Dependent patients discharged home from PRM departments: relevant indicators.

OBJECTIVE: To evaluate simple, measurable indicators of optimal organizational procedures for the hospital-to-home discharge of dependent patients. MATERIAL AND METHOD: All the general practitioners (GPs) in the Maine-et-Loire county of France were sent a questionnaire asking them to rank the three main criteria (from the most important to the least significant) from a list of 14. We analyzed the median ranking for each item and identified the most important items in terms of their relative frequency. RESULTS: The response rate was 10.77% (104 out of 966). Four criteria had a median score over 9: contact with the GP prior to discharge, informing the GP of the discharge date, training for the patient and his/her family in activities of daily living and providing a list of people to be contacted in the event of a problem at home. Respite hospitalization (in the event of difficulties at home) was cited as one of the three most relevant criteria. DISCUSSION-CONCLUSION: The criteria highlighted by the GPs were not highly specific for the discharge of a dependent patient. However, it would be interesting to extend this study by interviewing other stakeholders and determining whether these criteria indeed improve the organization of hospital-to-home discharge.

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional rehabilitation.

UNLABELLED: Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES: Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS: Open prospective study. POPULATION: 87 chronic LBP patients. INTERVENTION: multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME: work status and number of sick leaves due to LBP. RESULTS: The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION: Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE: Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS: A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS: Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the study's follow-up period. CONCLUSION: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

[Prospective study of the outcome at one year of patients with chronic low back pain in a program of intensive functional restoration and ergonomic intervention. Factors predicting their return to work]. / Etude du devenir à un an de lombalgiques chroniques inclus dans un programme associant reconditionnement à l'effort et action ergonomique. Recherche de facteurs prédictifs de retour et de maintien au travail.

OBJECTIVES: Evaluation of 1-year outcome after patients with chronic low back pain participated in an intensive functional restoration program associated with an ergonomic intervention on the workplace. Study of the factors predicts a return to work. METHODS: Prospective study of a cohort of 87 patients face major difficulties due to low back pain at work. Patients who visited a multidisciplinary clinic were included. Parameters, evaluating physical and psychological status, quality of life, presence at work, length of sick leaves, were determined before and after the program and at 6 and 12 months' followup. The correlation between these parameters and presence at work at 1 year was studied. RESULTS: A total of 86 patients completed the program; three were lost to followup at 1 year. Ergonomic interventions were tried in 53 patients. All parameters were improved at the end of the program and remained significantly improved at 12 months. A total of 90% of the patients returned to work at the end of the program, whereas only 17% were at work before; 72% were at work in 1 year. The number of sick leave days decreased by 60%. The Dallas index at the beginning and the end of the program, the number of sick leave days before the program and score on the item "feels able to work" correlated with the presence at work in 1 year. There was no correlation between presence at work and physical parameters. CONCLUSION: This study shows the effect of the program and determines factors predictive of successful return to work for patients with chronic low back pain. Further data are necessary to discuss the specific effect of ergonomic interventions.

[Clinical and developmental aspects of Horton's disease. Retrospective study of 100 cases]. / Aspects cliniques et évolutifs de la maladie de Horton. Etude rétrospective de 100 observations.

100 patients, from three internal medicine departments, were the subject of a retrospective study concerning the clinical manifestations and the evolution of Horton's disease. The mean age is 71 years, with a 2/1 female predominance. A temporal artery biopsy was obtained in all cases. Besides the prevalence of clinical symptoms (headaches: 80 p. cent; weight loss: 78 p. cent; fever: 65 p. cent; local inflammation: 52 p. cent, frequent pseudo-polyarthritis: 40 p. cent and sometimes severe ocular localizations (11 p. cent blindness), other signs should be emphasized: muscular pain (49%), skin hyperesthesias (37%), painful jaw (33%), etc. The inflammatory syndrome dominates the biological picture (96%); the alkaline phosphatases are increased in 37 p. cent of cases. Temporal artery biopsy was positive in 82 p. cent of cases, which confirms the excellent sensitivity of this test, preceded by a Doppler study in only 28 cases. Extension of the inflammatory process to the large vessels was demonstrated 8 times, on clinical data. Finally, the mean length of the steroid treatment was two years with 14 relapses and 8 deaths.