Dominique Brun-ney - Academia.edu (original) (raw)
Papers by Dominique Brun-ney
European Journal of Heart Failure Supplements, 2003
European Journal of Heart Failure Supplements, 2003
Revue d'Épidémiologie et de Santé Publique, 2008
PLoS ONE, 2010
Background: Syndromic surveillance systems have been developed in recent years and are now increa... more Background: Syndromic surveillance systems have been developed in recent years and are now increasingly used by stakeholders to quickly answer questions and make important decisions. It is therefore essential to evaluate the quality and utility of such systems. This study was designed to assess a syndromic surveillance system based on emergency departments' (ED) morbidity rates related to the health effects of heat waves. This study uses data collected during the 2006 heat wave in France.
PLoS ONE, 2010
Background: Syndromic surveillance systems have been developed in recent years and are now increa... more Background: Syndromic surveillance systems have been developed in recent years and are now increasingly used by stakeholders to quickly answer questions and make important decisions. It is therefore essential to evaluate the quality and utility of such systems. This study was designed to assess a syndromic surveillance system based on emergency departments' (ED) morbidity rates related to the health effects of heat waves. This study uses data collected during the 2006 heat wave in France.
Revue d'Épidémiologie et de Santé Publique, 2010
Revue d'Épidémiologie et de Santé Publique, 2010
Catheterization and Cardiovascular Diagnosis, 1989
Simultaneous recordings of airway pressure, pleural pressure, and right ventricular (RV) pressure... more Simultaneous recordings of airway pressure, pleural pressure, and right ventricular (RV) pressure were obtained during mechanically controlled ventilation In a group of patients requlrlng respiratory support. Changes in transpulmonary pressure (calculated as airway pressure minus pleural pressure) were measured at endexpiration and end-inspiration during intermittent positive pressure ventilation with or without the appllcation of a positive endexpiratory pressure, and were related to RV isovolumetric pressure changes at the onset of systole. It was found that any increase In transpulmonary pressure by intermittent positive pressure ventilation, or positive end-expiratory pressure (PEEP), or both, was associated with a proportional increase In RV isovolumetric pressure change. Moreover, when lung volume was progresslvely increased by Incremental increases in tidal volume or PEEP level, transpulmonary pressure and RV lsovolumetric pressure changes were strongly and linearly correlated. These results suggest that: 1) RV isovolumetric pressure change might be used as an index of RV output Impedance during respiratory support by mechanically controlled ventilation; and 2) lung Inflation resulting from the use of a positive alrway pressure during respiratory support can increase RV output impedance and thereby contribute to the decrease in RV stroke output.
Journal Européen des Urgences, 2007
Journal Européen des Urgences, 2007
Clinical Biochemistry, 2004
Objectives: We examined the analytical correlation N-terminal pro-brain natriuretic peptide (NT-p... more Objectives: We examined the analytical correlation N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP).
European Journal of Emergency Medicine, 2014
The length of stay in the emergency department (ED) has been proposed as an indicator of performa... more The length of stay in the emergency department (ED) has been proposed as an indicator of performance in many countries. We conducted a survey of length of stay in two large areas in France and tested the hypothesis that patient and ED-related variables may influence it. During 2007, we examined lengths of stay in ambulatory patients, that is, excluding admitted patients. The following variables were considered: (a) at the patient level, age, sex, the day and month of the visit, and the French clinical classification of emergency patients (CCEP) class; (b) at the ED level, annual ED total number of visits, mean age, the proportions of patients less than 15 and more than 75 years, and the proportions of admitted and clinically stable patients with CCEP class 1 and 2. A multilevel hierarchical analysis was carried out. We analyzed 988 591 visits in 53 EDs. The ED-specific median length of stay was 98 (IQR: 62-137) min and the ED-specific median proportion of patients with length of stay of more than 4 h was 15 (5-24) %. There was a strong correlation between the ED-specific median length of stay and the ED-specific proportion of patients with a length of stay of more than 4 h (R=0.96, P<0.001). Using a multilevel analysis, only three variables were associated significantly with the length of stay: the age and the CCEP class of the patient, and the ED census. We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED.
