Spinal epidural abscess Report of two cases

The case histories of two patients with an acute spinal epidural abscess are reported. When presented with a patient suffering from a spinal cord syndrome, the physician must keep in mind the possibility of a spinal epidural abscess. A rapid diagnostic procedure, prompt laminectomy, and medical treatment are particularly essential to total recovery in such cases.     

Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine

ObjectiveTo compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine.MethodsWe analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone.ResultsAmong 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81–1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24–2.02) in the full model.ConclusionsAfter adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.     

Does being informed and feeling informed affect patients’ trust in their radiation oncologist?

Objective

We investigated whether the content of information provided by radiation oncologists and their information giving performance increase patients’ trust in them.

Methods

Questionnaires were used to assess radiotherapy patients (n = 111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance.

Results

Patients mean trust score was 4.5 (sd = 0.77). The more anxious patients were, the less they tended to fully trust their radiation oncologist (p = 0.03). Patients’ age, gender, educational attainment and anxious disposition together explained 7%; radiation oncologists’ information giving (content and performance) explained 3%, and patients’ perception of radiation oncologists’ information-giving explained an additional 4% of the variance in trust scores.

Conclusion

It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients.

Practice implications

It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation oncologists’ information giving performance, our data suggest that they can particularly improve their assessments of patients’ understanding.     

Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL

Introduction

Although quality of life (QoL) is recognized as an important indicator of the course of a disease, it has rarely been addressed in studies evaluating the outcome of care for patients with pulmonary embolism (PE). This study primarily aimed to evaluate the QoL of patients with acute PE in comparison to population norms and to patients with other cardiopulmonary diseases, using a generic QoL questionnaire. Secondary, the impact of time period from diagnosis and clinical patient characteristics on QoL was assessed, using a disease-specific questionnaire.

Methods

QoL was assessed in 109 consecutive out-patients with a history of objectively confirmed acute PE (mean age 60.4 ± 15.0 years, 56 females), using the generic Short Form-36 (SF-36) and the disease specific Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL). The score of the SF-36 were compared with scores of the general Dutch population and reference populations with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), a history of acute myocardial infarction (AMI), derived from the literature. Scores on the SF-35 and PEmb-QoL were used to evaluate QoL in the short-term and long-term clinical course of patients with acute PE. In addition, we examined correlations between PEmb-QoL scores and clinical patient characteristics.

Results

Compared to scores of the general Dutch population, scores of PE patients were worse on several subscales of the SF-36 (social functioning, role emotional, general health (P < 0.001), role physical and vitality (P < 0.05)). Compared to patients with COPD and CHF, patients with PE scored higher (= better) on all subscales of the SF-36 (P ≤ 0.004) and had scores comparable with patients with AMI the previous year. Comparing intermediately assessed QoL with QoL assessed in long-term follow-up, PE patients scored worse on SF-36 subscales: physical functioning, social functioning, vitality (P < 0.05), and on the PEmb-QoL subscales: emotional complaints and limitations in ADL (P ≤ 0.03). Clinical characteristics did not correlate with QoL as measured by PEmb-QoL.

Conclusion

Our study demonstrated an impaired QoL in patients after treatment of PE. The results of this study provided more knowledge about QoL in patients treated for PE.