Missed pertussis diagnosis during co-infection with Bordetella holmesii.

The purpose of this study is to identify predictive factors associated with missed diagnosis of B. pertussis-B. holmesii co-infection by assessing the analytical performance of a commercially available multiplexed PCR assay and by building a prediction model based on clinical signs and symptoms for detecting co-infections. This is a retrospective study on the electronic health records of all clinical samples that tested positive to either B. pertussis or B. holmesii from January 2015 to January 2018 at Geneva University Hospitals. Multivariate logistic regression was used to build a model for co-infection prediction based on the electronic health record chart review. Limit of detection was determined for all targets of the commercial multiplexed PCR assay used on respiratory samples. A regression model, developed from clinical symptoms and signs, predicted B. pertussis and B. holmesii co-infection with an accuracy of 82.9% (95% CI 67.9-92.8%, p value = .012), for respiratory samples positive with any of the two tested Bordetella species. We found that the LOD of the PCR reaction targeting ptxS1 is higher than that reported by the manufacturer by a factor 10. The current testing strategy misses B. pertussis and B. holmesii co-infections by reporting only B. holmesii infections. Thus, we advocate to perform serological testing for detecting a response against pertussis toxin whenever a sample is found positive for B. holmesii. These findings are important, both from a clinical and epidemiological point of view, as the former impacts the choice of antimicrobial drugs and the latter biases surveillance data, by underestimating B. pertussis infections during co-infections.

Visual aids in ambulatory clinical practice: Experiences, perceptions and needs of patients and healthcare professionals.

This study aims to explore how visual aids (VA) are used in ambulatory medical practice. Our research group (two doctors, one graphic designer and one sociologist) have led a qualitative study based on Focus Groups. A semi-structured guide and examples of VA were used to stimulate discussions. Participants were healthcare professionals (HP) working in ambulatory practice in Geneva and French-speaking outpatients. After inductive thematic analysis, the coding process was analyzed and modified to eventually reach consensus. Six focus groups gathered twenty-one HP and fifteen patients. Our study underlines the variety of purposes of use of VA and the different contexts of use allowing the distinction between "stand-alone" VA used out of consultation by patients alone and "interactive" VA used during a consultation enriched by the interaction between HP and patients. HP described that VA can take the form of useful tools for education and communication during consultation. They have questioned the quality of available VA and complained about restricted access to them. Patients expressed concern about the impact of VA on the interaction with HP. Participants agreed on the beneficial role of VA to supplement verbal explanation and text. Our study emphasizes the need to classify available VA, guarantee their quality, facilitate their access and deliver pertinent instructions for use.

[The role of stress in obesity]. / Rôle du stress dans l'obésité.

Stress is known to favour weight gain. This can be explained by various physiopathological and behavioural mechanisms. Specifically, chronic stress induces a dysfunction of the sympathetic nervous system and of the hypothalamic-pituitary-adrenal axis which favours obesity, and the other way around. Furthermore, stress promotes eating disorders and a decrease in physical activity. Various studies using strategies that act specifically on stress have shown benefits in terms of weight loss. It is therefore important to evaluate stress in any patient suffering from obesity and to propose a treatment adapted to the patient's needs.

Le stress est connu comme un facteur favorisant la prise de poids. Cela s'explique par différents mécanismes physiopathologiques et comportementaux. Concrètement, le stress chronique induit un dysfonctionnement du système nerveux sympathique et de l'axe hypothalamo-hypophyso-surrénalien qui favorise l'obésité, et inversement. De plus, le stress favorise des troubles du comportement alimentaire et une baisse de l'activité physique. Diverses études utilisant des stratégies agissant spécifiquement sur le stress ont montré des bénéfices en termes de perte pondérale. Il est donc important d'évaluer le stress chez tout patient souffrant d'obésité et de proposer un traitement adapté en fonction des besoins du patient.

[Optimal hospital-home transition for a type 2 diabetic patient : some tools]. / Transition optimale hôpital-domicile d'un patient diabétique de type 2 : quelques outils.

The prevalence of patients with type 2 diabetes who are hospitalized is constantly increasing. A minority of facilities have standardized hospital protocols for the diabetic patient regarding medication and continuity of care. This article offers practical tools to optimize the transition of diabetic patients because they are more at risk of readmission and adverse events. Establishing a structured and personalized discharge plan can help anticipate the hospital discharge and approach, in a more standardized way the different stages of an optimized transition. Thus, a patient-centered approach including treatment adaptation, early anticipation of needs at discharge, transmission of essential points of therapeutic education and organization of outpatient monitoring, could improve glycemic control and reduce the number of readmissions or emergency consultations.

La prévalence de patients diabétiques de type 2 hospitalisés est en constante augmentation. Une minorité d'établissements dispose de protocoles standardisés hospitaliers pour le patient diabétique concernant la médication et la continuité des soins. Cet article propose des outils pratiques afin d'optimiser la transition des patients diabétiques, car ils sont plus à risque de réadmission et d'évènements indésirables. L'établissement d'un projet de sortie structuré et personnalisé peut aider à anticiper la sortie et approcher de manière plus standardisée les différentes étapes d'une transition optimisée. Ainsi, une approche centrée sur le patient qui comprend l'adaptation de son traitement, l'anticipation précoce de ses besoins à la sortie, la transmission de points essentiels d'éducation thérapeutique et l'organisation du suivi ambulatoire pourrait améliorer le contrôle glycémique et réduire le nombre de réadmissions ou consultations en urgence.

Apple, condom, and cocaine - body stuffing in prison: a case report.

BACKGROUND: Drug dealers and drug users resort to body stuffing to hastily conceal illicit drugs by ingesting their drug packets. This practice represents a medical challenge because rupture of the often insecure packaging can be toxic and even lethal. In an emergency setting, official guidelines are needed to help the medical team decide on the proper treatment. A preliminary observation period is generally accepted but its duration varies from hours to eventual packet expulsion. CASE PRESENTATION: This case involves a 20-year-old white man in detention who claimed to have ingested one cocaine packet wrapped in plastic food-wrap and a condom in anticipation of an impending cell search. He reached out to medical professionals on day 4 after having unsuccessfully tried several methods to expel the drug packet, including swallowing olive oil, natural laxatives, liters of water, and 12 carved apple chunks. An initial computed tomography scan confirmed multiple packet-sized images throughout his stomach and bowel. After 24 hours of observation and normal bowel movements without expelling any packets, a subsequent scan found only one air-lined packet afloat in the gastric content. Due to the prolonged retention of the package there was an increased risk of rupture. The packet was eventually removed by laparoscopic gastrotomy. CONCLUSIONS: This case report illustrates that observation time needs to be adapted to each individual case of body stuffing. Proof of complete drug package evacuation ensures secure patient discharge. Body stuffers should be routinely asked for a detailed history, including how the drug is wrapped, and whether or not they ingested other substances to help expel the packets. The history enables the accurate interpretation of imaging. Repeated imaging can help follow the progress of packets if not all have been expelled during the observation period. Drug packets should be surgically removed in case of prolonged retention. To ensure the best possible outcomes, patients should have access to high-quality, private, and confidential medical care, which is equal to that offered to the general population. This is paramount to earning trust and collaboration from people in detention who resort to body stuffing.