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P Queneau

Publications and source records attributed to P Queneau.

At least 19 recordsLinked to original sources
PubMed2005

[Adverse drug effects: a prospective study by Apnet performed in seven emergency care units in France: propositions for preventive measures].

Various studies have shown that adverse drug effects (ADEs) are a substantial cause of hospital admissions. However, little is known about the incidence and severity of ADEs resulting in hospital visits. To address this issue, we conducted a prospective survey in primary care and emergency departments of French public hospitals. This study was performed over two periods of one week, one in January, February and one in June 2003, in primary care and emergengy departments of four university hospitals and three general hospitals throughout France. Out of a total of 1826 patients consulting, 1663 were taking at least one drug during the previous week and were included for analysis according to the protocol. Altogether, 370 (22.2%; IC 95: 20.2-24.3%) of these patients receiving at least one drug consulted because of an ADE. From these 370 patients, 263 (15.8%) where considered as touched by a probably (12), likely (13) or very likely (14) ADE. The sex ratio was the same in both groups with or without ADE (0.88%; P=0.95). Patients with ADE were older than those without (62.4 vs 53.8 years, P=0.0016). Furthermore, ADE patients were more likely to have a higher severity score than no-ADE group (P=0.0003). The outcome seemed to be worse in patients with an ADE. The percentage of patients treated with 2 or more drugs and the number of drug exposures were significantly higher in patients with ADE than in those without (93.2% vs 84.2%, P<0.0001, and 5.8 vs 4.5 P<0.0001, respectively). The most frequent causes of visits for ADE-patients were digestive (n=38: 14.4%), neurological (n=23: 10.6%), malaise (n=48: 18,2%) events. The most frequently incriminated drug classes were (1) psychotropic agents, (including anxiolytics, hypnotics, antidepressants and antipsychotics), (2) diuretics (3) anticoagulants, (4) other cardiovascular drugs and (5) analgesics, including non steroidal anti-inflammatory agents. In 150 cases (40.8%; IC 95: 33.7% - 45%), the ADE was considered to be preventable because a contra-indication or a warning about drug use had not been respected.

Adult↗
PubMed2002

[Placebo effect on diastolic, systolic and pulsed arterial pressure].

UNLABELLED: THE PLACEBO EFFECT: In controlled clinical trials, use of a placebo has demonstrated that the lowering of blood pressure in hypertensive patients under medication is associated with a reduction in cardiovascular morbidity and mortality. Although a placebo clearly lowers levels of systolic and diastolic blood pressure (to varying degrees depending on the measurement used), it does not appear to have any effect on the pulse pressure, representing the difference between the systolic and diastolic pressures. CENTRAL MECHANISMS: The absence of placebo effect on the pulse pressure, demonstrated by controlled studies, suggests the activity of central mechanisms (notably bulbar), common to the placebo effect and to the control of neurogenic coupling between the heart and the large caliber arteries. IN PRACTICE: Since the pulse pressure after the age of 60 is a major factor for predicting myocardial infarction, these results suggest that modifications in pulse pressure should be more closely studied during controlled cardiovascular clinical trials in elderly patients.

Blood Pressure↗
PubMed2001

Evaluation of the placebo effect and reproducibility of blood pressure measurement in hypertension.

Pharmacologic studies in hypertension often describe blood pressure (BP) reductions in placebo control groups. This placebo effect is currently debated, as it seems to be related to BP measurement methods and as a regression to the mean phenomenon may lead to misinterpretation. Furthermore, data on pulse pressure are lacking. This study was designed to evaluate the placebo effect on BP and to differentiate it from regression to the mean. According to a crossover design, 26 mild-to-moderate hypertensive patients who were treated with placebo or given no treatment were followed-up for 1 month. Clinic and ambulatory BP was assessed at baseline and at the end of each 1-month period. Placebo administration resulted in significant reductions in clinic systolic, diastolic, and mean BP (P < .01), ambulatory 24-h SBP (P < .05), and daytime systolic, diastolic, and mean BP (P < .01, P < .05, P < .01, respectively). No significant differences were noted for pulse pressure and heart rate or between BP values measured at baseline and after 1 month without treatment. Despite a significant correlation between changes in clinic and ambulatory BP, the scatter of individual data suggests that the placebo response observed with one method cannot be systematically extrapolated to the other method. This study conclusively shows the effect of placebo in mild-to-moderate hypertension on both clinic and ambulatory systolic, diastolic, and mean BP, in which it has been shown to differ from the regression to the mean phenomenon. This effect was not observed for pulse pressure or heart rate.

Adult↗
PubMed2000

[Pain not associated with hypernociception. A physiopathologic, clinical and therapeutic approach].

It would be simplistic to consider the reality of pain as nothing more than heightened sensitivity to the pain. There are actually five types of pain, and it is often difficult to distinguish between them. Whereas hypernociceptive pain is mainly treated with analgesics belonging to one of the three categories as defined by the WHO, the mechanisms and treatment of the other four types of pain are very different It is obvious that close co-operation between the various healthcare professionals is indispensable in the treatment of these patients, while keeping in mind that the physician is "a symbol, an intermediary, a medicine that's better than medicine: the medicine works because it's a symbol - it's a symbol because it works". (P. Queneau and G. Ostermann.)

Humans↗
PubMed1998

[Prevention of avoidable iatrogenic effects: the obligation for vigilance].

PREVALENCE: Latrogenic-related morbidity and mortality rates are difficult to determine. Certain estimations in France and other countries have suggested that drug-related accidents alone could account for 5 to 10% of all acute hospitalizations. This would mean that in France, several thousand deaths are caused annuallty by drugs. COST CONSIDERATIONS: Independent of the human aspect, health care expenditures related to iatrogenic accidents are substantial. In France, the cost would be several ten billion francs. Although the cost/benefit ratio remains highly positive, statistically speaking one cannot ignore the high cost of severe accidents. THE NOTION OF RISK: There is an urgent need to persuade the public opinion that all effective medicines, like all surgical procedures, carry a risk. Zero risk does not exist. Patients, and the public in general, should come to realize that the objective is to minimize risk inherent in all therapies. PREVENTION: It is the duty of the entire health care team to calculate the level of acceptable risk and take all the necessary preventive measures. One of the objectives of the French National Educational Association for Training in Therapeutics (APNET) is to define means of reducing latrogenic effects.

France↗
PubMed1998

[Initial and continuous education. Entreaty for better education of physicians in therapeutics].

Concrete education on therapeutical decision must constitute a major institutional objective during the higher academic period of the medical students. The current therapeutics constitutes a branch of instruction based on the up-to-date of the "medical science" and on the evidence evaluation. However, such evidence-based medicine still biased, evolutionary and thus provisory valid; whereas at the same time it must be appropriate and suitable for the patients benefit. Data issued from medical science are on the basis of the interactive and pragmatic apprenticeship of the therapeutical decision and prescription with a personalized approach of patient and at each step of its disease. The continuous postgraduate education programs following the initial Academic instruction contributes to up date the knowledges and moreover the professional experience and practice. This evolution is performed with respect of both the individual ethic-related to the patient and the collective ethics in terms of public health.

Curriculum↗
PubMed1995

Chrono-pharmacological study of once daily curative dose of a low molecular weight heparin (200 IU antiXa/kg of Dalteparin) in ten healthy volunteers.

Low molecular weight heparin (LMWH) is currently prescribed for the treatment of deep vein thrombosis at the dose of 100 IU antiXa/kg twice daily or at a dose of 175 IU antiXa/kg once daily with a similar efficacy. We decided to study the chrono-pharmacology of curative dose of LMWH once daily administrated according to the one previously described with unfractionated heparin (UFH). Ten healthy volunteers participated in an open three-period crossover study according to three 24 h cycles, separated by a wash-out interval lasting 7 days: one control cycle without injection, two cycles with subcutaneous injection of 200 IU antiXa/kg of Dalteparin (Fragmin) at 8 a.m. or at 8 p.m. Parameters of heparin activity were analysed as maximal values and area under the curve. Activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT) and tissue factor pathway inhibitor (TFPI) were higher after 8 p.m. injection than after 8 a.m. injection (p < 0.05) while no chrono-pharmacological variation of anti factor Xa (AXa) activity was observed. Thus the biological anticoagulant effect of 200 IU antiXa/kg of Dalteparin seems to be higher after an evening injection than after a morning injection. A chrono-therapeutic approach with LMWH, as prescribed once daily, deserves further investigation since our results suggest that a preferential injection time may optimise the clinical efficacy of these LMWH.

Adult↗
PubMed1994

Dosing time optimizes sustained-release ketoprofen treatment of osteoarthritis.

A double-blind randomized parallel-group trial was undertaken to evaluate the influence of the dosing time of sustained-release ketoprofen (SRK) on its acceptability and efficacy. The SRK was prescribed for 2 weeks (200 mg once a day) to 117 outpatients with osteoarthritis of the knee and/or hip. One group received SRK in the morning (at 8 a.m.) and the other group in the evening (at 8 p.m.). The principal aim of the trial concerned the acceptability, whereas efficacy was its secondary aim. The principal trial criterion was defined as the number of spontaneous recordings of adverse effects. Results showed clearly that the acceptability of SRK in the SRK morning group was worse than that in the evening group (39% of patients with one or more adverse effects in the SRK morning group versus 19% in the evening group; p = 0.019). It is important to stress the difference concerning the number of adverse effects (48 for SRK morning group versus 23 for SRK evening group; p = 0.0234). The analgesic efficacy seemed to be similar, but one criterion was statistically significant: The duration of analgesic efficacy was more important for the SRK evening group than for the morning group (9.37 and 5.47 h, respectively; p = 0.001). To increase its acceptability, evening administration of SRK seems to be preferred over morning administration in osteoarthritis. However, other trials of the same type, assessing other antiinflammatory agents, are necessary before a general extrapolation of such results can be undertaken.

