CTL cross reactivity between HIV strains.
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Antigenic Variation↗
Biomedical subjects
D Jolly
Publications and source records attributed to D Jolly.
How to induce physicians to engage in quality assurance activities in a university hospital: a policy.
This article reports on a 3-year quality assurance (QA) support activity in the Assistance Publique-Hôpitaux de Paris, a large university hospital system covering the Greater Paris area. This activity stressed the interprofessional and voluntary character of QA. As well as showing the traditional reservations that usually prevent physicians from embracing QA. French physicians have specific problems with the word "evaluation" that has for them greater monetary than scientific connotations. In addition, the above-mentioned reservations are aggravated by the background culture and career structure of university physicians in France. In spite of these initial difficulties the support programme succeeded in getting QA off the ground in 60 departments in 25 hospitals. The need for a well developed medical information system as an incentive for QA activities in AP is discussed.
France↗
[Evaluation of quality of care in the United States].
Quality assessment in the USA has been undertaken during the past twenty years by different institutions sponsored by the Congress, the government and professional associations. The evaluation tools which were developed reflect both the diversity of the American medical scene fashions in health care management. They evolved from norms to incentives, but each step in this evolution left its marks in the form of regulations, financial incentives and traditions.
Consensus Statements as Topic↗
[Hospitalization of foreign residents living abroad at the Assistance Publique--hospitals of Paris (1981-1988)].
In 1988, 10,386 foreign patients living abroad were hospitalized in the public Hospitals of "Assistance Publique" in Paris. Specific statistical methods starting from an anonymous file of patients, made it possible to study these hospital stays in terms of patients for each year between 1981 and 1988. Several factors are described: the various origins of the hospitalized patients; the overall decrease in the number of hospitalized patients during the period taken into account, with a detailed analysis for certain nationalities; the comparatively higher rate of tumors and cardiovascular diseases; the distribution of patients by diseases and by geographical origin. These data are in keeping with those of a recent survey on morbidity carried out by the Department of Health.
Ethnicity↗
[Effects of contrast media products on erythrocyte aggregation. An ex vivo study].
It has been suggested (Fisher and al., Rainiko and al.) that contrast media could interfere with a red blood cell aggregation, low-osmolarity and non ionic contrast media leading to red blood cell aggregates in vitro. Clinical significance of this phenomenon is not known. We have studied 21 consecutive patients admitted in X ray department for pyelography. Sodium and meglumine ioxitalamate (Telebrix 38 R; Guerbet) osmolarity 2 100 mOsm kg--viscosity 8.5 cp at 37 degrees C is used for contrast. Red blood cell aggregation is studied by erythraggregometer Sefam. Samples are collected before (T0), 10 and 30 minutes (T10, T30) after contrast infusion. Hemogram and coagulation parameters are measured in parallel. Results show a significant increase of aggregation times at T10, with a trend towards baseline at T30. Dissociation shear rates follow the same fluctuations. We note a concomitant diminution of both fibrinogen and hematocrit levels, well-correlated with red blood cell aggregation. These results suggest a process of hemodilution which could explain the diminution of red blood cell aggregation with this type of contrast medium.
Adult↗
Inhibin secretion during the rat estrous cycle: relationships to FSH secretion and FSH beta subunit mRNA concentrations.
Serum inhibin and FSH and FSH beta subunit mRNA levels were measured at 3h intervals throughout the 4 day estrous cycle in female rats and hourly between 1000 and 2400 h of proestrus. On proestrus, serum inhibin concentrations fell during the late morning-early afternoon, then increased transiently during the late afternoon gonadotropin surges. Inhibin levels decreased during the late evening of proestrus, coincident with the FSH surge-related rise in FSH beta mRNA levels. Serum inhibin remained relatively stable during estrus and early metestrus, but rose during the late evening of metestrus and remained elevated until early diestrus. FSH beta mRNA levels were elevated on late estrus and early metestrus and declined during the evening of metestrus as serum inhibin levels increased. These data show that concentrations of serum inhibin change during the estrous cycle and that a general inverse relationship exists between serum inhibin and FSH levels and FSH beta mRNA concentrations in the pituitary. This suggests that inhibin may inhibit FSH beta gene expression and FSH secretion during the 4 day cycle in female rats.
