Biomedical subjects

P Ingrand

Publications and source records attributed to P Ingrand.

At least 19 recordsLinked to original sources

PubMed2006

A multicentre trial of education strategies at CPAP induction in the treatment of severe sleep apnoea-hypopnoea syndrome.

BACKGROUND AND PURPOSE: Compliance with continuous positive airway pressure (CPAP) treatment in obstructive sleep apnoea syndrome (OSAS) may be difficult. Patient education is important but strategies and their outcomes are not clear. PATIENTS AND METHODS: We studied the effects of four education strategies on compliance and quality of life changes with CPAP treatment in seven centres in the French ANTADIR homecare network. Patients received from prescribers either a simple oral explanation (SP) or an oral and written explanation (RP) of CPAP use. In addition, they received from homecare technicians either a single home visit (SH) at CPAP onset or repeated home visits at CPAP onset and at 1 week, 1 month and 3 months after (RH). Compliance and quality of life were evaluated at CPAP onset, and at 3, 6 and 12 months after initiation of treatment. RESULTS: One hundred twelve patients with severe OSAS (mean age 58+/-11 year, apnoea-hypopnoea index 58+/-25/h) were allocated randomly to groups (SP+SH; SP+RH; RP+SH; RP+RH) with no initial differences. Quality of life, evaluated by the generic SF-36 questionnaire, improved in the combined emotional domains. Compliance was over 5h in all four education groups. These effects were sustained over 12 months and were not different between the four groups. We conclude that standard education strategies for CPAP induction in France are sufficient for good compliance and improved quality of life with CPAP. Education with reinforced input should be focussed on identified subgroups prone to problems.

Affect↗

PubMed2006

[Health behaviours of students at the University Institute of Technology in Poitiers].

Better knowledge and understanding of students' health attitudes and behaviours are necessary to more effectively plan targeted prevention strategies. A survey conducted among 617 students at the University Institute of Technology in Poitiers showed that although some indicators affirm good health (relationships with friends and family, appropriate contact with care providers in the health system and regular visits to prevention centres, sexual life, and sports and physical fitness), other indicators reveal a certain amount of suffering among the student population. Students reported suicidal thoughts, symptoms of poor well-being (fatigue, sleeping disorders, concentration problems, sadness or depression) and poor eating habits and/or eating disorders. Consumption of both legal and illegal products seems to be a means utilised to facilitate the social integration process for some students. Therefore, this underlines a significant challenge for prevention campaigns to develop an alternative role model, which promotes the image and profile of a healthy student, with a strong sense of self-esteem, who is well-integrated with his peers without having to engage in substance abuse.

Adolescent↗

PubMed2004

[Usefulness of biological markers in the evaluation of smoking at the first visit of a smoking cessation program].

INTRODUCTION: We have studied the relationship between urinary cotinine and other tobacco markers to assess the relevance of urinary cotinine in the dosage of nicotine substitutes. METHODS: One hundred and fifty-five patients, who were regular cigarette smokers not taking any nicotine substitutes took part in the study. The parameters examined were daily consumption, nicotine contents of the cigarettes, the Fagerström test score, levels of carbon monoxide (CO) in exhaled breath air and urinary cotinine. RESULTS: The most significant correlation was between urinary cotinine and exhaled CO (Spearman rs=0,59 p<0,001). The correlation between urinary cotinine, the Fagerström test (rs=0,32 p<0,001) and daily cigarette consumption (rs=0,32 p<0,001) was less significant. The nicotine content was not related to urinary cotinine (rs =-0,10NS). CONCLUSIONS: For economic reasons measuring urinary cotinine is not necessary when the CO level is or=35 ppm. It becomes useful if the CO level is between 15 and 34 ppm, as CO level in itself is insufficient to determine the dosage of nicotine substitutes.

Adolescent↗

PubMed2003

[Diversity of bedside pretransfusion ABO compatibility devices in metropolitan France].

