Search

Your search keyword '"SOMME, D."' showing total 45 results
Start Over Author "SOMME, D." Language french
45 results on '"SOMME, D."'

13. Les Auteurs

Author

Abroug, F., Abtan, J., Aguilar, C., Aissaoui, N., Ait Hssain, A., Ait-Oufella, H., Ajzenberg, N., Aloy, B., Ammirati, C., Amoura, Z., Amstutz, P., Anglicheau, D., Annane, D., Anxionnat, R., Arab, K., Argaud, L., Arnaout, M., Arrivé, L., Assouad, J., Aubron, C., Augis, V., Ayari, H., Azabou, E., Azoulay, E., Bakhos, D., Bailly, E., Bailly, P., Baldolli, A., Barbaud, A., Barbier, F., Barbut, F., Bardon, J., Barraud, D., Barreda, T., Barrot, L., Barry, B., Bartier, J.-C., Bastien, O., Baud, F.J., Baudel, J.-L., Beaussier, M., Bedos, J.-P., Bédry, R., Béduneau, G., Beloncle, F., Beltrami, A., Benghanem, S., Ben Ammar, M., Ben Hadj Salem, O., Benchetrit, D., Benyamina, M., Benzidi, Y., Bernardin, G., Bertholdt, C., Bertocchio, J.-P., Bertoletti, L., Bertrand, C., Besnier, E., Beuret, P., Beydon, L., Bialais, É., Bienaimé, F., Bigé, N., Bihan, K., Bilbault, P., Binoche, A., Biour, M., Birgand, G., Bitker, L., Blanc, J.-V., Blatteau, J.-E., Blivet, S., Blot, F., Bodenes, L., Boels, D., Bohé, J., Boissier, F., Boiteau, R., Boles, J.-M., Bollaert, P.-E., Bondeelle, L., Bonnet, N., Boudon, M., Bouglé, A., Boulain, T., Boulanger, D., Bounab, R., Bourcier, S., Bourigault, C., Bourenne, J., Bouteau, I., Boutonnet, M., Bouzgarrou, R., Boyer, A., Boyer, D., Boyer-Suavet, S., Bracard, S., Brault, C., Bretonnière, C., Bréchot, N., Bridoux, F., Brivet, F.-G., Brochard, L., Bruder, N., Bruneel, F., Brunet, J., Burgel, P.-R., Buscot, M., Cabrio, D., Cadranel, J., Calvet, L., Camus, C., Canaud, B., Canellas, A., Canet, E., Capaldo, L., Capellier, G., Carbonell, N., Cariou, A., Carli, P., Carpentier, D., Carrat, F., Carteaux, G., Casolla, B., Castanares-Zapatero, D., Castelain, V., Cavaillon, J.-M., Cecchini, J., Cha, O., Chamaraux-Tran, T.-N., Champigneulle, B., Chanard, J., Charles, P.-E., Charpentier, J., Chastre, J., Chaussard, M., Chemla, D., Cherifa, M., Chiche, J.-D., Cholley, B., Chopin, C., Chosidow, O., Choukroun, M.-L., Clair, B., Claude, F., Clavier, T., Clément, E., Clere-Jehl, R., Clouzeau, B., Cochereau, I., Cohen, Y., Collins, M., Combes, A., Commandeur, D., Contou, D., Coppo, P., Cordonnier, C., Coriat, P., Cornelis, F., Costedoat-Chalumeau, N., Cottin, V., Cour, M., Coutrot, M., Couturier, J., Couzigou, C., Cravoisy-Popovic, A., Crozier, S., Danel, V., Danin, P.-E., Dargaud, Y., Darmaun, D., Darmon, M., Daubin, C., David, S., De Backer, D., De Cagny, B., Decavèle, M., Decousus, H., Degos, V., De Groote, E., De Jong, A., Dekeyser, T., Delabranche, X., Delahaye, A., Delarue, J., Delclaux, C., Delemazure, J., Delile, E., Delisle, S., Dellamonica, J., Delluc, A., Delplancq, H., Deltour, S., De Martin, E., Demeret, S., Demiselle, J., De Montalembert, M., Demoule, A., Dépret, F., de Prost, N., Dequatre-Ponchelle, N., Dequin, P.-F., Deray, G., Derelle, A.-L., Deriaz, H., De Schryver, N., Deshayes, S., Desmettre, T., Desrousseaux, J., Dessevre, A., Dewitte, A., Deye, N., Dhainaut, J.-F., Didier, S., Diehl, J.-L., Di Martino, V., Djibré, M., Dolz, M., Dorandeu, F., Dorent, R., Do Vale, J., Dres, M., Dreyfuss, D., Dromer, C., Dubée, V., Duburcq, T., Duceau, B., Du Cheyron, D., Ducloy-Bouthors, A.-S., Dugernier, J., Durand, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eckert, C., Écotière, L., Ehrmann, S., El Gharbi, F., Elbaz, M., Embriaco, N., Étienne, H., Essig, M., Fagon, J.-Y., Fagot-Gandet, F., Fartoukh, M., Faugeras, F., Favory, R., Faisy, C., Ferrière, N., Ferry, T., Flamant, M., Folscheid, D., Fontaine, E., Forel, J.-M., Fourrier, F, Fraipont, V., Franchineau, G., Francoz, C., Frat, J.-P., Fresco, R., Friedlander, G., Friedman, D., Fromentin, M., Gainnier, M., Galanaud, D., Garcia, H., Garret, C., Garrouste-Orgeas, M., Gateau, C., Geeraerts, T., Gehanno, P., Gempp, E., Geri, G., Germain, A., Giacardi, C., Gibelin, A., Gibot, S., Girardot, T., Girault, C., Giura, G., Gkalea, V., Godard, A., Godeau, B., Goffinet, F., Gonzalez-Bermejo, J., Gory, B., Gouëllo, J.-P., Goulenok, C., Goursaud, S., Goury, A., Goutagny, S., Graftieaux, J.-P., Grangé, S., Grimaldi, D., Gros, A., Gruson, D., Gruson-Vescovali, D., Guérin, C., Guérot, E., Guettrot-Imbert, G., Guervilly, C., Guidet, B., Guillon, A., Guillot, M., Guitton, C., Gutton, Ch., Haidar, M., Halimi, C., Hamada, S., Hammoud, K., Hansmann, Y., Hariri, G., Harlay, M.-L., Harrois, A., Harry, P., Hauw-Berlemont, C., Hébuterne, X., Hejblum, G., Helms, J., Hékimian, G., Heming, N., Herbrecht, J.-E., Hertig, A., Heshmati, F., Hickmann, C., Hites, M., Hong Tuan Ha, V., Houfflin-Debarge, V., Houhou, N., Houillier, P., Hua, C., Hullin, T., Humbert, M., Hugon-Vallet, É., Hurel, D., Ichaï, P., Ioos, V., Isnard-Bagnis, C., Jaber, S., Jacobs, F., Jacquens, A., Jaffal, K., Jaïs, X., Janus, N., Jardel, B., Jars-Guincestre, M.-C., Jaubert, P., Jehl, F., Jirka, A., Joannès-Boyau, O., Joffre, J., Jolliet, P., Joly, F., Joly, L.-M., Joly-Guillou, M.-L., Jouffroy, R., Jonard, M., Jougon, J., Jourdain, M., Jozwiak, M., Jully, M., Jung, B., Juniat, A.-A., Kandji, M., Kanfer, A., Karoubi, P., Kentish-Barnes, N., Kerlan, V., Khalil, A., Kim, S., Kimmoun, A., Klouche, K., Koffel, J.-C., Kopferschmitt, J., Laaban, J.P., Labadie, M., Labbé, V., Lachâtre, M., Labrousse, J., Lacroix, D., Lancel, S., Lanceleur, A., Landais, M., Landelle, C., Landman, C., Lanternier, F., Larcher, R., Launay-Vacher, V., Langeron, O., Lapostolle, F., Larmignat, P., Laterre, P.-F., Laudenbach, V., Laurent, V., Lautrette, A., Lavillegrand, J.-R., Lavolé, A., Law-ye, B., Lebas, B., Lebranchu, Y., Lebreton, G., Lebrun-Vignes, B., Leclercq, D., Le Conte, P., Le Corre, B., Lefaucheur, J.-P., Lefevre, J., Leflon-Guibout, V., Léger, D., Legrand, M., Le Gouez, A., Leguay, T., Lejay, M., Lellouche, F., Lemaire, F., Lemaitre, C., Lemarié, J., Lemiale, V., Lemonnier, M.-P., Lepape, A., Leprince, P., Leray-Moraguès, H., Léon, A., Leone, M., Lerolle, N., Le Roux, M., Leroy, O., Leteurtre, S., Lescot, T., Le Tulzo, Y., Leverve, X., Levy, B., Lévy, P., L'Her, E., Liao, L., Lienhart, A., Llitjos, J.-F., Lofaso, F., Lothe, M.-N., Loubières, Y., Louge, P., Lucet, J.-C., Luyt, C.E., Lyazidi, A., Maamar, A., Mahieu, R., Maillet, J.-M., Mainardi, J.-L., Maître, B., Maizel, J., Mallaret, M.-R., Mancebo, J., Manzo-Silberman, S., Marchalot, A., Marit, G., Markowicz, P., Marqué, S., Martin, O., Martin-Lefèvre, L., Marx, T., Massanet, P.L., Mathian, A., Mathieu, C., Mathieu, D., Maury, E., Maxime, V., Mazeraud, A., Meffert, A., Mégarbane, B., Mehl, J., Mekontso Dessap, A., Melchior, C., Meng, P., Mentec, H., Mercier, F.-J., Mercat, A., Merdji, H., Méresse, Z., Mertes, P.-M., Mesland, J.-B., Meyer, G., Meynard, J.-L., Meziani, F., Miatello, J., Michard, B., Mira, J.-P., Mismetti, P., Misset, B., Miyara, M., Moga, L., Mohty, M., Monchi, M., Monéger, G., Monneret, G., Monnet, X., Monnier-Cholley, L., Montani, D., Mora, P., Morau, E., Moreau, AS., Morel, G., Morawiec, E., Mortaza, S., Mottier, D., Murgier, M., Naccache, L., Nace, L., Naeije, R., Naïm, G., Nave, S., Nitenberg, A., Nouette-Gaulain, K., Nouri-Neuville, M., Nousbaum, J.B., Novy, E., Nuss, P., Obadia, É., Offenstadt, G., Oger, E., Onimus, T., Orlikowski, D., Oro, S., Osman, O., Ouanes, I., Ouanes-Besbes, L., Ouedraogo, R., Outin, H., Oziel, J., Ozier, Y., Pajot, O., Papazian, L., Parmentier, E., Parquin, F., Parrilla, F.J., Parrot, A., Pasquet, A., Pateron, D., Paugam-Burtz, C., Peigné, M., Peineau, S., Pelaccia, T., Pène, F., Perrotin, D., Pessey, F., Pham, T., Philit, F., Pichené, C., Picod, A., Piette, J.-C., Pillet, O., Pilmis, B., Pineau, J., Pineton de Chambrun, M., Piquilloud, L., Pirracchio, R., Piton, G., Plantefève, G., Podglajen, I., Poidevin, A., Poissy, J., Pottecher, J., Poujol, A.-L., Poussardin, C., Prat, F., Préau, S., Preiser, J.-C., Prevel, R., Prot-Bertoye, C., Pruvo, J.-P., Pujol, S., Puntous, M., Quenot, J.-P., Quevrain, E., Quillerou, B., Rabaud, C., Raynard, B., Raynaud, L., Regard, L., Reignier, J., Reizine, F., Réminiac, F., Renault, A., Revest, M., Ricard, J.-D., Richalet, J-P., Richard, C., Richard, J-C.M., Ricôme, J.-L., Ridel, C., Rigollot, M., Rigaud, J.-P., Rigolet, A., Rimmelé, T., Rineau, E., Robert, R., Robert, T., Robineau, O., Roch, A., Roesler, J., Roger, I., Rohaut, B., Roullet, S., Rousset, D., Roux, D., Rozé, H., Rudler, M., Rugeri, L., Ruppé, E., Sab, J.-M., Sacleux, S.-C., Saliba, F., Samuel, D., Sauder, P., Saulnier, F., Sauvanet, A., Savale, L., Savoye, G., Schlemmer, B., Schlemmer, F., Schmidt, E., Schmidt, M., Schneider, F., Schneider, S.M., Schortgen, F., Schuby, M., Schwan, R., Schwebel, C., Seguin, A., Seksik, P., Senneville, É., Seronde, M.-F., Sharshar, T., Sigaut, S., Silva, S., Si-Tahar, M., Sitbon, O., Sivanandamoorthy, S., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Souday, V., Soufir, L., Soussi, S., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Sterlin, D., Stiel, L., Sublon, M., Sudre, E., Surgers, L., Szychowiak, P., Tacquard, C., Tadié, J.-M., Talvard, O., Tamburini, J., Tamion, F., Tarazona, V., Tardy, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Tazarourte, K., Teboul, J.-L., Terzi, N., Thabut, D., Thaler, F., Thellier, D., Thervet, E., Thévenot, T., Thibault, M., Thibault, R., Thierry, A., Thille, A.W., Thomas, G., Thumerel, M., Thuong, M., Thy, M., Timsit, J.-F., Tissières, P., Tonnelet, R., Touchard, G., Tournoy, A., Tourtier, J.-P., Tourtier, Y., Tran Van Nhieu, J., Troché, G., Trouillet, J.L., Ubeaud-Séquier, G., Uhel, F., Urbina, T., Valeyrie-Allanore, L., Van de Louw, A., Van der Meersch, G., Vargas, F., Velly, L., Venet, F., Verdon, R., Veyradier, A., Vieillard-Baron, A., Vignon, Ph., Vigué, B., Villers, D., Vinsonneau, C., Voiriot, G., Weil-Verhoeven, D., Wiel, É., Wittebole, X., Woch, S., Woerther, P.-L., Woimant, F., Wolff, M., Wysocki, M., Xhaard, A., Yazdanpanah, Y., Zafrani, L., Zahar, J.-R., Zarrouk, V., Zéni, F., Zerbib, P., Zerbib, Y., Zieleskiewicz, L., Zlotnik, D., and Zuber, B.

Published
2020
Full Text
View/download PDF

15. Les Auteurs

Author

Boles, J.-M., Bollaert, P.-E., Mercat, A., Mira, J.-P., Offenstadt, G., Saulnier, F., Wolff, M., Zéni, F., Aboab, J., Abou-Ayache, R., Abroug, F., Abtan, J., Adam, N., Aissaoui, N., Ait Hssain, A., Ait-Oufella, H., Aloy, B., Alves, M., Amour, J., Amstutz, P., Andréjak, C., Anglicheau, D., Annane, D., Anxionnat, R., Arab, K., Argaud, L., Arich, C., Arrivé, L., Aubron, C., Auneau, J.-C., Azabou, E., Azoulay, É., Bailly, P., Bakhos, D., Baldolli, A., Barbier, C., Barbier, F., Barbut, F., Bardon, J., Bargues, L., Barraud, D., Barreda, T., Barrot, L., Barry, B., Basille-Fantinato, A., Bastien, O., Baud, F., Baudel, J.-L., Bauwens, M., Bazire, A., Beaussier, M., Bedos, J.-P., Bédry, R., Beduneau, G., Begot, E., Belhadj-Tahar, N., Beloncle, F., Beltramini, A., Ben Hadj Salem, O., Benyamina, M., Benzidi, Y., Bernardin, G., Bertoletti, L., Beuret, P., Beydon, L., Bialais, É., Bilbault, P., Binoche, A., Biour, M., Birgand, G., Bitker, L., Blatteau, J.-E., Blivet, S., Blot, F., Boels, D., Bohé, J., Boisramé-Helms, J., Boissier, F., Boiteau, R., Boivin, A., Bonadona, A., Bonmarchand, G., Bonnot, B., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Bouglé, A., Boulain, T., Boulanger, D., Boulard, G., Bourcier, S., Boyer, A., Bracard, S., Bréchot, N., †Bricca, G., Bridoux, F., Brivet, F.-G., Brochard, L., Bruder, N., Brun-Buisson, C., Bruneel, F., Brunet, J., Brun-Vézinet, F., Bumsel, F., Burgel, P.-R., Cabasson, S., Cadranel, J., Calvet, L., Camus, C., Camus, Y., Canaud, B., Canellas, A., Canet, E., Capaldo, L., Capellier, G., Carbonell, N., Cariou, A., Carli, P., Carpentier, D., Carpentier, F., Carrat, F., Carteaux, G., Castanares-Zapatero, D., Castelain, V., Cavaillon, J.-M., Cecchini, J., Cha, O., Chaize, M., Champigneulle, B., Chanard, J., Charbonneau, P., Charles, P.-E., Charpentier, J., Chastre, J., Chemla, D., Chemouni, F., Chenine, L., Chiche, J.-D., Cholley, B., Chopin, C., Chosidow, O., Choukroun, M.-L., Chrétien, F., Clair, B., Claude, F., Clément, É., Clément-Rigolet, M., Cochereau, I., Cohen, Y., Combe, C., Combes, A., Commandeur, D., Coppo, P., Coquerel, D., Cordonnier, C., Coriat, P., Costedoat-Chalumeau, N., Cottin, V., Cour, M., Crozier, S., Danel, V., Danin, P.-E., Darmaun, D., Darmon, M., Darnal, E., Daubin, C., David, S., De Backer, D., De Cagny, B., De Jong, A., De Montalembert, M., De Prost, N., De Schryver, N., Decavele, M., Decousus, H., Degos, V., Delabranche, X., Delahaye, A., Delarue, J., Delclaux, C., Delile, E., Delisle, S., Dellamonica, J., Delluc, A., Demondion, P., Demoule, A., Dequatre-Ponchelle, N., Deray, G., Derelle, A.-L., Deriaz, H., Desrousseaux, J., Dewitte, A., Deye, N., Dhainaut, J.-F., Diehl, J.-L., Djibré, M., Dolz, M., Dorent, R., Dres, M., Dreyfuss, D., Dromer, C., Du Cheyron, D., Dubée, V., Ducloy-Bouthors, A.-S., Dugernier, J., Duguet, A., Durand, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eberhardt, N., Eckert, C., Égreteau, P.-Y., Ehrmann, S., El Esper, N., El Gharbi, F., Embriaco, N., Essig, M., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faugeras, F., Favory, R., Ferry, A., Ferry, T., Fialon, P., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Fontaine, E., Forel, J.-M., Fourel, D., Fournier, A., Fourrier, F., Francoz, C., Frat, J.-P., Friedlander, G., Friedman, D., Fromentin, M., Fulgencio, J.-P., Gainnier, M., Garçon, P., Garo, B., Garrouste-Orgeas, M., Gebel, H., Geeraerts, T., †Gehanno, P., Gempp, E., Genestal, M., Georges, H., Germain, A., Giacardi, C., Gibot, S., Girardot, T., Girault, C., Giura, G., Godard, A., Godeau, B., Goffinet, F., Goldgran-Toledano, D., Gonzalez, F., Gonzalez-Bermejo, J., Goulenok, C., Goutagny, S., Graftieaux, J.-P., Grangé, S., Grimaldi, D., Gros, A., Gruson-Vescovali, D., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Guettrot-Imbert, G., Guglielminotti, J., Guidet, B., Guillot, M., Guitton, C., Haddad, L., Halimi, C., Hallynck, C., Hamada, S., Hammoudi, K., Hansmann, Y., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hauw-Berlemont, C., Hébuterne, X., Herbrecht, J.-E., Hertig, A., Heshmati, F., Hickmann, C., Hilbert, G., Houfflin-Debarge, V., Houhou, N., Houillier, P., Houzé, S., Hullin, T., Humbert, M., Hurel, D., Ichaï, P., Ioos, V., Isnard Bagnis, C., Jaber, S., Jacobs, F., †Jaeger, A., Jaffal, K., Jaïs, X., Janus, N., Jardin, F., Jars-Guincestre, M.-C., Jolliet, P., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jouffroy, R., Jougon, J., Jounieaux, V., Jourdain, M., Jozwiak, M., Jung, B., Kanfer, A., Karie-Guigues, S., Karila, L., Karoubi, P., Kentish-Barnes, N., Kerlan, V., Khalil, A., Khouri, T., Kim, S., Kimmoun, A., Koffel, J.-C., Kopferschmitt, J., Kummerlen, C., L'Her, E., Laaban, J.-P., Labbé, V., Labrousse, J., Lachâtre, M., Lacroix, D., Lamhaut, L., Lanceleur, A., Landman, C., Langeron, O., Lanternier, F., Lapostolle, F., Larmignat, P., Lascarrou, J.-B., Laterre, P.-F., Laudenbach, V., Launay-Vacher, V., Laurent, V., Lautrette, A., Lavaux, T., Lavillegrand, J.-R., Law-ye, B., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, G., Le Gall, J.-R., Le Gouez, A., Le Roux, G., Le Tulzo, Y., Lebas, B., Lebranchu, Y., Lebreton, G., Leclerc, F., Leclercq, D., Leclercq, R., Lecuyer, L., Lefaucheur, J.-P., Lefèvre, J., Lefèvre, M., Leflon-Guibout, V., Léger, P., Legrand, M., Leguay, T., Lellouche, F., Lemaire, F., Lemaitre, C., Lemarié, J., Lemiale, V., Lemonnier, M.-P., Léon, A., Lepape, A., Leprince, P., Leray-Moragues, H., Lerolle, N., Leroy, O., Lescot, T., †Leverve, X., Levy, B., Lévy, P., Leys, D., Lienhart, A., Lofaso, F., Lortholary, O., Losser, M.-R., Lothe, M.-N., Lotthé, A., Loubières, Y., Louge, P., Lucet, J.-C., Lutun, P., Luyt, C.-E., Lyazidi, A., Maamar, A., Magalhaes, E., Maillet, J.-M., Mainardi, J.-L., Maitre, B., Maizel, J., Mancebo, J., Manzo-Silberman, S., Marchalot, A., Marek, A., Marit, G., Markowicz, P., Marqué, S., Mattéi, M., Maurel, V., Maury, E., Maxime, V., Mazeraud, A., Mazighi, M., Mégarbane, B., Mekontso Dessap, A., Mentec, H., Mercier, F.-J., Mertes, P.-M., Meyer, G., Meynard, J.-L., Meziani, F., Miatello, J., Michelet, C., Mignon, A., Mismetti, P., Misset, B., Mohty, M., Monchi, M., Monéger, G., Monneret, G., Monnet, X., Monnier-Cholley, L., Montani, D., Morinière, P., Moritz, F., Mortaza, S., Mossé, P., Mottier, D., Mourvillier, B., Naccache, L., Nace, L., Naeije, R., Neuville, M., Nevière, R., †Nicolas, F., Nitenberg, A., Nousbaum, J.-B., Novy, E., Nuss, P., Obadia, E., Oger, E., Oliva-Labadie, M., Onimus, T., Orlikowski, D., Osman, D., Ouanes, I., Ouanes-Besbes, L., Outin, H., Oziel, J., Ozier, Y., †Paillard, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrilla, F.-J., Parrot, A., Pasquet, A., Pateron, D., Paugam-Burtz, C., Pavie, A., Peigné, M., Peineau, S., Pène, F., Perrigault, P.-F., Perrotin, D., Pessey, F., Pham, T., Philit, F., Pichené, C., Pierrot, M., Piette, J.-C., Pillet, O., Pilmis, B., Pioche, P.-A., Piquilloud, L., Piton, G., Plantefève, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Poidevin, A., Pottecher, J., Pottecher, T., Potton, L., Pourrat, O., Prat, G., Préau, S., Pruvo, J.-P., Pujol, S., Puntous, M., Quevrain, E., Rabaud, C., Rabbat, A., Rameix, S., †Raphaël, J.-C., Rapp, C., Raynard, B., Regard, L., Régnier, B., Reignier, J., Réminiac, F., Renault, A., Revelly, J.-P., Revest, M., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C., Ricôme, J.-L., Ridel, C., Rigolet, A., Rigollot, M., Rimmelé, T., Rineau, E., Robert, R., Robert, T., Roch, A., Roeseler, J., Roger, I., Roger, P.-A., Rohaut, B., Rouche, J., Roujeau, J.-C., Rozé, H., Rudler, M., Rugeri, L., Ruiz, J., Ruppé, É., Sab, J.-M., Saïkhali, E., Saliba, F., Samuel, D., †Santré, C., Sauder, P., Saumon, G., Sauvanet, A., Savale, L., Savoye, G., Scemla, A., Schlemmer, B., Schlemmer, F., Schmidt, M., Schneider, F., Schneider, S.-M., Schortgen, F., Schuby, M., Schwan, R., Schwebel, C., Seguin, T., Seksik, P., Senneville, É., Seronde, M.-F., Sharshar, T., Sigaut, S., Silva, S., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Souday, V., Soufir, L., Soussi, S., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Sterkers, G., Stiel, L., Sublon, C., Sudre, E., Surgers, L., Tabah, A., Tacquard, C., Tadié, J.-M., Talvard, O., Tamburini, J., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Tazarourte, K., Teboul, J.-L., Tenaillon, A., Terzi, N., Tesnière, A., Thabut, D., Thaler, F., Thellier, D., Théodore, J., Thervet, E., Thierry, A., Thille, A.W., Thirion, M., Thomas, G., Thumerel, M., Thuong, M., Timsit, J.-F., Tissières, P., Tonnelet, R., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, J.-P., Tourtier, Y., Tran Van Nhieu, J., Troché, G., Tromeur, C., Trouillet, J.-L., Tubiana, J., Ubeaud-Séquier, G., Uhel, F., Vachon, F., Valeyrie-Allanore, L., Van de Louw, A., Vargas, F., Velly, J.-F., Velly, L., Verdon, R., Vesin, A., Veyradier, A., Vieillard-Baron, A., Vignon, P., Vigué, B., Villers, D., Vincent, F., Vinsonneau, C., Voiriot, G., Voisin, B., Wattel, F., Wiel, E., Wittebole, X., Woerther, P.-L., Woimant, F., Wysocki, M., Xhaard, A., Yazdanpanah, Y., Yéni, P., Zarrouk, V., Zerbib, P., Zieleskiewicz, L., and Zuber, B.

