Melun

This research aims to find out how common cardiac amyloidosis is in older adults aged 80 years and above who have been hospitalized for heart failure and have thickening of the heart muscle (left ventricular hypertrophy). Patients will be recruited from 31 geriatric or cardiology centers over 24 months. Each participant will have a baseline visit where medical history, clinical data, frailty status, genetic testing, and heart ultrasound data will be collected. Bone scans using 99mTc-DPD or 99mTc-HMDP will be done during or after hospitalization to check for amyloidosis in the heart muscle. After the initial visit, participants will receive follow-up phone calls every 3 months for 12 months to track hospitalizations, nursing home admissions, and death. The main measure is the number of patients diagnosed with cardiac amyloidosis based on bone scintigraphy at the start of the study.

This research investigates the impact of an early inhaled sedation strategy using Isoflurane delivered by an ANACONDA132; system compared to a conventional intravenous sedation method in intensive care patients who require invasive mechanical ventilation. The study focuses on preventing delirium, a common and serious complication in ventilated patients, by exploring sedation approaches in a Phase 3 clinical trial setting. Delirium is linked to worsened outcomes, including longer ventilation and hospital stays, and potential long-term cognitive effects. Participants receive either sedation through inhaled Isoflurane combined with analgesic drugs or conventional intravenous sedation with propofol and analgesics. Both groups use nurse-driven analgesia protocols including pain assessment scores and various pain management options such as opioids and non-opioid adjuncts. Sedation starts early, either at rapid sequence induction if intubated in intensive care or upon admission if pre-hospital intubation occurred. Throughout the study, patients are monitored for the occurrence of delirium within 28 days. Researchers assess comfort, safety, sedation effectiveness, and other clinical outcomes. Consent is obtained from patients or relatives, and sedation and analgesia are carefully managed using standardized protocols. The study excludes patients with certain neurological conditions, severe respiratory distress, and other specific criteria to ensure safety and reliable assessment of the sedation strategies.

Researchers are studying anticoagulation methods during Renal Replacement Therapy (RRT), a treatment used for Acute Kidney Injury. The focus is on comparing two regional anticoagulation techniques for the extracorporeal circuit (ECC) to prevent blood clotting. The study investigates whether reducing ionized calcium levels using a calcium-free dialysate and hemofilter performance can avoid the need for citrate infusion, which can cause metabolic side effects. This comparison evaluates the traditional Regional Citrate Anticoagulation (RCA) against a citrate-free decalcification method during intermittent RRT. Participants requiring RRT in the intensive care unit will undergo Sustained Low-Efficiency Dialysis (SLED) and be randomly assigned in a crossover manner to receive either regional anticoagulation with 4% citrate infusion or regional anticoagulation without citrate via decalcification. Both methods aim to maintain ionized calcium concentrations around 0.25 to 0.35 mmol/L to prevent clot formation in the ECC. During the study, researchers will measure plasma urea levels for up to 8 hours to assess treatment effects. Participants will be monitored for anticoagulation efficiency and potential side effects related to the different anticoagulation methods. The study ensures close observation of metabolic changes and coagulation status throughout the treatment period to evaluate the safety and performance of each approach.

Small Bowel Obstruction (SBO) often leads to emergency department visits and is usually diagnosed using an abdominal CT scan. Although CT scans help guide treatment decisions such as surgery or medical management, they have drawbacks including radiation exposure, higher costs, and longer emergency department stays. Researchers are evaluating the use of Point of Care Ultrasound (POCUS) combined with a clinical assessment called Gestalt probability to safely rule out SBO in patients with low or moderate risk, potentially reducing the need for CT scans. In this diagnostic multicenter study, trained emergency physicians perform POCUS on patients presenting with suspected SBO who have been assessed as having low or moderate Gestalt clinical probability. The ultrasound looks for signs of SBO in nine abdominal zones using a curvilinear probe. After POCUS, all patients undergo a CT scan, which serves as the gold standard for confirming SBO. The study aims to assess the ability of POCUS to exclude SBO in this patient group, with participation lasting 28 days including follow-up. Participants are involved during their emergency department visit with POCUS and CT imaging, followed by a phone call at 28 days. Researchers collect information on POCUS findings, duration, difficulty, and investigator details, while CT results are interpreted independently. The main outcome measures include the accuracy of POCUS to rule out SBO in patients with low or moderate Gestalt probability, aiming to improve patient care by reducing unnecessary CT scans, radiation exposure, costs, and radiologist workload.

Researchers are evaluating the efficacy and safety of trimodulin as an additional treatment to standard care in adults hospitalized with severe community-acquired pneumonia (sCAP) who require invasive mechanical ventilation. This phase III, randomized, placebo-controlled, double-blind, multi-center trial aims to compare trimodulin plus standard care against placebo plus standard care. The study also includes substudies to understand the pharmacokinetics and pharmacodynamics of trimodulin. Participants will be randomly assigned to receive either trimodulin or placebo via intravenous infusion once daily for five consecutive days alongside standard care. After the treatment phase, patients will be followed for up to 23 days, with an end-of-follow-up visit or telephone call on day 29. For those still hospitalized after day 29, extended follow-up continues until discharge or day 90, followed by a final visit or call on day 91. During the study, participants will undergo various assessments including monitoring of mortality rates up to day 29, clinical evaluations, and safety monitoring. Researchers will collect data on inflammation markers and other health parameters. Follow-up contacts and visits will ensure ongoing evaluation of patient status and adverse events throughout the study period, which may last up to 91 days or longer depending on hospital discharge timing.

