Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

OBJECTIVE: The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS: This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS: Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION: A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.

Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland.

UNLABELLED: Phenomenon: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. APPROACH: A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for ... ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. FINDINGS: Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). Insights: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors (Published online: 30 Aug 2014)

Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior.

Ability of physicians to diagnose influenza and usefulness of a rapid influenza antigen test in febrile returning travelers: A randomized controlled trial.

BACKGROUND: Fever is a frequent cause of medical consultation among returning travelers. The objectives of this study were to assess whether physicians were able to identify patients with influenza and whether the use of an influenza rapid diagnostic test (iRDT) modified the clinical management of such patients. METHODS: Randomized controlled trial conducted at 2 different Swiss hospitals between December 2008 and November 2012. Inclusion criteria were 1) age ≥18 years, 2) documented fever of ≥38 °C or anamnestic fever + cough or sore throat within the last 4 days, 3) illness occurring within 14 days after returning from a trip abroad, 4) no definitive alternative diagnosis. Physicians were asked to estimate the likelihood of influenza on clinical grounds, and a single nasopharyngeal swab was taken. Thereafter patients were randomized into 2 groups: i) patients with iRDT (BD Directigen A + B) performed on the nasopharyngeal swab, ii) patients receiving usual care. A quantitative PCR to detect influenza was done on all nasopharyngeal swabs after the recruitment period. Clinical management was evaluated on the basis of cost of medical care, number of X-rays requested and prescription of anti-infective drugs. RESULTS: 100 eligible patients were referred to the investigators. 93 patients had a naso-pharyngeal swab for a PCR and 28 (30%) swabs were positive for influenza. The median probability of influenza estimated by the physician was 70% for the PCR positive cases and 30% for the PCR negative cases (p < 0.001). The sensitivity of the iRDT was only 20%, and specificity 100%. Mean medical cost for the patients managed with iRDT and without iRDT were USD 581 (95%CI 454-707) and USD 661 (95%CI 522-800) respectively. 14/60 (23%) of the patients managed with iRDT were prescribed antibiotics versus 13/33 (39%) in the control group (p = 0.15). No patient received antiviral treatment. CONCLUSION: Influenza was a frequent cause of fever among these febrile returning travelers. Based on their clinical assessment, physicians had a higher level of suspicion for influenza in PCR positive cases. The iRDT used in this study showed a disappointingly low sensitivity and can therefore not be recommended for the management of these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00821626.

Les femmes, oubliées de la recherche clinique [Women, forgotten by clinical research].

Durant des années, les femmes ont été sous-représentées dans les études cliniques. Or, de nombreuses molécules n'ont pas le même effet chez les hommes et les femmes, en raison de différences pharmacodynamiques et pharmacocinétiques. Il en découle un manque d'informations sur les effets thérapeutiques ou indésirables des substances mais aussi, plus généralement, une moins bonne connaissance des pathologies chez les femmes et une prise en charge plus souvent sous-optimale.La sous-représentation est due à divers facteurs, allant de la perception des femmes au sein de la société à des enjeux éthiques vis-à-vis de la grossesse. L'importance d'inclure suffisamment de femmes comme sujets d'études nécessite ainsi une prise de conscience médicale et également sociale ; elle devra s'accompagner de changements entre autres politiques ou législatifs. For years, women were underrepresented in clinical studies. But the effect of many drugs differ among women and men, due to pharmacokinetic and pharmacodynamic differences. As a result, there is a lack of information on therapeutic or adverse effets of drugs and, more generally, a lack of knowledge on diseases, leading more frequently to sub-optimal medical care in women. This underrepresentation is due to various factors, including the social role of women or ethical issues about pregnancy. The need for adequate representation of women in clinical studies is a social as well as medical concern, that implies political and legal changes.

Ownership, Incentives and Hospitals

This article analyzes hospital privatization by comparing costs and quality between different ownership forms. We put the attention on the distinction between public hospitals and private hospitals with public funding. Using information about Spanish hospitals, we have found that private hospitals provide services at a lower cost at expenses of lower quality. We observe that property rights theory is fulfilled at least for the Spanish hospital market. The way that Heath Authorities finance publicly funded hospitals may be responsible for the differences in incentives between public and private centers. We argue that the trade-off between costs and quality could be minimized by designing financing contracts with fixed and variable components.

Soins aux mineurs non accompagnés (MNA): l'expérience lausannoise [Caring for unaccompanied minors: an experience from Lausanne].

La prise en charge médicale du mineur non accompagné est complexe et nécessite la mise en place d'un réseau biopsychosocial. A Lausanne, l'Unité multidisciplinaire de santé des adolescents (UMSA) joue un rôle préventif et curatif pour cette population extrêmement vulnérable. Une prise en charge psychologique rapide est souvent nécessaire en raison des événements de vie dramatiques auxquels la plupart de ces adolescents ont été confrontés. L'absence de projet d'avenir pour la majorité de ces adolescents reste une entrave majeure à leur développement et à leur santé mentale et physique. Medical treatment of an unaccompanied minor is made more complicated firstly by its connections with the politics of immigration and secondly by the difficulty in gaining recognition of the priority of the minor's interests. Enabling healthcare teams to travel and meet these particularly vulnerable youths makes medical care more accessible to them and facilitates an optimal bio-psycho-social treatment. For most of these adolescents it is their lack of plans for the future which remains the major obstacle to their development and mental and physical health.

Centre d'assitència primària CAP Concòrdia a Sabadell

Award-winning

Market Potential of Northwest Russia for Telemedicine Applications

The level of health care in Russia is mostly still below the western standards, but lately it has been developing quite positively. Many ICT solutions (telemedicine applications) have been developed for health care in Finland, but since the domestic market is so small, it’s necessary to expand to foreign markets to make the Finnish R&D projects more profitable. Telemedicine applications are not yet widely used in Russia, but since the health care system is going through fast changes, leapfrog effects can be expected and new modern applications and technologies will be implemented. This will open numerous business opportunities for Finnish technology developers. This thesis aims to be the first evaluation of the market and form an outlook of the health care system and telemedicine applications already utilized in Russia. The results of this study can be used for focusing further research ultimately aiming at technology implementation. The study showed that there is potential for many types of telemedicine solutions, e.g. electronic patient records and home monitoring systems; providing that further research in this field is needed.

Lääkintähuollon ja materiaalihallinnon yhtenäisen RFID-seurannan perusteita

Tässä diplomityössä tarkastellaan radiotaajuisen tunnistamisteknologian (RFID) seurannan yhtenäisiä perusteita puolustusvoimien lääkintähuollolle ja materiaalihallinnolle. Nykytilaa selvitettiin pääpainona lääkintähuollon ja materiaalihallinnon osa-alueet ja samalla tarkasteltiin koko puolustusvoimien RFIDtekniikan käyttöä. Puolustusvoimissa RFID-teknologiaa käytetään myös vaatehuollon ja kulunvalvonnan toiminnoissa. Tämän työn teoriaosuudessa tarkastellaan RFID-tekniikkaa ja sen komponentteja sekä niiden hyödyntämistä eri sektoreilla ja logistiikassa. Työn empiirisessä osuudessa selvitetään, mitkä ovat puolustusvoimien tarpeet RFID:n käytöllä ja vaatimuksia ensihoidon kiireellisyysluokittelulle (TRIAGE) sekä materiaalihallinnon ja niiden kautta saatavalle tilannekuvalle. Työn tuloksena saadaan perusteita puolustusvoimien RFID-ratkaisujen suunnittelun pohjaksi.

High-Performance-Tensile-Strength Alpha-Grass Reinforced Starch-Based Fully Biodegradable Composites

Though there has been a great deal of work concerning the development of natural fibers in reinforced starch-based composites, there is still more to be done. In general, cellulose fibers have lower strength than glass fibers; however, their specific strength is not far from that of fiberglass. In this work, alpha-fibers were obtained from alpha-grass through a mild cooking process. The fibers were used to reinforce a starch-based biopolymer. Composites including 5 to 35% (w/w) alpha-grass fibers in their formulation were prepared, tested, and subsequently compared with those of wood- and fiberglass-reinforced polypropylene (PP). The term “high-performance” refers to the tensile strength of the studied composites and is mainly due to a good interphase, a good dispersion of the fibers inside the matrix, and a good aspect ratio. The tensile strength of the composites showed a linear evolution for fiber contents up to 35% (w/w). The strain at break of the composites decreased with the fiber content and showed the stiffening effects of the reinforcement. The prepared composites showed high mechanical properties, even approaching those of glass fiber reinforced composites

Analysis of the tensile modulus of polypropylene composites reinforced with stone groundwood fibers

One of the most relevant properties of composite materials to be considered is stiffness. Fiberglass has been used traditionally as a fibrous reinforcing element when stiff materials are required. However, natural fibers are been exploited as replacements for synthetic fibers to satisfy environmental concerns. Among the different natural fibers, wood fibers show the combination of relatively high aspect ratio, good specific stiffness and strength, low density, low cost, and less variability than other natural fibers of such those from annual crops. In this work, composites from polypropylene and stone groundwood fibers from softwood were prepared and mechanically characterized under tensile loads. The Young’s moduli of the ensuing composites were analyzed and their micromechanics aspects evaluated. The reinforcing effect of stone groundwood fibers was compared to that of conventional reinforcement such fiberglass. The Halpin-Tsai model with the modification proposed by Tsai-Pagano accounted fairly for the behavior of PP composites reinforced with stone groundwood fibers. It was also demonstrated that the aspect ratio of the reinforcement plays a role in the Young’s modulus of injection molded specimens

Bio-based composites from stone groundwood applied to new product development

This paper deals with the product design, engineering, and material selection intended for the manufacturing of an eco-friendly chair. The final product is expected to combine design attributes with technical and legal feasibility with the implementation of new bio-based materials. Considering the industrial design, a range of objectives and trends were determined after setting the market requirements, and the final concept was proposed and modeled. The product geometry, production technology, and legal specifications were the input data for product engineering. The material selection was based on the technical requirements. Polypropylene (PP) composite materials based on coupled-fiberglass, sized-fiberglass, and coupled-stone ground wood reinforcements were prepared and characterized. Final formulations based on these PP composites are proposed and justified

A mechanistic approach to methylene blue sorption on two vegetable wastes: Cork bark and grape stalks

Two vegetable wastes, cork bark and grape stalks, were investigated for the removal of methylene blue from aqueous solution. The effects of contact time, dye concentration, pH, and temperature on sorption were studied relative to adsorption on a commercially-activated carbon. The highest adsorption yield was obtained within the pH range 5 to 10 for grape stalks and 7 to 10 for cork bark. The sorption kinetics of dye onto activated carbon and grape stalks was very fast. Kinetics data were fitted to the pseudo-first and second order kinetic equations, and the values of the pseudo-second-order initial rate constants were found to be 1.69 mg g-1 min-1 for activated carbon, 2.24 mg g-1 min-1 for grape stalks, and 0.90 mg g-1 min-1 for cork bark. Langmuir maximum sorption capacities for activated carbon, grape stalks, and cork bark for methylene blue estimated by the Orthogonal Distance Regression method (ODR) were 157.5 mg g-1, 105.6 mg g-1, and 30.52 mg g-1, respectively. FTIR spectra indicated that carboxylic groups and lignin play a significant role in the sorption of methylene blue. Electrostatic forces, n-p interactions, cation-p, and p-p stacking interactions contribute to methylene blue sorption onto grape stalks and cork bark. Grape stalks can be considered an efficient biosorbent and as a viable alternative to activated carbon and ion-exchange resins for the removal of methylene blue

Research on the suitability of organosolv semi-chemical triticale fibers as reinforcement for recycled hdpe composites

The main objective of this research was to study the feasibility of incorporating organosolv semi-chemical triticale fibers as the reinforcing element in recycled high density polyethylene (HDPE). In the first step, triticale fibers were characterized in terms of chemical composition and compared with other biomass species (wheat, rye, softwood, and hardwood). Then, organosolv semi-chemical triticale fibers were prepared by the ethanolamine process. These fibers were characterized in terms of its yield, kappa number, fiber length/diameter ratio, fines, and viscosity; the obtained results were compared with those of eucalypt kraft pulp. In the second step, the prepared fibers were examined as a reinforcing element for recycled HDPE composites. Coupled and non-coupled HDPE composites were prepared and tested for tensile properties. Results showed that with the addition of the coupling agent maleated polyethylene (MAPE), the tensile properties of composites were significantly improved, as compared to non-coupled samples and the plain matrix. Furthermore, the influence of MAPE on the interfacial shear strength (IFSS) was studied. The contributions of both fibers and matrix to the composite strength were also studied. This was possible by the use of a numerical iterative method based on the Bowyer-Bader and Kelly-Tyson equations