N Molinari

Publications (10)27.59 Total impact

• Article: Addition of enoxaparin to aspirin for the secondary prevention of placental vascular complications in women with severe pre-eclampsia. The pilot randomised controlled NOH-PE trial.

  Jean-Christophe Gris, Céline Chauleur, Nicolas Molinari, Pierre Marès, Pascale Fabbro-Peray, Isabelle Quéré, Jean-Yves Lefrant, Bassam Haddad, Michel Dauzat
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  ABSTRACT: Administration of heparin in the secondary prevention of placental vascular complications is still experimental. In women with a previous severe pre-eclampsia, we investigated the effectiveness of enoxaparin, a low-molecular-weight heparin, in preventing these complications. Between January 2000 and January 2010, 224 women from the NOHA First cohort, with previous severe pre-eclampsia but no foetal loss during their first pregnancy and negative for antiphospholipid antibodies, were randomised to either a prophylactic daily dose of enoxaparin starting from the positive pregnancy test (n=112), or no enoxaparin (n=112). The primary outcome was a composite of at least one of the following: pre-eclampsia, abruptio placentae, birthweight ≤ 5th percentile, or foetal loss after 20 weeks. Enoxaparin was associated with a lower frequency of primary outcome: 8.9% (n=10/112) vs. 25 % (28/112), p=0.004, hazard ratio = 0.32, 95% confidence interval (0.16-0.66), p=0.002. Enoxaparin was safe, with no obvious side-effect, no thrombocytopenia nor major bleeding event excess. This pilot study shows that enoxaparin given early during the second pregnancy decreases the occurrence of placental vascular complications in women with a previous severe pre-eclampsia during their first pregnancy.
  Thrombosis and Haemostasis 09/2011; 106(6):1053-61. · 5.04 Impact Factor
• Article: Impact of an intervention designed to improve the documentation of the reassessment of antibiotic therapies in an intensive care unit.

  C Pulcini, J Dellamonica, G Bernardin, N Molinari, A Sotto
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  ABSTRACT: The study objectives were: (i) to design an intervention to improve the written documentation of empiric antibiotic prescriptions' reassessment; (ii) and to assess the impact of this intervention on the quality of prescriptions. A prospective before and after 7-month intervention study in a medical ICU in a French teaching hospital, using interrupted time-series analysis. The intervention was made to improve the documentation of four process measures in medical records: antibiotic plan, reviewing the diagnosis, adapting to positive microbiological results, and IV-per os switch. One hundred and fourteen antibiotic prescriptions were assessed, 62 before and 52 after the intervention. The reassessment of antibiotic prescriptions was more often documented in the ICU after the intervention (P=0.03 for sudden change). The prevalence of appropriate antibiotic prescriptions was not statistically different before and after the intervention, either for sudden change and/or linear trend. A better documentation of antibiotic prescriptions' reassessment was achieved in this ICU, but it did not improve the quality of antibiotic prescriptions.
  Médecine et Maladies Infectieuses 08/2011; 41(10):546-52. · 0.72 Impact Factor
• Article: Impact of an assisted reassessment of antibiotic therapies on the quality of prescriptions in an intensive care unit.

  L Bornard, J Dellamonica, H Hyvernat, F Girard-Pipau, N Molinari, A Sotto, P-M Roger, G Bernardin, C Pulcini
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  ABSTRACT: The study's objective was to assess the impact of a professional multifaceted intervention designed to improve the quality of inpatient empirical therapeutic antibiotic courses at the time of their reassessment, i.e. 24 to 96 hours after treatment initiation. We conducted a 5-month prospective pre- and post-intervention study in a medical Intensive Care Unit (ICU) in a teaching hospital, using time-series analysis. The intervention was a multifaceted professional intervention combining systematic 3-weekly visits of an infectious diseases specialist to discuss all antibiotic therapies, interactive teaching courses, and daily contact with a microbiologist. Eighty-one antibiotic prescriptions were assessed, 37 before and 44 after the intervention. The prevalence of adequate antibiotic prescriptions was high and not statistically different before and after the intervention (73% vs. 80%, P=0.31), both for sudden change (P=0.67) and linear trend (P=0.055), using interrupted time-series analysis. The intervention triggered a more frequent reassessment of the diagnosis between day 2 and day 4 (11% vs. 32%, P=0.02) and slightly improved the adaptation of antibiotic therapies to positive microbiology (25% before vs. 50% after, P=0.18). Our multifaceted intervention may have improved the quality of antibiotic therapies around day 3 of prescription, but the difference did not reach statistical significance, possibly because of a ceiling effect.
  Médecine et Maladies Infectieuses 07/2011; 41(9):480-5. · 0.72 Impact Factor
• Article: Junior doctors' knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland.

