Adherence to recommendations for the use of antifungal agents in a tertiary care hospital

OBJECTIVES: The aim of our study was to assess the adherence to labelling and international guidelines for antifungal prescribing. METHODS: A retrospective study was performed in intensive care units in addition to the oncology and haematology department, which covered 70% of antifungal consumption at Hautepierre Hospital, Strasbourg, France. On reviewing medical charts, the antifungal prescription was examined in relation to the recommendations of indication, dosage, risk of drug-drug interactions and, where appropriate, antifungal susceptibility testing. Treatments were considered appropriate, inappropriate or debatable. RESULTS: Between January and April 2007, 199 treatments were given for 179 different episodes in 133 adult patients. Treatments were prescribed for pre-emptive or targeted therapy (n = 90, with 60 for candidiasis, 26 for aspergillosis and 4 for other mould diseases), empirical therapy (n = 17) and primary (n = 81) or secondary (n = 11) prophylaxis. Fluconazole accounted for 67% of prescriptions, followed by voriconazole (19%), caspofungin (10%), posaconazole (2%), conventional or liposomal amphotericin B (2%), itraconazole (<1%) and terbinafine (<1%). Indication and dosage were found to be appropriate in 65% and 62% of cases, inappropriate in 22% and 21%, and debatable in 13% and 17%, respectively. The overall (by combining all assessment criteria) rate of inappropriate use was 40%. The overall survival rate at 12 weeks was highest in patients receiving appropriate therapy (81% versus 72% and 68% in the debatable and inappropriate therapy groups, respectively), with between-group differences not being significant (P = 0.49). CONCLUSIONS: Our evaluation revealed a high proportion of inappropriate or debatable use of antifungal agents, while highlighting significant issues, such as inadequate dosage or indications

