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Biomedical subjects

L R Salmi

Publications and source records attributed to L R Salmi.

At least 19 recordsLinked to original sources
PubMed2007

Reliability of the pulp nail bone (PNB) classification for fingertip injuries.

Evans and Bernardis proposed the 'PNB classification', by which a fingertip injury is classified according to each structure: pulp P, nail N, bone B. The objective of this study was to assess the inter-observer reliability, repeatability and accuracy of PNB. One hundred patients presenting with a fingertip injury were included prospectively, photographed, then classified in randomly chosen orders by nine independent observers. A third were drawn randomly and classified a second time to measure repeatability. A reference classification was also provided by one of the authors of the PNB system. Classifications agreed with the reference in 59% of injuries for P, 55% for N and 54% for B. The Kappa values for inter-observer agreement were 0.520 for P, 0.512 for N, and 0.504 for B; for intra-observer agreement, they were 0.616 for P, 0.658 for N, and 0.577 for B. Although levels of agreement are comparable with results found for other classifications, they are insufficient for use of the PNB classification without improvement.

Adolescent↗
PubMed2006

Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

Blood Glucose↗
PubMed2004

Pathways to care of first-admitted subjects with psychosis in South-Western France.

BACKGROUND: A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care. METHOD: Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions. RESULTS: Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care. CONCLUSIONS: The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.

Adolescent↗
PubMed2002

Multivariate analysis of determinants of bacterial contamination of whole-blood donations.

BACKGROUND AND OBJECTIVES: Introduction of bacteria into blood components at the collection stage seems to be a frequent occurrence. We therefore assessed determinants of bacterial contamination of whole-blood donations to gain insight into contamination mechanisms and direct prevention. MATERIALS AND METHODS: A cross-sectional study was carried out on donors accepted for whole-blood donation in four French blood banks. Each blood bank used its own two-stage procedure for phlebotomy site preparation. Contamination was identified by culturing two 15-ml samples (collected aseptically at the outset of donation) in a BacT/Alert 240 system. Determinants were assessed by logistic regression analysis. RESULTS: Bacterial contamination, mainly by skin flora, occurred in 76 (2.2%) out of 3385 donations. Significant determinants were as follows: the blood bank (odds ratio [OR] range = 3.0-5.6, P < 0.001); lack of repetition of scrub (OR = 2.7, P = 0.032); and donor age > 35 years (OR = 1.8, P = 0.036). CONCLUSION: Systematic scrub repetition should be implemented to reduce bacterial contamination by skin flora at the collection stage. Further research is required to clarify the role of different antiseptic agents and of donor age.

Adult↗
PubMed2002

Factors associated with nurses' poor knowledge and practice of transfusion safety procedures in Aquitaine, France.

OBJECTIVES: To (1) describe knowledge, attitudes, and reported practice of blood transfusion of nurses in Aquitaine's hospitals; (2) measure the potential threat for patient safety of poor transfusion-related knowledge and practice; and (3) identify factors associated with poor knowledge and practice. DESIGN: Survey conducted in 14 hospitals in Aquitaine (one university and 13 general hospitals). SETTING: Hospitalized care. PARTICIPANTS: A random sample of nurses. MATERIALS: Data were collected anonymously by investigators through structured individual interviews. The questionnaire contained mainly knowledge and practice questions about blood transfusion regulation. MAIN OUTCOME MEASURES: Hazardous knowledge and practice scores have been constructed, reflecting the levels of potential danger in the answers to the questionnaire. Factors associated with these scores have been studied using a random-effect linear regression. RESULTS: In our sample of 1090 nurses, poor knowledge and practice concerned mainly (1) the bedside blood compatibility test [proportion of responses (PR) with potential life threat between 12.7 and 35.5%]; (2) pre-transfusion compatibility check when receiving blood units (PR = 34.5%); (3) delay between screening of red cell antibodies and transfusion (PR = 20.5%); (4) delay in preservation of blood unit in the ward (PR = 33.4%); and (5) recognition of abnormal reactions after transfusion (PR = 47.1%). Frequency of transfusion and training were the factors most strongly associated with hazardous knowledge and practice scores. CONCLUSION: Low training and transfusion activity were key determinants of poor transfusion-related knowledge and practice.

