C. Genty

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (63)135.13 Total impact

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    ABSTRACT: Introduction: The National Ranking Examination (NRE) is the key to the choice of career and specialty for future physicians; it lets them choose their place of employment in a specialty and an hospital for their internship. It seems interesting to model the success factors to this exam for the medical students from Grenoble University. Methods: For each of the medical students at Grenoble University who did apply to the NRE in 2012, data have been collected about their academic background and personal details from the administration of the University. A simple logistic regression with success set as being ranked in the first 2000 students, then a polytomous logistic regression, have been performed. Results: The 191 students in the models are 59% female, 25 years old in average (SD 1.8). The factors associated to a ranking in the first 2000 are: not repeating the PCEM1 class (odds ratio [OR] 2.63, CI95: [1.26; 5.56]), performing nurse practice during internships (OR=1.27 [1.00; 1.62]), being ranked in the first half of the class for S3 pole (OR=6.04 [1.21; 30.20] for the first quarter, OR=5.65 [1.15; 27.74] for the second quarter) and being in the first quarter at T5 pole (OR=3.42 [1.08; 10.82]). Conclusion: Our study finds four factors independently contributing to the success at NRE: not repeating PCEM1, performing nurse practice and being ranked in the top of the class at certain academic fields. The AUC is 0.76 and student accuracy is more than 80%. However, some items, for example repeating DCEM4 or participating in NRE mock exams, have no influence on success. A different motivation should be a part of the explanation… As these analysed data are mainly institutional, they are accurate and reliable. The polytomic logistic model, sharing 3 factors with the simple logistic model, replace a performing nurse practice factor's by a grant recipient factor.
    No preview · Article · Nov 2015 · La Presse Médicale

  • No preview · Article · Sep 2015 · Journal des Maladies Vasculaires
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    ABSTRACT: In cases of suspected deep-vein thrombosis (DVT), different compression ultrasound (CUS) protocols are used, and the usefulness of systematically screening the asymptomatic contralateral leg is a matter of controversy. In a recent article, Le Gal et al., reported that unilateral whole-leg CUS detected the large majority of DVT and that the number of contralateral CUS examinations needed (NCCN) to diagnose one case of DVT after a negative unilateral examination of the ipsilateral side was high.[1] This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Thrombosis and Haemostasis
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    ABSTRACT: Supraglottic devices are thought to allow efficient ventilation and continuous chest compressions during cardiac arrest. Therefore, the use of supraglottic devices could increase the chest compression fraction (CCF), a critical determinant of patient survival. The aim of this study was to assess the CCF in out-of-hospital cardiac arrest (OHCA) patients ventilated with a supraglottic device. We conducted an open prospective multicenter study with temporal clusters. OHCA patients treated by emergency nurses received either intermittent chest compressions with bag-valve mask ventilations (30:2 rhythm; BVM group); or continuous chest compressions with asynchronous ventilations by laryngeal tube (LT group). The primary endpoint was the CCF assessed using an accelerometer connected to the defibrillator. We also investigated the ease of use of the laryngeal tube. Eighty-two patients were included (41 in each group); 68% were male and the median age was 68 (54-80) years. Patients and cardiac arrest characteristics did not differ between groups. The CCF was 75% (68-79%) in the LT group and 59% (51-68%) in the BVM group (p<0.01). LT insertion failed in nine out of 40 cases (23%). The median time of LT insertion was 26 s (11-56 s). CCF was significantly lower when LT insertion failed (58% (48-74%) vs. 76% (72-80%) when LT insertion succeeded; p=0.01). The use of the LT during OHCA increases the CCF when compared to standard BVM ventilation. However, the impact of LT use on mortality remains unclear. Copyright © 2015. Published by Elsevier Ireland Ltd.
    No preview · Article · Jun 2015 · Resuscitation
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    ABSTRACT: This prospective study aimed to provide detailed clinical information on a sinus augmentation procedure, i.e., transcrestal sinus floor elevation with a bone block using the press-fit technique. A bone block is harvested with a trephine burr to obtain a cylinder. This block is inserted into the antrum via a crestal approach after creation of a circular crestal window. Thirty-three patients were treated with a fixed prosthesis supported by implants placed on 70 cylindrical bone blocks. The mean bone augmentation was 6.08±2.87mm, ranging from 0 to 12.7mm. Only one graft failed before implant placement. During surgery and the subsequent observation period, no complications were recorded, one implant was lost, and no infection or inflammation was observed. This proof-of-concept study suggests that the use of a bone block inserted into the sinus cavity via a crestal approach can be an alternative to the sinus lift procedure with the creation of a lateral window. It reduces the duration of surgery, cost of treatment, and overall discomfort. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jun 2015 · International Journal of Oral and Maxillofacial Surgery
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    ABSTRACT: In the first year of medical studies in France, students prepare for a highly selective entrance exam limited by numerus clausus into the second year. We have discontinued live lectures, made maximum use of new information and communication technologies and introduced tutorials in an attempt to make the first year more equitable and to personalise teaching. The reform is based on blended learning with flipped classroom organized into a four-week cycles of different activities. Each cycle corresponds to a learning module. The teachers' and students' opinions were analysed to evaluate the reforms and allow teaching methods to be adapted accordingly. The student profiles at registration and success in the exams following the reform are described. The tutorial's notes are correlated to the final scores at the entrance exam. The keys to success seem to be modified by the reform providing greater equality of opportunity between students. The factors associated to success are baccalaureate highest grades, high School Specialisation (maths, physics or earth and life sciences) and repeating the first year class. The use of blended learning allows us to face the increase of student enrolment, and to facilitate the acceptance of these pedagogical methods for both students and teachers.
    No preview · Article · May 2015 · Studies in health technology and informatics

  • No preview · Article · Mar 2015 · Journal des Maladies Vasculaires

  • No preview · Article · Dec 2014
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    ABSTRACT: Objectifs Devant un épisode isolé de maladie thromboembolique veineuse (MTEV), il est usuel de rechercher un néoplasie occulte. Cependant, aucun bénéfice en termes d’amélioration de la morbi-mortalité en lien avec cette pratique n’est démontré. Nous avons cherché à isoler un sous-groupe de patient pour lequel la question du dépistage de cancer vaut encore d’être posée après un épisode de MTEV. Matériel et méthode Nous avons utilisé les données de la cohorte OPTIMEV (étude prospective multicentrique) afin de rechercher un sous-groupe de patient à haut risque de cancer après un épisode de MTEV par un modèle de Cox regroupant les caractéristiques de l’événement thrombotique chez les patients de plus de 50 ans, puis en réalisant une stratification du risque par pondération des hazard ratios (HR) significatifs et en estimant le taux de cancer selon la classe. Résultats Trois mille quatre cent douze patients avec ou sans MTEV ont été suivis 3 ans avec 4,1 % de perdus de vue ; 4,66 % [3,67–5,83] des patients avec MTEV ont présenté un cancer durant le suivi. Le HR pour les patients de plus de 50 ans est de 11,1 [2,7–45,5] (p < 0,01). Parmi eux (n = 1169), la récurrence sous traitement anticoagulant (AC) (HR 6,6 [3,2–13,6] [p < 0,01]), la récurrence après arrêt des AC (HR 3,6 [1,9–6,7] [p < 0,01]), la thrombose veineuse profonde bilatérale (HR 1,9 [1,01–3,7] [p = 0,05]) ou idiopatique (HR 1,7 [1,1–2,8] [p = 0,02]) sont significativement associées à un sur-risque de cancer, permettant de définir 3 groupes de patients à risque faible (n = 597), intermédiaire (n = 525) ou élevé (n = 47) avec respectivement un taux de cancer de 3,4 % [2,5–5,1], 8,0 % [5,8–10,6] et 21,3 % [10,7–35,7]. Discussion La recherche systématique de néoplasie après un épisode isolé de MTEV n’ayant pas montré de bénéfice en termes de survie, il ne paraît pas justifié de proposer un dépistage autre que celui habituellement recommandé adapté à l’âge et au sexe. Mais en combinant les caractéristiques de la MTEV, on peut isoler un petit groupe de patients à très haut risque pour lequel un dépistage exhaustif pourrait être proposé. Conclusion Seul un petit sous-groupe de patients à très haut risque chez les patients de plus de 50 ans devrait faire l’objet d’études complémentaires afin d’évaluer s’il existe ou non un bénéfice à modifier la politique de dépistage en vigueur du fait de cet événement thromboembolique particulier.
    No preview · Article · Oct 2014 · Journal des Maladies Vasculaires