Published
2016
Full Text
View/download PDF

17. Trajectoire initiale des patients âgés et impact sur leur orientation après leur passage dans les services d’urgences. Résultats d’une enquête nationale

Author

Lazarovici, C., Somme, D., Chatellier, G., Saint-Jean, O., and Espinoza, P.

Subjects
*OLDER patients, *HOSPITAL emergency services, *SOCIODEMOGRAPHIC factors, *GENERAL practitioners
Abstract

Abstract: Purpose: We have little information on the geriatric characteristics of elderly patients visiting the emergency departments (ED) in France. In order to develop an adapted prevention of the arrival of some elderly patients, the determinants of their arrival to the ED deserves to be better known. Methods: A one-day cross-sectional study was conducted in French ED. A standardized questionnaire was used for each patient over 80 years (Pts), specifying the sociodemographic characteristics, the circumstances of visit to and care received in the ED, and the orientation of the patients after consulting the ED. Results: On a sample of 1298 Pts, health event leading to ED started at home in 63.8% of cases. When the patients initiated themselves the recourse to health care (RHC), they called less often a general practitioner (61.9% of cases) than when the RHC was triggered by their family (69.6%, p =0.01). When a health care professional initiated the RHC, it was a GP in more than 80% of cases. Return to residence was more frequent when the patient triggered the RHC (34.5% versus 22.9% for the family and 16.0% for the professional health care, p <0,001). Conclusion: The actor of the decision of arrival to the ED has an impact in the RHC, in resources utilisation, and on the patient''s orientation after coming in ED. The results of this study may help to design strategies aiming at avoiding unnecessary ED consultations of elderly persons. [Copyright &y& Elsevier]

Published
2008
Full Text
View/download PDF

18. Non-pertinence hospitalière dans deux services de gériatrie aiguë: description du phénomène et étude des facteurs de risque

Author

Somme, D., Cauterman, M., Huet, B., Durand-Gasselin, B., and Saint-Jean, O.

Subjects
*HOSPITAL utilization, *HOSPITAL care of older people, *GERIATRICS, *HOSPITAL care, *LONG-term care facilities
Abstract

Abstract: Background: Inappropriateness of hospital use occurs when a gap between the patient''s needs and the level of care delivered exists. Taking into account the improvement of number of acute geriatric care, it appears relevant to study the rate and causes of inappropriate hospital use in this context. Methods: All patients in two services of acute geriatrics were included: medical and socioeconomic data were collected, the appropriateness of each day of their hospitalization was evaluated using the French version of the Appropriateness Evaluation Protocol and the inappropriate days'' Causes Analysis Protocol. Risk factors of having at least one inappropriate day occurring during the stay were searched using relevant statistical tests. A logistic regression model assessed influence of independent variables on the risk of inappropriateness. Results: Only the existence of cognitive impairment and the department where the hospitalization takes place were found to be risk factors of inappropriateness. The ranking of inappropriateness according to the causes is the same in the two services, yet with statistically different rates, in particular for causes related to waiting for admission in subacute or long-term care institutional network and for a service provided outside the hospital where the patient was admitted. In the two departments, over 25% of the inappropriate days were related to a patient''s or his family''s choice. Conclusion: Access to subacute or long-term care institution is the first cause of inappropriate hospital use in the two departments. The importance of the rate of inappropriate days related to a choice of the patient or his family was probably a Geriatric specificity. Furthermore, in view of reducing the inappropriate hospital use, attention should be particularly paid on patients with cognitive impairment. [Copyright &y& Elsevier]

