Dependent patients discharged home from PRM departments: relevant indicators

OBJECTIVE

To evaluate simple, measurable indicators of optimal organizational procedures for the hospital-to-home discharge of dependent patients.

MATERIAL AND METHOD

All the general practitioners (GPs) in the Maine-et-Loire county of France were sent a questionnaire asking them to rank the three main criteria (from the most important to the least significant) from a list of 14. We analyzed the median ranking for each item and identified the most important items in terms of their relative frequency.

RESULTS

The response rate was 10.77% (104 out of 966). Four criteria had a median score over 9: contact with the GP prior to discharge, informing the GP of the discharge date, training for the patient and his/her family in activities of daily living and providing a list of people to be contacted in the event of a problem at home. Respite hospitalization (in the event of difficulties at home) was cited as one of the three most relevant criteria.

DISCUSSION-CONCLUSION

The criteria highlighted by the GPs were not highly specific for the discharge of a dependent patient. However, it would be interesting to extend this study by interviewing other stakeholders and determining whether these criteria indeed improve the organization of hospital-to-home discharge.

Intrathecal baclofen in cerebral palsy. A retrospective study of 25 wheelchair-assisted adults

OBJECTIVE

To study the efficacy and safety of intrathecal baclofen therapy (ITB) in wheelchair-dependent adults with cerebral palsy.

PATIENTS AND METHODS

A retrospective analysis and clinical examination of 25 wheelchair-assisted adults with cerebral palsy receiving ITB initiated between 1999 and 2009 in three different cities in western France.

RESULTS

ITB improves spasticity and facilitates wheelchair comfort and nursing care. The therapy has an effect on motor disorders and pain. Eighty percent of the ITB patients were satisfied. Dissatisfaction was related to complications or adverse events and not lack of efficacy. Complications occurred in 32% of the patients and transient interruption of the treatment or surgical removal of the ITB pump was necessary in 16% of cases.

DISCUSSION AND CONCLUSION

Wider use of ITB in this indication is likely and should lead to a better understanding of the drug's pharmacological effects on motor disorders and pain. Use of the Goal Attainment Assessment Scale or Caregiver Questionnaire can help us.

Social functioning and self-esteem in young people with disabilities participating in adapted competitive sport

AIMS

The aim of this study was to investigate social functioning quality of life and self-esteem in young people with disabilities taking part in adapted competitive sport.

METHOD

A sample of 496 athletes (mean age 16 years 4 months, range: 9 years to 20 years 9 months) was obtained from the 540 participants (91.8%) involved in a French national championship. The main outcome measurements were a social functioning inventory (PedsQL 4.0 social functioning) and a self-esteem inventory in physical areas (physical self inventory 6 PSI-6).

RESULTS

The mean PedsQL SF score was 74.6 (SD: 17.7). Comparisons of PedsQL SF according to gender, age, self mobility and training revealed no significant differences between the groups. PedsQL SF was weakly but significantly correlated with all subscales of the PSI-6 in the total population. PSI-6 scores were significantly different between boys and girls, with better self-esteem for boys on general self-esteem (7.7 vs. 6.9, P=0.018), physical condition (6.8 vs. 6.0, P=0.023) and attractive body subscores (6.5 vs. 5.1, P<0.001).

CONCLUSION

Social functioning scores were significantly higher in this population than in the samples of young people with disabilities available in the literature. Interactions between self-concept, social functioning quality of life and participation in adapted sport activities require further studies.

[Teaching and perception of urology by medical students at the end of the second cycle: an appraisal]

OBJECTIVES

Our purpose was to determine how the medical students from the second cycle perceived urology and what their learning methods were.

MATERIAL AND METHODS

An e-questionnaire was sent to 1600 students in 16 teaching faculties during the last year of their second cycle.

RESULTS

Overall, we obtained 590 answers (36.8%). In our population, 70.2% of the students were women. Of them, 24.1% had been already enrolled in an academic urology unit. Urology was defined as a medical, surgical and medico-surgical discipline by 3.7%, 37.8% and 58% of the students, respectively. Urology was considered as very important, important, not very important and not important at all by 5.1%, 54.4%, 37.5% and 2.4% of the students. The teaching methods used to learn urology were duplicated-notes for ENC preparation (45.3%), conferences for ENC (French national ranking exam) preparation (43.7%), courses of the national urology college (38.6%) and courses of the faculty (32%). The best mastered items were lithiasis disease (86.3%), voiding dysfunction (76.3%) and urological cancers (56.7%). On the contrary, only 34.7% and 28% considered their knowledge sufficient on the erectile dysfunctions and on renal transplantation. Lastly, 7.3% intended to become urologists. Having a work experience in a urology unit was significantly associated to the feeling of being prepared to become an intern (p<0.001) and to the project of becoming a urologist (p<0.001).

CONCLUSION

Urology was considered like an important discipline by half of the students at the end of the second cycle even though it is under-represented in the national teaching programme for ENC. A third of the students used courses from the faculty to learn urology and a quarter of them had a work experience in a urology unit during their second cycle.

Contraception and screening for cervical and breast cancer in neuromuscular disease: a retrospective study of 50 patients monitored at a clinical reference centre

OBJECTIVE

To analyse contraceptive methods and the extent of screening for breast and cervical cancer in women with neuromuscular disease, compare these results with data and guidelines for the general population and determine the environmental and attitudinal barriers encountered.

PATIENTS AND METHODS

A retrospective, descriptive study in a population of female neuromuscular disease patients (aged 20 to 74) monitored at a clinical reference centre.

RESULTS

Complete datasets were available for 49 patients. Seventy percent used contraception (hormonal contraception in most cases). Sixty-eight percent had undergone screening for cervical cancer at some time in the previous 3 years and 100% of the patients over 50 had undergone a mammography. Architectural accessibility and practical problems were the most common barriers to care and were more frequently encountered by wheelchair-bound, ventilated patients.

CONCLUSIONS

In general, the patients had good access to contraceptive care and cervical and breast cancer screening. However, specific measures may be useful for the most severely disabled patients.

[Evidence-based medicine and French medical students: an appraisal]

INTRODUCTION

Nowadays, evidence-based medicine (EBM) is essential to learn and to practice medicine. The aim of the current study was to investigate the baseline level of knowledge of French students regarding EBM.

MATERIALS AND METHODS

Between April and May2008, a questionnaire was sent by e-mail to 900students in their last year of medical study.

RESULTS

On 327 answers, 297 (91%), 94 (29%) and 85 (26%) students declared they read, write and speak medical English. Ninety (28%) read an article of a French medical review once a month and 43 (13%) read an article of an international medical review once a month. Three hundred and eleven (95%) knew the bases of medical research on the Internet and 219 (67%) used them. Twenty-four (7%) had already participated in a editorial staff of a medical article, 7 (2%) had been co-authors. Two hundred and seventy-two (83%) had made an oral presentation during a medical staff and 3 (1%) during a congress. Finally, 237 (73%) understood the interest of the critical analysis of an article at the ECN and 70 (21%) thought they were prepared.

CONCLUSION

The incapacity of learning EBM is one of the limits of the French medical training system. The introduction of the reading critical of an article at the ECN is the concrete beginning of an answer to this problem.

Intrathecal baclofen in the treatment of spasticity, dystonia and vegetative disorders

Baclofen (beta-p-chlorophenyl-GABA) binds to a number of spinal and cerebral sites and depresses the excitability of motor neurons. Intrathecal administration induces much higher CSF concentrations compared to the limited passage through the blood-brain barrier after oral administration. The development of reliable implanted pumps allows long-term intrathecal baclofen treatment (ITB). Baclofen is mainly an antispastic drug and the main indication of ITB is generalized lower limb spasticity in spinal cord injury and multiple sclerosis. The side-effects are due to either drug over-dose or withdrawal and to malfunctions of the implanted device (disconnections of the catheter, infections, etc.). Large numbers of patients have been treated over the past twenty years. More recently, baclofen has been used in the treatment of spasticity of cerebral origin, and in the treatment of other motor disorders, mainly dystonia. The results in cerebral palsy are promising and ITB's role will probably grow in the management of the movement disorders of these children. Further studies are required on the exact site of action, on the possible association with other drugs, especially clonidine and on the development of sustained release formulations.