Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study.

BACKGROUND: In France, the most severe bone and joint infections (BJI), called "complex" (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification. METHODS: Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients. RESULTS: Inter-expert agreement during one MTM was moderate (κ=0.49), and fair (κ=0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ=0.50, range 0.27-0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ=0.58), it was better between MTMs with professor (κ=0.65) than without (κ=0.51) and with longer median time per case (κ=0.60) than shorter (κ=0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ=0.40). CONCLUSION: The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM.

Aerobic exercise in the adjunctive treatment of depression: a randomized controlled trial.

Two clinical trials have been conducted in a sample of depressed patients to determine whether the addition of an aerobic exercise programme to their usual treatment improved outcome after 12 weeks. In the first trial, an aerobic exercise group had a superior outcome compared with a control group in terms of trait anxiety and a standard psychiatric interview. A second trial was then conducted to compare an aerobic exercise programme with low intensity exercise. Both groups showed improvement but there were no significant differences between the groups. In neither trial was there any correlation between the extent of change in the subjects' physical fitness due to aerobic exercise and the extent of the improvement of psychiatric scores.

The admission of the elderly to places of care: a socio-psychiatric community survey.

Elderly persons over the age of 60 who were admitted for psychiatric care were compared with a random sample of persons living in the same community in respect of psychiatric, medical and socio-economic variables. The group admitted to hospital for psychiatric reasons was very similar to the latter in general characteristics. However, those people admitted to old age homes, which are the other major resource of psychiatric illness, constitute a distinctly separate population, being older and having considerably more physical illnesses and socio-economic problems. Factors predicting admission to an old age home were largely irremediable age-related conditions (dementia, physical infirmity, etc.), but there were also adverse social circumstances, including marked isolation and a lack of social and emotional support. A comparative analysis of the many psychiatric, social and medical factors is presented, with particular reference to reasons for referral and prevention of admission.

Reasons for referral of the elderly for psychiatric hospitalization.

The reasons for referral of elderly persons to a psychiatric hospital in Cape Town were investigated in respect of behavioural difficulties, impairment of function, psychiatric diagnosis and the attitudes and understanding of relatives and caring agents. Confused behaviour was the most common reason for admission, followed by depression, and anxiety symptoms were frequent. An impaired ability to manage their daily lives was a factor in 90% of cases. In general, referrals were appropriate and families showed a considerable ability to put up with disturbed behaviour. However, manifestations of anxiety and depression often went unrecognized and skill in handling difficult behaviour in old-age homes was often lacking. It was considered that a better level of general medical care would have obviated the need for admission in several cases. Response to a short period of hospitalization reduced the degree of impairment very considerably, even in patients with organic brain damage.