Echocardiography, 2008
The diagnosis of pulmonary embolism (PE) is difficult, despite validated diagnostic models. We so... more The diagnosis of pulmonary embolism (PE) is difficult, despite validated diagnostic models. We sought to determine the value of a portable ultrasound device for triage of patients with suspected PE referred to the emergency department, using simplified echo criteria. We prospectively studied 103 consecutive patients with suspected PE, referred to our emergency department. After D-dimer screening, 76 patients were prospectively enrolled in this ultrasound study and underwent helical chest tomography, transthoracic echocardiography, and venous ultrasonography. Among patients with PE (n = 31), a right ventricular dilation was detected in 17 patients (55%), a direct visualization of clot in the lower limbs was present in 18 patients (58%), and 8 patients (26%) had both right ventricular dilation and deep venous thrombosis. The sensitivity and specificity of a combined ultrasound strategy using echocardiography and venous ultrasonography were respectively 87% (95% confidence interval 74% to 96%), and 69% (95% confidence interval 53% to 82%). The sensitivity of this combined strategy was significantly improved as compared to venous ultrasonography alone (P = 0.01) or echocardiography alone (P = 0.005). In patients with dyspnea or with high clinical probability of PE, this combined strategy was particularly relevant with high sensitivities (respectively 94% and 100%). Echocardiography combined with venous ultrasonography using a portable ultrasound device is a reliable method for screening patients with suspected PE referred to an emergency department, especially in patients with dyspnea or with high clinical probability. (ECHOCARDIOGRAPHY, Volume 25, May 2008) pulmonary embolism, emergency department, echocardiography, deep venous thrombosis Pulmonary embolism (PE) is a life-threatening disease, which is difficult to diagnose despite validated clinical and diagnostic models. Emergency department physicians need rapid tests for management of patients, such as D-
Critical Care Medicine, 1990
To further define cardiovascular abnormalities in patients with septic shock, serial conventional... more To further define cardiovascular abnormalities in patients with septic shock, serial conventional hemodynamic measurements combined with two-dimensional echocardiographic studies were performed at the bedside in 21 patients admitted for an acute episode of sepsis-related circulatory failure. Measurements obtained during the first hours of hospitalization revealed a group of six patients (group 1) with markedly depressed left ventricular function, as evidenced by a low cardiac index (CI) (2.2 +/- 0.8 L/min.m2), reduced left ventricular ejection fraction (LVEF) (21 +/- 8%), and an increased arterial-venous oxygen content difference. Right ventricular systolic function was also severely depressed. These patients were characterized as having sepsis-related cardiogenic shock secondary to profound myocardial depression, which was reversible within 24 to 48 h with inotropic support. The 15 remaining patients (group 2) exhibited an initially increased CI (4.9 +/- 1.8 L/min.m2), with a low systemic vascular resistance. In group 2, LVEF remained within the normal range despite abnormally low peripheral vascular resistance. This finding would suggest the presence of slight to moderate depression of left ventricular systolic function. All patients in this series had a normal left ventricular end-diastolic volume, whether profound myocardial depression was present or not.
Critical Care Medicine, 1985
Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonar... more Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less than .001) and stroke index (from 16.6 +/- 6.7 to 21 +/- 5 ml/m2, p less than .01), and also reduced pulmonary vascular resistance. Additional hemodynamic improvement was observed until weaning from dobutamine, which was successfully completed 3.3 +/- 0.9 days after the start of infusion.
Clinical Radiology, 2002
AIM: To assess medical emergency radiology referral practice compared with a set of French guidel... more AIM: To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the eciency of computer-based guidelines on unnecessary medical imaging. MATERIALS AND METHODS: All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured. RESULTS: The proportion of requests that did not conform to the guidelines was 33.2% when the guidelines were inactive and decreased to 26.9% when the recommendations were active (P 0.0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24.9% and 15.8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate. CONCLUSION: While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the eect of our intervention was weak. However, our study identi®ed the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more speci®c actions for these situations.
BMC Medical Informatics and Decision Making, 2009
The health impacts of heat waves are serious and have prompted the development of heat wave respo... more The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.
BMC Medical Informatics and Decision Making, 2009
The health impacts of heat waves are serious and have prompted the development of heat wave respo... more The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.
Biomedicine & Pharmacotherapy, 2005
... Yasmin Alibay a , Alain Beauchet b , Rami El Mahmoud c , Caroline Schmitt a , Dominique Brun-... more ... Yasmin Alibay a , Alain Beauchet b , Rami El Mahmoud c , Caroline Schmitt a , Dominique Brun-Ney d , Marie-Odile Benoit e , Olivier ... The increase in plasma BNP or NT-proBNP concentration may be useful for the detection of asymptomatic left ventricular dysfunction [15] ...
Revue d'Épidémiologie et de Santé Publique, 2008
Mots clés. -Alerte sanitaire ; Activité SAU ; Méthode statistique Objectif. -Validation d'une mét... more Mots clés. -Alerte sanitaire ; Activité SAU ; Méthode statistique Objectif. -Validation d'une méthode statistique (modèle de régression de Farrington) pour l'alerte sanitaire sur la base des données d'activité d'un service d'urgence par la confrontation du ressenti de cette activité par les urgentistes du service.
European Journal of Heart Failure Supplements, 2003
European Journal of Heart Failure Supplements, 2003
Revue d'Épidémiologie et de Santé Publique, 2008
PLoS ONE, 2010
Background: Syndromic surveillance systems have been developed in recent years and are now increa... more Background: Syndromic surveillance systems have been developed in recent years and are now increasingly used by stakeholders to quickly answer questions and make important decisions. It is therefore essential to evaluate the quality and utility of such systems. This study was designed to assess a syndromic surveillance system based on emergency departments' (ED) morbidity rates related to the health effects of heat waves. This study uses data collected during the 2006 heat wave in France.
PLoS ONE, 2010
Background: Syndromic surveillance systems have been developed in recent years and are now increa... more Background: Syndromic surveillance systems have been developed in recent years and are now increasingly used by stakeholders to quickly answer questions and make important decisions. It is therefore essential to evaluate the quality and utility of such systems. This study was designed to assess a syndromic surveillance system based on emergency departments' (ED) morbidity rates related to the health effects of heat waves. This study uses data collected during the 2006 heat wave in France.
Revue d'Épidémiologie et de Santé Publique, 2010
Revue d'Épidémiologie et de Santé Publique, 2010
Catheterization and Cardiovascular Diagnosis, 1989
Simultaneous recordings of airway pressure, pleural pressure, and right ventricular (RV) pressure... more Simultaneous recordings of airway pressure, pleural pressure, and right ventricular (RV) pressure were obtained during mechanically controlled ventilation In a group of patients requlrlng respiratory support. Changes in transpulmonary pressure (calculated as airway pressure minus pleural pressure) were measured at endexpiration and end-inspiration during intermittent positive pressure ventilation with or without the appllcation of a positive endexpiratory pressure, and were related to RV isovolumetric pressure changes at the onset of systole. It was found that any increase In transpulmonary pressure by intermittent positive pressure ventilation, or positive end-expiratory pressure (PEEP), or both, was associated with a proportional increase In RV isovolumetric pressure change. Moreover, when lung volume was progresslvely increased by Incremental increases in tidal volume or PEEP level, transpulmonary pressure and RV lsovolumetric pressure changes were strongly and linearly correlated. These results suggest that: 1) RV isovolumetric pressure change might be used as an index of RV output Impedance during respiratory support by mechanically controlled ventilation; and 2) lung Inflation resulting from the use of a positive alrway pressure during respiratory support can increase RV output impedance and thereby contribute to the decrease in RV stroke output.
Journal Européen des Urgences, 2007
Journal Européen des Urgences, 2007
Clinical Biochemistry, 2004
Objectives: We examined the analytical correlation N-terminal pro-brain natriuretic peptide (NT-p... more Objectives: We examined the analytical correlation N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP).
European Journal of Emergency Medicine, 2014
The length of stay in the emergency department (ED) has been proposed as an indicator of performa... more The length of stay in the emergency department (ED) has been proposed as an indicator of performance in many countries. We conducted a survey of length of stay in two large areas in France and tested the hypothesis that patient and ED-related variables may influence it. During 2007, we examined lengths of stay in ambulatory patients, that is, excluding admitted patients. The following variables were considered: (a) at the patient level, age, sex, the day and month of the visit, and the French clinical classification of emergency patients (CCEP) class; (b) at the ED level, annual ED total number of visits, mean age, the proportions of patients less than 15 and more than 75 years, and the proportions of admitted and clinically stable patients with CCEP class 1 and 2. A multilevel hierarchical analysis was carried out. We analyzed 988 591 visits in 53 EDs. The ED-specific median length of stay was 98 (IQR: 62-137) min and the ED-specific median proportion of patients with length of stay of more than 4 h was 15 (5-24) %. There was a strong correlation between the ED-specific median length of stay and the ED-specific proportion of patients with a length of stay of more than 4 h (R=0.96, P<0.001). Using a multilevel analysis, only three variables were associated significantly with the length of stay: the age and the CCEP class of the patient, and the ED census. We observed that the length of stay in the ED needs to be stratified by case mix and the total number of visits of the ED.
Echocardiography, 2008
The diagnosis of pulmonary embolism (PE) is difficult, despite validated diagnostic models. We so... more The diagnosis of pulmonary embolism (PE) is difficult, despite validated diagnostic models. We sought to determine the value of a portable ultrasound device for triage of patients with suspected PE referred to the emergency department, using simplified echo criteria. We prospectively studied 103 consecutive patients with suspected PE, referred to our emergency department. After D-dimer screening, 76 patients were prospectively enrolled in this ultrasound study and underwent helical chest tomography, transthoracic echocardiography, and venous ultrasonography. Among patients with PE (n = 31), a right ventricular dilation was detected in 17 patients (55%), a direct visualization of clot in the lower limbs was present in 18 patients (58%), and 8 patients (26%) had both right ventricular dilation and deep venous thrombosis. The sensitivity and specificity of a combined ultrasound strategy using echocardiography and venous ultrasonography were respectively 87% (95% confidence interval 74% to 96%), and 69% (95% confidence interval 53% to 82%). The sensitivity of this combined strategy was significantly improved as compared to venous ultrasonography alone (P = 0.01) or echocardiography alone (P = 0.005). In patients with dyspnea or with high clinical probability of PE, this combined strategy was particularly relevant with high sensitivities (respectively 94% and 100%). Echocardiography combined with venous ultrasonography using a portable ultrasound device is a reliable method for screening patients with suspected PE referred to an emergency department, especially in patients with dyspnea or with high clinical probability. (ECHOCARDIOGRAPHY, Volume 25, May 2008) pulmonary embolism, emergency department, echocardiography, deep venous thrombosis Pulmonary embolism (PE) is a life-threatening disease, which is difficult to diagnose despite validated clinical and diagnostic models. Emergency department physicians need rapid tests for management of patients, such as D-
Critical Care Medicine, 1990
To further define cardiovascular abnormalities in patients with septic shock, serial conventional... more To further define cardiovascular abnormalities in patients with septic shock, serial conventional hemodynamic measurements combined with two-dimensional echocardiographic studies were performed at the bedside in 21 patients admitted for an acute episode of sepsis-related circulatory failure. Measurements obtained during the first hours of hospitalization revealed a group of six patients (group 1) with markedly depressed left ventricular function, as evidenced by a low cardiac index (CI) (2.2 +/- 0.8 L/min.m2), reduced left ventricular ejection fraction (LVEF) (21 +/- 8%), and an increased arterial-venous oxygen content difference. Right ventricular systolic function was also severely depressed. These patients were characterized as having sepsis-related cardiogenic shock secondary to profound myocardial depression, which was reversible within 24 to 48 h with inotropic support. The 15 remaining patients (group 2) exhibited an initially increased CI (4.9 +/- 1.8 L/min.m2), with a low systemic vascular resistance. In group 2, LVEF remained within the normal range despite abnormally low peripheral vascular resistance. This finding would suggest the presence of slight to moderate depression of left ventricular systolic function. All patients in this series had a normal left ventricular end-diastolic volume, whether profound myocardial depression was present or not.
Critical Care Medicine, 1985
Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonar... more Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less than .001) and stroke index (from 16.6 +/- 6.7 to 21 +/- 5 ml/m2, p less than .01), and also reduced pulmonary vascular resistance. Additional hemodynamic improvement was observed until weaning from dobutamine, which was successfully completed 3.3 +/- 0.9 days after the start of infusion.
Clinical Radiology, 2002
AIM: To assess medical emergency radiology referral practice compared with a set of French guidel... more AIM: To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the eciency of computer-based guidelines on unnecessary medical imaging. MATERIALS AND METHODS: All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured. RESULTS: The proportion of requests that did not conform to the guidelines was 33.2% when the guidelines were inactive and decreased to 26.9% when the recommendations were active (P 0.0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24.9% and 15.8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate. CONCLUSION: While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the eect of our intervention was weak. However, our study identi®ed the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more speci®c actions for these situations.
BMC Medical Informatics and Decision Making, 2009
The health impacts of heat waves are serious and have prompted the development of heat wave respo... more The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.
BMC Medical Informatics and Decision Making, 2009
The health impacts of heat waves are serious and have prompted the development of heat wave respo... more The health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.
Biomedicine & Pharmacotherapy, 2005
... Yasmin Alibay a , Alain Beauchet b , Rami El Mahmoud c , Caroline Schmitt a , Dominique Brun-... more ... Yasmin Alibay a , Alain Beauchet b , Rami El Mahmoud c , Caroline Schmitt a , Dominique Brun-Ney d , Marie-Odile Benoit e , Olivier ... The increase in plasma BNP or NT-proBNP concentration may be useful for the detection of asymptomatic left ventricular dysfunction [15] ...
Revue d'Épidémiologie et de Santé Publique, 2008
Mots clés. -Alerte sanitaire ; Activité SAU ; Méthode statistique Objectif. -Validation d'une mét... more Mots clés. -Alerte sanitaire ; Activité SAU ; Méthode statistique Objectif. -Validation d'une méthode statistique (modèle de régression de Farrington) pour l'alerte sanitaire sur la base des données d'activité d'un service d'urgence par la confrontation du ressenti de cette activité par les urgentistes du service.