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Biomedical subjects

L Pazart

Publications and source records attributed to L Pazart.

16 recordsLinked to original sources
PubMed1997

[What alternatives to rectal temperature recording with a mercury thermometer?].

Fever is a major symptom to characterize individual health status. Measurement of temperature is systematically made in everyday medical practice. In France, this measurement is generally assumed with a rectal glass mercury thermometer. In order to protect people and the environment, the "Conseil Supérieur d'Hygiène Publique de France" has approved recommendations to withdrawn medical use of mercury, specifically for thermometer. Rectal measurement is also debated since infectious risks are described. Thus, substitution of rectal glass mercury thermometer is on the agenda. New sites and techniques for measurement of temperature have been studied through a literature review, interview of experts and companies, and clinical research protocols. Cutaneous and axillary measurements are inaccurate and unsatisfactory. Two methods seems to be worth: oral measurement and tympanic measurement. Oral measurement is widespread in the world. This technique has some limits. Tympanic measurement is a new method in progress without these limits. Whatever the choice of the technique is, the substitution of rectal glass mercury thermometer requires training and awareness of staff and patients.

Axilla↗
PubMed1996

Fetal heart rate monitoring by telephone during pregnancy--opinion of users and non-users of a new technology.

OBJECTIVE: To compare the opinions of obstetricians who currently use fetal heart rate monitoring (FHRM) by telephone with the opinions of obstetricians in favour of this technique, but who do not use it. STUDY DESIGN: A mail questionnaire was sent to the 612 members of a professional organization of obstetricians. The response rate was 76%. RESULTS: Fourteen percent of the respondents used FHRM by telephone and 43% did not use it, but were in favour of it. Compared with current users, non-users who were in favour of this technique indicated a wider range of clinical indications for monitoring, considered a greater proportion of women to be eligible, and wanted more frequent monitoring. These differences cannot be explained by the characteristics of the obstetricians (age, type of practice or attitude towards FHRM performed in maternity unit). CONCLUSION: Our survey shows a risk of extensive use of FHRM by telephone if this technique becomes easily accessible.

Female↗
PubMed1996

[A study of practice patterns of albumin administration in surgical patients by anesthetists].

The establishment of guidelines has to take into account the current practice patterns. For the preparation of the consensus conference organized by the French Society of Anesthesia and intensive care (SFAR) on the prescription of albumin, an interview with a questionnaire was undertaken in order to assess the practice patterns of anaesthetists during the perioperative period. A group of 498 anaesthetists were interviewed during a congress. Two out of three prescribe albumin. In case of haemorrhage, the decision to administer albumin depends on the limits for using other colloids (for 65% of the responders), the amount of blood loss (46%) and albuminaemia (for only 26%). In other cases, albumin is mainly administered in the burn patient and for recurring ascite; albuminaemia is a decision criterion for one anesthetist out of two. About 25% of them use a 20% concentration, another 25% of them a 4% concentration and the remaining 50% use both concentrations. Adverse effects have been seen in less than 5% of the responders. These data have been presented at the consensus conference and can also be used for the assessment of the impact of the guidelines after their publication.

Adult↗
PubMed1996

[Tumor markers in the cytodiagnosis of thyroid nodules. Detection of dipeptidyl aminopeptidase IV (DAP IV) activity].

Dipeptidyl-aminopeptidase IV (DAP IV), an exopeptidase involved in T-cell activation is absent from normal thyroid tissue but highly expressed by malignant thyroid cells. It has been suggested to be a useful adjunct for the diagnosis of malignant thyroid tumors on fine needle aspirates (FNA). To assess this assumption DAP IV activity was demonstrated by histochemical staining on FNA performed on 102 thyroid nodules at the time of surgery (60 macrofollicular adenomas, 15 microfollicular adenomas. 7 Hashimoto's thyroïditis, 3 Graves' disease. 13 papillary carcinomas and 4 follicular carcinomas). A staining score based on the percentage of positive epithelial cells and staining intensity was established for each case and results were compared to histological diagnosis. Most cells in malignant tumors were deeply stained except in one case of papillary carcinoma. Null or very low scores resulting from light or medium staining of less than 40% of the cells were obtained in 78/85 benign nodules. In 6 macrofollicular adenomas and in 1 case of thyroiditis staining score was as as high as in carcinomas. DAP IV staining was correlated to malignancy in all follicular tumours (4 malignant tumours were positive and 15 benign were negative). The sensitivity for diagnosis of malignancy was 94.1% and the specificity 91.7%. This study brings confirmation that DAP IV activity detection could be an useful adjunct to cytological examination for the distinction between benign and malignant thyroid nodules, especially in cases of follicular tumors.

