Shared Reflection to Maximize Resources and Minimize Costs: The Reflecting Team Applied to a Hospital Environment.

Severe mental illness entails multiple hospital admissions and a large use of public resources. The Reflecting Team (RT), together with other dialogue strategies, place in a single therapeutic space, the patient, his family and a team of professionals to find together a solution to a situation of stagnation. The aim of this study was to evaluate feasibility and cost-effectiveness of a RT intervention in psychiatric inpatients in a public hospital. Six RT were performed, and clinical variables were collected retrospectively for six months pre-RT and post-RT. Both number of hospital admissions and total time spent in the psychiatric acute unit show a significant decrease. All computed cost showed statistically significant reduction. The results suggest RT might be a good strategy to introduce a positive change in the treatment of those psychiatric cases in which the patient and family find themselves caught in a system that seems to offer stale and ineffective help to problems that have become chronic.

Bisphosphonates, a new treatment for glucocorticoid-induced osteoporosis in children.

BACKGROUND: Long-term corticoids used as a treatment for rheumatic diseases are the most frequent cause of osteoporosis in the pediatric population. Bisphosphonates have been proved to be useful in treating osteoporosis. OBJECTIVE: To investigate the efficacy of pamidronate in corticoid-induced osteoporosis in children. PATIENTS AND METHODS: Ten children affected with rheumatic diseases and osteoporosis underwent biannual cycles of intravenous pamidronate (4 to 12 cycles). Complete clinical, radiological, biochemical and densitometric follow-up was performed at every treatment cycle. RESULTS: Good clinical and radiological evolution was observed in most of our patients; no new vertebral fractures were reported. Good densitometric evolution has been linked to the onset of puberty (rise in IGF-I levels) and low values for inflammatory activity markers (ESR and CRP). Self-limited hyperthermia and mild abdominal pain were observed during pamidronate infusion, but no other side effects were reported. CONCLUSIONS: Pamidronate is a safe and useful treatment for corticoid-induced osteoporosis in the pediatric population.

[Neuromuscular pathology in a critical pediatric patient]. / Patología neuromuscular del paciente crítico en pediatría.

OBJECTIVE: To describe and provide diagnosis guidelines for the neuromuscular pathology of the pediatric critical patients, manifested as extubation difficulty, based in our experience. CLINICAL CASES: A retrospective study has been performed on three patients in the Pediatric Intensive Care Unit that were diagnosed by using clinical, analytical and electromyographical findings. In the three patients the presence of the disorder was suspected due to the extubation difficulty and the hypotony. All them received vecuronium as neuromuscular blockage while dexamethasone was provided to one of them due to a nodal tachycardia. Myopathic causes were discarded in view of the normally of the muscular enzymes. The electromyography showed an axonal disorder in all three child. Neither lumbar puncture nor muscular biopsy were performed in any of them. CONCLUSIONS: The three patients were diagnosed for a drug neuropathy (neuromuscular blocked and/or corticotheraphy). There were described another causes of the critical patient polyneuropathy in the literature, but we didn't find any of them.