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Biomedical subjects

C Colin

Publications and source records attributed to C Colin.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Hidden factors of breast cancer: recommended follow-up for hyperplasia or carcinoma in situ].

After the diagnosis of breast epithelial hyperplasia or carcinoma in situ, the clinical follow-up must take into account several parameters. First, the adequacy of the diagnostic and the therapeutic approach is to be evaluated. Second, the patient must be informed of her risk of subsequent breast cancer. In such a protocol, one can recommend a program of close follow-up in an attempt at early detection. An annual clinical examination combined with a mammographic and a sonographic exam is considered as the method of choice. In between annual check-ups, clinical exam is encouraged. The potential benefits of magnetic-resonance imaging in these circumstances is currently evaluated. In rare instances, the absolute risk of breast cancer is so high that a prophylactic mastectomy can be considered.

Breast Neoplasms↗
PubMed1999

Wound infection in open versus laparoscopic appendectomy. A meta-analysis.

The authors performed a meta-analysis to determine whether open or laparoscopic appendectomy would reduce wound infection incidence in adult patients with acute appendicitis. The meta-analysis included nine of seven patients from eight randomized controlled trials. Data were analyzed using the fixed effect-model method of Mantel-Haenszel. Wound infection incidence was lower in the laparoscopic group.

Acute Disease↗
PubMed1998

Specific pattern of nitric oxide synthase expression in glial cells after hippocampal injury.

In the central nervous system (CNS), nitric oxide (NO) is thought to be involved in a variety of functions including synaptic plasticity, long term potentiation, and neurotoxicity. The aim of the present study was to investigate the expression of nitric oxide synthase (NOS) in the mouse CNS, following surgical injury to the hippocampus. NOS expression was assessed by histochemical detection of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-diaphorase) activity and immunohistochemistry of the inducible NOS (iNOS). Two days after injury to the CA1 hippocampal field, NADPH-diaphorase activity was detected in pyramidal and granular neurons and also in glial cells in the hippocampus, in contrast to the non-injured one where NADPH-diaphorase staining was observed only in a few interneurons. NADPH-diaphorase histochemistry combined with immunolabelling for GFAP and F4/80 demonstrated that these glial cells were astrocytes and microglia. This pattern of NOS expression is induced specifically after a hippocampal injury since lesion to the prefrontal or cerebellar cortex leads to NOS activity only in monocytes/macrophages like cells. Despite the large expression of NOS detected by NADPH-diaphorase histochemistry after lesioning the hippocampus, immunostaining for iNOS was confined to microglia. The fact that induction of high levels of NOS activity are detected in glial cells after a lesion to the hippocampus could be accounted for by the sensitivity of this structure to a high release of glutamate.

Animals↗
PubMed1998

Estradiol and progesterone regulate the proliferation of human breast epithelial cells.

OBJECTIVE: To study the effects of estradiol and progesterone on the proliferation of normal human breast epithelial cells in vivo. DESIGN: Double-blind randomized study. SETTING: Departments of gynecology and of cell biology at a university hospital. PATIENT(S): Forty postmenopausal women with untreated menopause and documented plasma FSH levels of >30 mIU/mL and estradiol levels of <20 pg/mL. INTERVENTION(S): Daily topical application to both breasts of a gel containing a placebo, estradiol, progesterone, or a combination of estradiol and progesterone during the 14 days preceding esthetic breast surgery or excision of a benign lesion. MAIN OUTCOME MEASURE(S): Plasma and breast tissue concentrations of estradiol and progesterone. Epithelial cell cycles were evaluated in normal breast tissue by counting mitoses and performing quantitative proliferating cell nuclear antigen immunolabeling analyses. RESULT(S): Increasing the estradiol concentration enhanced the number of cycling epithelial cells, whereas increasing the progesterone concentration significantly limited the number of cycling epithelial cells. CONCLUSION(S): Exposure to progesterone for 14 days reduced the estradiol-induced proliferation of normal breast epithelial cells in vivo.

Aged↗
PubMed1998

Perioperative artificial nutrition in elective surgery: an impact study of French guidelines.

OBJECTIVE: In France, the consensus conference, held on 16 December 1994, produced guidelines on perioperative artificial nutrition (AN) use in patients undergoing elective surgery. The aim of this study was to assess the impact of these guidelines on practice patterns. METHODS: The study was a practice pattern study with a 'before-after' design and a control group in England. A retrospective cross-sectional sample of adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus conference. RESULTS: Malnourished patients received postoperative AN in 94% of 'before' cases and 82% 'after' but inadequate preoperative AN (40% 'before' and 26% 'after'). Postoperative AN appeared to be over-prescribed in non-malnourished patients without prolonged postoperative fasting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' periods. CONCLUSION: This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in France and thus confirms the need to enforce the dissemination of the guidelines.

Adult↗
PubMed1998

Comparative assessment of digital and analog radiography: diagnostic accuracy, cost analysis and quality of care.

