Reaudit report on Cass County Memorial Hospital in Atlantic, Iowa for the period July 1, 2008 through June 30, 2009

Reaudit report on Cass County Memorial Hospital in Atlantic, Iowa for the period July 1, 2008 through June 30, 2009

Treatment of suicide attempters prior to hospital admission

Résumé : De nombreux auteurs ont rapporté des sérieux problèmes dans le traitement des patients suicidaires. Cette étude a examiné le traitement que des patients, ayant commis une tentative de suicide avant leur admission à un hôpital psychiatrique en Suisse, ont eu avant leur tentamen. 31 patients ont été admis à l'hôpital pendant l'année 2000, ce qui représente 36 tentamen et cela correspond à 6,5 ci/0 du nombre annuel d'admissions. Trois de ces patients ont été admis deux fois, et un patient a été admis trois fois. Des entrevues personnelles ont permis de rassembler l'information sur le traitement précédent l'hospitalisation : la médication et son dosage, à un mois et à deux semaines avant la tentative de suicide, et si le patient avait bénéficié d'une psychothérapie. En outre, des détails sur l'aspect psychosocial du tentamen et les moyens utilisés pour la tentative de suicide ont été enregistrés. Des médicaments psychotropes avaient été prescrits dans 24 situations à 21 patients, mais seulement dans 17 événements qui concernent 15 patients, des antidépresseurs avaient été prescrits avant l'hospitalisation. Des antipsychotiques et des benzodiazépines ont été prescrits dans 6 et 21 situations (8 situations avec des hypnotiques). Aucun des patients n'avait été traité avec du lithium, pourtant connu pour diminuer la suicidalité chez des patients à risque. Dans 19 situations, 16 patients avaient reçu la psychothérapie avant l'admission. Dans 32 situations, des médicaments psychotropes ont été employés pour le tentamen. En conclusion, ces résultats confirment le sous-traitement de patients qui commettent une tentative de suicide, comme déjà rapporté par d'autres auteurs. Bien que la majorité de patients ait été soignée par un psychiatre, aucune pharmacothérapie adéquate n'avait été prescrite, en particulier pour des patients dépressifs.

Patients with AIDS-defining cancers are not universally screened for HIV: a 10-year retrospective analysis of HIV-testing practices in a Swiss university hospital.

OBJECTIVES: Kaposi's sarcoma (KS), invasive cervical carcinoma (ICC) and non-Hodgkin lymphoma (NHL) have been listed as AIDS-defining cancers (ADCs) by the Centers for Disease Control and Prevention since 1993. Despite this, HIV screening is not universally mentioned in ADC treatment guidelines. We examined screening practices at a tertiary centre serving a population where HIV seroprevalence is 0.4%. METHODS: Patients with KS, ICC, NHL and Hodgkin lymphoma (HL), treated at Lausanne University Hospital between January 2002 and July 2012, were studied retrospectively. HIV testing was considered part of the oncology work-up if performed between 90 days before and 90 days after the cancer diagnosis date. RESULTS: A total of 880 patients were examined: 10 with KS, 58 with ICC, 672 with NHL and 140 with HL. HIV testing rates were 100, 11, 60 and 59%, and HIV seroprevalence was 60, 1.7, 3.4 and 5%, respectively. Thirty-seven patients (4.2%) were HIV-positive, of whom eight (22%) were diagnosed at oncology work-up. All newly diagnosed patients had CD4 counts < 200 cells/μL and six (75%) had presented to a physician 12-236 weeks previously with conditions warranting HIV testing. CONCLUSIONS: In our institution, only patients with KS were universally screened. Screening rates for other cancers ranged from 11 to 60%. HIV seroprevalence was at least fourfold higher than the population average. As HIV-positive status impacts on cancer patient medical management, HIV screening should be included in oncology guidelines. Further, we recommend that opt-out screening should be adopted in all patients with ADCs and HL.

Médecine interne hospitalière: l'année 2009 en revue (1). La perspective des chefs de clinique [Hospital based internal medicine: the year 2009 in review (I). The perspective of chief residents]

Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.

