PubMed Health⌕ Search

Biomedical subjects

C Trivalle

Publications and source records attributed to C Trivalle.

At least 19 recordsLinked to original sources
PubMed2005

[Use of low molecular weight heparin for medical prophylaxis by European geriatricians].

PURPOSE: Many hospitalised elderly patients are at increased risk of venous thromboembolism (VTE). The aim of this study was to assess the rate and duration of medical utilization of low molecular weight heparin (LMWH) for VTE prevention by European geriatricians. METHOD: A questionnaire was sent to 94 geriatricians of the European Academy for Medicine of Ageing (EAMA), to be filled out for each patient older than 65 years of their institutions who received LMWH during 1 day of December 2000. RESULTS: In the 37 centers that participated (representing 11 different European countries) 2912 patients were present on the day of the study: 857 patients in acute care, 367 in rehabilitation care, 1568 in long-term care and 141 in day hospital. Prophylaxis by LMWH was given to 284 medical patients (9.75%, mean age 82.2 years). Use of LMWH was more frequent in acute and rehabilitation care (22.4% and 9.8%) than in long-term care (3.1%). The main risk factors in patients with LMWH prophylaxis were: bedridden (53%), infectious disease (18%), heart failure (17.6%), venous insufficiency (17.6%), paralysis of lower limbs (16.6%), recent stroke (15%) and malignancy (10%). The duration of the treatment for VTE prophylaxis exceeded 30 days in 51 patients (12%) and one year in 15 patients (3.3%). CONCLUSION: In Europe, VTE prophylaxis by LMWH is widely used in elderly medical patients without specific guidelines in this population. Further studies are necessary to evaluate the appropriate duration of prophylaxis in very prolonged immobilization.

Aged↗
PubMed2001

[Heparin use in geriatrics and risk profiles of treated patients. A survey in France].

OBJECTIVES: Nursing home residents and geriatric ward patients have a high risk of venous thromboembolism. Prevention is a major challenge. We conducted a one-day audit to ascertain heparin use patterns in a large sample of geriatric facilities in France. METHODS: This one-day audit was made with a questionnaire mailed to 150 geriatric centers in France. Items were the number of subjects receiving heparin on the day of the survey, and for each of these subjects, the reason for the prescription, risk factors for venous thromboembolism and date of treatment onset. RESULTS: Ninety-six centers (63%) participated. These centers had 14,208 beds the day of the survey (short-term hospitalization, day-care hospitalization, nursing homes, retirement homes). These centers reported 1,312 subjects (9.2%) receiving heparin on the day of the survey. Their mean age was 83.4 days. Among the hospital centers, heparin had been prescribed in 33.4% of the short-term hospitalization patients, 27.3% of the day-care patients, and 5.6% of the nursing home patients. Heparin was prescribed for prophylaxis in 1,143 patients (87%)--basically low-molecular-weight heparin. These patients had on the average 3.33 risk factors. The duration of preventive treatment was more than 30 days in 481 subjects (50%) and 161 (17%) had received heparin for 6 months or more. CONCLUSION: Prevention of venous thromboembolism is a major concern in geriatric centers in France. Although the preventive efficacy has not been clearly demonstrated in geriatric medical patients, low-molecular weight heparin is widely used for this purpose with, in a large number of cases, very long treatment durations.

Aged↗
PubMed2000

Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue.

The secretion and the blood levels of the adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) decrease profoundly with age, and the question is posed whether administration of the steroid to compensate for the decline counteracts defects associated with aging. The commercial availability of DHEA outside the regular pharmaceutical-medical network in the United States creates a real public health problem that may be resolved only by appropriate long-term clinical trials in elderly men and women. Two hundred and eighty healthy individuals (women and men 60-79 years old) were given DHEA, 50 mg, or placebo, orally, daily for a year in a double-blind, placebo-controlled study. No potentially harmful accumulation of DHEAS and active steroids was recorded. Besides the reestablishment of a "young" concentration of DHEAS, a small increase of testosterone and estradiol was noted, particularly in women, and may be involved in the significantly demonstrated physiological-clinical manifestations here reported. Bone turnover improved selectively in women >70 years old, as assessed by the dual-energy x-ray absorptiometry (DEXA) technique and the decrease of osteoclastic activity. A significant increase in most libido parameters was also found in these older women. Improvement of the skin status was observed, particularly in women, in terms of hydration, epidermal thickness, sebum production, and pigmentation. A number of biological indices confirmed the lack of harmful consequences of this 50 mg/day DHEA administration over one year, also indicating that this kind of replacement therapy normalized some effects of aging, but does not create "supermen/women" (doping).

Absorptiometry, Photon↗
PubMed2000

[Characteristics of pain and pain management in the elderly].

A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to suffer from many acute and chronic conditions. DIFFICULT ASSESSMENT: Clinical assessment of pain often depends on the patient's ability to communicate his or her experience. If self-assessment of pain is not possible, behavioral hetero-evaluation instruments have been built for easy pain assessment by caregivers. ADJUSTED PAIN MANAGEMENT: As for younger patients, the most common strategy for pain management is the use of analgesic drugs. Special care should be taken however when such drugs are initiated in the elderly because increased sensitivity, prolonged drug half-life and adverse effects and drug interactions are more likely.

Aged↗
PubMed2000

Does treatment of constipation improve faecal incontinence in institutionalized elderly patients?

OBJECTIVE: to evaluate whether faecal incontinence can be improved by treatment of constipation in elderly patients with faecal incontinence associated with impairment of rectal emptying. DESIGN: a prospective randomized study with a 2-month follow-up. SETTING: five long-term care units. SUBJECTS: 206 patients with daily faecal incontinence associated with chronic rectal emptying impairments such as faecal impaction received either a single osmotic laxative (group I) or an osmotic agent along with a rectal stimulant and weekly enemas (group II). MEASUREMENTS: episodes of faecal incontinence and associated details of soiled laundry (used as indicators of the workload for caregivers). We performed periodic digital rectal examinations on group II patients to evaluate whether treatment resulted in complete and long-lasting rectal emptying. We compared data between groups and in group II between persistently constipated patients and patients with complete rectal emptying. RESULTS: the frequency of faecal incontinence did not significantly differ between the two groups. The 23 patients in group II who had complete rectal emptying had 35% fewer episodes of faecal incontinence and 42% fewer incidents of soiled laundry than the rest of the group. CONCLUSIONS: when long-lasting and complete rectal emptying is achieved by laxatives, the number of episodes of faecal incontinence as well as the workload for caregivers is reduced.

Aged↗
PubMed1999

[Drug use in the elderly. Undesirable drug effects in the elderly: epidemiology and prevention].

A COMMON PROBLEM: Adverse drug effects are common and severe in patients over 70. Most concern widely prescribed drugs or drugs with small safety margins. CLINIC: It is important to recognize the most frequently encountered modes of expression including cardiovascular, metabolic and neuropsychiatric manifestations. The effects of bleeding and low blood sugar are particularly severe. PREVENTION: Certain pharmacological favoring factors are closely related to the aging process. A large number of iatrogenic side effects could however be avoided if the patientís clinical situation is carefully considered in light of the risk of drug interactions, the patientís behavior (observance errors), or prescriber behavior (inappropriate prescriptions in light of the therapeutic goals).

Aged↗
PubMed1998

Nosocomial febrile illness in the elderly: frequency, causes, and risk factors.

BACKGROUND: Although nosocomial febrile illness (NFI) is common in hospitalized patients, it has been less extensively studied in the elderly. OBJECTIVE: To determine the frequency, causes, and risk factors of NFI in elderly inpatients. METHODS: This prospective study involved 608 patients (> or = 65 years of age) admitted in an acute geriatric unit. Investigators followed this cohort until 1 of the following events occurred: development of NFI, discharge from the geriatric unit, or death. The cause of NFI was classified into 3 groups: infectious, noninfectious, and no apparent diagnosis. We systematically studied 17 comorbid conditions, 6 drugs, and 7 invasive procedures. For comparison, the patients were stratified into 2 groups: patients with NFI and patients without NFI. RESULTS: Sixty-six patients (10.9%) with NFI were identified. They were compared with the remaining 542 patients without NFI. In 49 patients (74%) with NFI, the cause was infectious; in 9 (13.5%), it was noninfectious; and in 8 (12.5%), there was no apparent cause. After multivariate analysis, only fecal incontinence (odds ratio [OR], 5.54; 95% confidence interval [CI], 2.13-14.5), congestive heart failure (OR, 2.97; 95% CI, 1.53-5.76), and pressure ulcers (OR, 2.93; 95% CI, 1.19-7.17) were independent risk factors for NFI. The number of invasive procedures preceding the febrile episode was a significant predictor of infection (OR, 3.68; 95% CI, 1.14-9.21). CONCLUSIONS: Nosocomial febrile illness is a common event in elderly hospitalized patients. In 74% of the patients with NFI, an infection is found. Measures to decrease infectious NFI in the elderly require a reduction in the number of invasive procedures.

Aged↗
PubMed1998

Group B streptococcal bacteraemia in the elderly.

The aim of this retrospective study was to determine the clinical spectrum of group B streptococcal (GBS) bacteraemia in patients over 70 years old. Sixty-six adults with GBS bacteraemia were reviewed over a 5-year period. Disease characteristics, clinical diagnoses and underlying disease were compared in 33 older patients (mean age 82.4 years) and 33 younger patients (mean age 54.2 years). The older patients were also compared with a control group (mean age 81.3 years). Urinary tract infection (39%), skin infection (33%) and pneumonia (24%) were the most frequent clinical diagnoses in older patients. Urinary tract infection (39% versus 6%) was significantly more frequent in older than in younger patients. One underlying disease and one condition were more frequent in elderly patients: congestive heart failure (39% versus 6%) and being bedridden (36% versus 0%). A comparison with the older control group showed that being bedridden was highly associated with GBS bacteraemia and was an important mortality factor amongst older patients (10% versus 30%). In conclusion, GBS disease in the elderly was found to be a severe clinical problem with a high mortality despite appropriate treatment.

Adult↗
PubMed1997

[Infectious complications of implantable infusion ports in patients with HIV infection].

Thirty-four implantable ports were consecutively implanted in 27 AIDS patients (mean CD4 lymphocyte count: 39/mm3) from January 1993 to December 1995. We observed 33 complications in these patients. Perioperative complications included: one pneumothorax (3%), one haematothorax (3%) and one septic shock (3%). Later complications included one venous thrombosis (3%) and 26 infectious complications (79%). Fever of unknown origin was observed in three patients (9%). A total of 19 bacteremias occurred in 12 patients. The global rate of infection for 100 catheter-days was 0.51 for a total of 5,096 catheter-days. The following microorganisms were isolated: Staphylococcus (n = 21; 72%), Pseudomonas (n = 3; 11%) and others (n = 5; 17%). Thirty-eight percent of the ports (n = 13) were removed, after a mean of 89 days. During the study, 21 patients died. Two patients died from a catheter infection with septic shock (8%). It seems to be important to clearly define the indications of implantable infusions ports in AIDS patients with respect to their life expectancy.

Adult↗