Published
2007
Full Text
View/download PDF

19. Liste des auteurs

Author

Abadie, Y., Abou-Ayache, R., Adhoum, A., Adib-Conquy, M., Adnet, F., Ait Hssain, A., Albanese, J., Alquier, P., Amstutz, P., Anglicheau, D., Annane, D., Annat, G., Ansart, S., Antoun, S., Anxionnat, R., Appéré de Vecchi, C., Argaud, L., Arich, C., Arrault, X., Arrivé, L., Asfar, P., Attaix, D., Aumeran, C., Auneau, J.-C., Ayem, M.-L., Azoulay, E., Barbar, S., Barnoud, D., Baron, D., Barouk, D., Barraud, D., Barry, B., Barthélémy, A., Bastien, O., Baud, F., Baudin, F., Bauwens, M., Bazin, C., Beague, S., †Beaufrère, B., Bedock, B., Bedon-Carte, S., Bédos, J.-P., Bédry, R., Bégueret, H., Belaouchi, F., Belle, E., Benali, A., Bengler, C., Benyamina, M., Bernardin, G., Berré, J., Bertrand, J.-C., Bilbault, P., Binoche, A., Biour, M., Bismuth, C., Blackwell, F., Blanc, P.-L., Blanchard, E., Bleichner, G., Blettery, B., Blivet, S., Blot, F., Bobin, S., Boccheciampe, N., Bohé, J., Boiteau, R., Boncompain-Gérard, M., Bonmarchand, G., Bonnaud, I., Bonnet, N., Bouadma, L., Bouchet, M.-F., Bouffandeau, B., Boulain, T., Boulard, G., Boulétreau, P., Boulo, M., Bourgoin, A., Boussat, S., Boussuges, A., Boyer, A., Bracard, S., Briand, E., Bridoux, F., Brivet, F., Brocas, E., Brochard, L., Bruder, N., Bruel, C., Brun-Buisson, C., Bruneel, F., Brun-Vézinet, F., Bumsel, F., Camou, F., Camus, C., Camus, Y., Canaud, B., Cannesson, M., Capellier, G., Capron, F., Carbonell, N., Cariou, A., Carlet, J., Carpentier, F., Carrat, F., Carrat, X., Cartier, F., Cary, E., Castaing, Y., Castelain, V., Cavaillon, J.-M., Cha, O., Chambrier, C., Chambrin, M.-C., Chanard, J., Chapplain, J.-M., Charbonneau, P., Chastre, J., Chaumoitre, K., Chemla, D., Chenine, L., Chevrolet, J.-C., Chiche, J.-D., Chiras, J., Chopin, C., Chouchane, N., Choukroun, M.-L., Clair, B., Clavier, B., Clec'h, C., Cluzel, P., Cochereau, I., Cohadon, F., Cohen, Y., Combe, C., Combes, A., Cordonnier, C., Coriat, P., Corne, P., Coulange, M., Cros, A.-M., Crozier, S., Dailland, P., Danel, V., Darmon, M., Darnal, E., David, S., de Cagny, B., De Deyne, C., De Jonghe, B., Decousus, H., Deklunder, G., Delabranche, X., Delafosse, B., Delahaye, A., Delarue, J., de Montalembert, M., Demoule, A., Dequin, P.-F., Deray, G., Deriaz, H., Descamps, J.-M., Devictor, D., Deye, N., Dhainaut, J.-F., di Costanzo, J., Diehl, J.-L., Dingemans, G., Djibré, M., Doise, J.-M., Dolz, M., Donati, S.Y., Dreyfuss, D., Drizenko, A., Du Cheyron, D., Ducloy-Bouthors, A.-S., Dugernier, T., Duguet, A., Durand, F., Duranteau, J., Durocher, A., Dussaule, J.-C., Eckert, Ph., Edouard, D., El Esper, N., Essig, M., Esteban, C., Eurin, B., Fagon, J.-Y., Faisy, C., Fangio, P., Fartoukh, M., Faurisson, F., Favarel-Garrigues, J.-C., Feihl, F., Ferrand, E., Ferry, T., Fialon, P., Fischer, E., Flamant, M., Flamens, C., Flesch, F., Folscheid, D., Forget, A.-P., Fourel, D., Fournier, A., Fournier, G., Fourrier, F., François, B., Francoz, C., Frat, J.-P., Frederic, M., Friedlander, G., Frossard, J.-L., Gabinski, C., Gainnier, M., Gajdos, P., Gamelin, L., Garo, B., Garot, J., Garré, M., Garrouste-Orgeas, M., Gastinne, H., Gbikpi-Benissan, G., †Gehanno, P., Gelas, P., Genestal, M., Gerbeaux, P., †Gibert, C., Gibot, S., Girault, C., Girot, M., Goarin, J.-P., Godeau, B., Goetghebeur, D., Goldgran-Toledano, D., Gonzalez, F., Goulenok, C., †Goulon, M., Grimaldi, D., Grosdidier, G., Gruson, D., Guenoun, T., Guérin, C., Guérin, J.-M., Guérot, E., Guervilly, C., Gueye, P., Guglielminotti, J., Guiavarch, M., Guidet, B., Guyomarc'h, S., Hallynck, C., Hamzaoui, O., Haniez, F., Harlay, M.-L., Harrois, A., Harry, P., Hasselmann, M., Hattab, A., Hébuterne, X., Heng, A.-É., Hertig, A., Hervé, P., Hilbert, G., Himbert, D., Holzapfel, L., Hommel, S., Houhou, N., Houillier, P., Hours, S., Hurel, D., Ichaï, P., Isnard-Bagnis, C., Jacobs, F., Jaffrelot, M., Jaffuel, S., Janvier, G., Jardel, B., Jardin, F., Jarrin, I., Jars-Guincestre, M.-C., Joly, L.-M., Joly-Guillou, M.-L., Jonquet, O., Joseph, T., Jourdain, M., Journois, D., Jung, B., Kahn, D., Kanfer, A., Karie-Guigues, S., Kerlan, V., Khalil, A., Koffel, J.-C., Kopferschmitt, J., Korach, J.-M., Kummerlen, C., L'Her, E., Laaban, J.-P., Laarbaui, F., Labrousse, J., Lacroix, D., Lachérade, J.-C., Lambert, H., Lanceleur, A., Langeron, O., Langevin, B., Lannes, B., Lapostolle, F., Larmignat, P., Laterre, P.-F., Laurent, C.h., Lautrette, A., Lavaux, T., Laxenaire, M.-C., Le Conte, P., Le Corre, B., Le Gall, C., Le Gall, G., Le Gall, J.-R., Le Prado, D., Le Tulzo, Y., Lebranchu, Y., Leclerc, F., Leclerc, X., Leclercq, R., Lefevre, M., Legendre, C., Leger, P., Legras, A., Lellouche, F., Lemaire, F., Lemiale, V., Lemonnier, M.-P., Léon, A., Léone, M., Leprince, P., Leray-Moragues, H., Lerebours, E., Leverve, X., Lévy, B., Lévy, Ph., Leys, D., Lheureux, P., Lienhart, A., Lissac, J., Loirat, P., Loubières, Y., Lucet, J.-C., Lutun, P., Luyt, C.-E., Maillet, J.-M., Mainardi, J.-L., Mancebo, J., Manel, J., Mangiapan, G., Manier, G., Manzon, C., Manzo-Silberman, S., Marek, A., Marit, G., Markowicz, P., Marqué, S., Marquette, C.-H., Marthan, R., Martin, C., Martin, O., Mathien, C., Mathieu, D., Mattéi, M., Maury, E., Maxime, V., Mayaud, C., Mayeur, C., Mazighi, M., Mégarbane, B., Melchior, J.-C., Mélot, C., Mentec, H., Mercat, A., Mertes, P.-M., Meyer, G., Meziani, F., Michelet, C., Micheletti, G., Mignon, A., Mira, J.-P., Mira, L., Mismetti, P., Misset, B., Monchi, M., Monnet, X., Monnier-Cholley, L., Moriconi, M., Morinière, P., Moritz, F., Mortier, E., Mottier, D., Mourvillier, B., Nace, L., Naeije, R., Nicolas, F., Nicolas-Chanoine, M.-H., Nitenberg, A., Nitenberg, G., Nousbaum, J.-B., Noyon, V., Obadia, E., Oger, E., Onimus, Th., Orizet, C., Ould Ahmed, M., Outin, H., Ozier, Y., Page, Y., Paillard, M., Pairault, M., Pajot, O., Papazian, L., Parer, S., Parquin, F., Parrot, A., Pavie, A., Pène, F., Penouil, F., Peraldi, M.-N., Perrin-Gachadoat, D., Perrotin, D., Petitjean, T., Philippart, F., Philit, F., Picard, L., Picart-Jacq, J.-Y., Pichené, C., Pillet, O., Pinsard, M., Plantefeve, G., Pochard, F., Pocidalo, M.-A., Podglajen, I., Pointet, P., Pourrat, O., Prat, G., Préveraud de Vaumas, C., Pruvo, J.-P., Puntous, M., Rabaud, C., Rabbat, A., Rackelboom, T., Racy, E., Raherison, C., Ralec, B., Ramakers, M., Rambaud, L., Rameix, S., Raphaël, J.-C., Ramon, P., Raynard, B., Régnier, B., Renault, A., Revest, M., Reynaert, M.-S., Reynaud, J., Ribaud, P., Ricard, J.-D., Richalet, J.-P., Richard, C., Richard, J.-C.M., Ricome, J.-L., Ricot, J., Ridel, C., Rigolet, A., Robert, D., Robert, R., Roger, I., Rondeau, E., Roques, S., Rossert, J., Roujeau, J.-C., Rozenberg, A., Rugeri, L., Rusterholtz, T., Sab, J.-M., Safran, D., Saïkhali, E., †Sainty, J.-M., Saissy, J.-M., Saliba, F., Samuel, D., Sauder, P., Saumon, G., Savineau, J.-P., Savoye, G., Schabanel, J.-C., Schaeffer, A., Schaller, M.-D., Schiano, P., Schlemmer, B., Schlossmacher, P., Schneider, F., Schneider, S.-M., Schortgen, F., Schwartz, A., Segouin, C., Seguin, Th., Seknadji, P., Serre-Sapin, A.-F., Sharshar, T., Silleran-Chassany, J., Similowski, T., Simonneau, G., Sitbon, O., Slama, M., Sollet, J.-P., Somme, D., Sonneville, R., Soubrier, S., Soufir, L., Souweine, B., Spaulding, C., Squara, P., Steg, P.-G., Stéphanazzi, J., Sterkers, G., Straus, C., Subtil, D., Sztrymf, B., Tabah, A., Taboulet, P., Tamion, F., Tardy, B., Tardy-Poncet, B., Taright, N., Tasseau, F., Tattevin, P., Tauzin-Fin, P., Teboul, J.-L., Tempé, J.-D., Tenaillon, A., Terzi, N., Tesnière, A., Textoris, J., Thabut, D., Thaler, F., Théodore, J., Thierry, A., Thille, A.W., Thirion, M., Thomas, R., Thuong, M., Timsit, J.-F., Tissières, P., Touchard, G., Tournoud, C., Tournoys, A., Tourtier, Y., Tranchant, C., Troché, G., Trouillet, J.-L., Trzeciak, M.-C., Tunon de Lara, J.-M., Ubeaud-Séquier, G., Vachon, F., Valatx, J.-L., Valentin, J.-M., Vallée, F., Vallet, B., Van de Louw, A., Vargas, F., Venet, C., Verdon, R., Vergier, B., Vésin, A., Vial, A., Viale, J.-P., Viau, F., Vieillard-Baron, A., Vignon, P., Villers, D., Vinatier, I., Vincent, B., Vinsonneau, C., Wassermann, D., Wattel, F., Willems, V., Woimant, F., Wysocki, M., Yéni, P., Zahar, J.-R., and Zelter, M.

Published
2009
Full Text
View/download PDF

23. [Utilité de la tomographie thoraco-abdomino-pelvienne chez les patients âgés hospitalisés pour altération de l'état général].

Author

Boussard P, Menand E, Le Pabic E, Corvol A, Prud'homm J, and Somme D

Subjects
Aged, 80 and over, Humans, Consensus, Hospitals, University, Retrospective Studies, Hospitalization, Weight Loss
Abstract

Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.

Published
2024
Full Text
View/download PDF

24. [Cross-perspectives on telemedicine in nursing homes: a survey of professionals involved in the setting-up of teleconsultations in nursing homes in Rennes area].

Author

Cady L, Costes M, Andres E, Dillinger F, and Somme D

Subjects
Humans, Pandemics, Nursing Homes, Remote Consultation, Telemedicine, General Practitioners
Abstract

The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.

Published
2023
Full Text
View/download PDF

25. [Geriatric units at the beginning of the 2020 COVID-19 epidemic in France].

