Poppers Use and High Methaemoglobinaemia: ‘Dangerous Liaisons’

Poppers are legal and largely used in France despite severe side effects, such as methaemoglobinaemia (MetHbia). Our work aimed to assess the prevalence of poppers consumers among patients with a MetHbia higher than or equal to 5% in French university hospitals and its evolution before and after the legalization of poppers in France. We conducted a national multicentre observational retrospective study. All patients for whom at least one MetHbia measurement was performed from 2012 to 2017 in university hospitals where the French addictovigilance network (FAN) is implanted were included. For each MetHbia measurement exceeding or equal to 5%, a return to the clinical file was made by the FAN to assess poppers consumption. We calculated the prevalence of MetHbia exceeding or equal to 5% and 25% and the prevalence of poppers consumption before and after the legalization. A total of 239 (0.14%) patients had a MetHbia level exceeding or equal to 5% with 25 (10.46%) cases of poppers consumption. Poppers consumption represented 68.4% (13 out of 19) of cases with MetHbia greater than or equal to 25%. Poppers consumption among patients with MetHbia exceeding or equal to 5% increased after the legalization from 4.76% to 11.67% (prevalence ratio PR = 2.45, 95% CI = [0.98–8.37], p-value = 0.190). The proportion of patients with a MetHbia level of 25% or more increased after the legalization from 4.76% to 8.63% (PR = 1.81, 95% CI = [0.68–6.82], p-value = 0.374). The use of poppers is very frequently reported by patients with MetHbia greater than or equal to 25%.

Internationale Projekte zur homöopathischen Behandlung von Covid-19

ZusammenfassungCovid-19 ist eine globale Herausforderung. Im Folgenden werden 3 Projekte vorgestellt, die durch eine produktive internationale Zusammenarbeit getragen werden: Robbert van Haselen regt das Verfassen von qualitativ hochwertigen Covid-19-Fallberichten (Case Reports) an. Praktische Formularvorlagen helfen bei der Erstellung (HOM-CASE-CARE-Richtlinie, MONARCH-Kriterien). Lex Rutten hat auf die ihm vorliegenden Falldaten das Bayes-Theorem angewandt und auf Basis dieser mathematischen Analyse eine App entwickelt, die schnell und konkret Hinweise zur Arzneiwahl liefern kann. Clificol® (Clinical File Collection) ist eine Onlineplattform zur Sammlung von Falldokumentationen, die die Möglichkeit bietet, unsere klinischen Erfahrungen international auszutauschen. Yvonne Fok berichtet über erste Ergebnisse des dieser Datenbank angegliederten Covid-19-Supportprojekts.

Clinical File Management, Translational Research and Continuing Education for Cancer: a Single-unit Experience

Background: Cancer is considered clinically heterogeneous. Some cancers are indolent and localized, while others are aggressive and easily spread to other parts of the body with metastasis. Whether diagnosis methods or therapy selection has moved towards combination, personalization and diversity. Therefore, it is important to standardize clinical file management, biospecimen collection and translational research of cancer.Methods: Data were retrieved from the Clinical Study Project on Cancer in XXXX, an ongoing longitudinal study including more than 1500 genitourinary cancer people.Results: The standard clinical diagnosis, treatment and translational research workflow was built based on current medical administration technology, molecular research method and triangle coordination relationship among doctor, patient and researcher. Raised awareness of warning signs and improved healthy styles showed high-quality follow-up and clinical outcome. At last, the system helps research ability improvement based on the skills proficiency and achieve medicine-research-education integration. Conclusion: Our analysis will help ensure patient health, enhance doctor-patient relationship, improve research efficiency and support continuing education. The goal of sustainable work participation in cancer survivors can be improved by the delivery of a personalised clinical management and education intervention. Furthermore, successful work outcomes often involve the cooperation of doctors, cancer survivors and clinical researchers.

TRANSFORAMINAL INTERSOMATIC LUMBAR ARTHRODESIS: COMPARISON BETWEEN AUTOGRAFT AND CAGE IN PEEK

ABSTRACT Objective: To compare the postoperative outcomes of transforaminal intersomatic lumbar arthrodesis with structured iliac bone autograft and PEEK device. Methods: The total of 93 medical records of patients undergoing transforaminal intersomatic fusion between January 2012 and July 2017 with at least 1 year of postoperative follow-up, with complete medical record, containing clinical file and radiological exams, were reviewed. Results: From the medical records evaluated, 48 patients underwent the procedure with structured iliac autograft (group 1) and 45 with PEEK device (group 2). There was an improvement in functional capacity in both groups (p < 0.001), however there was no difference when comparing them (p = 0.591). Conclusion: The postoperative clinical and radiological results of lumbar arthrodesis with TLIF technique, using a structured iliac bone autograft compared to a PEEK device, were similar. Level of Evidence II, Retrospective study.

An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014

Objective: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria. Method: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act. Results: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT. Conclusion: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed.

Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study

Background:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Audit of the use of Seclusion in an Approved Centre following introduction of an Integrated Care Pathway

Introduction: The Mental Health Commission (MHC) has published guidelines on the rules governing the use of seclusion. These must be followed and the use of seclusion recorded in the patient’s clinical file during each seclusion episode. We devised a Seclusion Integrated Care Pathway (ICP) for use in the Approved Centre in Tallaght Hospital, Dublin, Republic of Ireland. This document was developed in conjunction with the MHC guidelines to assist in the recording and monitoring of each seclusion episode.Methods: The MHC has listed 13 rules governing the use of seclusion. These include the responsibility of the registered medical practitioner (RMP), nursing staff and the levels of observations and frequency of reviews that must take place during each seclusion episode. Using the seclusion register we identified a total of 60 seclusion episodes; 30 prior to the introduction of the ICP and 30 following the introduction of the ICP. We conducted a retrospective chart review to assess the documentation of each seclusion episode. The purpose of this audit was to compare adherence to MHC codes of practice on the use of seclusion before and after the introduction of our ICP.Results: There was overall improvement in adherence following the introduction of the ICP. Areas of improvement included consultant notification, informing the patient of the reasons for and likely duration of seclusion, informing the next of kin, 15 minute nursing observations and 2-hourly nursing review. Medical reviews within 4 hours, documentation of whether seclusion could be discontinued and subsequent medical assessment disimproved following introduction of the ICP.Conclusion: While an ICP is a robust document and ensures that many of the rules in relation to seclusion are explicitly stated adjustments to the document and regular staff training are needed to ensure full adherence to MHC guidelines.

Lesão Visceral em Trauma Abdominal: Um Estudo Retrospetivo

Background: Abdominal trauma is a major cause of morbi-mortality all over the world which makes it essential an approach focused on rapid diagnosis and treatment. The main goals of this study are to identify global epidemiologic data of abdominal trauma in our tertiary trauma center and to study traumatic lesions, treatment and outcome.Material and Methods: Retrospective analysis of the clinical file of all patients admitted with abdominal trauma, over a period of 5 years, in a tertiary trauma center.Results: the total mean of ages was 42.6 years and the male gender was the most affected (74.2%). At admission, most patients had a Revised Trauma Score > 4. The mainly causes of trauma were blunt from motor-vehicle collisions (39.9% as motor-vehicle occupant and 10.7% from pedestrian collisions) and falls (25.5%). Penetrating trauma, by abdominal stab wounds and gunshot wounds, occurred only in 12.3% of the cases. Hollow visceral injuries were more frequent in that context. In 19.5% of the cases multiple abdominal organinjury occurred. Conservative treatment was performed in 65.3% of the cases. Global mortality was 12%, being null after penetrating lesions.Conclusions: Abdominal trauma, more frequently, is the result of motor-vehicle crashes and falls, being blunt in the majority of the cases. The most affected organs are solid and the approach is conservative. Hollow visceral lesions continue to be of difficult diagnose.