Accreditation knowledge acquired by personnel in the Marseille hospital

Sensitization and educational training programmes are important pre-requisites in order to ensure the understanding of the issues at stake in the accreditation process. According to the preparatory research involved for this work, there has been no study published nor is there any documentation available on such a topic, specifically on carrying out the sensitization process to successful completion. The aims of this study are to evaluate the effectiveness of the sensitization phase and to refine general recommendations to serve as a guide for health institutions and their communications policies. A transversal randomised study was conducted through the distribution of a questionnaire to 107 health professionals from 23 clinical services in the public hospital system in Marseille. The results demonstrate that the knowledge about accreditation seems to be well integrated, with only 7 of the professionals being unaware of the accreditation programme, and 58% of them associating the accreditation process with an administrative procedure. Grouping the staff's responses according to professional category has shown to have almost no influence on the results. The level of overall knowledge is greater in more highly trained personnel (p < 0.05), but there was a poor level of knowledge regarding the internal organisational structures that existed. 75% of the health professionals thought that communication about accreditation was insufficient. The study authenticated the positive benefits of communication and identified a certain number of stumbling blocks to avoid. Several recommendations are proposed.     

Comparative analysis of aggregate shapes by digitized microscopic images. Application to hypertension

The main objective of the present work was to study modifications in RBC aggregate morphology by analyzing digitized microscopic images and compare them between healthy subjects and patients suffering from essential hypertension. Blood samples were obtained from normal subjects (n=30) and patients suffering from essential hypertension (n=20). RBC aggregate morphology was quantified using direct microscopic observation and numerical analysis of images. ASP (Aggregation Shape Parameter) defined as the ratio of the area of the projected image to its square perimeter was calculated. Other rheological parameters have been determined in order to establish the hemorheological profile of the studied hypertension states. ASP appears significantly higher (p<0.001) in patients suffering essential hypertension (0.69+/-0.11) than in normal control subjects (0.25+/-0.12). RBC aggregation is known to be responsible for the high increase in apparent blood viscosity at low shear rates. By compare ASP values with whole blood viscosity at low rate (2.30 s(-1)) a high correlation was formed between both parameters (Spearman coefficient was 0.8835 and p<0.001). The applied method is simple, direct and quantitative and provides a useful tool for measuring deviations of RBC aggregate morphology.     

Hydrosyringomyelia in demyelinating diseases

Spinal cord cavitation is a frequent finding in optic neuromyelitis (Devic's syndrome) (DS) but it is also, although rarely, observed in patients with multiple sclerosis (MS). The objective of our study was to compare the MRI characteristics of the syringomyelic cavities in 6 patients with DS and 3 patients with MS. All the patients with DS had a relapsing clinical form with normal brain MRI. Spinal MRI revealed unenhanced central cavities which extended more than 3 vertebral bodies and remained unchanged in follow-up studies. Two patients presented multiple cavities.MS patients suffered a relapsing remitting form of the disease, they all had hyperintense T2 enhancing lesions on their spinal MRI. Moreover spinal MRI also revealed non communicating cavities which extended less than 2 vertebral bodies. Follow-up studies in MS patients revealed a reduction of both the spinal lesions and the cavities. It is still debated whether DS represents a distinct clinical entity different from MS. These findings help distinguishing both disorders in cases when spinal cavities are present and also contribute to the therapeutic choice.     

Retrieval of a Greenfield IVC Filter Displaced to the Right Brachiocephalic Vein

During insertion of a central venous sheath an inferior vena cava stainless steel Greenfield filter was dislodged to the right brachiocephalic vein without a free end. Successful retrieval was achieved by using a combination of a guidewire and a snare. Percutaneous retrieval of this vena cava filter is feasible with minimal risk using this method.     

Lacrimal drainage system inflammatory masses from retained silicone tubing

In two cases studied we found inflammatory masses of the lacrimal system associated with retained silicone material. We saw the first patient two years after a failed dacryocystorhinostomy. A mass of the superior punctum mimicking a lacrimal sac or canalicular neoplasm consisted of chronic granulomatous inflammation centered around retained silicone tubing. In the second patient, a foreign body giant cell inflammatory reaction occurred in the lacrimal sac in which there were retained knots of silicone tubing. We believed the inflammation in these patients to be caused by the knots and the cut ends of the silicone tubing present in the lacrimal drainage system.     

An assessment of emergency medical technicians' performance as related to seasonal population influx

The periodic influx of large numbers of people into resort areas substantially increases the use of emergency medical services. This investigation assesses the effects of such a threefold increase in the summer population of the Cape Cod area upon the accuracy of emergency medical technicians' diagnoses and treatments. The technicians' diagnoses for ambulance patients were evaluated against those given by the emergency room physicians during the months of August 1975 and February 1976. The distribution of conditions was similar for both months and the observed frequency of correct diagnoses for common conditions was more than 90% in both months. The overdiagnosis rate of 25% to 50% for common conditions and the correct treatment rate for suspected myocardial infarction of 65% did not vary significantly between summer and winter.Thus, a large influx in population does not seem to affect adversely EMT diagnosis rates. Although misdiagnoses were uncommon, a high frequency of overdiagnosis was found, as well as a 41% rate of failure to follow through with a correct treatment for patients with suspected myocardial infarctions, thus indicating the need for better quality control on EMT performance.The authors are with the Department of Medicine, Boston University School of Medicine, and Boston City Hospital, Thorndike Memorial Laboratories, Boston, Massachusetts. Requests for reprints should be addressed to Dr. Pozen, Cardiology Department, Sears 108, Boston City Hospital, 818 Harrison Avenue, Boston, Massachusetts 02118. This work was supported by research grants from the Massachusetts Regional Medical Program, the Emergency Medicine Foundation, and The Medical Foundation, Inc., Boston, Massachusetts.     

Standards and Options for the use of radiation therapy in the management of patients with osteosarcoma. Update 2004]

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French regional cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVE: To update the SOR recommendations for the use of radiation therapy in the management of patients with osteosarcoma. This work was performed in collaboration with the French society against cancers in children and adolescent (SFCE).METHODS: Data have been identified by literature search using Medline (from January 1992 to October 2003). In addition several Internet sites were searched in October 2003. RESULTS: The 3 mains standards are: 1) local and exclusive curative irradiation is not indicated as primary treatment for osteosarcoma or for local and operable recurrence, except for lesion in inaccessible sites or if the patient refuses surgery; 2) local and prophylactic adjuvant irradiation is not indicated for the treatment of osteosarcoma after chemotherapy (neoadjuvant and/or adjuvant) and complete macro or microscopic surgery, except for non-operable R1 or R2 surgical resection; 3) whole-lung prophylactic irradiation is not indicated in non-metastatic osteosarcoma. Systemic metabolic radiotherapy for pain treatment, using samarium-153 ethylenediaminetetramethylene phosphonic acid (Sm-153-EDTMP) can be offered to patients with painful metastatic osteosarcoma or in case of recurrent bone sites inaccessible to local therapies (surgery, external irradiation).