[Evaluation of temporality semantic knowledge in normal aging and in mild and moderate stages of Alzheimer's disease]. / Évaluation des connaissances sémantiques de la temporalité au cours du vieillissement normal et de la maladie d'Alzheimer aux stades légers à modérés, étude préliminaire.

OBJECTIVE: Episodic and semantic processes are involved in temporality used in daily life. Episodic memory permits one to place an event on the time axis, while semantic memory makes us aware of the time segmentation and its symbolic representation. Memory of the knowledge connected to the passing of time is materialized on the calendar and can be seen symbolically on the dial of a clock. In AD, semantic memory processes are preserved longer than processes related to episodic memory. We wonder whether the specific field of knowledge about time is altered during AD. METHODOLOGY: We validated a specific evaluation with a control group (354 healthy subjects). Then we applied this battery to assess AD patients to appreciate the feasibility of this tool for this population. We then compared 22 AD patients with a control group matched for age, sex and educational level. Our clinical scale of temporal semantic knowledge consists of four parts: (a) hour reading with a.m. and p.m. hours; (b) using a clock: 12 clock faces with the hour numbers already placed: the patient draws hour and minute hands for various hours; (c) temporal segmentation: exploration of the knowledge on daytime scale and of the calendar; (d) time duration estimation: calculate how long the interview has lasted after indicating the time of its beginning and its end, then the time between 10.40 to 12.00. RESULTS: While age and educational level had an influence on all the scores, in the two groups control and patients, gender did not. Temporal segmentation, independent of the cultural level, revealed the best acquired knowledge in our control population. All the scores differentiated patients from control subjects. The temporal semantic knowledge correlated with the AD severity seemed to be correlated with the attention, verbal comprehension, and some components of executive functions, but was not related to the clock drawing test result. Depression did not have any influence on this scale in our AD group. DISCUSSION: The temporal semantic knowledge clinical scale shows differential alterations, notably in hour reading and using a clock, and less in temporal segmentation. CONCLUSION: Temporal semantic knowledge is altered in AD. The diagnosis and follow-up of these alterations allow professionals and caregivers to consider adaptations of the patient's environment according to their needs.

Implementation of JACIE accreditation results in the establishment of new indicators that unevenly monitor processes contributing to the delivery of hematopoietic SCT.

More than 145 European hematopoietic SCT programs have received JACIE (Joint Accreditation Committee for ISCT Europe and EBMT) accreditation since 2000, demonstrating compliance with FACT (Foundation for the Accreditation of Cell Therapy)-JACIE international standards. The association of JACIE with improved patient outcome was recently documented. However, conditions in which quality management systems were introduced and the actual benefits remain to be fully evaluated. Our study focuses on one aspect of quality management: introduction and use of indicators. Through a questionnaire sent to JACIE-accredited centers and responses from 32 programs (or 40%), we identified 293 indicators, including 224 (76%) that were introduced during the preparatory phase of JACIE accreditation. Indicators were associated with the following processes: measurement, analysis and improvement (54/293 or 18%); donor collection (49/293 or 16%); processing and storage of cell therapy products (37/293 or 12.5%); and administration of hematopoietic progenitor cells (67/293 or 23%). Mapping revealed an uneven distribution of indicators across the different subprocesses that contribute to this highly specialized medical procedure. Moreover, we found that only 101/293 indicators (34%) complied with the rules for implementation of a quality indicator, as defined by the FDX 50-171 standard. This suggests that risks to donors/recipients are unevenly monitored, leaving critical medical steps with low levels of monitoring.

[Deployment of the checklist "Patient safety in the operating room" in two Lorraine hospitals. Performances and difficulties]. / Déploiement de la check-list "Sécurité du patient au bloc opératoire" dans deux hôpitaux lorrains. Performances et difficultés.

