Parental attitude towards alternative medicine in the paediatric intensive care unit.

The interest in alternative medicine (AM) is growing. In the USA and Canada, studies showed that 34% of adults and 11% of children use AM. In a prospective cohort study, we investigated the interest in AM among parents of critically ill children in the paediatric Intensive Care Unit (ICU) of a university hospital. From January 1996 to April 1997, we distributed questionnaires to the parents of critically ill children. These strictly anonymous questionnaires were completed at home and returned by mail. Exclusion criteria were short ( < 1 day) or repeated hospitalizations, and insufficient proficiency of the German language. The inclusion criteria were fulfilled by 591 patients; 561 received the questionnaire (95%) and 289 (52%) were returned. Of the respondents, 70% would appreciate AM as a complementary therapy on the ICU, 23% found AM equally or more important than conventional medicine whereas only 7% regarded AM as unimportant. On the ICU, 18% used AM; surprisingly 41% of them did not discuss it with physicians or nurses. An additional 21% would have liked to use AM, but did not do so. Typically, AM-users administered AM also at home to their children and themselves. Their children were however, older.CONCLUSIONS: A substantial proportion of parents used measures of alternative medicine in the intensive care unit, or would have like to do so. However, few had the confidence to discuss this wish with the medical personal. This suggests that alternative medicine is of great interest, even on an intensive care unit. Nevertheless, discussion about alternative medicine seems to be taboo in doctor-patient relations.

10 ans de lutte contre la violence domestique dans le canton de Vaud: résumé de la recherche menée par l'Unité de Médecine des Violences (UMV) sur mandat de la Commission cantonale de lutte contre la violence domestique (CCLVD)

[Sommaire] Introduction. - 1. Quelques données de base: le contexte juridique, la violence domestique: une réalité chiffrée, principales institutions du réseau d'aide dans le canton de Vaud. - 2. Résumé de la recherche "10 ans de lutte contre la violence domestique dans le canton de Vaud": contexte, méthode, résultats, recommandations à l'intention de la CCLVD. - 3. Axes stratégiques de la politique cantonale de prévention de lutte contre la violence domestique 2011-2015. - Bibliographie [Introduction (extrait)] La violence entre membres d'une même famille ou entre proches, à savoir la violence domestique, a longtemps été considérée comme une affaire privée et un tabou. Un important changement de mentalité s'est toutefois opéré ces 20 dernières années. La lutte contre la violence envers les femmes d'une manière générale et contre la violence domestique en particulier préoccupe de plus en plus les organes internationaux, nationaux et locaux et est reconnue comme une tâche d'intérêt public. [...] Dans le canton de Vaud, en 1999, le Bureau de l'égalité entre les femmes et les hommes (BEFH) a mandaté l'Unité de Prévention de l'Institut de médecine sociale et préventive du CHUV, afin de mener une étude sur la violence conjugale, auprès des institutions concernées2. Cette recherche visait à établir un état des lieux et à identifier les besoins prioritaires. En 2001, des recommandations ont émergé de cette étude sous la forme de 40 mesures. Six d'entre elles ont été retenues comme prioritaires par la Conseillère d'Etat Madame Jacqueline Maurer Mayor. Presque 10 ans après, en automne 2008, la Commission cantonale de lutte contre la violence domestique (CCLVD), instituée par le Conseil d'Etat afin de coordonner les efforts en vue de la prévention et de la lutte contre la violence domestique, a décidé de faire un bilan sur la réalisation de ces mesures, d'identifier les besoins actuels des professionnel-le-s de terrain et les problématiques émergeantes. Les résultats de cette étude, menée par L'Unité d médecine des violences (UMV) ont servi de fondement à la CCLVD dans l'établissement d'un plan stratégique 2011-2015, en matière de lutte contre la violence conjugale dans le canton de Vaud. Le présent document présente à la fois un éclairage contextuel sur la situation dans le canton de Vaud aujourd'hui et une synthèse de la recherche précitée.

Audit report on the Iowa Department of Human Services – Targeted Case Management Unit for the year ended June 30, 2011

Audit report on the Iowa Department of Human Services – Targeted Case Management Unit for the year ended June 30, 2011

Prospective monitoring of cefepime in intensive care unit adult patients.

INTRODUCTION: Cefepime has been associated with a greater risk of mortality than other beta-lactams in patients treated for severe sepsis. Hypotheses for this failure include possible hidden side-effects (for example, neurological) or inappropriate pharmacokinetic/pharmacodynamic (PK/PD) parameters for bacteria with cefepime minimal inhibitory concentrations (MIC) at the highest limits of susceptibility (8 mg/l) or intermediate-resistance (16 mg/l) for pathogens such as Enterobacteriaceae, Pseudomonas aeruginosa and Staphylococcus aureus. We examined these issues in a prospective non-interventional study of 21 consecutive intensive care unit (ICU) adult patients treated with cefepime for nosocomial pneumonia. METHODS: Patients (median age 55.1 years, range 21.8 to 81.2) received intravenous cefepime at 2 g every 12 hours for creatinine clearance (CLCr) >or= 50 ml/min, and 2 g every 24 hours or 36 hours for CLCr < 50 ml/minute. Cefepime plasma concentrations were determined at several time-points before and after drug administration by high-pressure liquid chromatography. PK/PD parameters were computed by standard non-compartmental analysis. RESULTS: Seventeen first-doses and 11 steady states (that is, four to six days after the first dose) were measured. Plasma levels varied greatly between individuals, from two- to three-fold at peak-concentrations to up to 40-fold at trough-concentrations. Nineteen out of 21 (90%) patients had PK/PD parameters comparable to literature values. Twenty-one of 21 (100%) patients had appropriate duration of cefepime concentrations above the MIC (T>MIC >or= 50%) for the pathogens recovered in this study (MIC <or= 4 mg/l), but only 45 to 65% of them had appropriate coverage for potential pathogens with cefepime MIC >or= 8 mg/l. Moreover, 2/21 (10%) patients with renal impairment (CLCr < 30 ml/minute) demonstrated accumulation of cefepime in the plasma (trough concentrations of 20 to 30 mg/l) in spite of dosage adjustment. Both had symptoms compatible with non-convulsive epilepsy (confusion and muscle jerks) that were not attributed to cefepime-toxicity until plasma levels were disclosed to the caretakers and symptoms resolved promptly after drug arrest. CONCLUSIONS: These empirical results confirm the suspected risks of hidden side-effects and inappropriate PK/PD parameters (for pathogens with upper-limit MICs) in a population of ICU adult patients. Moreover, it identifies a safety and efficacy window for cefepime doses of 2 g every 12 hours in patients with a CLCr >or= 50 ml/minute infected by pathogens with cefepime MICs <or= 4 mg/l. On the other hand, prompt monitoring of cefepime plasma levels should be considered in case of lower CLCr or greater MICs.