L’invention de la gestion des finances publiques

Le vote et la mise en œuvre de la loi organique relative aux lois de finances du 1er août 2001 ont rappelé l’importance de la régulation et de la gestion des finances publiques. Pour ses promoteurs, la LOLF introduirait de manière inédite des préoccupations managériales dans le droit budgétaire et comptable, volontiers présenté comme peu soucieux de considérations d’efficacité ou d’efficience. Cette actualité de la LOLF incite l’historien, le juriste ou le politiste à prendre de la distance en réinscrivant ces mutations dans la longue durée. À travers une série d’études inédites, cet ouvrage retrace l’histoire mal connue des principes, des règles, des instruments et des pratiques qui ont façonné le droit budgétaire et compta ble tout au long du XIXe siècle, depuis sa refondation sous la Restauration jusqu’au début de la Première Guerre mondiale. Comment et à travers quels enjeux sont produites les normes du droit budgétaire et comptable ? Quels débats de doctrine suscitentelles ? Que nous apporte la perspective historique pour (re)penser les relations entre la mise en place d’un droit des finances publiques et les préoccupations gestionnaires ? Quelles pratiques ce droit génère-t-il ? Telles sont les grandes questions auxquelles s’efforce de répondre ce livre sur la période 1815-1914. Les analyses et hypothèses avancées dans l’ouvrage sont issues de la confrontation féconde de plusieurs champs disciplinaires, l’histoire, le droit et la science politique. Premier tome d’une « Histoire de la gestion des finances publiques de 1815 à nos jours », ce volume contribue à une histoire de l’État qui s’inscrit au cœur d’un dialogue passé-présent et qui suit le fil riche et complexe du développement de la gestion des finances publiques.The passing and the implementation of the constitutional bylaw on budget acts [LOLF] of 1 August 2001 reminded us of the importance of the regulation and management of public finances. For its sponsors, the LOLF was an unprecedented move to introduce managerial concerns into budgetary and accounting law, readily presented as caring little for effectiveness or efficiency. As the LOLF is relatively recent, this prompts historians, law specialists or political analysts to take the longer view, by putting these changes into perspective. Through a series of groundbreaking studies, this work traces the little known history of the principles, the rules, the instruments and the practices which moulded budgetary and accounting law throughout the course of the 19th century, from the time it was recast under the Reformation up to the beginning of the First World War. How were the rules of budgetary and accounting law developed and which issues helped to form them? What debates on legal theory have they provoked? How does the historical perspective help us to think about (or to re-think) the relationship between the introduction of a public finance law and managerial concerns? What sort of practices does this law give rise to? These are the major questions which this book covering the period 1815-1914 attempts to answer. The analyses and hypotheses put forward in this work are the result of a fruitful debate between several disciplines: history, law and political science. As the first volume in a series entitled ‘Histoire de la gestion des finances publiques de 1815 à nos jours’ [History of public finance management from 1815 to the present], this book is a contribution towards the history of the State, which lies at the heart of the dialogue between the past and the present, and which traces the rich and complex history of the development of public financial management.La votación y puesta en vigor de la Ley Orgánica relativa a las Leyes de Presupuestos (LOLF) de 1 de agosto de 2001 recordaron la importancia de la regulación y gestión de las finanzas públicas. Para sus impulsores, esta LOLF tuvo como novedad el introducir criterios gestores en el derecho presupuestario y contable, a menudo presentado como poco preocupado por consideraciones de eficacia o eficiencia. Esta actualidad de la LOLF invita al historiador, el jurista o el politólogo a tomar distancia enmarcando dichos cambios en el largo plazo. La obra retoma así una serie de estudios inéditos para trazar la historia mal conocida de los principios, reglas, mecanismos y prácticas que a lo largo del s. XIX, desde su refundación en tiempos de la Restauración hasta el estallido de la I Guerra Mundial, fueron dando forma al derecho presupuestario y contable. Cómo e impulsadas por qué desafíos se fueron forjando las normas del derecho presupuestario y contable; qué debates disciplinarios abren; qué nos aporta la perspectiva histórica para (re)pensar las relaciones entre la puesta en vigor de un derecho de las finanzas públicas y las preocupaciones propias del gestor; qué prácticas genera dicho derecho… Éstas son las grandes cuestiones a las que el libro intenta dar respuesta durante el periodo 1815-1914. Los análisis e hipótesis expuestos en la obra son el fruto de la fértil confrontación entre varios campos disciplinarios: la historia, el derecho y la ciencia política. Primer tomo de una “Historia de la gestión de las finanzas públicas desde 1815 a nuestros días”, este volumen es la aportación a una historia del Estado que se inscribe en el núcleo mismo del diálogo entre el pasado y el presente y que sigue el hilo rico y complejo del desarrollo de la gestión de las finanzas públicas.La mission du département Histoire économique et financière de l’Institut de la gestion publique et du développement économique est de contribuer à une meilleure connaissance de l’histoire de l’État et de son rôle en matière économique et financière depuis le Moyen Âge jusqu’à nos jours, de susciter des travaux scientifiques et d’en aider la diffusion. Le Comité pour l’histoire économique et financière de la France est rattaché à l’Institut de la gestion publique et du développement économique, il a pour mission de l’assister dans ses activités de recherches historiques

Circulating cell-free BRAF V600E as a biomarker in children with Langerhans cell histiocytosis

International audienceThe BRAFV600E mutation is reported in half of patients with Langerhans cell histiocytosis (LCH). This study investigated the detection of the BRAFV600E allele in circulating cell-free (ccf) DNA in a paediatric LCH cohort. Children with BRAFV600E -mutated LCH were investigated to detect ccf BRAFV600E at diagnosis (n = 48) and during follow-up (n = 17) using a picolitre-droplet digital PCR assay. At diagnosis, ccf BRAFV600E was positive in 15/15 (100%) patients with risk-organ positive multisystem (RO+ MS) LCH, 5/12 (42%) of patients with RO- MS LCH and 3/21 (14%) patients with single-system (SS) LCH (P < 0·001, Fisher's exact test). The positive BRAFV600E load was higher for RO+ patients (mean, 2·90%; range, 0·04-11·4%) than for RO- patients (mean, 0·16%; range, 0·01-0·39) (P = 0·003, Mann-Whitney U test). After first-line vinblastine-steroid induction therapy, 7/7 (100%) of the non-responders remained positive for ccf BRAFV600E compared to 2/4 (50%) of the partial-responders and 0/4 of the complete responders (P = 0·002, Fisher's exact test). Six children treated with vemurafenib showed a clinical response that was associated with a decrease in the ccf BRAFV600E load at day 15. Thus, ccf BRAFV600E is a promising biomarker for monitoring the response to therapy for children with RO+ MS LCH or RO- LCH resistant to first-line chemotherapy