Animals↗
High technology in health care.
The structure of the Assistance Publique-Hôpitaux de Paris renders necessary an inhouse centralized technology assessment unit. This unit, named CEDIT (Committee for the Evaluation and the Diffusion of Innovative Technologies), has been functioning since 1982 and has advised the Director General on 70 new technologies, including the lithotriptor and plasma-exchange therapy. A particular feature of the CEDIT is that it is in charge of both the assessment and the implementation of the recommendations following this assessment. We attempt to describe the consequences of the CEDIT's functioning compared to other countries' technology assessment organizations.
Evaluation Studies as Topic↗
[Comparative study of antitoxoplasmic IgG isotypes titrated by high sensitivity direct agglutination and indirect immunofluorescence: consequence of the choice of methods on the expression of results in international units].
The use of International Units per ml (IU/ml) to express antitoxoplasmic IgG antibody titers in the various diagnostic systems presently proposed, is misleading owing to discrepancies in the values found from one test to the other for a given serum. The authors compared the results of high sensitivity direct agglutination (HSDA) to those of indirect immunofluorescence (IIF) in two studies, systematic and longitudinal, dealing with 158 sera stratified for values ranging from 102,400 to 5 IU/ml. Discordances between the methods, which are greater for high values, prompt the use of low-titer sera for standardization. From the systematic study, a correlation table was established and proposed to convert the HSDA results into the theoretical corrected values close to those that would be obtained by IIF. Although this may be of interest in maintaining a coherent language, this table has its limits, particularly in acute episodes where the various antibody kinetics vary and amplify further the discrepancies. In such situations, it seems advisable for both clinicians and biologists to raise any equivocal kept going by what is termed as International Units. Consequently, if the titers obtained by one method cannot be correlated to those of the technique of reference (IIF, Dye test), on the basis of using I.U., it would be appropriate to express the results in units related to the method or kit used (e.g. U/ml/HSDA for high sensitivity direct agglutination). Finally, whatever the technique, it is still mandatory to conserve a significant threshold value of protective immunization, common and identical to those classically adopted (8-12 IU/ml).
Adult↗
[Effect of contrast media products on the erythrocyte aggregation and deformability in vitro].
It has been suggested that contrast media could interfere with red blood cell aggregation, hyperosmolar media leading to an inhibition of red blood cell aggregation whereas non ionic products might induce a sludge phenomenon. We present an in vitro study accompanying two contrast media: 1) Ioxitalamate of sodium and meglumin (ionic, hyperosmolar). 2) Iopaminol (non ionic). In their effect on hemorheological parameters of red blood cell aggregation. Blood samples have been obtained from 7 healthy donors. Contrast media have been tested at increased contrast media (O.1, 1, 2, 10, 100 mg/ml of Iodine in final concentration). The following parameters have been studied: hematocrit, fibrinogen level, erythrocyte aggregation using the Erythro-aggregometer*, whole blood viscosity at 3 different shear rates (0.87, 18.74, 118 sec.-1) using Low Shear 30*. Deformability of red blood cell was assessed by ektacytometry. Osmolarity was controlled in each sample. Results show an inhibition effect of both contrasts media on red blood cell aggregation. There is a concomitant decrease of blood viscosity at low shear rates. On the contrary, apparent viscosity increases at high shear rates in parallel with the contrast media concentration. This effect is more pronounced with ioxitalamate above a concentration of 10 mg/ml. Ektacytometric parameters are not modified by contrast media and this could indicate a complete reversibility of the media-induced alteration on red blood cell. In order to precise the prothrombotic effect on contrast media, hemorheological studies have to be completed by the assessment of their effect on hemostatic parameters.
Adult↗
Evaluation of the efficacy of prophylactic intravenous antibiotherapy with ceftriaxone in post-chemotherapy agranulocytic patients.
