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Biomedical subjects

E Toussaint

Publications and source records attributed to E Toussaint.

8 recordsLinked to original sources
PubMed2006

Causes of fever in cancer patients (prospective study over 477 episodes).

GOALS OF WORK: The aim of this study was to determine the causes of fever among cancer patients. METHODS: All febrile cancer patients were followed up prospectively. Clinical, microbiological and radiological documentations were performed. Aetiologies of fever, type of tumour, site of infection, type of microorganism and outcome were assessed and compared between neutropenics and non-neutropenics. RESULTS: Four hundred and seventy-seven episodes were evaluated. Infection, non-infectious causes and fever of unknown origin represented 67, 23 and 10%, respectively. The respiratory tract is the most frequently involved site in infection (29%), and in microbiologically documented infections, Gram-negative bacilli were predominant. The tumour itself (27%) or an invasive procedure (17%) were the main causes of non-infectious febrile episodes. Mortality from infection was higher among non-neutropenic (11.1%) than neutropenic patients (4.3%). CONCLUSION: Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. However, the infection-related mortality is low either in neutropenic or non-neutropenic patients.

Belgium↗
PubMed2005

[Requests for access to medical files at the Nancy University Hospital Center].

OBJECTIVE: Law 2002-303 of March 04, 2002, authorizes patients to have direct access to their medical record, without requiring a physician to serve as interme-diary. The aim of this study was to characterize these requests for a 23-month period. METHOD: A database was created to record information about these requests. The descriptive and quantitative analysis here covers 23 months. RESULTS: There were 942 requests in all, 64.5% by patients themselves and 18.5% by their heirs or assignees. The mean age of the patients seeking access to their medical file was 53 years, with a slight majority of men. Heirs and assignees av-eraged 49 years of age and were generally women. Thirty percent of them reported wanting some additional information, while 51% requested a copy of the entire file. Only 5.8% asked for a physician to help them understand the file, although that was systematically offered. CONCLUSION: Patients' new legal rights to direct access to their medical files imply that physicians will modify the way they maintain these files.

Adolescent↗
PubMed2002

[Subcutaneous nodules and lung cavitated nodules].

An african 22-year old man consulted because of disseminated subcutaneous nodules which appeared two months ago with an increasing number. He also complained from productive cough, wheezing and dyspnea on exertion. A chest CT-scan revealed multiple cavitated nodular lesions in both lungs.

Adult↗
PubMed2002

Patient's permanent identification and PMSI chaining system. Complementary or competing methods?

In order to "chain" all the information concerning their patients' files, hospitals have set up their own identification system. This system is not easy to manage and can encounter several difficulties. When entering the hospital, each patient is given an identification number resulting mainly from his ID card, his Health Care card data and other data... The clerk who registers a patient seeks for possible prior hospital stays of this patient: should the patient be unknown, a new record of identification will be created; but should this patient be already registered, the clerk will link the patient's new hospital stay to the already existing file and update the permanent patient's identification data if necessary. In spite of all the care taken to carry out this process, some errors may occur: creation of "doubles", which means creating a new patient's file for an already existing patient, or conversely wrong chaining for an already existing patient. In order to track down these kinds of errors hospitals have set up a quality system. Moreover, since January 2001, in the frame of the Prospective Payment System (in French PMSI), a hospital stay chaining system based on a calculated key (H coding) has been designed. If the use of this key is meant to provide statistics concerning patients' cares and not patients' stays it may also become part of the quality policy of an establishment concerning patients' permanent identification data. Considering the 61 486 hospital stays at the C.H.U of Nancy for the first six months in 2001, it has been possible to compare the results in term of a patient population calculated from the permanent identification system of the hospital with the results obtained by the PMSI chaining system. No important differences have been detected and the results are very close. Besides, in order to track down possible doubles in the C.H.U patient identification system, chaining differences have been analysed. For the 22 detected cases, no identification management anomalies can be found; the doubles are the result of the calculating system of the chaining key used by the PMSI. A single interesting case can be mentioned: it concerns an anonymous registration stay; despite a previous stay in the hospital, the patient was given another identification number to ensure her complete confidentiality.

