[Health-related quality of life evaluation of elderly aged 65 years and over living at home]

BACKGROUND

To assess health-related quality of life in French adults aged 65 years and over, living at home, with a specific self-administered questionnaire, the LEIPAD, cross-culturally adapted in French.

METHODS

Elderly completed socio-demographic and medical questionnaires, a questionnaire about negative life events during the last 12 months and the LEIPAD.

RESULTS

Data of 195 subjects (mean age: 72.6 years, men: 56.5%) were analyzed. The response rates to the LEIPAD scales were superior to 90%. Elderly reported on the whole a good health-related quality of life. Age had a negative effect on quality on life, which deteriorates over years. Age was correlated to the scales "Physical function", "Self-care", "Cognitive functioning" and "Sexual functioning". Elderly hospitalized in the last year had worse quality of life with a significant difference for "Physical function" scale. The number of health problems was positively correlated to "Physical function" scale. Elderly declaring at least one health problem had worse quality of life for this scale. Problems in couple, materials and financial problems had also negative effects on health-related quality of life.

CONCLUSION

Our study highlights a good health-related quality of life for the majority of these adults aged 65 years and over, as well as the negative effect of age, health, couple, materials and financial problems on their quality of life.

[The access of independent midwives to maternity ward technical facilities: the experimentation of a level-1 department]

OBJECTIVES

The first aim of this study was to evaluate the access of independent midwives to the technical facilities of a level-1 maternity hospital, with a follow-up of 2 years. The second aim was to evaluate the transfer of clinical responsibility, when a patient stops being managed by the independent midwife to be taken care of by the hospital team.

PATIENTS AND METHODS

A retrospective study including 51 patients. Analysis of maternal and perinatal data.

RESULTS

Of the 51 births, there were 42 vaginal deliveries without intervention (82.35%), 3 instrumental deliveries (5.88%), 6 caesarean sections (11.76%). The midwife-led care was completed in 70.59% of cases. The rate of transfer of clinical responsibility during labor was 25.49%. We conducted a neonatal transfer due to a respiratory distress syndrome.

DISCUSSION AND CONCLUSION

The access to technical support appears as an opportunity for independent midwives to establish a special relationship with their patients. However, this device preserves the possibility of a traditional hospital care when needed. This way, access to the technical support is a safe alternative that has the consent of the users (patients and midwives) as well as of the entire hospital team. Moreover, such device allowed an increase of 5% per year of our obstetrical activity with an estimated increase of 10% per year.

Transcultural validation of the Risk Assessment and Predictor Tool (RAPT) to predict discharge outcomes after total hip replacement

OBJECTIVE

To assess the relevance of the RAPT (Risk Assessment and Prediction Tool), among a cohort of patients undergoing total hip arthroplasty (THA).

METHOD

Prospective study of a cohort of patients evaluated before and after THA. The difference between the postoperative orientation predicted by the RAPT and the real one is assessed. Clinical, environmental and psychosocial criteria that could significantly change the orientation are discussed.

RESULTS

One hundred and thirty-four patients (94 women and 40 men) were included. The average age was 71.6 (±10) years. Primary hip osteoarthritis was the indication for surgery in 78% of cases. The average length of stay in the surgery ward was 10 (±3) days. It was significantly higher for patients referred to a rehabilitation ward (P<0.0001). Sixty-six percent of patients were referred to a rehabilitation ward and 34% returned directly home. The average length of stay in rehabilitation ward was 27 (±13) days. The validity of the RAPT as a help decision tool has been confirmed. Thus, a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward, conversely, a high RAPT score is significantly related to more frequent direct return to home.

CONCLUSION

This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty. The patient preference remains the main variable for orientation after THA. By the way, the patient preference must not be integrated into the RAPT, but need to be collected and be discussed with the patient.

[Management of allergic conjunctivitis. An observational study among ophthalmologists]

PURPOSE

To describe the management of allergic conjunctivitis in private ophthalmology practice and to evaluate the collaboration between ophthalmologists and allergists.

PATIENTS AND METHODS

Multicenter retrospective study. Each ophthalmologist was required to collect demographic and clinical data from the records of 10 patients with a 2- to 3-year history of allergic conjunctivitis.

RESULTS

A total of 353 records were interpretable, corresponding to 885 visits. Slightly more than 60% of patients had a history of allergy (rhinitis, asthma or cutaneous allergy), and 40% of patients had had allergy testing. Fewer than 2% of patients had seen an allergist. Analysis of presenting symptoms reveals that itching, burning, tearing, photophobia and discomfort led frequently to the diagnosis of allergic conjunctivitis. This was confirmed through the interview concerning the circumstances of symptom development (most frequently involving exposure to trees and flowers) and ophthalmologic examination (presence of hyperemia, follicles, watery discharge, chemosis). The presence of non-specific symptoms such as ocular dryness was relatively frequent in association with perennial conjunctivitis. Over 95% of patients were given a topical treatment while fewer than 10% were referred to an allergist.

CONCLUSION

Allergic conjunctivitis, particularly seasonal, is easily identifiable by an ophthalmologist. Perennial and more serious forms of conjunctivitis could be referred to an allergist more frequently.

Rates of progression of weight and forced vital capacity as relevant measurement to adapt amyotrophic lateral sclerosis management for patient Result of a French multicentre cohort survey

OBJECTIVES

To compare survival, to describe the progression of anthropometry, pulmonary capacity and functioning in ALS (Amyotrophic Lateral Sclerosis) and to identify the most relevant variables to adapt ALS management for patients.

METHODS

A cohort study was performed in French ALS centres between January 2003 and July 2005. Eligible patients were treated by Riluzole and had a slow vital capacity (SVC) or a forced vital capacity (FVC) at least equal to 60%. Demographic, medical and ALS characteristics were registered. Manual Muscular Testing (MMT) and ALS Functional Rating Scale (ALSFRS) were performed. Kaplan Meier method was used to analyse survival. ALS progression was measured by the percentage weight, FVC, SVC, MMT and ALSFRS loss and was analysed as longitudinal data using mixed model.

RESULTS

Three hundred and eighty three patients were included. The median survival since ALS diagnosis was 2.34 years (95%CI 2.10-2.65). Mixed model analyses revealed a more significant worsening progression of weight and FVC loss for bulbar onset. The drop of ALSFRS and SVC is similar whatever the ALS forms.

CONCLUSIONS

Rates of progression of weight and FVC should be regularly watched over to support neurologists to adapt ALS management for patients.

Cross-cultural evaluation of the French version of the LEIPAD, a health-related quality of life instrument for use in the elderly living at home

PURPOSE

To cross-culturally adapt a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life (HRQoL) in adults aged 65 years and over living at home, and to evaluate its psychometric properties.

METHODS

After having translated LEIPAD in accordance with guidelines, we studied psychometric properties: reliability and construct validity-factor analysis, relationships between items and scales, internal consistency, concurrent validity with the Medical Outcome Study Short-Form 36 and known-groups validity.

RESULTS

The results obtained in a sample of 195 elderly from the general population showed very good acceptability, with response rates superior to 93 %. Exploratory factor analysis extracted eight factors providing a multidimensionality structure with five misclassifications of items in the seven theoretical scales. Good internal consistency (Cronbach's alpha ranging from 0.73 and 0.86) and strong test-retest reliability (ICCs higher than 0.80 for six scales and 0.70 for one) were demonstrated. Concurrent validity with the SF-36 showed small to strong expected correlations.

CONCLUSION

This first evaluation of the French version of LEIPAD's psychometric properties provides evidence in construct validity and reliability. It would allow HRQoL assessment in clinical and common practice, and investigators would be able to take part in national and international research projects.

[Assessment of topical steroid treatment for childhood phimosis: review of the literature]

OBJECTIVES

Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations. Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery.

AIM

To assess the effectiveness of topical steroid therapy in boys with phimosis.

METHODS

Literature review. All randomized controlled trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials were also searched. The trials were analyzed using the ANAES guide from a therapeutic article.

RESULTS

Seven randomized controlled trials (n=714 patients) were in accordance with the inclusion criteria. The patients were between 1 and 12 years old. The treatment lasted for 4-8 weeks. The success rate at the end of the study was higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P<0.05 for 6 randomized control trials.

DISCUSSION

According to the ANAES criteria, the level of scientific evidence is low (gradeC) because of the lack of power in clinical trials and numerous methodological shortcomings and biases, even when examining both randomized control trials and nonrandomized trials. Only a few local side effects were noted.

CONCLUSION

The use of topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.

How a university hospital improves its prevention performance: results of two biennial studies 2004-2006

INTRODUCTION

Prevention is a legal obligation for French hospitals and should be systematically assessed.

AIM

To measure how a French University Hospital improved its prevention performance between two biennial prevention studies after incentives measures were applied.

METHODS

45 medical, obstetrical or surgical units were included. A doctor-nurse pair was free to select inpatients at random. 14 preventive procedures were evaluated: blood pressure check, measures of weight, height and body mass index, screenings for diabetes, cervix and breast cancers, tetanus and influenza immunizations, serologies of viruses, research for a prostatic and cognitive disorder and evaluation of alcohol and tobacco consumptions and addictions. Incentives measures for prevention were enacted during the same time.

RESULTS

In 2004 and in 2006, respectively 253 inpatients and 243 inpatients were respectively included. Tetanus immunization was checked in less than one tenth of cases in both the studies. Seven acts were performed more in 2006 and only body mass index was measured less.

DISCUSSION

The results were encouraging but insufficient especially for tetanus immunization. Weight was measured more than body mass index, probably meaning that's weight and more precisely its variations are a better clinical sign. Bad results for tetanus immunization meant that incentive strategies only displayed within the hospital were ineffective. Lastly, two propositions were done to improve the questionnaire and the prevention performance: to add five preventive services and a medical file first page, common to all units, summing up all preventive procedures evaluated.

CONCLUSION

The ability of this University Hospital to improve its prevention performance answering to local incentive measures was weak. Another solutions need to be found.

[The evaluation of the level of integration within a perinatal network]

OBJECTIVES

Our goal was to evaluate the level of integration of general practitioners within the perinatal network in the Auvergne.

MATERIALS AND METHODS

A cross-sectional study was realized. The questionnaire was sent by post to the 1346 general practitioners who were members of the "Union régionale des médecins libéraux" (Regional association of private doctors in the Auvergne). Follow-up phone calls were also made.

RESULTS

The overall response to the questionnaire was 29.8%. Of those who replied, 76.3% were involved in the care of pregnant women or newly born babies. Among them, 51.2% had a consultation with a pregnant woman less than once a week and 53,5% had a consultation with a newly born more than once a week. A third were aware of the network and 25.7% had knowledge of the medical record provided by the network. Among them, 91.3% thought that a common medical record was necessary to improve the coordination of care. The answers differed according to age, area of responsibility, the administrative geographic position in the Auvergne, type of practise (hospital, private), and the sex of those who replied.

CONCLUSION

Despite a high a priori agreement, we must improve the level of information and training given to general practitioners within our perinatal network.

[Assessment strategies of the impact of healing touch in nursing care]

New care methods have emerged in the last few years. Healing Touch is relaxing and as such, helps prepare the patient for the medical act, the pain of which he may often feel anxious about As they foster confidence between the patient and the medical practitioner, such practices create better conditions for the medical care act to be performed. Even if there is no doubt about its impact on the patient, the effect of Healing Touch has never been scientifically assessed, and the only available references are rather scarce. This is the reason why we wished to assess the impact of this care in a number of clinical situations through a randomised clinical experiment. The object of this paper is to assert the efficacy of such care on the patient, especially on pain relief and the decrease of anxiety. To this end, authenticated assessment scales were used, such as the visual analog pain scale or Spielberg's test anxiety inventory. A prospective multicentre randomised study was carried out to create a control group to be compared to the group treated with Healing Touch. Only willing patients who were prescribed healing touch were included in the experiment. Patients with cognitive problems - be they temporary (linked to a temporary clinical conditions) or not - or those suffering from some disabilities preventing them from using assessment scales and questionnaires are excluded. The recruitment of a 784-patient panel was needed to set out the 8 situations in which a Healing Touch indication may be effective.