Author

Berrut G, de Decker L, Aquino JP, Ahmine S, Amalberti N, Arlaud C, Aubry A, Beau P, Behara H, Bernard F, Bloch F, Bonin-Guillaume S, Boureau AS, Chaffringeon A, Chaudier B, Collins C, Courau A, Cudennec T, Debray M, Fougère B, Gaudeau D, Huvent-Grelle D, Laurent M, Mizzi B, Maley K, Mecheri H, Merlhès C, Merouani B, Nicolini M, Pautas E, Pellerano B, Piet E, Rascle C, Rouaud A, Somme D, Gavazzi G, Salles N, and Guérin O

Subjects
Aged, Aged, 80 and over, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections mortality, Female, France epidemiology, Health Services Needs and Demand, Humans, Male, Pandemics, Pneumonia, Viral epidemiology, Pneumonia, Viral mortality, Surveys and Questionnaires, Telemedicine, Coronavirus Infections therapy, Geriatrics, Hospital Units statistics & numerical data, Pneumonia, Viral therapy
Abstract

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

Published
2020
Full Text
View/download PDF

26. [Motivations of general practitioners (GPs) working in healthcare centres. Interview-based study].

Author

Ridard E and Somme D

Subjects
Adult, Career Choice, Female, Health Facilities, Humans, Interviews as Topic, Male, Middle Aged, Quality of Life, Attitude of Health Personnel, General Practice, General Practitioners psychology, Motivation
Abstract

Objective: Healthcare centres (CDS) are mono- or multidisciplinary ambulatory healthcare services staffed by salaried personnel, designed to facilitate access to affordable healthcare. New healthcare centres have been created over recent years in order to attract general practitioners (GP). In order for healthcare centres to constitute a solution to physician shortages, the motivations of doctors working in these centres must be defined in order to determine whether it is possible to extend this process. This study tried to determine the reasons why physicians choose this type of practice and their motivations., Methods: A qualitative study based on semi-structured interviews was conducted with GPs working in health centres in the Brittany and Pays de la Loire regions. Thematic analysis was used to study the data obtained., Results: Twelve GPs were interviewed. The main incentives were salary and benefits, and good working conditions. Often informal professional exchanges were considered to be particularly important. Other motivations were also revealed during the interviews: physicians emphasized the service provided to the population, the accessibility of healthcare centres, and their feeling of being able to provide good quality of care., Conclusion: The motivations of GPs working in healthcare centres can be classified as external and internal. In order to extend the healthcare centre model and recruit and retain physicians, administrators, in addition to providing good working conditions, should also develop public health actions, and improve their communication to raise awareness about these centres.

Published
2018
Full Text
View/download PDF

28. Complexity of the care of the elderly

Author

Jean-Baptiste B and Somme D

Subjects
Aged, Geriatrics, Humans, Health Services for the Aged
Abstract

Competing Interests: B. Jean-Baptiste et D. Somme déclarent n’avoir aucun lien d’intérêts.

Published
2016

29. [In Process Citation].

Author

Somme D, Corvol A, Couturier Y, Pimouguet C, Moreau O, Perivier S, Balard F, and de Stampa M

Published
2015

30. [New professional field in France: Analysis of the training needs of case managers].

Author

Somme D, Corvol A, Couturier Y, Pimouguet C, Moreau O, Perivier S, Balard F, and de Stampa M

Subjects
Aged, 80 and over, Chronic Disease epidemiology, Chronic Disease therapy, Comorbidity, Education, Nursing, Continuing methods, Education, Nursing, Continuing standards, Female, France epidemiology, Health Personnel standards, Health Planning Support organization & administration, Health Planning Support standards, Humans, Middle Aged, Universities, Workforce, Case Management ethics, Case Management organization & administration, Case Management standards, Delivery of Health Care, Health Personnel education, Health Services Needs and Demand statistics & numerical data
Abstract

Case management is a relatively new career field in France. It was first introduced on an experimental basis in 2007-2008, and was then developedfollowing the National Alzheimer Plan and finally enshrined in legislation in 2012. This careerfield is based on a set of tasks widely described internationally: identifying the right level of intervention, standardized multidimensional assessment, planning all aid (care and social services), implementation of the plan, monitoring and reassessment and periodic reassessment of all needs in a continuous and long-term process. The specific, systematic and dedicated nature of these tasks to these tasks makes training essential. Regulations also stipulate that the professional must acquire additional training by a dedicated inter-university degree. This requirement is a French specificity The authors present the history of case management and training in France and analyze the various international training frameworks identified by an Internet search. Moreover, based on the opinions expressed by case managers at different times of the scientific assessment and a review ofseveral studies conducted by inter-university case management program students, this article highlights the specific training needs of case managers and how the proposed training can meet these needs.

Published
2015

31. [The French Society of Geriatrics and Gerontology position paper on the concept of integration. Part two].

Author

Somme D, Trouvé H, Passadori Y, Corvez A, Jeandel C, Bloch MA, Ruault G, Dupont O, and de Stampa M

Subjects
Aged, France, Humans, Delivery of Health Care, Integrated, Health Services for the Aged organization & administration
Abstract

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports that group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and returns on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In the second part of the position paper, its authors have developed arguments that could lead professionals and non-professional caregivers to adopt integrated care as an answer to their aspirations. Policy-maker perspectives and politicians are also analyzed. Bearing in mind that integrated care necessarily will always involve a human component which may find expression during individual case-management; relations between integration and case managements are clarified. Finally, lessons learned from national and international experiments are examined. Results suggest that integrated care must to be accompanied by a local pilot. Results of recent experiments have shown that it is possible to initiate a dynamic towards integrated care in France and hence join the international movement towards adapting our healthcare systems to new challenges.

Published
2014
Full Text
View/download PDF

32. [The French Society of Geriatrics and Gerontology position paper on the concept of integration, Part One].

Author

Somme D, Trouvé H, Passadori Y, Corvez A, Jeandel C, Bloch MA, Ruault G, Dupont O, and de Stampa M

Subjects
Aged, France, Health Services Needs and Demand, Humans, Societies, Medical, Delivery of Health Care standards, Geriatrics trends
Abstract

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in the French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports the group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and feed-back on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In this first part of the position paper, its authors analyzed integrated care definitions used in international literature in view of designing the most important components of integrated care. The examination of this concept must be articulated with the idea of "coordination" which has been the cornerstone of the majority of public policies applied to the field of geriatrics and gerontology since the 1960s in France. The components of integrated care highlight that it is an ambitious process leading to real systemic modification. The authors also have proposed to open up a dialogue between citizens' aspirations and integrated care objectives with the aim to verify that the latter respond to the needs as expressed by the targeted group.

Published
2014
Full Text
View/download PDF

33. [Validity of cardiovascular prescriptions to the guidelines in the elderly according to the STOPP and START method].

Author

Coupet M, Renvoize D, Rousseau C, Fresil M, Lozachmeur P, and Somme D

Subjects
Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Angiotensin-Converting Enzyme Inhibitors adverse effects, Anticoagulants administration & dosage, Anticoagulants adverse effects, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Calcium Channel Blockers administration & dosage, Calcium Channel Blockers adverse effects, Cardiovascular Agents adverse effects, Cardiovascular Diseases epidemiology, Comorbidity, Constipation chemically induced, Constipation epidemiology, Drug Utilization statistics & numerical data, Female, France, Heart Failure drug therapy, Heart Failure epidemiology, Humans, Hypertension drug therapy, Hypertension epidemiology, Male, Myocardial Infarction drug therapy, Myocardial Infarction epidemiology, Retrospective Studies, Cardiovascular Agents administration & dosage, Cardiovascular Diseases drug therapy, Guideline Adherence, Inappropriate Prescribing
Abstract

Cardiovascular diseases are the first cause of death in elderly patients. So it seems important to estimate the adequacy of the medical prescriptions to the guidelines in this population and for these diseases. A retrospective analysis was performed in nine hospitals on 736 patients aged 65 years old and over hospitalized in the acute care geriatric unit. Cardiovascular prescribing were analyzed for each patient according to STOPP and START. The population (n=736) has a mean age of 86.7 years and belongs in 45.0% of the cases to the group of dependence GIR3-4. According to STOPP, two inappropriate prescriptions are noticed: calcium channel blockers with chronic constipation concerning 9% of the included population and aspirin at dose > 150 mg/day representing 8.4% of this population. According to START, angiotensin converting enzyme inhibitor are under-prescribed in elderly patients with heart failure (140 patients = 19.0% of the population) and following acute myocardial infarction (116 patients = 15.8%). Anticoagulation in patients with atrial fibrillation is also under-prescribed: 82 patients are concerned (11.0% of the population). The prescription of ACE inhibitor is influenced by renal insufficency in patients with heart failure. The anticoagulation in atrial fibrillation is age and dependence-related. This analysis demonstrates an inadequacy between the clinical practice and guidelines for two major cardiovascular diseases: the heart failure and the atrial fibrillation. The importance of the inadequacy was suspected of opportunities for improvement, in particular in the presence of their risk factors: very elderly patients, loss of autonomy and renal insufficiency.