  C Pulcini, F Williams, N Molinari, P Davey, D Nathwani
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  ABSTRACT: Our objective was to assess junior doctors' perceptions of their antibiotic prescribing practice and of bacterial resistance. We surveyed 190 postgraduate doctors still in training at two university teaching hospitals, in Nice (France) and Dundee (Scotland, UK), and 139 of them (73%) responded to the survey. The main results presented in this abstract are combined for Nice and Dundee, because there was no statistical difference for these points between the two hospitals. Antibiotic resistance was perceived as a national problem by 95% of the junior doctors, but only 63% rated the problem as important in their own daily practice. Their perceptions of the causes of antibiotic resistance were sometimes at variance with available medical evidence, with excessive duration of antibiotic treatment and poor hand hygiene practices rarely being perceived as important drivers for resistance. Only 31% and 26% of the doctors knew the correct prevalences of antibiotic misuse and of methicillin-resistant Staphylococcus aureus in hospitals, respectively. They preferred educational interventions, such as specific teaching sessions, availability of guidelines or readily accessible advice from an infectious diseases specialist, to improve antibiotic prescribing, rather than restricted prescription of antibiotics. These data provide helpful information for the design of strategies to optimize adherence to good antimicrobial stewardship.
  Clinical Microbiology and Infection 01/2011; 17(1):80-7. · 4.54 Impact Factor
• Article: Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland: Doctors’ perceptions of antibiotics

  C. Pulcini, F. Williams, N. Molinari, P. Davey, D. Nathwani
  Clinical Microbiology and Infection - CLIN MICROBIOL INFECT. 01/2010;
• Article: Association between caries experience and body mass index in 12-year-old French children.

  P Tramini, N Molinari, M Tentscher, C Demattei, A G Schulte
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  ABSTRACT: The prevalence of overweight and obesity reached 19.7% in 12-year-old French children in the year 2005. Recently, nationwide programs have been broadly implemented in France to reduce the overconsumption of sugars, salt and fat. The aims of this study were to assess the distribution of body mass index (BMI) and D(3+4)MFT index in a sample of 12-year-old French children, and to compare several regression models in order to analyze the association between these two indices. A cross-sectional study was conducted in Montpellier, France, and the height, weight, D(3+4)MFT, sugar and soft drink consumption were recorded in a randomly selected sample of 835 schoolchildren. In order to analyze the association between BMI and DMFT, four models of regression were tested: logistic, Poisson, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The mean BMI was 18.9 for the whole sample and the corresponding DMFT value was 1.47. The caries prevalence was 51.7%. The best fitted models for testing the association between BMI and DMFT were ZIP and ZINB models. They showed a significant association between DMFT and sugar consumption, but not with BMI. As a result of the best fitted models (ZIP and ZINB), where BMI was not statistically associated with DMFT, we conclude, within the limits of a cross-sectional survey, that there is no association between these two variables.
  Caries Research 12/2009; 43(6):468-73. · 2.33 Impact Factor
• Article: [Investigating clinical practice in antibiotic therapy for acute community-acquired pneumonia].

  A Minchella, C Lechiche, H Poujol, N Molinari, A Sotto
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  ABSTRACT: Methods used for the assessment of professional practices must be dependable and reproducible. The aim of this study was to assess a method used in our hospital to assess antibiotic therapy for acute community-acquired pneumonia (CAP). In this study, a pharmacist and two infectious disease specialists retrospectively and independently evaluated the compliance to local antibiotic guidelines for 124 patients. The assessment tool was a Medical Appropriateness Index (MAI) (nine items). The kappa agreement index (K) among experts was calculated. The agreement among experts was poor for the initial antibiotic treatment (K=0.16) and route of administration (K=0.14), low for the duration of treatment (K=0.34), and null for the dose and adjustment to 72 hours. Differences between experts can be explained by the complexity of medical records, the number of items assessed, the complexity of the MAI, but also by the specialization and experience of experts. Thus, the assessment of CAP antibiotic therapy requires the use of appropriate methods targeting reliable criteria.
  Médecine et Maladies Infectieuses 09/2009; 40(2):100-5. · 0.72 Impact Factor
• Article: Association between Caries Experience and Body Mass Index in 12YearOld French Children

