Comparison of the Automated Oscillometric Method With the Gold Standard Doppler Ultrasound Method to Access the Ankle-Brachial Pressure Index

Objective: Despite its screening interest, the ankle-brachial pressure index (ABPI) remains uncommon in general practice, because it needs training and specific devices as Doppler. Easier methods such as the use of automated oscillometric devices may facilitate the peripheral arterial diseases (PADs) screening. We wanted to assess the reliability of the automated oscillometric measurement of the ABPI, compared with the gold standard Doppler ultrasound measurement. Patients and Method: In 287 patients aged 65 years or older without diagnosed PAD, we performed ABPI measurements with oscillometric and Doppler devices. Reproducibility was assessed by the intraclass correlation coefficient of agreement (R) and the Bland and Altman method. Results: The intermethod reliability was bad (R = .346, 95% CI = (0.268-0.420)), with a large confidence interval of the individual differences between the 2 methods: 95% CI = (—0.183-0.346). Conclusion: Automatic oscillometric devices cannot be recommended as reliable methods for ABPI measurement

A mixture partial credit model for identifying latent classes responsible for differential item functioning

AIMS : Ideally, the item response probability to a quality of life (QoL) questionnaire should only depend on the respondents’ QoL level. If such a probability also depends on other characteristics such as ethnicity, gender or socioeconomic status, differential item functioning (DIF) may be present. Identifying DIF plays a key role in verifying measurement invariance when validating questionnaires. Moreover, being able to take into account DIF allows limiting measurement biases when analyzing patient-reported ouctomes (PRO) data. Several methodologies have been proposed for dealing with DIF, one of the most flexible and powerful being the IRT-based likelihood ratio test. With such a method, the covariate suspected to be responsible for DIF on a given item can be identified. For this purpose, nested models (with and without DIF) are compared: one constrained to be DIF-free for the suspected item, and one considering DIF by including interactions between the item parameter and the considered covariate. The best model is then chosen for analyzing data, allowing taking into account DIF if necessary. However, some problems can occur when covariates responsible for DIF are not well identified. Multiple covariates can be wrongly suspected, leading in multiple comparisons thus in type I error rate inflation. Moreover, the covariate truly responsible for DIF might not be identified because it is not a directly observed covariate but a latent variable. METHODS : We propose an adaptation of the IRT likelihood ratio test based on mixture partial credit models (PCM). With these models, items parameters are considered as fixed effects and both the latent trait to be analyzed (for example QoL) and the covariate responsible for DIF are considered as continuous and categorical latent variables, respectively. Latent classes can finally be constructed based on such categorical latent variables using individual posterior probabilities, and then described using observed data. RESULTS : We illustrate the properties of such likelihood ratio test based on mixture PCM using both simulated data and observed data from the Pays-de-la-Loire Workers Surveillance Program (France), and provide a MPlus based macro-program working under Stata for performing such a procedure. CONCLUSIONS : We believe that such program may facilitate the use of these methods by researchers.

Étude comparative tensiomètre automatique versus doppler à ultrasons dans la mesure de l’index de pression systolique à la cheville (Ipsc)