Researchers are evaluating the effectiveness of cotrimoxazole compared to the best standard antibiotic treatment for ventilator-associated pneumonia (VAP) caused by Enterobacteriaceae in adult patients admitted to intensive care units (ICU). This is a multicenter, randomized, non-inferiority Phase 3 trial aiming to show that cotrimoxazole is not worse than standard care in terms of patient survival 28 days after treatment begins. Participants must have a confirmed diagnosis of VAP with bacteria susceptible to cotrimoxazole. Patients are randomly assigned to receive either cotrimoxazole or the best standard antibiotic therapy, which may include beta-lactam or fluoroquinolone antibiotics. Treatment lasts for seven days, starting with an initial appropriate empiric antibiotic therapy. The dosing and administration of antibiotics are tailored according to current ICU guidelines. The trial is open-label due to variable antibiotic regimens in the control group. During the study, patients are closely monitored daily until death, ICU discharge, or 28 days after inclusion. Assessments include vital status, antibiotic use, new infections, and Clostridium difficile infections. Clinical signs and chest X-rays are reviewed on day 7 to evaluate cure. Weekly screenings for multidrug-resistant bacteria are performed until ICU discharge. The vital status is also checked at day 90, with follow-up contact for patients discharged before this time. An independent committee reviews the clinical and radiological outcomes without knowing the treatment assignments.

Researchers are evaluating the effects of early intravenous high-dose vitamin C combined with vitamin B1 in patients admitted to intensive care after an out-of-hospital cardiac arrest (OHCA) who develop post-cardiac arrest shock. This shock involves heart and blood circulation failure and can lead to multiple organ failure and early death in up to 35% of patients. The study is a phase II multicenter randomized controlled trial designed to assess if vitamin C and vitamin B1 can improve outcomes compared to standard care following OHCA. Participants are randomly assigned to one of two groups. The experimental group receives standard care plus intravenous high-dose vitamin C at 200 mg/kg per day, given as 50 mg/kg every 6 hours for 3 days, starting within one hour after randomization. They also receive intravenous thiamine (vitamin B1) 200 mg twice daily for 3 days. The control group receives standard care according to guidelines, with no high-dose vitamin C during the first 3 days. From day 4, standard vitamin C and thiamine supplementation at lower doses are allowed. During the 28-day participation, patients are monitored for recovery from the shock, including the need for blood pressure support medications (vasopressors). The primary outcome is the cumulative rate of weaning off vasopressors by day 3 after cardiac arrest. Researchers will also assess safety and recovery progress. The study plans to enroll 234 patients over 24 months, with follow-up lasting 28 days after enrollment.

Researchers are evaluating the impact of a temporary accommodation program (HTSH) on the length of hospital stays for elderly patients in the Ile-de-France region. This observational, non-interventional study involves multiple hospital departments and nursing home or long-term care units. The program is designed to provide short-term nursing home stays for elderly people discharged from hospital who cannot immediately return home due to their stabilized but complex social or medical situations. The study is supported by the Regional Health Agency of Ile-de-France. The study does not involve investigational drugs or specific interventions but rather observes the medical and social care pathways for elderly patients using HTSH beds. These beds are grouped in dedicated units with specialized staff, funded and maintained by the Regional Health Agency. The program aims to assess whether HTSH improves patient care and facilitates decisions about returning home. Participants will be followed for up to 24 months to measure outcomes including the length of hospital stays in referring services. Data collection includes documentation of consent, evaluation of social and medical care, and follow-up on patients' return home plans. Caregivers and healthcare professionals involved in the HTSH circuit may also participate by providing information through questionnaires. The study observes real-life care processes without altering patient treatment.

This research aims to understand how well patients hospitalized at Melun hospital know their own vaccination status. It also seeks to learn about patients' attitudes toward vaccination in general and the number of patients interested in updating their vaccination records. The study will observe how factors like gender, occupation, having a general practitioner, and chronic illness affect vaccination status among patients in Melun, France. Patients at Melun hospital are randomly selected from ten different departments, including internal medicine, infectious diseases, gastroenterology, pneumology, surgery, cardiology, nephrology, follow-up care and rehabilitation, and geriatrics. These patients will be asked to complete a questionnaire during their hospitalization. The questionnaire is designed by the hospital's Public Health Unit and Hygiene Operational Team and focuses on their knowledge of their vaccination status and their views on vaccination. Participants will be involved during their hospital stay, completing the questionnaire with assistance if needed. Researchers will evaluate the rate at which patients know their own vaccination status on the first day of the study. The study includes 140 patients, and their responses will help provide insight into vaccination awareness and attitudes among hospitalized patients in Melun. The information gathered may help guide future vaccination efforts and education.

Older adults face a high risk of serious respiratory infections like influenza, SARS-CoV-2, respiratory syncytial virus, and human metapneumovirus, which often cause hospitalization, death, and loss of independence. This international study focuses on people aged 60 years and older who are hospitalized with these infections to better understand how these illnesses affect their ability to perform daily activities and recover function. The goal is to provide evidence that can guide vaccination and prevention efforts to support healthier aging. Participants are hospital patients confirmed by PCR test to have one of the listed respiratory viruses, including those with co-infections. The study observes their functional dependency over time using daily living activity scores. There are no interventions or treatments tested in this study; it is observational and collects data at hospital admission and during follow-up. During the study, researchers assess participants' abilities to perform daily and instrumental activities at baseline, hospital discharge, 7 days, 3 months, and 6 months after discharge. These evaluations help measure how infection impacts independence and recovery. Follow-up phone calls at 3 and 6 months are conducted to monitor progress. The study also tracks safety and adherence to ensure accurate data collection over the study period.