Relationship between calcifications and structural lesions on hand radiography and axial calcifications on CT-scan: A retrospective study in systemic sclerosis.

The objectives of this study were to describe the prevalence and characteristics of radiographic lesions of the hands, and calcifications of the spine on computer tomography scans (CT-scans), and to investigate the relationships between radiographic and CT-scan abnormalities and clinical features in a population of patients with systemic sclerosis (SSc).Subjects underwent X-ray examination of the hands, and thoracic or thoraco-abdominal and pelvic CT scan or lumbar CT scan in the year. Structural lesions on hand X ray was scored and spinal calcifications were evaluated in the anterior, intracanal and posterior segments. Intra and inter-reliability was tested for radiography and CT- scan. Prognostic factors considered were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death.This study involved 77 SSc patients, 58 (75%) with limited cutaneous SSc (lcSSc) and 19 (25%) with diffuse SSc (dSSc). The prevalences of radiographic lesions of the hand were 28.6% for periarticular calcifications and 26% for calcinosis. On CT scan, 64 (83%) patients exhibited at least 1 calcification. Spine calcifications were depicted in 80.5%, 27.3%, and 35.1% at the anterior, intracanal and posterior segments respectively. Calcifications were mainly localized on thoracic spine. Inter reader reliabilities were good for hands and moderate for spine respectively. Spine calcifications and periarticular calcifications in the hands were associated (P = .012). Calcinosis in the hands was related to PAH (P = .02). Posterior calcification segment and foraminal calcifications were associated with interstitial lung disease (ILD) (P = .029) and death (P = .001).More than 80% of systemic sclerosis patients presented spine calcifications. A significant association between hands and spinal calcifications were confirmed and some localization in the posterior segment considered as a bad prognostic factor.

[Therapeutic patient education practices in Ivory Cost: investigation among health professionals] / Pratique de l'éducation thérapeutique du patient en Côte d'Ivoire : enquête auprès des professionnels de santé.

INTRODUCTION: Patient education is an important component in the management and monitoring of chronic diseases. It plays an important role in the decline of the disease severity, mortality and socioeconomic burden and the complications of these chronic diseases. In Côte d'Ivoire, there are few studies to evaluate the reality of this activity. OBJECTIVE: To explore the practice of patient education in Ivory Coast. METHOD: This qualitative study has been carried out by means of semi-structured interviews with 24 healthcare professionals including 14 health managers for individual interviews and 10 care providers for focus group discussion. RESULTS: There are various representations of therapeutic patient education among health professionals. There was no real distinction between patient education and the broader concept of health education. Absence of national patient education policy, the lack of training in TPE and lack of experience of educational practice lead health professionals to realize an unstructured educational activity. CONCLUSION: These results show the need for Côte d'Ivoire to have a national policy of patient education to educate patients in accordance with international recommendations.

[Impact of the referral letter on triage decisions in adult patients admitted to the emergency department]. / Impact du contenu du courrier médical sur la qualité du triage initial des patients adultes admis aux urgences.

INTRODUCTION: We conducted a two-month prospective study (8,171 admissions) in the Angers university hospital emergency room to analyse the impact of the referral letter on the initial triage of patients admitted to the emergency room performed by the reception and triage nurse. METHODS: We analysed the level of priority of the CIMU triage scale (nurse's classification of emergency room patients), the presenting complaint, and the need for an urgent procedure before and after reading the referral letter and examined the nurse's comments for explanations concerning any triage changes. RESULTS: 1,516 patients arriving with a referral letter (18.5% of admissions) were included and interpretable data were available for 756 of these cases. After reading the referral letter, nurses modified the CIMU triage level for 34 (4.5%) patients, the presenting complaint for 50 (6.6%) patients and eliminated the need for an urgent procedure for 70 (9.3%) patients. No significant difference was observed concerning the choice of the CIMU triage level (p = 0.908). However, changes in triage level were significantly more frequently towards a more urgent category (p = 0.005). Analysis of the nurse's comments showed that these results can be explained by the signs of severity indicated in the referral letter. Certain histories and/or diagnostic hypotheses appeared to lead nurses to eliminate the need for an urgent procedure. CONCLUSION: In this study, the referring physician's letter had a limited impact on the choice of triage level defined by the nurse on admission to the emergency room except for patients in whom the referral letter mentioned signs of severity, not observed at reception, led the nurse to apply a more urgent triage level. It would be interesting to study the information contained in the referral letter, useful for triage of patients admitted to the emergency room, in order to improve the impact of the referral letter on the quality of triage.

