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Laurent Gerbaud

Publications and source records attributed to Laurent Gerbaud.

8 recordsLinked to original sources
PubMed2007

Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis.

OBJECTIVE: To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. DESIGN: Population-based cost-effectiveness study. SETTING: Auvergne EP registry (France). PATIENT(S): Women (n = 1,664) registered between 1994 and 2003. INTERVENTION(S): Standard diagnosis and treatment of EP. MAIN OUTCOME MEASURE(S): Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. RESULT(S): Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. CONCLUSION(S): Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.

Adolescent↗
PubMed2006

Elderly suicide attempters: characteristics and outcome.

PURPOSE: We made a descriptive survey to assess the outcome of elderly patients discharged from a hospital psychiatric service after a suicide attempt (rates of overall mortality and repeat attempts), to identify the factors that had a significant impact on their survival and to determine patient characteristics. METHODS: Fifty-nine suicide attempters over 60 years of age admitted to hospital between 1993 and 2000 were included in the study. Their outcome was assessed by questioning their attending physicians over the telephone. We traced 51 of the 59 patients; 8 were lost to follow-up. Statistical analysis (Log Rank tests, Cox model) was computed to determine which factors altered the overall survival and the survival without further attempt. The patients sociodemographic, medical and psychiatric characteristics were recorded from hospital patient files. RESULTS: Elderly suicide attempters showed an increased mortality from suicide and natural causes and the risk of a repeat attempt increased in female patients with memory disorders. The factors altering survival were advanced age, pre-existing physical disability, several co-existing physical illnesses, severe physical consequences of the suicide attempt, history of psychiatric illness other than depression, memory disorders and one previous suicide attempt. The elderly suicide attempter was most likely to be a widowed woman suffering from social isolation, loneliness and depression. CONCLUSION: Elderly suicide attempters remained both physically and mentally vulnerable after their attempt. A repeat act represents a turning point in personal life progression which it is essential to detect.

Age Factors↗
PubMed2006

[Medical guidelines and medical practices: The example of lipid lowering therapy].

INTRODUCTION: The SPOT epidemiologic survey assessed the results of long-term cholesterol-lowering therapy in France and the reasons why patients do or do not meet their therapeutic objectives. OBJECTIVE: To assess the guidelines on which doctors base their practices for cholesterol-lowering therapy and make suggestions to improve the match between recommendations and practices. METHODS: LDL cholesterol was measured in 2479 French outpatients in 2003 and classified according to whether it met therapeutic objectives of 3 different scales: the official French (AFSSAPS) recommendations issued in 2000, the physician's opinion of the ideal level for the patient, and the physician's goal level for the patient. Agreement between these 3 criteria was analyzed. RESULTS: French doctors used guidelines stricter than the official recommendations to assess the achievement of lipid-lowering objectives. DISCUSSION: Physicians rely more on American than French guidelines. They also considered the patient's history and clinical condition in setting individual goals.

Attitude of Health Personnel↗
PubMed2005

Impact of the motor complications of Parkinson's disease on the quality of life.

The impact of motor complications of Parkinson's disease (PD), especially levodopa-induced dyskinesias, on quality of life (QL) was studied in 143 patients with PD. All were evaluated on the Hoehn and Yahr (H&Y) scale, and the Motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). Motor complications were analyzed using the UPDRS Parts IV(A) and IV(B) and the Abnormal Involuntary Movement Scale. A specific Parkinson's disease quality of life questionnaire (39-item version, PDQ-39) was used. Motor complications significantly worsened the PDQ-39 Summary Index (PDQ-SI) of patients with PD. The dimensions of Mobility, Activities of Daily Living, Stigma, and Communication were the most strongly affected. "Peak dose" dyskinesia decreased Mobility, Emotional Well-Being, and Cognition, whereas biphasic dyskinesia affected Mobility, Stigma, Communication, and Activities of Daily Living. Morning akinesia, end-of-dose fluctuations, and "unpredictable offs" decreased QL on the dimensions of Mobility, Activities of Daily Living, Stigma, and Communication. Nocturnal akinesia led to a deterioration of all dimensions of the PDQ-39. Thus, motor complications and especially nocturnal akinesia and biphasic dyskinesias worsened the QL of PD patients.

Adult↗
PubMed2004

Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancies in France (1992-2002).

BACKGROUND: We aimed to assess the recent incidence trends of ectopic pregnancies (EP) in France (1992-2002). METHODS: A population-based register of all women aged 15-44 years with EP was set up in Auvergne (central France). We calculated rates of EP as a 'reproductive failure' or as a 'contraceptive failure', frequencies of exposure to the two main risk factors for EP (cigarette smoking and chlamydial infection) and contraceptive methods between 1992 and 2002. RESULTS: The overall EP rate decreased by 2%, from 96.4 per 100 000 women aged 15-44 in 1992 to 95.3 per 100 000 in 2002. However, the rate of 'reproductive failure' EP increased by 17%, while the rate of 'contraceptive failure' EP, mostly intrauterine device failure, decreased by 29%. CONCLUSION: Appropriate analysis reveals that the rate of EP as reproductive failure is increasing again in France. This result is of interest for many European and North America countries where chlamydial infections or smoking or both are increasing in women of reproductive age. The rates of EP as contraceptive failure and of that as reproductive failure evolve differently in the population and should not be confused in epidemiological studies.

Adolescent↗
PubMed2004

[Measurement of the prevention policy in the hospital].

INTRODUCTION: Prevention policy is a legal obligation for French hospitals. As such, preventive clinical practices should therefore be assessed. OBJECTIVE: Assess the results of the hospital prevention policy. METHOD: A cross-sectional, stratified epidemiological survey, took place in 10 hospital wards of the university hospital of Clermont-Ferrand. The patients included had to be aged over 60 and leaving the hospital. The criteria for prevention assessment were surveillance of blood pressure and glycaemia, screening of viral serologies for people having had blood transfusion or major surgery, surveillance of weight, check of tetanus vaccination, check of influenza vaccination for people aged 65 and over, detection of prostatic disorders for men aged 70 and over, and detection of dementia in people aged 60 and over. RESULTS: 315 patients were examined during the 33 weeks study. The probable malnutrition rate was twice the obesity rate (10.7 vs 5.9%) but detection of obesity was better in the hospital. Tetanus vaccination rate decreased with age and was lower than influenza vaccination rate (59.5 vs 73.0%). Detection of prostatic disorders was only biological. DISCUSSION: The hospital prevention policy could be improved in terms of data collection and transmission of information to the GP's. We dispose of a tool for the measure of secondary prevention, independent of the treatment context, in the hospital. Measurements reveal wide gaps between norms and reality and would help to increase awareness among the health care providers.

Age Factors↗
PubMed2003

Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.

This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.

Adult↗