H Juchet

Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrenees, France

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Publications (99)71.2 Total impact

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    ABSTRACT: Nous avons mis en place, aux urgences, un algorithme de prise en charge des patients présentant une douleur thoracique d’allure angineuse, fondé sur l’évaluation de la probabilité diagnostique de syndrome coronarien aigu (SCA). L’objectif principal de cette étude était d’évaluer les performances de cet algorithme pour le diagnostic de SCA.Nous avons inclus, de février à avril 2012, 212 patients admis pour douleur thoracique d’allure angineuse. Ces patients ont été classés à probabilité forte, intermédiaire ou faible de SCA. Nous avons étudié les performances de ces trois groupes comparativement au diagnostic final de SCA, fondé sur les définitions internationales.L’incidence du SCA dans les groupes de forte, intermédiaire et faible probabilité était respectivement de 59, 24 et 3%. Tous les infarctus dumyocarde (IDM) se trouvaient dans le groupe de forte probabilité. La sensibilité et la spécificité du groupe forte probabilité pour le diagnostic de SCA étaient de 77 % (IC 95 %: [64–89]) et de 85 % (IC 95 %: [78–90]). La sensibilité et la spécificité du groupe faible probabilité pour l’exclusion du SCA étaient de 72 % (IC 95 %: [64–78]) et de 91 % (IC 95 %: [80–98]).Notre algorithme permet de stratifier précocement et de façon efficace la probabilité de SCA. Cette classification permet de ne pas laisser rentrer à domicile les patients les plus graves et d’identifier les patients nécessitant la mise en oeuvre d’un traitement antithrombotique.
    01/2014; 4(2).
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    ABSTRACT: IntroductionL’analyse des plaintes est un élément essentiel de la démarche qualité dans un service d’urgence. Notre étude a pour objectif de recenser les lettres de plaintes, d’analyser leur contenu et les réponses. MéthodologieIl s’agit d’une étude rétrospective monocentrique des lettres de plaintes reçues entre 2002 et 2007. Les données concernant l’épidémiologie, la typologie des doléances, les buts recherchés, les réponses apportées et les suites ont été analysées. RésultatsCent lettres de plaintes ont été étudiées entre 2002 et 2007, correspondant à une incidence globale de 5,6/10 000 passages, avec des variations selon les années entre 3,5 et 8,6/10 000. Les plaignants étaient le plus souvent un parent (47 %) ou le patient (38 %). Dans ces 100 lettres, 153 doléances étaient recensées. Elles étaient d’ordre médical (50 %), organisationnel ou relationnel (44 %), ou divers (6 %). Les plus fréquentes concernaient les erreurs diagnostiques (32), les prises en charge non appropriées (23), le comportement du personnel (21) et les atteintes à la dignité (14). Le signalement (71 %) était le but le plus recherché. Une lettre de réponse était adressée à 78 % des plaignants. Un tiers environ des erreurs diagnostiques ont été reconnues. Quatre-vingt-neuf plaintes n’ont pas eu de suite. Neuf conciliations, une indemnisation, une procédure au tribunal administratif ont eu lieu. ConclusionL’incidence des plaintes aux urgences est faible. Elles sont autant médicales qu’organisationnelles ou relationnelles. Elles sont un indicateur de dysfonctionnement qui doit être utilisé pour améliorer la prise en charge des patients. IntroductionThe analysis of complaint letters is essential for quality improvement in an ED. The purpose of this work was to study the content of complaint letters received in an ED over six years. MethodologyRetrospective study of complaint letters sent to an ED between 2002 and 2007. The items analyzed were epidemiology, complaints typology, purposes and hospital responses. ResultsOne hundred complaint letters were studied between 2002 and 2007, corresponding to a global incidence of 5.6/10,000 ED admissions. The annual incidence varied from 3.5 to 8.6 per 10,000 admissions. The letters were written by the relatives of patients (47%) or the patients themselves (38%). Among 153 grievances in the 100 letters, 50% concerned medical problems, 44% organization and communication problems and 46% other problems. The most frequent grievances were diagnostic errors (32), inappropriate care (23), relationship (21) and violation of human dignity (14). The aim of the letters was a warning (71%). A response to plaintiffs was sent in 78% of cases. One third of diagnostic errors were recognized. Eighty-nine complaints ended without consequences, nine in arbitration committee, one in administrative court and one was compensated. ConclusionComplaints incidence in our ED was low. Complaints are related with medical and organizational problems. Complaint letters must be used to improve patients care. Mots clésUrgences–Plaintes–Qualité KeywordsEmergencies–Complaints–Quality
    05/2011; 1(3):170-174.