  • No preview · Article · Oct 2014 · Journal des Maladies Vasculaires
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    ABSTRACT: Background: Stroke volume variation (SVV) during mechanical ventilation predicts preload responsiveness. We hypothesized that the prone position would alter the performance of this dynamic indicator. Methods: Two parallel groups of ventilated neurosurgical patients with low tidal volume (6-8 ml.kg-1) were studied before surgical incision. SVV was measured at T0, T15 and T30 min during a fluid volume expansion (250 mL hetastarch 6% over 30 min) with patients in either the supine (N.=29; Supine group) or prone position (N.=23; Prone group). Fluid responsiveness was defined as an increase in the stroke volume index (SVI) of ≥20% at T30. Receiver-operating characteristics (ROC) curves were generated for SVV. Results: Prone positioning significantly increased SVV. Volume expansion in the Prone group increased SVI but led to a decline in SVV from 16% (12-22; median, 25-75th percentile) at T0 to 9% (8-13%) at T30. These effects on SVI and SVV were more pronounced compared to those obtained in the Supine group (P ≤0.05). Fluid responsiveness was predicted by SVV >12% at T0 (sensitivity 88%, specificity 62%) in the Supine group. In the Prone group, the area under the ROC curve of SVV (0.53; 95% confidence interval 0.27-0.79) did not allow the determination of a threshold SVV value. Conclusion: In ventilated patients with low tidal volume, a prone position may have a direct effect on the heart that alters the performance of SVV in predicting fluid responsiveness. External factor such as prone position renders difficult the interpretation of SVV as a dynamic indicator of cardiac preload.
    No preview · Article · Sep 2014 · Minerva anestesiologica
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    ABSTRACT: Introduction The diagnosis of deep vein thrombosis (DVT) in pregnant women remains a challenge for physicians. The ‘LEFt’ clinical decision rule was recently derived, that might help in estimating the pretest probability of DVT during pregnancy. Our aim was to externally validate the LEFt clinical decision rule among pregnant women included in the OPTIMEV study. Materials and Methods The OPTIMEV study is a diagnostic and epidemiologic study that included patients with suspected VTE between November 2004 and January 2006. All patients underwent standardized clinical data collection, and a bilateral whole-leg venous ultrasonography. A 3-month follow-up was performed in all patients with confirmed VTE, and in a randomly selected subsample of patients with negative diagnostic workup. Results Of the 8,256 included patients, 96 were pregnant women. A DVT was diagnosed at CUS in 9 women (9.4%). The LEFtscore was computed in all but 7 women with missing values: one point in case of left (‘L’) leg suspicion, one point for edema (‘E’) and one point if the suspicion occurred during the first trimester (‘Ft’) of pregnancy. Prevalence of confirmed DVT was as follows: 1/30 (3%) in women with no LEFt criteria, 3/35 (9%), 2/20 (10%), and 3/4 (75%) in women with 1, 2 and 3 points, respectively. Conclusions Our results confirm the ability of the LEFt rule to estimate the pretest probability of DVT. Future studies are required to prospectively validate these findings and to define the role of the rule in a diagnostic algorithm for DVT during pregnancy.
    No preview · Article · Sep 2014 · Thrombosis Research
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    ABSTRACT: After a proximal deep-vein thrombosis (P-DVT), the risk of diagnosis of a previously unsuspected cancer is high. Isolated distal DVT (iD-DVT; i.e. infra-popliteal DVT without pulmonary embolism [PE]) and isolated superficial-vein thrombosis (iSVT; i.e. without concomitant DVT and PE) are at least as frequent as P-DVT but their association with subsequent cancer is uncertain. We exploited data from the OPTIMEV prospective, observational, multicentre study to i) compare the risk of subsequent cancer three years after a first objectively confirmed iSVT, iD-DVT and iP-DVT in patients without a prior history of cancer or of venous thromboembolism, ii) assess predictors of subsequent cancer in cases of iD-DVT. The overall cumulative rates of cancer among the 304 patients with iSVT, 536 patients with iD-DVT, and 327 patients with iP-DVT were similar (3.4% 95% confidence interval [1.8-6.2], 3.9% [2.5-5.9] and 3.9% [2.3-6.8], respectively), regardless of whether the index venous thromboembolic event was unprovoked or associated with a major transient risk factor. Neither anatomical (muscular vs deep-calf DVT) nor ultrasound scan characteristics (number of thrombosed veins, clot diameter under compression) seemed strongly associated with the risk of cancer in cases of iD-DVT. In patients managed in routine practice, all the different clinical expressions of lower limb venous thromboembolism are associated with a similar risk of subsequent cancer. From a clinical practice point of view, this suggests that cancer screening, without discussing the necessity, or not, of such screening, should not differ between a deep-proximal, deep-distal or superficial location of thrombosis.
    No preview · Article · Aug 2014 · Thrombosis and Haemostasis
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    ABSTRACT: Introduction: Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery. Patients and methods: Prospective, multicentre observational cohort study of 1134 consecutive patients with coronary stents undergoing non-cardiac surgery between April 2007 and April 2009. The primary outcome measure was the occurrence of an hemorrhagic complication during the first 30days following the surgery or intervention. Results: Among the 1134 patients evaluated, 108 (9.5%) experienced a postoperative hemorrhagic complication (with a median time to occurrence of 5.3days). These complications were considered major, involved the operative site, and required reoperation in 92 (85.2%), 92 (85.2%), and 20 (18.5%) of patients, respectively. Mortality in patients with a haemorrhagic complication was 12% (n=13). Independent postoperative factors associated with haemorrhagic complications were identified as a high and intermediate bleeding risk procedure and the use and dose of anticoagulants. When interrupted before the procedure, resumption of antiplatelet treatment was delayed in patients developing early postoperative hemorrhagic complications. Conclusion: Patients with coronary stents who undergo surgery are at high risk for hemorrhagic complications.
    No preview · Article · May 2014 · Thrombosis Research
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    ABSTRACT: Background Isolated distal deep-vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism (PE)) represents half of all lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence. Methods Using data from the OPTIMEV study, a prospective, observational, multicentre study, we compared, three years after an index VTE event and after discontinuation of anticoagulants, i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal deep-vein thrombosis (iPDVT); ii) predictors of recurrence after iDDVT. ResultsAs compared with patients with iPDVT (n=259), patients with an iDDVT (n=490) had a lower annualized incidence of overall VTE recurrence (5.2% [3.6-7.6] vs. 2.7% (95% CI) [1.9-3.8]) respectively, p=0.02) but a similar incidence of PE recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6] respectively, p=0.83). An Age>50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, this latter being then ≥3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence. Conclusion After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than patients with iPDVT, but a similar risk of serious recurrent VTE. Age>50, unprovoked iDDVT, and number of thrombosed veins (>1) influenced the risk of recurrence and may help to define patients at significant risk of recurrence.This article is protected by copyright. All rights reserved.
    No preview · Article · Apr 2014 · Journal of Thrombosis and Haemostasis
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    ABSTRACT: To determine whether the addition of spa therapy to home exercises provides any benefit over exercises and the usual treatment alone in the management of generalised osteoarthritis associated with knee osteoarthritis. This study was a post-hoc subgroup analysis of our randomised multicentre trial (www.clinicaltrial.gov: NCT00348777). Participants who met the inclusion criteria of generalized osteoarthritis (Kellgren, American College of Rheumatology, or Dougados criteria) were extracted from the original randomised controlled trial. They had been randomised using Zelen randomisation. The treatment group received 18days of spa treatment in addition to a home exercise programme. Main outcome was number of patients achieving minimal clinically important improvement at six months (MCII) (≥-19.9mm on the VAS pain scale and/or ≥-9.1 points in a WOMAC function subscale), and no knee surgery. Secondary outcomes included the "patient acceptable symptom state" (PASS) defined as VAS pain ≤32.3mm and/or WOMAC function subscale ≤31 points. From the original 462 participants, 214 patients could be categorized as having generalised osteoarthritis. At sixth month, 182 (88 in control and 94 in SA group) patients, were analysed for the main criteria. MCII was observed more often in the spa group (n=52/94 vs. 38/88, P=0.010). There was no difference for the PASS (n=19/88 vs. 26/94, P=0.343). This study indicates that spa therapy with home exercises may be superior to home exercise alone in the management of patients with GOA associated with knee OA.
    Full-text · Article · Mar 2014 · Annals of physical and rehabilitation medicine

