Rural–urban inequalities in detection rates of colorectal tumours in the population

Abstract Background Because few data are available on this topic, we investigated the influence of geographical determinants on colorectal adenoma detection and cancer incidence rates. Methods Between 1990 and 1999, 6220 Cote d’Or inhabitants (France) were first-diagnosed with a colorectal adenoma, and 2389 with an invasive adenocarcinoma. The impact of the rural–urban place of residence and of a physician location in municipalities on adenoma and cancer detection rates was studied using Poisson regression. Results World-standardized adenoma detection rate was significantly higher in urban areas (102 [95%CI: 97–107]) than in rural areas (78 [95%CI: 72–84]). The impact of the absence of phys…

Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study.

Summary Introduction Serum concentration of C-reactive protein (CRP) that exceeds a pre-defined threshold between the 3rd and 5th postoperative day is a reliable marker of infectious complications after colorectal surgery. However, the optimal strategy to follow when a high CRP is found has not been defined. The aim of this study was to analyze the usefulness of computed tomography (CT) scan in this situation in a prospective cohort of patients following colorectal surgery. Methods Between November 2011 and April 2015, patients at two surgical centers who had undergone elective colorectal resection with anastomosis and who had a CRP > 12.5 mg/dL on the 4th postoperative day (POD) were prosp…

Social deprivation and 1‐year survival after stroke: a prospective cohort study

BACKGROUND Social deprivation may have a deleterious influence on post-stroke outcomes, but available data in the literature are mixed. AIM The aim of this cohort study was to evaluate the impact of social deprivation on 1-year survival in patients with first-ever stroke. METHODS Social deprivation was assessed at individual level with the EPICES score, a validated multidimensional questionnaire, in 1312 patients with ischemic stroke and 228 patients with spontaneous intracerebral hemorrhage, who were prospectively enrolled in six French study centers. Baseline characteristics including stroke severity and pre-stroke functional status were collected. Multivariable Cox models were generated …

A decision tree to help determine the best timing and antiretroviral strategy in HIV-infected patients.

SUMMARYOptimal antiretroviral strategies for HIV-infected patients still need to be established. To this end a decision tree including different antiretroviral strategies that could be adopted for HIV-infected patients was built. A 10-year follow-up was simulated by using transitional probabilities estimated from a large cohort using a time-homogeneous Markov model. The desired outcome was for patients to maintain a CD4 cell count of >500 cells/mm3without experiencing AIDS or death. For patients with a baseline HIV viral load ⩾5 log10copies/ml, boosted protease inhibitor-based immediate highly active antiretroviral therapy (HAART) allowed them to spend 12% more time with CD4 ⩾500/mm3than…

Measuring threshold and latency of motion perception on a swinging bed.

Introduction Our objective was to develop and to evaluate a system to measure latency and threshold of pendular motion perception based on a swinging bed. Materials and methods This prospective study included 30 healthy adults (age: 32 ± 12 years). All subjects were tested twice with a 10 min. interval. A second trial was conducted 2 to 15 days after. A rehabilitation swinging bed was connected to an electronic device emitting a beep at the beginning of each oscillation phase with an adjustable time lag. Subjects were blindfolded and auditory cues other than the beep were minimized. The acceleration threshold was measured by letting the bed oscillate freely until a natural break and asking…

Factors influencing inclusion in digestive cancer clinical trials: A population-based study

Inclusion in a randomized therapeutic trial represents an optimal therapeutic strategy.To determine the influence of demographic characteristics and deprivation on the enrolment of patients in digestive cancer clinical trials.Between 2004 and 2010, 4632 patients were recorded by the Burgundy Digestive Cancer Registry. According to a balancing score, the 136 patients included in a clinical trial were matched with 272 patients who met the eligibility criteria for trials. Deprivation was measured by the ecological European deprivation index. A conditional multivariate logistic regression was performed.Patients aged over 75 years were significantly less likely to be included in clinical trials …

Marqueurs inflammatoires pour le diagnostic précoce d’infection postopératoire : le même seuil pour la chirurgie rectale et colique ?

Resume Introduction La fistule anastomotique est la complication redoutee apres chirurgie colorectale. De nombreux travaux ont montre l’interet du dosage de la CRP en postoperatoire comme marqueur diagnostic precoce. Le seuil critique des marqueurs biologiques de l’inflammation doit-il rester le meme que la resection soit colique ou rectale ? Patients et methode Il s’agit d’une etude basee sur une cohorte constituee entre 2011 et 2014, incluant 497 patients avec une resection colorectale programmee. La proteine C-reactive et la pro-calcitonine ont ete mesurees tous les jours entre la veille et le 4e jour. Toutes les complications postoperatoires intra-abdominales ont ete considerees comme u…

Disparités du taux de détection des adénomes colorectaux en fonction du lieu de domicile et de la distance aux médecins en Côte-d’Or, entre 1990 et 1999

Analyse de l’impact des facteurs socioéconomiques sur la sévérité initiale des accidents vasculaires cérébraux en France métropolitaine et aux Antilles (étude INDIA)

