[Crisis unit at the general hospital: Determinants of further hospitalization]. / Facteurs prédictifs d'hospitalisation à partir des lits de crise des urgences d'un hôpital général.

INTRODUCTION: The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. OBJECTIVE: The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. METHOD: All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. RESULTS: Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of hospitalization were the presence of a personality disorder (OR=0.31), a precipitating conflict situation (OR=0.41), age between 20 and 39 years (OR=0.42), being employed (OR=0.49). CONCLUSION: Our study confirms that clinical factors such as the presence of a personality disorder or the context of a precipitating conflict situation are predictive of a community return. Interestingly, it points out the importance of the patient's initial wish in the hospitalization decision.

[Economic impact of second- and third-line erlotinib treatment of non small-cell lung cancer]. / Conséquences économiques de l'erlotinib dans le traitement des cancers bronchopulmonaires non à petites cellules.

OBJECTIVE: This study examined care consumption and management costs among patients who received second- or third-line oral erlotinib therapy for non small-cell lung cancer (NSCLC). METHODS: The study involved two observational cohorts of NSCLC second- or third-line treated patients. In the first, patients received IV chemotherapy alone (233 patients), while patients in the second cohort, received oral erlotinib (166 patients). Only direct costs were taken into account. The analysis adopted the payer's perspective. RESULTS: The treatments lasted a similar length in the second- line setting (respectively 94,5+/-67,5 and 105+/-79,4 days for the IV and erlotinib cohorts) but was significantly longer in the erlotinib cohort during third-line therapy (76.6+/-96.5 versus and 114.4+/-74.5 days, p<0.008). In the erlotinib cohort, there were more women (p=0.023), a higher rate of adenocarcinoma (p=0.0043), a similar rate of conventional hospitalization, but less daycare clinics (p<0.001). The erlotinib cohort received significantly less antiemetic treatment (p<0.0001), erythropoietin stimulating agents (p<0.005) and G-CSF (p<0.001). Monthly management costs per patient in the IV and erlotinib cohorts were respectively 3126 +/-1904 and 2750+/-1450 euros during second-line treatment, and 3026+/-1029 and 2823+/-1490 euros during third-line treatment (no significant difference). These results must be validated by prospective observational studies focusing on quality of life and the time spent in hospital.

[Prevalence of trauma-related disorders in the French WHO study: Santé mentale en population générale (SMPG)]. / Prévalence des troubles psychotraumatiques en France métropolitaine.

INTRODUCTION: Trauma-related disorders are disabling affections of which epidemiological data change according to the country, population and measuring instruments. The prevalence of posttraumatic stress disorder (PTSD) appears to have increased over the past 15 years, but one cannot tell whether it has indeed increased or whether the standardized procedure has improved. Moreover, very few epidemiologic studies among the general population have been conducted in Europe, notably in France. DESIGN OF THE STUDY: The "Santé mentale en population générale" (SMPG) survey, that took place in France between 1999 and 2003 among more than 36 000 individuals, gives an estimation of the prevalence of psychotraumatic disorders in the general population. Multi-varied analyses were performed on PTSD-related variables and comorbid disorders. The instantaneous prevalence (past month) of PTSD was of 0.7% among the whole SMPG sample, with almost the same proportion of men (45%) and women (55%). There was a high rate of comorbidity among PTSD individuals, notably with mood disorders, anxiety disorders and addictive behaviour. There was an obvious relationship with suicidal behaviour, with 15-fold more suicide attempts during the past month among the PTSD population. RESULTS: This survey analysed the consequences of a psychic traumatism over and above complete PTSD according to DSM-IV criteria, observing for instance the consequences for people exposed both to a trauma and suffering from at least one psychopathological symptom since the trauma. Those who suffered from a psychotraumatic syndrome, according to our enlarged definition, represented 5.3% of the population, half suffered from daily discomfort and a third of them used medication. Then, we compared those psychotraumatic syndromes to complete PTSD from a sociodemographic, functional and type of care point of view. There was little difference in prevalence of PTSD between men and women in the SMPG survey (45% vs 55%), which is clearly distinct from the other epidemiologic surveys named above. Regarding age, as in the ESEMeD survey, anxiety disorders appeared to be more frequent among younger people. The originality of the SMPG survey is obviously in the fact that it studied the functional impact of the psychic disorder, the type of care and the satisfaction level after care. Only 50% of the PTSD population feels sick which is, however, twice as high as for the psychotraumatized population. This doesn't fit either with the fact that 100% of the PTSD population say they feel uncomfortable with other people. The type of care is in the same vein: 50% of psychotherapies and 75% of medication, but also 25% of mild medicines and 25% of traditional medicines. Moreover, among the drugs, antidepressants (that are still the first choice treatment in all international recommendations) represent only 30%, whereas anxiolytics, hypnotics and phytotherapy represent the remaining 70%. DISCUSSION: Regarding the type of care, the differences between the psychotraumatized population and the PTSD population are obvious. They are obvious in that which concerns the type of care, since the medication is similar. From a very global point of view, patients suffering from a subsyndromal PTSD rarely choose medical care (religion, mild or traditional medicine), while full PTSD patients definitely choose classical medical care (drugs, psychotherapy, and 30% of hospitalization). The prevalence of those who ask for care is very close to that observed in the ESEMeD survey, which was four individuals out of 10 suffering from PTSD. CONCLUSION: The SMPG data show that its necessary to maintain the distinction between subsyndromal PTSD and full PTSD since the populations differ, but both need care.