Oral anticoagulant treatment - evaluating the knowledge of patients admitted in physical medicine and rehabilitation units.

INTRODUCTION: While numerous therapeutic education programs exist in physical medicine and rehabilitation (PM&R), they rarely concern pharmacological treatments. Nevertheless, drugs prescribed during a hospital stay can have a significant risk of adverse events. Vitamin K antagonists (VKA) are among them. OBJECTIVE OF THE STUDY: To assess patients' knowledge on their oral anticoagulant treatment before their hospital discharge. METHODS: Fifty patients were enrolled in this prospective, monocenter study. Their level of knowledge was assessed by a semi-structured interview between the pharmacist and the patients and/or their caregivers. RESULTS: Seventy percent of patients were able to give the name of the drug they were taking, 82% could explain its effect and finally, 24% of patient knew their INR target values. Twenty-two percent of patients were able to describe the symptoms in case of overdose and what to do in that case. Forty percent of patients were aware of food interactions and 60% of self-medication risks. The patient's knowledge and behavior acquired during their hospital stay are not enough to guarantee a safe treatment management upon discharge. Based on this study, therapeutic patient education sessions were implemented. CONCLUSION: These results suggest that specific drug therapy management sessions should be developed as part of PM&R's therapeutic education programs for patients.

High prevalence of nosocomial infections in rehabilitation units accounted for by urinary tract infections in patients with spinal cord injury.

This study (part of the nationwide French prevalence survey of 2001) was organized to investigate the prevalence and risk factors of nosocomial infections (NIs) and the resistant flora in patients hospitalized in rehabilitation units. Two hundred and eighty-six patients were included from two hospitals in the 'Hospices Civils de Lyon' group. Patients were classified into those with and without a spinal cord injury (SCI). Seventy-eight (27.3%) patients had an SCI. They were younger and more often characterized by a low Activity of Daily Life score, bladder incontinence and chronic respiratory disease. Urinary catheterization and mechanical ventilation were more common in these patients. The NI prevalence rate was higher in the SCI group (21.8% vs 4.3%, P<0.00001), particularly for urinary tract infections (UTIs, 19.2% vs 3.4%, P<0.00001). There was a positive relationship between the number of risk factors and NI acquisition. Multi-variate analysis showed that the only independent risk factor for NI acquisition was indwelling urinary catheterization [odds ratio (OR): 11.64, 95% confidence intervals (CI): 2.53-53.65, P=0.002]. Marginally significant factors were chronic kidney or liver disease (OR: 5.84, 95%CI: 0.80-42.68, P=0.082) and SCI (OR: 2.97, 95%CI: 0.61-14.60, P=0.179). The prevalence of antibiotic-resistant micro-organisms was high (nine cases of resistant organisms for 31 infection sites), but there were no differences between the groups. The high rate of NIs, especially UTIs, in SCI patients was not due to an independent effect of SCI but was probably due to the high number of risk factors. These high-risk patients need targeted NI surveillance.

[Effusions rich in amylase without pancreatitis. 14 cases]. / Les épanchements riches en amylase en dehors des pancréatites. Quatorze observations

This study involved 14 cases or pleural effusions or ascites rich in amylase and unrelated to chronic pancreatitis, a pseudo-cyst of the pancreas or acute pancreatitis. A pleural effusion rich in amylase may be secondary to a pancreatic neoplasm but this possibility seems rare. Amylase-containing effusions related to a nonpancreatic neoplasm are more common. The lesion is in general an advanced pleuro-pulmonary carcinoma, frequently an adenocarcinoma. The amylase activity of neoplastic effusion fluid is significantly increased but although levels similar to those of certain pancreatic effusions may be seen, very high figures would appear to be rare. Finally, two cases of amylase-rich pleural effusions were related to a pleuro-digestive fistula and one left-sided effusion was secondary to abdominal trauma.