Talking about sexuality with the physician: are patients receiving what they wish?

QUESTIONS UNDER STUDY/PRINCIPLES: Little is known concerning patients' expectations regarding sexual history taking by doctors: to ascertain expectations and actual experience of talking about sexuality among male patients attending outpatient clinics, and their sexual behaviour. METHODS: Patients consecutively recruited from two outpatient clinics in Lausanne, Switzerland were provided with an anonymous self-administered questionnaire. Survey topics were: patients' expectations concerning sexual history taking, patients' lifetime experience of sexual history taking, and patients' sexual behaviour. RESULTS: The response rate was 53.0% (N = 1452). Among respondents, 90.9% would like their physician to ask them questions regarding their sexual history in order to receive advice on prevention (60.0% yes, 30.9% rather yes). Fifteen percent would be embarrassed or rather embarrassed if asked such questions. Nevertheless, 76.2% of these individuals would like their physician to do so. Despite these wishes, only 40.5% reported ever having a discussion "on their sexual life in general" with a doctor. Only one patient out of four to five was asked about previous sexually transmitted infections (STIs), the number of sexual partners and their sexual orientation. No feature of their sexual life distinguishes those who had discussed sexual issues with a doctor from those who had not, except a history of previous consultation for health problems related to sexuality. Conversely, being embarrassed about conducting this discussion was significantly associated with lack of discussion regarding sexuality. CONCLUSIONS: This study highlights the gap existing in the field of STI prevention in terms of doctors' advice and patients' wishes.

Late removal of retrievable caval filters.

The advent of retrievable caval filters was a game changer in the sense, that the previously irreversible act of implanting a medical device into the main venous blood stream of the body requiring careful evaluation of the pros and cons prior to execution suddenly became a "reversible" procedure where potential hazards in the late future of the patient lost most of their weight at the time of decision making. This review was designed to assess the rate of success with late retrieval of so called retrievable caval filters in order to get some indication about reasonable implant duration with respect to relatively "easy" implant removal with conventional means, i.e., catheters, hooks and lassos. A PubMed search (www.pubmed.gov) was performed with the search term "cava filter retrieval after 30 days clinical", and 20 reports between 1994 and 2013 dealing with late retrieval of caval filters were identified, covering approximately 7,000 devices with 600 removed filters. The maximal duration of implant reported is 2,599 days and the maximal implant duration of removed filters is also 2,599 days. The maximal duration reported with standard retrieval techniques, i.e., catheter, hook and/or lasso, is 475 days, whereas for the retrievals after this period more sophisticated techniques including lasers, etc. were required. The maximal implant duration for series with 100% retrieval accounts for 84 days, which is equivalent to 12 weeks or almost 3 months. We conclude that retrievable caval filters often become permanent despite the initial decision of temporary use. However, such "forgotten" retrievable devices can still be removed with a great chance of success up to three months after implantation. Conventional percutaneous removal techniques may be sufficient up to sixteen months after implantation whereas more sophisticated catheter techniques have been shown to be successful up to 83 months or more than seven years of implant duration. Tilting, migrating, or misplaced devices should be removed early on, and replaced if indicated with a device which is both, efficient and retrievable.

The hospital pharmacist: an important contributor to improved patient safety in the hospital.

Injectable drugs are high-risk products and their reconstitution in hospital wards is a potential source of errors. Thus, in order to secure the reconstitution process and thereby improve safety, the pharmacy department of Lausanne University Hospital is focusing on developing ready-to-use forms (CIVAS). These preparations are compounded in controlled clean rooms and are analyzed prior to release. In the intensive care unit, amiodarone 12.5 mg/mL in glucose 5% is one of the high-risk preparations, which has led the pharmacy to develop a ready-to-use solution. To this end, a one-year stability study was initiated, and the preliminary results (after six months) are illustrated here. A stability-indicating HPLC method was developed and validated for monitoring the concentration of amiodarone. Batches were stored at 5 °C and 30 °C, which were analyzed immediately after preparation, after one, two, four and six months of storage. The pH and osmolality values were monitored at the respective time intervals. It was observed that after six months, all the results were within specifications. However, the pH values started to decrease after two months when amiodarone was stored at 30 °C. After six months, a degradation peak appeared on the chromatogram of these solutions, which suggested that amiodarone is more stable at 5 °C. The preliminary results obtained in this study indicated that injectable amiodarone solutions are stable for six months under refrigerated storage conditions. The study is ongoing.

Attitudes of detainees and prison staff towards tobacco control policy in Switzerland: a qualitative interview study.

PURPOSE: To explore detainees and staff's attitudes towards tobacco use, in order to assist prison administrators to develop an ethically acceptable tobacco control policy based on stakeholders' opinion. DESIGN: Qualitative study based on in-depth semi-structured interviews with 31 prisoners and 27 staff prior (T1) and after the implementation (T2) of a new smoke-free regulation (2009) in a Swiss male post-trial prison consisting of 120 detainees and 120 employees. RESULTS: At T1, smoking was allowed in common indoor rooms and most working places. Both groups of participants expressed the need for a more uniform and stricter regulation, with general opposition towards a total smoking ban. Expressed fears and difficulties regarding a stricter regulation were increased stress on detainees and strain on staff, violence, riots, loss of control on detainees, and changes in social life. At T2, participants expressed predominantly satisfaction. They reported reduction in their own tobacco use and a better protection against second-hand smoke. However, enforcement was incomplete. The debate was felt as being concentrated on regulation only, leaving aside the subject of tobacco reduction or cessation support. CONCLUSION: Besides an appropriate smoke-free regulation, further developments are necessary in order to have a comprehensive tobacco control policy in prisons.

