Transition as a topic in psychiatry training throughout Europe: trainees’ perspectives

European Child & Adolescent Psychiatry - The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and...     

The relationship of self-rated health with functional status,toxicity and mortality: Results of a prospective pilot study of older patients with newly-diagnosed cancer

ObjectivesTo determine the association between self-rated health (SRH) and functional status, comorbidity, toxicity of treatment and mortality in older patients with newly-diagnosed cancer.Materials and MethodsPatients aged 65 and over, newly diagnosed were recruited at the Jewish General Hospital, Montreal, Canada. SRH and functional status [instrumental activities of daily living (IADL), basic activities of daily living (ADL), Eastern Cooperative Oncology Group performance status (ECOG PS), frailty markers and number of comorbid conditions] were evaluated prior to the start of treatment, and at 3, 6 and 12 months (SRH only). Treatment toxicity and mortality data were abstracted from the chart. Logistic regression was also used to examine the relationship between functional status, comorbidity and SRH at baseline. Logistic and Cox regression were used to examine the association between baseline SRH and treatment toxicity/time to death.ResultsThere were 112 participants enrolled on this study (median age 74.1). At baseline, 74 patients (66.1%) had a good SRH and 38 patients (33.9%) had poor SRH. Only an increasing number of comorbid conditions was associated with poor SRH at baseline in both univariate and multivariable analysis. We found no association between SRH and toxicity or mortality.ConclusionA substantial proportion had poor SRH prior to and during cancer treatment. An increasing number of comorbidities was associated with poor SRH at baseline. SRH did not predict toxicity or mortality. Attention to comorbid conditions in older patients with cancer is warranted considering their impact on SRH in this population.     

Suivre les nouveau-nés à risque. Pourquoi ? Comment ? Pour une action médico-psychosociale dès l’hospitalisation néonatale

The usual follow-up of high-risk children concentrates on screening for sequelae of perinatal pathology, required by emergency pediatricians and neonatologists to assess their practices. The objective is to manage pathologies by intervening as early as possible. However, is this classical medical model, i.e., the diagnosis of something pathological and a schedule of consultations planned at specific dates, adapted to the needs of high-risk children and their parents? Beyond screening, the child development consultation at the Rozanoff Early Medico-Social Action Center, set up at the A. Trousseau Hospital in 1985, proposes a consultation in which a neuropediatrician, a physical therapist, a pediatric psychiatrist-psychoanalyst, and a social worker closely collaborate. The care begun during neonatal hospitalization concentrates on the needs of the child and parents, with a primary objective of lending support to child–parent interaction. The observation of a child born at 26 GW presenting gaze avoidance concurrent with symptoms of depression in the mother exemplifies the importance of this visit. Why are there still so few of this type of consultation taking into account the medical, psychological, and social risks in a single visit? Why is the attention given to neurologic problems, for which there is currently no cure, so disproportionate to the lack of awareness of the psychological and social risks for which effective prevention and treatment possibilities do exist?     

High-Throughput Analysis of Antimalarial Susceptibility Data by the WorldWide Antimalarial Resistance Network (WWARN) In Vitro Analysis and Reporting Tool

Assessment of in vitro susceptibility is a fundamental component of antimalarial surveillance studies, but wide variations in the measurement of parasite growth and the calculation of inhibitory constants make comparisons of data from different laboratories difficult. Here we describe a Web-based, high-throughput in vitro analysis and reporting tool (IVART) generating inhibitory constants for large data sets. Fourteen primary data sets examining laboratory-determined susceptibility to artemisinin derivatives and artemisinin combination therapy partner drugs were collated from 11 laboratories. Drug concentrations associated with half-maximal inhibition of growth (IC₅₀s) were determined by a modified sigmoid E_max model-fitting algorithm, allowing standardized analysis of 7,350 concentration-inhibition assays involving 1,592 isolates. Examination of concentration-inhibition data revealed evidence of apparent paradoxical growth at high concentrations of nonartemisinin drugs, supporting amendment of the method for calculating the maximal drug effect in each assay. Criteria for defining more-reliable IC₅₀s based on estimated confidence intervals and growth ratios improved correlation coefficients for the drug pairs mefloquine-quinine and chloroquine-desethylamodiaquine in 9 of 11 and 8 of 8 data sets, respectively. Further analysis showed that maximal drug inhibition was higher for artemisinins than for other drugs, particularly in ELISA (enzyme-linked immunosorbent assay)-based assays, a finding consistent with the earlier onset of action of these drugs in the parasite life cycle. This is the first high-throughput analytical approach to apply consistent constraints and reliability criteria to large, diverse antimalarial susceptibility data sets. The data also illustrate the distinct biological properties of artemisinins and underline the need to apply more sensitive approaches to assessing in vitro susceptibility to these drugs.     

Determination of standard times of nursing activities based on a Nursing Minimum Dataset

Title.  Determination of standard times of nursing activities based on a NursingMinimum Dataset.
Aim.  This paper is a report of a study conducted to determine the standard time per nursing activity and the proportion of nursing time covered by the nursing activities of the Belgian Nursing Minimum Dataset compared to the total time of a nurse shift, and to evaluate the correlation between hospital size and standard times of nursing activities.
Background.  Because of a shrinking workforce and rising workload, nursing managers need tools that help them to allocate their staff to the wards. Such tools should be based on objective time measurements.
Methods.  The study was performed in surgical, internal medicine and elder care wards in an acute hospital care setting. In the first phase, a two-round Delphi-procedure was used to operationalize the definitions of nursing activities. In the second phase, the standard time for each nursing activity was determined, based on data collected over a 6-month period during 2006–2007. A combination of 13,292 work sampling observations by external observers, 3000 recordings of direct time measurement by self-recording and subjective time assessments yielded times that were used to analyse the duration of the nursing activities.
Results.  A standard time for 102 nursing activities was established. The coverage of the Belgian Nursing Minimum Dataset in the surgical, internal medicine and elder care wards was 47·5%, 46·4% and 51·0% respectively. The Belgian Nursing Minimum Dataset was found to cover almost 70% of direct and indirect nursing care.
Conclusion.  Further research is needed to assess the impact on the standard times of nursing activities of inefficient organizational structures and different cultural interpretations of the way an activity is conducted.     

<Emphasis Type="Italic">Mycobacterium tuberculosis</Emphasis> complex drug resistance pattern and identification of species causing tuberculosis in the West and Centre regions of Cameroon

Background  

Data on the levels of resistance of Mycobacterium tuberculosis complex (MTBC) strains to first line anti-tuberculosis drugs in Cameroon, and on the species of MTBC circulating in the country are obsolete. The picture about 10 years after the last studies, and 6 years after the re-organisation of the National Tuberculosis (TB) Control Programme (NTBCP) is not known.