Enhanced recovery following posterior spinal fusion for adolescent idiopathic scoliosis: A medical and economic study in a French private nonprofit pediatric hospital.

INTRODUCTION: Little data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). HYPOTHESIS: ERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications. MATERIALS AND METHODS: This was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation. RESULTS: The mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5). The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group. CONCLUSION: Implementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain. LEVEL OF EVIDENCE: III; retrospective comparative study.

The use of the Montreal Cognitive Assessment (MoCA) screening tool to evaluate cognitive deficits in Lebanese in-patients with schizophrenia.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a brief cognitive impairment screening tool suitable for a rapid diagnosis of cognitive functioning. The primary objective was to examine the ability of the MoCA to detect cognitive impairment and functioning (autonomy and social cognition) among Lebanese patients with schizophrenia. The secondary objective was to evaluate factors related to cognition. METHODS: A cross-sectional study conducted between July 2019 and Mars 2020 that enrolled 120 in-patients diagnosed with schizophrenia. The MoCA tool and the BACS were used to evaluate the patients' cognitive functioning. RESULTS: The MoCA adjusted total score was significantly correlated with the BACS total score (r = .72, p < .001). The cut-off value of the MoCA for detecting mild cognitive impairment was 21, moderate cognitive impairment was 20.50 and severe cognitive impairment was 19.5. The multivariable analysis showed that the MoCA total score and the BACS score resulted in a non-significant association with autonomy. Also, higher cognition (higher BACS) (B =.10, p < 0.001) was significantly associated with a higher MoCA total score. However, higher depression (B=-.18, p = .02) and higher psychosis (B=-.04, p = .01) were significantly associated with lower MoCA. CONCLUSION: The Arabic version of the MoCA can be a useful tool for screening cognitive impairment in patients with schizophrenia.

Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec.

BACKGROUND: In 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models' similarities and differences. METHODS: We relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS's components included in the initially designed program, Mitchell and Lewis (2003)'s logic model framework, and Chaudoir and colleagues (2013)'s framework on contextual factors' influence on an innovation's implementation. RESULTS: Findings show the APSS-CRDS program's regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists' availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors' influence, like ministerial and medical associations' involvement, collaborations, the context's implementation readiness, physician practice characteristics, and the program's adaptability. INTERPRETATION: Findings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.

Self-assessment of social cognition in a sample of Lebanese in-patients with schizophrenia.

OBJECTIVE: The primary objective was to evaluate social cognitive complaints in a sample of chronic in-patients with schizophrenia and compare it to healthy controls. The secondary objective was to explore factors related to social cognitive complaints in these patients, such as neurocognition, clinical symptoms, depression, and insight. METHODS: A cross-sectional study conducted between July 2019 and March 2020 at the Psychiatric Hospital of the Cross (HPC)-Lebanon enrolled 120 chronic in-patients diagnosed with schizophrenia and schizoaffective disorders and 60 healthy controls. The Self-Assessment of Social Cognition Impairments (ACSo) scale was used to assess social cognitive complaints. RESULTS: A significant difference was found between schizophrenia patients and healthy controls in all social cognitive complaints: theory of mind complaint, attributional biases complaint, emotional processes complaint, and social perception and knowledge complaint (p < 0.001 for all). All objective cognitive disorders were significantly associated with social cognitive complaints except for attention and speed of information processing. Higher verbal memory and verbal fluency were significantly associated with lower emotional processes complaint scores. The results of the multivariate analysis showed that a higher cognition (Beta = -0.08, p = 0.001) was significantly associated with a lower social cognitive complaint, contrary a higher depression (Beta = 0.38, p = 0.04) was significantly associated with a higher social cognitive complaint, in particular attributional biases complaints. CONCLUSION: This study showed that patients with schizophrenia have complaints about their social cognition. It could also demonstrate that subjective social cognitive complaints are correlated with depressive symptoms and objective cognitive deficits among these patients.

General description of cognitive deficits in schizophrenia and assessment tools in Lebanon: A scoping review.

Many cognitive functions are affected in schizophrenia patients, particularly memory, attention, motor skills, executive function, and social cognition. Cognitive assessment is one of the best indicators of the functional and social prognosis of schizophrenic patients. In Lebanon, no study has yet examined the assessment of cognitive functions in patients with neurological or psychiatric diseases. This review aims to provide an overview of the cognitive profiles of schizophrenia and describe the different cognitive tests used in Lebanon. The MEDLINE/PubMed database was used to conduct a literature review covering all studies related to cognition in psychosis patients from 1990 until March 2021. This screening resulted in 97 articles focused on cognition in psychiatric patients or cognitive tests in schizophrenia and required an in-depth analysis. The majority of measures developed to evaluate cognition in patients with schizophrenia were from Western countries, most of which are long and complex and may require several hours to administer. The number of neuropsychological tests available in Arab countries is unknown, although it is likely to be limited compared to what is available in Western countries. In Lebanon, some neuropsychological batteries have been locally used to assess cognition without being translated and validated to be adapted to the Lebanese sociocultural context. Clinicians in Lebanon underestimate the extent of cognitive impairment in schizophrenia patients as they have limited options, using untranslated tests or using translations that have not been validated. Future studies should target the development and adaptation of instruments that predict and measure cognition and functional ability.

Cross-cultural adaptation and validation of the Arabic version of the BACS scale (the brief assessment of cognition in schizophrenia) among chronic schizophrenic inpatients.

BACKGROUND: Assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls. METHODS: A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session. RESULTS: Mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p < .01). Principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r = .73, p < .001) and healthy controls (r = .78, p < .001). Also, correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < .05). CONCLUSION: Results showed that the Arabic version of the BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls and it is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon.

A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India.

BACKGROUND AND AIMS: Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India. APPROACH AND RESULTS: We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV. CONCLUSIONS: Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.

Surface imaging for real-time patient respiratory function assessment in intensive care.

PURPOSE: Monitoring of physiological parameters is a major concern in Intensive Care Units (ICU) given their role in the assessment of vital organ function. Within this context, one issue is the lack of efficient noncontact techniques for respiratory monitoring. In this paper, we present a novel noncontact solution for real-time respiratory monitoring and function assessment of ICU patients. METHODS: The proposed system uses a Time-of-Flight depth sensor to analyze the patient's chest wall morphological changes in order to estimate multiple respiratory function parameters. The automatic detection of the patient's torso is also proposed using a deep neural network model trained on the COCO dataset. The evaluation of the proposed system was performed on a mannequin and on 16 mechanically ventilated patients (a total of 216 recordings) admitted in the ICU of the Brest University Hospital. RESULTS: The estimation of respiratory parameters (respiratory rate and tidal volume) showed high correlation with the reference method (r = 0.99; P < 0.001 and r = 0.99; P < 0.001) in the mannequin recordings and (r = 0.95, P < 0.001 and r = 0.90, P < 0.001) for patients. CONCLUSION: This study describes and evaluates a novel noncontact monitoring system suitable for continuous monitoring of key respiratory parameters for disease assessment of critically ill patients.

The Cultural Dimensions of Freshwater Wetland Assessments: Lessons Learned from the Application of US Rapid Assessment Methods in France.

Given the recent strengthening of wetland restoration and protection policies in France, there is need to develop rapid assessment methods that provide a cost-effective way to assess losses and gains of wetland functions. Such methods have been developed in the US and we tested six of them on a selection of contrasting wetlands in the Isère watershed. We found that while the methods could discriminate sites, they did not always give consistent rankings, thereby revealing the different assumptions they explicitly or implicitly incorporate. The US assessment methods commonly use notions of "old-growth" or "pristine" to define the benchmark conditions against which to assess wetlands. Any reference-based assessment developed in the US would need adaptation to work in the French context. This could be quite straightforward for the evaluation of hydrologic variables as scoring appears to be consistent with the best professional judgment of hydrologic condition made by a panel of French local experts. Approaches to rating vegetation condition and landscape context, however, would require substantial reworking to reflect a novel view of reference standard. Reference standard in the European context must include acknowledgement that many of the best condition and biologically important wetland types in France are the product of intensive, centuries-long management (mowing, grazing, etc.). They must also explicitly incorporate the recent trend in ecological assessment to focus particularly on the wetland's role in landscape-level connectivity. These context-specific, socio-cultural dimensions must be acknowledged and adjusted for when adapting or developing wetland assessment methods in new cultural contexts.