Adult↗
PubMed1994

[Ischio-vertebral dysplasia (a dangerous syndrome for the spinal cord)].

PURPOSE OF STUDY: A previously unreported condition is defined, diagnostic features identified, and clinical course and treatment modalities presented. MATERIAL AND METHODS: This is a retrospective study of 11 patients with ischio-vertebral dysplasia (IVD), accomplished by record and radiographic review. RESULTS: 11 patients were included in the study group, age at presentation from 1 day to 33 yrs. Follow-up ranged from 5-30 yrs. Involvement of 3 successive generations (grandmother, mother and daughter) with similar findings was present in 1 family. Common features of IVD include: peculiar facies incomplete ossification of the ischial ramus, and a dysplasic scoliosis with a significant kyphotic element, constituting a rotatory dislocation. 2 patients followed from birth demonstrated the natural history of the condition, beginning without spinal deformity, and progressing to significant deformity. The spinal deformity was manageable surgically. The scoliosis ranged from 10 degrees to 235 degrees, and the kyphosis from 0 degrees to 200 degrees (the 10 and 0 being at day 1 of age). 6 patients incurred neurological sequelae, either spontaneously or associated with surgical treatment. 2 patients died, 1 due to cardiopulmonary failure at age 33; the 2nd was an infant with severe neurologic and cardiopulmonary complications due to the spinal deformity. Multiple surgical approaches to the problems were employed. Analysis of results permitted formulation of a logical and successful approach to the problem. Pre-op mean kyphosis = 112 degrees, post-op at maximum follow-up = 67 degrees. Deformity stabilization and neurologic normalcy was produced in every patient operated but 1. DISCUSSION: The characteristics of the syndrome are clear, as is the progressive nature of the deformity. The very high risk of neurologic involvement is emphasized. Before age 10, circumferencial fusion prevents progression and neurologic deterioration. Older patients require gradual correction by skeletal traction, followed by anterior concave strut stabilization and posterior fusion (with or without instrumentation). Extreme care is necessary for protection of the particularly vulnerable neurologic structures. Early stabilization and correction is recommended for prevention of the deterioration of cardiopulmonary function.

Abnormalities, Multiple↗
PubMed1992

Acceptability and efficacy of two associations of paracetamol with a central analgesic (dextropropoxyphene or codeine): comparison in osteoarthritis.

A double-blind randomized parallel group trial was undertaken to compare the acceptability and efficacy of 2 forms of analgesic treatment, DI-Antalvic (Houde Laboratories, Puteaux, France) (30 mg dextropropoxyphene and 400 mg paracetamol per capsule) and Efferalgan-Codeine (UPSA Laboratories, Rueil Malmaison, France) (30 mg codeine and 500 mg paracetamol per tablet) prescribed for 1 week at doses of 6 capsules/day and 6 tablets/day, respectively, in 141 outpatients with active osteoarthritis of the knee or hip. The principal aim of the trial was concerned with acceptability, with efficacy as its secondary aim. The principal trial criterion was defined as overall assessment of acceptability by the patient at the end of the trial (success or failure) or by treatment dropouts because of an adverse effect (failure). Comparability of the groups was confirmed before any treatment regarding the physical characteristics of the patients, characteristics of osteoarthritis, and the initial level of pain and functional consequences of pain. Results show that the analgesic efficacy of the treatment was similar, but that the acceptability of Efferalgan-Codeine was significantly worse than that of DI-Antalvic: 53% failure with Efferalgan-Codeine versus 29% failure with DI-Antalvic (P = .005). Other trials of the same type would seem necessary (comparison of lower doses, other types of pain) before being able to generally extrapolate such findings.

Acetaminophen↗
PubMed1992

[Chronopharmacology of fractionated heparin (nadroparin) administrated by subcutaneous route at prophylactic doses in healthy volunteers].

This study evaluated the effect of injection time on pharmacodynamic of a single subcutaneous bolus of nadroparine (7500 anti-Xa IC U) evaluated by anti-Xa activity (Hepaclot and Heptest) and by activated partial thromboplastin time (APTT by auto PTT reagent). 10 healthy male volunteers were studied at 4 different 24 hours periods with 4 different injection times (6 am, 12 am, 6 pm, 12 pm) and with a one week wash-out period between each period. No chronopharmacological variation of the anti-Xa activity evaluated by Hepaclot was found. However the anti-Xa activity evaluated by Heptest was higher at the sixth hour after 12 am injection (p = 0.0022). No difference on APTT values was observed whatever the injection time. So the injection time of nadroparine has a weak influence on anti-Xa activity and no effect on APTT; Before to conclude on the lack of chronopharmacological effect of nadroparine, it seems necessary to evaluate such a possibility with higher dosage, with sick and older subjects.

Adult↗