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    ABSTRACT: Heart fatty acid-binding protein (h-FABP) and ischemia-modified albumin (IMA) have recently been evaluated, but to the best of our knowledge, no study has reported an analysis of these two markers for the detection of early myocardial infarction and myocardial ischemia in a large cohort of consecutive patients presenting to an emergency department (ED). This study evaluates the diagnostic accuracy and the clinical utility of h-FABP and IMA for non-ST-segment elevation acute coronary syndrome (ACS) diagnosis in the first hour of management in an ED. In a prospective 11-month study, 677 patients admitted to the ED with chest pain and suspected non-ST-segment elevation ACS were enrolled. On presentation, blood samples were obtained for the measurement of the biomarkers h-FABP (immunodetection with CardioDetect) and IMA (albumin cobalt-binding test). Two physicians, blinded to the results of the markers, independently categorized patients as having or not having non-ST-segment elevation ACS. Of the 677 patients who were prospectively recruited, non-ST-segment elevation ACS was diagnosed in 185 (27.3%). While IMA was not predictive of the ACS diagnosis (odds ratio [OR] = 1.23; 95% CI = 0.87 to 1.81), h-FABP was predictive of ACS diagnosis (OR = 4.65; 95% CI = 2.39 to 9.04) with specificity at 96.8% (95% CI = 95.4% to 98.1%) and sensitivity at 13.5% (95% CI = 10.9% to 16.1%). However, h-FABP did not add significant additional information to a predictive model that included the usual diagnostic tools for non-ST-elevation ACS management (p = 0.40). In this study on a large cohort of patients admitted to an ED for chest pain, IMA and h-FABP did not provide valuable information for ACS diagnosis.
    Academic Emergency Medicine 01/2010; 17(1):27-35. · 2.20 Impact Factor
  • Health Policy. 01/2007; 20(1):57-57.
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    ABSTRACT: The objective of the study was to assess the clinical validity of a non-invasive diagnostic strategy for acute pulmonary embolism using clinical assessment combined with both ELISA D-dimer and complete lower limb ultrasound (US) examination of proximal and distal veins, before single-detector helical computed tomography (CT) of pulmonary arteries. We expected the strategy to have a high diagnostic exclusion power and to safely decrease the number of CT scans. This prospective, multicenter outcome study included 274 consecutive outpatients. All underwent a priori clinical probability, D-dimer and bilateral complete lower limb US assessments. Only patients with a high clinical probability and both tests negative, or positive D-dimer and negative US assessments, underwent CT. This was deemed necessary in 114 patients (42%). At baseline, venous thromboembolism (VTE) was detected in 110 patients (40%), either by US showing proximal (n=65) or distal (n=36) thrombosis, or by CT (n=9). Anticoagulant was withheld in the remaining patients with negative results in both D-dimer and US but a non-high clinical probability (n=59), or in both US and CT (n=90), or with negative US (n=6) and inadequate CT (n=9). All patients underwent a three-month clinical follow-up. VTE occurred in one patient with inadequate CT, yielding an incidence of 0.6% [95% confidence interval: 0.1-3.4]. No patient died from VTE or had major bleeding. Using clinical probability, ELISA D-dimer and complete US before helical CT is a safe strategy resulting in a substantial reduction in CT scans.
    Thrombosis and Haemostasis 06/2005; 93(5):982-8. · 5.76 Impact Factor
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    ABSTRACT: Previous studies have examined peritraumatic distress, peritraumatic dissociation, and acute stress disorder as predictors of posttraumatic stress disorder (PTSD). The authors examined whether these three predictors were associated with PTSD symptoms when considered simultaneously. Two-hundred victims of a factory explosion in Toulouse, France, were surveyed two and six months after the event with use of retrospective self-reports of peritraumatic distress, peritraumatic dissociation, and acute stress disorder. A hierarchical multiple regression predicting PTSD symptoms six months posttrauma indicated that all three constructs explained unique variance, accounting for up to 62 percent. Peritraumatic distress and dissociation and acute stress disorder appear conceptually different from one another and show promise in identifying who is at risk of PTSD.
    Psychiatric Services 02/2005; 56(1):93-5. · 2.01 Impact Factor
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    ABSTRACT: A limited ultrasound (US) confined to the popliteal and femoral veins is usually performed to detect deep vein thrombosis (DVT) in patients with clinically suspected acute pulmonary embolism (PE). Our objective was to assess the diagnostic accuracy of complete lower limb US examining both the proximal and distal veins in this setting. In this prospective study, 210 consecutive patients were included. Complete US was performed by independent operators and compared blindly with a reference strategy combining clinical probability, ventilation perfusion scan and pulmonary angiography to a three-month clinical follow-up. Simultaneously, VIDAS D-dimer (DD) assay and helical computed tomography (HCT) of the lungs were assessed independently and blindly. PE was present in 74 patients (35%). Complete US detected DVT in 91 patients (43%), proximal in 51 and distal in 40. Sensitivity and specificity with a 0.95 confidence interval were respectively 0.93 [0.85 - 0.97] and 0.84 [0.77 - 0.89]. Limited US detected DVT in only 46 patients (22%). Sensitivity and specificity were respectively 0.55 [0.44 - 0.66] and 0.96 [0.92 - 0.98]. For DD they were 0.92 [0.83 - 0.96] and 0.24 [0.17 - 0.32] and for HCT 0.84 [0.73 - 0.90] and 0.87 [0.80 - 0.92]. Complete lower limb US has higher sensitivity and capacity to exclude PE than limited US, but a slightly lower specificity. Complete US results also compared favourably with those of HCT and DD. The utility of including this method in diagnostic strategies for PE needs to be assessed in cost-effectiveness analysis and in outcome studies.