To prevent the occurrence of the ABO incidental incompatibility, the bedside pretransfusion ABO control is mandatory in France since 37 years. If the quality of the reagents is regularly controlled, no technical specification exists concerning the type of support. To describe the different types of devices used by the French hospitals, a brief questionnaire was sent, from December 2000 to March 2001, to each hemovigilance correspondent working in the 1782 hospitals with transfusion activity in 1999. Every participant had to send back the device used in his establishment. The rate of replies was 29.4%, varying from a region to another. The devices distributed by laboratories were the most used (67.4%) vs. 25.6% for the devices provided by the regional establishments of the French Establishment of Blood and 6.7% for the devices manufactured by hospitals. The presence in the region of a local office of the French Establishment of Blood providing some devices was the only factor determining the choice of the device type (p < 10(-8)). Almost half of the hospitals (46.8%) declared to have renewed their devices after 1996, most often in favor of a device provided by a laboratory (p < 10(-8)). We evaluated 30 different devices taking into account the general presentation, the available information on the device. The results of this survey showed a large disparity and heterogeneity in the quality of the devices used by the French hospitals in the context of a lack of standardization.

ABO Blood-Group System↗

PubMed2002

Relationship between sleep apnoea syndrome, snoring and headaches.

There is still a controversy regarding the relationship between sleep apnoea syndrome and headaches, especially morning headaches. Our objectives were: (i) to compare the prevalence and the clinical data of headaches in sleep apnoea syndrome (SAS) and control (snorers) groups defined by polysomnographic recording; (ii) to analyse the clinical improvement of headaches with appropriate treatment; and (iii) to correlate headaches with mood disorders, and nocturnal respiratory and architectural sleep parameters in order to understand the underlying pathophysiological mechanisms. This is a prospective study of 324 consecutive patients referred to our sleep centre for snoring. Of these, 312 patients who underwent sleep polysomnography were finally included. Patients and controls were interviewed about their medical past, headache history and clinical characteristics, their daytime sleepiness (Epworth's sleepiness scale) and their mood disorders (Zerssen's scale). Follow-up of patients with headaches (SAS and control groups), treated or not, was also assessed. According to our definition of SAS, patients were dissociated in SAS (n=164) and snorers (n=148). Fifty-three SAS patients had headaches, of whom 58.5% (n=30) suffered from morning headaches. However, there was no statistical difference between the two groups concerning the prevalence and the clinical characteristics of headaches. In addition, headaches and morning headaches were not correlated with nocturnal respiratory and architectural sleep parameters, nor with excessive daytime sleepiness, but were strongly correlated with mood disorders. In 36 SAS patients, headaches improved under treatment, but this was not statistically different from what was found among untreated snorers. Headaches and morning headaches are common in patients with SAS but may be considered as a non-specific symptom. The underlying mechanisms are not fully elucidated but depression could play an important role. Despite this absence of specificity, the treatment of SAS, especially nasal continuous positive airway pressure, leads to an improvement in headaches in several cases.

Antidepressive Agents↗

PubMed2002

[Depression and Parkinson's Disease: study of a series of 135 Parkinson's patients].

OBJECTIVE: The prevalence of depression in Parkinson's disease (PD) raises the issues of the difficulties of diagnosing the condition and of the relationships between depression and the natural history of the disease. METHODS: A cohort of 135 consecutive patients with idiopathic PD underwent psychiatric (DSM-III-R, Goldberg depression scale), neurological (distinguishing "axial" signs from other signs of parkinsonism), and neuropsychological (particularly frontal tests) evaluations. RESULTS: Depression is present in more than half of the patients and it seems to be more frequent in patients with the akinetic and fluctuating forms of the disease. The subjects who are depressed do not have a greater degree of cognitive impairment, but their scores on frontal tests are higher. Moreover, the axial signs of the disease (postural instability, axial rigidity) are more severe in depressed parkinsonians suggesting a link between depression and the non-dopaminergic lesions of the disease. Even though slowness, appetite and sleep disturbances, and fatigue may be encountered in non-depressed parkinsonian patients, separation of the parkinsonian population into subgroups shows that certain symptoms are never seen in parkinsonians who are not depressed: it is thus evident that "the impression that life is not worth living", "the hopelessness", "the impression of being worthless and incompetent", "the low level of energy", "the morning sadness" are characteristic of parkinsonian depression. Parkinsonian depression has two major clinical forms. The first one is associated with a greater number of somatic manifestations: sleep disturbances, morning fatigue. corresponding to more severe depression with hopelessness and loss of self confidence. The second exhibits few somatic manifestations with apathy and slowness as frequent complaints. CONCLUSIONS: This study defines the symptoms of parkinsonian depression which should be better recognised in order to be treated. The link between depression and axial signs of the disease may explain why L-dopa and dopaminergic agonists improve the motor signs of depression without influencing depressive manifestations in most cases.

Aged↗

PubMed2002

[Chronic renal failure in Poitou-Charentes: prevalence, structure adequacy, and patient satisfaction].

The characteristics of the existing cases in the region, the adequacy of the structures with respect to the needs, and the satisfaction of patients undergoing dialysis have been analysed as part of an ongoing project for the development of a Regional Outline for Health Organisation in the Poitou-Charentes region of France. A cross-sectional survey was conducted in the haemodialysis units, dialysis facilities and patient associations in the region and bordering areas where patients were being treated. As of March 31, 2000, the prevalence of chronic renal failure was estimated to be 373 people per one million of the population. According to the nephrologist, the adequacy of the care structures was found to be satisfactory for 82% of the patients. The main reasons for non-adequacy were first, the lack of intermediate structures between centres and outpatient units; second, the patient's refusal to be referred to another structure; and finally, other medical, physical and intellectual factors. For 90% of patients, their treatment method corresponded to their choice of therapy. The lack of a nearby structure was equally recognised as a primary reason for dissatisfaction. It should be noted that 42% of the patients under 60 years old felt that they were either poorly or very poorly informed of their rights, the coverage and the treatment of this illness.

Adolescent↗

PubMed2002

[The sleep apnea syndrome: diagnosis and management in general practice. A descriptive survey of 579 French general practitioners].

General practitioners (GP's) should be the first to recognise the sleep apnoea/hypopnoea syndrome (SAHS) and could play a major role in the follow up of patients treated with continuous positive airways pressure (CPAP) at home. We have carried out a prospective study in order to evaluate the knowledge and diagnostic and therapeutic practice of GP's in relation to SAHS. 579 GP's agreed to participate in the study by means of a telephone questionnaire. Although daytime somnolence and the presence of apnoeas and snoring were the most frequently quoted clinical symptoms suggesting the diagnosis of SAHS, a combination of these symptoms was quoted in only one third of cases. On the other hand the complications of SAHS were not well known by GP's as only 25% of them mentioned the possibility of cardiovascular complications; cerebrovascular accidents and arterial hypertension being quoted by only 15% and 8.8% respectively. With regard to the follow up of patients treated with CPAP more than 50% of GP's did not know the minimum duration of ventilation required and 60% did not understand the method of function. These results, which emphasise the underestimation of SAHS and its complications, confirm the need to develop an educational strategy specifically for GP's in an attempt to improve the diagnosis of this disorder and to allow them to take part in the management and monitoring of treatment with CPAP.

Cardiovascular Diseases↗

PubMed2001

Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group.

BACKGROUND: In France, there are no guidelines available on withholding and withdrawal of life-sustaining treatments, and information on the frequency of such decisions is scarce. METHODS: We undertook a prospective 2-month survey in 113, of a total of 220, intensive-care units (ICUs) in France to study the frequency of, and processes leading to, decisions to withhold and withdraw life-sustaining treatments. FINDINGS: Life-supporting therapies were withheld or withdrawn in 807 (11.0%) of 7309 patients (withholding in 336 [4.6%] and withdrawal in 471 [6.4%], preceded in 358 by withholding). Of 1175 deaths in ICU, 628 (53%) were preceded by a decision to limit life-supporting therapies. Futility and poor expected quality of life were the most frequently cited reasons. Decisions were strongly correlated with the simplified acute physiological score, but an independent centre effect persisted after adjustment for this score. Decisions were mostly taken by all the ICU medical staff, with (54%) or without (34%) the nursing staff; however, a single physician made decisions in 12% of cases. The patient's family was involved in the decision-making process in 44% of cases. The patient's willingness to limit his or her own care was known in only 8% of the cases; only 0.5% of the patients were involved in decisions. INTERPRETATION: Withholding and withdrawal of life-support therapies are widely practised in French ICUs, despite their prohibition by the French legislation. The lack of an official statement from French scientific bodies may explain several limitations on the various steps of the decision-making process.

Adult↗

PubMed2001

[Regional program to improve the quality of blood transfusions in hospitals: experience of the Poitou-Charentes region].

In the Poitou-Charentes area, a regional pilot program was implemented over a two year-period to improve transfusion safety in public and private hospitals. This program consisted in: (i) an evaluation of the transfusion chain in hospitals; (ii) a regional program to guide hospitals in improving the quality process. Five workgroups were set up. Three persons in each hospital should participate in the workgroup: one representing the administration, one the medical staff and one the nursing staff. After a six months follow-up several hospitals were prompted to implement corrective and preventive measures to improve transfusion safety; (iii) a letter was regularly published to contribute to set-up a regional haemovigilance network. Such a quality improvement program revealed to be a relevant method to steer the changing blood transfusion process in hospitals.

Blood Specimen Collection↗

PubMed2001

Self-consciousness and Alzheimer's disease.

OBJECTIVES: To propose a neuropsychological study of the various aspects of self-consciousness (SC) in Alzheimer's disease. METHODS: Forty-five patients with probable mild or moderate AD were included in the study. Severity of their dementia was assessed by the Mini Mental State (MMS). Fourteen questions were prepared to evaluate SC. RESULTS: No significant correlations were found between SC score and educational level, age, and duration of disease. A significant correlation was found between SC score and the severity of dementia, whereas frontal disturbances were just short of the significance threshold. The various aspects of SC were not impaired to the same degree. The most disturbed ones were awareness of cognitive deficiencies, moral judgements and prospective memory. The least disturbed aspects were awareness of identity and of mental representation of the body. Items relating to anosognosia and moral judgements were significantly correlated with the MMS score, whereas affective state, body representation disorders, prospective memory, and capacities for introspection were not related to the severity of the dementia. Consciousness of identity was sound, regardless of MMS score. CONCLUSIONS: AD clearly induces an heterogeneous impairment of SC. SC requires a convergence of many neural networks. In AD, neuronal alterations involve many cortical areas and information sent to the associative frontal cortex from memory, language and visuospatial areas is lacking or disturbed. Thus, the sequential order of successive stimuli cannot be maintained by the heteromodal associative cortex (dorsal convexity of the prefrontal cortex), and the supramodal associative cortex (located rostrally in the frontal lobes) is unable to provide reliable monitoring and assessment of simultaneous neural cognitive networks carrying insufficient and inadequate input. The core deficiency in AD patients might be impaired SC equated with the disability to maintain sequential and simultaneous "attention to life". The Self-Consciousness Questionnaire, a clinical scale providing multidimensional measurement, indicates that different aspects of consciousness are not correlated with overall cognitive deficiency as determined by the MMSE.

Aged↗

PubMed2001

Intracranial hemorrhage and oral anticoagulant treatment.

OBJECTIVE: To detect risk factors for intracranial hemorrhage (ICH) in patients with long-term oral anticoagulant and to identify clinical or radiological data specific of anticoagulant-related ICH. METHODS AND PATIENTS: Three groups of patients were included. Group 1 represents patients who were admitted because of anticoagulant-related ICH between January 1984 and February 1996. All patients underwent CT scan. Clinical data, anticoagulation parameters, location and volume of the ICH, treatment and the 30-days in-hospital mortality were analyzed. Group 2 consisted of patients selected at random among all patients with spontaneous ICH admitted to our department during the same period of time. Patients without ICH, but regularly taking oral anticoagulants constituted group 3. RESULTS: Seventy-nine patients with anticoagulant-related ICH were compared to 127 patients with spontaneous ICH. The volume of supratentorial ICH was greater in group 1 of patients and was correlated with a worse prognosis. Comparison of group 1 with group 3 (212 controls) demonstrated that length of anticoagulation, prothrombin time or excessive anticoagulation, prior cerebral infarct and use of acénocoumarol, but not age or indication of anticoagulant, were significant risk factors for ICH in multivariate analysis. CONCLUSIONS: The results emphasize that anticoagulant-related ICH are not clinically different from spontaneous ICH except for volume of bleeding, and that frequent and careful coagulation monitoring is needed, especially during the first year in order to decrease the risk of ICH.