  P. Tramini, N. Molinari, M. Tentscher, C. Demattei, A. G. Schulte
  [show abstract] [hide abstract]
  ABSTRACT: The prevalence of overweight and obesity reached 19.7% in 12-year-old French children in the year 2005. Recently, nationwide programs have been broadly implemented in France to reduce the overconsumption of sugars, salt and fat. The aims of this study were to assess the distribution of body mass index (BMI) and D3+4MFT index in a sample of 12-year-old French children, and to compare several regression models in order to analyze the association between these two indices. A cross-sectional study was conducted in Montpellier, France, and the height, weight, D3+4MFT, sugar and soft drink consumption were recorded in a randomly selected sample of 835 schoolchildren. In order to analyze the association between BMI and DMFT, four models of regression were tested: logistic, Poisson, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The mean BMI was 18.9 for the whole sample and the corresponding DMFT value was 1.47. The caries prevalence was 51.7%. The best fitted models for testing the association between BMI and DMFT were ZIP and ZINB models. They showed a significant association between DMFT and sugar consumption, but not with BMI. As a result of the best fitted models (ZIP and ZINB), where BMI was not statistically associated with DMFT, we conclude, within the limits of a cross-sectional survey, that there is no association between these two variables.
  Caries Research - CARIES RES. 01/2009; 43(6):468-473.
• Source

  Available from: free.fr

  Article: Free knot splines for logistic models and threshold selection.

  F Bessaoud, J P Daures, N Molinari
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  ABSTRACT: The logistic regression model has been in use in statistical analysis for many years. The paper introduces a spline model to remove the linear restriction on logit function. By considering knot locations as free variables, spline approximation of data is improved. The number of knots and the degree of the spline functions can still be determined by using a model selection procedure. Moreover, a knot, seen as a free parameter for a piecewise linear spline, represents a break point in the logit function which may be interpreted as a threshold value. This method is applied to a clinical trial for an in vitro fertilization program.
  Computer Methods and Programs in Biomedicine 02/2005; 77(1):1-9. · 1.52 Impact Factor
• Article: Role of allelic variants Gly972Arg of IRS-1 and Gly1057Asp of IRS-2 in moderate-to-severe insulin resistance of women with polycystic ovary syndrome.

  S A El Mkadem, C Lautier, F Macari, N Molinari, P Lefèbvre, E Renard, J C Gris, G Cros, J P Daurès, J Bringer, M F White, F Grigorescu
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  ABSTRACT: To assess the role of insulin receptor, insulin receptor substrate (IRS)-1, and IRS-2 genes in insulin resistance, we explored the genomic DNA in women with polycystic ovary syndrome (PCOS) and a variable degree (mean +/- SE) of insulin resistance (homeostasis model assessment index for insulin resistance [HOMA(IR)] 3.2 +/- 0.6, n = 53; control subjects 1.56 +/- 0.34, n = 102) using direct sequencing. Whereas no novel mutations were found in these genes, gene-dosage effects were found on fasting insulin for the Gly972Arg IRS-1 variant and on 2-h plasma glucose for the Gly1057Asp IRS-2 variant. The Gly972Arg IRS-1 variant was more prevalent in insulin-resistant patients compared with non-insulin-resistant individuals or control subjects (39.3 vs. 4.0 and 16.6%, P < 0.0031, respectively). A multivariate model that included BMI as a variable revealed significant effects of the Gly1057Asp IRS-2 variant on insulin resistance (P < 0.016, odds ratio [OR] 7.2, 95% CI 1.29-43.3). HOMA(IR) was higher in carriers of both IRS variants than in those with IRS-2 mutations only or those with wild-type variants (6.2 +/- 2.3, 2.8 +/- 0.5, and 1.8 +/- 0.2, respectively; P < 0.01), and it was significantly associated with this genotype (P < 0.0085, OR 1.7, 95% CI 1.09-2.99). We conclude that polymorphic alleles of both IRS-1 and IRS-2, alone or in combination, may have a functional impact on the insulin-resistant component of PCOS.
  Diabetes 09/2001; 50(9):2164-8. · 8.29 Impact Factor
• Source

  Available from: free.fr

  Article: Multiple temporal cluster detection.

  N Molinari, C Bonaldi, J P Daurès
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  ABSTRACT: This article proposes a simple method to determine single or multiple temporal clustering on a variable size population. By a transformation of the data set, the method based on a regression model allows consideration of a variable population size during the time of study. A model selection procedure and a resampling method are used to select the number of clusters. The results have applications in epidemiological studies of rare diseases.
  Biometrics 07/2001; 57(2):577-83. · 1.83 Impact Factor
• Source

  Available from: free.fr

  Article: Regression splines for threshold selection in survival data analysis.

  N Molinari, J P Daurès, J F Durand
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  ABSTRACT: The Cox proportional hazards model restricts the hazard ratio to be linear in the covariates. A survival model based on data from a clinical trial is developed using spline functions with variable knots to estimate the log hazard function. Moreover, the main point of the method is that a knot, seen as free parameters for a piecewise linear spline, represents a break point in the log hazard function which may be interpreted as a threshold value. The likelihood ratio test is used to select the final model and to determine the threshold number for a covariate. Confidence intervals for these threshold values are computed by bootstrapping the data. Two examples illustrate the method.
  Statistics in Medicine 02/2001; 20(2):237-47. · 1.88 Impact Factor