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L R Salmi

Publications and source records attributed to L R Salmi.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Effect of dapsone on survival in HIV infected patients: a meta- analysis of finished trials].

BACKGROUND: The aim of the study was to estimate the effect of dapsone on survival in HIVinfected patients. METHOD: The method was a metaanalysis. Data searches used MEDLINE, AIDS TRIALS, and AIDS DRUGS databases from 1983 to January 1996, clinical trials registries of appropriate collaborative research groups, abstract books of International Conferences on AIDS and infectious diseases between 1988 and 1996, references listed within selected articles and active experts in HIV infection. Were considered as eligible: randomized clinical trials, conducted in adults, with one arm evaluating dapsone as prophylactic agent for Pneumocystis Carinii Pneumonia (PCP). Each primary investigator was asked to provide the most recent aggregated study data by completing a standardized questionnaire and to provide files of individual patient data whenever possible. RESULTS: Overall, 17 trials (4343 patients) were eligible for the metaanalysis. The analysis of all available aggregated data included 16 trials (4267 patients) and showed no deleterious effect of dapsone on survival: OR=1.11, 95% Confidence Interval (CI)=0.961.29. There was no evidence of heterogeneity among studies (p=0.50). The analysis of individual data included 10 trials (3115 patients) (OR for aggregated data from those trials=1.10, CI=0. 931.29) and confirmed the absence of deleterious effect of dapsone on survival: stratified Hazard Ratio=1.12, CI=0.991.27 (logrank test: p=0.08). In this subsample, there was evidence of a deleterious effect of dapsone used as secondary prophylaxis. However, this result did not remain when the trial reporting the greatest negative effect of dapsone on survival was omitted. CONCLUSION: Dapsone may be used safely as a primary prophylactic regimen for PCP or toxoplasmosis. However, no definitive recommendation can be made for the use of dapsone as secondary PCP prophylaxis.

AIDS-Related Opportunistic Infections↗
PubMed2000

[Which health information systems for the evaluation of health actions?].

The evaluation of health actions requires large amounts of information allowing an assessment of relevance, coherence, efficacy, efficiency and impact of these interventions. Information systems should support evaluation processes by helping to obtain pertinent indicators, tracers and standard operating procedures. To reach this objective, specific functions need to be implemented, including traceability, documentation, investigation and scientific awareness. But this supposes that health information systems respect quality criteria that this article defines. The following criteria are considered: simplicity, validity, acceptability, informative value, representativeness, continuity, reactivity, fluidity, flexibility of the system, and also confidentiality of information. The historical developments of medical informatics have induced the creation of independent information systems, answering to specific objectives. This lack of integration is an obstacle to the evaluation of health actions because of the difficulty to view transversally and longitudinally the sequence of actions for a same patient. Thus integrated health information systems, organised around patient care episodes, are necessary to support evaluation and to contribute effectively to decision making in public health, because the evaluation of health actions implies the availability of information about the individuals who are the targets of these actions.

Decision Making↗
PubMed2000

[Process assessment: importance and current limits].

Assessment of processes in health care is needed for the measurement of six domains of quality of care (appropriateness, security, respect and caring, availability, continuity and timeliness). We propose here a typology of care, organisational and management processes. Process indicators can be classified according to objectives of the evaluation, type of processes, concerned healthcare professionals, and stage of the process. Process assessment is hindered by two main difficulties. Due to the lack of data about processes in information systems and in medical records, specific data collection is often needed and impede the feasibility of routine evaluation. The second difficulty is related to the lack of information about the properties of the indicators, their appropriateness (capacity to infer improvement actions from the result of the indicators), their operational properties (cost of data collection and acceptability by the concerned professionals), and their measurement properties (reliability and validity). Process assessment is strongly needed because outcome assessment can be not possible or not appropriate. The lack of information about the process-outcome relationship is the major obstacle and the main contra-indication to its use. Validation of process indicators is therefore an important research area for the future.

Delivery of Health Care↗
PubMed1999

Assessing the quality of randomized trials: reliability of the Jadad scale.

