Pro re nata medications in mental health: Results of a transversal study.

BACKGROUND: Pro re nata are frequent in psychiatry. The risks engendered by this treatment requires that their prescription and administration be made safer. The frequency of administration of pro re nata depends mainly on the nurse's clinical judgment. AIMS: Our first objective was to assess nurses' satisfaction about the quality of doctors' pro re nata prescriptions. Our second objective was to assess the nurses' self-reported practices for administering pro re nata treatments as written in the prescription. METHOD: Self-administered questionnaires were sent by the hospital's internal mail between November 13, 2014, and December 10, 2014 to all nurses in our psychiatric establishment in France. The questionnaire included multiple-choice questions and questions based on clinical vignettes. RESULTS: The response rate was 51.9% (124/239). Overall, 75.6% considered that the quality of the prescriptions in terms of dosage was satisfactory. However, regardless of the quality of the doctor's pro re nata prescription, nurses did not contact the doctor even when the prescription quality was poor. Unexpectedly, we found that 88.7% have administered medication "as needed" without a doctor's prescription and sometimes acted without consulting doctors. CONCLUSIONS: The nurses appeared globally satisfied with doctors' prescriptions of pro re nata medications. On the other hand, most administered some medications without any prescription, that is, illegally. Physicians must be rigorous in the quality of their PRN prescriptions. At the same time, nurses must comply with the medical prescription or contact the physician if the quality of the PRN prescription appears poor.

Validation of the 'EPICES' social deprivation score in a population of women who have just given birth: a French cross-sectional study.

OBJECTIVES: To assess the diagnostic performance of the EPICES score for identifying social deprivation during pregnancy in a population of women in the immediate postpartum period. STUDY DESIGN: This cross-sectional survey took place between 5th June and 5th August 2017, among women who had just given birth in either of the maternity units in Clermont-Ferrand, France. METHODS: A self-administered questionnaire was completed by women. The questionnaire came in two parts: the EPICES index and the criteria for social deprivation defined by French law. These criteria were chosen to define the reference standard. The women were classified into two groups, living in precarious circumstances or not, according to the criteria defined by the French law (reference standard). To determine the most relevant threshold of the EPICES score, the precision associated with the threshold (the fraction of those predicted positive who are true positives: positive predictive value) was balanced with its sensitivity. EPICES scores above the threshold were classified as deprived, those below as non-deprived. RESULTS: Of the 947 women who gave birth during the study period, 700 (73.9%) completed the self-administered questionnaire. The best trade-off between precision and sensitivity was obtained with a threshold of 22. For this threshold value, the positive predictive value was 42.3% and the sensitivity 70.3%. CONCLUSIONS: The EPICES score with a threshold validated in the population of pregnant women is a useful, rapid, and easy-to-use tool that makes it possible to identify maternal deprivation at an individual level.

A screening focusing on aftereffects of alcohol consumption in a student population. A National cross-sectional survey.

INTRODUCTION: Students overestimate alcohol consumption of those around them and underestimate their own, so that quantitative approach may not be the most relevant to assess students' drinking. The main objective was to provide an appropriate tool for screening for students with potential drinking problems. METHODS: A multicentre cross-sectional survey was conducted by internet between February and June, 2013 in France. Thirteen questions explored alcohol consumption, including 8 concerning after-effects of drinking episodes (4 items of the AUDIT) and alcohol behaviour (CAGE test). A multiple correspondence analysis (MCA) was conducted to identify profiles of student's alcohol consumption. Partitioning methods were used to group students by mode of alcohol use. The most relevant items included in the MCA were identified. Three questions were identified as most pertinent among the students with potential drinking problems and ranked by a decision tree with the Chi-square Automatic Interaction Detector method. Finally, we assessed the generalisation of the model. RESULTS: A total of 36,427 students participated in the survey: 25,679 were women (70.5% of respondents), sex ratio 0.42 and mean aged 21.2 (sd 3.7 years). Among those who had experimented with alcohol (N = 33,113), three consumption profiles were identified: "simple/non-use" (66.9%), "intermediate consumption" (25.9%) and "problem drinking" (7.2%). For the latter group, the three most relevant items were (Q20) "not able to stop drinking after starting", (Q21) "failed to do what was normally expected", and (Q23) "unable to remember what happened the night before". CONCLUSIONS: These results provide healthcare professionals with a 3-item screening tool for students "problem drinking".

Exposure of pregnant women to persistent organic pollutants and cord sex hormone levels.