Archaeospicularia, new radiolarian order; a new step for the classification of the Lower Paleozoic Radiolaria.

A new radiolarian order - Archaeospicularia - is proposed for some Lower Paleozoic radiolarians previously considered to belong to Spumellaria and to Collodaria. It is characterized by a globular shell made of several spicules which can be free, interlocked, or fused to formed a latticed wall. The present paper gives the definition of this order and proposes a first classification. It is supposed that the Archaeospicularia represents the oldest radiolarian group and that in the Lower Paleozoic it gave rise to the orders Entactinaria, Albaillellaria, and probably Spumellaria by the reduction of the number of initial spicules. The origin of this order and its relationships with other groups of organisms with siliceous skeletons are also briefly discussed. (C) 2000 Academie des sciences / Editions scientifiques et medicales Elsevier SAS.

Chimioradiothérapie postopératoire des cancers des voies aérodigestives : vers un nouveau standard [Post-operative radiochemotherapy of the head and neck: Towards new standards?]

Head and neck squamous cell carcinomas are frequently diagnosed at an advanced stage. Their treatment remains controversial, and has to be multidisciplinary. External beam radiotherapy is a recognized treatment option after radical curative surgery in order to improve local control. Different adjuvant treatment options have been studied in order to improve the outcome of these patients. We review in this paper the different prognostic factors indicating an adjuvant treatment and the interest of treatment intensification in bad prognostic patients.

Profile order and time-dependent artifacts in contrast-enhanced coronary MR angiography at 3T: origin and prevention.

To enhance the clinical value of coronary magnetic resonance angiography (MRA), high-relaxivity contrast agents have recently been used at 3T. Here we examine a uniform bilateral shadowing artifact observed along the coronary arteries in MRA images collected using such a contrast agent. Simulations were performed to characterize this artifact, including its origin, to determine how best to mitigate this effect, and to optimize a data acquisition/injection scheme. An intraluminal contrast agent concentration model was used to simulate various acquisition strategies with two profile orders for a slow-infusion of a high-relaxivity contrast agent. Filtering effects from temporally variable weighting in k-space are prominent when a centric, radial (CR) profile order is applied during contrast infusion, resulting in decreased signal enhancement and underestimation of vessel width, while both pre- and postinfusion steady-state acquisitions result in overestimation of the vessel width. Acquisition during the brief postinfusion steady-state produces the greatest signal enhancement and minimizes k-space filtering artifacts.

HIV infection and suicide risk: an epidemiological inquiry among male homosexuals in Switzerland.

Conflicting results have been published about suicidality among HIV+ subjects; part of the alleged increased risk may be linked to premorbid risk factors such as drug addiction and homosexuality. In order to cope with these confounding factors, we assessed the degree of suicidal ideation in a sample of Swiss male homo- and bisexuals, comparing HIV- and HIV+ subjects. A total of 164 subjects returned a self-administered, home-completed questionnaire, which had been circulated among homosexuals in the French speaking part of Switzerland. Suicidal ideation was assessed through Pöldinger's scale. Serostatus was known for 149 subjects, among whom 65 were HIV+. A high rate of suicide attempts was found among homosexuals, both HIV- and HIV+. Scores on Pöldinger's scale are significantly, though moderately, higher among HIV+ subjects, and this finding seems to be a direct consequence of HIV infection.

Meta-analysis of gene-level associations for rare variants based on single-variant statistics.

Meta-analysis of genome-wide association studies (GWASs) has led to the discoveries of many common variants associated with complex human diseases. There is a growing recognition that identifying "causal" rare variants also requires large-scale meta-analysis. The fact that association tests with rare variants are performed at the gene level rather than at the variant level poses unprecedented challenges in the meta-analysis. First, different studies may adopt different gene-level tests, so the results are not compatible. Second, gene-level tests require multivariate statistics (i.e., components of the test statistic and their covariance matrix), which are difficult to obtain. To overcome these challenges, we propose to perform gene-level tests for rare variants by combining the results of single-variant analysis (i.e., p values of association tests and effect estimates) from participating studies. This simple strategy is possible because of an insight that multivariate statistics can be recovered from single-variant statistics, together with the correlation matrix of the single-variant test statistics, which can be estimated from one of the participating studies or from a publicly available database. We show both theoretically and numerically that the proposed meta-analysis approach provides accurate control of the type I error and is as powerful as joint analysis of individual participant data. This approach accommodates any disease phenotype and any study design and produces all commonly used gene-level tests. An application to the GWAS summary results of the Genetic Investigation of ANthropometric Traits (GIANT) consortium reveals rare and low-frequency variants associated with human height. The relevant software is freely available.