Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice

BACKGROUND: Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets. METHODS: A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients’ clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life. RESULTS: 1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups. CONCLUSION: An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov, number NCT0034885

Gaviscon® vs. omeprazole in symptomatic treatment of moderate gastroesophageal reflux. a direct comparative randomised trial

<p>Abstract</p> <p>Background</p> <p>Medical management of GERD mainly uses proton pump inhibitors. Alginates also have proven efficacy. The aim of this trial was to compare short-term efficacy of an alginate (Gaviscon^®, 4 × 10 mL/day) and omeprazole (20 mg/day) on GERD symptoms in general practice.</p> <p>Methods</p> <p>A 14-day multicentre randomised double-blind double-dummy non-inferiority trial compared Gaviscon^®(4 × 10 mL/day) and omeprazole (20 mg/day) in patients with 2-6 day heartburn episodes weekly without alarm signals. The primary outcome was the mean time to onset of the first 24-h heartburn-free period after initial dosing. Secondary outcomes were the proportion of patients without heartburn by D7, pain relief by D7, and reduction in pain intensity by D7 and D14.</p> <p>Results</p> <p>278 patients were recruited; 120 were included in the Gaviscon^®group and 121 in the omeprazole group for the per protocol non-inferiority analysis. The mean time to onset of the first 24-h heartburn-free period after initial dosing was 2.0 (± 2.2) days for Gaviscon^®and 2.0 (± 2.3) days for omeprazole (<it>p </it>= 0.93); mean intergroup difference was 0.01 ± 1.55 days (95% CI = -0.41 to 0.43): i.e., less than the lower limit of the 95% CI of -0.5 days predetermined to demonstrate non-inferiority. The mean number of heartburn-free days by D7 was significantly greater in the omeprazole group: 3.7 ± 2.3 days vs. 3.1 ± 2.1 (<it>p </it>= 0.02). On D7, overall quality of pain relief was slightly in favour of omeprazole (<it>p </it>= 0.049). There was no significant difference in the reduction in pain intensity between groups by D7 (<it>p = </it>0.11) or D14 (<it>p = </it>0.08). Tolerance and safety were good and comparable in both groups.</p> <p>Conclusion</p> <p>Gaviscon^®was non-inferior to omeprazole in achieving a 24-h heartburn-free period in moderate episodic heartburn, and is a relevant effective alternative treatment in moderate GERD in primary care.</p> <p>Trial registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN62203233">ISRCTN62203233</a>.</p

Thèmes, objets et méthodes de recherche dans les Abstracts des présentations orales acceptées dans les congrès de Médecine Générale de 2007 à 2010 (TOMATE - MG)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Prescription de morphine par les médecins généralistes européens dans les douleurs chroniques cancéreuses et non cancéreuses

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Le suivi ambulatoire des patients insuffisants cardiaques chroniques

La prise en charge de l'insuffisance cardiaque chronique est un problème de santé publique. 80% des actes concernant cette pathologie sont réalisés en médecine générale. L'objectif de cette thèse était de décrire la prise en charge ambulatoire des patients insuffisants cardiaques chroniques et de vérifier son adéquation avec les données actuelles de la science. Après avoir rappelé les données épidémiologiques, quelques définitions et les étiologies de l'insuffisance cardiaque, les recommandations sur l'approche diagnostique et la stratégie thérapeutique actuelles sont exposées. Afin de connaître les pratiques des médecins généralistes concernant les patients insuffisants cardiaques chroniques, une enquête a été réalisée auprès des médecins généralistes des départements du Val de Marne et de Seine et Marne. L'hypothèse était que les patients ne bénéficiaient pas d'une échographie ou d'un avis cardiologique et que les traitements prescrits étaient décalés par rapport aux recommandations européennes (IEC, bêtabloquants et spironolactone en particulier). Les résultats ont montré que le suivi cardiologique était satisfaisant. En revanche, les traitements prescrits n'étaient pas en adéquation avec les recommandations en particulier pour la trithérapie IEC, diurétique et bêtabloquants. Il y a un réel manque d'information ou un déficit de pratique des médecins généralistes et des cardiologues qu'il faudrait compenser par un programme de formation continue adaptéThe management of chronic heart failure is a public health issue. 80% of actions within this pathology ar made in primary care. The aim of this thesis was to describe the following out management of patients with chronic heart failure and to verify its adequacy with the current scientific data. After reviewing the epidemiological data, some definitions and the etiology of heart failure, the recommendations on the diagnostical approach and the current therapeutic strategy are presented. In order to identify the practices of general practioners concerning patients with chronic heart failures. A survey was carried out on general practioners in the Val-de-Marne and the Seine-et-Marne. The hypothesis was that the patients did not benefit from an echography or a cardiological opinion and that the prescribed treatments were not aligned with the european recommandations (ace, blockers and particularly spironolactone). The results have shown that the cardiological follow up was satisfactory. In contrast, the prescribed treatments were not in line with the recommandations in particular for the ace tritherapy, diuretic and blockers. There is either a real lack of information or a deficit of practical experience within general practitioners and cardiologists that would need to be compensated by a suitable continuous training programmePARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Combination of hydroxychloroquine and azithromycin as a treatment of Covid-19. Results of an observational study including 80 Covid-19 patients

National audienc

À propos de l’article : « Baclofène titré pour consommation à haut risque d’alcool »

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