57 research outputs found
HEALTH-CARE RESOURCE UTILIZATION IN ADVANCED MELANOMA: AN ANALYSIS FROM THE MELODY OBSERVATIONAL STUDY
No full textOBJECTIVES: We conducted this study to document the health-care resource utilization associated with treatment of patients with advanced melanoma. METHODS: MELODY (Melanoma treatment patterns and outcomes among patients with unresectable stage III or stage IV disease: a retrospective longitudinal survey) is an observational study managed at 31 centers in France, Italy, and the UK. Eligible patients had attended at one of the sites with a diagnosis of unresectable stage III or IV melanoma between July 1, 2005 and June 30, 2006; data were retrieved from diagnosis (no limit date) until 2008. The primary objective was to document the first-line treatments received by patients. Secondary objectives included ascertaining health-care resource utilization related to up to three lines of treatment (anticancer and supportive care). Data were collected from patients (n = 776) using a case-report form that included information on hospitalizations, outpatient visits, hospice care, and adverse- event management (transfusions and concomitant medications including antiemetics and growth factors). Resource use data were collected from patients (n = 606) that received systemic treatment outside a clinical trial and/or supportive care. RESULTS: Twenty-nine percent (176/606) of patients required medical management for treatment-related adverse events and 32% (195/606) were hospitalized while receiving systemic treatment and/or supportive care with 25% of these having at least four hospitalizations. The median duration of hospitalization was 17 days, with 25% spending at least 29 days in hospital (may comprise multiple stays). The hospitaliza- tion rate was higher in patients receiving supportive care than those receiving anticancer treatment (86/170; 51% vs. 140/553; 25%), but median duration of hospitalization was similar (15.0 vs. 14.5 days). Results by line of anticancer therapy and supportive care will be presented. CONCLUSIONS: These results from MELODY suggest that the systemic and palliative treatments used to manage advanced melanoma are associated with considerable resource utilization, highlighting the need for more effective treatment options
Economic impact of healthcare resource utilisation patterns among patients diagnosed with advanced melanoma in the United Kingdom, Italy, and France: results from a retrospective, longitudinal survey (MELODY study).
No full textOBJECTIVE: To describe patterns of healthcare resource utilisation and associated costs for patients with advanced melanoma in the United Kingdom (UK), Italy, and France. METHODS: For patients receiving systemic treatment, or supportive care, data describing hospitalisations, hospice care, and outpatient visits were retrieved retrospectively from advanced disease diagnosis as part of a multicountry observational study. Costs were estimated by multiplying utilisation level by unit cost. In an exploratory analysis, costs were compared between individuals who died within one year of initiating first-line treatment (short-term survivors) and those with ≥ 1 year follow-up (long-term survivors). RESULTS: Hospitalisation costs were highest in France (€6262 per-person compared with €3225 in the UK and €2486 in Italy), reflecting higher rates of hospitalisation. In contrast, outpatient costs were highest in the UK (€782 per-person, compared with €115 in France and €72 in Italy), reflecting the highest rate and frequency of outpatient visits and the highest cost per visit. Hospitalisation rates were consistently higher during supportive care compared with systemic therapy. Roughly one-third of patients entered clinical trials and were not included in the analysis. In exploratory analysis, total costs were generally higher for long-term survivors, but monthly per-patient costs were generally lower for long-term survivors, consistent with a hypothesis that resource utilisation and costs do not necessarily increase proportionally with extended survival. CONCLUSION: Total costs associated with resource utilisation for advanced melanoma patients varied across countries. Overall cost differences were due to differences in frequency and intensity of utilisation patterns and variation in unit costs of health resources
Treatment patterns and outcomes among patients diagnosed with unresectable stage III or IV melanoma in Europe: A retrospective, longitudinal survey (MELODY study)
No full textBackground: MELanoma treatment patterns and Outcomes among patients with unresectable stage III or stage IV Disease: a retrospective longitudinal surveY (MELODY), the first multicountry, observational survey in patients with advanced melanoma, aimed to quantify the impact of existing treatment strategies by capturing information on treatment patterns and clinical outcomes. Patients and methods: Patients attending a participating site between 1st July 2005 and 30th June 2006 with ≥2 months follow-up were eligible. Data were retrieved retrospectively from advanced melanoma diagnosis until 1st May 2008. Treatment data were collected by line of therapy and response and progression-free survival data by line of systemic treatment. Overall survival (OS) was evaluated for all treated patients. Results: Among all patients screened, 776 were eligible for this analysis. Median OS from the date of advanced disease diagnosis was 16.4 months. After excluding patients diagnosed prior to 1st July 2005 to account for any bias resulting from patient selection, the 12-month survival rate and median OS from the start date of second-line treatment was 28.8% and 6.8 months, respectively. Survival was lower in patients with brain metastases, elevated lactate dehydrogenase levels and more advanced disease. Rates of complete/partial tumour response were 15% and 7% in patients treated with first- and second-line systemic therapy, respectively. Conclusions: Despite receiving first- and second-line treatment, most patients with advanced melanoma have short survival times and poor prognoses, reinforcing the need for new treatments. © 2012 Elsevier Ltd. All rights reserved
Fc receptor polymorphisms of immunoglobulin G and autoimmune diseases in Martinique : Impact of FcγRIIb on the regulation of the B lymphocyte
No full textLes récepteurs du Fc des Immunoglobulines G (FcγR) sont impliqués dans de nombreuses réactions immunitaires. Deux groupes de faible affinité existent : les FcγRIIa/b/c et les FcγRIIIa/b, FcγRIIb étant le seul inhibiteur. Plusieurs polymorphismes, modifiant l’affinité au ligand et la réponse du récepteur, sont favorisés par une pression de sélection infectieuse et associés aux Maladies Auto-Immunes (MAI). Nous avons étudié l’association des polymorphismes FcγRIIa-R131H, FcγRIIb-I232T, FcγRIIIa-F158V, FcγRIIIb-Na1/Na2 aux Lupus érythémateux systémique (LES), la neuromyélite optique (NMO) et la sclérose en plaque (SEP) en Martinique. Nos résultats montrent une forte fréquence des allèles T232, V158 et des génotypes 232TT et 158VV dans la population générale, une augmentation de la fréquence de l’homozygote Na1, des allèles Na1 et 158F dans le LES, une augmentation du génotype 131RR ainsi que des allèles 131R et 158V dans le LES avec atteinte rénale, une augmentation du génotype 131RR et une diminution du NA2/NA2 dans la SEP ainsi qu’une augmentation de l’allèle 232T dans les NMO. L’étude de l’influence du FcγRIIb-I232T sur l’activation du récepteur à l’antigène des lymphocytes B (BCR) chez des lupiques et des témoins sains porteurs des formes IT, TT ou II montre que la régulation du BCR est effective même en présence de la forme TT. Ces résultats démontrent pour la première fois que la population martiniquaise possède un terrain génétique particulier qui faciliterait l’apparition de MAI avec pronostic plus sévère.Receptors of Fc of Immunoglobulin G (FcγR) are involved in many immune responses. Two low affinity groups exist: FcγRIIa/b/c, and FcγRIIIa/b, FcγRIIb is the only inhibitor. Several polymorphisms, altering the affinity ligand and receptor response, are selected by an infectious pressure and associated with autoimmune diseases (AID). We studied the association of polymorphisms FcγRIIa-R131H, FcγRIIb-I232T, FcγRIIIa-F158V, FcγRIIIb-Na1/Na2 to systemic lupus erythematosis (SLE), neuromyelitis optica (NMO) and multiple scelrosis (MS) in Martinique. Our results show a high frequency of alleles T232, V158 and 232TT and 158VV genotypes in Martinican, an increase in the frequency of the homozygous Na1, Na1 and 158F alleles in SLE, an increase of 131RR genotype, the 131R and 158V alleles in SLE with kidney disease, an increase of 131RR genotype and a decrease of NA2 / NA2 in MS but an increase in the 232T allele in NMO. Study of the influence of FcγRIIb-I232T on the activation of the B cells receptor (BCR) in lupus and healthy controls controls exibiting IT, TT or II forms, shows that the regulation of BCR is effective even in the presence TT form. These results show for the first time Martinican population has a particular genetic background which would facilitate the appearance of MAI particularly serious
Identification of biological signatures for the stratification of patients with systemic autoimmune diseases
No full textLes maladies auto-immunes telles que la maladie de Sjögren (SjD) et le lupus érythémateux systémique (LES) posent des défis majeurs liés à une grande hétérogénéité clinique et biologique. Au travers d’analyses multi-omiques, cette thèse présente des objectifs multiples : (i) Caractériser le profil clinique et biologique des patients atteints de SjD selon leur profil d’auto-anticorps, (ii) Créer un outil en ligne facilitant l'accès et l'interprétation des données de transcriptomique du LES, et (iii) Analyser les interactions cellulaires dans le tissu rénal du LES. Dans la SjD, la stratification selon les autoanticorps anti-Ro60/SSA et anti-Ro52/TRIM21 est corrélée avec une maladie plus sévère, en fonction de la signature IFN. De plus, un outil d’analyse de résultats de transcriptomique sanguine en ligne a été mis en place dans le LES, permettant de faciliter la réutilisation des données. Enfin, des analyses phénotypiques multiplexées couplées à de la transcriptomique spatiale ont permis de mettre en évidence la complexité du microenvironnement de la néphropathie lupique, avec l’identification de différentes cibles