[Psychiatric disorders observed in the Angers university hospital occupational psychopathology department]. / Troubles psychiatriques rencontrés en consultation de psychopathologie du travail au Centre hospitalier universitaire d'Angers.

INTRODUCTION: This epidemiological study was conducted on the medical records of 168 employees consecutively evaluated by the occupational health psychiatrist between 2007 and 2009. METHODS: Psychiatric disorders were listed according to the WHO International Classification of Diseases. RESULTS: The diagnoses observed were anxiety disorder including post-traumatic stress disorder, major depressive episode, burn-out and work-related stress. Suicidal thoughts were systematically investigated and more often affected men and were associated with major depressive episodes, burn-out and post-traumatic stress disorder. DISCUSSION: This study opens several fields of reflection. The delayed management of suffering employees could be improved by better awareness and training of healthcare professionals in work-related mental health problems. Employees should be encouraged to more readily consult occupational health services. The creation of specific healthcare networks would avoid inappropriate treatment and delayed management that predispose to chronic disorders. A detailed analysis by policy-makers on working conditions in post-modern societies is essential to prevent progression of mental suffering in the workplace.

[Seasonal and pandemic A (H1N1) 2009 influenza vaccination coverage among health-care workers in a French university hospital]. / Couverture vaccinale antigrippale saisonnière et pandémique (H1N1) 2009: étude auprès du personnel du chu d'Angers.

The aim of this study was to highlight the perceived risk, behavioural changes and acceptance of the seasonal and pandemic (H1N1) 2009 influenza vaccine by healthcare workers in a French teaching hospital. We surveyed healthcare workers from the Angers French teaching hospital (CHU) using a cross-sectional intercept design during phase 5A of the French National Plan for the Prevention and Control of the 2009 "Pandemic Influenza". Professionals were asked to take the survey in their workplace from November 2009 to February 2010. The primary endpoint was immunization coverage among healthcare workers who had contact with at-risk patients. Among the 532 workers responding, 22.3% were vaccinated against seasonal influenza and 36.5% against H1N1 influenza. The immunization coverage rate was significantly higher among physicians. For seasonal influenza, the 2 most-cited reasons for vaccination were "to protect the patient" and "to avoid getting sick"; arguments against vaccination were "I never get the flu" or "getting vaccinated is inconvenient and takes too long". For the pandemic A (H1N1) 2009 flu, the arguments for vaccination were "to protect the patient" and "to protect the family"; arguments against vaccination were linked to vaccine safety. Vaccination coverage against seasonal influenza was lower than that reported in the literature, possibly because of the time required between vaccination for pandemic (H1N1) 2009 influenza and seasonal influenza and the priority often given to vaccination against H1N1. This study emphasizes the lack of perception of pandemic (H1N1) 2009 influenza severity and lack of understanding about the process of developing the seasonal and H1N1 influenza vaccines. Concerns about safety, the possibility of side effects and the vaccine development process need to be addressed. An information campaign stressing the necessity for healthcare workers to be vaccinated must be strengthened.

Acceptance of seasonal and pandemic a (H1N1) 2009 influenza vaccination by healthcare workers in a french teaching hospital.

INTRODUCTION: The aim of this study was to highlight the perceived risks, behavioural changes and the rate of acceptance of seasonal and pandemic (H1N1) 2009 influenza vaccines by healthcare workers (HCWs) in a French Teaching Hospital. METHODS: We sampled HCWs from the Angers French Teaching Hospital (France) using a cross-sectional intercept design during phase 5A of the 2009 French National Plan for the Prevention and Control of 'Pandemic Influenza'. From November 2009 to February 2010, HCWs were approached in the workplace to undertake the survey. The primary endpoint assessed immunization coverage among HCWs who had contact with at-risk-patients. RESULTS: Of the 532 HCWs who answered the questionnaire, 119 (22.4%) had received a seasonal vaccine and 194 (36.5%) the H1N1 pandemic vaccine. Coverage rate was significantly higher among physicians (45% for the seasonal vaccine, 61% for the H1N1 vaccine). The main reasons given for acceptance of the seasonal vaccine were "protection of the patient" and "self-protection", whereas the main arguments against were "low risk of being infected" and "doubts about vaccine safety". For the H1N1 vaccine, reasons for vaccination were to "protect the patient" and "protect the family". The main arguments against were "fear of side effects" and "doubts about vaccine safety". CONCLUSION: This study emphasizes the lack of perception by HCWs of the importance of being immunized against seasonal and pandemic A (H1N1) 2009 Influenza. In the future, particular efforts are needed, during vaccination campaigns, to provide more information to HCWs regarding development process and safety of such vaccines.