Could CT scan avoid unnecessary flexible bronchoscopy in children with active pulmonary tuberculosis? A retrospective study.

Background: Systematic flexible bronchoscopy is advocated in the initial management of childhood pulmonary tuberculosis.

Methods: Our aim was to describe and to compare the systematic flexible bronchoscopy findings of 53 children (6.5 + or - 4.

[Access to medicines in France].

In France the total cost of medicinal products reimbursed by health insurers in 2007 was over 25 thousand million euros, and access to new drugs is neither restricted nor rationed, despite the unfavorable economic situation. In 2007 and 2008 the Transparency Commission (TC) of the French National Authority for Health (Haute Autorité de Santé) approved the reimbursement of 97% of new drugs and new indications for existing products, within 90 days on average. The 3% of medicinal products that were not approved did not represent therapeutic advances and could be considered to be of dubious utility.

Drug reimbursement and GPs' prescribing decisions: a randomized case-vignette study about the pharmacotherapy of obesity associated with type 2 diabetes: how GPs react to drug reimbursement.

This study sought to identify the effect of drug reimbursability--a decision made in France by the National Authority for Health--on physicians' prescribing practices for a diet drug such as rimonabant, approved for obese or overweight patients with type-2 diabetes. A cross-sectional survey of French general practitioners (GPs) presented a case-vignette about a patient for whom this drug is indicated in two alternative versions, differing only in its reimbursability, to two separate randomized subsamples of GPs in early 2007, before any decision was made about reimbursement. The results indicate that (i) more than 20% of GPs in private practice would be willing to prescribe a non-reimbursed diet drug for patients with obesity complicated by type 2 diabetes; (ii) the number of GPs willing to prescribe it would increase by 47.

Intrapleural administration of pemetrexed: a pharmacokinetic study in an animal model.

Background: Pemetrexed is a key drug for the treatment of malignant pleural mesothelioma. The intrapleural administration of pemetrexed might increase its efficacy and decrease its toxicity in comparison with intravenous administration. The aim of this study was to assess in an animal model the pharmacokinetics of pemetrexed administered intrapleurally compared with intravenously.

Analysis of the DYSF mutational spectrum in a large cohort of patients.

Dysferlinopathies belong to the heterogeneous group of autosomal recessive muscular dystrophies. Mutations in the gene encoding dysferlin (DYSF) lead to distinct phenotypes, mainly Limb Girdle Muscular Dystrophy type 2B (LGMD2B) and Miyoshi myopathy (MM). Here, we analysed the mutational data from the largest cohort described to date, a cohort of 134 patients, included based on clinical suspicion of primary dysferlinopathy and/or dysferlin protein deficiency identified on muscle biopsy samples.

Influence of -308 A/G polymorphism in the tumor necrosis factor alpha gene on etanercept treatment in rheumatoid arthritis.

Objective: To determine whether the -308 A/G tumor necrosis factor alpha (TNFalpha) gene polymorphism can predict the outcome of etanercept therapy in 86 patients with rheumatoid arthritis (RA), as already observed in patients treated with infliximab.

Methods: Eighty-six RA patients treated with etanercept were genotyped for -308 A/G TNFalpha gene polymorphism by polymerase chain reaction and melting curve analysis, using specific gene primers and probes. Patients were subdivided into group A (G/A genotype) and group G (G/G genotype).

Impact of intensive care on renal function before graft harvest: results of a monocentric study.

Background: The aim of life-support measures in brain-dead donors is to preserve the functional value of their organs. In renal transplantation, serum creatinine level is one of the criteria for graft harvest. The aim of this study was to assess the impact of intensive care on donor renal function through two criteria: preharvesting serum creatinine level above 120 micromol/L and the elevation of serum creatinine level above 20% between intensive care unit (ICU) admission and graft harvest.

Textual guidelines versus computable guidelines: a comparative study in the framework of the PRESGUID project in order to appreciate the impact of guideline format on physician compliance.

Background: The compliance of physicians with the clinical practice guidelines (CPG) is insufficient and needs to be improved.

Objective: To determine whether standalone computerized CPG within the PRESGUID project could improve compliance with the recommendations than the use of CPG in textual format.

Method: Comparative analyses of the responses made by two groups of resident physicians to a set of clinical cases.

Ventilator-associated pneumonia: breaking the vicious circle of antibiotic overuse.

Objective: To assess the rate of appropriateness of empirical antimicrobial therapy for ventilator-associated pneumonia, to evaluate de-escalation in patients with ventilator-associated pneumonia treated according to local pathway, and to identify the bacteria responsible for recurrence of ventilator-associated pneumonia.

Design: Prospective observational study during a 36-month period.

Setting: Medical-surgical intensive care unit of a university hospital.

[The worrying rise in the frequency of cesarean section].

The rise in the incidence of Cesarean section over the last thirty years is due to several factors. In particular, maternal age is increasing, parity is declining, and situations potentially requiring Cesarean section are more frequently encountered than before (prematurity, medically assisted procreation, antenatal diagnosis, previous Cesarean section, etc.).

[Generic drugs in the medical-economic context of drug prescriptions].

REIMBURSABLE DRUGS: The reimbursement, or coverage of pharmaceutical costs by the sickness benefits is governed in the French system by two conditions: the drugs must have been prescribed, and must be listed in the reimbursable drug list. Inscription in the reimbursable drugs list requires approval by the transparency commission, sole commission capable of assessing the medical service rendered (MSR) by the drugs and to propose a reimbursement rate of 65 or 35%. Exceptional drugs and those prescribed in the context of long-term treatments have a specific reimbursement status.