    Thrombosis and Haemostasis 02/2004; 91(1):187-95. · 5.76 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/2003; 24.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2003; 24.
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    ABSTRACT: To assess the efficacy and tolerance of three methylprednisolone boluses (500 mg/d) followed by a standard dose of prednisolone, 20 mg/d, as the initial treatment of non-complicated giant-cell arteritis. A retrospective study of 15 cases. Six men and nine women with a mean age of 70.9 years were treated and followed for 41.5 months. Initial mean ESR was 83 mm; mean C-reactive protein level was 94.6 mg/L. The boluses were well tolerated, excepted in one patient who developed acute psychosis. After initiating the oral treatment, two patients presented signs of clinical relapse during the first month, and were given higher doses of corticosteroids. At 1 month, 12 patients were asymptomatic, nine of whom had normalized ESR and CRP. Mean ESR was 23; mean CRP was 13 mg/L. At 3 months, the mean prednisone dose delivered was 18.2 mg/d. Mean ESR was 12 mm. The cumulative prednisone dose given during the first year was 5,349 (+/- 2,512) mg. In the 13 patients who necessitated no more than 20 mg/d prednisone, no sequelae of giant-cell arteritis, no fractures nor major treatment intolerance occurred-during the first 2 years of treatment. Treatment was stopped in eight patients after a mean duration of 48.6 months. Treatment with pulse methylprednisolone 500 mg/d for 3 days followed by 20 mg/d oral prednisone could be a valuable corticosteroid-sparing strategy in many patients with uncomplicated temporal arteritis.
    La Revue de Médecine Interne 12/2001; 22(11):1032-8. · 0.90 Impact Factor
  • La Revue de Médecine Interne 06/2001; 22:63-64. · 0.90 Impact Factor
  • La Revue de Médecine Interne 01/2001; 22(11). · 0.90 Impact Factor
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    ABSTRACT: Purpose. – To assess the efficacy and tolerance of three methylprednisolone boluses (500 mg/d) followed by a standard dose of prednisolone, 20 mg/d, as the initial treatment of non-complicated giant-cell arteritis.Method. – A retrospective study of 15 cases.Results. – Six men and nine women with a mean age of 70.9 years were treated and followed for 41.5 months. Initial mean ESR was 83 mm; mean C-reactive protein level was 94.6 mg/L. The boluses were well tolerated, excepted in one patient who developed acute psychosis. After initiating the oral treatment, two patients presented signs of clinical relapse during the first month, and were given higher doses of corticosteroids. At 1 month, 12 patients were asymptomatic, nine of whom had normalized ESR and CRP. Mean ESR was 23; mean CRP was 13 mg/L. At 3 months, the mean prednisone dose delivered was 18.2 mg/d. Mean ESR was 12 mm. The cumulative prednisone dose given during the first year was 5,349 (± 2,512) mg. In the 13 patients who necessitated no more than 20 mg/d prednisone, no sequelae of giant-cell arteritis, no fractures nor major treatment intolerance occurred during the first 2 years of treatment. Treatment was stopped in eight patients after a mean duration of 48.6 months.Conclusion. – Treatment with pulse methylprednisolone 500 mg/d for 3 days followed by 20 mg/d oral prednisone could be a valuable corticosteroid-sparing strategy in many patients with uncomplicated temporal arteritis.
    Revue De Medecine Interne - REV MED INTERNE. 01/2001; 22(11):1032-1038.
  • La Revue de Médecine Interne 11/1999; 20:559s-559s. · 0.90 Impact Factor
  • La Revue de Médecine Interne 06/1999; 20. · 0.90 Impact Factor
  • L Sailler, H Juchet, P Arlet
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    ABSTRACT: Non-complicated giant-cell arteritis is defined by the absence of ischemic complications, a remarkable response to corticosteroid treatment, and the absence of corticodependence. It is the most common type of giant-cell arteritis. Treatment relies on corticosteroids (prednisone or prednisolone) at an initial dosage of 0.7 mg/kg/j. The median duration of treatment is 2 years, but many patients need a more prolonged course. Side effects are frequent, especially atherosclerosis and osteoporosis. There is no demonstrated efficiency of corticosteroid sparing agents such as hydroxychloroquine or methotrexate. Dapsone may be efficient, but is not indicated because of its serious side-effects.
    La Revue du praticien 04/1999; 49(6):613-7.
  • La Revue de Médecine Interne 02/1999; 20(1):81-2. · 0.90 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/1999; 20.
  • P Arlet, C Vilain, H Juchet
    La Presse Médicale 01/1999; 27(38):1956. · 0.87 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/1999; 20(1):81-82.