OBJECTIVE: The aim of this study was to compare digital and conventional radiography for diagnostic accuracy, direct costs, and quality of care. MATERIALS AND METHODS: Diagnostic accuracy was assessed by a critical review of the literature on sensitivity, specificity and ROC analysis of these imaging techniques and by a survey with a panel of radiologists. Direct costs and quality of care were evaluated with a before/after study of the implementation of digital radiography in a Department of Radiology in 'Hospices Civils de Lyon' (France). We included 292 patients and measured duration of examinations and direct costs of equipment, films, maintenance and depreciation. To evaluate any changes in working conditions and patient management, a questionnaire was filled out by the staff of the department. RESULTS: Diagnostic accuracy with digital radiography was equivalent to that of conventional radiography but there were wide variations depending on the type of examination. In 1993, although digital radiography resulted in savings of FF 18,000 including tax (US$ 3600) on film consumption for 1 year of examinations, there was a global additional cost of FF 253,000 (US$ 50,600) for maintenance and depreciation. Results showed a nonsignificant tendency to reduced procedure times for all examinations. Working conditions improved, including greater availability for the patient, improved safety, and increased job interest. CONCLUSION: Digital radiography can be introduced into a large hospital to improve patient and staff conditions, at a higher cost than analog radiography, and depending on the type of examinations performed by the radiology department.

Cost Savings↗
PubMed1998

Semiological value of ABCDE criteria in the diagnosis of cutaneous pigmented tumors.

OBJECTIVE: The aim of this study was to evaluate the semiological value of the so-called ABCDE criteria in the differential diagnosis of pigmented tumours. Aside from the classical ABCD criteria, an E criterion for 'enlargement' is studied. MATERIAL AND METHODS: Records from melanoma patients were obtained from a melanoma database prospectively including patients treated for melanoma in our department since 1992; 460 files were found informative for this study. A prospective control group was established including 680 cases of benign pigmented tumors. All cases included in the study were histopathologically controlled in our dermatopathology unit. Records of ABCDE, i.e. corresponding to asymmetry, irregular borders, irregular coloration, diameter > or = 6 mm and enlargement, were codified as present or absent in every case. Data were statistically compared for every individual criterion with the chi 2 test and for the number of criteria present in melanoma versus other pigmented tumors with Student's t test. RESULTS: Significant differences were observed for all individual criteria (p < 0.001) between melanomas and common nevi. Significant differences were also observed for B, C and E criteria between melanomas and atypical nevi. The sensitivity of the individual criteria for the diagnosis of melanoma was 57, 57, 65, 90 and 84% for ABCDE, respectively. The specificity of the individual criteria for the diagnosis of melanoma versus other pigmented tumors was 72, 71, 59, 63 and 90% for ABCDE, respectively. The number of criteria present was significatively different between common nevi (1.24 +/- 1.26) and melanomas (3.53 +/- 1.53; p < 0.001) and between common nevi and atypical nevi (3.62 +/- 0.83, p < 0.001), but no significant difference was found between melanomas and atypical nevi. Sensitivity and specificity of diagnosis of melanoma are 89.3 and 65.3% if 2 criteria are present. Sensitivity and specificity of diagnosis of melanoma are 65.5 and 81% if 3 criteria are present. CONCLUSION: The so-called ABCD criteria have a good semiological value in the differential diagnosis of pigmented tumors. Addition of an E criterion for enlargement optimizes sensitivity and specificity of diagnosis.

Diagnosis, Differential↗
PubMed1998

[Quality assessment of the medical information on the standardized discharge summary].

BACKGROUND: DRG-based management of public hospitals in France involves the use of standardised discharge abstracts for the "Medicalisation of Information Systems Program". METHODS: To assess the quality of the medical information in these abstracts, a sample of 649 abstracts for 1994 was collected from the Hospices Civils de Lyon's data base. To validate the information in these abstracts, we reviewed the medical records of each patient. RESULTS: The results showed an error rate of 32% (CI: 28-36) for the diagnosis-related group and an error rate of 40% (CI: 36-44) for the principal diagnosis. There was no significant difference between these error rates and the calculation of "Indices Synthétiques d'Activité" (French system for attributing points to hospital stays according to DRGs categories). CONCLUSIONS: The quality of the medical information for the "Medicalisation of Information Systems Program" remains a major challenge not only for budget allocation, but also for the study of the case-mix in hospitals.

Adult↗
PubMed1998

[Evaluation of information for renal insufficiency patients before dialysis].

The aim of this audit was to assess the quality of information given to patients before dialysis and to improve the use of this information on the acceptability of the treatment. Methods were those used in medical audit: retrospective data collection in a sample of patients, comparison to a set of standards given by professionals and recommendations disseminated in the group of professionals. Results showed that patients received a partial information on the various techniques used in dialysis. More complete information is needed. Recommendations consisted in a specialised team giving a detailed information on the disease and the techniques used in dialysis, with a psychological assistance. After implementation of this team, re-assessment showed a consistent benefit of structured information and entailed the necessity to improve the process of information delivery by general practitioners and specialists.

