Search PubMed⌕ Search

Biomedical subjects

T Lebrun

Publications and source records attributed to T Lebrun.

72 records · Page 4Linked to original sources
PubMed1988

[Cost/benefit study of the neonatal detection of phenylketonuria and hypothyroidism].

The medical importance of an early screening for phenylketonuria (PKU) and congenital hypothyroidism (CH) has been recognized for a long time. However, only rare cost-benefit analysis have been reported. A comparison between the cost of identification and care of PKU and CH patients and the expenditure for the care of untreated retarded patients has been established on the basis of the activity of the Nord-Pas-de-Calais regional screening centre and of patient's families interviews. The present analysis yields a cost-benefit ratio of 6.5 for PKU and 12.2 for CH prophylaxis. However cost-benefit varies depending on the economical partner: patient's family, Social Security or Administration. The present model may also be useful cost-benefit calculation when new tests will be planned to be introduced in the national neonatal screening programme.

Congenital Hypothyroidism↗
PubMed1985

[Clinical value of rapid bacteriological results in nosocomial infections. Comparison with traditional methods].

With automated analysers, bacterial identification and susceptibility testing can be performed in 4-5 hours instead of 12-18 hours with conventional methods. A controlled trial was carried out in the surgical ward of a university hospital to evaluate the clinical repercussions of these rapid methods. The automated analyser reduced delays in the laboratory by about 25%, and optimizing information transfer from laboratory to ward brought the reduction up to 50%. It was found that earlier results of susceptibility testing modified prescriptions and this may be expected to result in a more rational use of antibiotics.

Autoanalysis↗
PubMed1985

Risk-aversion and physicians' medical decision-making.

In this paper, we examine a physician's optimal therapeutic decisions in a risky environment as well as his response to exogenous changes such as increased risk-aversion or improvements in medical technology. We also analyze the value of diagnostic information and its relationship with risk-aversion.

Decision Making↗
PubMed1985

The determinants of biological prescription in French hospitals.

We present in this paper the first stage of a broader work, the aim of which is to better understand the volume, modalities, determinants and cost-benefit ratio of the medical prescription in hospitals. Through a sample of 1800 patients observed in 1978 and 1979, in 18 medical or surgical services of 6 French hospitals of different size, statute and location, we have pursued a double objective: first, to establish the basic elements of an 'observatory' of the biological prescription in order to quantify this prescription; secondly, to shed some light on the factors which might explain the differences observed between hospitals, services and diseases. Linear and non-linear econometric models have been used to perform the analysis of the 252,000 data that had been collected. This research has given rise to an evaluation of the informative content of the diagnostic tests ordered by the physicians. This analysis is discussed further in the present volume.

Cost Control↗
PubMed1985

The medical and economic consequences of automation in bacteriology: a case study in a French university hospital.

In a bacteriology laboratory where automated and non-automated procedures co-existed during the study period (1 year), patients were randomly assigned to each type of procedure and we observed the physicians behaviour as well as patients well-being in a surgical service using the results from the laboratory. Contrary to our expectations, the reduction in the time delay necessary to obtain information did not alter either the prescribing behaviour of physicians nor the welfare of patients. Besides, the gain in time was significantly lower than expected. We also discuss in detail the meaning and relevance of the results.

Automation↗
PubMed1982

[The low consumption of outpatient medical care in the department of Ardennes (France) (author's transl)].

The purpose of the research explained in this article was to build up a methodology which allows to set up a map of low consumption of outpatient medical care and to find out to which extent the low recorded demand is attributable tho the medical aids supply. French National Health Service files were the basic data for this research which was led into the department of Ardennes. First and foremost the investigation was to identify on a district level with low consumer families after having eliminated demands' factors. Thus one could set up maps of low consumption in comparison with maps of low prescription. The investigation showed that low consumer families live generally in the cantons of low medical care consumption concerned mainly with low medical aids suppliers.

Adult↗
PubMed1982

[The economic and social effects of rheumatoid pelvis-spondylitis].

The purpose of the research reported in this article was to reconstruct a typology of the various courses taken by rheumatoid pelvis-spondylitis based on medical evidence and then to assess the economic and social consequences of the illness generally and for each of the groups brought out by our research. The investigation dealt with 172 patients who had either been hospitalized or had consulted outside physicians or community clinics in the Nord-Pas-de-Calais Region or Paris. Between January 1978 and May 1979, these patients were asked to report to the places where they had had their consultations. Using the information in their medical records, the patients' statements and additional examinations, the case histories were pieced together, the patients' current condition was described and the typology of the disease was constructed. Then we collected the economic data and the disease's costs were reconstructed (medical costs, cost of losses in output, costs under the heading of either the individual or the community). Finally, data of a psychosocial nature made it possible to clarify the patients' understanding of the disease according to various criteria (particularly the different forms taken by the disease). The analysis of clinical, radiological, biological investigations makes it possible to bring out three trajectories of the disease. We have brought to light medical and economic costs of the disease clearly differentiated according to the trajectories of the illness. We have also underlined the role played by social factors in determining how the disease is perceived. Finally, the analysis of the effectiveness of known therapies shows that these therapies aim above all at easing the pain and limiting the stiffness and that a delay in applying these therapies does not seem decisive for the seriousness and the progression of the illness.

Adult↗
PubMedDate not supplied

[Pharmaco-epidemiological study on antipsychotic drug prescription in French Psychiatry: Patient characteristics, antipsychotic treatment, and care management for schizophrenia].

UNLABELLED: In 2000, a one week national survey was conducted among 202 psychiatrists (129 participants) in France, from hospitals and clinics, private or public. The first 20 inpatients and 10 outpatients prescribed at least one antipsychotic drug (age range 18-65), were included. The diagnostic procedure was standardized with a structured interview: the Mini International Neuropsychiatric Interview (MINI). A total 2 068 patients were included, among whom 892 (43.1%) reached the criteria of schizophrenia according ICD-10. We present here data on these latter patients. Mean age was 38.8 years; with 38.8% females. Median duration of current antipsychotic treatment was 0.5 year in inpatients and 2 years in outpatients. Median duration of any antipsychotic treatment was 10 years, without difference between groups. Comorbid situations (anxiety disorder, depression and suicidal risk) were found in 33.1% of schizophrenic patients, with higher frequency among inpatients in private hospitals (54.8%) than in other groups. 46.8% patients were prescribed at least 2 neuroleptics, and 73.6% at least one non-neuroleptic drugs. Cyamemazine accounted for 16.6% of all neuroleptics drugs, and 56% of patients were prescribed an atypical antipsychotic (risperidone, olanzapine, amisulpride or clozapine). Atypical drugs accounted for 59.4% of patients who were prescribed only one neuroleptic drug. Inpatients had more neuroleptics coprescription than outpatients (mean 1.8 vs 1.4 drugs), with higher daily dose. In addition, inpatients had more other psychotropics prescribed (mean 1.5 vs 1.1 drugs). Overall, more other psychotropic drugs were prescribed among patients with -, than those without - comorbid situations (1.7 vs 1.2 drugs). Median time since admission, at the time of the study, were similar in private and public hospitals (107 vs 99 days) but maximal time since admission was respectively 2.8 and 48.9 years. Visit frequency for outpatients was more than one every two weeks for 43.1% in private and 24.7% in public clinics. Among inpatients only we found a difference between private and public hospitals for polypharmacy of non neuroleptics psychotropics, (mean 1.9 vs 1.5). In outpatients, long acting depot accounted for 26.6% of neuroleptics treatments in public clinics and 15.4% in private clinics. Finally, we found that polypharmacy among outpatients increased with duration of antipsychotic treatment. CONCLUSION: in France, important differences are reported in antipsychotic prescription for schizophrenia between in- and outpatients. Current antipsychotic prescription is more recent in inpatients than in outpatients, with similar duration of overall antipsychotic treatment. Inpatients have more drug prescription, antipsychotics and other psychotropics, than outpatients. Differences are less important between private and public providers. Inpatients in private hospitals receive more non neuroleptic drugs than in public hospitals, and depot antipsychotics are more used among patients of public clinics. Long term inpatients are found in public hospitals only. Outpatients follow up is more intensive in private than in public clinics.

Adolescent↗
PubMedDate not supplied

Cost and cost effectiveness of the mechanical and pharmacologic bridge to transplantation.

A prospective study has been carried out to evaluate the cost and cost effectiveness of the mechanical bridge (MB) or pharmacologic bridge (PB) to transplantation (HTx) in patients referred in cardiogenic shock (CS), who are candidates for Htx unresponsive to sympathomimetics. Selection between MB and PB was based on immediate efficacy of i.v. enoximone (2 mg/kg/BW) therapy. From 1986 to 1989, 37 patients who should have been immediately treated by MB entered the protocol. Six were unresponsive and rapidly received a Jarvik heart or left ventricular bypass (MB). Thirty-one improved (PB), with the need for HTx reconfirmed in 22 and performed in 14. Survival of the entire group was 70% and 51% at 1 and 3 months, respectively. Cost per patient was $45,843 ranging from 38,326 in PB patients to $84,683 in MB patients. Cost per patient transplanted after PB was $50,745. Cost per survivor at 1 year was $210,000 for all, ranging from $254,000 in MB to $192,455 in PB. Cost per added day of survival was higher in MB (+ 228%) at 1 month compared to PB. The difference was reduced at 1 year.

Adult↗
PubMedDate not supplied

[Schizoaffective disorder: its nosographic significance].

This paper discusses the nosographic significance of schizoaffective disorder. Follow-up studies, genetic and familial studies, response to treatment studies, and neurobiological data are summarized and analysed. Methodological issues and importance of diagnostic criteria are also examined. Current opinion supports heterogeneity of schizoaffective disorder, among which schizophrenia variants or affective disorder variants. Some patients could present another disease. In that case, they are categorized in the sub-type "other" of the RDC classification for schizoaffective disorder.

Follow-Up Studies↗