Adaptation transculturelle francophone de la Confusion Assessment Method

Introduction

The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual.

Prehospital Anticholinergic Burden Is Associated With Delirium but Not With Mortality in a Population of Acutely Ill Medical Patients

ObjectivesAnticholinergic drugs have several side effects, and they have been associated with adverse outcomes, particularly in older patients. The aim of this study was to analyze anticholinergic burden and its relationship to delirium and mortality in older acutely ill medical patients.DesignCohort study.Setting and ParticipantsPatients 65 years of age and older who were admitted to an Internal Medicine ward between August 1 and December 31, 2016.MethodsAnticholinergic drug use, outpatient and inpatient, was assessed using the Anticholinergic Cognitive Burden Scale (ACB). Prevalent delirium was diagnosed by the Short Confusion Assessment Method (Short-CAM).ResultsOf the 198 patients, 28.3% developed delirium. Mortality rate was 13.6% in-hospital and 45.6% at 12 months. In multivariate analysis, outpatient ACB was associated with delirium, with an odds ratio (OR) of 1.65 [95% confidence interval (CI) 1.09-2.51]. Those with delirium had longer hospital stays (median 13 vs 8 days; P = .01), received more drugs (median 18 vs 15; P = .02), and presented a higher inpatient ACB (mean 3.9 vs 3.1; P = .034). No increased risk was found for in-hospital or 12-month mortality with drug use, ACB, or delirium.DiscussionIn the population studied, we found an association between anticholinergic burden as measured by the ACB and the presence of delirium, but not with mortality at 12 months. A very high 12-month mortality rate might have been an obstacle for association recognition.Conclusions and ImplicationsClinician awareness of possible drug side effects, especially in older populations, is crucial. As part of medication reconciliation at the time of hospitalization, ACB of prehospitalization medications should be routinely calculated by inpatient pharmacy services and made available to medical teams.     

Impact of Polypharmacy on Occurrence of Delirium in Elderly Emergency Patients

ObjectiveTo examine associations between polypharmacy and delirium diagnosed in elderly patients hospitalized in geriatric acute care unit after emergency hospital admission.MethodsStudy design was an observational cohort study in the acute geriatric care unit of a university hospital. We included 410 consecutive patients admitted to the acute geriatric ward during 9 months. Within 72 hours of each patient's hospitalization, a clinically trained geriatrician collected the following data: sociodemographic details (age, sex, type of residence), predisposing factors for delirium, main cause of hospitalization, and current medications. Polypharmacy was defined as 6 or more drugs a day. Delirium was assessed by a geriatrician using the Confusion Assessment Method and was diagnosed on the basis of clinical history with an acute change in usual functional status, behavioral observation, and clinical and cognitive assessment.ResultsNearly 25% of hospitalized patients had delirium. The Confusion Assessment Method was positive in 69% of patients receiving polypharmacy and in 30% of those not receiving polypharmacy, a relative risk of 2.33. The proportion of elderly patients receiving polypharmacy was 58.53%.ConclusionsIn our study, polypharmacy is an independent risk factor for delirium in a population of elderly patients after emergency admission. In the geriatric population, delirium is an underestimated scourge and because of its medicosocial and economic consequences and its impact on morbidity and mortality, we need to give increased attention to the prevention and control of polypharmacy, which is a predisposing factor for delirium.     

Effects of the Fungicide Benomyl on Earthworms in Laboratory Tests Under Tropical and Temperate Conditions

Soil organisms play a crucial role in the terrestrial ecosystem. Plant protection products (PPPs) are known to affect soil organisms and might have negative impacts on soil functions influenced by these organisms. Little research has been performed to date on the impact of PPPs on tropical soil ecosystems. Therefore, in this study it was investigated whether the effects of the fungicide benomyl (chosen as a model substance) differ between tropical and temperate regions and whether data generated under temperate conditions can be used for the Environmental Risk Assessment (ERA) in tropical regions. The effect of benomyl on earthworms was evaluated in acute and chronic laboratory tests modified for tropical conditions. These tests were performed at two temperatures (20°C and 28°C) and with two strains (temperate and tropical) of the compost worm Eisenia fetida. The fungicide was spiked in two natural and two artificial soils. In addition to the organization for economic cooperation and development (OECD) artificial soil, a tropical artificial soil (TAS), containing a tropical fern product (xaxim) instead of peat, was developed in this study. The results from the laboratory tests and a literature review showed that the effects of benomyl were, on average, lower under tropical conditions (LC₅₀: 450–630 mg active ingredient (a.i.)/kg; EC₅₀: 0.8–12.9 mg a.i./kg) than under temperate conditions (LC₅0: 61–67 mg a.i./kg; EC₅₀: 1.0–1.6 mg a.i./kg) by a maximum factor of 10.3 (acute tests) and 12.9 (chronic tests). This result might be caused by an increased degradation of benomyl, and/or its first metabolite carbendazim, at higher temperatures, but a different sensitivity of the two worm strains cannot be ruled out. Despite the lower toxicity under tropical conditions and assuming comparable application rates, a preliminary assessment confirms the risk of benomyl to soil invertebrates under both conditions.     

医院内部分配中的三个重要关系

医院内部分配改革是医院改革的重要内容之一。本文阐述了分配的依据和分配的形式。从内部分配与公开、公平、竞争的关系，正确处理工作业绩、工作资历的关系和民主程序及监督的关系等方面提出了人才与报酬、付出与收入、方法与政策的改革思路。     

疾病风险调整方法在病种精细化评价中的应用

目的应用疾病风险调整方法,实现对各专科病种平均住院天数、次均费用等指标的合理预测,为病种管理提供依据。方法应用疾病风险调整方法对某三甲综合医院2016年-2019年住院患者出院病案首页信息进行挖掘,围绕O/E指数、AW、ACMI和ACMP等主要监测指标展开分析。结果通过疾病风险调整,ACMI、ACMP更加合理地展现了服务难度,应用O/E值实现了分时间、分科室、分病种设置指标合理目标值,同时解决了各科室、病种间监测指标的横向比较问题。结论疾病风险调整方法能够更加真实、客观地评价临床服务能力、服务效率及技术水平,但其有效程度取决于历史数据的真实性、完整性和准确性。     

野战医疗队热区主要疾病救治流程优化

目的：了解临床路径在野战医疗队热区主要疾病救治流程的应用价值,规范救治流程中人员、时间和物品等配置要素,达到优化救治方案,提高救治效率的目的。方法本研究主要采用德尔菲法进行分析研究。通过两轮德尔菲法,汇总专家意见和建议,建立模块化数据库。结果构建热区主要疾病救治模块化数据库。结论基于临床路径的热区主要疾病流程研究和模块化综合数据库的构建具有一定学术价值,对战时伤员救治流程的研究也有一定借鉴作用。     

虱际卫生技术评估新进展和热点问题

综述了第7届国际卫生技术评估协会年会基本情况,围绕会议“卫生技术评估的价值最大化”主题介绍了3场大会的主要内容,反映了该领域的热点问题和新进展,以期对我国卫生技术评估的发展起到借鉴作用。     

The use of an automated notification system to identify and address early readmissions by a university hospitalist service

Objectives. To examine the association of an automated physician feedback system prompting physician review of early readmissions with a change in overall readmission rates. Methods. The University of Utah Internal Medicine Hospitalist Service created an automated system to alert discharging providers to any patient readmitted within 30 days. For any 7-day readmission, the physician was asked to complete a survey to describe the admission and discharge and to identify contributing factors to the readmission. Using the University HealthSystem Consortium database, readmission rates were compared prior to and following this intervention. Results. Following the intervention, 30-day readmission rates significantly decreased from 13.93% to 11.99% (p = 0.0298). The 7-day readmission rates decreased as well but the findings were not statistically significant. The discharging physician deemed 45% of the readmissions preventable or probably preventable. Conclusion. Readmissions are common, costly and potentially preventable. This tool for physician audit and feedback and identification of defects contributing to readmissions was associated with a statistically significant decrease in 30-day readmissions. Further investigation is needed to verify these results and evaluate the best mechanism of application.     

Preventive strategies and potential therapeutic interventions for delirium in sepsis

Delirium is the most frequent and severe clinical presentation of brain dysfunction in critically ill septic patients with an incidence ranging from 9% to 71%. Delirium represents a significant burden for patients and relatives, as well as to the health care system, resulting in higher costs, long-term cognitive impairment and significant risk of death after 6 months. Current interventions for the prevention of delirium typically involve early recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predisposes the individual to delirium. Several pharmacological interventions to prevent and treat delirium have been tested, although their effectiveness remains uncertain, especially in larger and more homogeneous subgroups of ICU patients, like in patients with sepsis. To date, there is inconsistent and conflicting data regarding the efficacy of any particular pharmacological agent, thus substantial attention has been paid to non-pharmacological interventions and preventive strategies should be applied to every patient admitted in the ICU. Future trials should be designed to evaluate the impact of these pharmacologic interventions on the prevention and treatment of delirium on clinically relevant outcomes such as length of stay, hospital mortality and long-term cognitive function. The role of specific medications like statins in delirium prevention is also yet to be evaluated.     

应用德尔菲法构建武汉城市圈传染病预警指标体系

目的 根据武汉城市圈传染病流行的特征,构建圈域内传染病预警指标体系.方法 采用德尔菲法进行两轮专家咨询,要求专家从及时性、有效性、必要性和可获得性对指标进行评分,并以此作为指标筛选的基础.结果 武汉城市圈传染病预警指标体系由3项一级指标、8项二级指标和32项三级指标构成,专家权威系数和熟悉程度均＞0.90,两轮咨询专家...     

气候变化对鼠传疾病的影响研究

气候多样性和气候变化对于啮齿类动物传播疾病的潜在影响,相比于蚊类等其他媒介传播的疾病更具不确定性,所受关注也较少。但是鼠类作为一种重要的媒介生物,其传播的疾病比如因携带鼠疫耶尔森菌而引起的鼠疫,对人类健康构成的严重威胁却不容忽视。气候变化影响了鼠类传播传染病宿主、媒介的生长发育,改变了鼠疫等传染病的流行、传播和分布。本文拟对近年来气候变化之下鼠类传染病流行特点的变化做一综述,为公共卫生决策部门制定科学防控措施提供可借鉴经验。