[Locoregional anesthesia for injuries of the lower limbs]. / Anesthésie loco-régionale pour traumatismes des membres inférieurs.

Isolated lower limb injuries are very common; difficulties for emergency anaesthesia may come from full stomach and drug interferences. The outcome of geriatric-fractured hip is influenced neither by a preoperative delay shorter than 48 hours, nor by the choice of anaesthetic technique; Nevertheless the use of acrylic cement is associated with an increased early mortality rate in hemiarthroplasties. Regional anaesthesia is the best choice for stable patients with a limited peripheral injury; The technique must be adapted to the pain induced by fracture; sitting position is useful for puncture. Spinal anaesthesia using 0.5% plain bupivacaine produces a block quickly achieved, not influenced by posture, allowing surgical installation and procedures. Postoperative analgesia using local anaesthetics may obscure symptoms of compartment syndrome which occasionally complicate tibial and femoral nailing.

[Preliminary validation of instruments used to measure the psychotherapeutic knowledge, skills and attitudes of family physicians]. / Validation préliminaire d'instruments de mesure des connaissances, des habiletés et des attitudes psychothérapeutiques chez des médecins de famille.

OBJECTIVE: To examine the validity and the reliability of three measurement instruments used to evaluate mental health training offered to residents in family medicine. DESIGN: Development and submission of three French-language instruments measuring knowledge, perceived skills, and attitudes of family physicians and residents. SETTING: Weekly psychotherapy workshop. PARTICIPANTS: A group of 90 family medicine residents and practising doctors were recruited by the authors and by teaching facilities. MAIN OUTCOME MEASURE: Reliability index KR20 and an evaluation of error in the instruments were used. RESULTS: The results satisfactory in terms of the measurement of perceived skills (KR20 = 0.86) and the measurement of attitudes (KR20 = 0.96); the measurement of knowledge (KR20 = 0.70) was clearly unsatisfactory and the instrument will require upgrading. The measurement of perceived skills was the only one to reveal a distinction between the groups; practising doctors and those interested in psychotherapy believed their skills to be superior to those of residents in training (P = 0.005). CONCLUSION: Instruments measuring attitudes and perceived skills have excellent psychometric potential; however, it remains to be determined whether the measurement of perceived skills is valid and whether these instruments are useful for monitoring family medicine residents during their training or for assessing the impact of mental health training programs.

Effectiveness of a three-month training program in psychotherapeutic intervention for family practice residents.

PURPOSE: To evaluate the influence on knowledge, perceived skills, and attitudes of a psychotherapeutic intervention program for family practice residents. METHODS: Between 1991 and 1993, a nonrandomized controlled study, using a pretest-posttest design, was used to compare a treatment group of 38 residents with a control group of 16 residents at two family medicine clinics affiliated with the Université de Montréal and Laval University Faculties of Medicine. The residents participated in a structured series of 12 seminars dedicated to psychotherapeutic interventions by family doctors. Three instruments were used to measure knowledge, perceived skills, and attitudes. Statistical analysis included two-tailed chi-square with Yates' correction and the Mann-Whitney test. RESULTS: Ten residents in the treatment group and one in the control group were excluded from analysis because they did not complete all the evaluations. Greater percentages of residents in the treatment group improved their perceived skills (89% versus 56%, p = .003), and their knowledge (82% versus 50%, p = .06). CONCLUSION: Skills of the "how-to" type improved more than relational skills. No significant effect on attitude was observed.

Chronic low back pain: a personal approach.

Sooner or later, all family physicians will face patients with chronic low back pain. This disorder does not result from the same causes and does not respond to the same treatment as acute back pain. A thorough assessment is the key to efficient treatment and should include data about familial, social, and occupational environments. The treatment should be multimodal and tailored to the patient's type of personality and to the causes of the syndrome.

Healthcare information systems: creating the competitive edge.

Recent surveys of information systems in healthcare organizations indicate they are, in many cases, inadequate to meet today's needs. Management has significant concerns related to the investments in these systems versus the benefits received. These systems' ability to support healthcare institutions in an even more competitive future environment is a major question. Therefore, the institution that recognizes the current shortcomings in its system and begins now to develop both short- and long-term approaches to dealing with them will have the competitive edge.