The implementation process of a new model of intensive rehabilitation in a hospital setting: the development of an innovative practice within the context of integration of settings, services and treatment models

This article describes the process of implementation of an internal intensive rehabilitation program at Douglas hospital for people with severe mental disorders. A discussion of contemporary paradigms of rehabilitation implies the integration of biological and psychosocial perspectives in the characterization and treatment of the pathology. The discussion of the reorganization of the entire rehabilitation services of the Program for severe mental disorders leads to specifying the organizational and regional context of the implementation. The axes of implementation in priority are the following : analysis of needs, training, reorganization of work and modification of the setting of care. These activities are implemented in reference to scientific developments that are empirically relevant and assessed regularly. Future challenges include the pursuit of integration of treatment models, of settings and services within the context of the hierarchy of mental health care in Québec.     

Chronic treatment with clomipramine and desipramine induces deficit in long-term visuo-spatial memory of rats

Although the effects of antidepressants in brain neurochemistry have been extensively studied, there are scarce and inconsistent data on the effect of these drugs in learning and memory. The authors studied the effect of daily administration of a single dose of either clomipramine or desipramine, two monoamine-reuptake-inhibitors with preferential serotonergic and noradrenergic profiles, respectively, during 15 days, on the visuo-spatial memory of adults rats measured through their performance in an eight-arm radial maze. Rats receiving 10 mg/kg i.p. daily of clomipramine or desipramine, 30 min before testing, committed a significantly greater number of errors than saline-treated control rats throughout the duration of the test (5 sessions, 15 days), excepting for session one (after 3 days of testing) where there were no differences between the 3 groups of rats. Results indicated that both serotonergic and noradrenergic antidepressants could impair long-term visuo-spatial memory in the rat, whereas inducing no changes in working memory, effects that are likely related to changes in brain monoamine metabolism induced by the antidepressant drugs.     

Repercussion on respiratory and hemodynamic parameters with a closed system of aspiration of secretion

Aspiration of bronchial secretions is a usual technique that may have an affect on hemodynamic and respiratory parameters of the patient. Our objects has been to assess if there are changes in these parameters based on two different aspiration systems: closed (CS) or open (OS) and to also compare the times used in the process. A clinical trial was performed using the crossing over method in which aspirations were performed to the same patient with the two systems. The onset system was randomized and, after a wash-out period of 3 hours, an alternative system was established. We recorded ventilatory, gasometric (baseline and at five minutes of finishing the technique) and hemodynamic (baseline, during the procedure and at five minutes) variables. The time used in each procedure was recorded. The aspiration was always performed with preoxygenation at 100% during one minute. A total of 26 patients subjected to mechanical ventilation in the assisted/controlled way entered the study and 52 aspirations were studied. We analyzed the data with the Student's t test for paired samples and ANOVA. There were no differences in the comparisons between the different determinations for the hemodynamic and gasometric variables. In the ventilatory ones, we only found a significant increase in the respiratory frequency posterior to the OS in regards to the baseline of the same system (p = 0.016). The time used in the technique was greater for the OS (p < 0.001). It can be concluded from the results that: 1. The aspiration technique does not produce clinically important alterations in the parameters studied. 2. There are no differences between the two aspiration systems. 3. The technique with CS is faster.     

Complicated acute pediatric bacterial sinusitis: Imaging updated approach

Acute bacterial sinusitis is usually a clinical diagnosis. Orbital complications require emergent evaluation with computed tomography. Using the orbital septum as an anatomic landmark, such infections can be classified as pre- or postseptal and treated with the most adequate therapy, ie, oral or intravenous antibiotics or surgical endonasal drainage. Intracranial complications can be seen in 3.7% to 11% of these patients, often with subtle clinical symptoms and signs. Radiologists play a decisive role in the final management of these patients and should be familiar with the most relevant complications. In this article, we present a retrospective review of all pediatric patients referred to our department for paranasal sinuses and orbital computed tomography because of acute complicated bacterial sinusitis. They were studied with an emergent enhanced facial and cranial computed tomography within 24 hours of admission, followed by magnetic resonance imaging when intracranial complications were suspected. Particular emphasis is placed on the imaging algorithm and the most relevant complications; we correlate imaging findings with clinical and bacteriological data.     