potentielles d’intérêt. Ces résultats soulignent le rôle des technologies « -omiques » pour identifier des signatures biologiques spécifiques ayant des répercussions diagnostiques, thérapeutiques et pronostiques majeures pour la meilleure prise en charge des patients atteints de maladies auto-immunes systémiques.Autoimmune diseases such as Sjögren's disease (SjD) and systemic lupus erythematosus (SLE) present major challenges related to significant clinical and biological heterogeneity.Through multi-omics analyses, this thesis sets multiple objectives: (i) Characterize the clinical and biological profile of patients with SjD based on their autoantibody profile, (ii) Create an online tool to facilitate access to and interpretation of SLE transcriptomic data, and (iii) Analyze cellular interactions in the renal tissue of SLE.In SjD, stratification according to anti-Ro60/SSA and anti-Ro52/TRIM21 autoantibodies is correlated with a moresevere disease, based on the IFN signature. Additionally, an online tool for analyzing blood transcriptomic results has been developed for SLE, enhancing data reusability. Lastly, multiplexed phenotypic analyses coupled with spatial transcriptomics have highlighted the complexity of the microenvironment in lupus nephropathy, identifying various potential therapeutic targets. These results underscore the role of “-omics” technologies to identify specific biological signatures that can have major diagnostic, therapeutic, and prognostic impacts to improve the management of patients with systemic autoimmune diseases
Influence of the Blade Roughness on the Hydraulic Performance of a Mixed-Flow Pump. A Viscous Analysis
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Relationship of interleukin-4 to isotypic distribution of anti-double-stranded DNA antibodies in systemic lupus erythematosus
No full textIgG subclasses of anti-double-stranded DNA antibodies were determined in 182 patients with systemic lupus erythematosus. All isotypes were detected, but IgG1 and IgG3 were predominant (62 and 51% of the cases, respectively). An average of 64 +/- 27% was IgG1, 16 +/- 22% IgG2, 16 +/- 19% IgG3 and 4 +/- 10% IgG4. The rank order or frequency was IgG1, IgG3, IgG2 and IgG4 in patients with musculoskeletal involvement; IgG1, IgG2, IgG3 and IgG4 in those with renal complications; IgG3, IgG1, IgG2 and IgG4 in those with cutaneous involvement; and IgG1, IgG3, IgG2 and IgG4 in those with hematological manifestations. Interleukin-4 (IL-4) was detectable in 17 of 36 selected patients, as opposed to 1 of 40 normal controls. The percentage of the total autoantibody contributed by IgG1 was significantly higher (p < 0.03) in these patients than in the remainder with undetectable levels of IL-4.Int Arch Allergy Immuno
Acceptabilité et tolérance du traitement de l’infection tuberculeuse latente chez les professionnels de santé en zone d’endémie tuberculeuse
No full textInvestigating added value of regional climate modeling in North American winter storm track simulations
No full textExtratropical Cyclone (EC) characteristics depend on a combination of large-scale factors and regional processes. However, the latter are considered to be poorly represented in global climate models (GCMs), partly because their resolution is too coarse. This paper describes a framework using possibilities given by regional climate models (RCMs) to gain insight into storm activity during winter over North America (NA). Recent past climate period (1981–2005) is considered to assess EC activity over NA using the NCEP regional reanalysis (NARR) as a reference, along with the European reanalysis ERA-Interim (ERAI) and two CMIP5 GCMs used to drive the Canadian Regional Climate Model—version 5 (CRCM5) and the corresponding regional-scale simulations. While ERAI and GCM simulations show basic agreement with NARR in terms of climatological storm track patterns, detailed bias analyses show that, on the one hand, ERAI presents statistically significant positive biases in terms of EC genesis and therefore occurrence while capturing their intensity fairly well. On the other hand, GCMs present large negative intensity biases in the overall NA domain and particularly over NA eastern coast. In addition, storm occurrence over the northwestern topographic regions is highly overestimated. When the CRCM5 is driven by ERAI, no significant skill deterioration arises and, more importantly, all storm characteristics near areas with marked relief and over regions with large water masses are significantly improved with respect to ERAI. Conversely, in GCM-driven simulations, the added value contributed by CRCM5 is less prominent and systematic, except over western NA areas with high topography and over the Western Atlantic coastlines where the most frequent and intense ECs are located. Despite this significant added-value on seasonal-mean characteristics, a caveat is raised on the RCM ability to handle storm temporal ‘seriality’, as a measure of their temporal variability at a given location. In fact, the driving models induce some significant footprints on the RCM skill to reproduce the intra-seasonal pattern of storm activity
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