Biomedical subjects

P Jarno

Publications and source records attributed to P Jarno.

8 recordsLinked to original sources

PubMed2006

Prognostic factors associated with severe leptospirosis.

Leptospirosis is an anthropozoonosis caused by Leptospira interrogans. It occurs worldwide and is endemic in French Polynesia. Leptospirosis is associated with a large variety of clinical symptoms. Most infections caused by leptospires are either sub-clinical or of very mild severity, but 5-10% of infections result in multiple organ damage, including kidney, liver and lung lesions. Among 71 patients hospitalised in Papeete for severe leptospirosis during a period of 2 years, the main risk-factors for a severe outcome were hypotension, oliguria and an abnormal chest auscultation at the first physical examination. Survival depends on rapid diagnosis and early appropriate management. Well-defined criteria may help physicians to improve the timely treatment of high-risk patients.

Humans↗

PubMed2005

[Clinical guidelines: what are the viewpoints of physicians and housestaff working in hospital medical departments?].

BACKGROUND: Factors facilitating use of clinical guidelines by physicians working in French public hospitals are unknown. We wanted to ascertain the desires of physicians and housestaff working in medical departments. METHODS: A cross-sectional survey using a self-administered questionnaire with closed-ended questions and free comment was conducted in the two academic regional hospitals and the 20 district hospitals of Brittany. The following items were noted: individual and professional characteristics, use of and opinion about clinical guidelines, perceived usefulness of specific attributes of guidelines or implementation efforts. The results are shown separately for physicians and housestaff. The statistical significance of associations between physician characteristics and their opinions was tested by using the chi-square test. RESULTS: 390 out of 783 responded (50%). Nine housestaff and eight physicians out of ten responders found more positive than negative points to guidelines (decision making tool, standardization of practices, versus rigidity, lack of freedom in practice). One out of three reported using them regularly. Guidelines focusing on general medicine, covering both diagnosis and treatment, developed at the national level with local adaptation, synthetic and pocket-sized guide-book given directly to the housestaff by the department's physicians, were more likely to be used. One physician out of two would use more guidelines from specialty organizations, or would use them as a self-training tool in practices evaluation. CONCLUSION: Implementation of guidelines in hospital medical departments should take into account the housestaff demands as well as the need for the physicians' implication.

Adult↗

PubMed2004

[Clinical practice guidelines, what do the internists think?].

OBJECTIVE: Study the opinion and expectations of the internists in the public hospitals in the Brittany area regarding Clinical Practice Guidelines (CPG). METHODS: Cross-sectional survey using an anonymous, self-administered questionnaire, with closed questions concerning age, gender and status (internist in general medicine (IGM) or internist specialization student [ISS]), years and context of practice, the personal opinion of the residents regarding the CPG, the nature of those that they apply, their opinion on the interest and foreseeable impact of efforts in improvements and elaboration and prompting to use the guidelines. Descriptive analysis and statistics (chi 2) were made of the associations between the replies concerning the CPG and the characteristics of the internists. RESULTS: Among the 106 questionnaires analysed (reply rate: 50%), 96 internists (90%) felt that the advantages of the CPG were greater than their inconveniences and 66 (62%) claimed they applied the CPG in routine practice. Eighty-five (80%) considered efforts to improve the elaboration of CPG were of interest and 97 (91%) replied likewise regarding their accompanied diffusion. Guidelines concerning both diagnosis and treatment of common diseases, developed on national level and adapted locally, presented in summarized pocket-sized form and transmitted directly by the physicians of the department would have the best chance of being used. CONCLUSION: Any program aimed at developing the use of CPG in hospital departments should take into account the enthusiasm of the internists, but also the implication of senior physicians required in their specific accompanied diffusion.

Adult↗

PubMed2001

[Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors].

STUDY AIM: The aim of this retrospective study was to report immediate and long term results of endarteriectomies of the common femoral artery (CFA) and/or femoral tripod and to analyse predictive factors of failure. PATIENTS AND METHODS: Between 1982 and 1995, 110 endarteriectomies were performed in 101 patients, 52% of them in limb salvage situation. The arteriogram showed a thrombosis or stenosis of the common femoral artery in 100% of cases. There was a stenosis of the deep femoral artery (DFA) in 79% of cases. The superficial femoral artery (SFA) was thrombosed in 40% of cases. One artery only of the lower leg was permeable in 43.3% of cases. Run off was judged bad in 38% of patients. RESULTS: The endarteriectomy could be realised in 93 patients (84.5%). It concerned the only common femoral artery in 20% of cases (patch angioplasty in 55% of cases), common and deep femoral arteries in 50.5% of cases (82% of patch), CFA, DFA and SFA at its origin in 29.1% of cases (93% of patch). Perioperative mortality rate was 1%. Local morbidity rate was 21.6% with 18% of minor complications and 3.6% of complications requiring a second operation. There were 2% of vascular complications (1 thrombosis and 1 false-aneurysm). Mean follow-up was 43 months in 90 patients. There were restenosis or thrombosis (5.5%), false-aneurysms (2.2%) and amputations (6.6%). Femoro-popliteal (10%) and iliac complementary bypasses (6.6%) were necessary. Permeability was 94.9% at 3 years and 88.8% at 5 years. Clinical results were considered good in 80.7% of the cases at 3 years and in 71.7% at 5 years. With univariate analysis, the predictive factors for failure were: limb salvage (P < 0.01), altered popliteal run off (P < 0.03) and extended distortion of the deep femoral artery (P < 0.05). CONCLUSION: Isolated endarteriectomy of the femoral tripod is a low risk and effective technique. A femoropopliteal revascularisation should be associated in case of a major alteration of the deep femoral artery.

Adult↗

PubMed2001

[Juvenile breast hypertrophy: analysis of long-term results of reductive mammoplasty].

UNLABELLED: Reduction mammaplasty has now become routine surgery with good results in middle-aged women. However the scars it leaves, its psychological and functional (breastfeeding) impact could limited its indications in teenage girls. AIM: The purpose of our study was to report the long-term results of reduction mammaplasty in teenage girls and to assess their consequences. MATERIAL AND METHODS: We conducted a retrospective study of 65 reduction mammaplasty carried out between 1981 and 1997 in 15 to 17 years old girls. The study was based on data in their medical records and answers to a questionnaire which was sent to each patient. RESULTS: Average followup was 8.1 years. The reduction technique with superior pedicle were mainly used. Average breast tissue excised was 1050 g. Minor complications occurred in three cases. Eleven revisions had to be carried out with 1.6 years on average after primary surgery. The psychological and functional complaints observed preoperatively disappeared in more than 90% of the cases. In over 80% of the cases the patients were pleased or very pleased with the shape, the volume kept and the symmetry. Scars were well accepted in 83% of the cases. Seventeen women were given birth to 25 children. Five of whom breast-fed their babies, while six refused because of their breast surgery history. Although information about breast-feeding after such surgery is systematically given, 41 women claimed they had not received it. CONCLUSION: Reduction mammaplasty is reliable in teenage girls. Patients are generally satisfied and the remaining scar is well accepted. Breast-feeding is possible after this surgery and information on that point ought to be better developed.

Adolescent↗

PubMed2000

[Critical analysis of health priorities determination in France].

Since the mid 1970's, reforms to the health care system were aimed at controlling expenditures. Furthermore, there was not much of a relationship between public health policies and expenditure control policies. The reforms of 1996 aimed to introduce a new paradigm. The French health care system, based until then upon the biomedical model, now must adopt public health tools: Definition of health objectives; Development of priorities; Evaluation; Allocation of resources based on needs; Public debates. The objective of this study is to evaluate the move toward defining priorities, three years after the introduction of this reform. The study focused on the type of priorities implemented (e.g. implicit or explicit priorities, access to health care services, or severity of health problems) and their links to the allocation of resources; and the practical development of priorities (e.g. political or technocratic procedure, the role of public debates). In France, priorities are defined by health problem and not by service. They are explicit, but the link to allocation of resources isn't clear. Despite a wide consultation, the system of defining priorities is more technocratic than political. Moreover, the system is more concerned with including health professionals (doctors, administrators) in this new approach to public health, than with taking public opinion into account.

Cost Control↗

PubMed1997

A network of web multimedia medical information servers for a medical school and university hospital.

Modern medicine requires a rapid access to information including clinical data from medical records, bibliographic databases, knowledge bases and nomenclature databases. This is especially true for University Hospitals and Medical Schools for training as well as for fundamental and clinical research for diagnosis and therapeutic purposes. This implies the development of local, national and international cooperation which can be enhanced via the use and access to computer networks such as Internet. The development of professional cooperative networks goes with the development of the telecommunication and computer networks and our project is to make these new tools and technologies accessible to the medical students both during the teaching time in Medical School and during the training periods at the University Hospital. We have developed a local area network which communicates between the School of Medicine and the Hospital which takes advantage of the new Web client-server technology both internally (Intranet) and externally by access to the National Research Network (RENATER in France) connected to the Internet network. The address of our public web server is http:(/)/www.med.univ-rennesl.fr.

Artificial Intelligence↗

PubMedDate not supplied

A first evaluation of a pedagogical network for medical students at the University Hospital of Rennes.

A pedagogical network has been developed at University Hospital of Rennes from 1996. The challenge is to give medical information and informatics tools to all medical students in the clinical wards of the University Hospital. At first, nine wards were connected to the medical school server which is linked to the Internet. Client software electronic mail and WWW Netscape on Macintosh computers. Sever software is set up on Unix SUN providing a local homepage with selected pedagogical resources. These documents are stored in a DBMS database ORACLE and queries can be provided by specialty, authors or disease. The students can access a set of interactive teaching programs or electronic textbooks and can explore the Internet through the library information system and search engines. The teachers can send URL and indexation of pedagogical documents and can produce clinical cases: the database updating will be done by the users. This experience of using Web tools generated enthusiasm when we first introduced it to students. The evaluation shows that if the students can use this training early on, they will adapt the resources of the Internet to their own needs.

Computer-Assisted Instruction↗