Enteral nutrition in French institutionalized patients: a multicentric study.

BACKGROUND: No previous studies have demonstrated either a nutritional improvement, or a survival benefit from tube placement in an institutionalized population. OBJECTIVE: The aim of this study was to determine current indications for tube feeding in French geriatric centers and to evaluate clinical outcome and mortality rates in these frail very old patients. DESIGN: Between November 1, 2000 and April 31, 2001, we prospectively recruited all hospitalized or institutionalized patients who received enteral nutrition (EN) in 7 Departments of Geriatric Medicine in France. Nutritional parameters and main indications of EN were recorded at the time of feeding tube placement. Pneumonia and mortality rates were observed over a period of one year. RESULTS: 57 patients of mean age 81.6 7.8 yrs underwent placement of a feeding tube. Mean BMI value was 20.7 4.8 and mean serum albumin level 26.1 6.1 g/L. The most frequent indications for EN included stoke (39%) and other neurologic diseases (42%). Fourteen patients (25%) died within 30 days, and 27 (47%) died over the 12-month follow-up period. During the first month, an episode of pneumonia was noted in 26 cases (55%). CONCLUSION: The similarity between rates of early mortality reported in our study and those reported in several previous studies involving younger, ambulatory subjects is surprising because we might expect poorer survival in our frail elderly patients. We can think that French geriatric teams have changed their attitudes toward EN in recent years, EN being less frequently used in patients with advanced dementia and at the end-stage of life.

[Value of puncture-arthrography in the diagnosis of infection of total hip arthroplasty]. / Intérêt de la ponction-arthrographie de hanche dans le diagnostic d'infection sur prothèse totale.

Arthrography with hip aspiration was performed in 143 patients with hip arthroplasties to determine its effectiveness as a technique for diagnosing infection. Thirty-three cases of infection were found. On 26 occasions the germ responsible was isolated in the joint fluid. In six other cases infection was revealed from cytologic or arthrographic findings, or from both. Only once was a diagnosis of infection not arrived at. In this series of patients, except in cases of evolutive inflammatory rheumatism, cytologic examination of the joint fluid was a discriminative factor in diagnosis. Hip aspiration arthrography had a sensitivity of 79 per cent for the diagnosis of infection in arthroplasty with isolation of the germ and a specificity of 100 per cent. The sensitivity of the diagnosis rose to 91% when any one of the following features was observed: leucocytosis of the joint fluid higher than 10,000 elements/mm3; presence of a fistula or of fistulization on arthrography; isolation of the germ in the joint fluid or the rinsing liquid.

[Family members integration in patients' care in haematology units: a new application of proximology.]. / L'intégration des familles aux soins des patients hospitalisés en hématologie : une nouvelle application de proximologie.

Hospitalization per se is a stress for the family members of a loved one. While their role as informal caregivers is well known with at home patients, especially in oncology, they usually are only mere visitors at the hospital. Hence the integration of family members of in patients' care might improve both patients and families' quality of life. Such a supportive care concept has been previously investigated in pediatric, neurology and intensive care units, but there is not such data in hematology although the therapeutic in this field is marked by long-term stay in hospitals' rooms. Since 2001, we developed in Clermont-Ferrand University hospital such a project of integration. Put together, the literature data and our first results (opinion poll) show that the main risk of this approach is the exhaustion of family caregivers, their fear of miss conduct and the alteration of the relationship they previously had with the patient. Conversely this approach is likely beneficial in improving both patients and family member's experience during hospitalization in lowering both patients' affective social and may be cultural loneliness and family members' feeling of uselessly and guilt. In France the development of supportive care and therapeutic education in oncology is nowadays encouraged and of there is no legal basis to restrain the development of this concept. Whose concept, nevertheless should be carefully set up and studied and its benefit remain to be clearly demonstrated.

[Dibekacin in the treatment of urinary infections in the elderly]. / La dibékacine dans le traitement de l'infection urinaire du sujet âgé.

Urinary tract infections in the elderly are severe and intractable, often justifying the use of aminoglycosides. We studied the effects of dibekacin in 28 patients, with no vesical catheter, whose average age was 78 +/- 6.1 years. The drug was given for ten days, in an average dose of 2.1 mg/kg/day divided into two injections. Serum concentration was measured after one hour on day 1 and after eight hours on days 1 and 10. Causative pathogens, all susceptible to dibekacin, were: 18 E. coli, 3 Proteus mirabilis, 3 Klebsiella, 1 Enterobacter cloacae, 1 Citrobacter and 2 Staphylococci. MIC and MBC of dibekacin were determined for each microorganism. Dibekacin was discontinued in four cases on day three because of persistent bacteriuria. Ten days after treatment end, 19 patients were cured, 4 had a relapse and 1 was reinfected. Average serum concentration of dibekacin, measured after eight hours, increased from 0.77 +/- 0.48 micrograms/ml on day 1 to 1.78 +/- 1.22 microgram/ml on day 10 (t = 4.42; p less than 0.0005), while, over the same period, there was no significant change in serum creatinine.

[Our experience with ofloxacin in the treatment of osteoarticular infections]. / Notre expérience de l'ofloxacine dans le traitement des infections ostéo-articulaires.

Twenty patients with osteoarticular infections, fourteen post-arthroplasty and six with osteitis, were treated with ofloxacin, usually in combination. Sixteen staphylococcus strains including eight aureus and eight coagulase negative (modal MIC and MBC: 0.5 micrograms/ml), three Escherichia coli (modal MIC and MBC: 0.06 micrograms/ml) and one Peptococcus (MIC: 0.25, MBC: 0.5) were isolated. Treatment was given at a mean dose of 9.81 +/- 2.46 mg/kg for a mean duration of 100 days. The serum concentration of ofloxacin was measured at 3.73 +/- 2.13 micrograms/ml for a dosage of 8.23 +/- 0.94 mg/kg (25 assays) and 7.42 +/- 4 micrograms/ml for 11.46 +/- 1.3 mg/kg (23 assays). Bacteriological control was carried out nineteen times; in one case of staphylococcal osteitis, a relapse occurred on the 43rd day of treatment when the strain isolated was resistant to ofloxacin. Three patients presented adverse effects: two cases of bone and muscle pain and one cutaneous allergic reaction: treatment was withdrawn after two restarts. The antibacterial action, the good tolerance and the easy administration of ofloxacin make it a useful antibiotic in the treatment of osteoarticular infections, where a dosage of 8 mg/kg appears to be necessary, particularly in infections due to staphylococci.