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Biomedical subjects

P Durieux

Publications and source records attributed to P Durieux.

At least 19 recordsLinked to original sources
PubMed1996

[Audit of the management of postoperative pain].

OBJECTIVE: The aim of this study was to assess the incidence and severity of postoperative pain in patients undergoing operations in various surgery clinics in the Assistance Publique des Hôpitaux de Paris (AP-HP) and to evaluate management of pain during the 24 hours following surgery. METHODS: Data from surgical and anesthesia observation sheets and from patient complaints collected in a one-day external audit were obtained for 96 surgery clinics in the AP-HP. RESULTS: At the time of surgery, most patients were receiving opioids, especially fentanyl: low dose ( < 1 microgram/kg/h) was given in 17.1% of the patients and regional anesthesia was used in 13%. In 95% of the cases, postoperative orders were written by anesthesiologists. Initial orders were modified according to patient response in 11.8% of the cases. "On demand" prescriptions were used in 10% of the orders. Patient controlled analgesia and regional analgesia were not routine techniques (2 and 0% respectively). Finally, 37.8% of the patients were given a single prescription of a step-1 drug (e.g. propacetamol i.v.), 25.9% a step-2 drug either alone or in combination with a step-1 drug, and 28.9% of the patients were given strong opioids at least once. CONCLUSIONS: For all types of drugs, dosage level was considered as correct in 86.5% of the cases. For approximately 10% of the opioid prescriptions, an ineffective dose was used. The interval between doses was too long in 54.1% of the prescriptions for at least one drug (e.g. for peripheral analgesia with propacetamol). The incidence of severe pain was 46.4%, especially after abdominal, high urologic and back surgery.

Analgesia↗
PubMed1996

Fetal heart rate monitoring by telephone during pregnancy--opinion of users and non-users of a new technology.

OBJECTIVE: To compare the opinions of obstetricians who currently use fetal heart rate monitoring (FHRM) by telephone with the opinions of obstetricians in favour of this technique, but who do not use it. STUDY DESIGN: A mail questionnaire was sent to the 612 members of a professional organization of obstetricians. The response rate was 76%. RESULTS: Fourteen percent of the respondents used FHRM by telephone and 43% did not use it, but were in favour of it. Compared with current users, non-users who were in favour of this technique indicated a wider range of clinical indications for monitoring, considered a greater proportion of women to be eligible, and wanted more frequent monitoring. These differences cannot be explained by the characteristics of the obstetricians (age, type of practice or attitude towards FHRM performed in maternity unit). CONCLUSION: Our survey shows a risk of extensive use of FHRM by telephone if this technique becomes easily accessible.

Female↗
PubMed1996

[Treatment of obstructive sleep apnea syndrome].

Obstructive sleep apnea syndrome (OSAS) is a chronic disorder in which the subject experiences an abnormally large number of episodes of more or less complete and prolonged ventilatory arrest due to pharyngeal obstruction leading to fragmented sleep pattern and reduced arterial oxygen saturation. OSAS produces invalidating daytime symptoms and appears to be associated with cardiovascular complications and overmortality. Diagnosis is based on an exploration of the sleeping pattern with recording of ventilation function, arterial oxygen saturation, heart rate, and electrophysiological characteristics (polysomnography). Prevalence of a high apnea index (more than 5 per hour of sleep) associated with day-time somnolence may be as high as 3% of the population in the 30 to 60 year age range. Current treatment is mainly based on nasal continuous positive airway pressure given via the nasal route during sleep and pharyngeal surgery (uvulopalatopharyngoplasty). Surgery is reserved for subgroups of patients with anatomic abnormalities and free of contraindications for anesthesia. Continuous positive pressure is always effective in case of symptomatic apnea and has a favorable effect on several associated complications. It can be proposed for any patient with OSAS but its use is limited due to incomplete compliance (approximately 70%). It appears that patients with particularly severe disease benefit most. Thus the ANDEM experts recommend treatment for all symptomatic patients with 30 or more episodes of apnea or hypopnea per hour of sleep during night-time exploration. Below this threshold, electrophysiological recordings are required to eliminate another cause of fragmented sleep which could explain the symptomatology despite a moderately elevated apnea index. Once the treatment has been started, regular surveillance is recommended. In addition, general health and nutritional counselling (weight reduction, smoking cessation, interruption of alcohol consumption and use of sedatives) should be proposed but usually have minimal and transitory effect.

Databases, Bibliographic↗
PubMed1994

Bone mass measurements around menopause and prevention of osteoporotic fractures.

The objective of this work is to try to answer the question: is it useful to recommend bone densitometry at the time of the menopause as a screening test for women at high risk of osteoporotic fractures? This analysis is based on a review of the literature for the period 1981-1993, considering published articles in English or French. Prospective studies demonstrate that low bone mass (BM) in women who have been menopausal for more than 10 years is actually a risk factor for fracture, with a fracture risk multiplied by about two for a decrease in BM of one standard deviation. At present no studies have shown this association when BM determinations have been realised at the age of 50 years. The use of BM measurements remains difficult in practice because there is no international consensus concerning the definition and the value of a threshold for a high fracture risk. Concerning the efficacy of preventive interventions applied following the identification of a low BM, i.e. hormonal replacement therapy (HRT), data are lacking concerning the magnitude of its efficacy on fracture prevention and in the presence of an already decreased BM. Moreover osteoporosis is not the only indication for HRT, which may be prescribed for other consequences of the menopause. There is not enough evidence for the screening, by BM measurements, of high risk fracture at the time of the menopause. These measurements may help women who hesitate to take HRT, but they do not seem to improve compliance with the treatment to a large extent. Knowledge concerning osteoporosis and its prevention remains a major determinant in the use of preventive measures.

Absorptiometry, Photon↗
PubMed1994

Clinical practice guidelines: from methodological to practical issues.

The main goal of clinical practice guidelines is to help clinical decision by practitioners, who can not integrate in their daily practice all the published data concerning new technologies and knowledge. Guidelines also have growing applications in the ethical, legal, socio-economic, public policy and health care funding fields. This article describes the various methodologies that have been proposed to develop guidelines. These methods rely to varying degrees on formal methods of analysis of scientific evidence and expert opinions. Then a step by step process is described, that should ensure a rigorous, feasible and explicit guideline development and lead to valid and applicable recommendations. In order for guidelines to be used, they have to be efficiently implemented. Respective efficiency and justification of educational and coercive methods of implementation are discussed.

Clinical Competence↗
PubMed1993

Assessment of screening tests for transfusion-associated non-A non-B hepatitis.

Non-A non-B hepatitis is the most common serious sequela of blood transfusion, and its screening has become an essential goal of blood transfusion centers. Before 1989, two surrogate screening tests (for alanine aminotransferase and for antibody to hepatitis B core antigen) were used; in 1989, a direct test for the antibody to hepatitis C virus (the main agent of this hepatitis) was developed. The French National Agency for the Development of Medical Evaluation undertook an investigation to determine the optimal prevention strategy for posttransfusion non-A and non-B hepatitis (PTH). A detailed literature review was performed, complemented by expert group opinion. The performance of each test was derived indirectly by calculating the number of cases of PTH averted by each test. Hepatitis C virus testing is probably the most promising strategy, but different policies can be developed given the uncertainties of scientific data. Cost considerations should be taken into account in identifying the best screening strategy.

Alanine Transaminase↗
PubMed1993

[Management of the thyroid nodule. Preliminary results of a practice survey of 685 general practitioners and specialists].

The authors present the preliminary results of a mailed survey of policies for the management of thyroid nodules (TN). This survey involved 685 general practitioners and specialists and was carried out at the initiative of APNET (National Educational Association for Training in Therapeutics) with the aid of ANDEM (National Agency for the Development of Medical Evaluation). Twelve percent of responders (13.1% among GPs) declare that they do not manage TNs. Those have been excluded from the analysis. The answers taken into account come from general practitioners (n = 179), endocrinologists (n = 233), specialist surgeons (n = 64), ENT practitioners (n = 93) and nuclear medicine practitioners (n = 26). The average number of patients with TN seen in a year varies according to the specialty: 6 a year for GPs, 30 in ENT, 89 for endocrinologists, 105 for surgeons. This survey reveals a number of common position: 1) the therapeutic attitude must be customized according to clinical findings and to complementary tests; 2) prescriptions are homogeneous as regards radionuclide scanning (technetium or iodine), TSH assays, ultrasonography and T4 assays; 3) ultrasonography is used in first intention; 4) ultrasonography has limitations, and is regarded by a majority or responders as unable to provide information about benignancy or malignancy. Conversely, responses are much more variable about a number of points: 1) the use of fine needle aspiration cytology which is mainly used by endocrinologists and nuclear medicine practitioners; 2) the management of nodules discovered on ultrasonography: the attitude is different from that adopted with palpable nodules for endocrinologists, surgeons and nuclear medicine practitioners, and identical for most general and ENT practitioners; 3) the usefulness of a suppressing treatment with thyroid hormones. Both general practitioners (47%) and, even more so, specialists (84%) are aware of these differences in practices. Faced to this situation, 69% of specialists are in favor of establishing consistent practices, but a minority (42%) only think that it is possible. Thus recommendations about practices may be useful only if they are adapted to the type of practice and to the conditions of access to complementary tests, and they should be aimed at rationalizing management rather than making it consistent.

Endocrinology↗
PubMed1992

[Evaluation of osteodensitometry. Report of the National Agency for the Development of Medical Evaluation].

The progress made in recent years in the field of bone densitometry, particularly concerning dual-energy x-ray absorptiometry, has resulted in the development of reliable techniques of bone mineral density measurement, especially for measurements in the lumbar spine on anteroposterior views and in the forearm. However, technical improvements are still necessary and concern the standardisation of equipment, measurements in the femur, on lateral views of the lumbar spine and on the whole body, and the definition of normal curves. The value of these measurements must be examined in the light of the epidemiological context of osteoporosis and its current and future cost to the community. They must be evaluated in relation to two pathological situations: osteoporosis and osteopenia. Osteoporosis is a disease characterised by the development of fractures due to bone fragility. It is accompanied by a reduction in bone density and other abnormalities of bone architecture and metabolism, without any disturbance of mineralisation. It is responsible for pain, a functional handicap which alters the patient's quality of life. Osteopenia corresponds to an abnormally low bone density. It is accompanied by an increased risk of fractures. Although it remains asymptomatic, therapeutic intervention may nevertheless be justified. The threshold of therapeutic intervention depends on the degree of bone loss, the patient's age, other associated risk factors and the benefit-risk ratio of the drug used. In all forms of vertebral osteoporosis, the essential conditions for the diagnosis are a decreased vertebral bone density and deformation of a vertebral body.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1990

[Epidemiology of tuberculosis].

In 1990, tuberculosis remains a major, world-wide problem, with 50 p. cent of the world's population being infected by Mycobacterium tuberculosis. In France, the latest known figures show a continuous decrease in the incidence of tuberculosis, despite the risk due to the development of AIDS, but the situation is totally different in developing countries where tuberculosis ranks first among the infections associated with AIDS. This TB-AIDS association makes it necessary to maintain in epidemiological tuberculosis watching system.

Acquired Immunodeficiency Syndrome↗