Biomarkers, Tumor↗
PubMed1994

The multifactorial and multistage character of protective immunity to Plasmodium falciparum, naturally acquired by an indigenous population in Burkina Faso.

In malaria-endemic areas, protective immunity is acquired gradually. Some authors have proposed that different stages can be distinguished during development. To test this hypothesis, several in vitro assays of the host immune response to P. falciparum were performed in three groups of individuals: 'unprotected' children with clinical attacks, 'semi-immune' children, without clinical attacks but with transient high parasitaemias during the transmission period, and 'protected' adults with low residual parasitaemias. By comparison of immune responses in these groups and multifactorial analyses, discriminant factors and potential protective mechanisms were identified. Anti-RESA antibody levels were lower in 'unprotected' than in 'semi-immune' children, while specific cellular responses, TNF levels and percentage of activated T lymphocytes were higher. Low humoral immunity and high cellular activation in children were followed by high humoral immunity and low cellular activation in adults. Therefore, protective immunity seems to pass through different stages and to result from the association of different immune mechanisms according to the level and duration of the individual experience of malaria.

Adolescent↗
PubMed1993

[Management of the thyroid nodule. Preliminary results of a practice survey of 685 general practitioners and specialists].

The authors present the preliminary results of a mailed survey of policies for the management of thyroid nodules (TN). This survey involved 685 general practitioners and specialists and was carried out at the initiative of APNET (National Educational Association for Training in Therapeutics) with the aid of ANDEM (National Agency for the Development of Medical Evaluation). Twelve percent of responders (13.1% among GPs) declare that they do not manage TNs. Those have been excluded from the analysis. The answers taken into account come from general practitioners (n = 179), endocrinologists (n = 233), specialist surgeons (n = 64), ENT practitioners (n = 93) and nuclear medicine practitioners (n = 26). The average number of patients with TN seen in a year varies according to the specialty: 6 a year for GPs, 30 in ENT, 89 for endocrinologists, 105 for surgeons. This survey reveals a number of common position: 1) the therapeutic attitude must be customized according to clinical findings and to complementary tests; 2) prescriptions are homogeneous as regards radionuclide scanning (technetium or iodine), TSH assays, ultrasonography and T4 assays; 3) ultrasonography is used in first intention; 4) ultrasonography has limitations, and is regarded by a majority or responders as unable to provide information about benignancy or malignancy. Conversely, responses are much more variable about a number of points: 1) the use of fine needle aspiration cytology which is mainly used by endocrinologists and nuclear medicine practitioners; 2) the management of nodules discovered on ultrasonography: the attitude is different from that adopted with palpable nodules for endocrinologists, surgeons and nuclear medicine practitioners, and identical for most general and ENT practitioners; 3) the usefulness of a suppressing treatment with thyroid hormones. Both general practitioners (47%) and, even more so, specialists (84%) are aware of these differences in practices. Faced to this situation, 69% of specialists are in favor of establishing consistent practices, but a minority (42%) only think that it is possible. Thus recommendations about practices may be useful only if they are adapted to the type of practice and to the conditions of access to complementary tests, and they should be aimed at rationalizing management rather than making it consistent.

Endocrinology↗
PubMed1988

[Control of malaria using mosquito nets impregnated with pyrethroids in Burkina Faso].

An experimental trial of malaria control was carried out in the village of Karangasso in the south-west Burkina Faso. It was based on the use by the whole population of deltamethrin impregnated bed nets at 25 mg/m2. During the first year pretreatment data on entomology, parasitology and pathological incidence of malaria were collected in the whole village. During the second year a quarter of the village with a population of 1,200 was chosen for the experiment and impregnated bed nets were given to everybody while the other quarter of the same population size was kept as a control area. Malaria transmission was reduced by 82% due to the decrease of both vector populations and sporozoitic indexes. It should be pointed out that this reduction in transmission was evaluated on non-protected catchers and consequently was underestimated for the villagers sleeping under nets. Parasitic index remained about the same but the mean parasitic load decreased significantly. Pathological incidence, based on the number of clinical malaria cases confirmed by blood examination, decreased by 59%. This trial shows that mass use of deltamethrin impregnated bed nets should be considered as a valuable tool for malaria control. The purchase of bed net is expensive but could be reduced sharply. The cost of the impregnation is very low regarding the residual effect which remains one year. The acceptance by the population was good.

Animals↗
PubMedDate not supplied

[The study of the impact of the consensus conference "Strategies for long-term therapy of patients with schizophrenia"].

UNLABELLED: The case management, treatment and psychosocial rehabilitation of schizophrenic patients is an important part of the activity of the psychiatric sector and takes up many human, scientific, organizational and financial resources. The best way to reach satisfactory results for the individual patient is still uncertain and current practice in France shows noticeable variations that have been rarely investigated in terms of outcome. A consensus conference (CC) on "Strategies for long-term therapy of patients with schizophrenia" was therefore held in Paris in 1994 to produce accurate guidelines designed to help both clinicians and patients and to improve practice. It was organized by the French Federation of Psychiatry, the National Union of Friends and Relatives of Mental Patients, and the National Agency for the Development of Health Evaluation. The conclusions of the CC were mailed, in the form of a booklet, to members of these associations (psychiatrists and relatives) and were reported in the medical and general press. METHODS: The impact of the CC was judged by (a) the psychiatrists'awareness of the existence of the CC, (b) their knowledge of its conclusions, and (c) changes in practice. The following were analyzed: press coverage; requests for the booklet; the results of a survey of a representative sample of 396 psychiatrists two years after the CC; prescription changes in the public sector in a cohort of 2,407 schizophrenic patients under treatment at the time of the CC; prescriptions to psychotic patients by a representative sample of psychiatrists in private practice. RESULTS: Awareness: Articles on the CC were published in 27 journals and newspapers, 30,000 booklets were distributed and 8,348 were mailed in response to 1,121 spontaneous requests; 78% of the psychiatrists interviewed said they were aware of the existence of the CC and 70% said they were aware of the conclusions. Knowledge: The psychiatrists' declared practice conformed with CC conclusions 41%-85% of the time depending on the recommendation. No difference in practice was noted between the psychiatrists who said they knew of the recommendations and those who said they did not. Changes in practice: A significant but small improvement in prescription habits was noted for a principal recommendation ("just one neuroleptic is enough"). One-neuroleptic prescriptions increased from 51.1% the year before the CC to 56.4% two years after the CC. The increase mainly concerned the most recently treated patients. However, during the same time-span, prescriptions of anti-cholinergics plus neuroleptics rose from 48.2% to 54.3%. CONCLUSION: It is difficult to attribute changes in practice to a CC. However, the impact of the CC seemed real even if inconstant and not great enough. Clearly, to enhance impact an action plan is needed. It should include corrective measures and focus on additional dissemination efforts, teaching and training programs, and updating of guidelines if necessary.

Adult↗
PubMedDate not supplied

[How to evaluate nursing practices?].

Assessment of clinical health care focuses on 'what is really done' in order to describe day-to-day practice. These data could be compared with standards or guidelines. The method used, the 'clinical audit', aims to improve the quality of care through specific actions. Finally, a second data collection could assess the efficacy of these actions. Many protocol designs could be used; they are illustrated by two examples in this article. The choice of protocols depends on the field and on the objectives of the work. Most of the time, assessment of clinical health care is included in a continuous quality improvement programme.

Evaluation Studies as Topic↗