3 research outputs found
Consiructions of the Materna1 Body in Legal, Medical and Cultural Discourses
No full textThis manusaipt has W n mproducud from the microfilm mutsr. UMI films the text directly from the original or copy submitted. Thur, wme thests and dissertation copies am in-ter face, whiie Othon may!s h m any type of cornputer pnnter. The qurlity of this reproduction is depondant upon the qurlity of th4 copy submkted. Braken or ~ndisîmct pnnt cobred or poor qwiii illustrations and photographs, pnnt bkadthrough, substandard margins, and irnpmper alignment can advenely affed reproducum ln ttie unlikely event ümt the author dd not send UMI a cornpiete rnanusçnpt and Viere are missing pages. tnese mil be noted Also, d unauüionzed wpyngftt matenal had to be mmoved. a note wrli indiMe the deletm. Overs~e matenals (e.g.. maps. drawings. ma*) are repcdducad by sedonmg the onginal. beginning at me uppcr letthand amer and continuing fmm lefi to ngnt in equal sedioris wttn small overlaps Photographs rnciudd in me onginai manuscnpt have been reproduœd xerogmph~cally in mis wpy Higher ouairty 6 ' x 9 ' biack and white photographie pnnts are avaibble for any photognphs or ~llustrations appeanng m mis copy for an addiuonal charge Contact UMI dincUy to order
Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study
No full textConflicts of interests: DD has received personal compensation for board participation and speaking fees from Sanofi and Urgo. SF has received personal compensation for board participation and speaking fees from Novo Nordisk, Roche Diagnostics, Lifescan, Sanofi, Diabeloop and Eli Lilly, received Research support from MSD and is employed by CERITD and is a shareholder of Diabeloop. GC is employed by CERITD and received personal compensation for board participation, research funding, and speaking fees from Astra-Zeneca, Boehringer, Eli Lilly, Johnson & Johnson, MSD, Novo-Nordisk, Sanofi-Aventis and Voluntis. LO and EB are employed by CERITD.MB has no conflict of interest to declare. IX was employed by CERITD. ZA (Zohra Amrous) is employed by CERITD.KLS has no conflict of interest to declare. BD was employed by Cemka, a consulting team specializing in health economics, epidemiology, and outcomes research. BD also received personal compensation for board participation and speaking fees from MSD, Novo-Nordisk, Sanofi, Eli Lilly, Janssen and Pfizer. AP received personal compensation for board participation and speaking fees from Abbott, Ascencia, Astra-Zeneca, Eli Lilly, Medtronic, MSD, Novartis, Novo Nordisk and Sanofi Aventis.International audienceBackground. Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial).Methods. Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed.Findings. In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0–17.8]) than in the intervention group (7.1 days [2.8–11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144–9226) in the control group and 3471 € (95% CI 1430–5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population.Interpretation. The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings.Funding. This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d’Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication
