Predicting prolonged length of hospital stay in older emergency department users: use of a novel analysis method, the Artificial Neural Network.

OBJECTIVE: To examine performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]) of a 10-item brief geriatric assessment (BGA) for the prediction of prolonged length hospital stay (LHS) in older patients hospitalized in acute care wards after an emergency department (ED) visit, using artificial neural networks (ANNs); and to describe the contribution of each BGA item to the predictive accuracy using the AUROC value. METHODS: A total of 993 geriatric ED users admitted to acute care wards were included in this prospective cohort study. Age >85years, gender male, polypharmacy, non use of formal and/or informal home-help services, history of falls, temporal disorientation, place of living, reasons and nature for ED admission, and use of psychoactive drugs composed the 10 items of BGA and were recorded at the ED admission. The prolonged LHS was defined as the top third of LHS. The ANNs were conducted using two feeds forward (multilayer perceptron [MLP] and modified MLP). RESULTS: The best performance was reported with the modified MLP involving the 10 items (sensitivity=62.7%; specificity=96.6%; PPV=87.1; NPV=87.5; positive LR=18.2; AUC=90.5). In this model, presence of chronic conditions had the highest contributions (51.3%) in AUROC value. CONCLUSIONS: The 10-item BGA appears to accurately predict prolonged LHS, using the ANN MLP method, showing the best criteria performance ever reported until now. Presence of chronic conditions was the main contributor for the predictive accuracy.

[A proposal of ready-made interpretative comments applicable to serum protein electrophoresis]. / Proposition de commentaires interprétatifs prêts à l'emploi pour l'électrophorèse des protéines sériques.

Zone electrophoresis for separation and quantification of serum proteins is useful in numerous pathological situations to make clinical diagnostics, to follow the evolution of a disease or to evaluate the efficiency of a treatment. The biologist must apply professional recommendations according to the official nomenclature of biological analysis. He must attach a comment to each result in order to help the physician to perform the best interpretation of the results. To answer those needs, a work of standardization of these comments has been realized by a group of biologists. They are members of the national college of biologists (CNBH). All the commentaries are assembled in a thesaurus which could be a base of ready-made comments, favouring the interpretation of serum protein electrophoresis results.

[Psychometric properties of a new instrument for evaluating quality of life, the WHOQOL-26, in a population of patients with neuromuscular diseases]. / Propriétés psychométriques d'un nouvel instrument d'évaluation de la qualité de vie, le WHOQOL-26, à partir d'une population de malades neuro-musculaires.

This study describes the principal psychometric properties of the French version of the WHOQOL-26, a short version (26 questions) of the WHOQOL-100, which are World Health Organization instruments for evaluation of quality of life (QOL) which include four dimensions (physical, psychological, environmental, social relations). The use of this tool with psychiatric patients is discussed. Collection of data was performed during a national inquiry on persons with neuromuscular disorders. The population included 2,102 subjects (mean age 42.9 +/- 15 years). Ten different clinical entities were represented, which differed in the type of lesion of the motor unit, the permanence and localization of the loss of muscle strength, the progression of the respiratory deficit, the moment of its occurrence and seriousness of prognosis. This questionnaire was well-adapted to the study population (weak effect of extremes) and was well-accepted (only 5% non-responses). Compared with the long version, homogeneity is less pronounced, but remains acceptable (the item-scale correlation is superior to 0.40 for 66.7% of some items), which is the same as the reliability (Cronbach's alpha coefficient always over 0.65). The sensitivity in relation to the diagnosis is verified for all four dimensions (p = 0.05). The concurrent validity, studied using general QOL evaluation scores, satisfaction with health, and the importance of repercussions of incapacities on daily life was also globally demonstrated (p < 0.0001).

Presence of enamel on the incisors of the llama (Lama glama) and alpaca (Lama pacos).

Attempts have been made to define the relationships among the South American camelids, the guanaco, llama, alpaca, and vicuna, by comparing the morphology of their incisors. The alpaca has been reported to have an incisor morphology similar to the vicuna, lacking enamel on the lingual surface. The llama and guanaco are said to have enamel on both the labial and lingual surface of their incisor teeth. These comparisons have been based on gross morphological observations and not on histologic analysis. This study was undertaken to determine whether or not alpaca teeth have enamel on the lingual surface. The cross-sectional histologic anatomy of the incisor teeth was compared in two closely related South American camelid species, the llama (Lama glama), and the alpaca (Lama pacos). Thick sections (300 microm) and scanning electron microscopy were the techniques utilized. The mandibular first, second, and third incisors were examined in four llamas and five alpacas. A substantial layer of enamel was present on all surfaces of all llama incisors. The enamel layer on the labial surface of the alpaca incisors closely resembled that found in the llama. The enamel layer on the lingual surface of the alpaca incisors, although greatly reduced, was distinctly present. Alpacas may be more closely related to guanacos and llamas than to vicunas. A histologic study of vicuna incisors would help to better define the relationships of the four camelids.

[Ensuring the safety of erythrocyte concentrates using quarantine]. / Sécurisation des concentrés de globules rouges par quarantaine.

We have decided that it is essential to establish a process to protect patients receiving concentrated red blood cells (CGR) from a residual risk of contamination by the HIV virus or by the hepatitis C virus. Viral inactivation techniques of labile blood products are not presently in use, only safety measures obtained by quarantine allow a reduction of this risk to a value approaching 0. We have developed, from known deep-freeze methods of red blood corpuscles, a process to place the samples of concentrated red blood cells in quarantine by means of deep-freezing. We have modified and automated the deep-freezing, thawing and washing manipulations of the red blood corpuscles in order to obtain a final product which is standardized in quantity and quality. The result of our work will show: That all the means employed are not a source of contamination of the end product. That the procedures employed may be easily adapted to all Blood Transfusion Centers. That the end-product may be used after 21 days of conservation. That the extra cost entailed by this procedure is realistic.

Nutritional assessment in Duchenne muscular dystrophy.

A specific-weight chart and simple clinical tools are sufficient to obtain an accurate diagnosis of undernutrition or obesity among patients with Duchenne muscular dystrophy (DMD). The authors collected weight-for-age measures from a sample of 252 boys and anthropometric data from 109 of those boys with DMD. The data confirm the accuracy of the DMD ideal-weight chart previously proposed by Griffiths and Edwards (1988). Obesity may occur from the age of seven years; its prevalence seems to reach 54 per cent by the age of 13 years. Undernutrition occurs after the age of 14 years, involving 54 per cent of boys at about 18 years of age. Obese boys show a centralized body-fat distribution, in agreement with other obese populations.

Tianeptine and amitriptyline. Controlled double-blind trial in depressed alcoholic patients.

129 chronic alcoholic patients, withdrawn from alcohol and presenting major depression or dysthymic disorder, were treated for 4-8 weeks under double-blind conditions either with a new antidepressant, tianeptine (37.5 mg per day), or with amitriptyline (75 mg per day). Both groups presented steady improvement of the symptoms of depression during treatment, as scored on the Montgomery and Asberg Depression Rating Scale and the Hopkins Symptom Checklist self-evaluation; for the latter scale, the improvement was significantly greater in the tianeptine group. In addition to the improvement of mood, tianeptine also produced significant reduction of the somatic complaints of the depressed patients. Furthermore, tianeptine possesses anxiolytic activity, as shown by the change of the Hamilton Anxiety Rating Scale global score, similar to that produced by amitriptyline. The anxiolytic activity of tianeptine was not accompanied by any impairment of vigilance, unlike that of amitriptyline. Tianeptine produced rare, mild anticholinergic effects. The results obtained show that tianeptine is an effective anxiolytic antidepressant, with better safety than amitriptyline, suitable for use in the treatment of mood disorders following alcohol withdrawal.