Administration, Oral↗

PubMed2001

Survival prognostic value of serum interleukin-6 level in very old people.

OBJECTIVE: To determine the survival prognostic value of serum interleukin-6 level in very old people. DESIGN: Prospective 12-month clinical survey in a long term ward and in a day care hospital. SETTING: A long-term ward and a day care hospital for very old and dependent people, located in Poitiers (France). PARTICIPANTS: A cohort of 115 old people [Range 64-101], either in a long-term ward (n=71) or in day care hospital (n=44). MEASUREMENTS: Patients were checked for different nutritional parameters and the Interleukin-6 level in the serum at baseline and patients were followed up for one year. RESULTS: A high level of interleukin-6 (Il-6) is associated with increased Prognostic Inflammatory and Nutritional Index (PINI) value, serum CRP thereby demonstrating the inflammatory role of this molecule. It is also associated with an increased risk of death. Using a survival regression model, a high Il-6 serum level observed at the beginning of the study is a bad prognostic indicator, with other biological or nutritional parameters having no significant influence. CONCLUSION: A high level of Interleukin-6 may be a better marker of prognosis than an increased PINI score.

Aged↗

PubMed2001

Prognostic impact of cathepsin D and c-erbB-2 oncoprotein in a subgroup of node-negative breast cancer patients with low histological grade tumors.

Some node-negative breast cancer patients, with initially good prognosis, relapse from their cancer and are poorly identified. In the present study, based on prospective data of 197 tumors, we measured cathepsin D (cath D, n=197), pS2 protein (n=125), c-erbB-2 oncoprotein (n=100) and epidermal growth factor receptor (EGF-R, n=99) to better define the risk of relapse of node-negative patients in comparison with that defined by the clinical and histological factors. The median follow-up in surviving patients was 75 months. Univariate analysis indicated that patients with histological grade III tumors (the Scarff, Bloom and Richardson classification) had a much poorer prognosis than those with histological grade I or II tumors (P=0.0027 for relapse-free survival and P=0.0156 for overall survival). When the population of node-negative patients was divided by tertiles, high cath D levels showed a significant association with an early relapse (P=0.0316). Using cut-off values, patients with high cath D (> or =25 pmol/mg protein) or c-erbB-2 oncoprotein (> or =4 Human Neu Unit/microg protein) levels, had a significant worse relapse-free survival (P=0.0147 and 0.0417, respectively). No prognostic information was supported by pS2 protein or EGF-R measurements. In multivariate analysis, histological grade, cath D and c-erbB-2 oncoprotein remained independent predictors of recurrence (P=0.005, 0.0361 and 0.0321, respectively). By combining low levels of cath D and c-erbB-2 oncoprotein in histological grade I or II tumors, we identified a subgroup of patients with a 100% relapse-free survival probability at 6 years of follow-up. Moreover, the subgroup of patients with histological grade I or II tumors and high values of both cath D and c-erbB-2 oncoprotein showed a prognosis as poor as the subgroup defined by histological grade III alone, respectively 66% and 70% relapse-free survival at 6 years of follow-up. In conclusion, the combination of conventional prognostic factor (histological grade) and biochemical factors (cath D and c-erbB-2 oncoprotein) enabled us to identify, in this preliminary study, a subgroup of patients having an increased risk of relapse in a group (node-negative patients with low histological grade tumors) considered as good prognosis.

Aged↗

PubMed2001

[Taste impairment in Alzheimer's disease].

We conducted a study of Alzheimer's disease focusing on taste impairment to determine at which step of gustatory information processing (discriminative or perceptive, gnosic or associative, gustatory-verbal) possible perturbations might be located. We used various foods found in a normal diet. Twenty patients and a matched control group participated in this study. The patients were divided into two subgroups according to disease severity (mild, moderate or severe). The study showed that patients with Alzheimer's disease exhibited an impairment at all three levels of gustatory information processing. Impairment of discriminative and gustatory-verbal stages was more obvious in the group of patients with severe Alzheimer's disease. Our study also showed that the gustatory deficiency can be described as an associative agnosia in the mild stage of Alzheimer's disease. This concept is in line with the notion of a dissociation between preservation of olfactory and gustatory thresholds and an alteration in odor identification in patients with mild stage Alzheimer's disease, suggesting that the alteration is central rather than peripheral. Our findings suggest that an alteration of the associative level of gustatory information processing can be found in Alzheimer's disease early stage.

Aged↗

PubMed2001

[Malnutrition is an independent risk factor of early complications following percutaneous endoscopic gastrostomy].

BACKGROUND: The relationship between malnutrition and complications occuring in hospitalized patients is debated. AIM: To assess prospectively the relationship between nutritional status and percutaneous endoscopic gastrostomy (PEG)-related complications and to determine the respective role of malnutrition and confounding variables on clinical outcome. METHODS: Ninety seven patients were followed up for 30 days after PEG insertion and complications were prospectively recorded. Patients were classified as malnourished when they met one of the following criteria: body mass index<20 kg/m(2) and/or weight loss > 5%. Multivariate logistic regression analysis was used to adjust for age, sex, diagnoses, functional status, antibiotic treatment and duration of hospital stay before PEG insertion. RESULTS: Sixty eight (70.1%) patients were malnourished. A significantly higher number of complications was seen in malnourished than in non malnourished patients (54.4% vs 31%; odds-ratio (OR): 2.65 [CI 95%: 1.06-6.66]; P=0.04). One-month mortality did not significantly differ between malnourished and non malnourished patients. Multivariate analysis showed that malnutrition (OR: 3.15 [1.21-8.24]; P=0.02) and > 10-day hospital stay (OR: 2.77 [1.13-6.82]; P=0.03) were significantly associated with early complications. CONCLUSION: These data suggest that malnutrition increases the risk of early complications after PEG insertion, independently of the underlying diseases and functional status of the patients.

Endoscopy↗

PubMed2000

Prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin: a multicenter randomized trial.

We report a prospective randomized multicenter trial that tested the efficacy of combining ursodeoxycholic acid and norfloxacin in the prevention of polyethylene stent clogging in patients with obstructive jaundice due to an unresectable malignancy at the level of the common bile duct. After insertion of a 10-Fr straight polyethylene stent, patients were allocated to receive oral treatment with ursodeoxycholic acid and norfloxacin, or conservative treatment. The primary outcome measure was stent blockage within six months. Thirty-three patients (group I) received ursodeoxycholic acid and norfloxacin, and 29 received conservative treatment (group II). At six months, cumulative stent patency rate did not differ significantly between group I (47+/-11%, mean +/- SE, median 149 days) and group II patients (24+/-10%, mean +/- SE, median 100 days, P = 0.23, log-rank test). Four stents were clogged by ursodeoxycholic acid. Survival did not differ between the two groups. Combined therapy with ursodeoxycholic acid and norfloxacin failed to improve stent patency. Moreover, ursodeoxycholic acid can cause stent obstruction.

Aged↗

PubMed2000

Neuropsychological disturbances in cerebellar infarcts.

BACKGROUND: Recent clinical and research reports suggest that the cerebellum may contribute to the modulation of higher cognitive functions. MATERIAL AND METHODS: We included 15 consecutive patients with isolated cerebellar infarcts (4 superior cerebellar artery territory infarcts, 1 anterior inferior cerebellar artery territory infarct and 10 posterior inferior cerebellar artery territory infarcts), all confirmed by magnetic resonance imaging. These subjects plus 15 controls matched for age, sex, and educational level underwent a neuropsychological test battery including vocabulary, similarities and block design subtests of the Wechsler Adult Intelligence Scale Revised (WAIS-R); verbal fluency tests (categorial, phonemic, and alternate categorial fluency tests); Rey's 15 auditory word learning list; the paced auditory serial addition task; the Stroop test and the Zerssen Rating Scale. One year after the cerebellar infarct, each subject with cerebellar infarct was asked to undergo a second neuropsychological examination with the same test battery. RESULTS: Patients with cerebellar infarcts exhibited significantly lower neuropsychological performances compared to those of the control group without any obvious difference between the different vascular cerebellar territories. After 1 year of follow-up, this neuropsychological impairment tended to improve. CONCLUSIONS: The pattern of deficits observed in isolated cerebellar infarcts highlights the nonmotor functions of the cerebellum and functional relationship between the cerebral cortex and the cerebellum.

Adult↗