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Biomedical subjects

A Perrier

Publications and source records attributed to A Perrier.

At least 19 recordsLinked to original sources
PubMed2007

Ethical difficulties in clinical practice: experiences of European doctors.

BACKGROUND: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services. METHODS: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK. RESULTS: Survey respondents (n=656, response rate 43%) ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct (47.5%), someone capable of providing specific advice (41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help expected to be useful varied among countries. CONCLUSION: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries.

Adult↗
PubMed2006

[Primary prevention of gastroduodenal ulcer: what is the evidence?].

Primary prevention of gastroduodenal ulcer and its major complication, gastrointestinal bleeding, has been studied mainly in the intensive care environment. Proton pump inhibitors (PPIs), H2-receptor antagonists and sucralfate have proved effective. By extension, PPIs are inappropriately prescribed in a variety of clinical situations. In contrast, they are probably underused in patients chronically treated by nonsteroidal anti-inflammatory drugs. This article reviews the situations in which an increased ulcer risk justifies primary prevention. Validated prophylactic options are also addressed.

Aged, 80 and over↗
PubMed2006

[Deployment of a computerized physician order entry: description of the process and challenges].

The introduction of a system of computerized physician order entry (CPOE) decreases medication error rates by formalizing the drafting of the orders and providing alarms which announce potential side effects, drug interactions and overly high doses. The quality of the CPOE does not insure its success. Its deployment must be preceded by an assessment and update of the available computer resources, by training of the users and setting up a help-desk attainable 24 hours a day. The project must be lead by senior medical and nursing staff. A joint effort is the key to ensure the success of CPOE and facilitate its acceptability. CPOE provides opportunities for improving: patient safety, training of professionals, quality and efficiency of care. CPOE systems are an ideal basis to set up clinical protocols and clinical pathways.

Medical Order Entry Systems↗
PubMed2006

[Anticoagulants and cancer: beyond thromboembolic disease prevention].

The association between cancer and thromboembolic disease is well documented. The procoagulant capacity of tumor cells seems to be related to malignant transformation. In this context, a preventive effect on tumoral progression by the adjunction of an anticoagulant such as vitamin K antagonists, unfractionated heparin or low molecular weight heparin (LMWH) was studied. Some studies concluded to a modest increase in survival in patients treated by LMWH in adjunction to conventional chemotherapy and/or radiotherapy. This benefit seems to be related to an inhibitory effect on tumoral progression. LMWH seems promising in an eventual routine clinical use. However, their type, dose and duration and in which cancers has to be further defined.

Anticoagulants↗
PubMed2006

Statisticodynamical approach of final state distributions in associative desorptions.

In associative desorptions governed by short-range forces, strong energy transfers between rotational, translational, and vibrational degrees of freedom of the nascent molecule take place beyond the transition state (TS). State or energy distributions are thus different at the TS and in the vacuum. Inspired by previous studies on unimolecular reactions, a statisticodynamical approach (SDA) is proposed which combines the transition state theory for the description of state distributions at the TS and a simple dynamical model to account for the effect of the post-TS dynamics on these distributions. The agreement found between the predictions of SDA, the much more demanding classical trajectory calculations, and experimental results in the case of H(2) and D(2) desorbing from Cu(111) is very satisfying. In addition to that, the formulation highlights some key factors of state distributions which would have been difficult to directly extract from a dynamical study. The notions of vibrational heating and rotational cooling are discussed within this context.

Journal Article↗
PubMed2006

[The prognosis of pulmonary embolism: are there practical implications for patient management?].

There is growing evidence that outpatient treatment is safe and effective for many patients with non-massive pulmonary embolism. Despite this evidence, the vast majority of patients with non-massive pulmonary embolism continue to be treated in an inpatient setting. A major barrier to outpatient treatment has been the lack of explicit criteria to identify patients with pulmonary embolism at low-risk of adverse medical outcome. This article discusses new risk stratification tools for pulmonary embolism such as echocardiography, biomarkers, and clinical prognostic scores, and their potential application for patient management.

Anticoagulants↗
PubMed2006

[Nesiritide in heart failure: commercial success or therapeutic advance?].

Severe decompensated congestive heart failure unresponsive to conventional diuretic and vasodilator treatment is a clinical challenge. A new molecule, nesiritide or recombinant human BNP, has been recently successfully marketed in the U.S. due to its attractive physiologic effects. Unfortunately, the safety of nesiritide is now questioned based on two meta-analyses suggesting that nesiritide may be responsible for a worsening of renal function and an increased mortality. In the absence of further large scale studies with relevant endpoints, which are now unlikely to be conducted, nesiritide is rapidly disappearing from the therapeutic armamentarium.

Heart Failure↗
PubMed2006

Ten years after...

Explore the source record for details and available documents.

Administration, Oral↗
PubMed2005

Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age.

INTRODUCTION: The diagnostic value of clinical presentation of pulmonary embolism (PE) is uncertain in the elderly, who often have concomitant cardiopulmonary diseases that may mimic PE. The aim of our study was to assess the differential value of risk factors, symptoms and clinical signs of venous thromboembolism, results of electrocardiogram and chest X-ray for the diagnosis of PE in suspected patients according to age. METHODS: We analyzed data from two outcome studies which enrolled 1721 consecutive patients presenting in the emergency department with clinically suspected PE defined as acute onset of new or worsening shortness of breath or chest pain without any other obvious etiology. All patients underwent a sequential diagnostic work-up and a 3-month follow-up. RESULTS: The proportion of confirmed PE was 24.2% (416 of 1721). Strength of the association with PE did not differ according to age group for history of venous thromboembolism (VTE), recent surgery, tachypnea at admission or right ventricular strain on electrocardiogram. Active malignancy, hemoptysis, tachycardia, hemidiaphragmatic elevation and pleural effusion at chest X-ray were no more associated with PE in the patients aged of 75 years or more. Finally, symptoms and signs of deep venous thrombosis, and an alternative diagnosis less probable than PE were associated with PE in all age groups, but the strength of this association decreased significantly with advancing age. CONCLUSION: Some risk factors, symptoms and signs of VTE are less strongly or even not at all associated with PE in the elderly. Physicians should take this into account when attending elderly patients suspected of PE and when assessing their clinical probability of PE.

Age Factors↗