STUDY QUESTION: Is prenatal exposure to persistent organic pollutants (POPs) associated with variations of sex hormone levels in cord blood? SUMMARY ANSWER: Prenatal exposure to a number of POPs is associated with a disruption of hormone levels in cord blood, with sex specificities. WHAT IS KNOWN ALREADY: Epidemiological studies have reported disorders of reproductive health, in relation with POPs exposure during early life and the endocrine disruption properties of these chemicals have been suggested as possible mechanisms. STUDY DESIGN, SIZE, DURATION: A subset of 282 mother-child pairs was selected from the prospective population-based PELAGIE birth cohort (n = 3421, 2002-2006, Brittany, France). Pregnant women were recruited before 19 weeks of gestation and followed until delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS: Sex hormone levels including sex hormone-binding globulin (SHBG), estradiol (E2), total testosterone (T), free testosterone (fT = T/SHBG) and the aromatase index (AI = T/E2) were measured in 282 cord blood samples. Anti-Müllerian hormone (AMH) was measured in male newborns only. Pesticide concentrations of α-endosulfan, ß-hexachlorocyclohexane (ß-HCH), γ-HCH, dieldrin, pp'-dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzene (HCB), heptachlor epoxide (HCE), as well as PCBs (congeners 153, 187 and the sum of anti-estrogenic PCBs 118, 138, and 170) and decabrominated diphenyl ether (BDE209) were also measured in cord blood. Associations between sex hormones and POPs exposure were explored using multiple linear regressions adjusted for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE: High PCB levels were associated with an increase of SHBG (P-trend < 0.01) and AMH (P-trend < 0.05) and a decrease of fT (P-trend < 0.05) and AI (P-trend < 0.01). High pesticide levels, particularly α-endosulfan and HCE, were associated with an increase of SHBG (P < 0.05) and E2 (P < 0.01) and a decrease of fT (P < 0.05) and AI (P < 0.01). Several of these associations were stronger, or specific, among male or female newborns. The associations were not altered in the sensitivity analyses. LIMITATIONS, REASONS FOR CAUTION: The study population was of relatively small sample size, and some compounds rarely detected in cord blood. The high level of correlation between POPs makes it difficult to identify the most contributing POPs. Hormone measurements were performed at birth (in cord blood) and may not adequately represent the infant endocrine system. Multiple statistical testing may have led to false-positive associations. WIDER IMPLICATIONS OF THE FINDINGS: Our results are in discordance with those reported in the only published study of the kind but in accordance with studies about prenatal exposure to other endocrine disruptors such as phthalates. These findings may help understanding the pathways involved in adverse reproductive outcomes associated with POPs exposure. STUDY FUNDING/COMPETING INTERESTS: The PELAGIE cohort is funded by Inserm, French Ministry of Health, French Ministry of Labor, InVS, ANR, ANSES, and French Ministry of Ecology. None of the authors has any competing interest to declare.

De novo unbalanced translocation 2;4 characterized by metaphase CGH and array CGH in a child with mental retardation and dysmorphic features.

BACKGROUND: It is known from postnatal diagnosis that imbalances of the subtelomeric regions contribute significantly to idiopathic mental retardation. PATIENT AND METHODS: We report a case of a 4-year-old child with growth retardation, minor physical abnormalities, hypotonia and developmental delay associated with a derivative chromosome 4. Molecular cytogenetic investigations were performed to characterize the chromosomal rearrangement. RESULTS: Multi fluorescence in situ hybridization revealed the presence of chromosome 2 material on the derivative chromosome 4. Metaphase comparative genomic hybridization detected a terminal 4q34 deletion. Array CGH analysis could precise breakpoints with duplication 2q36 → qter. The clinical phenotype was similar to those described in cases with a trisomy 2qter. CONCLUSION: This study emphasizes the value of array CGH to detect or characterize chromosome rearrangements in mentally retarded patients. Unlike metaphase CGH, the high resolution of array CGH in subtelomeric regions allows an accurate description of chromosomal aberrations.

Impact of ultrasound speed choice on the quality of the second-trimester fetal ultrasound examination in obese women.

PURPOSE: The purpose of this study was to assess the impact of the free choice of ultrasound propagation velocity on ultrasound image construction to improve the completion rate and anatomical quality of fetal second-trimester ultrasound examination in obese women. MATERIALS AND METHODS: This repeated cross-sectional single-center study retrospectively collected second-trimester ultrasound images of 88 obese women. During the first period, ultrasound examinations were performed in 44 women (mean age, 31.4±5.9 [SD] years; range: 21.1 - 45.3 years) applying only the standard 1540m/s tissue ultrasound velocity (group 1). During the second period, ultrasound examinations were performed in other 44 women (mean age, 31.4±5.1 [SD] years; range: 20.6 - 41.6 years) with the operator free to choose among three available velocity settings (1420m/s, 1480m/s or 1540m/s) for the scanning planes for the morphological images (group 2). All women underwent mid-trimester ultrasound examination at 20 to 24 gestational weeks. Two observers assessed the examinations in both groups for completeness, quality, and duration of fetal ultrasound examinations. RESULTS: No differences in age (P>0.99), body mass index (P=0.67), prevalence of previous cesarean delivery (P=0.30) or gestational age at the second-trimester scan (P=0.20) were found between the two groups. The mean cumulative duration of these ultrasound examinations was longer in group 1 than in group 2 (for both the complete (P=0.04) and incomplete (P=0.03) examinations). The quality of the anatomic images according to Salomon's criteria was less often acceptable in group 1 (5/44, 11.4%) than in group 2 (15/44, 34.1%) (P=0.02). CONCLUSION: Free choice of ultrasound velocity improves the overall performance of fetal second-trimester ultrasound examinations in obese women.

Are there risk factors for false-positive malformation diagnoses on obstetric ultrasound? A nested case-control study.

INTRODUCTION: In a population-based study, we found an overall false-positive rate of 8.8% for the second and third trimester ultrasounds. Although numerous studies have been performed to examine factors which lead to false negatives, the same is not true for the factors associated with false positives. The principal objective of this study was to look for risk factors for false-positive diagnoses of fetal malformations on obstetric ultrasound scans. MATERIAL AND METHODS: In this nested case-control study, the case infants were those whose mother had a false-positive antenatal ultrasound diagnosis of a malformation during the second or third trimester (ultrasound false-positives) and who were live - or stillborn in Auvergne in 2006-2010. The control group comprised all children who were ultrasound true-negatives in 2005 and 2007. The study included 46 cases and 184 controls, matched according to the level of the maternity unit in which they were born. RESULTS: Most false-positive diagnoses were minor malformations. The mean term at this false-positive diagnosis was 27.7±5.4 weeks; in 46.8% of cases, the diagnosis was made during the second-trimester ultrasound. A single malformation was suspected in 95.7% of the cases. In 97.9% of cases, only one anatomical system was affected. In all, 49 malformations were identified among the 46 cases and their distribution differed according to anatomical system. The only risk factor identified was a body mass index (BMI)<25 (ORa=1.7; 95%CI: 1.2-2.4). DISCUSSION: A maternal BMI<25 was the only risk factor identified for a false-positive ultrasound diagnosis of a fetal malformation.

Can hospital discharge data be used for monitoring indicators associated with postpartum hemorrhages? The HERA multicenter observational study.

OBJECTIVES: The principal objective of this study was to assess the reliability of measuring the incidence of postpartum hemorrhages (PPH) from the national hospital discharge summary database (PMSI). The secondary objectives were to assess this reliability according to the maternity unit level and status and to assess the measurement of second-line procedures for PPH. MATERIALS AND METHODS: This study compared PPH incidence rates from February through July 2011 in 131 maternity units, as measured in the PMSI and the prospective HERA study cohort, considered as the reference standard. RESULTS: Compared with the cohort, PPH incidence was over-reported in the PMSI among vaginal deliveries (4.0% vs. 3.5; P<0.0001), but not cesareans (3.2 vs. 2.9%; P=0.1). For the second-line curative procedures, PMSI data underestimated the incidence of vessel embolization and transfusion (P<0.0001) among vaginal deliveries and of hypogastric ligation (P=0.002), other vessel ligation (P=0.005), and transfusion (P<0.0001) among cesareans. CONCLUSION: Despite some coding inaccuracy in the PMSI, routinely collected data can provide acceptable estimates for maternity units and perinatal networks to use to improve quality of care through the monitoring of quality indicators. Improvements are nonetheless needed for international comparisons and other epidemiologic purposes.

Shear wave elastography safety in fetus: A quantitative health risk assessment.

PURPOSE: To identify the effects of shear wave elastography in the fetus for evaluation in widespread use. MATERIALS AND METHODS: The Health Risk Assessment method proposed by the National Research Council was used with literature to evaluate the safety of shear wave elastography for the fetus regarding its potential effects in human tissues. RESULTS: The experimental and epidemiologic data from 25 articles showed that shear wave elastography maintained the same thermal effect as pulsed Doppler ultrasound already authorized in obstetrics, and that cavitation effect on fetal tissue is improbable. Nonetheless, the vibratory character of shear waves could induce displacement of fetal tissue while potential effects of very short duration energy peaks of the radiation force focused wave front remain unknown. CONCLUSION: The actual knowledge does not provide enough information to assess the effects of shear wave elastography on fetal tissues, thus these points have to be explored by further experimental studies.