France↗
PubMed2001

Method to determine the bed capacity, different approaches used for the establishment planning project in the University Hospital of Nancy.

In France hospital bed capacity is determined according to a national and regional authorization which has been established by the regional hospital agency. The bed capacity evolution in a hospital is fixed by considering the different proposals of the hospital in negotiation with the regional hospital agency. Types of beds are differentiated according to the patients' needs : medicine, surgery and obstetrics. The first approach is taken at the national level and then at the regional level using a specific ratio of beds for 100,000 inhabitants in each category. For a given hospital, the authorized number of beds takes into consideration their occupation. Target bed occupation ratios were fixed in 1992 and are still in use. In the establishment project of the University Hospital of Nancy (developed over a five year period) four approaches have been formulated and their results have been compared. In this study, the two traditional methods of bed ratio per 100,000 inhabitants and target bed occupation have been updated according to the present conditions of hospitalisation; the third method is based on the reapportionment of the present patients and the possible risk to the hospital for refusing patients. The last method consists of determining the expected pathologies five years in advance in Lorraine and the beds needed to treat them. These four methods have given consistent results under the accepted revised target occupation bed ratios in accordance with the reduction of the length of stay between 1992 and 1999.

France↗
PubMed1999

CCAAT displacement protein binds to and negatively regulates human papillomavirus type 6 E6, E7, and E1 promoters.

Expression of human papillomavirus genes increases as the target cell, the keratinocyte, differentiates. CCAAT displacement protein (CDP) is a cellular protein which has been shown in other cell types to negatively regulate gene expression in undifferentiated cells but not in differentiated cells. We have previously shown that a 66-bp purine-thymidine-rich sequence (the 66-mer) binds CDP and negatively regulates the human papillomavirus type 6 (HPV-6) E6 promoter (S. Pattison, D. G. Skalnik, and A. Roman, J. Virol. 71:2013-2022, 1997). Cotransfection experiments with a plasmid expressing luciferase from the HPV-6 E6, E7, or E1 regulatory region and a plasmid carrying the CDP gene indicate that CDP represses transcription from all three HPV-6 promoters. Using electrophoretic mobility shift assays (EMSAs), we have shown that CDP binds HPV-6 both upstream and downstream of the E6, E7, and E1 transcription initiation start sites. Furthermore, when keratinocytes were induced to differentiate, all three promoter activities increased. Consistent with this, immunoblotting and EMSAs revealed that endogenous nucleus CDP and, correspondingly, DNA binding activity decreased when keratinocytes were induced to differentiate. The elevated promoter activities were abrogated by exogenously transfected CDP. Our data demonstrate that CDP fulfills the requirement of a differentiation-dependent negative regulator that could tie the HPV life cycle to keratinocyte differentiation.

3T3 Cells↗
PubMedDate not supplied

[Cost of medical imaging practices in acute abdominal syndromes].

OBJECTIVES: To describe the costs of medical imaging practices in the diagnosis management of acute abdominal pain (AAP). METHODS: Medical imaging techniques until decision for treatment were prospectively recorded in patients presenting with AAP. Direct costs used hospital analytic accountability. Time of human resources involved was also surveyed prospectively. RESULTS: In 122 adult patients (2.3 examinations on average) before treatment decision making, the more frequent practices were: initial plain abdomen x-ray followed by tomodensitometry (36.8%), by echography or endoscopy (17.2%), plain abdomen solely (19.6%) or initial abdominal tomodensitometry (12.3%). Direct costs ranged from 977 to 1073 FF for practices with initial plain abdomen x-ray, and from 996 to 1150 FF with initial tomodensitometry. It ranged from 808 to 880 FF when the treatment decision was surgery, and 300 FF higher when it was medical. CONCLUSION: Differences in costs assessed for practices were very narrow. Such information should be taken into account to determine cost-effective strategies, and to built up reference guidelines.

Abdomen, Acute↗