[Hospitalization in French forensic units: Results of a patient satisfaction survey]. / Hospitalisation en unité hospitalière spécialement aménagée : enquête de satisfaction auprès des patients.

BACKGROUND: In France, special full-time inpatient hospital units (UHSA) have been created for inmates with psychiatric disorders. Since they were established in 2010, the quality of care in such units has not been studied. Particularly, no patient satisfaction survey has been conducted yet. The main objective of this study was to assess the patients' satisfaction about their hospitalization in UHSA. METHODS: A descriptive study has been performed in two hospitals (UHSA of Villejuif and UHSA of Lille-Seclin). From February to May 2015, 125 adult patients were included, at the end of their hospitalization (voluntary or involuntary psychiatric care) in UHSA. The patient's satisfaction was assessed by a psychiatrist who did not participate in patient care with a 16-item scale exploring three areas (quality of care, quality of information provided and UHSA functioning and organization). The items were evaluated with a visual numeric scale (1 to 10). RESULTS: The average score of overall satisfaction was 7.3±1.9 (average±standard deviation) for this sample. For the care area, the average score was 7.6±2; for the quality of information provided, it was 7.5±2.5 and for UHSA functioning and organization, 7.0±2. Furthermore, 84.8 % of patients reported their wish to continue psychiatric care in prison and 77.6 % after release. CONCLUSION: This study demonstrates that patients hospitalized in UHSA are satisfied. Given the relationship between patient satisfaction and compliance, these structures could therefore have an important medical interest for inmates with psychiatric disorders. However, these results need to be replicated in a study involving all the UHSA of France.

Mediterranean spotted fever in Marseille: descriptive epidemiology and the influence of climatic factors.

The authors report the general epidemiologic features of Mediterranean spotted fever (MSF) in the Marseille area (South France). Age was a risk factor, increasing after 50 years, and annual incidence seemed positively correlated with the average temperature of the preceding year and negatively correlated with the number of days with frost of the preceding year. However, correlations were not significant.

Incidence, clinical observations and risk factors in the severe form of Mediterranean spotted fever among patients admitted to hospital in Marseilles 1983-1984.

Seven of 142 cases (5%) of Mediterranean spotted fever admitted to hospital in Marseilles in 1983 and 1984 were severe. All of them were confirmed by specific laboratory tests. The disease resembles Rocky Mountain spotted fever with purpuric exanthem, confusion, renal insufficiency, hypoxaemia, thrombocytopenia, hyponatraemia and hypocalcaemia. Two patients died. The predisposing factors for severity were old age, alcoholism, heavy smoking, respiratory insufficiency and glucose-6-phosphate dehydrogenase deficiency.

[Intrabronchial diffusion of amoxycillin when administered by two different injection modes (author's transl)]. / Diffusion intrabronchique de l'amoxicilline administrée selon deux modalités d'injection différentes.

Twelve ICU patients, all with broncho-pulmonary infection were treated with 50 mg/kg-1/24 h-1 of amoxycillin administered every eight hours, either by one hour perfusion, or by brief IV injection (2'). Both modes were given to all of the patients in order to determine, by comparison, the most efficient treatment. There is no significant difference in serum levels after perfusion or IV injection. However, IV injection is preferable because of a significant difference in bronchial levels after 3 hours (p less than 0.01). In most cases, the bronchial levels and the bronchio/serum concentration ratios, while not significantly different, are higher than after perfusion. None of the results justify the use of perfusion.

[Serial measurement of serum levels of amikacin. Value in therapy]. / Mesures répétées des taux sériques d'amikacine. Intérèt dans la conduite thérapeutique.

Amikacin serum levels were measured 256 times in 65 patients admitted into the intensive care unit for various reasons over 18 months. These measurements confirmed the dosage of 5 micrograms per kg repeated every 8 hours in patients with normal renal function. Forty eight hours before the first measurement, a control assay is essential to check that there is no residual antibiotic and that the antibacterial activity of the serum is zero. After this a single weekly control is sufficient to check that the residual level is effective and non toxic, i.e. between 2 and 6 micrograms per ml. However, in patients with acute renal insufficiency, there are three dosage schemas which should be used depending on the creatinine level. These three schemas are nevertheless not sufficient to continue effective therapy without a risk of toxic side effects. It is therefore necessary to check both the pack levels and the residual levels regularly from the beginning of treatment. Two to three weekly controls are essential to avoid a risk of toxic side effects.

[Kinetics of multiple-dose amikacin in the newborn infant]. / Cinétique de l'amikacine à doses multiples chez le nouveau-né.

A pharmacokinetic study of amikacin was carried out in 12 neonates hospitalized in the intensive care unit. Serum amikacin levels were measured using a bacteriological method after one of several intramuscular injections of 7.5 micrograms/kg. Serum levels were greater than 10 micrograms/ml during the first three hours in 11 cases with values greater than or equal to 30 micrograms/ml. during the first two hours in five cases. The half life was measured in five patients and varied between three and eight hours. The plasma clearance was between 8.9 and 14 mil per minute per 1.73 m2. There is an unpredictable accumulation of this antibiotic especially in premature babies aged less than five days with a birth weight less than two kg. This accumulation is transitory when the clinical evolution of the case is favorable but it can be prolonged in unfavorable cases. The elimination of amikacin depends mainly on a patient's renal function. So, because of the risk of ototoxicity, the dosage should be reduced to 10 mg per kg-1 per 24 h-1, with measurements of the serum peak level and the level just before the following injection.

[Bacteroides fragilis septicemia]. / Les septicémies à bactéroïdes fragilis.

On the basis of eight cases of Bacteroides fragilis septicaemia, the authors review recent data from the literature related to this topic. They first note the increasing prevalence, accounting for approximately 10 per cent of all septicaemias at the present time. They note that the most frequent portals of entry are sites of localised suppuration, related on the one hand to digestive or gynaecological surgery and, secondly, to the post-partum or post-abortum period. From a therapeutic standpoint, they stress the important role of imidazole derivatives (metronidazole or tinidazole) which are the most effective antibiotics at present. Certain authors even suggest their use on a preventive basis in high risk subjects.

[Treatment of septicemia and severe infections with a cefradine-tobramycin combination]. / Traitement des septicémies et des infections graves par l'association céfradine-tobramycine

The cefradine-tobramycine association was used in 11 cases of septicaemia and in 10 cases of non-septicaemic severe poly-infections. In 15 cases, the treatment was undertaken because of the serious state of the patients before the bacteriologic results were known. This association is characterized by its great effectiveness and its very good tolerance, mainly from the renal point of view. The results shown here corroborate those two elements.

[Evaluation of 1200 venous catheterizations in reanimation]. / Bilan de plus de 1200 cathétérismes veineux en réanimation

The authors present a series of 1247 venous catheterizations during resuscitation, the latter being carried out under particularly strict aseptic conditions. This series contains especially: - 364 internal jugular catheterizations; - 223 subclavian catheterizations; - 130 femoral catheterizations. The total number of days of infusion is 6300, of which 3,619 were of prolonged parenteral feeding. 79.5 p. 100 of the catheters cultured proved to be sterile; in the case of those cultures which were positive, 6.5 p. 100 were due to pathogenic organisms, 13.9 p. 100 were due to saprophytes. On the whole, 7 septicemies of venous origin (0.56 p. 100 of all of the catheterizations) were observed. The détailed study of each route shows that the frequency of cultures of pathogen positive catheters is practically the same in all cases. On the other hand, the frequency of cultures of catheters positive with saprophytes is evidently higher for the internal jugular vein; this being particularly true in the male where the role of the beard as a contaminating factor is evoked. The importance of asepsis in the procedure of putting venous catheters in place and in their maintenance seems to be welle demonstrated by the results presented.