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Biomedical subjects

L Mallet

Publications and source records attributed to L Mallet.

90 records · Page 5Linked to original sources
PubMedDate not supplied

Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

CONTEXT: Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. OBJECTIVES: To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. DESIGN AND SETTING: Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. PARTICIPANTS: A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients. MAIN OUTCOME MEASURES: Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. RESULTS: After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits. CONCLUSIONS: In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.

Adult↗
PubMedDate not supplied

[Should subdivision of regressive ischemic colitis be envisaged?].

The term "regressive ischemic colitis" is generally accepted and refers to acute hemorrhagic colitis which may occur at any age and recovers spontaneously in most cases, sometimes leaving colonic stenosis due to scarring. Critical analysis of the literature reveals that there is no formal diagnostic criterion for this condition and no real proof that the mechanism is ischemic, particularly in young subjects who have no vascular disorder or hemodynamic triggering factor. The number of clinical, radiological, endoscopic and even histological similarities between regressive ischemic colitis and some forms of infectious colitis, particularly due to enterohemorrhagic E. coli O157:H7 and hemorrhagic colitis due to penicillin derivatives and non-steroid anti-inflammatory drugs is also striking. These observations logically lead us to wonder whether the term "regressive ischemic colitis" does really correspond to a well-defined entity rather than to a group of acute colitis of miscellaneous etiology but with many common features.

Adult↗
PubMedDate not supplied

[Light chain deposit disease: an anatomopathological entity].

The light chain deposition disease was recently identified as a systemic clinicopathological entity characterized by amorphous extracellular deposits which differ from the amyloid substance. Various organs may be involved, notably the kidney, the liver, the myocardium and the skin. The histopathological aspects were investigated in 3 cases. By immunofluorescence using frozen sections the deposits were shown to contain monoclonal light kappa or lambda chains. By electron microscopy they appeared to be granular and usually located close to epithelial and/or vascular basal lamina. There was in every case a monoclonal lymphoplasmacytoid proliferation. In one case amyloid deposits were associated in small vessels. In another one, follow-up study after chemotherapy showed improvement of hepatomegaly, stabilization of renal function, and regression of light chain deposits in skin biopsy specimens.

Adult↗
PubMedDate not supplied

[Spontaneous pneumoperitoneum in scleroderma].

A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.

Aged↗
PubMedDate not supplied

[Monoamine oxidase inhibitors and food precautions. A comparison of utilization in Belgian psychiatric education institutes and current findings in the literature].

After an extensive survey of MAOI diets prescribed in different Belgian training institutes, there appears to be a confused situation which can cause obstacle for prescription. Of the diets received, we note that 211 foodstuffs and type of foodstuffs have been recommended for restrictive use. However, a most recent literature overviews shows restrictive recommendations for only 40 foodstuffs and types of foodstuffs. Its systematic analysis allows us to propose to the patient a personalized diet with little restrictions which is explained on an understandable rather than a descriptive basis. The adoption of this kind of diet should facilitate easier access to MAOI's, in case more simple therapy strategies have failed, especially in the atypical depressive disorders and tricyclic's refractory depressive disorders.

Alcoholic Beverages↗