Published
2013
Full Text
View/download PDF

34. [Factors facilitating and impairing implementation of integrated care].

Author

de Stampa M, Vedel I, Trouvé H, Jean OS, Ankri J, and Somme D

Subjects
Cooperative Behavior, Financial Support, France, Health Care Reform, Health Policy, Humans, Leadership, Delivery of Health Care, Integrated organization & administration, Health Plan Implementation, Health Services Accessibility
Abstract

Background: Better integration of healthcare is the focus of many current reforms in Western countries. The goal is to reduce fragmentation of health and social care delivery for patients with chronic diseases. In France, Alzheimer autonomy integration experimentations (Maison Autonomie Intégration Alzheimer [MAIA]) were introduced as part of the 2008-2012 National Alzheimer Plan. To date, implementation of such organizations remains challenging. It is thus paramount to identify factors obstructing, and on the contrary facilitating, implementation of integrated care., Methods: After an in-depth literature review of qualitative studies published from January 1995 to December 2010. We selected 10 qualitative studies on health care professionals' perceptions of barriers and facilitators to the implementation of integrated care., Results: Barriers and facilitating factors linked to the implementation of integrated care were identified at several levels: leadership; collaboration between services and clinicians; and funding and policy making. The operative strategy applied to change care delivery and the role of the leading pilot are key elements during the implementation phase., Conclusion: Strong leadership and active involvement of a broad spectrum of professionals from clinical practitioners to healthcare managers is crucial for a successful implementation of integrated care services., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Published
2013
Full Text
View/download PDF

35. [Case management in gerontology: new practice, new issue].

Author

Corvol A, Moutel G, and Somme D

Subjects
Aged, Alzheimer Disease psychology, Alzheimer Disease therapy, Canada, Confidentiality, Disease Management, France, Geriatrics ethics, Health Services Needs and Demand, Health Services for the Aged organization & administration, Humans, Managed Care Programs ethics, Managed Care Programs organization & administration, Mental Competency, Models, Theoretical, Patient Care Team, Precision Medicine, Professional-Family Relations, Professional-Patient Relations, Referral and Consultation, Treatment Refusal ethics, United States, Case Management ethics, Case Management organization & administration, Geriatrics organization & administration
Published
2012
Full Text
View/download PDF

36. [Frailty: learnings from the SAFEs cohort study and future perspectives for the research].

Author

Lang PO, Dramé M, Mahmoudi R, Jolly D, Lanièce I, Saint-Jean O, Somme D, Heitz D, Gauvain JB, Voisin T, de Wazières B, Gonthier R, Jeandel C, Couturier P, Ankri J, Blanchard F, and Novella JL

Subjects
Activities of Daily Living classification, Activities of Daily Living psychology, Aged, Aged, 80 and over, Biomarkers blood, Chronic Disease, Cohort Studies, Cross-Sectional Studies, Female, Forecasting, Frail Elderly statistics & numerical data, Hospitalization, Humans, Inflammation complications, Inflammation diagnosis, Male, Research trends, Risk Factors, Survival Rate, Frail Elderly psychology
Abstract

Even though the efforts in research have detailed further the physiopathology and the dynamics of the frailty process an operational definition of frailty is still far from being unequivocal. Studies carried out from the SAFEs cohort study allowed a pragmatic approach in the identification of the at-risk groups for the lost of independency during the hospital stay and factors influencing their future at short-, mid- and long-term. Based upon these results, we propose to discuss the relevance of the current operational indicators of frailty in order to show that clinical markers or indicators are insufficient to differentiate the frailty process from normal ageing. Finally we give rise to the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers.

Published
2011
Full Text
View/download PDF

37. [Level of evidence for case management in Alzheimer's disease: a literature review].

Author

Somme D, Carrier S, Trouve H, Gagnon D, Dupont O, Couturier Y, and Saint-Jean O

Subjects
Aged, Alzheimer Disease diagnosis, Alzheimer Disease psychology, Caregivers psychology, Cost of Illness, France, Humans, Patient Care Team, Quality of Life psychology, Randomized Controlled Trials as Topic, Referral and Consultation, Alzheimer Disease therapy, Case Management, Delivery of Health Care, Integrated, Evidence-Based Medicine
Abstract

Alzheimer's disease or related diseases patients are particularly vulnerable to fragmentation of the French system of care and support. The government has decided to implement a national plan from which two key steps are the implementation of integration and case management. We report results of a review of the literature on both the definition of these concepts and their impacts as reported in randomized controlled studies. Important differences are noticeable between studies concerning the spectrum of integration (acute and long-term care, social and health sectors, institutional and liberal sectors and financing mode notably). Case-management has multiple sense, and it must be paid attention to intensity and context of the intervention. According to available evidence, case management is likely to improve, for the person with Alzheimer's, quality of care, quality of life and quality of life of caregivers at least. Conditions for a program to be successful are adequate targeting of the target population, sufficient level of integration and adequate intensity of case management. The programs most successful and most intensive relate an effect on prevention of loss of autonomy, even death, and no extra cost. The effects on hospitalization or entry into the institution are currently hypothetical and should be further studied.

Published
2009
Full Text
View/download PDF

38. [Symptomatic antidementia drugs: methodological considerations and clinical relevance in the population].

Author

Saint Jean O, Somme D, Lahjibi-Paulet H, and Lazarovici C

Subjects
Alzheimer Disease diagnosis, Humans, Randomized Controlled Trials as Topic, Alzheimer Disease drug therapy, Cholinesterase Inhibitors therapeutic use, Receptors, N-Methyl-D-Aspartate antagonists & inhibitors
Abstract

The clinical pertinence of score variations on the measurement scales for Alzheimer disease remains uncertain. The metrological qualities of these scales are often uncertain. The population included in clinical trials is different from the population with the disease. Long-term tolerance of acetylcholinesterase inhibitors is not yet known in very elderly subjects who may be taking multiple drugs or psychotropic drugs or have cardiovascular disease, or any combination thereof. The long-term value of these drugs is unknown. Nonpharmacologic management remains the primary treatment option for elderly patients with cognitive decline, even though its results have not yet been assessed in depth.

Published
2008
Full Text
View/download PDF

39. [Prisma France: implementation program of an innovation in health and services system for disabled people. Adaptation of a case-management based integration model].

Author

Somme D, Trouvé H, Couturier Y, Carrier S, Gagnon D, Lavallart B, Hébert R, Cretin C, and Saint-Jean O

Subjects
France, Health Services Needs and Demand, Humans, Program Development, Case Management, Persons with Disabilities, Health Services Accessibility
Abstract

Background: The French health and services system to maintain at home is characterized by its fragmentation, whereas the need of the people for intervention is generally total. This fragmentation have consequences: delay in services delivery, inadequate transmission of information, redundant evaluation, service conditioned by the entrance point solicited rather than by the need of the person and inappropriate use of expensive resources by ignorance or difficulty of access to the less expensive resources., Presentation of the Innovation: The purpose of integration is to improve continuity of interventions for people in loss of autonomy. It consists in setting up a whole of organisational, managerial and clinical common tools. Organisational model "Projet et Recherches sur l'Intégration des Services pour le Maintien de l'Autonomie" (Prisma) tested in Quebec showed a strong impact on the prevention of the loss of autonomy in term of public health on a population level. This model rests on six principal elements: partnership, single entry point, case-management, a multidimensional standardized tool for evaluation, an individualized services plan and a system for information transmission., Contextual Analysis: Thus, it was decided to try to implement in France this organisational model. The project is entitled Prisma France and is presented here. The analysis of the context of implementation of the innovation which represents integration in the field of health and services for frail older reveals obstacles (in particular because of diversity of professional concerned and a presentiment of complexity of the implementation of the model) and favourable conditions (in particular the great tension towards change in this field)., Conclusion: The current conditions in France appear mainly favourable to the implementation of integration. The establishment of Prisma model in France requires a partnership work of definition of a common language as well on the diagnoses as on the solutions. The strategic and operational dialogue is thus a key element of the construction of integration. This stage currently occurs in parallel in three areas contrasted in France. The results of associated qualitative research should make it possible to define the factors fostering or hindering the realization of integration according to each site (analyzes contrasted) and in all the sites (related to the particular context of care and French services as a whole).

Published
2008
Full Text
View/download PDF

40. [Autonomy and dependence in the elderly].

Author

Somme D and Lahjibi-Paulet H

Subjects
Aging physiology, Cognition physiology, Environment, Humans, Motor Activity physiology, Movement physiology, Risk Factors, Self Concept, Sensation physiology, Social Environment, Activities of Daily Living, Aged physiology, Personal Autonomy
Published
2007

41. [Early indicators of prolonged hospitalization of the elderly: pilot study at Strasbourg University Hospital].

Author

Lang PO, Heitz D, Meyer N, Dramé M, Jovenin N, Ankri J, Somme D, Novella JL, Gauvain JB, Colvez A, Couturier P, Lanièce I, Voisin T, de Wazières B, Gonthier R, Jeandel C, Jolly D, Saint-Jean O, and Blanchard F

Subjects
Age Factors, Aged, 80 and over, Cognition Disorders, Cohort Studies, Diagnosis-Related Groups, Female, Follow-Up Studies, Humans, Logistic Models, Male, Pilot Projects, Prospective Studies, Risk Factors, Sex Factors, Socioeconomic Factors, Walking, Aged, Frail Elderly, Geriatric Assessment, Length of Stay
Abstract

Objectives: The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients., Methods: This prospective pilot study, conducted at Strasbourg University Hospital, included patients aged 75 years or older who were hospitalized via the emergency department (SAFES cohort: Sujet Agé Fragile: Evaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG)., Results: The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with a mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A "risk of malnutrition" (OR=14.07) and "mood disorders" (OR=2,5) were both early markers for prolonged hospitalization. Although not statistically significant, "walking difficulties" (OR=2.72) and "cognitive impairment" (OR=5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz's Activities of Daily Living Index or its course during hospitalization., Conclusion: Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.

Published
2007
Full Text
View/download PDF

42. [Characteristics and resource use of emergency department users older than 75 years. Results from a French national study].

Author

Lazarovici C, Somme D, Carrasco V, Baubeau D, and Saint-Jean O

Subjects
Age Factors, Aged, Aged, 80 and over, Ambulances statistics & numerical data, Chi-Square Distribution, Clinical Laboratory Techniques statistics & numerical data, Data Interpretation, Statistical, Electrocardiography statistics & numerical data, Family Practice, Female, France, Health Care Surveys, Humans, Male, Prospective Studies, Radiography statistics & numerical data, Referral and Consultation, Sex Factors, Emergency Service, Hospital statistics & numerical data
Abstract

Background: Because the elderly tend to have complex and multiple diseases, they are likely to use emergency department (ED) resources at higher rates than other age groups. This study sought to determine the characteristics and resource use of the elderly patients (>or=75 years old) visiting EDs in France and assessed the effect of age on resource use., Methods: The sample was selected from the DREES prospective study of 150 French EDs for one week in 2002. A case report form was completed for each patient, stating the reasons for consultation, method of arrival, treatment, and outcome. Data were weighted to produce a representative national description., Results: Of the 9801 patients seen that week, the elderly (n=1153) accounted for 11.8% of all ED visits, that is, 26 676 ED visits weekly nationwide. In this group, the mean age was 83 years and 60.9% were women. Most patients arrived by medical transportation: 55.6% by nonemergency ambulances and 24.6% by emergency medical transport. More than 75% were referred by their general practitioner (GP). Medical problems (69.5%) were much more frequent than trauma (24.8%). Clinical status was stable in 62% of cases. Use of ED resources was high: radiographs for 74.0%, laboratory testing for 71.0% and electrocardiography for 64.0%. The percentage of unnecessary or avoidable visits was small: 8.7% were not admitted, were clinically stable, and came for diagnostic tests that could have been performed on an outpatient basis. Age was an independent factor of pre-ED and ED resource use., Conclusion: Unplanned health care of the elderly uses substantial ED resources. Elderly patients appear to use available resources appropriately. Demographic trends show that their ED use will increase. Accordingly, analysis of the organization and funding of ED services for this population is indispensable.

Published
2006
Full Text
View/download PDF

43. [Emergency admission of eighty year-old and older patients. Characteristics and health care channels].

Author

Somme D, Yvain F, Levy A, Ellrodt A, Davido A, and St-Jean O

Subjects
Aged, Continuity of Patient Care, Day Care, Medical organization & administration, Geriatrics organization & administration, Health Services Research, Humans, Needs Assessment organization & administration, Paris, Patient Transfer statistics & numerical data, Aged, 80 and over statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Health Services for the Aged organization & administration, Patient Admission statistics & numerical data
Abstract

Objectives and Methods: The primary objective of this study was to describe characteristics and health channels of all octogenarians admitted during a 12 weeks period from two emergency units (EU) (A and B). To do so, an investigator collected data from each EU from the patients and medical teams. The secondary objective was to compare health channels between the two EU. In contrast with EU B, EU A had developed a formal cooperation with Geriatrics units. For comparison between the EU, the chi 2 and Student's t tests were used. For description of health channels, we used the following definitions: transfer: the patient was admitted after his admission to an EU in another hospital and inadequate orientation: patients in whom the diagnosis exceeded the specialty department to which they had been admitted., Results: A mean of 3.4 elderly patients/day aged 80 years and more were admitted in emergency. Most patients had initially been admitted to the EU. Length of stay in the EU was > 2 days in 26.5% of cases. To be able to cope with this flow of patients, the EU had organised health channels depending on local capacity and without the influence of the formal cooperation: in EU A, the transfer rate was of 51%; in EU B, transfers were less frequent (18%, p < 0.0001) but the proportion of inadequate orientation was of 39.4% vs. 22.7% in EU A (p = 0.02). The rate of admission to a geriatric unit was identical (13%)., Conclusions: Health channels of elderly patients admitted in emergency exhibit dysfunctions: frequent transfers, prolonged length of stay in an EU, inadequation. A formal cooperation between the EU and Geriatrics units is not sufficient to lastingly improve health care channels.

Published
2003

44. [Diabetic foot ulcers: anti-infectious strategies].

Author

Somme D, Reny JL, and Mainardi JL

Subjects
Algorithms, Amputation, Surgical, Anti-Bacterial Agents therapeutic use, Bacterial Infections classification, Bacterial Infections diagnosis, Blood Glucose analysis, Combined Modality Therapy, Debridement, Decision Trees, Diabetic Foot classification, Diabetic Foot metabolism, Drug Resistance, Humans, Microbial Sensitivity Tests, Patient Selection, Prognosis, Severity of Illness Index, Skin Care methods, Wound Infection classification, Wound Infection diagnosis, Bacterial Infections etiology, Bacterial Infections prevention & control, Diabetic Foot complications, Infection Control methods, Wound Infection etiology, Wound Infection prevention & control
Abstract

Infection is a common problem in diabetic patients with foot ulcers. The diagnosis of infection is not always easy to establish, but must be made for proper therapeutic decision making. In addition to local care, search for arteriopathy and strict control of blood glucose, treatment of infected foot ulcers requires an appropriate anti-infectious strategy. We developed diagnostic and therapeutic decisional algorithms from data available in the literature in order to establish a management strategy for different clinical situations. The fundamental role of clinical assessment is underlined and the different causal microorganisms are recalled, together with the anti-microbial activity and bone concentrations of the main antibiotics used. An optimal anti-infection work-up can undoubtedly significantly reduce the number of amputations in diabetic patients.

Published
2001

45. [CREST syndrome presenting as pulmonary hypertension].

Author

Somme D, Duterque M, Verdaguer M, and Lardoux H

Subjects
Antibodies, Antinuclear blood, Antihypertensive Agents, CREST Syndrome blood, CREST Syndrome diagnosis, Disease Progression, Dyspnea etiology, Echocardiography, Electrocardiography, Epoprostenol therapeutic use, Humans, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary drug therapy, Incidence, Infusions, Intravenous, Male, Middle Aged, Prognosis, Risk Factors, Scleroderma, Localized blood, Scleroderma, Localized diagnosis, Tomography, X-Ray Computed, Ventilation-Perfusion Ratio, CREST Syndrome complications, Hypertension, Pulmonary etiology, Scleroderma, Localized complications
Abstract

The authors report the case of a 62-year-old patient complaining of recent onset of disabling breathlessness on exertion, and presenting clinical signs of previously undiagnosed scleroderma. Echocardiography revealed a diagnosis of precapillary pulmonary hypertension (74/14 mmHg) (PHT), with no pulmonary cause revealed by pulmonary ventilation-perfusion scintigraphy or by thoracic fine section computed tomography. The diagnosis of PHT in the context of circumscribed scleroderma was confirmed by x-rays of the hands, capillaroscopy, oesophageal investigations and positive anticentromere antinuclear antibodies. The clinical course was marked by rapid deterioration of the symptoms, requiring treatment with prostacyclin by continuous intravenous infusion. The appearance of PHT in a context of circumscribed scleroderma, usually a relatively benign disease, is a rare, late event, exceptionally revealing the disease, as in this case, and indicating a very unfavourable prognosis.

Published
1999

Catalog

Books, media, physical & digital resources
See catalog results