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Biomedical subjects

P Queneau

Publications and source records attributed to P Queneau.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Iatrogenic disease observed in a hospital setting. II. Analysis of causes and suggestions for novel preventive measures].

In a previous article, we reported the results of a survey of iatrogenic illness in teaching hospitals. In the second part of this study, we shall consider the origins of the 109 adverse events which occurred in a 24-hour period among 1733 hospital patients in a total of 43 units (mean prevalence, 6.28%). In a total of 89 cases (83 of which were drug-related and 6 of which were of various non-instrumental causes), self-treatment and/or poor patient compliance appeared to be the main cause in 16 (18%); negligence or erroneous prescription (non-respect of a contraindication, wrong indication or dosage, excessive duration of treatment, inadequate monitoring, etc...) appeared to be responsible in 27 cases (30.3%). It may be that at least some of these cases of iatrogenic illness due to errors or negligence on the part of the patient and/or physician (48.3%) could be avoided in future by better training of health personnel and improved public health education. The human and financial costs of iatrogenic illness show that risk-prevention measures are required; we propose a number of strategies concerning both initial training in medical school and ongoing education in therapeutics, together with ways of improving the behaviour of both physicians and the pharmaceutical industry. The latter suggestions are addressed at the media and the health authorities; some concern legislation, while others are aimed at improving early public health education, an essential element in this setting.

Hospitals, University↗
PubMed1992

[Iatrogenic illness observed in the hospital environment. I. A report of 109 cases collected in a cross-sectional APNET study].

In an "on a given day" study, we analysed the prevalence and causes of drug-related and non-drug-related iatrogenic illnesses for educational and preventive purposes. Forty-three hospital departments of various specialties and involving 62 APNET members participated in the study. From a total of 112 cases reported, 109 were considered iatrogenic illnesses on the basis of the French criteria for adverse effects. Four major types of iatrogenic illness were defined, as follows: I--drug-related cases (n = 83); II--miscellaneous cases (n = 6); III--cases due to therapeutic instrumentation (n = 16); IV--cases due to diagnostic instrumentation (n = 4). Overall, 6.28% of the patients admitted presented an iatrogenic illness; 67 (61.46%) of the 109 cases concerned women and 66 (60.55%) concerned patients aged 65 years or more. The types of illness in the "drug-induced" and "miscellaneous" categories were endocrine and metabolic disturbances (n = 14), gastrointestinal conditions (n = 13) and hematological disorders (11 cases of bone marrow aplasia). Instrument-related iatrogenic illnesses comprised cardiovascular conditions (n = 6), locoregional anatomic lesions (n = 5), infectious complications (n = 3), bleeding (n = 3) and others (n = 3). Seventeen incidents were benign, 38 dangerous and 51 serious; there were three deaths. The main drug categories concerned in the 89 cases of "drug-related" and "miscellaneous" iatrogenic illnesses were as follows: cardiovascular agents (n = 20), antiinflammatory and analgesic drugs (n = 18), hormone and nutritional treatments (n = 11) and neuropsychiatric drugs (n = 11). Instrument-related iatrogenic illnesses chiefly involved venous approaches (n = 8), surgery (n = 4), intensive care procedures (n = 2), renal dialysis (n = 2) and radiation therapy (n = 2). The main causes of drug-related iatrogenic illnesses were self-treatment (n = 8), poor compliance (n = 8), and therapeutic errors (n = 27) [non-respect of a contraindication (n = 2), wrong indication (n = 6), excessive dose (n = 13), over-prolonged treatment (n = 2) and other errors (n = 4). A cost-analysis of 74 of the 109 cases gave a minimum figure of 2 million French francs. The human and financial costs of iatrogenic illnesses show that risk-prevention measures are required; these will be dealt with in a later paper, but should be based on stricter regulations and educational programmes aimed at doctors, patients, the general public, the pharmaceutical industry and the health authorities.

Cross-Sectional Studies↗
PubMed1991

Circadian dynamics of coagulation and chronopathology of cardiovascular and cerebrovascular events. Future therapeutic implications for the treatment of these disorders?

Arterial thromboembolic disorders are the leading cause of death in most of the advanced nations. The study of epidemiologic relationship of these disorders to biological rhythms may lead to a better understanding and perhaps a better treatment. Chronoepidemiologic studies demonstrated a morning peak for arterial thromboembolic disorders (cerebral and myocardial infarctions) and sudden cardiac deaths. These variations might be explained partially by circadian variations in hemostasis. Indeed chronophysiologic studies have shown that hemostatic variables follow circadian rhythms. The level of platelet aggregation and that of blood coagulation have been found to be increased in the morning whereas fibrinolytic activity is lower at this time of the day. The facts suggest a chronotherapeutic approach in thromboembolic disorders.

