RESUMEN
Liver fibrosis is often undetected whereas it is the determinant of liver-related mortality. We evaluate a pathway based on the systematic calculation of FIB-4 to screen for advanced hepatic fibrosis. Systematic calculation of FIB-4 was implemented in the centralized laboratory of a French University Hospital in 4 pilot departments. If ≥ 2.67, the FIB-4 result was returned to the prescribers, for patients between 18 and 70 years of age, with an incentive to measure liver stiffness by vibration controlled transient elastography. During a 2-years period, a FIB-4 was calculated in 2963 patients and 135 were ≥ 2.67 (4.6%). After exclusion of patients with a known cause of elevated FIB-4, 47 patients (34.8%) were eligible for elastography. Forty patients underwent elastography, but only 15% (7/47) at the spontaneous request of the referring physician. Fifteen patients were identified with significant fibrosis, among which 8 attended the scheduled specialist consultation, all with a confirmed diagnosis of cirrhosis. A sequential pathway based on the systematic calculation of FIB-4 enables the identification of patients with significant unknown liver fibrosis, allowing to refer them to specialized care. Raising awareness is essential to improve the care pathway.
Asunto(s)
Diagnóstico por Imagen de Elasticidad , Cirrosis Hepática , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Persona de Mediana Edad , Masculino , Femenino , Adulto , Anciano , Diagnóstico por Imagen de Elasticidad/métodos , Diagnóstico Precoz , Adolescente , Adulto Joven , Enfermedad Crónica , Tamizaje Masivo/métodosRESUMEN
BACKGROUND: For pertinent investigation of patient satisfaction it is important to know what type of data collection procedure yields optimal results. In this study, we compared a self- versus interview administration of the European Organisation for Research and Treatment of Cancer (EORTC) patient satisfaction questionnaire (QLQ-SAT32), noting response and item omission rates. We also assessed the correlation and agreement between responses according to these modalities of questionnaire administration. METHODS: 123 patients recruited in two anti-cancer Centers in France were asked to complete the QLQ-SAT32 at home within 2 weeks of hospital discharge and were randomly allocated to participate in a telephone interview-administration of the QLQ-SAT32, either before or after self-completing the QLQ-SAT32. RESULTS: 104 patients completed both modalities of questionnaire administration. Agreement proved excellent for the doctors' and nurses' subscales and satisfactory for the services' subscale and the general satisfaction single item. However, a significant difference in response rate showed up between Centers (different interviewers) and the interview modality revealed an item omission rate higher than for the self-administration modality. CONCLUSION: Self- and interview-administration of the QLQ-SAT32 provided similar responses however different response rate between interviewers and higher item omission rate in interviews suggests a biasing effect of that modality of data collection.
Asunto(s)
Neoplasias , Satisfacción del Paciente , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Recolección de Datos/métodos , Femenino , Francia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Doubts are expressed on the validity of patient satisfaction questionnaires. High satisfaction levels are consistently reported. Within the European Organisation for Research and Treatment of Cancer (EORTC) quality of life group, we developed a cancer inpatient satisfaction questionnaire (QLQ-SAT32), adopting several precautions to overcome the ceiling effect commonly reported in satisfaction ratings. Since patients are often more critical when expressing themselves in an interview, in order to study the validity of the QLQ-SAT32, we assessed the agreement between self- and interview-administered QLQ-SAT32 responses. One hundred and twenty three patients were asked to complete the QLQ-SAT32 at home within 2 weeks of hospital discharge and were randomly allocated to participate in a telephone interview-administration of the QLQ-SAT32, either before or after self-completing the QLQ-SAT32. One hundred and four of them completed both modalities of questionnaire administration. Correlation and agreement between self- and interview-administered QLQ-SAT32 ratings were examined, for each subscale and the general satisfaction item of the QLQ-SAT32, using Spearman correlation, intra-class correlation coefficients (ICC) or weighted kappa coefficients. Agreement showed excellent for the doctors' and nurses' subscales and satisfactory for the services' subscale and the general satisfaction single item. The telephone interview-administration modality did not prove an adequate procedure to assess the validity of a patient satisfaction questionnaire.
Asunto(s)
Pacientes Internos/psicología , Entrevistas como Asunto , Neoplasias/psicología , Satisfacción del Paciente , Calidad de Vida , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Francia , Humanos , Entrevistas como Asunto/métodos , Entrevistas como Asunto/normas , Oncología Médica/normas , Persona de Mediana Edad , Enfermería Oncológica/normas , Satisfacción del Paciente/estadística & datos numéricos , Psicometría , Calidad de la Atención de Salud/normas , Método Simple Ciego , Estadísticas no Paramétricas , TeléfonoRESUMEN
Typhoid fever is rare in Europe, but well-recognized endemic disease in tropical zones. We report our findings in a series of 25 cases of typhoid fever during pregnancy observed in French Guiana and reviewed the literature on clinical signs, diagnosis and treatment. Salmonellea typhi causes septicemia of digestive origin that can cross the placenta resulting in chorioamniotitis. Maternal-fetal infection with S. typhi can lead to miscarriage, fetal death, neonatal infection, as well as diverse maternal complications. In order to avoid maternal complications and possible fetal transmission, treatment with ceftriaxone should be initiated as early as possible
Asunto(s)
Enfermedades Endémicas , Complicaciones Infecciosas del Embarazo , Fiebre Tifoidea , Aborto Espontáneo/microbiología , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Farmacorresistencia Microbiana , Enfermedades Endémicas/prevención & control , Enfermedades Endémicas/estadística & datos numéricos , Femenino , Muerte Fetal/microbiología , Guyana Francesa/epidemiología , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pruebas de Sensibilidad Microbiana , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Estudios Retrospectivos , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológico , Fiebre Tifoidea/epidemiologíaRESUMEN
Malaria is the most frequent infection world wide affecting pregnant women. The association of malaria and pregnancy sometimes has serious repercussions on the foetus and increases maternal morbidity. We report 143 cases of pregnant women infected by Plasmodium falciparum in French Guyana. The consequences on the fetus in this area, where the maternal premunition rate is low, are serious: the rates of prematurity, hypotrophy and stillbirth are 3 times higher among pregnant women infected by malaria. The consequences for the fetus are all more serious if the infestation is repeated or prolonged, the closer one is to delivery, and if the parity is low. The histologic study of the placenta shows a significant correlation between the placental infection and the fetal hypotrophy. We tried to detect in utero the consequences malaria infection has on the fetus: the presence of an echographic oligoamnios and alterations of the Doppler ratings would be predictive of deleterious consequences of malaria on the fetus. We emphasize the need for rapid treatment as soon as the attack begins, before serious placental lesions occur.
Asunto(s)
Malaria , Complicaciones Parasitarias del Embarazo , Resultado del Embarazo , Femenino , Humanos , Recién Nacido , Malaria/diagnóstico , Malaria/epidemiología , Malaria/terapia , Embarazo , Complicaciones Parasitarias del Embarazo/diagnóstico , Complicaciones Parasitarias del Embarazo/epidemiología , Complicaciones Parasitarias del Embarazo/terapiaRESUMEN
Catalytic properties of a preparation of human pancreatic lipase purified from pancreatic juice have been compared to those of the enzyme present in pooled plasma from patients suffering from acute pancreatitis. They were very similar as regards influence of effectors (sodium deoxycholate, colipase and Ca2+), optimal pH and apparent KM in optimized conditions. The stability of the preparation appeared to be satisfactory. It was found to be stable for at least 200 days in a liquid form at +4 degrees C and predictive degradation rates per year of the lyophilized form at +4 degrees C and -20 degrees C were 0.06% and 0.00%, respectively. The close similarity of properties of this preparation with those of a recombinant human pancreatic lipase produced in V79 Chinese hamster lung cells suggests that both approaches (purification from human pancreatic juice and gene transfer technology) could be used to produce a suitable reference material for this enzyme.
Asunto(s)
Lipasa/metabolismo , Jugo Pancreático/enzimología , Calcio/farmacología , Catálisis , Colagogos y Coleréticos/farmacología , Ácido Desoxicólico/farmacología , Emulsiones , Liofilización , Humanos , Concentración de Iones de Hidrógeno , Indicadores y Reactivos , Cinética , Lipasa/química , Lipasa/aislamiento & purificación , Nefelometría y Turbidimetría , Aceite de Oliva , Aceites de Plantas/química , Espectrofotometría UltravioletaRESUMEN
Following the selection of the most appropriate method for emulsification and the optimization of the reaction medium, interlaboratory studies were conducted to check the effect of preparing substrates and measuring the catalytic concentration of lipase at different sites as well as the effect of transport on emulsion. The determinations of lipase activity in an abnormal chemistry control against emulsions prepared by two laboratories (and used by both laboratories) and, also, against five separate emulsions prepared by one laboratory (and used by five different laboratories) resulted in average enzyme activity values (2234 +/- 125 and 2263 +/- 204 U/l respectively) which are not statistically different. Standard preparations of lipase, control sera and reference materials can therefore be titrated according to the procedure followed by at least two laboratories for at least 3 days against two separate emulsions.