L’équipe 7334 REMES (Recherche Clinique ville-hôpital, Méthodologies et Société) sous la direction du Pr Olivier Chassany a la particularité de regrouper des médecins de ville et des hôpitaux, autour de travaux de recherche clinique qui placent le patient au centre de la prise en charge et des décisions médicales le concernant.
- Le 1er axe de recherche de l’équipe dirigé par le Dr Martin Duracinsky analyse la qualité de vie des personnes en situation de pathologie et mesure leurs perceptions (« Patient-Centered Outcomes ») afin d’améliorer leur parcours de vie avec la maladie. Comment vivent-ils avec cette pathologie ? Supportent-ils les traitements associés ? Comment leur prise en charge pourrait être améliorée, facilitée ?...
- Le 2e axe de recherche est quant à lui destiné à améliorer le parcours de soins du patient avec pour ambition de jeter un pont entre la médecine de ville et l’hôpital. Cet axe est rendu possible par la mobilisation des médecins généralistes universitaires de Paris-Diderot et leur collaboration avec d’autres enseignants-chercheurs exerçant à l’hôpital. Du fait de sa spécificité, cet axe est sous la responsabilité de 2 chercheurs, le Pr Isabelle Mahé du côté hôpital et le Pr Jean-Pierre Aubert pour la ville.
Pour finir, les chercheurs de l’EA 7334 REMES travaillent sur deux autres axes.
- Dans le 3e axe, sous la responsabilité de la juriste Mihaela Matei, ils se demandent comment améliorer la législation qui encadre la recherche clinique, en intégrant la notion d’approche basée sur le risque (« risk-based approach »).
- Le 4e axe, confié à Philippe Lechat, concerne le développement d’outils électroniques d’aide à la prescription. Ce projet comporte notamment une recherche sur l’élaboration et la faisabilité des algorithmes nécessaires à la construction d’un logiciel permettant de vérifier la validité, la cohérence et l’adéquation d’une ordonnance médicale des médicaments prescrits pour un patient donné dans une indication thérapeutique définie.
Responsable : Dr Martin Duracinsky (duracinsky.m@gmail.com)
Responsables : Pr Isabelle Mahé (Isabelle.Mahe@lmr.aphp.fr) & Pr jean Pierre Aubert (docteur.aubert@gmail.com)
Responsable : Mihaela Matei
Responsable : Pr Philippe Lechat (philippe.lechat@drc.aphp.fr)
Date: 29 Mar 2024 - 14:44
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Date: 27 Mar 2019 - 11:44
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Date: 14 sep 2018 - 16:52
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Date: 3 sep 2015 - 16:18
Desc: Background: In a context of change in the demographic profile of the older population, to identify an age threshold for increased risk and burden of herpes zoster (HZ) in 70+ patients. Methods: Post hoc analysis of the 12-month French nationwide prospective observational ARIZONA cohort study. HZ was assessed by means of the following validated questionnaires: Neuropathic Pain Symptom Inventory (NPSI), Zoster Brief Pain Inventory (ZBPI), Short-Form health survey (SF-12), and Hospital Anxiety and Depression Scale (HADS). Results: 644 general practitioners included 1,358 volunteer patients with acute HZ in the ARIZONA study; 609 patients (45%) were 70+. In 70+ patients, age did not increase rash severity or HZ-related pain intensity at diagnosis, but increased by 64% the frequency of ophthalmic zoster (from 5.5% in 70–74 years age-group to 9.0% in 85+ patients, p = NS). Age was significantly associated with low physical health as assessed by the SF-12 Physical Component Summary (SF-12 PCS) score and bad mood as assessed by the HADS depression score (p < 0.001). Within the year following HZ, post-herpetic neuralgia (PHN) was systematically but not significantly more frequent in 85+ patients than in the 70–74, 75–79, or 80–84 years age-groups (19.0% vs. 13.3%/15.3%/11.6% at month 3; 15.1% vs. 7.3%/11.0%/12.2% at month 6; 15.2% vs. 6.0%/8.0%/ 6.0% at month12, respectively). SF-12 PCS and HADS depression scores improved from day 0 to month 12 in all patients (p < 0.001). 85+ patients were more impaired than younger patients (p < 0.001), but without clear difference according to PHN. Conclusions: This study did not show in 70+ patients a clear and significant age threshold at which disease burden increased, although for some domains the impact seemed higher among the oldest patients; the cutoff of 70 years remains thus relevant for clinical and epidemiological studies. However, at individual level, assessment of the burden of HZ and HZ-related pain appears necessary to improve management and prevent functional decline in the most vulnerable 70+ patients.
Date: 11 oct 2018 - 11:09
Desc: OBJECTIVE: To construct a typology of general practitioners' (GPs) responses regarding their justification of therapeutic inertia in cardiovascular primary prevention for high-risk patients with hypertension. DESIGN: Empirically grounded construction of typology. Types were defined by attributes derived from the qualitative analysis of GPs' reported reasons for inaction. PARTICIPANTS: 256 GPs randomised in the intervention group of a cluster randomised controlled trial. SETTING: GPs members of 23 French Regional Colleges of Teachers in General Practice, included in the EffectS of a multifaceted intervention on CArdiovascular risk factors in high-risk hyPErtensive patients (ESCAPE) trial. DATA COLLECTION AND ANALYSIS: The database consisted of 2638 written responses given by the GPs to an open-ended question asking for the reasons why drug treatment was not changed as suggested by the national guidelines. All answers were coded using constant comparison analysis. A matrix analysis of codes per GP allowed the construction of a response typology, where types were defined by codes as attributes. Initial coding and definition of types were performed independently by two teams. RESULTS: Initial coding resulted in a list of 69 codes in the final codebook, representing 4764 coded references in the question responses. A typology including seven types was constructed. 100 GPs were allocated to one and only one of these types, while 25 GPs did not provide enough data to allow classification. Types (numbers of GPs allocated) were: 'optimists' (28), 'negotiators' (20), 'checkers' (15), 'contextualisers' (13), 'cautious' (11), 'rounders' (8) and 'scientists' (5). For the 36 GPs that provided 50 or more coded references, analysis of the code evolution over time and across patients showed a consistent belonging to the initial type for any given GP. CONCLUSION: This typology could provide GPs with some insight into their general ways of considering changes in the treatment/management of cardiovascular risk factors and guide design of specific physician-centred interventions to reduce inappropriate inaction.