OBJECTIVE: To evaluate the implementation of the checklist HAS 2010 in two Lorraine health facilities to identify objectively brakes and levers to suggest possible improvements. STUDY DESIGN: Descriptive survey. MATERIAL AND METHODS: Operating rooms of the Neurosciences building Central University Hospital, Nancy, Belle-Isle Hospital participating public hospital service, Metz. Two stages: a retrospective audit allowed to objectify quantitatively the presence of CL in the patient record and monitor compliance with the instructions of filling. A survey by self-administered questionnaire to professionals to assess the use of CL. RESULTS: CL was present in 50 % and 100 % records. The filling did not comply with instructions of the HAS (occupancy, three different times, time out before incision, stop the procedure if "no") and it was hard for about 30 % of participants, some items have problems of understanding. CL has strengthened information sharing about one third of respondents, over half of them are of interest, it has already helped to prevent errors. The deployment strategy influences directly the involvement of professionals. The evaluation of the use of CL cannot be done only through an audit record; the association with a self-administered questionnaire appears to be relevant. CONCLUSION: Good adhesion to the concept, hope for better results after stock enhancement: optimize information and training of all professionals, avoid duplication with other documents. The audit record alone is not a good tool for evaluating the use of LBC, we must associate a self-administered questionnaire.

Which generic health related Quality of Life questionnaire should be used in older inpatients: comparison of the Duke Health Profile and the MOS Short-Form SF-36?

OBJECTIVES: The objective of our study was to compare advantages and limitations of two generic Quality of Life questionnaires administered in older inpatients. DESIGN: Two validated generic health-related Quality of Life instruments : the MOS Short-Form 36 (9 dimensions, 36 items) and the Duke Health Profile (6 dimensions, 4 dysfunctions, 17 items) were administered to inpatients over 65 years. SETTING AND PARTICIPANTS: The sample was drawn from the CliniQualVie program that assessed systematically Quality of Life among hospitalized inpatients (18-79 years) in 10 medical and surgical wards at Nancy University Hospital. RESULTS: The two self-administered questionnaires were completed by 701 patients over 65 years at admission (mean age 71 +/- 4, 63% men). The proportion of patients who completed all items were 72.5% for the Duke and 66.9% for the SF-36 (p < .001). The Duke's internal consistency was low as compared with the SF-36, but other psychometric properties were comparable. Good correlations (Spearman) were observed between the two questionnaires for physical health (0.59, p < .0001), mental health (0.68, p < .0001) and health perception (0.56, p < .0001) scores. Low correlations were observed for the social score. CONCLUSIONS: This is the first study to our knowledge to assess the interest of using the Duke Health Profile in a general elderly inpatients population as compared with the SF-36 questionnaire. Although these two questionnaires have four comparable dimensions, they differ in their content and psychometric properties. The Duke questionnaire, due to its better completion rate and despite some psychometric limitations may be useful in this population, particularly in the more frail patients.

Quality of Life in elderly inpatients with atrial fibrillation as compared with controlled subjects.

OBJECTIVES: Since few studies have investigated Health related Quality of Life (HRQoL) in older patients with atrial fibrillation, the aim of this cross-sectional study was to compare HRQoL in AF elderly inpatients of 65 and more with that of age-matched controlled subjects. DESIGN: HRQoL was assessed with two generic HRQoL instruments: the MOS-SF 36, a largely recognized instrument, and the Duke Health Profile. SETTING AND PATIENTS: Nancy University Hospital patients presenting with atrial fibrillation and three controls per patient free of cardiac arrhythmias, matched by age, sex and hospital department to atrial fibrillation patients. RESULTS: Forty one atrial fibrillation patients and 123 controls were included. Both groups were comparable for associated disorders, other than coronary artery disease and chronic respiratory failure. After adjustment, scores among atrial fibrillation patients were lower than among controls in 8 of 10 Duke and 6 of 8 SF-36 subscales. In terms of Quality of Life, meaningful differences (>or= 5 points) were recorded in the Duke: Mental, Depression, Anxiety, General Score; and in the SF-36: Physical functioning, Role emotional, Social functioning and Vitality. Nevertheless statistically significant differences were only observed for the Duke Mental (p=0.01), Depression (p=0.003) and Anxiety (p=0.03) scores. CONCLUSIONS: In our study HRQoL measured in elderly inpatients with atrial fibrillation as compared with matched controlled was mainly altered in the "psychological" domains of the Duke Health Profile. From the patient's point of view, atrial fibrillation appears to have more mental than physical consequences. This study pointed out the utility to assess HRQoL in the management and treatment of elderly hospitalised atrial fibrillation patients.

[Postoperative pain management on surgical wards in one university hospital: short- and medium-term effects of a quality assurance program]. / Evaluation à court et à moyen terme d'une démarche qualité pour la prise en charge de la douleur postopératoire dans un CHU.

OBJECTIVES: Evaluation of the short- and medium-term impact of a postoperative pain management quality assurance programme in a university hospital. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: In 1998: chart review and survey of patients and professionals. Principal corrective actions: support for evaluation and tracking of potentially painful surgical procedures, prescription form including an emergency treatment plan, distribution of a set of guidelines. Evaluation was identical during the quality assurance programme and three years later, in 2003. RESULTS: In 2003, information regarding postoperative analgesia was received by 70% of patients and understood by 99% (50% in 1998, p<0.001). Sixty-two percent of patients were totally satisfied with their doctors in 2003 vs 75% in 1998 (NS). Pain was documented in 63.1% of charts in 2003, vs 10% in 1998 (p<0.001). Hundred percent of doctors were aware of the analgesic protocols in 2003 vs 69% in 1998 (p<0.02). In 2003, the treatment of analgesic side effects was known by 86% of doctors vs 29% in 1998 and these effects were looked for by 57% of caregivers in 2003 vs 11% in 1998 (p<0.001). CONCLUSION: Management of postoperative pain has progress significantly and the quality indicators used for evaluation have improved. Patients are better informed, which raises standards. The programme will be extended to all other surgical departments of the hospital, under the authority of CLUDS (Committee for Pain Control and Palliative Care).

[Proximal 4-part humerus fractures treated by antegrade nailing with self-stabilizing screws: 31 cases]. / Fractures à quatre fragments de l'humérus proximal traitées par enclouage léger antérograde à vis autostables: à propos de 31 cas.

PURPOSE OF THE STUDY: We present results of an internal fixation procedure for 4-part fractures of the upper part of the humerus with or without impaction. MATERIAL AND METHODS: Antegrade nailing with self-stabilizing screws, by Telegraph nail, was used in 31 patients treated between June 1998 and June 1999. The standard insertion technique or the cup-and-ball method were used for nail insertion depending on the type of fracture (Neer and Duparc classification), the cup-and-ball method allowing fixation of more complex fractures. Clinical and radiological data were available for 23 patients at a mean follow-up of two years. Functional outcome was assessed with the Constant score. RESULTS: At last follow-up, the rough Constant score was 63 and the age- and sex-balanced Constant score was 85. Mean antepulsion was 130 degrees. Outcome was significantly better for Duparc type 2 cephalotuberosity fractures (scapula valga) where the weighted Constant score was 93. There were two cases of necrosis. DISCUSSION: Complex fractures of the upper part of the humerus are a major therapeutic challenge. To date, there is no agreement on the most appropriate osteosynthesis method and the results of shoulder prosthesis after trauma remain controversial. The Telegraph nail appears to be a simple and reproducible method of achieving reduction, stability, and early mobilization. Functional outcome has been favorable for type 2 cephalotuberosity fractures and only two cases of necrosis were observed in this series in patients with type 3 and 4 cephalotuberosity fractures. These good results are related to the self-stabilizing effect of the locking screws which allow a stable fixation and revascularization of the bony fragments by creeping substitution. This new system is an attractive alternative to shoulder prostheses in trauma victims with complex displaced fractures without impaction. The surgical technique remains difficult. It would appear reasonable to expect remarkable and reproducible results for impacted fractures.

Factors associated with the consumption of psychotropic drugs in a cohort of men and women aged 50 and over.

OBJECTIVES: The use of psychotropic drugs has increased continuously over recent years in industrialized countries. In Europe, France has the highest consumption of such drugs. The aim of this study was to identify the sociodemographic and medical factors associated with the use of psychotropic agents. METHODS: Data, collected as part of the SUVIMAX (SUpplementation en VItamines et sels Mineraux AntioXydants) prevention trial, from a self- administered questionnaire involving 7299 subjects aged 45-60 years, were subjected to logistic regression analysis. RESULTS: A total of 467 subjects used psychotropic drugs (8.4% of the women, 4.6% of the men). Use of psychotropic drugs increased in subjects of both sexes with past history of depression, perception of poor health and use of other drug treatments. Widowhood in men [odds ratio (OR) = 3.4; 95% CI = 1.6-7.3] and divorce in women (OR = 2; 95% CI = 1.2-3.2) were also associated with an increased use of psychotropic drugs. Interaction was demonstrated between educational level and occupational satisfaction in men (OR = 2.9; 95% CI = 1.5-5.8) and between perception of health status and use of other types of medication in women (OR = 6.5; 95% CI = 4.6-9.5). CONCLUSION: The results of our study are consistent with those of others in demonstrating that specific socio-occupational factors in men and specific medical factors in women influence extent of use of psychotropic drugs.