Epidemiology of dementia in Central Africa (EPIDEMCA): protocol for a multicentre population-based study in rural and urban areas of the Central African Republic and the Republic of Congo.

BACKGROUND: The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the 'Epidemiology of Dementia in Central Africa' population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors. METHODS/DESIGN: A multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD's 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer's disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen's criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia. DISCUSSION: For now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.

[Anatomy of the CMRR and proposition of functioning]. / Anatomie des CMRR et proposition de fonctionnement.

OBJECTIVES: The main objective was to have a view of the functioning of the Centers Memory of Resources and Research (CMRR) to identify the difficulties which can interfere in the industrial clinical trials. The secondary objective was to make a proposal to optimize them. METHODOLOGY: Questionnaires were given in all CMRRs. RESULTS: One hundred thrity-five questionnaires were retrived (26 centers answered on the 27 that exist). Some elements appeared as strong structural factors but some weaknesses were highlighted such as: insufficient staff, lack of dedicated areas, lack of communication, activities multiplications, functional unit (UF) subdivision. CONCLUSION-PROPOSITION: After a Strenghts-Weakness-Opportunities-Threats (SWOT) analysis, we kept 3 main axis to improve: information and formation diffusion, transdisciplinary meetings establishment, better mobilization of doctors for clinical trials. We think that a special "clinical trail" unit within each CMRR should be created. It will enhance the level, the competences and the reactivtity of each clinical trial center which will lead to better collaboration with big pharmaceutical companies.

Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France.

BACKGROUND: The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. METHODS: The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. RESULTS: Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. CONCLUSIONS: Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.

[Ethnopsychiatry in the elderly]. / Ethnopsychiatrie et sujets âgés.

Ethnopsychiatry is defined as an approach aimed to understand the ethnic and cultural dimensions of mental illnesses. The triple interest of cross-cultural approach in psychiatry in the elderly is highlighted by a review of the literature and five clinical vignettes. The first interest is to help the diagnosis of mental disorders in aged immigrants. The second is to take into account the ethnopsychogeriatric specificities by the sanitary and social systems. The third involves some aspects of psychiatry in the elderly in Sub-Saharan Africa. With aging, the immigrant has to reinvent, successfully or not, new rationalizations of his/her presence. Moreover, he/she often presents a premature physical over-deterioration linked to difficult existing conditions. Caring for the elderly from an ethnopsychiatric approach supposes firstly, to grant him correct life and physical health conditions; secondly, training of professionals to consider their specific cultural dimensions and at last, adapting the care and help services. Ethnopsychiatry or cultural psychiatry in the elderly must take into account the social and cultural representations of the diseases. Presently, depression among the elderly is common in Africa and dementia is not rare.

[A descriptive national survey of 166 Alzheimer health networks]. / Enquête descriptive nationale de 166 réseaux de santé Alzheimer.

OBJECTIVE: Assess and describe the organization, operation, and aims of Alzheimer health networks in France. METHODS: Questionnaire sent by post or handed to physicians in France identified as involved in management of Alzheimer patients by Novartis Pharma sales representatives. RESULTS: 166 networks managing Alzheimer's disease (2/3 primarily gerontological and 1/3 specializing specifically in Alzheimer's). In 61.9% of the cases, the physician supervising the network was a hospital staff physician, often a geriatrician (48%). The other member physicians were essentially general practitioners. Several paramedics and social workers also participated. Most networks were organized as not-for-profit organizations. Financial support most often came from the relevant ministries and the health insurance funds. The number of active cases handled by the networks could not be globally assessed. The operating tools for the networks included membership charters, management guidelines and protocols, and shared medical files, but fewer than 30% of the networks used any one of these. The networks had as their primary objectives training and information, patient follow-up and gerontological coordination. These aims were consistent with the goals they felt that had come closest to attaining, i.e., improving the quality and organization of care, sharing information with and training other health professionals, and providing information to the public. Barely one third of the networks had developed an assessment procedure. Among the obstacles to network operations were the participants' lack of availability, the absence of collaboration between professionals, and financial problems. CONCLUSION: Despite the disparity in the quality and exhaustiveness of the data collected, our survey confirmed the diversity and dynamism, but also the lack of formal structure and the difficulties confronted by the Alzheimer networks in France.