluated in primary treatment of advanced stages of cervical carcinoma.

Adult↗
PubMed1996

Combined surgery and brachytherapy in the treatment of some cancers of the bladder (partial cystectomy and interstitial iridium-192).

Eighty-five bladder cancers were treated at the Urology Clinic of Nancy and the Centre Alexis Vautrin from 1975 to 1992 with short course preoperative radiation therapy (3 x 3.5 Gy), conservative surgery and brachytherapy by iridium-192. The tumours were classified according to the 1979 UICC pTNM classification. There were 27 pT1, 31 pT2 and 22 pT3, two pT4 and three pTx. The pT1-pT2 cases received only one brachytherapy (50 Gy at least) after the short course preoperative irradiation. The pT3 cases received only 30 Gy of brachytherapy and an external irradiation boost (generally 40 Gy to the node areas and 30 Gy to the tumour, but the dose varied during the time course). Surgery was often preceded by an endoscopic resection consisting of a tumoral resection or a partial cystectomy according to the localisation. The plastic vector tubes were put into place at the time of partial cystectomy. Until 1983 the radioactive wires were loaded into the vector tubes on the day following surgery, thereafter it was done one week later. The 85 patients were classified into two groups: 63 patients who were untreated previously and 22 patients who had received one or more endoscopic resections for recurrences. The median follow-up was 84 months. The local controls at 5 years were 78% in the first group versus 56% in the second group (p = 0.005) with an overall survival of 73 and 65%, respectively. The local control did not vary according to the differentiation (grade 1/2 vs. grade 3). The local control for pT1, pT2, pT3 was 85, 64 and 70% with a specific survival of 85, 76 and 72%, and an overall survival of 78, 66 and 66%. Among early complications, delay in healing of the bladder wall with subsequent vesico-cutaneous fistula depends mainly on the loading time of radioactive wires after surgery and is rare if the loading is delayed by one week. The late complications depend mostly on dosimetric factors. We found 24 grade 1, three grade 2, four grade 3 and one grade 4. The following factors are significant: the surface treated (> 14 cm2), a distance between the sources of more than 2 cm and, especially, activity of the wires of more than 2 mCi/cm (this factor was found in the five complications of grade 3 and 4), the other factors were not significant in univariate analyses.

Brachytherapy↗
PubMed1996

Nonspecific effects in longitudinal studies: impact on quality of life measures.

A variety of factors may influence outcome measures in longitudinal studies, including placebo, Hawthorne, or natural history effects. Quality of life (QoL) measures are particularly subject to these phenomena. This 2-month postal survey was set up to examine the extent of nonspecific effects in a treatment (vitamin supplementation) group (n = 180), a placebo group (n = 180), as part of a stratified, randomized controlled trial, and two control groups (n = 768 each). Quality of life was measured using the SF36. The placebo effect had a significant impact on improving physical, mental, and pain dimensions (p = 0.02 to 0.04), and the Hawthorne effect was significant (p = 0.03 to 0.009) for psychological dimensions. Although the impact of natural history was not significant, it tended to worsen all QoL dimensions. Vitamin supplementation had no effect on QoL. These results demonstrate the importance of placebo and Hawthorne effects and suggest that they may be responsible for misleading results or reductions in the power of controlled trials.

Adult↗
PubMed1996

Computer-controlled monitoring of bladder pressure in the prevention of 'TUR syndrome': a randomized study of 53 cases.

OBJECTIVE: To evaluate the performance of a computer-controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome. PATIENTS AND METHODS: The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0-500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood. RESULTS: When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings. CONCLUSION: The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.

Adenoma↗
PubMed1996

Correlates of functional disability in early rheumatoid arthritis: a cross-sectional study of 706 patients in four European countries.

In this cross-sectional study of 706 European patients with rheumatoid arthritis (RA) of < or = 4 yr duration, we examined possible correlates of functional disability assessed by the Health Assessment Questionnaire. First, we examined a subsample of 237 Norwegian patients. The Ritchie index, sex, age, erythrocyte sedimentation rate (ESR) and disease duration correlated significantly with disability, whereas serum rheumatoid factor, hand X-ray changes and educational level did not. Subsequently, we cross-validated these findings in a similar sample of 469 French, Dutch and Northern Irish patients. The results supported the Ritchie index, sex, ESR and disease duration as significant correlates of disability, whereas rheumatoid factor, age and education were not significantly correlated with disability. The correlation between X-ray changes and disability could not be cross-validated. The main findings of this study are that female sex correlates significantly with disability even early in the course of RA, whereas the rheumatoid factor does not.

Adult↗