Attitude of Health Personnel↗
PubMed2001

[Evaluation of the immediate transfusion reaction incident reporting system at the Brest University Hospital Center].

The Haemovigilance Unit of Brest University Hospital has had a reporting system of transfusion reactions since october 1994. Reporting "any unexpected or undesirable effect due or likely to be due to the administering of blood cell components" must be done on an answering machine immediately or in the next eight hours. The main goal of the evaluation of this epidemiological surveillance system was to assess its sensitivity, its positive predictive value, its acceptability, its timeliness and its simplicity, according to the Centers for Disease Control criteria. An exhaustive monitoring of the immediate transfusion reactions (ITR) occurring within the 24 hours following the procedure was conducted from April 1, to June 30, 1998. Two sources of information were used, the spontaneous notification to the Haemovigilance Unit using the answering machine, and a telephone survey of the nurse responsible for the transfusion or post-transfusion follow-up. During the survey, 19 ITR, among which 12 were reported to the Haemovigilance Unit on the answering machine, were recorded. The incidence rate of the I.T.R. was estimated at 5@1000 transfused blood cell components. The sensitivity of the notification system was estimated at 63% (95% confidence interval: 41-85) and the positive predictive value at 70% (95% confidence interval: 48-92). This notification system is operational. The function of sanitary alert is ensured at the primary level of the system surveillance. The undernotification of the ITR (37% of false negative) must be corrected by specific recommendations.

Academic Medical Centers↗
PubMed2001

Publication pattern of medical theses, France, 1993-98.

CONTEXT AND OBJECTIVE: In many countries, medical training must be completed by presentation of a thesis. We report publication patterns of French medical theses. MATERIALS: We drew a random sample of theses presented in the 36 French medical universities between 1 January 1993 and 31 December 1997. The sample was stratified according to size of university, and drawn from the CD-ROM Doc-Thèse. METHODS: We recorded the research area (medicine, surgery, biology) and study type (clinical, epidemiological, laboratory). We used the name of the student and supervisor to assess whether the thesis resulted in a publication indexed in MEDLINE. RESULTS: Most of the 300 theses included were from medicine (79.3%) and were clinical studies (69.3%). A total of 51 theses (17. 0%) resulted in publication. The proportion of theses which were published, the median impact factor of the journals in which they were published, the proportion of publications in English and the proportion of publications in which the name of the student was missing varied with the research domain and type of study. CONCLUSIONS: Most French medical theses are not made available to the scientific community. In the European context, where medical training and qualification have to be standardized, our study provides a simple method of assessing that publication objectives of thesis research are met. Further research is needed to explore the educational value of medical professional theses.

Academic Dissertations as Topic↗
PubMed2001

Efficacy of a new collection procedure for preventing bacterial contamination of whole-blood donations.

BACKGROUND: Transfusion-related bacterial contamination is a serious problem. The introduction of bacteria into donations at the collection stage seems frequent, despite well-conducted phlebotomy site preparation. Additional preventive measures are required. STUDY DESIGN AND METHODS: The aim of this study was to assess the potential efficacy of excluding the first 15 mL of blood to reduce the bacterial contamination of donations. A special device allowed the aseptic collection of two samples at the beginning of donation: S1 (first 15 mL) and S2 (next 15 mL). Bacteriologic cultures of S1 and S2 were performed by using an automated system. The procedure's efficacy was measured by the proportion of positive donations in S1 that were then negative in S2. RESULTS: S1 and/or S2 were positive in 76 (2.2%) of 3385 donations. In about three-fourths of the culture-positive donations, contamination was detected in the first 15-mL sample only. Gram-positive cocci accounted for 81 percent of species, gram-positive bacilli for 14 percent, and gram-negative bacilli for 5 percent. The new procedure would have prevented the introduction of bacteria in 55 donations, reducing to 0.6 percent the risk of contamination from the first 15 mL collected. CONCLUSION: Although the final effect on blood component bacterial contamination rates cannot be derived from the study, excluding the first 15 mL of blood may reduce the rate of bacterial contamination in donations.