The role of mobile phones in improving vaccination rates in travelers

RATIONALE: Noncompliance with vaccination schedules undermines the potential benefits of immunization. The purpose of this study was to evaluate whether a reminder of the next vaccine dose sent by the Short Messaging Service (SMS) to the vaccinee's mobile phone increases compliance with hepatitis A + B and hepatitis A vaccination schedule. SUBJECTS AND METHODS: In this experimental, controlled study, the study group comprised travelers who went to the Internacional-Clínic Vaccination Centre between the 1st June and 30th September of 2001 for the standard immunization schedule against hepatitis A + B and against hepatitis A. Trained health-care workers entered the data into a computer to generate text messages reminding vaccinees of their scheduled doses. Two control groups, one from the same period of the same year including travelers from the third office (Control 2001) and the second, all travelers seen in the same period of the previous year (Control 2000), were used. RESULTS: For the second hepatitis A + B dose, compliance in the study group (Message Groups) was 88.4% (83.3-92.2); in the Control 2001, 80.7% (76.3-84.4, relative risk [RR] 1.10 [1.02-1.17]); and in the Control 2000, 77.2% (73.3-80.5, RR 1.15 [1.07-1.22]). For the third hepatitis A + B vaccine dose, results were 47.1% (40.5-53.8); 26.9% (22.8-31.7, RR 1.75 [1.41-2.17]); and 23.6% (20.1-27.4, RR 2.00 [1.63-2.45]), respectively. As for the hepatitis A vaccine, compliance rates for the second dose were 27.7% (23.9-31.9); 16.4% (14.4-18.6, RR 1.69 [1.40-2.04]); and 13.2% (11.6-14.9, RR 2.10 [1.75-2.54]); respectively. CONCLUSIONS: SMS seems to be an effective tool for increasing compliance with vaccination schedules.     

Association after linkage analysis indicates that homozygosity for the 46C-->T polymorphism in the F12 gene is a genetic risk factor for venous thrombosis

In a family-based study called GAIT (Genetic Analysis of Idiopathic Thrombophilia) that included a genome-wide scan we demonstrated that a polymorphism (46C-->T) in the F12 locus jointly influences variability of plasma (Factor XII) FXII levels and susceptibility to thrombotic disease. It then became germane to determine the prevalence of the 46C-->T polymorphism and its relative risk of thrombotic disease. We followed up evidence for genetic linkage with a case-control study, including 250 unrelated consecutive Spanish patients suffering from venous thrombotic disease and 250 Spanish subjects matched for sex and age as a controls. We measured FXII levels and genotyped the 46C-->T polymorphism, as well as a number of classical risk factors for thrombotic disease.We confirmed that individuals with different genotypes for this polymorphism showed significant differences in their FXII levels. Most importantly, the mutated T allele in the homozygous state (genotype T/T) was associated with an increased risk of thrombosis (adjusted OR of 4.82; 95% CI 1.5-15.6), suggesting that the polymorphism itself is an independent risk factor for venous thromboembolism. This study confirms that the 46C-->T polymorphism is a genetic risk factor for venous thrombosis in the Spanish population. In addition, our results confirm that a genome-wide scan coupled with a classical case-control association study is an extremely valuable approach to identify DNA variants that affect complex diseases.     

Peripapillary glial cells in the chick retina: A special glial cell type expressing astrocyte, radial glia, neuron, and oligodendrocyte markers throughout development

Peripapillary glial cells of the chick are a special type of glia, not only because of their position, forming a boundary between the retina on one side and the optic nerve head (ONH) and the pecten on the other, but also because although they have the same orientation and similar shape as the retinal Müller cell (a type of radial glia) and express common markers for these cells and astrocytes, they do not express glutamine synthetase (GS) or carbonic anhydrase C (CA-C), enzymes intensely expressed by Müller cells and astrocytes. In this study, we present further molecular characterization of these cells, using immunohistochemistry techniques. We show that peripapillary glial cells express a novel neuron antigen, 3BA8, that in the adult retina is located only in one neuron type (the amacrine cell) and in the inner plexiform layer (IPL). They also express an antigen specific to myelin and oligodendrocytes, MOSP, and a glial antigen, 3CB2, expressed by radial glia and astrocytes throughout the CNS. The study of the developmental expression of these three antigens in the peripapillary glial cell territory shows different spatiotemporal labeling patterns: 3CB2 and 3BA8 are expressed much earlier (embryonic days E3 and E5, respectively) than MOSP (E12), and during a developmental window (E6-E10) 3BA8 labels the peripapillary glial cells intensely and does not label the ONH or the optic nerve (ON), which are labeled later. The expression of 3CB2 is much more intense in the peripapillary glial cells than in Müller cells from early stages of development up to E16, and the expression of MOSP starts earlier in the peripapillary glial cells than in the Müller cells and is maintained with much higher intensity in the peripapillary glial cells throughout development. These findings show that Müller and peripapillary glial cells follow independent courses of differentiation, which together with the fact that the peripapillary glial cells express molecules typical of neurons, oligodendrocytes, radial glia, and astrocytes are evidence that peripapillary glial cells are a unique type of glia in the CNS.