Anti-TNF-alpha therapy in patients with chronic non-infectious uveitis: the experience of Jules Gonin Eye Hospital.

BACKGROUND: The purpose of this study is to describe the experience of Jules Gonin Eye Hospital on the long-term outcome of anti-TNF-alpha therapy in chronic non-infectious uveitis. PATIENTS AND METHODS: We identified and followed those patients with chronic non-infectious uveitis who received systemic anti-TNF-alpha therapy. Anti-TNF-alpha therapy was administered when no response had been obtained with classical immunosuppressive therapies or in the presence of severe rheumatoid disease. RESULTS: Fifteen patients (28 eyes), 7 male and 8 female (mean age, 43 years; range: 7 to 70 years) were identified. Diagnoses included HLA-B27-associated anterior uveitis (n = 4), sarcoidosis (n = 2), juvenile idiopathic arthritis (n = 2), idiopathic retinal vasculitis with uveitis (n = 2), pars planitis (n = 2), Adamantiades-Behçet disease (n = 1), birdshot retinochoroidopathy (n = 1), and Crohn's disease (n = 1). Mean duration of ocular disease was 8 years (range: 1 to 29 years). Treatment with infliximab (n = 11), etanercept (n = 2), or adalimumab (n = 2) was initiated. One patient with etanercept was switched to infliximab due to lack of clinical response. Clinical and angiographic regression of uveitis was observed within the first two months of therapy in all patients, and was maintained throughout the entire follow-up period (mean 18 months; range: 3 - 72 months). Recurrence was observed in 3 patients, and resolved after adjustment of therapy. Adverse events were recorded in only one patient (arterial hypotension). CONCLUSIONS: In this series of patients with chronic non-infectious uveitis, anti-TNF-alpha therapy was effective and safe. Further clinical studies are needed to determine an adequate duration of therapy.

Polypharmacy as predictor of drug cost, length of hospital stay and mortality rate in nursing homes : a retrospective analysis of pharmacy medication records

Background and objectives: Polypharmacy (PP) is a typical con-sequence of multiple chronic conditions in elderly patients. PP is commonly defined as the use of multiple concurrent drug therapies although a standard definition is not used. The aims of this study were to assess the PP rate among nursing home (NH) residents using the data of the pharmacy medication records and to investigate the threshold level of PP as predictor of drug cost, length of hospital stay and mortality rate

Report on the Iowa Medical Assistance Disproportionate Share Hospital Payments Program and the accompanying schedule identified as Schedule 1 for the Iowa Department of Human Services for the year ended June 30, 2008

Report on the Iowa Medical Assistance Disproportionate Share Hospital Payments Program and the accompanying schedule identified as Schedule 1 for the Iowa Department of Human Services for the year ended June 30, 2008

EZ-IO(®) intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature.

INTRODUCTION: Intraosseous access is increasingly recognised as an effective alternative vascular access to peripheral venous access. We aimed to prospectively study the patients receiving prehospital intraosseous access with the EZ-IO(®), and to compare our results with those of the available literature. METHODS: Every patient who required an intraosseous access with the EZ-IO from January 1st, 2009 to December 31st, 2011 was included. The main data collected were: age, sex, indication for intraosseous access, localisation of insertion, success rate, drugs and fluids administered, and complications. All published studies concerning the EZ-IO device were systematically searched and reviewed for comparison. RESULTS: Fifty-eight patients representing 60 EZ-IO procedures were included. Mean age was 47 years (range 0.5-91), and the success rate was 90%. The main indications were cardiorespiratory arrest (74%), major trauma (12%), and shock (5%). The anterior tibia was the main route. The main drugs administered were adrenaline (epinephrine), atropine and amiodarone. No complications were reported. We identified 30 heterogeneous studies representing 1603 EZ-IO insertions. The patients' characteristics and success rate were similar to our study. Complications were reported in 13 cases (1.3%). CONCLUSION: The EZ-IO provides an effective way to achieve vascular access in the pre-hospital setting. Our results were similar to the cumulative results of all studies involving the use of the EZ-IO, and that can be used for comparison for further studies.

L'hépatectomie réglée. A propos de 18 cas opérés dans un hôpital périphérique [Standardized hepatectomy. 18 cases operated in a peripheral hospital]

Hepatectomy has long been a formidable surgical procedure because the risk of hemorrhage it can involve. With a better understanding of hepatic anatomy, left hepatectomy, right hepatectomy and segmental hepatic resections have been standardized. Between January 1989 and December 1992, 18 hepatectomies were performed on 16 patients in the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. The mean age of the patients was 65. The surgical indications were: hepatic metastases 11 (61%); gallbladder or biliary duct neoplasm 4 (22%); hydatic cyst 3 (17%). 11 segmental resection, 3 left hepatectomies, 2 right hepatectomies, 2 pericystectomies were performed. Blood loss during these operations averaged 2800 ml. Surgical complications appeared in 6 cases (hemorrhage 1, postoperative effusion 4, sepsis 1). One patient died within 30 days (mortality 5%). Hepatectomy is nowadays a safe procedure. It can be performed in a general hospital with a trained surgical team and an efficient intensive care unit

Personality traits influence clinical outcome in day hospital-treated elderly depressed patients

OBJECTIVES: Although personality traits are considered significant predictors of both physical and mental health, their specific impact on treatment outcome in elderly patients with depression remains largely unexplored. Impact of personality traits on the evolution of depressive symptoms, quality of life, and perception of clinical progress was assessed in a psychotherapeutic community. DESIGN: A prospective longitudinal study was conducted in 62 elderly outpatients. SETTING: Day hospital treatment as usual combined group and individual therapies, pharmacological treatment, as well as family and network meetings. PARTICIPANTS: Patients presented with major depression or a depressive episode of bipolar disease. MEASUREMENTS: The Geriatric Depression Scale, the Short Form Survey, and the Therapeutic Community Assessment scale were administrated at admission, 3, 6, 12 months, and at discharge. Personality was evaluated with the NEO Five-Factor Personality Inventory. RESULTS: Outcome revealed reduced depression and improved mental quality of life and clinical progress. Higher Geriatric Depression Scale scores were found in individuals with higher levels of Neuroticism (and its Vulnerability facet). Better self-perception of clinical progress was observed in individuals with lower levels of the Depressiveness and Modesty facets and higher openness to action. Improvement in quality of life was predicted by high Positive emotions facet. All these associations remained significant after controlling for age, gender, and treatment length. CONCLUSION: Personality traits may predict clinical outcome in psychotherapeutic hospital day care for elderly patients with depression.

Eight years experience from a skeletal dysplasia referral center in a tertiary hospital in Southern India: A model for the diagnosis and treatment of rare diseases in a developing country.

We report on a series of 514 consecutive diagnoses of skeletal dysplasia made over an 8-year period at a tertiary hospital in Kerala, India. The most common diagnostic groups were dysostosis multiplex group (n = 73) followed by FGFR3 (n = 49) and osteogenesis imperfecta and decreased bone density group (n = 41). Molecular confirmation was obtained in 109 cases. Clinical and radiographic evaluation was obtained in close diagnostic collaboration with expert groups abroad through Internet communication for difficult cases. This has allowed for targeted biochemical and molecular studies leading to the correct identification of rare or novel conditions, which has not only helped affected families by allowing for improved genetic counseling and prenatal diagnosis but also resulted in several scientific contributions. We conclude that (1) the spectrum of genetic bone disease in Kerala, India, is similar to that of other parts of the world, but recessive entities may be more frequent because of widespread consanguinity; (2) prenatal detection of skeletal dysplasias remains relatively rare because of limited access to expert prenatal ultrasound facilities; (3) because of the low accessibility to molecular tests, precise clinical-radiographic phenotyping remains the mainstay of diagnosis and counseling and of gatekeeping to efficient laboratory testing; (4) good phenotyping allows, a significant contribution to the recognition and characterization of novel entities. We suggest that the tight collaboration between a local reference center with dedicated personnel and expert diagnostic networks may be a proficient model to bring current diagnostics to developing countries. © 2014 Wiley Periodicals, Inc.