An instrument was developed and validated by Jadad, et al. to assess the quality of clinical trials using studies from the pain literature. Our study determined the reliability of the Jadad scale and the effect of blinding on interrater agreement in another group of primary studies. Four raters independently assessed blinded and unblinded versions of 76 randomized trials. Interrater agreement was calculated among combinations of four raters for blinded and unblinded versions of the studies. A 4 x 2 x 2 repeated measures design was employed to evaluate the effect of blinding. The interrater agreement for the Jadad scale was poor (kappa 0.37 to 0.39), but agreement improved substantially (kappa 0.53 to 0.59) with removal of the third item (an explanation of withdrawals). Blinding did not significantly affect the Jadad scale scores. A more precise description of how to score the withdrawal item and careful conduct of a practice set of articles might improve interrater agreement. In contrast with the conclusions reached by Jadad, we were unable to demonstrate a significant effect of blinding on the quality scores.

Double-Blind Method↗
PubMed1999

[Cost-benefit analysis of screening strategies by human immunodeficiency virus in French blood donors].

BACKGROUND: The residual risk of human immunodeficiency virus (HIV) infection from screened blood transfusion was estimated to be 1.7/10(6) between 1993 and 1995 in France. To orient blood safety policies, we have evaluated what would be, from the perspective of blood banks, the best screening strategy in terms of gain in effectiveness and added costs. METHODS: A cost-effectiveness analysis compared 20 HIV-testing protocols using (1) available data for performances of the current screening tests; and, (2) national insurance estimates for the cost of tests. Results were expressed as the number of false negative donations that would be avoided and the cost by avoided false negative donation. RESULTS: For 3 million donated blood units a year and a prevalence of 24 per million, there would be 72 infectious donated blood units, 70.56 of which would be detected by the current screening strategy. The number of additional donated blood infections avoided in all other strategies would be low (between 0.25 and 1.28) with a very high cost (280 million French francs per added false negative avoided or more). CONCLUSION: A change in screening strategies for blood donations in France is not currently justified. If such a change was to be done, adding p24 antigen detection to the current screening strategy would be one of the worst solutions.

AIDS Serodiagnosis↗
PubMed1999

Epidemiology of blood collection in France.

The objectives of the cross-sectional study (EpiCoS) were to describe, at different stages, volunteers offering their blood, and to characterize various ways of collecting blood. From 15 September 1996 to 31 December 1996, individuals presenting at fixed or mobile sessions in one of 11 randomly selected blood banks were included after they had a medical examination. Variables studied were relative to type of collection, individuals, medical examination, patterns of blood letting, use of collected donations and if unused, reasons for discarding. Sixty four thousand and ninety two volunteers, aged 17-66 years old were included. The proportion of exclusion during medical examination was 10.8% (95% confidence interval (CI): 10.6-11.0%). Exclusions were more frequent among new volunteers and were mostly related to the safety of recipients. Most of the 57,003 donations were whole blood (94.0%) and collected in mobile sessions (89.9%). Five percent of collected donations were discarded; 3.5% (95% CI: 3.4-3.7%) of donations discarded for biological abnormalities, including 1.5% only for initial screen reactions to infectious disease markers (HBs antigen, anti-HBc antibodies, anti-HCV antibodies, anti-HIV antibodies, anti-HTLV antibodies, malaria antibodies and anti-syphilitic antibodies). The most frequent biological abnormality was a high alanine aminotransferase level. A follow-up of these indicators, within the French haemovigilance system, should allow further identification of risk factors and high-risk contexts, and planning means of optimizing blood collection in France.

Adult↗
PubMed1999

Is there an association between Helicobacter pylori infection and coronary heart disease?

In addition to gastroduodenal diseases, Helicobacter pylori infection has been associated with extradigestive diseases, including coronary heart disease. Different studies have failed to demonstrate a clear association. The aim of this work was to carry out a meta-analysis of these studies' results, with a special emphasis on heterogeneity. A MEDLINE search of all studies published in English from 1994 to 1998 was conducted. Five criteria for eligibility of studies were defined. The quality of each study was assessed on a five-point scale adapted from studies by the Quebec Task Force. The final results are reported based on a fixed-effects model. Pooled odd ratios were calculated for subgroups of studies (defined on quality of adjustment, on confounding factors, and on the type of control population). Sixty-nine articles and abstracts fulfilling the defined criteria were analyzed. They were all case-control or cross-sectional studies. H. pylori diagnosis was carried out by serology, urea breath test or both; coronary heart disease was diagnosed mainly by coronary angiography. The total sample size was 6603. The quality score varied from 4 to 10. The pooled odds ratios of the 24 articles included in the model was 1.55 (95% confidence interval (CI): 1.38-1.74). It ranged from 1.07 to 2.34 when the quality of adjustment for confounding factors was considered and from 1.25 to 1.99 when the type of control group was considered. In any case there was significant heterogeneity (p < 0.001). The present study demonstrated a possible weak association but the high degree of heterogeneity in the studies impedes a clear demonstration.

Age Distribution↗
PubMed1999

A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators.

UNLABELLED: Concern about risks of allogeneic transfusion has led to an interest in methods for decreasing perioperative transfusion. To determine whether cell salvage reduces patient exposure to allogeneic blood, we performed meta-analyses of randomized trials, evaluating the effectiveness and safety of cell salvage in cardiac or orthopedic elective surgery. The primary outcome was the proportion of patients who received at least one perioperative allogeneic red cell transfusion. Twenty-seven studies were included in the meta-analyses. Cell salvage devices that do not wash salvaged blood were marginally effective in cardiac surgery patients when used postoperatively (relative risk [RR] = 0.85, 95% confidence interval [CI] = 0.79-0.92). Devices that wash or do not wash salvaged blood considerably decreased the proportion of orthopedic surgery patients who received allogeneic transfusion (RR = 0.39, 95% CI = 0.30-0.51 and RR = 0.35, 95% CI 0.26-0.46, respectively). No studies of cell savers that wash salvaged blood during cardiac surgery were included. Cell salvage did not appear to increase the frequency of adverse events. We conclude that cell salvage in orthopedic surgery decreases the risk of patients' exposure to allogeneic blood transfusion perioperatively. Postoperative cell salvage in cardiac surgery, with devices that do not wash the salvaged blood, is only marginally effective. IMPLICATIONS: This meta-analysis of all published randomized trials provides the best current estimate of the effectiveness of cell salvage and is useful in guiding clinical practice. We conclude that cell salvage in orthopedic surgery decreases the proportion of patients requiring allogeneic blood transfusion perioperatively, but postoperative cell salvage is only marginally effective in cardiac surgery.

Blood Transfusion↗
PubMed1999

[Factors associated with survival in Kaposi's sarcoma in patients infected with the human immunodeficiency virus. Clinical Epidemiological Group for AIDS in Aquitaine].

BACKGROUND: To study behavioral risk factors of Kaposi's sarcoma (KS) among HIV infected homosexuals in Bordeaux, southwest France. METHODS: A case-control study was performed within the Aquitaine Cohort. Cases of KS surviving in 1995 and homosexuals were systematically enrolled. For each case, two controls were selected among homosexuals surviving in the cohort. Cases and controls were matched on year of diagnosis of HIV infection. Data collection was based on a self administered questionnaire focusing on use of recreational drugs, detailed sexual practices and sexually transmitted diseases in the year preceeding the diagnosis of HIV infection, in the year after the HIV diagnosis and in the year preceeding the diagnosis of KS (or an equivalent period of time for controls). RESULTS: Twelve cases were matched to 2 controls, 15 cases to one control and 13 cases remained unmatched. Matched analysis identified an association between KS and regular sexual partner (odds ratio = 0.07; 95% confidence interval: 0.01-0.52 and p < 0.001) and active and passive oro-anal intercourse before HIV diagnosis and before KS diagnosis (p = 0.01). In the unmatched analysis including all cases, we found an association between KS and the overall number of sexual partners (p < 0.03) for all periods of interest. CONCLUSIONS: This case-control study identified sexual practices in favor of a sexually transmitted agent of KS.

Case-Control Studies↗
PubMed1999

[Arterial blood pressure in homozygote patients with drepanocytosis].

BACKGROUND: Relative hypotension has been reported in sickle cell patients. The aim of this study was to compare blood pressure in patients with SS disease and subjects with normal hemoglobin genotype AA and to assess whether the same clinical, biological and socio-demographic variables are associated to the mean arterial pressure in patients with sickle cell disease and normal subjects. METHOD: Blood pressure was measured with a standardized automated oscillometric method in 88 SS patients et 88 AA control subjects seen in the University Hospital of Pointe-à-Pitre (Guadeloupe). A multiple linear regression analysis for mean arterial pressure was done including type of hemoglobin (forced variable), age, sex, body mass index, pulse rate, hemoglobin concentration and interaction terms between type of hemoglobin and other variables. A regression was also fitted separately for each population. A downward stepwise strategy was used to simplify the models. RESULTS: The two groups were similar for age, height and gender ratio and pulse rate. Mean arterial pressure was significantly lower in sickle cell patients (81.6 mmHg in SS patients vs 89.9 mmHg in AA subjects, p < 10(-4)). The final model included type of hemoglobin, age, sex, body mass index, pulse rate and an interaction between type of hemoglobin and age (global F = 22.04, adjusted R2 = 42%). The separate models indicated that sex was associated with mean arterial pressure only in patients with sickle cell disease and that age and hemoglobin concentration was associated with mean arterial pressure only in normal subjects. CONCLUSION: Blood pressure determinants are not similar in the two populations. The effect of age, especially, is not the same in patients with sickle cell disease and in normal subjects. These results confirm that specific patho-physiological models should be defined in sickle cell disease.

Adolescent↗
PubMed1999

[Writing and publication of a medical article].

To advance in their strategies to manage patients, clinicians need new research results. To be accessible, medical research must be published. Writing and publishing medical articles should respect principles that are described in this article. Good writing is based on a logical organization and the application of scientific style. Organization according to the IMRD structure (Introduction, Methods, Results, Discussion) allows one to present the reasons for and objectives of the study (Introduction), details on whatever has been done to answer the question (Methods), data on the actual study population and answers to the main question (Results), and a critical appraisal of these results, given the limits of the study and current knowledge (Discussion). The main elements of scientific style are precision, clarity, fluidity and concision. Finally, submitting a paper to a scientific journal implies presenting the work in a covering letter and respecting rules for formatting a manuscript (order of presentation, typography, etc.).

Guidelines as Topic↗
PubMed1998

[Feasibility of following up transfused patients].

The aim of this study was to assess the natural history of patients after transfusion and the acceptability of a standardized biological follow-up. In 1995, during 1 month, in 13 French hospitals, a follow-up at 3 and 6 months after blood transfusion was proposed to all blood recipients who had not received any blood transfusion within the past 6 months (eligible patients): screening for red cell antibodies, alanine aminotransferase (ALT) activity and specific viral markers of hepatitis B (hepatitis B surface antigen and antibody to hepatitis virus core antigen), of hepatitis C (antibodies) and of Human Immunodeficiency Virus (antibodies). At the beginning of the study, 296 patients were followed for 6 months. A complete follow-up was available at 3 months for 183 patients (62%), at 6 months for 168 (57%) and after 6 months, 198 patients (67%) have been once followed. Of eligible patients, 76% were alive at six months. After transfusion, the incidence of red cell alloantibodies and elevated ALT concentration were respectively 4% and 17%. At 6 months, one patient had Hepatitis B surface antigen; the responsibility of blood transfusion was excluded. Within the first 24 hours, 68 patients (23%) required another blood transfusion and 42% of units were transfused to patients with malignant disease. Our study quantifies in real conditions the difficulty of a biological follow-up in a transfused population, mostly composed of patients that could not be followed in the hospital where they were transfused.

Adult↗
PubMed1998

[Evaluation of aa tracking system for labile blood products in the Midi-Pyrenes region].

At the request of the regional authority, the system of traceability of blood products in the Midi-Pyrenees area in France was assessed using available documentation, visits and interviews of participants. We studied the time needed to obtain traceability data in the Blood Banks and the reactivity of the system defined as the time needed to carry out a simulated descending transfusional survey. This information allowed us to assess usefulness and cost of the system, its applicability and the timeliness of information, according to the criteria of the Centers for Disease Control. The system is based on a standardized nominative form for the delivery of blood products and specific feedback. For the participants, traceability makes transfusional surveys easier and improves transfusions safety. In two of the 130 hospitals, the system is linked to the "program of medicalization of information systems". In the 2nd semester of 1996, the traceability proportion was 97%. For a given date of distribution, 75% of blood products were traced in 14 days and 83% in a month. The study of reactivity showed that all donations coming from two randomly chosen blood collection sites could be traced in about 2 hours. This first evaluation of a regional system of traceability showed its feasibility and acceptability, based on evaluation criteria of a public health surveillance system. A continuous evaluation process would be necessary to assess the good functioning of the system and to detect and prevent possible deficiencies.