Animals↗
PubMed1990

Good clinical practices in phase I studies.

In France, official guidelines for good clinical practices in clinical trials were issued in 1987. In December 1988, a law was passed that fixed the requirements for carrying out experiments in healthy subjects. It will be completed by official guidelines for the structures in which experiments on healthy subjects (and patients as well, when the investigation would not benefit the health of the patients) may be conducted. Hence a battery of recent legal instructions precisely state what good clinical practices are in the setting of phase I studies. Of particular importance are: subject recruitment and selection methods and procedures; specific competence of the investigator, in particular to interpret the pre-trial data; necessary and sufficient facilities to guarantee the subjects' safety; careful quality control to check all laboratory procedures; necessity of written standard operating procedures.

Drug Evaluation↗
PubMed1987

Circadian changes in the pharmacokinetics of oral ketoprofen.

Several investigations which have taken treatment time into account have shown that the pharmacokinetic parameters, the therapeutic efficacy and even the toxicity of a large number of products may vary according to the administration schedule. The present study was carried out in order to evaluate any circadian changes in pharmacokinetic parameters of ketoprofen, a new non-steroidal anti-inflammatory drug (NSAID). This randomised crossover study consisted of a single oral dose of ketoprofen 100mg administered to 8 healthy male volunteers, mean age 27.2 years, at 07.00 hours, 13.00 hours, 19.00 hours or 01.00 hours in 4 study periods during the first 3 months of the year. The order of administration was randomised, with each subject acting as his own control. A total of 14 blood and 4 urine samples were taken over a 12-hour period. The peak plasma concentration was twice as high after drug administration at 07.00 hours (13.4 +/- 1 mg/L) than after other administration times (13.00 hours: 6.9 +/- 1; 19.00 hours: 7.2 +/- 0.7; 01.00 hours: 6.3 +/- 0.5 mg/L) [p less than 0.001]. The time to reach peak concentration was much longer after drug administration at 01.00 hours (135 +/- 16.7 min) than at 07.00 (73.1 +/- 14.1 min), 13.00 (75 +/- 16.5 min) or 19.00 hours (82.5 +/- 12.7 min) [p less than 0.05]. The lag time was significantly longer at 01.00 hours than at 13.00 hours (p less than 0.01). The absorption rate constant after treatment at 01.00 hours was less than at the other times of administration (p less than 0.05). The bodyweight-corrected area under the curve (AUC0-12) was greater after 07.00 hours than after 13.00 (p less than 0.01) or 19.00 hours (p less than 0.05) and greater after 01.00 hours than after 13.00 hours (p less than 0.05). The elimination half-life was significantly longer after administration at 01.00 hours than after 19.00 hours (p less than 0.05), while the total clearance was lowest at 07.00 hours. Cosinor analysis demonstrated statistically significant circadian rhythms for all pharmacokinetic parameters described above. The amount of ketoprofen eliminated in the urine was delayed, and was significantly greater after the administration at 01.00 hours than 07.00 hours or 19.00 hours (p less than 0.01). The relationship between absorption, diffusion and/or elimination mechanisms of the drug are discussed.

Administration, Oral↗
PubMed1987

[Biological rhythm and thromboembolic disease. Physiological, epidemiological and pharmacological aspects].

Arterial and venous thromboembolic disorders are the leading cause of death in most of the advanced nations. The study of physiologic, epidemiologic and pharmacologic relationships of these disorders to biological rhythms, may lead to a better understanding and perhaps a better treatment. Chronophysiologic studies have shown that hemostatic variables follow circadian rhythms. The level of platelets aggregation and of blood coagulation has been found to be increased in the morning and decreased at night, whereas fibrinolytic activity is lower in the morning than in the evening. Chronoepidemiologic studies demonstrated a morning peak for arterial thromboembolic disorders and an evening peak for cerebral bleedings. These facts might partially be explained by circadian variations in hemostasis and suggest a chronotherapeutic approach in thromboembolic disorders. Unfractionated heparin, because of its antithrombotic effect, is one of the major drugs used to treat this disease. However, with such a treatment venous thrombosis recurs or bleeding complications occur yet in about 30% of patients. Chronopharmacologic studies indicate that anticoagulant effect of heparin is minimum in the morning and maximum at night, following the physiologic circadian variation of blood coagulation. Such results suggest that the heparin doses should be modulated as a function of administration times in order to increase its effectiveness and to minimize both bleeding risk and thrombosis. Further studies are needed to evaluate such a proposal.

Biological Clocks↗
PubMed1985

[Self-medication in rheumatologic consultation. Apropos of a study on 895 patients].

A study was undertaken to evaluate the use of self-administered medication in 895 patients with rheumatologic disorders by all of the 18 rheumatologists practicing in one region (the southern portion of the Loire Department and all of the Haute-Loire Department) over a six-day period. It was noted that 445 out of 895 patients (49.72 percent) reported taking one or several medications other than those prescribed during the previous 3 month period before their office visit. Self-administered medications were taken at least weekly in 53.5 percent of cases and at least monthly in 83,7 percent. Most often one or two medications were involved (60.9 and 25.6 percent respectively). Age, profession, the presence or absence of psychiatric disturbances, the duration of the doctor-patient relationship, as well as the patient's specific rheumatologic problem seemed to be influencing factors. Aspirin or other analgesics comprised 53.1 percent of the medication taken, whereas other non-steroidal antiinflammatory agents comprised only 2.3 percent. No steroids were self-administered. There are multiple potential side effects with self-administered drugs: therapy can be poorly suited for the illness in question, it may delay diagnosis and the beginning of effective therapy, there can be increased iatrogenic risk due to inadequate therapy, and unnecessary expense. Drugs used as self-administered medications originate most often from previous medical prescriptions which may or may not have been prescribed for the patient's same medical problem (34.4 percent), and most medication used was bought without needing a prescription (52.4 percent). Prevention, therefore, requires that potential consumers of self-administered drugs be educated concerning these problems, as well as health professionals, the pharmaceutical industry, and concerned government agencies.

Adolescent↗
PubMed1985

[Nycthemeral change in the anticoagulant effect of heparin given at a constant rate by the intravenous route].

Six subjects with venous thromboembolism volunteered for this prospective study. Heparin was administrated intravenously at a constant rate with an infusion pump. The activated partial thromboplastin time (A.P.T.T.) and thrombin time (T.T.) were measured every 4 hrs. for 48 hrs. These coagulation tests exhibited a nycthemeral variation with a large amplitude which was reproducible from one day to the next and statistically validated by the cosinor method (p less than 0.001). All patients had a nocturnal peak of A.P.T.T. and T.T. on both days. In four patients this peak for A.P.T.T. exceeded the upper desired limit.

Aged↗
PubMed1985

[Chronokinetics of ketoprofen administered orally and by continuous venous infusion].

The aim of the study was to evaluate a possible chronokinetic phenomenon of ketoprofen administered orally and by continuous intravenous infusion. In the first part of the study, ketoprofen was administered orally to 8 healthy male volunteers aged between 25 and 45 years, at a dose of 2 X 50 mg at 7:00 a.m. (time I), 1:00 p.m. (time II), 7:00 p.m. (time III) and 1:00 a.m. (time IV), on the same day of the week at an interval of 2 weeks, during the first three months of the year. The order of administration was randomised, each subject acted as his own control and received ketoprofen at the four times mentioned above. A total of 14 venous blood samples were taken over 12 hours. The results indicate that the maximal serum concentration (Cmax) was significantly higher at time I (13.4 +/- 14.1) than at times II, III and IV (6.9 +/- 1.1, 7.2 +/- 0.7, 6.4 +/- 0.5 mg/l) (p less than 0.01). The time required to reach this concentration (Tmax) was significantly longer for time IV (135.0 +/- 16,8) than for times I, II and III (73,1 +/- 14.1, 75,0 +/- 16.6; 82.5 +/- 12.7 minutes) (p less than 0.05). The excretion half-life (t 1/2B) was significantly longer for time IV (4.3 +/- 0.6) than for times II and III (2.8 +/- 0.5, 2.5 +/- 0.2 hours) (p less than 0.05). Statistically significant differences were also observed in the area under the curve measured at midday (AUC 12) and in the total clearance (CIT) for the various sample times.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1983

[Non-steroidal anti-inflammatory agents. Evaluation criteria in discal sciatic neuralgia].

Few controlled trials have been carried out with non-steroidal antiinflammatory drugs in this indication, mainly as a result of methodological difficulties. A prerequisite for correct evaluation is compliance with certain fundamental principles. The study must be controlled (i.e. comparative, prospective randomized, double-blind, with data quality control and statistical analysis). The sample size must be consistent with the objectives (at least 40 patients per group). The selection criteria must be well specified and the comparability of baseline data assessed. The most appropriate study design for assessing clinical efficacy is to compare two parallel groups of out patients treated during five to fifteen days. The main criterion of efficacy should be based on the judgments of both patients and physician. Time course of pain, improvement in the patient's functional capacity, improvement in physical findings (Schober, Lasègue), dosage of concomitant analgesic treatments when these are allowed, and evaluation at three and six months can also be used as efficacy criteria. Assessment of clinical and biological tolerance is mandatory. Considering the frequent use of non-steroidal antiinflammatory drugs in treating sciatica, there is a strong need for rigorous investigations.

Anti-Inflammatory Agents↗
PubMed1983

[Role and indications for surgery in Duchenne de Boulogne muscular dystrophy with rapid development].

One hundred and fifteen children suffering from muscular dystrophy had been treated surgically during the previous 12 years. The aim of the treatment was to slow the progression of development of spine deformity and obtain a prolongation of walking and standing ability. The indications for surgery were in relation to trauma in 17 cases or for progressive lower limb or spine deformity. In walking patients (21 cases) surgery was indicated only for contractures limiting walking ability. Surgery was also indicated in 35 cases soon after walking capability had ceased. In these cases correction of deformity allowed children to walk again with calipers for an average of 3 years. In 37 cases surgery was performed only to allow standing or to prevent or delay the development of spinal deformity. The indications for extensive spine fusion are discussed in relation to the speed of development of deformity, the pulmonary vital capacity, the dynamometric estimation of muscle strength, and the estimated duration of survival. Human, family and ethical factors are discussed.

Adolescent↗
PubMed1983

[Influence of tobacco on the serum levels and pharmacokinetics of phenylbutazone and oxyphenbutazone].

The serum levels of a number of drugs are reduced by smoking. The authors wanted to see whether this phenomenon occurred with phenylbutazone. With this objective, they compared the changes in serum levels of phenylbutazone and oxyphenbutazone, the hydroxylated metabolite of phenylbutazone, during ten days of administration, in 9 smokers and in 6 non-smokers. Blood samples were taken every day at 8:00 a.m. and the PB and OPB were assayed by high performance liquid chromatography. The comparison of the mean serum levels of PB in smokers and non-smokers revealed a statistically significant reduction (p less than or equal to 0.05) of this level in the smoker, between D5 and D10. Comparison of the mean serum levels of OPB in smokers and non-smokers revealed a statistically significant reduction of this level in the smoker, but only on days 9 and 10. When we compare these results with those reported in the literature for other drugs, it would appear that tobacco smoke accelerates the metabolism of phenylbutazone and oxyphenbutazone by a mechanism of enzyme induction. It is proposed that the therapeutic activity of phenylbutazone is reduced in the smoker, but this has not been confirmed by a reliable clinical evaluation in this initial study.

Adult↗
PubMed1982

[Value of anti hemolysin and anti-gammahemolysin assays for the diagnosis of staphylococcal infections, particularly of osteoarthritis (author's transl)].

The authors report the results of more than twelve years' personal research on the value of anti-alphahemolysin (AASTL) and antigammahemolysin (AGSTL) assays for the diagnosis of staphylococcal infections, and particularly of osteoarthritis. Among 574 controls, AASTL levels exceeded 2 IU in only 14 subjects (11 of these, levels were between 2 and 3 IU). Levels less than, or equal to, 2 IU were therefore considered normal. This is consistent with previously published data. In 144 staphylococcal infections, confirmed by bacteriology, an increase in AASTL was found in 95 of all cases (65.9%) and in 54 of the 76 osteoarthritis' (71%). Similarly, AGSTL titres, which were under 1/160 (upper normal limit) in 138 controls, were increased in 35 patients with unequivocal staphylococcal infections (61.4%), and in 25 of 36 patients with osteoarthritis (69.4%). These results show that AASTL assay is reliable and often abnormal. However, assay of both hemolysins yields even better results. This dual assay was performed in 57 patients with staphylococcal infection. One hemolysin at least was increased in 47 patients (82.4%). This represents additional positivity in 15.7% of patients when compared to AASTL assay alone, and in 21% when compared to AGSTL assay alone. The high level of positive results with dual assay is even more striking when only staphylococcal osteoarthritis is considered: one or both hemolysins were increased in 91.1% of these patients (31/34).

Antibodies, Bacterial↗
PubMed1982

[Acro-osteolysis in leprosy. Apropos of 19 personal cases].

Using their own personal series of 19 cases of leprosy complicated by massive osteolysis (AO), along with a comparison of these cases with data from previously published reports, the authors review the principal clinical and radiological findings of these manifestations which are not observed except in cases of leprosy where neuropathy is present, even though other factors (perforating plantar ulcers, poor hygiene, traumatisms) may play a contributing role independent of possible interference from non specific osteoarthritis or Hansen's bacilla, itself. After reviewing other causes of massive osteolysis and discussing the pathogeny of these manifestations during leprosy, the authors refer to the various therapies which can prevent or stabilize osteolysis or aid the patient to better tolerate its manifestations.

Adolescent↗