Audit report of the State University of Iowa, Iowa City, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2012 and 2011

Audit report of the State University of Iowa, Iowa City, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2012 and 2011

Audit report on the Iowa Department of Human Services – Targeted Case Management Unit for the year ended June 30, 2012

Audit report on the Iowa Department of Human Services – Targeted Case Management Unit for the year ended June 30, 2012

A Monte Carlo-based procedure for independent monitor unit calculation in IMRT treatment plans.

Intensity-modulated radiotherapy (IMRT) treatment plan verification by comparison with measured data requires having access to the linear accelerator and is time consuming. In this paper, we propose a method for monitor unit (MU) calculation and plan comparison for step and shoot IMRT based on the Monte Carlo code EGSnrc/BEAMnrc. The beamlets of an IMRT treatment plan are individually simulated using Monte Carlo and converted into absorbed dose to water per MU. The dose of the whole treatment can be expressed through a linear matrix equation of the MU and dose per MU of every beamlet. Due to the positivity of the absorbed dose and MU values, this equation is solved for the MU values using a non-negative least-squares fit optimization algorithm (NNLS). The Monte Carlo plan is formed by multiplying the Monte Carlo absorbed dose to water per MU with the Monte Carlo/NNLS MU. Several treatment plan localizations calculated with a commercial treatment planning system (TPS) are compared with the proposed method for validation. The Monte Carlo/NNLS MUs are close to the ones calculated by the TPS and lead to a treatment dose distribution which is clinically equivalent to the one calculated by the TPS. This procedure can be used as an IMRT QA and further development could allow this technique to be used for other radiotherapy techniques like tomotherapy or volumetric modulated arc therapy.

Differentiation of heroin and cocaine using dual-energy CT-an experimental study.

OBJECTIVE: To evaluate if heroin and cocaine can be distinguished using dual-energy CT. MATERIALS AND METHODS: Twenty samples of heroin and cocaine at different concentrations and standardized compression (SC) were scanned in dual-energy mode on a newest generation Dual Energy 64-row MDCT scanner. CT number, spectral graphs, and dual-energy index (DEI) were evaluated. Results were prospectively tested on six original samples from a body packer. Wilcoxon's test was used for statistical evaluation. RESULTS: Values are given as median and range. Under SC, the CT number of cocaine samples (-29.87 Hounsfield unit (HU) [-125.85; 16.16 HU]) was higher than the CT number of heroin samples (-184.37 HU [-199.81; -159.25 HU]; p < 0.01). Slope of spectral curves for cocaine was -2.36 HU/keV [-7.15; -0.67 HU/keV], and for heroin, 1.75 HU/keV [1.28; 2.5 HU/keV] (p < 0.01). DEI was 0.0352 [0.0081; 0.0528] for cocaine and significantly higher than for heroin samples (-0.0127 [-0.0097; -0.0159]; p < 0.001). While CT number was inconclusive, all six original packs were correctly classified after evaluation of the spectral curve and DEI. In contrast to the CT number, slope of the spectral curve and DEI were independent of concentration and compression. CONCLUSION: The slope of the spectral curve and the DEI from dual-energy CT data can be used to distinguish heroin and cocaine in vitro; these results are independent of compression and concentration in the measured range.

Pédiatrie. 1. Comment favoriser le développement de l'oralité en néonatologie [Pediatrics. How can we improve oral feeding in the neonatal intensive care unit?].

Preterm or sick neonates are frequently hampered in establishing a safe and efficient oral feeding. This can delay hospital discharge and impact on parent-child bonding, growth or neurodevelopment. Recent researches identified a pattern of interventions that could allow to reduce these troubles and to shorten hospital stays.

Gériatrie aiguë: un modèle d'unité intégree de soins aux seniors [How to prevent functional decline: an acute care unit model for the elderly].

Hospitalization in older patients is frequently associated with functional decline. Hospital factors and inadapted process of care are factors leading to this decline. Acute care units specifically developed for older patients can prevent functional decline. These units usually include a comprehensive geriatric evaluation, an interdisciplinary meeting, protocols for the treatment of geriatric syndromes and specific teaching for the care team. Globally, patients' cares are organized to preserve and improve functional performances. This article presents a pilot unit inspired by this model.

Audit report of Iowa State University of Science and Technology, Ames, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2013 and 2012

Audit report of Iowa State University of Science and Technology, Ames, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2013 and 2012

Evaluation of the Video Intubation Unit in morbid obese patients.

BACKGROUND: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. METHODS: We studied 40 MO patients (body mass index >35 kg/m(2)) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO(2) achieved during the procedure, were measured. RESULTS: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO(2) post-intubation. CONCLUSION: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions.