Influence de la sélection des médicaments des centres hospitaliers universitaires sur les prescriptions ambulatoires

Ce travail a pour objectif de tester l'existence d'une influence des choix hospitaliers de médicaments sur les prescriptions des médecins généralistes alentours. Une revue de la littérature a mis en évidence la pauvreté des données disponibles. Trois études limitées aux CHU et à 9 classes pharmacologiques concurrentielles sont proposées. La première décrit de façon inédite la sélection des médicaments dans les CHU. La deuxième à l'échelle d'un CHU et d'un département cherche à mettre en évidence des tendances similaires dans l'évolution des consommations hospitalières et ambulatoires. La deuxième étude quasi-expérimentale vise à quantifier l'influence des consommations de médicaments des CHU sur le marché ambulatoire de leurs bassins de santé et départements.This work aimed to test the existence of the influence of hospital choices of drugs on surrounding general practitioners' prescriptions. A review of the literature showed the paucity of the available data. Three studies, restricted to university hospitals (UH) and 9 competitive pharmacological classes were conducted. The first one described the selection of drugs in UH. The second aimed to detect similar trends in the evolutions of hospital and ambulatory consumptions of drugs. The second was a quasi-experimental study which goal was to quantify the influence of the consumption of drugs in UHs on their surrounding communities (département and catchment area). Our analyses confirmed the influence of hospital drug consumption on drug use in the community. This effect largely varied according to the pharmacological classes

MRI evaluation of the hydration status of non-pathological lumbar intervertebral discs in a pediatric population

Introduction The intervertebral disc (IVD) is made up of the annulus fibrosus (AF) and the nucleus pulposus (NP) – an inert hydrated complex. The ability of the IVD to deform is correlated to that of the NP and depends on its hydration. As the IVD ages, its hydration decreases along with its ability to deform. In adolescent idiopathic scoliosis, one of the etiological hypotheses pertains to the IVD, thus making its condition relevant for the diagnosis and monitoring of this pathology. Hypothesis IVD hydration depends on sex, age and spine level in an asymptomatic pediatric population. The corollary is data on a control group of healthy subjects. Material and methods A cohort of 98 subjects with normal spine MRI was enrolled; their mean age was 13.3 years. The disc volume and hydration of each IVD was evaluated on T2-weighted MRI sequences, using previously validated image processing software. This evaluation focused on the lumbar spine, from the thoracolumbar junction to the lumbosacral junction. It was assumed that IVD hydration was related to the ratio of NP and AF volumes. A mixed multivariate linear analysis was used to explore the impact of age, sex and spinal level on disc hydration. Results Disc hydration was higher overall in boys than in girls, but this difference was not significant. Hydration increased with age by +0.005 for each additional year (p = 0.0213). Disc hydration appears to be higher at the thoracolumbar junction than the lumbar spine, although this difference was not significant. Conclusion Through this MRI study, we established a database of non-pathological lumbar disc hydration as a function of age, sex and spinal segment along with 95% confidence intervals

Les anti-TNF alpha en Midi-Pyrénées (étude d'utilisation pour la polyarthrite rhumatoïde)

L'arrivée des médicaments anti-TNF alpha sur le marché français en 1999 a modifié considérablement la prise en charge des polyarthrites rhumatoïdes (PR) sévères. Ces médicaments récents, innovants et onéreux, ont fait la preuve de leur efficacité mais leur bénéfice et leur risque à long terme doivent être mieux évalués. A partir des données de l'Assurance maladie et des dossiers de patients traités au Centre hospitalier universitaire de Toulouse entre octobre 2001 et juillet 2006, notre étude présente l'évolution de la consommation des anti-TNFa et l'utilisation de ces médicaments dans le traitement de la PR dans la région Midi-Pyrénées. Nous décrivons notamment la population utilisatrice, le taux de maintien thérapeutique, les motifs d'arrêt retrouvés, l'efficacité des anti-TNFa et nous avons pu mettre en évidence des facteurs prédictifs du maintien et de la réponse thérapeutique.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes (Corrected Proof)

International audienceAfter diagnosis of Alzheimer's disease and related syndromes (ADRS), personalized care adapted to each patient's needs is recommended to provide a care plan and start symptomatic treatments according to guidelines. Over the past decade, dedicated structures and care have been implemented in various settings. Equal access to ADRS care, health care providers and services is crucial to ensure potential health benefits for everyone. However, the extent of use of recommended services and favorable health care utilization trajectories (HUT) may vary according to individual and contextual characteristics. The aim of this article was to (1) describe HUT patterns after multidimensional clustering of similar trajectories, (2) assess the proportion of individuals presenting favorable HUTs, and (3) identify factors associated with favorable HUTs

