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Biomedical subjects

A S Poisson-Salomon

Publications and source records attributed to A S Poisson-Salomon.

At least 19 recordsLinked to original sources
PubMed2000

Simple pediatric nutritional risk score to identify children at risk of malnutrition.

BACKGROUND: Although hospitalized children are at risk of malnutrition, routine screening of nutritional status has been hindered by lack of a validated nutritional assessment tool. OBJECTIVE: Our aim was to develop a simple pediatric nutritional risk score that could be used at hospital admission to identify patients at risk of acute malnutrition during hospitalization. DESIGN: Nutritional risk was assessed prospectively in 296 children. Anthropometric measurements, food intake, ability to eat and retain food, medical condition, and symptoms interfering with feeding (pain, dyspnea, and depression) were evaluated within 48 h of admission. Pathology was classified as mild (grade 1), moderate (grade 2), or severe (grade 3). The risk of weight loss was investigated with stepwise logistic regression. RESULTS: Weight loss during hospitalization occurred in 65% of the children and was >2% of admission weight in 45% of patients. Multivariate analysis indicated that food intake <50%, pain, and grade 2 and 3 pathologic conditions (P = 0.0001 for all) were associated with weight losses of >2%. The nutritional risk score ranged from 0 to 5 and was calculated by adding the values for the significant risk factors as follows: 1 for food intake <50%, 1 for pain, 1 for grade 2 pathologic condition, and 3 for grade 3 pathologic condition. A score of 1 or 2 indicated moderate risk and a score >/=3 indicated high risk of malnutrition. CONCLUSIONS: This simple score is suitable for routine use to identify patients at risk of malnutrition during hospitalization. Implementation may prevent hospital-acquired malnutrition.

Child↗
PubMed1999

[Impact of French consensus conference concerning the follow-up of patients surgically treated for stage I melanoma among French dermatologists and oncologists].

INTRODUCTION: Our aim was to assess the impact of the 1995 French Consensus Conference (CC) on the follow up of patients surgically treated for WHO stage I (AJCC/UICC stages IA to IIB) melanoma, two years after the recommendations had been provided to French dermatologists and oncologists by direct mailing and literature. Prior to this CC, a study of French dematologists' intentions of practice and dermatologists and oncologists effective practices had revealed a lack of homogeneity and the prescription of many paraclinical tests. MATERIAL AND METHODS: In 1997, we sent a questionnaire similar to 1995's one to French dermatologists (3585 practitioners) and oncologists (686), with a pre-paid envelop for the response. The statistical analysis compared these results with those of 1995 for dermatologists, and the results for dermatologists and oncologists using chi(2) test. RESULTS: The response rate was 29 p. 100 for dermatologists, 15 p. 100 for oncologists. Only the number of dermatologists following patients in private practice was increased. Prescriptions of paraclinical tests by dermatologists during initial investigation as well as during follow up dramatically decreased (-30 p. 100 to -50 p. 100), mainly for thoracoabdominal and brain computerized tomography scans and biological tests, to a lesser extent for chest X-rays and abdominal ultrasonographies. Prescriptions of paraclinical tests were higher among oncologists. The frequency of clinical surveillance in 1997 was more often as recommended. Detection of a second melanoma in the patients and their family had improved. However, oncologists' intentions of practice complied less to the CC as compared to dermatologists. DISCUSSION: This study clearly showed an impact of the CC in French dermatologists' intentions of practice leading to both an improvement of patient follow up and a reduction in its cost. This impact was not as great among oncologists.

Consensus Statements as Topic↗
PubMed1999

[Implication of French general practitioners in the follow-up of patients surgically treated for stage I melanoma].

INTRODUCTION: Our aim was to assess the implication of French general practitioners in the follow up of patients surgically treated for stage I melanoma 2 years after the publication of the 1995 French consensus conference recommendations. MATERIAL AND METHODS: In 1997, we sent a questionnaire to all the general practitioners of Hauts-de-Seine department (n = 1000). In that department, specific training on this topic had been conducted in 1996. RESULTS: The response rate was 12.4 p. 100. Follow up was performed in association with a dermatologist or a oncologist by 97 p. 100. There was a high rate of non-response for questions concerning follow up which reached 30.4 p. 100 for thick melanomas. DISCUSSION: Because of the low response rate, the interpretation of these results must be interpreted with precaution. Dermatologists seem to be the general practitioners' preferred correspondents for patients with melanoma.

Consensus Statements as Topic↗
PubMed1996

[Audit of the management of postoperative pain].