Introduction Malgre un systeme de sante tres favorable, les inegalites sociales de sante se sont creusees en France au cours des deux dernieres decennies. En depit de cette situation, l’impact des facteurs socioeconomiques a ete peu etudie a l’echelle individuelle sur le territoire francais et les donnees a meme de mobiliser les acteurs restent insuffisantes. Par ailleurs le retentissement des AVC sur l’etat de sante des francais est considerable : premiere cause de handicap de l’adulte, deuxieme cause de demence, troisieme cause de mortalite. De plus, le niveau socioeconomique, par son impact sur les facteurs de risque d’AVC, est susceptible d’affecter les manifestations cliniques initiale…

Is the Short and Fast Step Test a safe and feasible tool for exploring anaerobic capacities of individuals with coronary heart disease in clinical practice?

Background While its importance in daily living, the anaerobic metabolism is not taken into account in clinical practice. The lack of validated functional performance tests for patients with chronic disabilities may explain this defect. In this context, the Short and Fast Step Test (SFST) was recently developed and validated in healthy volunteers. Aim The purpose of this study was to investigate the safety, feasibility and reliability of the SFST, a functional test exploring anaerobic metabolism in coronary patients during cardiac rehabilitation. Design This study was a monocentric prospective study. Settings This study took place in the rehabilitation center of the University Hospital Cent…

Impact of a stay in the intensive care unit on the preparation of Advance Directives: Descriptive, exploratory, qualitative study.

Abstract Background Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. Methods The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home > 3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. Results In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of “advance directives”. Only 2% had executed AD before ICU admis…

Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery? A Prospective Study

Infections are the most frequent complication after colorectal surgery. It has been suggested that adipose tissue metabolism could be related to the risk of post-operative infection, but this could be partially related to the body-mass index. The aim of this study was to look for a relation between adipocytokine levels and the risk of post-operative infection and its type.This prospective cohort study was conducted between March 2013 and March 2014 in two French teaching hospitals. Pre-operative plasma levels of adiponectin and leptin were measured in consecutive patients undergoing elective colorectal surgery. All infections in the 30 d following surgery were recorded.Among the 142 patient…

Faut-il réaliser un scanner quand la protéine C réactive est élevée après chirurgie colorectale ? Résultats de la cohorte IMACORS

Resume Introduction Les concentrations seriques de proteine C reactive (CRP) en deca d’un seuil predefini entre le 3e et le 5e jour postoperatoire sont un marqueur fiable de l’absence de complication infectieuse apres chirurgie colorectale. Cependant, la strategie a mettre en place en cas de CRP elevee n’est pas codifiee. Le but de ce travail etait d’analyser l’utilite du scanner dans cette situation au sein d’une cohorte prospective de chirurgie colorectale reglee. Methodes Entre novembre 2011 et avril 2015, les patients ayant une CRP > 125 mg/L au 4e jour postoperatoire d’une resection colorectale reglee dans l’un des 2 centres participants ont ete inclus prospectivement dans une base. To…

Walking Speed as an Alternative Measure of Functional Status in Patients with Lumbar Spinal Stenosis

Objective The main objective was to compare estimated walking perimeter (WP) and actual WP during a free walking test (6-minute walk test [6MWT]) in patients with lumbar spinal stenosis (LSS). The second objective was to describe the correlation between measured gait parameters and functional parameters. Methods This was a single-center prospective study including 38 patients with symptomatic LSS (23 men, 15 women; mean age, 69.3 ± 7.9 years). The intervention was the 6MWT. For the main outcome measure, patients were first asked to verbally estimate their WP. Then, WP was evaluated using a 6MWT at a self-selected speed. In the absence of need to stop, and if a distance of 500 m was not reac…

Vasopressor Cumulative Dose Requirement and Risk of Early Death During Septic Shock: An Analysis From The EPISS Cohort

Septic shock is the primary cause of death in intensive care units, with about 20% of patients dying in the first 3 days. To design future trials focused on early mortality, we require knowledge of early indicators that can detect patients at high risk of early death from refractory septic shock.The aim of this study was to assess whether the cumulative dose of vasopressors (CDV), calculated as the cumulative dose of epinephrine + norepinephrine, is a predictor of early death (within 72 hours) attributable to refractory septic shock (EDASS). This substudy of the EPISS trial was based on 370 patients admitted to a French ICU for septic shock between 2009 and 2011. The area under the receivin…

Rural–urban differences in the long-term risk of colorectal cancer after adenoma removal: A population-based study

Abstract Background We investigated the impact of municipality of residence on colonoscopic surveillance and colorectal cancer risk after adenoma resection in a French well-defined administrative area. Methods This registry-based study included all patients residing in Cote d’Or (n = 5769) first diagnosed with colorectal adenomas between January 1, 1990, and December 31, 1999. Information about colonoscopic surveillance and colorectal cancer incidence was collected until December 31, 2003. Results A rural place of residence reduced the probability of colonoscopic surveillance in men [HR = 0.89 (95%CI: 0.79–0.99), p = 0.041] and in patients without family history of colorectal cancer [HR = 0…