  • No preview · Article · Mar 2014 · Journal des Maladies Vasculaires

  • No preview · Article · Mar 2014 · Journal des Maladies Vasculaires
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    ABSTRACT: Introduction Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery. Patients and Methods Prospective, multicentre observational cohort study of 1134 consecutive patients with coronary stents undergoing non-cardiac surgery between April 2007 and April 2009. The primary outcome measure was the occurrence of an hemorrhagic complication during the first 30 days following the surgery or intervention. Results Among the 1134 patients evaluated, 108 (9.5%) experienced a postoperative hemorrhagic complication (with a median time to occurrence of 5.3 days). These complications were considered major, involved the operative site, and required reoperation in 92 (85.2%), 92 (85.2%), and 20 (18.5%) of patients, respectively. Mortality in patients with a haemorrhagic complication was 12% (n = 13). Independent postoperative factors associated with haemorrhagic complications were identified as a high and intermediate bleeding risk procedure and the use and dose of anticoagulants. When interrupted before the procedure, resumption of antiplatelet treatment was delayed in patients developing early postoperative hemorrhagic complications. Conclusion Patients with coronary stents who undergo surgery are at high risk for hemorrhagic complications.
    No preview · Article · Jan 2014 · Thrombosis Research
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    ABSTRACT: Background: Infections are risk factors for venous thromboembolism (VTE), especially if severe and acute. The role of chronic infections such as active tuberculosis is ill defined, although several case reports and small series have suggested an association between tuberculosis and VTE. Methods: Using data from the Premier Perspective database (27 659 947 admissions), we performed a multivariate analysis to assess the specific VTE risk associated with tuberculosis. The analysis was adjusted on classic risk factors for VTE. Results: The prevalence of VTE among patients with active tuberculosis was 2.07% (95% confidence interval [CI], 1.62%-2.59%). In a multivariate analysis model, adults with active tuberculosis had a greater risk of VTE than those without (odds ratio, 1.55 [95% CI, 1.23-1.97], P < .001), close to the previously reported risk associated with neoplasia. No particular link was found between pulmonary tuberculosis and pulmonary embolism, or between extrapulmonary tuberculosis and deep vein thrombosis. This may suggest the preponderant role of a systemic hypercoagulable state over an intrathoracic venous compression mechanism. In-hospital mortality of patients with both active tuberculosis and VTE (11/72 [15%]) was higher than mortality of patients with only active tuberculosis (92/3413 [2.7%]) or only VTE (5062/199 480 [2.5%]) (P < .001). Pulmonary embolism was more frequent in black patients, suggesting that this population, which is also more likely to suffer from tuberculosis, should be followed carefully. Conclusions: Tuberculosis must be considered as a pertinent risk factor for VTE and should be included in thromboembolism risk evaluation similar to any acute and severe infection.
    Preview · Article · Nov 2013 · Clinical Infectious Diseases

Publication Stats

823 Citations
135.13 Total Impact Points

Institutions

  • 2015
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2011-2015
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
    • University of Grenoble
      Grenoble, Rhône-Alpes, France
  • 2008-2014
    • University Joseph Fourier - Grenoble 1
      • Grenoble Institut des Neurosciences
      Grenoble, Rhône-Alpes, France
  • 2009
    • Centre Hospitalier Universitaire de Grenoble
      Grenoble, Rhône-Alpes, France