Blood Banks↗
PubMed1998

[Evaluation of the actual traceability of labile blood products using medical records].

The traceability of blood products is an essential part of haemovigilance and transfusion safety. A pilot survey assessed the actual traceability by analysing transfusion information collected from medical records of a representative sample of 390 labile blood products transfused in a French university hospital. Transfusion and distribution forms were missing in 2.3% and 6.9% respectively. Availability and validity of transfusion information varied according to the nature of the expected information, elements of patients' records and types of wards. The location where the transfusion was performed was false or ambiguous in 38% of cases in surgery. Crude traceability, evaluated by the feedback of validated distribution forms, was estimated at 85.2% whereas actual traceability was estimated at 81.9% (SD 1.7%). High availability (98.7%) of at least one of the two sheets of the distribution form in medical records, or in the blood bank, revealed that a significant improvement of traceability should come from a better compliance to the rules of information transmission. The actual traceability differed significantly according to clinical services (worse in surgery) and was lower in case of autologous or absence of previous transfusion. An analysis of markers of good traceability should suggest efficient evolution of organization and information systems. This pilot study shows the relevance and feasibility of this kind of survey which could interestingly be performed on a large national representative random sample.

Blood Transfusion↗
PubMed1998

Factors affecting both peripheral blood progenitor cell mobilization and hematopoietic recovery following autologous blood progenitor cell transplantation in multiple myeloma patients: a monocentric study.

The aim of the study was to analyze the factors influencing peripheral blood progenitor cell (PBPC) collection after high-dose cyclophosphamide (HDCYC) (7 g/m2) and hematopoietic recovery after autologous transplantation of HDCYC-mobilized PBPC (ABPCT) in 116 patients with aggressive multiple myeloma (MM). Following HDCYC 74 patients received hematopoietic growth factors (HGF), either G-CSF (n = 19) or GM-CSF (n = 55). All the patients were subsequently planned to undergo ABPCT. PBPC collection was possible for 106 patients. The most important prognostic factor for collection of more than 25 x 10(4) CFU-GM cells/kg and 2 x 10(6) CD34+ cells/kg was the use of HGF (P = 0.002 and 0.009, respectively). Previous use of an alkylating agent, response to treatment before HDCYC, and interval between diagnosis and HDCYC were also significant factors (P = 0.004, 0.025 and 0.001, respectively). The number of CFU-GM cells infused was the most important parameter for rapid and complete hematological recovery after ABPCT (P < 0.0001). Thus the use of HGF post-HDCYC is the major factor which, associated with reduced time between diagnosis and HDCYC and the use of an alkylating agent, could increase the numbers of hematopoietic progenitors collected, and subsequently improve hematopoietic recovery following ABPCT in MM patients.

Adult↗
PubMed1998

[Major statistical software usable in epidemiology].

Quality assurance of biostatistical data analysis is becoming mandatory. The aim of this review of statistical software was to guide uses who are faced with the increasing number of these tools. A list of softwares was obtained from statisticians and computer scientists, computerized databases, computer science lay press, and commercial documents. The softwares were described and their possibilities measured. The following functions were studied: functions considered as essential (descriptive analysis, Student's t, Mann-Whitney or Wilcoxon, ANOVA, Kruskall-Wallis, Pearson's chi 2, Fisher's exact test, Pearson's r), survival and multivariate analysis (logistic regression, proportional hazards modelling, times series). User-friendliness and quality of graphs were also studied. Among the 220 listed softwares, 26 could be considered as general softwares and were extensively analyzed. Statistical softwares may be classified into four categories: easy-to-use general public softwares with limited functions, such as EPI INFO; simple reference softwares with satisfactory user-friendliness and performing most of the statistical analyses, such as PCSM, STATISTICA or STATA; complex reference softwares intended for statisticians (EPILOG PLUS, SAS); specific cases such as EGRET performing only multivariate analysis or SUPERANOVA performing only analysis of variance. Such a review should be regularly updated.

Analysis of Variance↗