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

Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?

International audienceBackground Recent research has highlighted that patients with borderline personality disorder (BPD) could experience symptomatic remissions. This led to the production of guidelines concerning the most appropriate care. In addition, as BPD patients frequently present at an emergency department (ED), specific recommendations concerning how they should be cared for there have also been developed. The recommendations include the referral of patients to inpatient, outpatient or specific crisis care. However, an issue that has not been addressed is the capacity of ED services to apply the care recommendations. The objective of our study, therefore, was to identify the factors limiting their use in the ED of Toulouse University Hospital. Methods A panel of psychiatrists specializing in BPD care examined the medical files of 298 patients with a BPD diagnosis to determine which referrals were consistent or not, according to the care recommendations. A logistic regression was then performed to identify which sociodemographic, clinical, organizational or professional-training factors were associated with inconsistent referrals. Results 32% of patients experienced an inconsistent referral. Consultations performed during an on-call or day-off schedule were linked with inconsistent referrals, while an active follow-up was associated with the provision of consistent care. Conclusion Changing how evaluations of BPD patients in the ED are organized during on-call and day-off schedules could improve the application of the care recommendations regarding the most appropriate referrals

Red Blood Cell Omega-3 Fatty Acid Composition and Psychotropic Drug Use in Older Adults: Results from the MAPT Study

International audienceLow docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) concentration has been associated with the development of some psychiatric disorders.Objectives: to assess the association between red blood cell (RBC) DHA-EPA concentration and psychotropic drug use in older adults and between the 1-year change in RBC DHA-EPA and psychotropic drug use at 12 months.Design: secondary analysis of multicenter, randomized controlled trial testing multidomain intervention and/or n-3 PUFA supplement on cognitive function (MAPT study).Setting: France, 2008-2014.Participants: 1680 participants ≥70 years, community-dwelling were included.Measurements: Psychotropic drug use was self-reported during medical interviews and assessments. RBC n-3 PUFA concentration was defined by % of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) among total fatty acids. Logistic regressions models controlling for age, sex, education, depression risk and intervention group were used.Results: 1594 participants had baseline DHA-EPA concentration available (mean age=75.5±4.5 years, 65% females). At baseline, participants with DHA-EPA ≤4.82% (lowest quartile) reported higher prevalence of use of overall psychotropic drugs (34.0% vs 24.4%; aOR=1.33, 95%CI=[1.03-1.72]), anxiolytic/hypnotic drugs (25.0% vs 18.2%; aOR=1.42, 95%CI=[1.07-1.89]), and antidepressants (18.3% vs 13.5%; aOR=1.25, 95%CI=[0.93-1.72]) than participants with higher DHA-EPA. Participants who experienced an increase in DHA-EPA from baseline were less likely to use a psychotropic drug at 12 months than participants with no change or a decrease (aOR=0.72, 95%CI=[0.55-0.96]).Conclusion: Low RBC DHA-EPA concentration was independently associated with psychotropic drug use. Future studies are needed to assess whether low RBC DHA-EPA is a risk marker for psychotropic drug use in older adults and to better understand underlying pathophysiological mechanisms. Registration number: ClinicalTrials.gov database (NCT00672685)

How to assess patient satisfaction regarding physician interaction: A systematic review

International audiencePatient satisfaction is an important health care quality indicator. This is particularly relevant in chronic diseases, such as, many dermatological diseases. The purpose of the current systematic review was to assess the validated tools measuring patient satisfaction with physician interaction. We performed a systematic review search in Pubmed, Cochrane Library, and EMBASE. The psychometric properties of the instruments and the domains explored were assessed. Overall, 2229 articles were extracted from the literature search. Of these, 146 articles were eligible for inclusion, 55 were included, and 22 scores were selected. A total of 13 instruments reported cross-cultural validation and the EUROPEP score highlighted the most diverse cross-cultural validation involving 11 different countries. All scores were assessed for content validity, construct validity, factor analysis, reliability, and responsiveness to change. The extent of the validation varied between scores with a few assessing practicability. The following domains were explored: listening skills, empathy, caring/compassion, confidentiality, honesty, behavior, competency/technical skills, satisfaction with the information provided, time given, availability, the environment, trust in the physician, ability to comply with the recommendations, and readiness to recommend the physician to other patients. We identified a total of 22 validated instruments. The major gaps in the validation process appear to be the practicability of the scores and the cross-cultural validation. Major domains evaluated by the scores are communication skills that can be improved by specific training. There is a need to improve evaluation of the quality of the patient-physician relationship in dermatology using validated instruments

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

Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3‐year analysis of the multidomain Alzheimer preventive trial (MAPT) study

International audienceAim The aim of the present study was to assess the association between anticholinergic (atropinic) burden and cognitive decline in older adults over the course of 3 years. Methods We used data from Multidomain Alzheimer Preventive Trial (MAPT) study participants aged ≥70 years and at risk of cognitive decline. Cognitive function was assessed with a composite score [Mini‐Mental State Examination (MMSE) orientation, Free and Cued Selective Reminding Test, Category Naming Test, Digit Symbol Substitution Test] at 12, 24 and 36 months. Participants declining by more than 0.236 points on the composite score (representing the lowest quintile of 1‐year cognitive change) during any 1‐year period were considered to have undergone cognitive decline. Anticholinergic exposure was defined by four methods for each of four anticholinergic scales (Anticholinergic Drug Scale, Anticholinergic Cognitive Burden, Anticholinergic Risk Scale, the Durán list). The association between cognitive decline and time‐varying anticholinergic exposure [primary analysis using the Durán list and maximal anticholinergic score (0, 1 or 3)] was assessed using Cox proportional hazards models. Other cognitive decline definitions were used in sensitivity analyses. Results At baseline, among 1396 patients included, 7.4–23.5% were exposed to anticholinergic agents, depending on the anticholinergic scale used. Sixty‐four per cent of participants experienced cognitive decline during follow‐up. Regardless of the anticholinergic scale/exposure measurement used, no significant association was observed with cognitive decline {primary analysis: compared with non‐anticholinergic agent users, hazard ratio [HR] = 1.14 [95% confidence interval (CI) = 0.95, 1.38] for anticholinergic score = 1; HR = 0.92 [95% CI = 0.65, 1.30] for score = 3}. Results were stable in sensitivity analyses. Conclusion We found no significant association between anticholinergic exposure and cognitive decline in older adults using anticholinergic scales and definitions of exposure