[Multidisciplinary management of angiomas]. / Prise en charge multidisciplinaire des angiomes.

Angiomas are heterogenous vascular abnormalities, in terms of anatomy, biology and clinical course. Patients and families are often emotionally concerned. For all these reasons, a multidisciplinary approach is necessary in order to structure diagnostic and therapeutic work-up, and to ensure proper advice. The present paper summarizes contemporary classification of angiomas and presents some principles of multidisciplinary approach as it is applied for the past fifteen years at the University Hospitals of Geneva.

Criterion validity of the French version of Patient Health Questionnaire (PHQ) in a hospital department of internal medicine.

OBJECTIVES: Depressive disorders are overrepresented among the patients admitted to non-psychiatric units in general hospitals. However, the majority of depressed patients fail to be identified within this care setting. Since a self-administered questionnaire (Patient Health Questionnaire, PHQ-9) has given encouraging results in English and Spanish, new research should test its criterion validity in a French-speaking environment. DESIGN: The study included 292 patients admitted to the internal medicine units of the University Hospitals of Geneva. Each patient filled the PHQ-9; 212 patients also underwent a blinded DSM-IV diagnostic assessment by a psychiatrist. METHODS: In order to assess the validity of PHQ-9 against the gold standard of the psychiatrist's DSM-IV diagnosis, we calculated overall accuracy, sensitivity, specificity, positive predictive value and Cohen kappa coefficients. We also studied the relationship between the PHQ-9 diagnostic and the severity of depression. Finally, analysis focused on the presence of a diagnosis of depression. RESULTS: Within the framework of the study, PHQ-9 showed an acceptable level of specificity. However, its sensitivity in detecting major depression was low (about 50% of false-negative results). As regards the overall presence of depressive disorders, this instrument performed hardly any better (35% of false negatives). Other characteristics of the population under investigation may have affected the data. CONCLUSIONS: The French version of PHQ-9 demonstrated low sensitivity as compared with psychiatrist-established diagnosis of DSM-IV A criterion and major depressive episode.

Guidelines and evaluation: improving the quality of consultation-liaison psychiatry.

Previous research has shown that residents in the consultation-liaison unit of Geneva University Hospital did not meet proposed guidelines on three counts: quickness of response to emergency situations, reporting cases to supervisors, and consulting with supervisors on major issues. The introduction of daily meetings between residents and supervisors improved the level of compliance with guidelines, from 69.2% to 82.6% for quickness of response, from 57.6% to 97.3% for reporting cases to supervisors, and from 25.0% to 98.0% for consulting with supervisors on major issues. Periodical evaluation would thus appear to enhance performance.