Physician and patient perceptions of cultural competency and medical compliance.

To examine the relationship between the different perceptions of medical teams and their patients of the cultural competence of physicians, and the influence of this relationship on the conflict between them. Physicians' cultural competence (Noble A. Linguistic and cultural mediation of social services. Cultural competence of health care. Echo New Studio 2007; 91:18-28) might reduce this phenomenon. Structured questionnaires were distributed to 90 physicians working in outpatient clinics in a central hospital in Israel, and to 417 of their patients. Each physician had four to six sampled patients.The findings showed a significant negative correlation (r = -0.50, P < 0.05) between the physicians' perception of their cultural competence and the patients' perception of physician competence. The more patients perceive the physician as culturally competent, the more they comply with their medical recommendations. In addition, the findings show that ethnicity significantly affects patients' perception of the cultural competence of physicians, and their satisfaction with the medical care they receive.

Control of an ACC-1-producing Klebsiella pneumoniae outbreak in a physical medicine and rehabilitation unit.

This article describes an outbreak of ACC-1-producing Klebsiella pneumoniae involving 40 patients. These were mainly men under 40 years old with a spinal cord injury, in a physical medicine and rehabilitation unit. The main risk factors were prolonged hospital stay, multiple-bed rooms, tracheostomy care and assisted defaecation. The outbreak was only controlled after the introduction of rigorous patient placement (i.e. single rooms or cohorting in the same room), while allowing the patients to have free access to the various technical services (e.g. physiotherapy and occupational therapy) and living spaces necessary for re-education.

[Routine screening of antibiotic-resistant bacteria in acute rehabilitation units]. / Intérêt du dépistage actif des bactéries multirésistantes dans les services de médecine physique et réadaptation.

OBJECTIVES: The objective of this study was to evaluate the epidemiology of antibiotic-resistant bacteria among motor impaired patients admitted to an acute rehabilitation unit. METHODS: From January 2000 to December 2002, the acute rehabilitation units of R. Poincare Hospital have screened patients for methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase enterobacteria (ESBL-EB) carriage by nasal and rectal swab at admission, every month and exit. RESULTS: Finally, MRSA was isolated form screening or diagnosis samples of 360 patients and ESBL-EB from screening or diagnosis samples of 170 patients, corresponding respectively to an incidence of 3.6 for 1000 days of hospitalization (DH) and 1.7 for 1000 DH. 66% (236/360) of MRSA carriers and 58% of ESBL-EB carriers were identified only by screening samples. Carriage origin was identified for year 2002: Cases were imported for 40% (26/65) of MRSA carriers and 43% (18/42) of ESBL-EB carriers. The median acquisition delays were of 31 days [3-154] for MRSA and 19 days [3-317] for ESBL-EB. CONCLUSION: This allowed to set up contact precautions for more than 2 fold patients that would have allowed diagnosis samples alone.

Blood lactate disappearance dynamics in boys and men following exercise of similar and dissimilar peak-lactate concentrations.

Characteristically, children recover faster than adults from various types of exercise. The purpose of the present study was to explain the children's faster recovery, in part, by addressing lactate (La) removal and comparing La disappearance dynamics in the two age groups following exercise of both similar and dissimilar peak blood-lactate concentration values ([La]pk). The subjects were 14 prepubertal boys and 12 men of similar peak oxygen consumption, normalized for body mass. All subjects performed 30 s supra-maximal cycling (Wingate anaerobic test [WAnT]). [La]pk was 10.7 +/- 1.9 and 14.7 +/- 1.7 mmol x l(-1) for the boys and men, respectively (p < 0.001). The men were later retested in shortened versions of the WAnT so as to attain [La]pk values (10.5 +/- 0.7 mmol x l(-1)) comparable to those achieved by the boys. [La]pk lag time following the boys' standard WAnT was similar to that found in the men following the shortened WAnT (5.0 +/- 2.6 vs 5.7 +/- 1.3 min, respectively), but considerably shorter than that following the men's 30s-WAnT (7.6 +/- 2.1 min; p < 0.05). The La disappearance dynamics were closely matched between groups following the matched [La]pk WAnTs. [La] half-life was similar under all conditions (ca. 20 min). It is concluded that prepubertal boys are characterized by a lower [La]pk and a shorter time lag before reaching it, following 30-s supra-maximal cycling exercise. However, boys' La disappearance dynamics are not different from that of men.

A review of the antitumour activity of vinorelbine in breast cancer.

The use of vinorelbine 30 mg/m2/week as a single-agent treatment in advanced breast cancer has achieved response rates of > 20% as second-line treatment and 40 to 50% as first-line treatment. The major toxicity of the drug is reversible neutropenia; 35 to 50% of treated patients have grade IV neutropenia. The agent did not induce thrombocytopenia and proved mildly emetogenic and neurotoxic. Activity was confirmed in combination with fluorouracil or doxorubicin, when response rates ranging from 60 to 74% were achieved. Thus, vinorelbine appears to be a promising agent in the treatment of advanced breast cancer.

[Menetrier's disease and gastric tumors (author's transl)]. / Maladie de Ménétrier et tumeur gastrique.

The authors describe three patients with Menetrier's disease and cancer of the stomach. Menetrier's disease may be a precancerous condition of the association may be a coincidence, but it would still seem preferable to propose surgical treatment and "rather a total gastrectomy". Detecting early signs of cancer on fibroscopy is difficult in this disease because of the characteristic large hypertrophied mucosal folds.