Adult↗
PubMed2001

Determinants of transfusion-associated bacterial contamination: results of the French BACTHEM Case-Control Study.

BACKGROUND: Transfusion-associated bacterial contamination (TABC), probably the most frequent transfusion-transmitted infection, may induce serious adverse events. Systematic information and documentation on determinants are lacking. STUDY DESIGN AND METHODS: The BACTHEM Study is a French matched case-control study assessing TABC determinants. Included were cases of TABC reported in France in a 2-year period, as determined from uniform definitions. Information on recipient-, blood component-, and donor-related potential determinants was collected on site. ORs were estimated by conditional logistic regression. RESULTS: Of the 158 cases of suspected TABC reported, 41 that involved transfusion with 25 RBCs and 16 platelet concentrates were included. Gram-negative rods accounted for nearly half of the bacteria species involved and for all six deaths. In comparison with the risk of TABC for patients receiving RBCs for anemia, the risk was higher for patients receiving RBCs for pancytopenia (OR, 7.3; 95% CI, 1.3-41.0) and for those receiving platelets for thrombocytopenia (OR, 5.3; 95% CI, 1.2-24.1). Other potential determinants were platelet transfusion for pancytopenia (OR, 4.5; 95% CI, 0.5-40.0), immunosuppressive treatment (OR, 2.8; 95% CI, 0.7-10.6), shelf-life of more than 1 day for platelets or 8 days for RBCs (OR, 2.6; 95% CI, 0.7-9.6), and more than 20 previous donations by donors (OR, 1.9; 95% CI, 0.7-5.3). CONCLUSION: This first comparative study revealed TABC determinants that suggest approaches for prevention.

Adult↗
PubMed2001

Clinical prediction of lower limb deep vein thrombosis in symptomatic hospitalized patients.

We evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hospitalized patients (Wells' and Kahn's). We included 273 patients referred to the vascular exploration unit for the suspicion of DVT. A clinical questionnaire was tilled in by the practitioner and the scores were calculated from this form. 66 of the 273 patients had a DVT. When Wells' score was 3, a DVT was found by duplex echography in 51% patients; when the score was 0, a DVT was found in 9%. Kahn's score was not adapted to this population. We then developed a new simple score (cancer, palsy or plaster immobilization, warmth, superficial venous dilation, unilateral pitting edema, other diagnosis). A DVT was found in 76% patients with a score of 3 and in 11% in those with a score of 0. We therefore propose a 6-item score whose main advantages are simplicity and usefulness in routine practice.

Female↗
PubMed2000

What should be included in meta-analyses? An exploration of methodological issues using the ISPOT meta-analyses.

OBJECTIVE: To explore the impact of methodologic issues on the results of meta-analyses. The following issues were examined: the type of literature search strategy used; inclusion or exclusion of non-peer-reviewed studies; the inclusion or exclusion of non-English language publications; the effect of trial quality; and the inclusion or exclusion of non-placebo-controlled studies. METHODS: The International Study of Perioperative Transfusion (ISPOT) meta-analyses were used to evaluate each of the methodologic issues. The 10 meta-analyses consisted of technologies to reduce the need for perioperative red blood cell transfusion. The number of trials for each of the meta-analyses varied from 2 to 45. Both EMBASE and MEDLINE searches were conducted, including the use of systematic search strategies. RESULTS: MEDLINE identified the vast majority of trials. Alone, MEDLINE would have missed 8 studies compared to 10 for EMBASE. Use of the systematic search strategies greatly reduced the number of articles to be reviewed compared to open searches. Type of publication, country of study origin, inclusion of non-English publications, and trial quality had very little impact on the estimates of effect. The use of placebo versus open-label control affected the magnitude of the odds ratio for two of the meta-analyses. The results of the two meta-analyses were not statistically significant if only placebo-controlled trials were included. CONCLUSIONS: While methodologic issues had very little impact on the ISPOT meta-analyses, further studies are needed in a variety of other clinical settings. Because MEDLINE, coupled with a review of the references in the identified trials, identified the vast majority of trials, one needs to consider the costs and benefits of searching EMBASE and the pursuance of unpublished and unindexed trials.

Databases, Bibliographic↗
PubMed2000

Capture-recapture method to determine the best design of a surveillance system. Application to a thyroid cancer registry.

The capture-recapture method is often confronted, when assessing completeness of surveys, to problems of dependence of data sources. The objective of this paper is to discuss the application of capture-recapture methods to choose the optimal combination of sources for a surveillance system. Our approach is based on: (1) using multiple sources, (2) assessing dependence between sources and between pools of dependent sources and other sources, (3) ruling out combinations that yield biased estimates, and (4) choosing the combinations of sources that have the best ratio between precision and applicability. We studied the independence for each pair of sources by computing the capture-recapture odds ratio. We characterized all combinations of sources by their sensitivity, coefficient of variation of the estimated number of cases, and level of resources needed to ascertain cases. Application of the approach is illustrated by data from a survey of thyroid cancer in New Caledonia, where five sources were used to estimate the incidence. The five sources provided 119 cases; the exhaustivity of sources and combinations of sources varied from 27.1 to 99.2%. Determination of dependence revealed ten dependencies out of 22 combinations. Coefficients of variation of the estimated number of cases varied from 0.83 to 27.79. The preferred combination included four sources and had a sensitivity of 97.5 and a coefficient of variation of 0.94. An assessment of dependence, based on simple criteria, can be used to choose the best combination of sources for a registry or a surveillance system.

Epidemiologic Methods↗
PubMed2000

Blood transfusion in a random sample of hospitals in France.

BACKGROUND: Representative information on blood use is scarce. A large-scale study of blood recipients and blood use in France was conducted. STUDY DESIGN AND METHODS: Based on a random sampling, this study was carried out in teaching and other hospitals between March and December 1997. In each hospital, a patient was included if he or she received an allogeneic or an autologous transfusion during the observation period for that hospital. For each recipient, product and patient characteristics for 24 hours after inclusion were collected. RESULTS: From the 175 hospitals that had given a transfusion to at least one patient during the observation period, 3206 patients were included. Most transfusion recipients (57%) were over 65 years old; 42 percent were in teaching hospitals and 53 percent in medical wards. Among the 3044 adults, 91 percent received an allogeneic transfusion. Fifty-three percent of allogeneic units were WBC reduced. The indications most frequently reported for allogeneic transfusion were neoplasms (48%) and those for autologous transfusion were disorders of musculoskeletal (63%) or circulatory (15%) systems. The patients in nonteaching hospitals were more often transfused during surgery and were more likely to be aged and to have a musculoskeletal disorder than were patients in teaching hospitals. CONCLUSION: General collection of such data, within a system of traceability, could provide relevant denominators from which to interpret adverse-reaction data.

Adult↗
PubMed2000

Errors in interpreting the pretransfusion bedside compatibility test: an experimental study.

BACKGROUND AND OBJECTIVE: Analysis of reports of incidents, involving ABO incompatibility suggests that the main problem is poor interpretation of the pretransfusion bedside compatibility test (PBCT). We studied sources of error as experienced by nurses as to the blood groups of donor blood and of the recipient. MATERIALS AND METHODS: According to their seniority in the profession and on the ward, 48 nurses were randomly selected from four transfusion sectors of the University Hospital of Grenoble, France. Each nurse interpreted 24 photos of PBCTs, including some with procedural irregularities, and was asked to assess the compatibility of the blood types of the donor and the recipient. At random, half the nurses were provided with a diagram to facilitate interpretation. RESULTS: The overall frequency of errors was 39.8%. Errors were fewer when the tests were interpreted as compatible (7.3%) or incompatible (6.3%), and when the nurse had been in the profession between 3 and 5 years and in the ward less than 3 years (25.5%), or worked in hematology (34.7%) or anesthesia (36.5%). Use of the diagram limited the number of errors, provided the test was interpretable (22.2%). CONCLUSION: PBCTs cannot be considered a valid safety procedure. We need other, more effective methods to reduce the risk of incompatibility accidents.

ABO Blood-Group System↗