References of "ERNEST, Philippe"
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See detailComment j’explore …Une différence de risque de survenue d’un événement dans les études cliniques
SCHEEN, André ULg; ERNEST, Philippe ULg; JANDRAIN, Bernard ULg

in Revue Médicale de Liège (2012), 67(11), 597-602

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or ... [more ▼]

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or at least a non-inferiority (versus an active reference) concerning a primary endpoint that has been defined a priori (occurrence of a major clinical event, for instance). The difference in the occurrence of such an event between two treatments may be statistically analyzed by absolute risk reduction, relative risk reduction, hazard ratio or odds ratio. The present article discusses the nuances, sometimes of importance, concerning the significance of these various indices and analyses the cautions to be taken and the pitfalls to be avoided in their interpretation and use in practice. The clinician is, indeed, increasingly confronted to results of clinical trials, but is generally poorly informed regarding the nuances of these various statistical analyses. [less ▲]

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See detailInhibiteurs du cotransporteur du glucose SGLT rénal pour traiter le diabète de type 2
SCHEEN, André ULg; RADERMECKER, Régis ULg; ERNEST, Philippe ULg et al

in Revue Médicale Suisse (2011), 7(306), 1621-1629

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See detailStrategies pour eviter l'inertie et la non-observance dans les essais cliniques.
Jandrain, Bernard ULg; Ernest, Philippe ULg; Radermecker, Régis ULg et al

in Revue Médicale de Liège (2010), 65(5-6), 246-9

Randomised controlled trials play a key role in evidence-based medicine as far as the assessment of both efficacy and safety of drugs is concerned. Various strategies are used to avoid physician's inertia ... [more ▼]

Randomised controlled trials play a key role in evidence-based medicine as far as the assessment of both efficacy and safety of drugs is concerned. Various strategies are used to avoid physician's inertia and to combat patient's non compliance, two pitfalls that may hinder the demonstration of the therapeutic efficacy of the drug. Clinical inertia may be limited by titration, forced or optional, driven by therapeutic targets, or by the use, if necessary, of rescue medications. Compliance may be verified by "pill count". This simple technique allows to exclude non compliant patients when they are detected during the placebo run-in period before randomisation or not to take into account patients with poor compliance in the final evaluation by using a statistical analysis restricted to individuals who have strictly adhered to the study protocol ("per protocol analysis"). Self-monitoring and patient's empowerment in the treatment also contribute to improve drug compliance. Clinicians may take advantage of these approaches derived from clinical trials to improve their daily practice. [less ▲]

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See detailLe traitement du diabète de type 2: entre insulinosensibilisateurs et insulinosécrétagogues
Scheen, A. J.; Radermecker, R. P.; Philips, J. C. et al

in Revue Médicale de Liège (2007), 62 Spec No

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease ... [more ▼]

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease in a particular patient. Besides the lifestyle changes, the treatment strategy comprises the administration of agents that promote insulin secretion and/or that improve insulin sensitivity. Drugs facilitating weight loss also improve glucose control by reducing insulin resistance. A global approach should be recommended to reduce the high cardiovascular risk of diabetic patients. The present article aims at summarizing our contribution to the development of drugs designed for the treatment of type 2 diabetes. [less ▲]

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See detailPrevention du diabete de type 2: style de vie ou medicaments?
Scheen, André ULg; Letiexhe, Michel ULg; Ernest, Philippe ULg

in Revue Médicale de Liège (2003), 58(4), 206-10

The World Health Organisation strongly recommends strategies for the prevention of type 2 diabetes, knowing the epidemics of the disease and its strong association with that of obesity. Several ... [more ▼]

The World Health Organisation strongly recommends strategies for the prevention of type 2 diabetes, knowing the epidemics of the disease and its strong association with that of obesity. Several intervention studies, in China ("Da-Qing Study"), in Europe ("Malmo study", "Finnish Diabetes Prevention Study") and in the United States ("Diabetes Prevention Program"), showed that lifestyle change are able to reduce by around 50% the incidence of type 2 diabetes in at risk individuals. Various pharmacological approaches have also proven their efficacy in preventing type 2 diabetes, but in most cases with less impressive reductions, between 25% and 35%. It is the case for metformin, acarbose, orlistat or various inhibitors of the renin-angiotensin system. After the report of promising results with troglitazone, large prospective studies are ongoing to test the efficacy of rosiglitazone and pioglitazone in such an indication, two insulinsensitizers of the thiazolidinedione family. We will briefly described the main results of intervention studies to prevent type 2 diabetes in at risk subjects, because of the presence of obesity, impaired glucose tolerance and/or arterial hypertension. [less ▲]