ObjectifL’évaluation de l’index de pression systolique à la cheville (IPSC) est la méthode non invasive la plus simple de dépistage de l’artériopathie des membres inférieurs (AOMI) mais reste peu usitée en pratique courante, car elle est chronophage, implique un équipement et une formation appropriés. Le but de notre étude est d’évaluer la validité et la fiabilité de la mesure de l’IPSC à l’aide d’un tensiomètre automatique par comparaison avec les résultats obtenus par doppler continu, méthode de référence. Méthodes Les patients de 65 ans et plus hospitalisés au CHU d’Angers de juillet 2008 à mars 2009 en médecine interne et n’ayant pas d’AOMI documentée au moment de l’inclusion ont participé à l’étude. Les critères d’exclusion étaient la présence d’une fibrillation auriculaire et une incompressibilité des artères distales des membres inférieurs. Pour chaque patient, l’IPSC a été évalué par tensiomètre automatique et par la méthode Doppler de référence ; ces mesures étant faites par le même examinateur. La concordance entre les deux mesures était appréciée par la méthode de Bland et Altman et le coefficient de corrélation intraclasse (ICC). Résultats Sur 287 patients participant à l’étude, 221 ont étés inclus. Cinquante-six (25 %) de ces patients avaient un IPSC < 0,90. La concordance entre les deux méthodes était médiocre : ICC à 0,35 ± 0,08 et moyenne à 0,08 ± 0,26 selon la méthode de Bland et Altman. Conclusion La méthode de dépistage de l’AOMI par mesure de l’IPSC par tensiomètre automatique ne peut être retenue comme une alternative à la méthode Doppler

Risks linked to accidental inoculation of humans with veterinary vaccines: a 7-year prospective study

AIM: Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors. METHODS: Prospective observational study conducted from 2007 to 2014 at Angers University Hospital\u27s Poison Control Centre. The endpoints examined were: early and late locoregional complications, surgical treatment, and absence from work. The statistical analysis was based on a multivariate analysis. DISCUSSION: The presence of mineral oil adjuvants, the injection of the vaccine under pressure and injection in joint and tendon of the hand significantly increased early locoregional complications and surgery but only the presence of mineral oil adjuvant increased significantly late locoregional complications at one month. Absence from work is significantly correlated to the site of injection and the presence of mineral oil adjuvant. CONCLUSION: It is important to know about the contents of the veterinary vaccine in order to anticipate early and late complications that may arise (particularly due to the presence of mineral oil adjuvants). Special attention must also be given do the site of injection. We think that any accidental injection of veterinary vaccine into humans, especially those containing mineral oils, must lead to an early medical consultation. This must also be indicated on the product

Metformin overdose: A serious iatrogenic complication-Western France Poison Control Centre Data Analysis

INTRODUCTION: The prevalence of type 2 diabetes (T2D) continues to rise across the world. Metformin is still considered the "gold standard" and is, therefore, increasingly prescribed. Monitoring of metformin continues to be debated because of its association with lactic acidosis (MALA), a rare but life-threatening complication. The aim of this study was to identify the main individual characteristics associated with severe poisoning in self-poisonings and therapeutic accidents reported at the Western France Poison Control Centre (PCC). METHODS: Retrospective study of metformin poisoning from September 1999 to September 2016 at the Western France PCC recorded in the French PCC\u27s database (SICAP). The end-point was clinically high severity (mortality and/or cardiovascular shock and/or GCS ≤ 7/15). RESULTS: Of the 382 cases included, 197 concerned acute accidental exposures, 127 self-poisonings and 58 therapeutic accidents. MALA concerned 63 patients: 44 therapeutic accidents and 19 self-poisonings. High severity concerned 59 patients: 47 therapeutic accidents and 12 self-poisonings. T2D and age > 60 significantly increase the risk of high severity (OR 7.7, CI [1.54-38.41]; P = 0.013; OR 3.5, CI [1.60-7.84]; P = 0.002, respectively). CONCLUSIONS: Metformin may lead to MALA and severe poisoning in therapeutic accidents but also in self-poisoning circumstances. Among reported cases, T2D history and age >60 increase the risk of serious poisoning. Monitoring of their treatment should be taken seriously especially in the event of digestive symptoms such as diarrhoea

Quetiapine Poisoning and Factors Influencing Severity

PURPOSE/BACKGROUND: Quetiapine is a relatively new atypical antipsychotic with fewer adverse effects. It is increasingly prescribed to patients. The purpose of this study was to describe the cases of poisoning observed at the western France Poison Control Centre and identify potential risk factors that increase the severity of the cases. METHODS: This was a retrospective study of self-poisoning with quetiapine as reported by the western France Poison Control Centre between 2007 and 2017. RESULTS: There were 372 cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of null severity (grade 0), 133 cases of mild severity (grade 1), 85 cases of moderate severity (grade 2), and 79 cases of high severity (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%), and antidepressants (37%). An evaluated ingested dose 1500 mg or greater and 2 or more coagents increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine was associated with high severity (odds ratio, 2.478 [confidence interval, 1.3-4.723]; odds ratio, 1.820 [confidence interval, 1.010-3.316]). CONCLUSIONS: Quetiapine may lead to severe poisoning for which there is currently no specific treatment. Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning

Création d’un score d’évaluation du risque de symptômes musculo-squelettiques basé sur des facteurs professionnels

Objectif L’objectif de ce travail est la création d’un score d’évaluation du risque de symptômes musculo-squelettiques (SMS) chroniques des membres supérieurs, uniquement basé sur des données d’exposition professionnelle aux déterminants biomécaniques, psychosociaux et organisationnels. Ce score ne prenant pas en compte les facteurs individuels, permettra de classer les situations de travail devant bénéficier d’une action de prévention. Méthodes L’échantillon d’étude était constitué de 1749 salariés recrutés lors de la phase d’inclusion de la cohorte des salariés ligériens (COSALI). Les facteurs organisationnels, biomécaniques et psychosociaux et les variables associées aux SMS chroniques ont été recueillis par auto-questionnaire. Un score a été créé selon trois méthodes statistiques : une régression logistique binaire, une analyse en clusters suivie d’une analyse par arbre de décision et une modélisation par classes latentes. Chacune de ces méthodes est susceptible d’entraîner la création de scores différents. Résultats L’area under the curve (AUC) obtenu par la régression logistique était de 0,75 contre 0,66 pour l’analyse en clusters et 0,65 pour l’analyse en classes latentes. La régression logistique a donc été retenue pour la création du score. Les facteurs associés aux SMS chroniques des membres supérieurs étaient l’intensité élevée des efforts physiques ressentie (échelle RPE de Borg), la répétitivité des gestes plus de 4 h/j, la flexion du coude plus de 2 h/j, l’utilisation de la pince pouce-index plus de 4 h/j, la possibilité d’influencer le déroulement de son travail et l’aide des collègues. Le score a ensuite été créé à partir des paramètres estimés de la régression logistique, il s’étend de −1 à 15. Par exemple, 66 % de l’échantillon a un score supérieur ou égal à deux. Pour ce seuil, la valeur prédictive négative est de 93,4 %. Conclusions Selon le seuil choisi, le score aboutit à une forte valeur prédictive négative. Il pourrait constituer un outil utile aux préventeurs en entreprise afin de cibler l’effectif pour lequel il n’est pas indispensable de mettre en place des actions de prévention. Néanmoins ce score ne permet pas de prédire avec confiance les salariés qui seront atteints de SMS. Pour avoir un score plus performant, il faudrait intégrer des facteurs individuels tels que l’âge et le sexe, mais la caractérisation par situation de travail n’est alors plus envisageable

Intra-test and test-retest reliability of exercise oximetry in arterial claudication

BACKGROUND: Transcutaneous oxygen pressure (tcpO2) reliability is blunted by an unpredictable transcutaneous gradient through the skin. We hypothesized that the "Decrease from Rest of Oxygen pressure (DROP: subtraction of limb-changes from chest-changes from the respective starting values) would show a good to excellent reliability during Exercise -tcpO2 investigations. METHODS: In three different experiments we tested: The intra-test variability at the peripheral level (Experiment A: 32 patients, 16 at each location), at the chest level (Experiment B: 45 patients) and the test-retest reproducibility within 3 months (Experiment C: 67 patients). We calculated the intra-class coefficient of correlation (ICC) with 95% confidence interval [Lower/upper limit]. ICC between 0.60 and 0.749 indicate a good agreement. ICC above 0.750 indicates an excellent agreement. RESULTS: ICC values for DROP-min were 0.848 [0.723/0.935] at the buttock and 0.920 [0.846/0.967] at the calf levels, in experiment A; ICC were 0.873 [0.799/0.923] at the buttock and 0.898 [0.790/0.953] at the calf levels, in experiment B; 0.806 [0.716/0.871] at then buttock level (n = 67) and 0.807 [0.722/0.868] at the calf in experiment C. CONCLUSIONS: Intra-test and test-retest reliability is excellent using the DROP calculation for exercise-tcpO2 investigations

Long-term outcome of noninvasive positive pressure ventilation for obesity hypoventilation syndrome

BACKGROUND: Few data are available on the long-term outcome of noninvasive positive pressure ventilation (NPPV) for obesity hypoventilation syndrome (OHS). This study was designed to determine long-term survival, treatment adherence, and prognostic factors in patients with OHS in whom NPPV was initiated in an acute setting vs under stable clinical conditions.METHODS: One hundred thirty consecutive patients with OHS (56 women) who started NPPV between January 1995 and December 2006 either under stable conditions (stable group, n = 92) or during ICU management of acute hypercapnic exacerbation (acute group, n = 38) were retrospectively analyzed. RESULTS: Arterial blood gases and the Epworth sleepiness scale were both significantly improved after 6 months of NPPV. With a mean follow-up of 4.1 +/- 2.9 years, 24 (18.5%) patients died and 24 (18.5%) discontinued NPPV. On Kaplan-Meier analysis, 1-, 2-, 3-, and 5-year survival probabilities were 97.5%, 93%, 88.3%, and 77.3%, respectively. Mortality was lower than that described in a previous series of patients with untreated OHS. Supplemental oxygen therapy was the only independent predictor of mortality. The probability of continuing NPPV was 80% at 3 years with a high rate of daily use ( > 7 h). Female sex was predictive of lower long-term adherence to NPPV. The acute and stable groups did not differ in terms of arterial blood gases and Epworth sleepiness scale at 6 months, long-term survival, and treatment adherence. CONCLUSIONS: The results of this study support long-term NPPV as an effective and well-tolerated treatment of OHS whether initiated in the acute or chronic setting

Vasodilator response to galvanic current stimulation of the skin accurately detects acetylsalicylic acid intake: A study in 400 vascular patients

Background and aims The first cause of low-dose acetylsalicylic-acid (ASA) inefficacy is poor adherence to treatment. No non-invasive technique is available to assess ASA intake. Current-induced vasodilation (CIV) was found abolished in healthy volunteers after low-dose ASA intake. We tested clinical characteristics, treatments, and comorbid conditions influencing CIV amplitude in vascular patients. Methods CIV was tested in 400 patients (277 males and 123 females, aged 65.4 ± 13.4 years). We focused on clinical characteristics, treatments, and comorbid conditions as covariates of CIV amplitude. We studied the CIV amplitude to covariate relationships with multivariate linear regression and receiver operating characteristics (ROC). Results The multivariate linear model determined that ASA intake within the last 48 h and the interaction between ASA intake and body mass index (BMI) were the sole covariates associated with CIV amplitude. For the whole population, the area under the ROC curve (AUC) for CIV to predict ASA intake was 0.853 [95% confidence interval (CI): 0.814–0.892]. Considering separately the areas observed for non-obese (BMI ≤30, n = 303) and obese (BMI>30, n = 93) patients, the AUC [95% CI] was 0.873 [0.832–0.915] and 0.776 [0.675–0.878], respectively (p = 0.083). Conclusions ASA is the only drug that affects the amplitude of CIV response observed after galvanic current application to the skin of vascular patients. CIV depends on BMI but not age or gender. As such, CIV appears to be a potential objective marker of ASA intake and could facilitate future non-invasive assessments of adherence to ASA treatment