[Automated screening for transfusionnal hemochromatosis]. / Dépistage automatisé de l'hémochromatose post-transfusionnelle.

Post-transfusion hemochromatosis is a major concern in patients with chronic transfusion (i.e. more than 20 red blood cell concentrates). While the monitoring of infectious complications and transfusion accidents is clearly one of the missions of haemovigilance, hemochromatosis is not yet subject to such a systematic monitoring. We therefore wanted to assess the incidence of this complication in the context of a general hospital (hospital of Aix) and propose the establishment of a screening and a comprehensive monitoring of post transfusion hemochromatosis.

[Suitability of red blood cell transfusion: a multicenter study]. / Évaluation multicentrique de la pertinence des prescriptions de concentrés de globules rouges.

The purpose of this retrospective observational multicenter study was to assess appropriateness of red blood cell (RBC) transfusion, according to the French national guidelines (Agence française de sécurité sanitaire des produits de santé) published in 2002. Six hundred and thirty-nine RBC transfusions from nine institutions have been randomly selected and analysed. The data collected are issued from different specialities. Patients' characteristics, occurrences of transfusion, admission, pre-transfusion, post-transfusion and discharge haemoglobin concentrations have been collected. Two physicians (who are in charge) must evaluate the appropriateness of pre-transfusion, discharged haemoglobin concentrations, quantity and quality of transfused RBC. The mean pre-transfusion haemoglobin concentration was 7.89 ± 1.24, the median number of transfused RBC was two (extremes: 1-16), the mean discharge haemoglobin concentration was 10.14 ± 1.30 (-5 days after the end of transfusion). The pre-transfusion and discharge haemoglobin concentrations were higher if the patient presented a co-morbidity factor. Ninety-three percent of pre-transfusion and 79% of discharge haemoglobin concentrations are in accordance with the guidelines. According to the physicians, the RBC transfusions are too "precocious" when pre-transfusion haemoglobin concentration is above nine and the anaemia is asymptomatic. 50% of RBC transfusion with discharge haemoglobin concentration above 10 is not excessive. In case of acute anaemia, the pre-transfusion and discharge haemoglobin concentrations are higher and RBC transfusion excessive. In this study, the trigger haemoglobin concentration is "restrictive", but the target haemoglobin concentration is "liberal" with a high-discharge haemoglobin concentration. Inappropriate RBC transfusions are mainly due to over-transfusion.

Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes.

BACKGROUND: Pain arising in burns sufferers is often severe and protracted. The prospect of a dressing change can heighten existing pain by impacting both physically and psychologically. In this trial we examined whether pre-procedural virtual reality guided relaxation added to patient controlled analgesia with morphine reduced pain severity during awake dressings changes in burns patients. METHODS: We conducted a prospective randomized clinical trial in all patients with burns necessitating admission to a tertiary burns referral centre. Eligible patients requiring awake dressings changes were randomly allocated to single use virtual reality relaxation plus intravenous morphine patient controlled analgesia (PCA) infusion or to intravenous morphine patient controlled analgesia infusion alone. Patients rated their worst pain intensity during the dressing change using a visual analogue scale. The primary outcome measure was presence of 30% or greater difference in pain intensity ratings between the groups in estimation of worst pain during the dressing change. FINDINGS: Of 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone. The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher pain intensities during the dressing change (mean=7.3) compared with patients receiving morphine PCA alone (mean=5.3) (p=0.003) (95% CI 0.6-2.8). INTERPRETATION: The addition of virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes. In the absence of a validated predictor for responsiveness to virtual reality relaxation such a therapy cannot be recommended for general use in burns patients having awake dressings changes.

Successful psychotropic management of drug related psychosis in Parkinson's disease.

This study reports on the clinical effectiveness of the combined use of conventional major tranquillisers and augmented levodopa dosage for the management of paranoia, hallucinations and confusion in patients with Parkinson's disease (PD). The medical records of patients admitted with PD and target symptoms were retrospectively reviewed. A total of 52 patients were treated over the 3 year period. Approximately 70% demonstrated an improvement in psychotic symptoms, but only 54% could also maintain mobility. Side-effects occurred in 37% of patients and consisted of decreased mobility, excessive sedation and excessive salivation. The drop out rate on follow-up was 47% so that at the end of the 3 year period 23 patients still remained on the major tranquilliser from 44 patients who were discharged on a major tranquilliser. The effectiveness of this approach is similar to that published for atypical major tranquillisers; however, the tranquillisers used in this study do not carry the risks of serious side effects or high cost.