Potential determinants of unfavourable healthcare utilisation trajectories during the last year of life of people with incident Alzheimer Disease or Related Syndromes: a nationwide cohort study using administrative data

International audienceBackground : people approaching the end-of-life frequently face inappropriate care. With Alzheimer Disease or Related Syndromes (ADRS), end-of-life is characterised by progressive decline, but this period remains difficult to identify. This leads to a lack of anticipation and sometimes with unfavourable healthcare utilisation trajectories (HUTs). Objective : to quantify unfavourable HUTs during the last year of life and identify their potential determinants in both community and nursing-home settings. Design : nationwide cohort study using administrative database. Setting : French community and nursing-home residents. Subjects incident ADRS people identified in 2012, who died up to 31 December 2017. Methods : we used multidimensional clustering to identify 15 clusters of HUTs, using 11 longitudinal healthcare dimensions during the last year of life. Clusters were qualitatively assessed by pluri-disciplinary experts as favourable or unfavourable HUTs. Individual and contextual potential determinants of unfavourable HUTs were studied by setting using logistic random-effect regression models. Results 62,243 individuals died before 31 December 2017; 46.8% faced unfavourable end-of-life HUTs: 55.2% in the community and 31.8% in nursing-homes. Individual potential determinants were identified: younger age, male gender, ADRS identification through hospitalisation, shorter survival, life-limiting comorbidities, psychiatric disorders, acute hospitalisations and polypharmacy. In the community, deprivation and autonomy were identified as potential determinants. Contextual potential determinants raised mostly in the community, such as low nurse or physiotherapist accessibilities. Conclusions : Nearly half of people with ADRS faced unfavourable HUTs during their last year of life. Individual potential determinants should help anticipate advance care planning and palliative care needs assessment. Contextual potential determinants suggest geographical disparities and health inequalities

Developing and Testing a Local Expert-Based Reading Process for Use to Examine Discrepancies Between Guidelines and Current Clinical Practices

International audienceThe use of relevant guidelines is critical in psychiatric clinical practice to ensure the homogeneity of the global care provided. Consequently, it is important to identify whether they are utilized successfully and, if not, why. This would enable pragmatic solutions to be agreed to improve the organization of care and the removal of any barriers to the guidelines' implementation. The first step in this process, before any exploration of the limitations of the guidelines themselves, involves a determination of whether they are actually applied in clinical practice. We therefore evaluated discrepancies between the guidelines relating to patients with borderline personality disorder and current practices in the psychiatric Emergency Department at Toulouse University Hospital. This was achieved using a reading process involving a panel of eight local experts who analyzed relevant medical files extracted from a database. They were guided by, and instructed to answer, six standardized questions in relation to each file to determine the method's feasibility. A total of 333 files were analyzed to determine whether, in the local experts' judgment, the care provided reflected current guidance. This reading process revealed substantial agreement (0.85%; Fleiss Kappa −0.69), which is a promising outcome and suggests that such methods could be used in future protocols. Moreover, the process is practical and reliable and requires very few materials

The Prevalence of Hepatitis E in a Patient Cohort Presenting With Addictive Injection Behavior

International audienceIntroduction: Hepatitis E is the most common cause of acute viral hepatitis worldwide. Seroprevalence is approximately 15% in developed countries, and 22% in France. hepatitis E virus (HEV) can be transmitted via transfusions and therefore possibly intravenous (IV) drug use. Hepatitis E serology is routinely tested in patients who seek medical advice for addictive injection behavior at the addiction treatment, support and prevention unit of Toulouse University Hospital. We assume that hepatitis E is more prevalent in patients presenting with addictive injection behavior than in the general French population.Methods: Hepatitis E serological assays [immunoglobulin M (IgM) and IgG] were carried out for all patients presenting with addictive injection behavior during an initial evaluation. The controls were taken from a cohort of 3,353 blood donors living in southern France and who donated blood during the first 2 weeks of October 2011.Results: We included 52 patients presenting with addictive injection behavior and 103 healthy controls matched for age, sex, and area of residence. We found no difference between patients and controls for the prevalence of hepatitis E: patients vs. healthy controls: positive IgGs: 42.31%, 95% confidence interval (CI) (28.73–56.80%) vs. 43.43%, 95% CI (33.50–53.77%) (p = 0.89) and positive IgMs: 3.85%, 95% CI (0.47–13.22%) vs. 4.85%, 95% CI (0.16–10.97%) (p = 0.57).Conclusion: There was no difference in HEV seroprevalence between IV drug users and the general population, suggesting that the IV route of HEV infection is not significant in this population