A prospective study was carried out in 44 patients treated by intensive chemotherapy inducing a prolonged neutropenia (granulocytes less than 0.5.10(9)/l). All the patients were isolated in protected rooms, received a pathogen-free diet and nonabsorbable oral antibiotics. After double-blind randomization, 22 patients received 2 g of Ceftriaxone (Cef) in a daily infusion beginning on the first day of chemotherapy; and 22 patients received 2 g of placebo (P) under the same conditions. Prophylaxis was continued until the neutropenia resolved (granulocytes greater than 0.5.10(9)/l) or until the onset of infectious symptoms. 19 patients in each group developed febrile episodes, occurring significantly later in the Cef group (16.6 days versus 10.6 days in the P group). No Cef-resistant organism was isolated. Finally, the time at which apyrexia was obtained after the beginning of curative antibiotherapy was the same in both groups. The routine intravenous administration of Cef in combination with nonabsorbable antibiotics is a useful approach in reducing the risk of infection in the neutropenic host.
Adult↗
[Differential analysis of mitral and tricuspid regurgitation by continuous Doppler].
The following parameters have been measured by continuous Doppler in 40 patients with both mitral failure (MF) and tricuspid failure (TF): effusion time (ET), peak time (PT), maximum effusion speed (S. max), maximum anterograde speed (S. ant), taking into account the cardiac rate and the ejection fraction. Only the S. max. and the S. ant. are significantly different and enable the determination of the effusion origin with a percentage error of about 4%. When a straight line is drawn to joint 3.7 m/s on the ordinate (S. ant) and 5 m/s on the abcissa (S. max), the TF lie below the line and the MF above it. The selection of the sub-groups with low ejection fraction (less or equal to 30%) or with arterial pulmonary hypertension (S. max MF higher or equal to 3 m/s) does not modify the precision of the discrimination. The graph suggested seems therefore to be a rapid and reliable means of characterizing TF in order to assess the arterial pulmonary hypertension of dilated hypokinetic cardiomyopathies.
Adult↗
Preoperative anxiety and myocardial ischaemia: is there a relationship?
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Angina, Unstable↗
WHO's European member states look at quality assurance. Report on the technical discussions at the thirty-eighth session of the Regional Committee for Europe.
This paper is the report on the technical discussions on "Quality assurance of health services" at the 38th session of the WHO Regional Committee for Europe, one of the activities aiming at achieving WHO's regional health for all target 31, which requests WHO's Member States to establish a quality assurance mechanism. Attended by national health authorities and experts in quality assurance, the technical discussions identified the European context for developing quality assurance and looked at national initiatives. Having agreed that the question is no more, "Is there a need for quality assurance of health services?" but, "How can it best be carried out?", the participants identified a range of quality assurance activities at national and international levels, including national strategies and financial incentives, criteria for clinical practice, information systems and coordination and management mechanisms. The report concludes with recommendations for Member States on, for example, inclusion of quality assurance in national health policies, dissemination of information, research on quality assurance, information systems and role of professional organizations.
Europe↗
[Diagnostic, prognostic and therapeutic value of Doppler echocardiography in pulmonary embolism. Apropos of 41 cases].
In 41 patients with acute or recent pulmonary embolus (PE), a prospective study was conducted with cardiac Doppler sonography (CDS). The test is performed first in all patients, then immediately following a treatment fibrinolytics in 10 of them. The PE is confirmed by pulmonary angiography in 39 patients and embolectomy for the 2 patients who presented a mobile thrombus in the right atrium. A tricuspid insufficiency (TI) is almost always recorded by continuous Doppler: the systolic pulmonary artery pressure (sPAP) is calculated from the maximum velocity of the regurgitating tricuspid flow, using Bernouilli's equation. The correlation between Doppler sPAP and sPAP obtained by catheterization is: r = 0.95 (n = 34; p less than 0.001). A severe pulmonary hypertension, corresponding to a TI exceeding 3.5 m/s is related to a pulmonary migration occurring on a pathological heart. There is a satisfactory relationship between the elevation of the Doppler sPAP and the degree of pulmonary obstruction in the "Pe on healthy heart" population: r = 0.6 (n = 29; p less than 0.001). The dilated right ventricle observed on the sonogram (RV) is proportional to the severity of the angiographic image: correlation between the RV/LV ratio and the percentage of vascular obstruction is r = 0.73 (n = 27; p less than 0.001). The drop in the sPAP and the regression of the symptoms of pulmonary heart noted on CDS after fibrinolysis, correspond to a significant improvement of the pulmonary perfusion. The CDS seems to be absolutely necessary in PE because of the major and reliable informations it provides.
Adult↗
Impact of technology on healthcare: a European perspective.
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Diffusion of Innovation↗
[Comparative study of pulsed and continuous Doppler in the quantification of aortic insufficiency].
31 patients whose mean age was 61 +/- 29 yrs. presenting with aortic regurgitation (AR) benefited from cardiac catheterization which was preceded by Doppler ultrasound examination in a prospective study to compare the diagnostic contributions made by continuous vs pulsed wave techniques respectively in the quantitative assessment of AR, with reference to semi-quantitative angiographic evaluation. Pulsed Doppler analysis involves mapping of the left ventricle in two projections as well as the investigation of blood flow in the aortic isthmus using a suprasternal approach. Collection of continuous wave signals from the cardiac apex makes it possible to measure circulatory deceleration and the half-time of decrease in signal velocity and the protodiastolic pressure gradient. Our results corroborate the reliability of data obtained using continuous-wave Doppler technique in finding significant correlations for each parameter respectively: r' = 0.88 (p less than 0.001); r' = -0.81 (p less than 0.001); r' = -0.75 (p less than 0.001). Values determined by pulsed wave Doppler mapping of the left ventricle appear to be less satisfactory but are significant: r' = 0.68 (p less than 0.001) while measurement of end-diastolic blood flow recorded in the isthmus of the aorta is more highly correlated: r' = 0.84 (p less than 0.01), with the main disadvantage being its limited applicability to a small number of our patients (48%). We thus concluded that continuous-wave Doppler ultrasound is a better technique in the quantitative evaluation of AR, while recalling the essential additional value of pulsed-wave Doppler technique to localize the leakage and of ultrasound to assess its impact on the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Diagnostic and prognostic value of continuous Doppler in pulmonary embolism].
A prospective study of 18 patients admitted to hospital for acute pulmonary embolism confirmed the reliability of continuous wave cardiac doppler as a non-invasive method of evaluating systolic pulmonary artery pressures. These pressures were calculated by applying the simplified Bernoulli equation to the maximal velocity of regurgitant tricuspid flow and compared with the results of cardiac catheterisation and angiography, the percentage of vascular obstruction being assessed using Miller's index. The correlations between the two methods were good, r = 0.96; p less than 0.001, with a standard error of +/- 5.2 mmHg. The correlations between the velocity of tricuspid flow and the percentage of obstruction were less significant (r = 0.65; p less than 0.005) but improved when patients with pre-existing cardiopulmonary disease were excluded. This technique of non-invasive assessment of haemodynamic parameters also helps in evaluating the underlying pathology; tricuspid regurgitation with velocities greater than 3.5 m/s is associated with pre-existing chronic cor pulmonale, information of prognostic interest which would guide therapeutic management.
Acute Disease↗
[Validation of a method for measuring the area of aortic stenosis using only continuous Doppler. Value for the surveillance of transluminal aortic valvuloplasties].
Forty patients with aortic valve stenosis underwent continuous wave doppler-echocardiographic exploration followed by catheterization within 24 hours on average. Three methods of aortic functional area calculation, based on the continuity equation principle, were tried and compared with the haemodynamic data. The results of the reference equation (continuity through the whole systole) gave a correlation coefficient r = 0.77 with a standard error (SE) of 0.17 cm2. The continuity equation using only maximum velocity values was less satisfactory: r = 0.69; SE = 0.19 cm2. The simplified equation with an arbitrary 2 cm subaortic diameter and a subaortic velocity obtained by continuous wave doppler recording yielded results that were very similar to those of the reference equation: r = 0.78; SE = 0.16 cm2. It is suggested that this third equation should be used in the follow-up of transluminal aortic valvuloplasties, since its calculation is based only on aortic velocity, which reflects the degree of stenosis, and subaortic velocity, which indirectly reflects left ventricular function.
Adult↗