Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

Background:Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events.Objectives:To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS).Methods:This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%.Results:The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia.Conclusions:BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

Some mites of Yemen collected by the Medical Mission of the United States Naval Medical Research Unit No.3. / Charles D. Radford.

v.34:no.28(1954)

Memòria: estada a London South Bank University (Regne Unit)

Investigación producida a partir de una estancia en la London South Bank University, Reino Unido, entre los meses de setiembre y diciembre del 2005. Se estudia el trabajo sexual en el Reino Unido desde tres perspectivas diferentes. Por una parte, se trata la historia del feminismo anglosajón respecto a sus visiones sobre la prostitución, desde una aproximación a las fuentes. Por otra parte, se plantea la situación jurídico-política. Finalmente, se presenta brevemente a las principales entidades que dan apoyo al colectivo de trabajadoras del sexo en la ciudad de Londres.

Weighted Hardy spaces for the unit disc: approximation properties

In this paper we study basic properties of the weighted Hardy space for the unit disc with the weight function satisfying Muckenhoupt's (Aq) condition, and study related approximation problems (expansion, moment and interpolation) with respect to two incomplete systems of holomorphic functions in this space.

Importation of Acinetobacter baumannii into a burn unit: a recurrent outbreak of infection associated with widespread environmental contamination.

A burn patient was infected with Acinetobacter baumannii on transfer to the hospital after a terrorist attack. Two patients experienced cross-infection. Environmental swab samples were negative for A. baumannii. Six months later, the bacteria reemerged in 6 patients. Environmental swab samples obtained at this time were inoculated into a minimal mineral broth, and culture results showed widespread contamination. No case of infection occurred after closure of the unit for disinfection.

Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Prévention des alcoolisations aiguës a l'adolescence: quel rôle pour le médecin de famille [Prevention of binge drinking in adolescents: do family doctors have a role to play?].

Binge drinking has nearly become the norm for young people and is thus worrying. Although alcohol use in males attracts more media attention, females are also frequently affected. A variety of preventive measures can be proposed: at the individual level by parents, peers and family doctors; at the school and community level, particularly to postpone age of first use and first episode of drunkenness; at the structural level through a policy restricting access to alcohol for young people and increasing its price. Family doctors can play an important role in identifying at risk users and individualising preventive messages to which these young people are exposed in other contexts.

Diarrhées aiguës: propositions de prise en charge ambulatoire [Acute diarrhea: proposal for outpatient management]

Dans la majorité des cas, les diarrhées aiguës sont bénignes et d'évolution spontanément favorable. Il faut cependant savoir reconnaître les situations pouvant mener à des complications, en l'occurrence identifier les diarrhées invasives, inflammatoires, caractérisées par la présence de fièvre, de douleurs abdominales, de ténesmes, de mucus et, ou de sang dans les selles. Celles-ci sont à distinguer des diarrhées sécrétoires, non invasives, non inflammatoires, sans fièvre, généralement aqueuses et volumineuses. En cas de doute diagnostique, l'identification de leucocytes par microscopie ou test à la lactoferrine dans les selles permet d'évoquer une gastroentérite invasive. Les indications à une antibiothérapie empirique dans l'attente du résultat de la coproculture sont la présence d'un syndrome dysentérique (T > 38°C, > 6 selles/24 heures, douleurs abdominales, diarrhées mucopurulentes), l'âge avancé, des comorbidités significatives, une immunosuppression et la présence d'une prothèse endovasculaire. In the majority of the cases, an acute diarrhea is mild and of spontaneously favorable evolution. It is however necessary to know how to recognize the situations being able to lead to complications, in particular to identify the invasive, inflammatory diarrheas, characterized by the presence of fever, abdominal pains, mucus and\or blood. The identification of leukocytes by microscopy or lactoferrine test is helpful. Empiric quinolones treatment is recommended in the presence of dysenteric syndrome (T > 38 degrees C, > 6 stods/24 h 00, abdominal pain muco-purulent diarrhea), advanced age, significant comorbidities, immunosuppression or presence of an endovascular prothesis

Política de la competència de la Unió Europea en el sector audiovisual. El cas dels operadors públics estatals de televisió a Espanya i el Regne Unit: RTVE i BBC

Estudi elaborat a partir d’una estada al Center for Socio-Legal Studies de la Universitat d’Oxford, Gran Bretanya, entre setembre del 2006 i gener del 2007. L'objectiu d'aquesta recerca ha estat determinar i avaluar com la política de la competència de la Unió Europea ha contribuït a la configuració del sector públic televisiu espanyol i britànic. El marc teòric està basat en el concepte d’ “europeització”, desenvolupat per Harcourt (2002) en el sector de mitjans, i que implica una progressiva referencialitat de les polítiques estatals amb les europees mitjançant dos mecanismes: la redistribució de recursos i els efectes en la socialització de la política europea. Per tal de verificar aquest impacte en el sector televisiu, la recerca ha desenvolupat una aproximació en dues etapes. En primer lloc, a banda de fer un inicial repàs bibliogràfic s'han estudiat les accions de la Comissió Europea en aquest terreny, sobre tot la Comunicació sobre aplicació de la reglamentació d'ajudes públiques al sector de la radiodifusió de 2001. En una segona etapa, s'han desenvolupat un seguit d'entrevistes personals a directius i polítics del sector a Brussel•les, Londres i Madrid. Els resultats de la recerca mostren que el procés d’Europeïtzació es un fenomen creixent en el sector audiovisual públic a Espanya i el Regne Unit, però que encara les peculiaritats estatals juguen un factor preponderant en regular aquesta influència de la UE. L'anàlisi de les entrevistes qualitatives mostren també que hi ha una relació inversament proporcional entre la tradició democràtica i el grau d’influència i de referència que suposa la UE en el sector audiovisual. Mentre que el Regne Unit, l'acció de la política de la competència de la UE es percep com a element suplementari, a Espanya la seva referencialitat ha estat clau, tot i que no decisiva, per la reforma dels mitjans públics estatals.  

The interconnection of somatic and mental issues within a multidisciplinary adolescent health unit. [L'intrication des problématiques somatiques et psychiques dans une unité multidisciplinaire de santé des adolescents.]

Les aspects physiques et psychiques sont étroitement intriqués à l'adolescence, et le corps représente un lieu privilégié d'expression des conflits. C'est dire l'importance de donner une place de choix au versant psychologique au sein d'une consultation de santé des adolescents, pour tenter de discerner la souffrance psychique souvent cachée derrière la plainte somatique.

Les temporalités des médicaments : trajectoires en soins palliatifs à l'hôpital

A partir d'un terrain ethnographique réalisé au sein d'une équipe mobile de soins palliatifs d'un hôpital universitaire, cette thèse de doctorat porte sur les médicaments dans le contexte de la fin de vie. Au carrefour d'une socio-anthropologie de la maladie grave, du mourir et des médicaments, elle interroge les rapports à la morphine, ainsi qu'à certains psychotropes et sédatifs utilisés en soins palliatifs. Entre temporalité vécue et temporalité institutionnelle, les manières d'investir le temps lorsqu'il est compté, y sont centrales. Dans une dimension microsociale, les résultats montrent que l'introduction de certains médicaments comme la morphine et l'entrée en scène d'une équipe mobile de soins palliatifs sont des points de repère et peuvent sonner comme une annonce, sorte de sanction, dans la trajectoire incertaine de la personne malade. En outre, les médicaments permettent d'agir sur « le temps qui reste » en plus de soulager les symptômes lorsque la maladie grave bascule en maladie incurable. Ils font l'objet d'usages détournés du but initial de soulagement des symptômes pour repousser, altérer ou accélérer la mort dans une perspective de maîtrise de sa fin de vie. Dans une dimension mésosociale, ce travail considère les médicaments à la base d'échanges entre groupements professionnels sur fond d'institutionnalisation des soins palliatifs par rapport à d'autres segments de la médecine actifs dans la gestion de la fin de vie. Dans une médecine caractérisée par l'incertitude et les décisions -avec une teinte toute particulière en Suisse où le suicide assisté est toléré - les médicaments en soins palliatifs peuvent être considérés comme des instruments de mort, qu'ils soient redoutés ou recherchés. Interrogeant les risques de reproduire un certain nombre d'inégalités de traitements à l'approche de la mort, qui s'accentuent dans un contexte de plus en plus favorable aux pratiques euthanasiques, ce travail se propose, en définitive, de discuter le temps contraint de la mort dans les institutions hospitalo-universitaires, entre acharnement et abstention thérapeutique.¦-¦Based on ethnographie fieldwork conducted within a palliative care mobile team in an academic hospital, this doctoral thesis focuses on medicines used in end of life contexts. At the intersection of a socio-anthropology of illness, dying and pharmaceuticals, the relations to morphine, as well as to some psychotropic and sedative drugs used in palliative care are questioned. Between "lived" experiences of temporality and institutional temporality, the ways by which actors invest time when it is counted, appeared to be central. In a microsocial dimension, the results showed that introducing drugs such as morphine, as well as the arrival of a palliative care mobile team, are landmarks and sound like an announcement, a sort of sanction, during the uncertain trajectory of the ill person. In addition, medicines can act on "the remaining time" when severe illness shifts into incurable illness. Indeed, medicines are being diverted from the initial aim of symptom relief in order to defer, alter or hasten death in a perspective of control over one's death. In a mesosocial dimension, pharmaceuticals are seen as core to professional exchanges and to palliative care institutionalisation compared to other active medical segments in end of life care. In a medical context characterised by uncertainty and decision-taking-with a special shade in Switzerland where assisted suicide is tolerated - palliative medicines can be seen as instruments of death, whether sought or feared. Questioning the risks of reproducing treatment inequalities at the approach of death, which are accentuated in a context increasingly favorable to euthanasia practices, this study aims, ultimately, at discussing death's constrained time in academic hospitals, between therapeutic intervention and abstention.

