Concordance Study of Diagnoses and Therapeutic Management for Military Personnel Evacuated for Medico-psychological Reasons: From the Theater of Operations to the Military Training Hospital.

INTRODUCTION: The evolving global landscape has led to increased involvement of the French armed forces, exposing military personnel to operational challenges that can affect their mental well-being. As a result, psychiatry has become the second most common reason for Medical Evacuation (MEDEVAC). In war zones where specialized medico-psychological consultations may not be readily available, medical officers play a vital role in providing initial care. Therefore, there is a growing emphasis on the precise evaluation of these practices. MATERIALS AND METHODS: In this retrospective observational study, we analyzed MEDEVAC request files from the Operational Health Headquarters (Patient Medical Request sheets), Aeromedical Evacuation Mission Order sheets, and hospital records from the entire military hospital complex in the Île-de-France region for French military personnel who underwent low-priority MEDEVAC (P3) for medico-psychological reasons from a non-metropolitan area to metropolitan France. The study spanned from January 1, 2013, to December 31, 2016. The primary objective is to evaluate the concordance of diagnoses between general practitioners and psychiatrists. The secondary objective is a detailed description of the introduction of psychotropic drugs, especially benzodiazepines, by the medical officer in the field. RESULTS: In total, our study included 610 patients. Significant differences were observed between diagnoses made by military general practitioners and military psychiatrists, except for "psychotic disorders" and "other diagnoses" categories. During hospitalization, benzodiazepines were prescribed to 26.5% of repatriated patients, antidepressants to 12.7%, hypnotics to 17.6%, neuroleptics to 24.23%, and hydroxyzine to 18.8%. Upon discharge, benzodiazepines were prescribed to 23.5% of patients, antidepressants to 17.8%, hypnotics to 9.9%, neuroleptics to 28.9%, and hydroxyzine to 19.7%. The chi-squared test revealed significant differences in prescription between military operations and hospitalization for all molecules except hydroxyzine. Among patients diagnosed with Psychological Disorder Related to a Traumatic Event (TPRET) (<1 and >1 month) by psychiatrists during hospitalization, 66.2% were prescribed benzodiazepines during operational theaters, 24.3% continued during hospitalization, and 16.8% received a prescription upon discharge.The duration of missions often hinders precise psychiatric diagnoses, leading medical officers to transmit clinical data for optimized specialized care at military training hospitals. Furthermore, significant differences in therapeutic administration between medical officers and psychiatrists, particularly in benzodiazepine prescriptions for patients with TPRET, highlight the importance of prioritizing psychotropic prescription modalities in the training of medical officers on mental disorders. Strengthening operational preparations in recent years could enable more practitioners to benefit from these measures. CONCLUSIONS: We suggest several measures to enhance the transmission of medical information between medical officers and military psychiatrists. First, optimizing the drafting of Patient Movement Requests could involve implementing pre-filled drop-down menus or providing an adapted bilingual lexicon, facilitating the optimal transmission of clinical information for repatriated patients. Second, strengthening the training of medical officers before deployment and sharing the "Emergency Psy Kit," a comprehensive support tool developed by French military psychiatrists, would further enhance the tool kit available to field practitioners for judiciously prescribing psychiatric drugs.

Direct oral anticoagulant plasma level measurement in clinical practice: A French single-institution retrospective study.

INTRODUCTION: To describe patient characteristics and clinical situations where DOAC assays were ordered and determine whether the assays indications and subsequent patient management were consistent with current guidelines. METHODS: Retrospective study of data from patients with prescriptions for three DOACs: dabigatran, rivaroxaban and apixaban treated at Percy Military Hospital (France) between 2016 and 2019. RESULTS: During the study period, 196 DOAC measurements were performed on 148 patients (median age: 82.5 years). The most frequently prescribed DOAC was rivaroxaban (57.5%) and the commonest indication was nonvalvular atrial fibrillation (77%). Measurements were performed on 3.5% of patients with an active prescription for DOAC, and DOAC prescriptions complied with the product's characteristic summary in 62.8% of cases. The number of assays performed increased 2.5-fold between 2017 and 2019. Most DOAC assays were ordered due to emergency surgery or procedures (46.9%), bleeding (19.9%) or a risk of drug accumulation (13.8%). Time from the last DOAC dose to sample collection was specified in the medical file in only 25.5% of cases. Reasons for ordering DOAC measurements were consistent with the guidelines in 87.2% of cases. Subsequent clinical decisions were consistent with the guidelines in 86.2% of cases. CONCLUSIONS: DOAC assays ordering frequency was rare but increased during study. Acute clinical situations were the most common source of test orders. A correct interpretation of the results and subsequent management occurred in most but not all cases, indicating the need for additional education for physicians to raise awareness about tests indications and results interpretation.

[Plasmacytoïd dendritic cells acute leukemia: a case report]. / Leucémie aiguë dérivée des cellules dendritiques plasmacytoïdes : à propos d'un cas.

We describe a case of a patient hospitalized in haematology unit for treatment to blastic plasmacytoid dendritic cell neoplasm. Apart skin lesions found at diagnosis in 83% of patients, few elements suggest the diagnosis. Cytology is not characteristic and no cytogenetic abnormality is specific to the LpDC, the karyotype shows generally at least three cytogenetic abnormalities. Definitive diagnosis rests to identification of a blastic population with immunophenotype CD4+ CD56+. This leukemia is chemosensitive but the relapse rate is important and the survival time is 16 months.