Adult↗
PubMed1998

[National study of screening practices for hepatitis C among hemodialysis patients. Hepatitis Group].

French and American consensus conferences on hepatitis C confirmed the burden of that disease, especially in high risk populations. In France, the seroprevalence of HCV is about 20% among haemodialysed patients. This study aimed at describing the French screening practices in haemodialysed patients. In 1995, 1213 self-administered questionnaires were sent to nephrologists working in 715 dialysis units. The response rate was 48% (585/1213) and 485 questionnaires were analysed. In 98% of questionnaires nephrologists answered that they prescribed screening test. Routine screening with alanine amino-transferase (ALT) was reported in 98% of questionnaires, usually once a month (57%) or four times a year (23%). Routine anti-HCV serology was reported by 96%, usually once (28%) or twice (46%) a year. The two main annual strategies combining ALT and anti-HCV serology were 12 ALT and 2 serologies (21%), or 12 ALT and 1 serology (14%) per year. HCV RNA detection was reported mainly in the case of positive anti-HCV serology (70%). The study suggested heterogeneity in screening practices and revealed the need to determine the cost-effectiveness ratios of the various strategies.

Adult↗
PubMed1998

[The impact of the data collection method on the medico-economic classification of admissions for myocardial infarction at the public hospitals in Lyon].

The aim of the PMSI (Programme de Médicalisation du Système d'Information) is to describe the activity of hospitals for budget allocation. To control the quality of this information, the authors carried out a study comparing the classification in homogenous disease groups (HDG) obtained from the PMSI with that obtained from the epidemiological data base of the PRIMA trial for patients admitted to the Civil Hospitals of Lyon for myocardial infarction between September 1st 1993 and January 31st 1995. Six hundred and fifty standardised hospital summaries were reconstituted form PRIMA data and grouped using the GENRSA 3 software. Five hundred and forty-one of these hospital stays were found in the PMSI data base and grouped. The concordance not due to chance between the two classifications was then assessed by the global kappa coefficient. It was less than the 40% threshold under which concordance not due to chance is considered to be unlikely. The discordances were essentially due to the presence of an associated diagnosis classifying the hospital stay in the HDG corresponding to complicated myocardial infarction. The presence of a classifying associated diagnosis was observed significantly more often in the PRIMA than in the PMSI data base. This results in an underestimation of the hospital activity and could have important repercussions in terms of budget allocation.

Budgets↗
PubMed1998

[Perception of social support given by health professionals according to the participants in a prenatal prevention program who live in extreme poverty].

One of the essential elements of the "Programme intégré de prévention en périnatalité--Naître-égaux-Grandir-en-san t" (Born Equal--Brought up Healthy) is to have a health professional offering general support to pregnant women living in poverty. This research is based on a secondary analysis of the transcriptions of interviews done in order to implement the program. The thematic content analysis was employed to analyze the women's perception of the support provided by the health professional, the relationship between client-professional, and the perceptions of these women about the impact that the social support had on their pregnancy experience. The categories of support that emerged from the analysis are: information support, emotional support, instrumental support, changing life style support, recreational support, and availability of support. The categories of impact perceived by the participants are: learning, changes in life style, to be in a good mood, and the use of community resources. A key element in the perception of support by the participants is the establishment of a relationship of trust between professional and client. This relationship of trust is important to the development of intimacy and to foster the perception of a more intense kind of support. Hence social support and the relationship of trust work in synergy and reinforce each other.

Attitude to Health↗
PubMed1997

[Evaluation of the hospital management of insulin-dependent diabetics].

OBJECTIVE: There is a known relationship between blood glucose control and development or progression of complications in diabetes mellitus. The aim of our study was to assess the quality of hospital care in patients with insulin-dependent diabetes. PATIENTS AND METHODS: A prospective study was conducted over a 6-month period (April 95-September 95) to perform a clinical audit comparing results obtained with care standards. The study group included 257 consecutive patients (age range 15-39 years) who consulted the hospital outpatient clinic of were hospitalized for insulin-dependent diabetes mellitus RESULTS: Results differed depending on the care standards used for comparison. There were 45 patients (17%) who consulted 4 times or more; 43% of the patients were not hospitalized and 32% did not had a fundus examination during the preceding year. There was a 51% deviation from the standard number of capillary blood glucose measurements and 72% of the patients stated they adapted their insulin dose. Mean glycosylated hemoglobin level (HPLC method) was 9.78 +/- 2.37% (standard = 7%). CONCLUSION: This assessment of hospital care demonstrated a deviation of medical surveillance from standard care. More frequent consultations would help improve patient information. It is important to recall that an annual hospitalization and rigorous application of clinical surveillance with annual fundus examination are essential. Information provided by physicians, nurses and dietitians should be an integral part of hospital care. Likewise, it is undoubtedly useful to provide psychological counselling for diabetic patients. A reassessment should evaluate the impact of such recommendations in order to determine the impact, in terms of reduced mortality, of improved hospital care.

Adolescent↗