Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût

Purpose

Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.

Methods

This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.

Results

Our study showed a significant decrease in the number of drugs (mean  ±  standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.

Conclusion

Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted.     

舒血宁对老年缺血性脑卒中疗效及生活质量的影响

目的 探讨舒血宁对老年缺血性脑卒中患者临床疗效和生活质量的影响.方法 212例老年缺血性脑卒中患者随机分为治疗组和对照组各106例,两组均予常规治疗,治疗组加用舒血宁,对照组加用安慰剂,2周为一疗程.进行神经功能缺损评分,采用SS-QOL量表对患者进行生活质量问卷评价,检测血中内皮素1和降钙素基因相关肽.结果 治疗组总有效率为86.8％,明显高于对照组的76.5％(P＜0.05);治疗后,治疗组SS-QOL量袁评分明显提高,内皮素1含量下降,降钙素基因相关肽含量上升,与对照组差异有显著性(P ＜0.05或P＜0.01).结论 舒血宁结合常规治疗可明显改善老年缺血性脑卒中患者神经功能缺损评分,提高患者生活质量.     

The course of delusional beliefs

The aim of this study was to explore possible regional differences in the use of coercion in psychiatric care as experienced by patients and relatives. At four psychiatric care settings in different parts of Sweden, 138 committed and 144 voluntarily admitted patients were interviewed at admission using the Nordic Admission Interview. At discharge or, if the care episode was still ongoing, after 3 weeks of care, a follow-up patient interview and an interview with 162 relatives of these patients took place. In one of the centers, where involuntarily admitted patients were treated without locking the doors of the wards, the patients reported less coercion at admission than in the other three centers. Regarding the patients’ reports of the use of coercive measures, personal treatment and outcome of care, and concerning the relatives’ experiences, few differences were found between centers among committed and voluntarily admitted patients, respectively. Coercion in psychiatric care, as reported by patients and relatives, was not always legally based, and many of the patients reported they felt violated during the admission process. Only a minority of patients and relatives reported participation in treatment and care planning, as regulated by law. Still, a majority of both committed and voluntarily admitted patients reported they had been well treated by the personnel at admission as well as during the stay at the ward, and that they had been improved in their mental health after the psychiatric care episode.     

The heavy users of a psychiatric hospital: A description of patient characteristics,admission patterns,and need for care

Characteristics, diagnosis, need for care, GAF score, and admission patterns were obtained for a group of patients (n 48) who were heavy users of a psychiatric hospital. The need for care was measured with the Camberwell assessment of need. More than half of the patients had a diagnosis of schizophrenia. The second most common diagnosis was personality disorder. Mean age was 37.5 years. Median number of need for care was 11 according to the patients and 12 according to the staff. Overall, the results showed very heterogeneous patterns with regard to age, disability, need for care, and admission patterns. This could indicate that the mental health services should become more differentiated and flexible owing to the presence of a heterogeneous, long-term patient population. Individual needs assessment and treatment programs tailored the single long-term patient are necessary.     

Book Reviews

Despite caregivers' impact on suicidal patients' compliance with treatment and suicide prevention, little is known about mental-health professionals' perceptions of work with suicidal patients. The roles of psychiatric staff's training and supervision in the care of suicidal patients were investigated by means of a postal questionnaire sent to a random sample of 1543 psychiatric staff members. The response rates were 71% for psychiatrists and 57% for nurses and assistant nurses. The responses of 53 psychiatrists, 164 nurses and 333 assistant nurses working with suicidal patients on a regular basis were compared and analysed using the Kruskal-Wallis test. Thirty-five per cent of the assistant nurses, 43% of the nurses and 74% of the psychiatrists who worked with suicidal patients on a regular basis perceived that they were sufficiently trained for this work, while 75% of the assistant nurses, 72% of the nurses and 34% of the psychiatrists received supervision in their work with suicidal patients. In spite of receiving supervision, nursing staff who perceived that they lacked training reported uncertainties in their work with suicidal patients to a larger extent than those who perceived that their training was sufficient. Uncertainties were significantly more prevalent among nursing staff than among psychiatrists. Basic and specific training in suicidology is needed and cannot be replaced solely by supervision, since psychiatric staff often have to deal with suicidal patients in emergency situations and must be able to rely on their own skills.     

中青年人初治耐多药肺结核的胸部CT征象分析

目的 分析中青年人初治耐多药肺结核患者的CT表现,探讨其影像学特点.方法 回顾性分析2013年1月至2014年12月本院经药敏试验证实的28例中青年人耐多药(观察组)及同期84例中青年人非耐药(对照组)肺结核患者的CT影像资料;运用统计学方法检验两组间影像表现差异.结果 两组间具有统计学意义的CT表现:(1)观察组少于对照组:病灶内钙化(x2 =5.60,P＜0.025);(2)观察组多于对照组:肺毁损(x2=11.03,P＜0.005)、胸膜钙化(x2=16.85,P＜0.005)、脓气胸(x2=14.54,P＜0.005)、支气管扩张(x2 =8.82,P＜0.01).两组间无统计学意义的CT表现(P＞0.05):斑片灶(x2=0.39)、结节灶(x2=0.9)、斑条灶(x2=2.68)、播散灶(x2=0.63)、空洞分布(x2=0.018)、多发空洞(x2=0.59)、空洞内液平(x2=0.11)、胸腔积液(x2=1.96)、纵隔肺门淋巴结肿大(x2=2.09)、纵隔肺门淋巴结钙化(x2 =0.72).结论 两组患者病灶内钙化的差异具有统计学意义(P＜0.025);在肺毁损、胸膜钙化、脓气胸、支气管扩张的征象上差异具有显著统计学意义(P＜0.01).在CT诊断肺结核时,除斑片、结节、斑条、播散灶及多发空洞、胸腔积液等结核征象外,如存在肺毁损、胸膜钙化、脓气胸、支气管扩张等征象,要高度怀疑为耐多药肺结核.     

Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study

Purpose: To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home.

Methods: A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke,?<1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette.

Results: The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants.

Conclusion: Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect.

• Implications for Rehabilitation

• Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation.

• Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient’s own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient’s daily life context.

• The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.

     

老年患者腰麻联合静脉应用右美托咪定的麻醉效应与安全性

目的：探析老年患者腰麻联合静脉应用右美托咪定(DMT)麻醉效应以及安全性。方法择取本院于2014年8月-2016年1月期间收治的经尿道前列腺电切除术患者114例,按照患者的入院顺序,划分为对照组与研究组,每组各57例。对照组患者接受常规麻醉,研究组患者接受腰麻联合DMT静脉注射麻醉,对比两组患者的麻醉效应。结果研究组患者的最高感觉阻滞平面消退时间、术中镇静评分、低氧饱和发生率、心动过缓发生率、低血压发生率均优于对照组患者,数据组间差异具有统计学意义(P<0.05)。结论对老年患者行腰麻+DMT静脉注射麻醉,不仅具有良好的镇痛效果以及镇静效果,而且临床应用安全性较高,值得临床大面积推广。     

Patients agressés en milieu psychiatrique : revue de la littérature et implications cliniques

Background

The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder.