Papers by Martine Louis Simonet
PubMed, Jan 18, 2017
The general internist cannot be a passive bystander of the anticipated medical revolution induced... more The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals.
Poster: "ECR 2013 / C-2548 / Imaging of Urethral Pathology Before and After Treatment: A Rev... more Poster: "ECR 2013 / C-2548 / Imaging of Urethral Pathology Before and After Treatment: A Review with Emphasis on Conventional Urethrography" by: "I. Santos Gomez, M. Cespedes, B. Y. Barragan Requena, N. Rojo Sanchis, A. Marin Canete, M. Simonet, M. R. Cambra Marti, A. M. Sanchez Laforga; Sant Boi de Llobregat/ES"
BMC Health Services Research, Feb 13, 2018
Background: Early identification of patients requiring transfer to post-acute care (PAC) faciliti... more Background: Early identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study's aim was to assess medical and neurological patients' post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome ("gold standard"). Methods: In this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores' accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cutoff levels. Results: Medical patients' day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cutoff of ≥8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients' scores showed lower accuracy both days: using the same cutoff , respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%. Conclusion: PACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores' value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation.
Revue médicale suisse, 2018
In medicine, there are progresses which radically transform practices, change recommendations and... more In medicine, there are progresses which radically transform practices, change recommendations and win unanimous support in the medical community. There are some which divide, questioning principles that seemed established. There are also small advances, which can answer the questions that internists ask themselves in the daily care of their patients. Here are several articles published in 2017, read and commented for you by hospitalists, selected according to their impact on the medical world.
Revue Médicale Suisse, 2017
Illustrating the sensitivity, specificity and AUC (CI: 95%) values for PACD day 1 and PACD day 3 ... more Illustrating the sensitivity, specificity and AUC (CI: 95%) values for PACD day 1 and PACD day 3 in medical and in neurological patients. (DOCX 23 kb)
Scoring of the PACD day-3. (JPEG 685 kb)
Revue médicale suisse, 2015
The lack of clear recommendations makes optimal pain management difficult in patients with hepati... more The lack of clear recommendations makes optimal pain management difficult in patients with hepatic function impairment. This article reviews the evidence on commonly used analgesics (paracetamol, NSAIDs, opiates). Paracetamol can be safely used at low doses (2-3 grams per day) for a period not exceeding a few days. NSAIDs should be avoided because of their direct hepatic toxicity and an increased risk of life-threatening side-effects (hemorrhagic, renal). Glucuronoconjugated opiates should be preferred but all must be used carefully because of the risk of side effects. Dosage reduction and/or increased dose interval are often required.
Revue medicale suisse, 2017
Paracentesis is a frequent procedure, especially in patients with cirrhosis. In these patients, g... more Paracentesis is a frequent procedure, especially in patients with cirrhosis. In these patients, given the fears of severe bleeding associated with coagulation disorders as well as thrombocytopenia, we were interested to review the literature on this subject. Few studies are available and, for the moment, recommendations are of a low level of evidence. Paracentesis seems to be a safe procedure without severe haemorrhagic complications (< 1%), regardless of coagulation disorders and platelet count. Renal insufficiency, Child-Pugh C cirrhosis, thrombocytes < 50 G/L and cirrhosis of alcoholic origin may however increase the risk of bleeding. Caution should be observed in these patients.
Journal of Family Medicine, 2019
Background Medication adherence remains a challenge for patient management. Changes in the drug r... more Background Medication adherence remains a challenge for patient management. Changes in the drug regimen after a hospital stay can lead to confusion or misunderstandings. We implemented a structured patient-centered interview during which a computer-generated individualized medication plan was discussed and provided to patients at discharge. Objective To explore whether a medication plan can be a quality indicator, in terms of its content (quality) and its implementation in the resident’s workflow (feasibility). Methods An observational mixed method study with interviews of 174 patients from general internal medicine wards at 1 week and 1 month after discharge, and of 91 physicians at baseline. We report the quality of the medication plan in terms of content and state of completion. We describe feasibility for residents to complete this plan, as well as patient and resident satisfaction with the plan. Results 83% of participants received a medication plan. Physicians verified renal f...
European Journal of Internal Medicine, 2019
BACKGROUND In US healthcare system, handoffs are associated with an increase in medical error and... more BACKGROUND In US healthcare system, handoffs are associated with an increase in medical error and in hospital length of stay. In non-US healthcare systems, this phenomenon has not been well studied. We studied the association between early handoffs (EH) in a non-US internal medicine ward with length of stay (LOS), use of resources, major complication (MC) and discharge to post-acute care (PAC) facility. METHODS We conducted a retrospective cohort study on patients admitted to the general internal medicine division. Patients with EH (defined as a transfer of responsibility between primary teams within the first 72 h) were compared with patients without EH. The primary outcome was LOS in the general internal medicine division. Secondary outcomes were the use of resources, the incidence of MC (transfer to intensive care, to intermediate care or death) and discharge to a PAC facility. RESULTS We included 11,869 patients, 38% of whom were in the EH group. Patients were 67.7±16.6 years old and 53% were males. EH was independently associated with an increase of LOS (+6.4% [95% CI, 3.5%-9.5%], P < .001) and with an increased rate of MC (OR 1.3 [95% CI, 1.1-1.7], P = .012). In our subgroup analysis, the association between early handoff and LOS and MC rate were not statistically significant when the admission occurred on public holidays and weekends. CONCLUSIONS Among patients admitted in our general internal medicine division, early handoffs were associated with significantly higher length of stay and major complication rate, but not in patients admitted during week-ends.
Medecine Et Hygiene, 2002
L'allergie aux piqures d'hymenopteres est un probleme frequent et ancien. Le traitement d... more L'allergie aux piqures d'hymenopteres est un probleme frequent et ancien. Le traitement d'urgence consiste, en cas d'exposition accidentelle, en l'administration d'adrenaline, de corticoides et d'antihistaminiques, traitement que le patient allergique devrait porter sur lui. Les mesures prophylactiques visant a reduire l'exposition aux hymenopteres sont egalement tres importantes. En 1975 apparait une immunotherapie specifique (desensibilisation) et des 1996 nous pratiquons celle-ci selon un protocole d'induction rapide (ultra-rush). Celui-ci permet une economie de temps et d'argent, et les effets secondaires sont moins frequemment rencontres qu'avec l'immunotherapie classique.
Journal Européen des Urgences, 2004
Revue médicale suisse, Jan 3, 2010
Several meta-analysis support the prescription of aspirin for primary prevention of cardiovascula... more Several meta-analysis support the prescription of aspirin for primary prevention of cardiovascular events in patients at risk. Though diabetics are particularly prone to these complications, a review of the literature shows that they have fewer benefits from the protective effects of such treatment. In these patients, controlling dyslipidemia, blood pressure and glycemia remains the main aim. Prescription of aspirin, in combination with an already existing medication, should not be solely based on the presence of diabetes, but on the overall risk profile of the patient, as well as his motivation.
Revue médicale suisse, Jan 17, 2012
When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing be... more When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing between a nasogastric tube (NGT) and a percutaneous endoscopic gastrostomy (PEG) is not always an easy decision. In neurological patients with swallowing disturbances or in patients with head and neck tumors, PEG is associated with lower rates of feeding tube dislodgement, while NGT has lower rates or morbidity. A meta-analysis showed that the interruption of nutrition is less frequent with PEG but there is no difference in terms of mortality and aspiration pneumonia between PEG and NGT. The European Society for Clinical Nutrition and Metabolism recommends PEG when enteral nutrition is expected to last more than 3 weeks.
BMC Health Services Research, Jul 22, 2008
Background: Early identification of patients who need post-acute care (PAC) may improve discharge... more Background: Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time. Methods: We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort. Results: Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score ≥ 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results. Conclusion: A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning. Background Efficient discharge planning is an important component of hospital care. The goals of discharge planning are to ensure continuity in health care beyond hospital discharge and optimal use of hospital beds [1].
Revue Médicale Suisse, 2017
Contains the data about the quality of the feedback perceived by the students. (XLSX 41 kb)
Revue Médicale Suisse, 2017
The general internist cannot be a passive bystander of the anticipated medical revolution induced... more The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals
Le Pharmacien Hospitalier et Clinicien, 2017
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Papers by Martine Louis Simonet