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See detailNew antiobesity agents in type 2 diabetes: overview of clinical trials with sibutramine and orlistat.
Scheen, André ULg; Ernest, Philippe ULg

in Diabètes & Métabolism (2002), 28(6 Pt 1), 437-45

Besides genetic predisposition, obesity is the most important risk factor for the development of type 2 diabetes mellitus. Even modest weight reduction can improve blood glucose control in overweight ... [more ▼]

Besides genetic predisposition, obesity is the most important risk factor for the development of type 2 diabetes mellitus. Even modest weight reduction can improve blood glucose control in overweight subjects. After failure of lifestyle modifications, antiobesity drugs such as orlistat, a potent and selective inhibitor of gastric and pancreatic lipases that reduces lipid intestinal absorption, or sibutramine, a noradrenaline and 5-hydroxytryptamine reuptake inhibitor that regulates food intake, may be considered to favour weight loss and/or weight maintenance. Several placebo-controlled studies have recently demonstrated that both drugs are able to promote weight loss in obese type 2 diabetic patients treated with diet alone, sulphonylureas, metformin or insulin. The greater weight reduction as compared to placebo was associated with a significant reduction of glycated haemoglobin levels and/or of the doses of classical antihyperglycaemic agents, especially in good responders who lost at least 10% of initial body weight. In addition, vascular risk factors associated to insulin resistance were also reduced after weight loss. These antiobesity agents may also contribute to delay or prevent the progression from impaired glucose tolerance to overt type 2 diabetes in at risk obese individuals ("Xenical in the prevention of diabetes in obese subjects" trial). Large long-term prospective studies, such as the "Sibutramine cardiovascular and diabetes outcome study" should better determine the place of pharmacological anti-obesity strategy in the overall management of obese patients with impaired glucose tolerance or type 2 diabetes. [less ▲]

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See detailSubstituts des globules rouges: émulsions de fluorocarbures et solutions d'hémoglobine
Remy, Bernadette ULg; Deby, Ginette ULg; D'Ans, V. et al

in Annales Françaises d'Anesthésie et de Réanimation (1999), 18(2), 211-24

OBJECTIVE: To review the current data on perfluorocarbon (PFC) emulsions and haemoglobin (Hb) solutions. DATA SOURCES: For this paper we analysed the literature using Medline search along with major ... [more ▼]

OBJECTIVE: To review the current data on perfluorocarbon (PFC) emulsions and haemoglobin (Hb) solutions. DATA SOURCES: For this paper we analysed the literature using Medline search along with major review articles. DATA SELECTION AND EXTRACTION: The collected articles were reviewed and selected according to their quality and originality. DATA SYNTHESIS: PFCs are synthetic fluorinated hydrocarbons capable of dissolving, at increased FIO2, large amounts of oxygen. They deliver oxygen at tissular level, and are administered as emulsions containing particles of around 0.1 micron, reaching the smallest vessels. They are exhaled unchanged by the lungs within 7 days. The first clinically used PFC was Fluosol-DA 20%. Currently, Oxyfluor 40% and Oxygent 60% are under evaluation. PFCs are not true blood substitutes, but rather a means to support tissue oxygenation during extreme haemodilution. Solutions of free Hb do not require compatibility testing and are fully saturated with oxygen at ambient FIO2. Hb is either human, bovine or recombinant Hb. In order to maintain adequate intravascular half-life and affinity for oxygen, the Hb molecules are modified by internal cross-linking, polymerisation and encapsulation. After promising results using animal models, some of these modified Hb solutions are now undergoing phase III clinical trials. Among these, diaspirin cross-linked haemoglobin (DCLHb) has been tested in cardiac and orthopaedic surgery, as well as in trauma patients. The initial results of these multicentre trials are currently being analysed. [less ▲]

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See detailPharma-clinics le medicament du mois. L'orlistat (xenical).
Scheen, André ULg; Ernest, Philippe ULg; Letiexhe, Michel ULg

in Revue Médicale de Liège (1999), 54(3), 192-6

Orlistat (tetrahydrolipstatin), launched by Roche under the trade name Xenical, is a selective inhibitor of pancreatic and gastro-intestinal lipases. It reduces the digestion of dietary fat and its ... [more ▼]

Orlistat (tetrahydrolipstatin), launched by Roche under the trade name Xenical, is a selective inhibitor of pancreatic and gastro-intestinal lipases. It reduces the digestion of dietary fat and its resorption through digestive mucosa by around 30%. It is indicated, at a dose of 3 x 120 mg/day (one dose with each meal) and together with a moderately low-calorie and low-fat diet, for the treatment of obesity. It has been shown, in placebo-controlled two-year trials, to almost double the number of obese subjects who succeed in loosing at least 10% of initial body weight. Independently, it contributes to decrease serum cholesterol levels by 6-10%. Because of its mechanism of action, this drug can induce intestinal side-effects which tend to decrease with time and with the reduction of fat intake, thus improving diet compliance. [less ▲]

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