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Biomedical subjects

Sylvie Meaume

Publications and source records attributed to Sylvie Meaume.

16 recordsLinked to original sources
PubMed2003

Risk factors for nosocomial pneumonia in a geriatric hospital: a control-case one-center study.

OBJECTIVES: To determine the risk factors (RFs) and the incidence of nosocomial pneumonia (NP). DESIGN: Control/case study conducted from January 1 to April 15, 1999. Prospective enrollment. SETTING: Geriatric university hospital with long-, intermediate-, and short-term care facilities. PARTICIPANTS: Inpatients aged 65 and older with NP. MEASUREMENTS: NP diagnosis relied on at least two clinical signs of respiratory infection and on chest radiography. Each NP case was randomly paired with two controls and followed up for 30 days to determine complication and mortality rates. RFs between cases and controls were compared (chi-square test, odds ratio (OR), 95% confidence interval, significance level P =.05). RFs that were significant in univariate analysis were tested using multivariate analysis and logistic regression. RESULTS: Seventy-five cases of NP were diagnosed in 2,142 patients. The average incidence rate was 3.5% (short-term facilities = 0.5%; intermediate-term facilities = 8.3%; long-term care facilities = 5.3%). The complication rate was 58.1%. The most frequent complications were recurrent NP, heart and respiratory failure, phlebitis, and pressure ulcers. The NP mortality rate was 12.2%. The independent RFs of NP were a history of NP during the previous 6 months (OR = 4.50) and oxygen therapy (OR = 16.15), P <.001. Additional RFs were severe malnutrition, heart failure, prescription of antibiotics during the month preceding the emerging NP, eating dependency, and feeding by nasogastric tube. CONCLUSION: The main RF for NP is a history of pneumonia. NP prevention in geriatrics should rely on early management of respiratory infections and malnutrition, surveillance of oxygen therapy and enteral feeding, rational use of antibiotics, and adaptation to the patient's dependency.

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PubMed2002

Sequential treatment with calcium alginate dressings and hydrocolloid dressings accelerates pressure ulcer healing in older subjects: a multicenter randomized trial of sequential versus nonsequential treatment with hydrocolloid dressings alone.

OBJECTIVES: To compare the efficacy of a sequential strategy combining calcium alginate and hydrocolloid dressings treatment of grade III or IV pressure ulcers (PUs) and the efficacy of nonsequential strategy with hydrocolloids alone. DESIGN: An open, randomized, multicenter parallel-group trial. SETTING: Twenty geriatrics hospital wards. PARTICIPANTS: One hundred ten older patients with grade III or IV PUs. INTERVENTION: The control strategy consisted of applying hydrocolloid dressings (DuodermE) for 8 weeks; the sequential strategy consisted of applying combined calcium alginate dressings (UrgoSorb) for the first 4 weeks and hydrocolloid dressings (Algoplaque) for the next 4 weeks. MEASUREMENTS: PU surface areas were measured weekly by ulcer tracing. The endpoints were the mean absolute surface area reduction (SAR) during the 8-week study period and the number of patients achieving a 40 or more SAR (SAR40). RESULTS: Fifty-seven and 53 patients were randomly allocated to sequential and control strategies respectively. Baseline patient characteristics and PU ulcer features at inclusion were similar in the two groups. Mean +/- standard deviation SAR was significantly larger in the sequential treatment group (5.4 +/- 5.7 cm2 and 7.6 +/- 7.1 cm2 at 4 and 8 weeks) than in the control group (1.6 +/- 4.9 cm2 and 3.1 +/- 7.2 cm2, P< .001). In the sequential treatment group, 68.4 of the patients reached SAR40 at 4 weeks and 75.4 at 8 weeks, proportions significantly larger than in the control group (22.6 and 58.5, respectively, P< .0001). Dressing tolerance was good in both strategies. CONCLUSIONS: In grade III or IV PUs, treatment using first calcium alginate dressings and then hydrocolloid dressings promotes faster healing than treatment with hydrocolloid dressings alone.

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PubMed2002

Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.

RATIONALE AND OBJECTIVES: Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia. METHODS: During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation. RESULTS: One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03). CONCLUSIONS: Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.

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PubMed2002

[Immunity, autoimmunity, and the aging process: complex interactions].

Immune deficiency is not an age-related process, but rather a progressive process where predominantly cellular immune response is gradually, but never totally, replaced by antibody response. Cellular immune response appears to be associated with the intrinsic mechanisms of pathological aging. Cellular immunity resulting from induction of macrophage stimulation and cytokine secretion appears to involved. These immuno-inflammatory changes mimic the effects of pathological aging in the different organs. Are they essential factors or simply accessory phenomena? Switching towards an antibody response appears to be a mechanism of adaptation rather than a mechanism of deterioration. Immune status provides a good means of assessing general status in an elderly subject. An attempt should be made to identify the cause of any immune deficiency since age is not in itself an underlying cause. Etiological treatment is indicated.

Aged↗
PubMedDate not supplied

Chronic wound scars.

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Chronic Disease↗
PubMedDate not supplied

Aortic pulse wave velocity: an independent marker of cardiovascular risk.

Aortic pulse wave velocity, a classic index of aortic stiffness, may be easily measured in humans using noninvasive ultrasound methods of high reproducibility. Recent epidemiologic studies have shown that, independently of confounding factors such as age, blood pressure and cardiac mass, aortic pulse wave velocity is a predictor of cardiovascular mortality in populations of hypertensive subjects, whether they have end-stage renal disease or not. Since aortic pulse wave velocity is dominantly influenced by age, this finding may be of major importance for the evaluation of cardiovascular risk in geriatric populations.

Age Factors↗