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Biomedical subjects

Y Charpak

Publications and source records attributed to Y Charpak.

46 records · Page 3Linked to original sources

Evaluation of a protocol for selective ordering of preoperative tests.

A protocol for selective ordering of 12 preoperative tests, according to clinical status and type of surgery, was prospectively tested for one year in a teaching hospital. 3866 consecutive surgical patients had an average of about 4 tests each. The possible value of tests that were omitted was assessed in the light of events during and after operation. According to predetermined criteria, 0.4% of non-ordered tests would have been potentially useful; but in the opinion of the anaesthetists, only 0.2% would actually have been useful. The protocol therefore had little adverse effect on patient care and was acceptable to clinicians.

Adult↗

[Is it possible to predict the cleanliness of the colon before double-contrast enema? Study of the image of the abdomen without preparation, and the number of liquid stools].

Correlations between evaluations by two observers of cleanliness of colon on straight abdominal images (ASP) and on barium enema (LDC) results were studied, as well as predictions of cleanliness of LDC by ASP. Correlation between observers was practically nul for ASP and was poor for LDC. There is lack of correlation between cleanliness of colon on ASP and cleanliness of LDC. It is concluded that no purpose is served in performing ASP before LDC in order to predict cleanliness and that the definition of cleanliness itself requires updating. In contrast, however, the presence of less than three liquid stools appears to be related to diminished cleanliness (p less than 0.05).

Colon↗

[An approach to the evaluation of medical journals: application to original articles of La Presse Médicale and the New England Journal of Medicine published in 1982].

Medical journals play an important role in the diffusion of scientific medical information. We tried to evaluate the French medical journal, La Presse Médicale, and to compare it with the New England Journal of Medicine. We reviewed all the original articles published in 1982 (207 articles In La Presse Medicale and 152 articles in the New England Journal of Medicine): specialties, methodologies used in the studies, environment (number of authors, geographical origin, institutional origin, number and language of references, number of subjects included in the studies). The articles in both journals concerned virtually the same specialties, more than 50% of the articles dealing with the following: cancerology, cardiology, infectious diseases, endocrinology, gastroenterology. Many specialties including highly prevalent diseases were underrepresented in both journals. When treating the same kind of problems, different methodologies were used: faced with a therapeutical problem, authors in La Presse Medicale used mostly non controlled evaluations (46%, 30 articles), and few randomized controlled trials (12%, 8 articles). On the other hand, authors in the New England Journal of Medicine used mostly randomised controlled trials (56%, 36 articles), and less non controlled evaluations (26%, 16 articles). Most references were in English, even in La Presse Medicale, in which 76% of all references were not in French, and 14% of all articles had no French references. In conclusion, this study shows differences between the two journals: in particular, the methodologies used by the authors in La Presse Medicale were less pertinent than those used by the authors in the New England Journal of Medicine. This finding is important with regard to the formation of and information given to the French speaking physicians, and a strong reaction from the editors and physicians concerned is desirable.

Evaluation Studies as Topic↗

Prognostic factors from a randomized clinical trial in resected lung cancer.

Prognostic information has three main uses: prediction of the course of evolution of disease, decisions about treatment and limitation of complementary tests. Using data from a randomized controlled clinical trial of immunotherapy in resected lung cancer, we identified factors of prognostic importance. In particular we demonstrated that a time-consuming and expensive cell-mediated immunity test is not of prognostic value. Our cooperative group decided to cancel this test in the routine examination of patients with resected lung cancer. Disease stage was confirmed as the main prognostic factor.

Clinical Trials as Topic↗

Designing a study for evaluating a protocol for the selective performance of preoperative tests.

Some basic concepts concerning classification of studies evaluating diagnostic procedures are given. The specific problem of assessment of routine preoperative tests is discussed: actual knowledge and methodological criticisms of previous studies, hypothesis for further evaluations, difficulties in the choice of a design and realization of a clinical study to assess a protocol for selective ordering of preoperative tests during one year in a teaching hospital. 3866 consecutive patients were included. The protocol led to perform only 33 per cent of all potential tests and did not apparently produce major adverse effects on the quality of care as appreciated by a clinical decision analysis.

Clinical Trials as Topic↗

[Cross-sectional study of the prevalence of adjustment disorder with anxiety in general practice].

Although Adjustment Disorder (AD) is considered a marginal diagnostic category by many clinicians and researchers, all the rare studies undertaken in the last decades indicate that the prevalence of this disorder is high in psychiatric settings, but has never been investigated in general practice. The purpose of this study was to evaluate the current prevalence of Adjustment Disorders With Anxiety (ADWA) in primary care settings and to describe the characteristics of the population, nature of the stressors and management of the disorder by General Practitioners (GPs). This French study involved 78 random liberal GPs, in 7 distinct regions (Paris, Lille, Bordeaux, Rouen, Dijon, Castres and Compiègne). GPs had to register all the consecutive attenders over 18 years old. For each physician, the registration period was over when 200 patients were registered, or 10 days of consultation were completed, or when 5 MINI had been performed. The average study period was 10 days per physician. At the first stage, they selected all the patients with psychological complaints, which were eventually associated to physical complaints. At the second stage, only the patients whose complaints were linked to a psychosocial stressor and without A1 and/or A2 DSM IV criteria for a Major Depressive Episode (MDE) were proposed the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured clinical diagnostic interview that identifies the main axis-I DSM IV diagnoses in about 15 minutes. Before starting the study, all of the GPs participated in an intensive course on AD criteria recognition and were trained to use the MINI. The GPs registered a total of 7,759 consecutive patients. Twenty-two per cent (n = 1,719) of the patients reported psychological complaints, associated or not to physical complaints. Among them, 49% (n = 844) linked their complaints to identifiable psychosocial stressors. About half of the latter (n = 450) coded positive to A1 and/or A2 criteria for MDE. At the end, a total of 314 patients agreed to complete the MINI. Among the 1,719 patients with psychological complaints, the prevalence of ADWA eventually associated to other psychiatric disorders was 9.2%. The prevalence of "pure" ADWA was 4.5%. When considering the whole population of consecutive patients in primary care settings, the prevalence of pure ADWA was 1.0%. Patients suffering from pure ADWA were mostly women (66.7%), young patients (mean age: 42 years), with a professional activity. Patients had a psychiatric disorder history in 53.8% of the cases (mostly anxiety disorder). The main life events cited as being responsible for the disorder were work-associated problems (23.1%), followed by family illness (9.0%) and serious personal illness or accident (7.7%). The average duration of the disorder was 2.32 months. In 91% of the cases, GPs estimated that the patient required a pharmacological or psychological treatment. In most cases, they treated the patients with drug therapy (74.0%) associated with psychological support (counselling or psychotherapy, 76%). Anxiolytic agents were usually prescribed (64.9%), followed by antidepressants (10.8%) and hypnotics (8.1%). In conclusion, this first prevalence study of ADWA in general practice demonstrates that this disorder is frequent in primary care. It seems to be more present in patients who are of working age, especially women. ADWA would thus seem to preferentially affect active subjects. In most cases, GPs treat their patients with both psychological support and drug therapy. Anxiolytic is the elicited treatment of this disorder.

Adjustment Disorders↗