Revue Internationale des Droits de l'Antiquité LVIII (2011) (parue en septembre 2012)

in Revue Internationale des Droits de l'Antiquité [= RIDA] (2011), LVIII

Controle glycemique avant et apres sitagliptine en medecine generale: analyse des facteurs determinants dans l'etude observationnelle belge "SUGAR".

in Revue Médicale de Liège (2011), 66(7-8), 440-6

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4 with a so-called incretin effect, has been evaluated in SUGAR, a large Belgian prospective observational study carried out in ... [more ▼]

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4 with a so-called incretin effect, has been evaluated in SUGAR, a large Belgian prospective observational study carried out in general practice. Sitagliptin, at a dose of 100 mg once daily, was added to previous treatment of not well controlled type 2 diabetic patients (> 95% on metformin monotherapy). Among 605 patients analysed in intention to treat, the worse the glycaemic control at entry, the greatest the reduction in glycated haemoglobin (HbA1c) and fasting plasma glucose levels after the addition of sitagliptin (p < 0.001). No specific factor was associated with the quality of initial glucose control among age, body mass index, the duration of diabetes or the modalities of its pharmacological treatment. Similarly, among these factors, none was significantly associated with the reduction in HbA1c or fasting plasma glucose levels observed with the addition of sitagliptin. Thus, sitagliptin was as active in older as in younger subjects, in obese as in nonobese people and in patients with diabetes of long versus short duration. In particular, SUGAR recruited data on 191 patients above 70 years in whom sitagliptin was as effective and safe as in younger patients with type 2 diabetes. [less ▲]

Le tractus digestif comme organe endocrine : une nouvelle vision de la chirurgie bariatrique

in Médecine des Maladies Métaboliques (2011), 5(2), 155-161

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission ... [more ▼]

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improve metabolic control in obese patients with type 2 diabetes. The frequently observed remission of diabetes occurs very early, before any significant weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. These hormonal changes result from partial stomach amputation (leading to reduced ghrelin secretion), from bypass of duodenal-jejunal foregut (leading to reduced secretion of still unknown factors that may counteract insulin secretion and/or action) and from an earlier contact of food with hindgut (leading to enhanced secretion of incretin hormones such as glucagon-like peptide-1 [GLP-1] by the ileal L cells, neuropeptide YY and oxyntomodulin). The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery. [less ▲]

Antifracture efficacy of currently available therapies for postmenopausal osteoporosis.

in Drugs (2011), 71(1), 65-78

Osteoporosis is a systemic bone disease characterized by low bone mass and bone mineral density, and deterioration of the underlying structure of bone tissue. These changes lead to an increase in bone ... [more ▼]

Osteoporosis is a systemic bone disease characterized by low bone mass and bone mineral density, and deterioration of the underlying structure of bone tissue. These changes lead to an increase in bone fragility and an increased risk for fracture, which are the clinical consequences of osteoporosis. The classical triad for consideration in osteoporosis is morbidity, mortality and cost. Vertebral fracture is an important source of morbidity in terms of pain and spinal deformity. On the other hand, hip fracture is associated with the worst outcomes and is widely regarded as a life-threatening event in the elderly; it is the source of the bulk of the cost of the disease in contemporary healthcare. The prevention of osteoporosis-associated fracture should include fall prevention, calcium supplementation and lifestyle advice, as well as pharmacological therapy using agents with proven antifracture efficacy. The most commonly used osteoporosis treatments in Europe are the bisphosphonates alendronate, risedronate, ibandronate and zoledronic acid; the selective estrogen receptor modulator (SERM) raloxifene; teriparatide; and strontium ranelate. Recent additions include the biological therapy denosumab and the SERM bazedoxifene. In this review, we explore the antifracture efficacy of these agents with the aim of simplifying treatment decisions. These treatments can be broadly divided according to their mode of action. The antiresorptive agents include the bisphosphonates, the SERMs and denosumab, while the bone-forming agents include parathyroid hormone and teriparatide. Strontium ranelate appears to combine both antiresorptive and anabolic activities. We collated data on vertebral and hip fracture efficacy from the pivotal 3-year phase III trials, all of which had a randomized, double-blind, placebo-controlled design. The relative reductions in risk in the osteoporosis trials range from 30% to 70% for vertebral fracture and 30% to 51% for hip fracture. This translates into 3-year number needed to treat values of between 9 and 21 for vertebral fracture and from 48 upwards for hip fracture. International guidelines agree that agents that have been shown to decrease vertebral, nonvertebral and hip fractures should be used preferentially over agents that only demonstrate vertebral antifracture efficacy. This is the case for alendronate, risedronate, zoledronic acid, denosumab and strontium ranelate. Finally, therapeutic decisions should be based on a balance between benefits and risks of treatment, which must be carefully considered in each particular case both by the physician and the patient. Indeed, no single agent is appropriate for all patients and, therefore, treatment decisions should be made on an individual basis, taking into account all measures of treatment effect and risk before making informed judgments about the best individual treatment option. [less ▲]

compte rendu de l'ouvrage de Manuel Nicolaon. — Vie de saint Thibaut de Provins. Édition critique d’après le Ms. Paris, BNF, fr. 17229, fol. 230d-233b (version française inédite en prose). Turnhout, Brepols, 2007, 164 pp. (Textes vernaculaires du Moyen Âge, 2).

in Cahiers de Civilisation Médiévale (2011)

De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2

in Médecine des Maladies Métaboliques (2011), 5(3),

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these ... [more ▼]

Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with type 2 diabetes. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures and to propose them to patients with type 2 diabetes but without severe obesity (body mass index <35 kg/m² or even <30 kg/m²). Therefore, we may progress in a near future from bariatric surgery to a so-called metabolic surgery, which may open a new paradigm for the management of type 2 diabetes. This innovative approach, promising but still insufficiently validated yet, deserves further careful evaluation in a multidisciplinary approach involving digestive surgeons, gastroenterologists, endocrinologists and diabetologists. [less ▲]

Cost effectiveness of denosumab compared with oral bisphosphanates in the treatment of post-menopausal osteoporotic women in Belgium

in PharmacoEconomics (2011), 29(10), 895-911

Measuring educational efficiency at student level with parametric stochastic distance functions: an application to Spanish PISA results

in Education Economics (2011), 19(1), 29-49

Les étudiants comme usagers et co-concepteurs des dispositifs pédagogiques. Proposition d’un cadre épistémologique et d’une méthodologie d’investigation de l’usage des dispositifs de formation dans le cadre de l’alternance.

in Maubant, Philippe; Martineau, Stéphane (Eds.) Fondements des pratiques professionnelles des enseignants. (2011)

Dans le domaine de la recherche Educatif , nous considérons en général qu'un formateur ou un programme de formation donne des instructions au sujet d'un concept de la façon dont l'apprentissage doit avoir ... [more ▼]

Dans le domaine de la recherche Educatif , nous considérons en général qu'un formateur ou un programme de formation donne des instructions au sujet d'un concept de la façon dont l'apprentissage doit avoir lieu . L'impact de l'activité des apprenants sur ces concepts ou d'autres arrangements , en revanche, n'est guère pris en compte. Toutefois , un certain nombre de courants en épistémologie , comme l'analyse de l'activité et l'approche instrumentale , ont montré que dans de nombreux domaines , les apprenants ou les utilisateurs de participer à la conception de l'apprentissage des procédures ou des matériaux qu'ils utilisent . Dès que l'on considère les étudiants comme un utilisateur (et non seulement de l'apprenant ) , il devient possible de considérer que l'utilisateur en tant que co -concepteur de procédures et / ou matériaux qui seront utilisés dans l'apprentissage, aussi longtemps que nous appliquons de manière suffisamment détaillée cadre théorique . Cette idée révolutionne l'approche traditionnelle de l'ingénierie pédagogique (ou de conception pédagogique ) dans au moins deux façons . D'une part, au lieu d'une idée générale qui sépare la phase de conception de la phase de mise en œuvre , en les considérant comme deux actions différentes impliquées dans la formation , nous avons plutôt d'avis que le design est une fonction distribuée partageable entre ceux qui participent , pendant toute la durée de la l'activité qui se passe. En d'autres termes encore , au lieu de différencier les « activités » créatrice de la part d'un étudiant et « activité » réactive de la part de l'étudiant , il suffit de visualiser le stagiaire comme une personne participant à la conception . Sur la base de cette approche , soutenue par un cadre méthodologique fondée sur la psychologie cognitive , ainsi que les résultats de la recherche dans les systèmes de psychologie et du travail concernant la créativité et la dynamique de groupe , nous avons conçu un programme original et la méthode d'enquête , fondé sur une métaphore de base de la verbalisation de l'activité de conception, telle qu'elle est exercée par l'étudiant . Afin d'illustrer cette construction théorique et méthodologique , une action de recherche est présenté . L'analyse des résultats est basée sur une méthode d' analyse de contenu thématique et permet de discuter des orientations pour le développement méthodologique et pracxeological de ce cadre théorique et méthodologique . [less ▲]

Attitudes towards end-of-life issues in disorders of consciousness : a European survey

in Journal of Neurology (2011)

Previous European surveys showed the support of healthcare professionals for treatment withdrawal [i.e., artificial nutrition and hydration (ANH) in chronic vegetative state (VS) patients]. The recent ... [more ▼]

Previous European surveys showed the support of healthcare professionals for treatment withdrawal [i.e., artificial nutrition and hydration (ANH) in chronic vegetative state (VS) patients]. The recent definition of minimally conscious state (MCS), and possibly research advances (e.g., functional neuroimaging), may have lead to uncertainty regarding potential residual perception and may have influenced opinions of healthcare professionals. The aim of the study was to update the end-of-life attitudes towards VS and to determine the end-of-life attitudes towards MCS. A 16-item questionnaire related to consciousness, pain and end-of-life issues in chronic (i.e., >1 year) VS and MCS and locked-in syndrome was distributed among attendants of medical and scientific conferences around Europe (n = 59). During a lecture, the items were explained orally to the attendants who needed to provide written yes/no responses. Chi-square tests and logistic regression analyses identified differences and associations for age, European region, religiosity, profession, and gender. We here report data on items concerning end-of-life issues on chronic VS and MCS. Responses were collected from 2,475 participants. For chronic VS (>1 year), 66% of healthcare professionals agreed to withdraw treatment and 82% wished not to be kept alive (P < 0.001). For chronic MCS (>1 year), less attendants agreed to withdraw treatment (28%, P < 0.001) and wished not to be kept alive (67%, P < 0.001). MCS was considered worse than VS for the patients in 54% and for their families in 42% of the sample. Respondents’ opinions were associated with geographic region and religiosity. Our data show that end-of-life opinions differ for VS as compared to MCS. The introduction of the diagnostic criteria for MCS has not substantially changed the opinions on end-of-life issues on permanent VS. Additionally, the existing legal ambiguity around MCS may have influenced the audience to draw a line between expressing preferences for self versus others, by implicitly recognizing that the latter could be a step on the slippery slope to legalize euthanasia. Given the observed individual variability, we stress the importance of advance directives and identification of proxies when discussing end-of-life issues in patients with disorders of consciousness. [less ▲]