[A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results]. / Un nouveau clou verrouillé pour les fractures proximales de l'humérus.

We present a new nail, the telegraph nail, designed for the treatment of proximal fractures of the humerus. This nail has a new locking system providing a self-stabilization of the cancelous screws inserted in small fragments. We discuss the surgical technique and present preliminary results. The anterolateral approach and nail insertion through the medial and well vascularized part of the cuff is described for simple fractures. With the cup and ball technique, this nail can also be used for complex fractures of the proximal humerus with three or four fragments and major displacement. With this method, the nail is inserted before reduction and locked in the distal humerus before fixation of the head and tuberosities around the head once the targeting device removed. We report results for the first 64 nails inserted in our unit during the first year (1998-1999). Outcome was assessed at 11 months mean follow-up using the Constant score. Outcome was favorable, including in patients with complex fractures involving 3 or 4 separate displaced fragments. Besides providing an anatomically stable reconstruction, the telegraph nail has the advantage of allowing early mobilization of the shoulder joint. This method is a useful alternative to prosthetic reconstruction for traumatic fractures of the proximal humerus.

Factors determining inpatient satisfaction with care.

The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases. Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of care and services, recommendations/intentions). Patient satisfaction and complaints were treated as dependent variables in multivariate ordinal polychotomous and dichotomous logistic stepwise regressions, respectively. Patient sociodemographic, health and stay characteristics as well as organization/ activity of service were used as independent variables. The two strongest predictors of satisfaction for all dimensions were older age and better self-perceived health status at admission. Men tended to be more satisfied than women. Other predictors specific for certain dimensions of satisfaction were: married, Karnofsky index more than 70, critical/serious self-reported condition at admission, emergency admission, choice of hospital by her/himself, stay in a medical service, stay in a private room, length of stay less than one week, stay in a service with a mean length of stay longer than one week. The factors associated with inpatient satisfaction elucidated in this study may be helpful in interpreting patient satisfaction scores when comparing hospitals, services or time periods, in targeting patient groups at risk of worse experiences and in focusing care quality programs.

[Satisfaction of patients hospitalized in Ho Chi Minh City, Vietnam]. / Satisfaction des patients hospitalisés à Hô Chi Minh-Ville, Viet Nam.

This study aims to describe the level of satisfaction of patients and their families, according to the type of hospital and the sociodemographic characteristics of patients hospitalised within Ho Chi Minh City (HCMC), Vietnam. The study is supported by a sample of 538 patients and their families from all of the hospitals in HCMC to whom an evaluation questionnaire was given to be filled out on the day of their release. The average age is 39, and 64.4% are women. The scores measuring the level of satisfaction vary from 57.7 to 90.7 points (on a scale of 0 to 100). The section under the heading "treatment provided by the doctors" received the highest scores (90.7/100). Dissatisfaction was primarily associated with factors such as the amount of time spent waiting, the behaviour of the hospital staff, cleanliness, the cafeteria and parking for motorbikes. Almost 100% of the patients spoke about their experiences during their stay in the hospital, and 50.2% had some negative opinions (1.042 complaints registered). The older patients, having a lower level of education and living either in other cities or in the rural region of HCMC, tented to be more satisfied than the younger patients, possessing higher levels of education and generally residing in the sub-urban or urban regions of HCMC. The patients who judged their condition to be very serious and their problems bad enough to justify hospitalisation, and who also felt that their health and condition had improved at the time of release compared to the time of admission were more satisfied than the other patients. Patients hospitalised who had an individual private room in a specialised hospital tended to be more satisfied that those who had a room sharing many beds for several patients in either a general hospital or in the emergency area of a specialised hospital. The authors observed no correlation between the level of satisfaction and the patient's gender. The results of this study have highlighed that certain domains, notably hat of the hospital's environment, should be reviewed and examined by health care administrators and managers in order to ensure the quality of the patient's care and coverage.

No correlation between wine intolerance and histamine content of wine.

BACKGROUND: Histamine is thought to be the main cause of adverse reactions to wines. OBJECTIVE: The purpose of this study was to test the hypothesis that the level of histamine in wine affects the tolerance to wine in 16 subjects with wine intolerance. METHODS: We performed a study to examine the effects of wine histamine content in 16 adults with wine intolerance. Each subject underwent 2 double-blind provocation tests with wine: 1 with a wine poor in histamine (0.4 mg/L), and 1 with a wine rich in histamine (13.8 mg/L). Blood was collected for histamine and methylhistamine RIAs at 0, 10, 30, and 45 minutes after ingestion of the wine. Methylhistamine and methylimidazolacetic acid (gas chromatography and mass spectrometry) were measured in urine 5 hours before and 5 hours after ingestion. RESULTS: No significant differences in the occurrence of adverse reactions were noted after ingestion of either of the wines (McNemar test). At 10 minutes, a significant increase was observed in plasma histamine with histamine-poor wine. No significant changes (Wilcoxon test) were observed in the methylhistamine and methylimidazolacetic acid levels after ingestion of either histamine-poor or histamine-rich wine. CONCLUSION: This study demonstrates that there is no correlation between the histamine content of wine and wine intolerance. The increase of plasma histamine levels at 10 minutes with histamine-poor wine suggested the role of a histamine-releasing substance. The role of acetaldehyde is discussed.

[Evaluation of professional practices]. / Evaluation des pratiques professionnelles.

Concepts and methods in professional practices evaluation are often confused. After a description of the classical conceptual framework, we present these methods in an approach in which practice is the principal result to be measured. Thus it makes it possible to apply the traditional epidemiological concepts to the evaluation of the professional practices with their three traditional fields: 1) In the descriptive approach, cross-sectional practice studies allow an observation and description of the usual behaviors, possibly compared to references. The methodological constraints are the same as which of descriptive epidemiological studies; 2) In the analytical approach, factors associated with practice - simple or conformed to criteria - are evidenced on a representative sample; 3) In the evaluative approach of practices improvement, the objectives are the assessment of formative, organizational or structural interventions, aiming at modifying practices. Three types of studies are to be used: quasi experimental in which clinical audit is the reference method in the field of medical care. The six main steps of clinical audit are described; experimental, based on the community randomized trial scheme, which have the advantage to provide results that can be immediately generalized; observational in which no control on the implementation of intervention is done. "Here and else" and "before and after" studies are used. To be effective for evaluation of professional practice, theses methods must come within the scope of a favorable institutional context.

[Clinical research, evaluation of care and quality assurance]. / Recherche clinique, évaluation des soins et assurance qualité.

This paper aims to clarify the concepts and terminology of clinical research, evaluation, and quality. Clinical research or clinical epidemiology aims to demonstrate the efficacy of medical care. The optimal methodology is a randomized, double-blind trial that allows a causal inference in respect of efficacy. This should be the first stage before generalization of all medical practice. Evaluation of quality of care aims to verify the effectiveness of medical care by comparing practice with references. The optimal methodology is clinical audit that allows fine-tuned diagnosis of the existence of deviant practices. The analysis of causes and correction of the care process are an integral part of the evaluation work. Thus quality assurance and quality management concepts and methods have been developed which tend to ensure solutions for better care and to maintain the level of quality of care to achieve patient satisfaction. Evaluation, clinical research and management quality could in fact be seen as the complementary facets of a comprehensive approach to quality of care.

Evaluating a computerized tool for coding patient information.

OBJECTIVE: Computerized tools may be useful in speeding up and facilitating the laborious task of coding patient information. This paper describes a method of objectively evaluating their efficiency. DESIGN: 38 study subjects were randomly assigned to a manual coding group or an automated coding group, with stratification according to two variables (used to coding yes/no, physician yes/no). Subjects then coded the same standardized set of diagnoses in a limited time. The numbers of exact codes retrieved were compared using a global analysis of variance model. RESULTS: The two groups were not significantly different with regard to the number of physicians (p = 0.74) and the number of usual coders (p = 0.52) they included. Significantly more exact codes were achieved in the group using automated coding than among the manual group (p = 0.04). Physicians were significantly more efficient at coding than non-physicians (p = 0.02). CONCLUSION: This study describes an objective means of evaluating the performance of an automated coding tool. It shows that better results were achieved with the computerised compared to the manual method, even when the superior abilities of physicians were taken into account.