Biomedical subjects

Guy van Melle

Publications and source records attributed to Guy van Melle.

25 records · Page 2Linked to original sources

PubMed2003

Electronic monitoring of long-term use of the nicotine nasal spray and predictors of success in a smoking cessation program.

This study evaluated the efficacy of prolonged administration (18 months) of a nicotine nasal spray in smoking cessation and attempted to characterize the pattern of use of the nasal spray with a specially developed electronic monitor in an effort to assess the factors associated with cessation success or failure. Study participants were 92 patients in a smoking cessation unit of a medical outpatient clinic in Switzerland. Participants were daily smokers who had smoked for more than 5 years and were highly motivated to quit. The main outcome measure was the number of abstainers at 12 and 24 months. Their use of the spray was monitored using a microchip (MDILog) that recorded the date and time of every actuation. Success rates were 17.4% at 12 months and 9.8% at 24 months. During the first month of study, median use was 12 puffs/day in abstainers and 6 puffs/day in failures (p=.049). Abstainers used the spray less in the morning compared with failures (26.6% vs. 32.8% of the total median daily dose; p=.028). By contrast, abstainers used the spray more in the evening/night compared with failures (35.3% vs. 26.7% of the total median daily dose; p=.007). Abstinence during the first two weeks was associated significantly with cessation success at 6 months (OR=17.10) and 24 months (OR=11.09). Although the pattern of use of the nasal spray differed between successful quitters and failures (used in higher doses by the successful quitters), mean daily consumption during the first month was not predictive of success. Mean daily consumption of the nicotine nasal spray remained lower than expected in most participants, particularly in failures.

Administration, Inhalation↗

PubMed2002

Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of "sign-by-sign" correlation.

Our objective was a prospective comparison of MR enteroclysis (MRE) with multidetector spiral-CT enteroclysis (MSCTE). Fifty patients with various suspected small bowel diseases were investigated by MSCTE and MRE. The MSCTE was performed using slices of 2.5 mm, immediately followed by MRE, obtaining T1- and T2-weighted sequences, including gadolinium-enhanced acquisition with fat saturation. Three radiologists independently evaluated MSCTE and MRE searching for 12 pathological signs. Interobserver agreement was calculated. Sensitivities and specificities resulted from comparison with pathological results ( n=29) and patient's clinical evolution ( n=21). Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and lymphadenopathy (ADP), showed better interobserver agreement on MSCTE than on MRE (BWT: 0.65 vs 0.48; BWE: 0.51 vs 0.37; ADP: 0.52 vs 0.15). Sensitivity of MSCTE was higher than that of MRE in detecting BWT (88.9 vs 60%), BWE (78.6 vs 55.5%) and ADP (63.8 vs 14.3%). Wilcoxon signed-rank test revealed significantly better sensitivity of MSCTE than that of MRE for each observer ( p=0.028, p=0.046, p=0.028, respectively). Taking the given study design into account, MSCTE provides better sensitivity in detecting lesions of the small bowel than MRE, with higher interobserver agreement.

Artifacts↗

PubMed2002

Determinants of protracted cytomegalovirus infection in solid-organ transplant patients.

BACKGROUND: Recurrent infection frequently follows the response to the initial treatment of cytomegalovirus (CMV) infection in solid-organ transplant (SOT) recipients. The objective of this study was to describe the course of CMV infection in SOT patients and to identify factors that would predict protracted CMV infection with recurrences. METHODS: Quantitative polymerase chain reaction (PCR) assay for CMV DNA in leukocytes and in plasma were used to assess viral load changes retrospectively in consecutive SOT patients, whose CMV infection episodes had been attended therapeutically or preemptively using quantitative blood culture. RESULTS: Among 101 SOT patients, CMV infection occurred in 63, of whom 32 developed recurrent infection after the initial episode. In patients with recurrent infection, PCR indicated that a majority (27) of recipients had high level of CMV DNA in peripheral blood leukocytes and plasma throughout a protracted (>/=1 month) period including after preemptive or therapeutic ganciclovir courses. Predictors of protracted high-level infection were increasing age, CMV donor seropositivity, and all measures of viral load during the initial episode. CMV recipient seropositivity protected strongly against protracted infection. End of treatment plasma CMV DNA best discriminated between patients who did or did not develop protracted infection. CONCLUSIONS: In SOT patients, protracted CMV infection is associated with increasing age, donor seropositivity, recipient seronegativity, and high viral load during the first episode. End of therapy plasma CMV DNA level best predicts the occurrence of protracted infection. In patients with a high risk of protracted infection, prophylaxis is likely to be particularly cost effective.

Adult↗

PubMed2002

Efficacy of resident training in smoking cessation: a randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients.

BACKGROUND: New educational programs must be developed to improve physicians' skills and effectiveness in counseling patients about smoking cessation. OBJECTIVE: To assess the efficacy of an educational program based on behavioral theory, active learning methods, and practice with standardized patients in helping patients abstain from smoking and changing physicians' counseling practices. DESIGN: Cluster randomized, controlled trial. SETTING: Two general internal medicine clinics in Switzerland. PARTICIPANTS: 35 residents and 251 consecutive smoking patients. INTERVENTION: A training program administered over two half-days, during which physicians learned to provide counseling that matched smokers' motivation to quit and practiced these skills with standardized patients acting as smokers at different stages of change. The control intervention was a didactic session on management of dyslipidemia. MEASUREMENTS: Self-reported abstinence from smoking at 1 year of follow-up, which was validated by exhaled carbon monoxide testing at one clinic; score of overall quality of counseling based on use of 14 counseling strategies; patient willingness to quit; and daily cigarette consumption. RESULTS: At 1 year of follow-up, abstinence from smoking was significantly higher in the intervention group than in the control group (13% vs. 5%; P = 0.005); this corresponded to a cluster-adjusted odds ratio of 2.8 (95% CI, 1.4 to 5.5). Residents who received the study training provided better counseling than did those who received the control training (mean score, 4.0 vs. 2.7; P = 0.002). Smokers' willingness to quit was also higher in the intervention group (94% vs. 80%; P = 0.007). A nonsignificant trend toward lower daily cigarette consumption in the intervention group was observed. CONCLUSION: A training program in smoking cessation administered to physicians that was based on behavioral theory and practice with standardized patients significantly increased the quality of physicians' counseling, smokers' motivation to quit, and rates of abstinence from smoking at 1 year.

Adolescent↗

PubMed2002

Occlusion due to carotid artery dissection: a more severe disease than previously suggested.

BACKGROUND: Stroke due to internal carotid artery dissection is considered to have a good prognosis. OBJECTIVE: To determine whether the prognosis of internal carotid artery dissection is worse than classically reported by comparing the characteristics of patients who had an acute ischemic stroke admitted to a population-based primary care center with internal carotid artery occlusion due to either dissection (DO) or atherothrombosis (AO). PATIENTS AND METHODS: Among 3502 patients admitted to our population-based primary care center, DO (n = 73) was diagnosed by angiography or magnetic resonance imaging, while AO (n = 81) was diagnosed by angiography. The characteristics of patients with DO or AO were compared using univariate and multivariate analysis. RESULTS: Patients with DO were younger (mean [SD] age, 44.6 [10] vs. 60.1 [10] years, P<.001), had fewer vascular risk factors, and presented more frequently with global middle cerebral artery territory involvement (42% vs. 17%, P<.05) and less frequently with watershed infarcts (3% vs. 19%, P<.05) than patients with AO. Unexpectedly, patients with DO were noted to have more severe clinical impairment, with an increased frequency of decreased consciousness, and a poorer outcome at 1 month. Multivariate analysis showed that the independent factors associated with DO were age younger than 55 years, nonsmoker, no history of hypertension, headache at presentation, and global aphasia. CONCLUSIONS: Patients with DO are younger and are initially seen with fewer risk factors than patients with AO, but their clinical features and prognosis are worse. Large infarcts involving the whole middle cerebral artery territory that may be due to the lack of collateral circulation are responsible for the bad prognosis of patients with DO.

Adult↗

PubMed2002

Measuring potentially avoidable hospital readmissions.

The objectives of this study were to develop a computerized method to screen for potentially avoidable hospital readmissions using routinely collected data and a prediction model to adjust rates for case mix. We studied hospital information system data of a random sample of 3,474 inpatients discharged alive in 1997 from a university hospital and medical records of those (1,115) readmitted within 1 year. The gold standard was set on the basis of the hospital data and medical records: all readmissions were classified as foreseen readmissions, unforeseen readmissions for a new affection, or unforeseen readmissions for a previously known affection. The latter category was submitted to a systematic medical record review to identify the main cause of readmission. Potentially avoidable readmissions were defined as a subgroup of unforeseen readmissions for a previously known affection occurring within an appropriate interval, set to maximize the chance of detecting avoidable readmissions. The computerized screening algorithm was strictly based on routine statistics: diagnosis and procedures coding and admission mode. The prediction was based on a Poisson regression model. There were 454 (13.1%) unforeseen readmissions for a previously known affection within 1 year. Fifty-nine readmissions (1.7%) were judged avoidable, most of them occurring within 1 month, which was the interval used to define potentially avoidable readmissions (n = 174, 5.0%). The intra-sample sensitivity and specificity of the screening algorithm both reached approximately 96%. Higher risk for potentially avoidable readmission was associated with previous hospitalizations, high comorbidity index, and long length of stay; lower risk was associated with surgery and delivery. The model offers satisfactory predictive performance and a good medical plausibility. The proposed measure could be used as an indicator of inpatient care outcome. However, the instrument should be validated using other sets of data from various hospitals.

Adolescent↗

PubMed2002

Small intestine without mucosa as a growing vascular conduit: a porcine experimental study.

OBJECTIVE: This study was conducted to check the feasibility of using small intestine without mucosa as a growing vascular conduit. METHOD: Autologous proximal jejunum without mucosa after treatment with heparin bonding was used as a free inferior vena cava interpositional graft between the renal veins and bifurcation of inferior vena cava in 8 piglets. Intravenous ultrasonography was performed at 1 to 3 months after the operation and at autopsy. RESULTS: One intraoperative death was related to anesthesia. At a mean follow-up of 80 days for the 7 surviving pigs, the weight had increased by 201%, from a mean of 32 kg to a mean of 94 kg. The grafts had increased in length by 128%, from a mean of 2.3 cm at implantation to a mean of 5.1 cm (P <.018) at explantation. In 6 animals the diameter of the graft was equal to that of the adjacent inferior vena cava. At postmortem examination, 6 grafts were patent. The single blocked graft had been patent 1 month after surgery. One graft had extensive septae inside, 2 had minor septae, 2 had microscopic septae, and 2 had no septae at all. Normal appearing adventitia, fibrous tissue, and endothelium (factor VIII-related antigen positive) lined all the grafts. In all 7 grafts, scattered proliferating fibroblasts (MIB1 positive) were observed. CONCLUSIONS: Small intestine without mucosa remodels and acts like a live, growing, layered, endothelialized, nonthrombogenic (after re-endothelialization) vascular conduit in a growing pig. This graft material could have potential as a growing vascular conduit in children.

Animals↗