Five-year evolution of drug prescribing in a university adult intensive care unit

Introduction: Drug prescription is difficult in ICUs as prescribers are many, drugs expensive and decisions complex. In our ICU, specialist clinicians (SC) are entitled to prescribe a list of specific drugs, negotiated with intensive care physicians (ICP). The objective of this investigation was to assess the 5-year evolution of quantity and costs of drug prescription in our adult ICU and identify the relative costs generated by ICP or SC. Methods: Quantities and costs of drugs delivered on a quarterly basis to the adult ICU of our hospital between 2004 and 2008 were extracted from the pharmacy database by ATC code, an international five-level classification system. Within each ATC first level, drugs with either high level of consumption, high costs or large variations in quantities and costs were singled out and split by type of prescriber, ICP or SC. Cost figures used were drug purchase prices by the hospital pharmacy. Results: Over the 5-year period, both quantities and costs of drugs increased, following a nonsteady, nonparallel pattern. Four ATC codes accounted for 80% of both quantities and costs, with ATC code B (blood and haematopoietic organs) amounting to 63% in quantities and 41% in costs, followed by ATC code J (systemic anti-infective, 20% of the costs), ATC code N (nervous system, 11% of the costs) and ATC code C (cardiovascular system, 8% of the costs). Prescription by SC amounted to 1% in drug quantities, but 19% in drug costs. The rate of increase in quantities and costs was seven times larger for ICP than for SC (Figure 1 overleaf ). Some peak values in costs and quantities were related to a very limited number of patients. Conclusions: A 5-year increase in quantities and costs of drug prescription in an ICU is a matter of concern. Rather unexpectedly, total costs and cost increases were generated mainly by ICP. A careful follow-up is necessary to try influencing this evolution through an institutional policy co-opted by all professional categories involved in the process.

Etendue des prestations de l'assurance-maladie sociale : le catalogue des prestations est- il suffisant pour que tous accèdent à des soins de qualité ?

Le projet "prestations de l'assurance-maladie sociale" est l'un des projets partiels élaborés par l'Office fédéral des assurances sociales (OFAS) dans le cadre de l'analyse des effets de la LAMal. Deux approches complémentaires sont adoptées pour répondre à la question du caractère suffisant du "catalogue" suisse des prestations à charge de l'assurance-maladie sociale: d'une part, la comparaison des "catalogues" des prestations remboursées en Suisse et à l'étranger et, d'autre part, l'examen de la couverture par le "catalogue" des prestations de problèmes de santé utilisés comme traceurs. [Table des matières] 1.1. Contexte. 1.2. Définition et limites du mandat. 1.3. Le "catalogue" des prestations : composition actuelle, participation d'autres assurances sociales et des pouvoirs publics. 1.4. Approches méthodologiques : comparaison internationale, étude de conditions-traceurs. 2. Analyse par comparaison internationale. 2.1. Recherche de documentation et collaborations. 2.2. Résultats : Suisse, France, Allemagne, Israël, Pays-Bas, Luxembourg, comparaison internationale des prestations générales, par catégorie, et des prestations spéciales. 3. Analyse par conditions traceurs. 3.1. Stratégie de la recherche documentaire. 3.2. Critères de choix des documents. 3.3. Variations méthodologiques et particularités. 3.4. Résultats : Accident vasculaire cérébral (ischémique), fracture de hanche, obésité, leucémie aigüe (LA), grossesse normale et nouveau-né en bonne santé. 3.5. Discussion.