OBJECTIVE: The aim of this study was to assess the incidence and severity of postoperative pain in patients undergoing operations in various surgery clinics in the Assistance Publique des Hôpitaux de Paris (AP-HP) and to evaluate management of pain during the 24 hours following surgery. METHODS: Data from surgical and anesthesia observation sheets and from patient complaints collected in a one-day external audit were obtained for 96 surgery clinics in the AP-HP. RESULTS: At the time of surgery, most patients were receiving opioids, especially fentanyl: low dose ( < 1 microgram/kg/h) was given in 17.1% of the patients and regional anesthesia was used in 13%. In 95% of the cases, postoperative orders were written by anesthesiologists. Initial orders were modified according to patient response in 11.8% of the cases. "On demand" prescriptions were used in 10% of the orders. Patient controlled analgesia and regional analgesia were not routine techniques (2 and 0% respectively). Finally, 37.8% of the patients were given a single prescription of a step-1 drug (e.g. propacetamol i.v.), 25.9% a step-2 drug either alone or in combination with a step-1 drug, and 28.9% of the patients were given strong opioids at least once. CONCLUSIONS: For all types of drugs, dosage level was considered as correct in 86.5% of the cases. For approximately 10% of the opioid prescriptions, an ineffective dose was used. The interval between doses was too long in 54.1% of the prescriptions for at least one drug (e.g. for peripheral analgesia with propacetamol). The incidence of severe pain was 46.4%, especially after abdominal, high urologic and back surgery.

Analgesia↗
PubMed1995

[Unilateral inguinal hernia in infants: costs, risks and benefits of herniography? Methodology].

AIM: To assess the validity and the interest to health of systematic herniography in cases of unilateral inguinal hernia in children under two years of age. METHOD: Decision theory was used to assess the effect of herniography on individual health by estimating gonadic benefit and establishing a benefit-risk ratio, and on collective health by the use of cost-effectiveness analysis. RESULTS: a decision tree and algorithms were developed. DISCUSSION: Decision analysis is used in complex medical decision making, clarifying choices and subdividing a problem into several more manageable sub-problems. The threshold approach pinpoints factors requiring more information.

Cost-Benefit Analysis↗
PubMed1995

[Unilateral inguinal hernia in infants: costs, risks and benefits of herniography? Results].

AIM: To assess the advantages of systématic herniography in cases of unilateral inguinal hernia in infants. METHOD: Decision analysis presented in the first part of this article was used. A preliminary retrospective study of 348 cases as well as a literature review were utilized to determine the probabilities required in order to create and run the decision aid algorithm. Gonadic benefit was used as the health indicator. RESULTS: For males, gonadic benefit procured by the herniography depends on the risk of strangulation in cases of groin hernia and on the frequency of testicular atrophy after inguinal hernioplasty. The evaluation of these two elements largely determines the choice of medical and surgical practices. For a 0.44% risk of post-operative testicular atrophy and a risk of strangulated hernia estimated at 20%, the cost-effectiveness ratio is FF, 199681 to save a testicle. One testicle is saved every 455 herniographies, with 24 possible post-examination complications. For female, herniography provides no gonadic benefit. DISCUSSION: Decision analysis permits the quantification of results, leading to improved clinical judgement and facilitating the evaluation of medical practice.

Atrophy↗
PubMed1995

[Medical and social factors in the orientation of patients with AIDS after discharge].

The objectives of this cohort survey performed in acute care patients were to identify and to describe HIV patients needing long-term care with or without daily assistance (home care of health care institutions). This exhaustive sample was recruited from among the hospitalized AIDS patients of fifteen departments of Assistance Publique-Hôpitaux de Paris; 24% of them required post-discharge medical care (home care or health care institutions). The effects of different factors were assessed to explain the choice of home care or various health care institutions: medical reasons, type of care required, functional disability, and socio-economic conditions. Home care patients had complex care needs, parenteral treatments mainly related to Cytomegaloviral retinitis, and poor functional status. They had a favourable socio-economic environment and help with household activities. Two groups of patients were sent to health care institutions. The first, comprised patients in very poor functional or/and mental conditions, especially in the terminal stage of central nervous system illness. The second, included patients with acceptable functional status, multiple pathologies, and poor socio-economic conditions. After adjustment, significant factors influencing the possibility of home care were: a previous successful home care experience and a high educational level. The factors limiting the possibility of home care were important neurologic symptoms, drug use, living alone and poor lodgings. The results of this study suggest that it would be necessary to increase the availability of long term care facilities for persons with AIDS and develop earlier medico-social follow-up, in order to anticipate the problems related to bad socio-economic conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Evaluation in gynecology and obstetrics. Propositions for routine evaluation of professional practices].

All the scientific prerequisites for auditing Gynaecology-Obstetrics clinics are currently available. Nevertheless, it is often difficult to usefully evaluate routine decision making. The aim of this paper was to offer matter for thought concerning the choice of methods and themes to be used in evaluating routine management in Gynaecology-Obstetrics clinics. Several methods are discussed, including monitoring synthetic indicators and complex evaluation of routine decision making (relationship between recruitment, practices and results). Details of this latter method were presented with several examples: prematurity prevention, perinatal mortality and morbidity, screening tests and antenatal diagnosis, cesarean section.

France↗
PubMed1994

[Evaluation of hospital care. An experiment at the Public Assistance Hospitals in Paris].

Since 1990 the Assistance Publique--Hôpitaux de Paris (AP-HP) developed a policy of health care assessment in agreement with the implications of the law of July 31, 1991. The department of Evaluation of health care, in close collaboration with the local Committees which operate in most of the hospitals of AP-HP, performed during the last three years about fifty studies dealing with two main topics: professional procedures and quality of care. Through three specific selected studies, the authors emphasize the requirements of an assessment policy to efficiently contribute to the improvement of quality of care.

Hospitals, Public↗
PubMed1989

Intra-uterine growth: a comparison of longitudinal and cross-sectional approaches.

The great majority of the fetal growth curves are constructed through a cross-sectional approach. Before the use of ultra-sonography, fetal growth was first evaluated from birthweights of infants born at different gestational ages. More recently, curves were established for different ultrasonographic parameters which combination can provide an immediate but imperfect evaluation of fetal weight. All the curves used as standards of normal growth derive from cross-sectional studies. Several longitudinal studies of fetal growth exist, with two aspects. The first method is to make serial measurements at special intervals, among a group of fetuses with known dates of conception, in order to determine average longitudinal curves. The aim of the standards of fetal growth is obstetric management and the threshold of a percentile, for instance the tenth, of an ultra-sonographic parameter can define the intra-uterine growth retardation. The result of the fetal growth is evaluated with the standards of birthweight which define the small for gestational age infant. Another longitudinal approach is the use of a mathematical growth model to establish an individual growth curve, each fetus is then its own control. This last approach still belongs to the research field.

Birth Weight↗
PubMed1987

Distribution of ultrasound examination during pregnancy in France between 1976 and 1981.

In France, between 1976 and 1981, the use of ultrasound examination during pregnancy increased from 11.3 to 81.8%. In spite of this dramatic increase, many inequalities observed in 1976 still exist in 1981. Despite a decrease in 1981 of the differences in practice in public maternity units and private care units, large differences remained between general practitioners and specialists. In a logistic regression, the type of practitioner responsible for care appeared to be the most important factor determining access to ultrasound examination. Independent of other inequalities in the type of antenatal care, three groups of women remained disadvantaged in 1981: women under 20 years old, grand multiparas and women of low educational level. The latter group was particularly disadvantaged. Obstetric pathology has little influence on the overall distribution of ultrasound examinations.

Adult↗
PubMed1987

[Intrauterine growth retardation. Changes in obstetrical practice in France].

The change in practice in connection with fetal growth retardation was studied using two national enquiries on pregnancy and delivery carried out in 1976 and 1981. These showed important changes in practice between the two studies. Although ultrasound and fetal heart rate monitoring are widely used and are shown as being very important for pregnancies overall, they are not used more often in cases of fetal growth retardation. On the other hand, when they have been started these examinations are more often easily repeated. Recourse to hormonal essay has not changed in intra-uterine growth retardation cases (17%). The percentage of caesareans carried out for retardation rose from 9.4 to 17.4% and these caesarean operations were carried out earlier. 50% of this increase is due to the decision to carry out a caesarean before labour starts. This more aggressive tendency means that the number of premature babies in growth retarded infants was higher in 1981, although the difference not significant and this practice would need further study. There are improvements in neonatal health as a result of the changes although one cannot pinpoint for certain which procedure has caused this improvement.

Amniocentesis↗
PubMed1986

Can the number of cesarean sections be reduced without risk? An analysis of rates and indications in a university clinic.

This study concerns women followed from the first trimester of pregnancy, in a university clinic in Paris in 1977, 1979 and 1981. The cesarean section rate was separately analysed for primiparas, and multiparas with and without previous cesarean section. The overall rate of cesarean section was 11.4% in 1977, 17.2% in 1979 and 21.1% in 1981. The 9.6% increase observed between 1977 and 1981 is mainly attributable to an increase in primary cesarean section, particularly among primiparas, between 1977 and 1979. This does not seem to have arisen from sample variations. There is a change in obstetrical attitude and more cesarean sections are performed in cases of hypertension, breech presentation or intrauterine growth retardation. The greater number of previously sectioned women explains the increase in the rate between 1979 and 1981. The main fact among primiparas is the 18.8% increase in diagnosis of dynamic dystocia between 1979 and 1981. Three key areas allow us to envisage a reduction in cesarean section rate: obstetrical attitude towards previous cesarean section, breech presentation, and management of labor, whose perturbations lead to diagnosis of dynamic dystocia.

Academic Medical Centers↗