[Hemodialysis performance in Center East Tunisia: Compliance and adequacy of biological tests (PHCET study 2014)]. / Performance des centres d'hémodialyse au Centre Est Tunisien : conformité et adéquation des examens biologiques (Étude PHCET 2014).

BACKGROUND: Determining the performance level of hemodialysis facilities, including an evaluation of biological tests, is a prerequisite for quality assessment of these healthcare structures. OBJECTIVE: The purpose of this work was to evaluate the compliance and adequacy of biological tests performed in 2014 in Center-East Tunisia hemodialysis units. METHODS: Data were collected using an analysis grid for 15 biological indicators including 11 process items and four results items used to determine the compliance and adequacy rates respectively. RESULTS: This study included 660 hemodialysis patients (sex ratio 1.16; mean age 53.9±15.32 years). A low level of compliance was noted for several biological tests (blood glucose: 0.8%; hemoglobin 34.5%). The rate of adequacy of the biological results was insufficient, especially for anemia (32.7%) and calcium-phosphorus surveillance (41.8%). Intercenter and inter-region variability was noted, both for compliance and for adequacy of biological tests. CONCLUSION: This study demonstrated low compliance of biological tests performed for hemodialysis patients and the non-adequacy of the results obtained. It is thus urgent to institute a quality management system for biological tests performed in hemodialysis units.

[Diagnostic performance of graphical anomalies in the detection of large platelets and platelet clumps]. / Performances diagnostiques des anomalies graphiques dans la détection des macroplaquettes et des agrégats plaquettaires.

UNLABELLED: Thrombocytopenia is a current situation for making a blood smear in routine practice in a medical analysis laboratory. Recent automated hematology analyzers enumerate platelets and generate histograms and specific flags. Operators must be aware of the characteristics of their analyzer in order to avoid spurious results in the case where microscopy review is not possible. OBJECTIVE: We evaluated the diagnostic performance of various graphical anomalies in the detection of large platelets and platelet clumps. PATIENTS AND METHODS: Three hundred cases of thrombocytopenia were included in the study on the basis of a platelet count less than 150 × 10(9)/L. This evaluation is expressed by the results of the sensitivity, specificity, positive predictive value and negative predictive value compared to the microscopic review of blood smear. RESULTS: Graphical performances are variable according to microscopic review of blood smears. Indeed, a not fitted curve is the most sensitive change on platelet histogram to the presence of large platelet. A high specificity to the presence of platelet clumps is announced when the platelet curve fails to return to the baseline. Moreover, characteristic findings on the DIFF scattergram are very specific to the presence of platelet clumps. CONCLUSION: A normal platelet histogram can validate with great confidence thrombocytopenia in cases where a blood smear cannot be read immediately.

[Effects of video information in patients undergoing coronary angiography]. / Intérêt d'un film d'informations pour les patients avant coronarographie.

BACKGROUND: informed consent is a fundamental and legal obligation for each interventional cardiologist. The effect of consent form describing risks of invasive procedure on anxiety is controversial. This trial was aimed to assess the added value of video information to the standard informed consent process. METHODS: 200 consecutive patients undergoing coronary angiography were enrolled. The first one hundred were assigned to conventional education conducted by the physician (no video group) and the second one hundred had consent obtained in the conventional manner assisted by video information (video group). The outcome variables for this comparison consisted of a standard anxiety score (Spielberger Statement Anxiety Inventory questionnary) plus hemodynamics measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent In addition, before discharge, patients graded the tolerability and satisfaction on a 4-point scale. RESULTS: The groups were similar with regard to their baseline characteristics and anxity score (37+23 vs 37+23). Patients who had not had prior experience of catheterization had higher baseline anxiety than those who had prior angiography (45 + 22 vs 31 + 20; p = 0.027). Patients who watched the video were significantly less anxious after informed consent (28 + 21 vs 34 + 22; p = 0.048) and had a significantly lower heart rate (65 + 10 vs 71 + 12; p = 0.03). The benefits of video information were especially prominent in those with higher anxiety scores at baseline (score after 45 + 24 vs 57 + 26; p = 0.046). Tolerability were higher in the video group compared with no video group (98% vs 86%; p = 0.003). Finally, satisfaction of information for informed consent process was higher in video group than in no video group (99% vs 76%; p = 0.001). CONCLUSION: a video information decreased anxiety level after written informed consent and improved tolerability and satisfaction scales in patients undergoing coronary angiography. The most likely to benefit from video information are patients with higher anxiety level at baseline. Beneficial effect on informed refusal should be investigated in larger population.

[Intra-individual variability of the platelet anti-aggregation effect of aspirin in coronary patients]. / Variabilité intra-individuelle de l'effet antiagrégant plaquettaire de l'aspirine chez le coronarien.

UNLABELLED: Several studies have reported a biochemical resistance to aspirin in 5 to 10% of coronary patients. However, the stability of the platelet anti-aggregation effect with aspirin over time remains poorly understood. OBJECTIVE: To study the intra-individual variability at 6 months of the anti-platelet action of aspirin in coronary patients. METHOD: Prospective study including 40 consecutive patients with acute coronary syndrome and taking regular aspirin (250 mg a day). The biochemical impact of aspirin was determined by measuring the time to occlusion (TO) on a collagen/epinephrine cartridge with PFA-100. The determination of the TO was performed 2 months (TO1) and then 8 months (TO2) after starting aspirin. In our population, a resistance to aspirin was defined as a TO < or =125 sec. RESULTS: The median value for TO was generally stable over the two periods, at 158 sec for TO1 and 179 sec for TO2 (p = 0.29). Among the 9 initially resistant patients (22.5%), 4 became sensitive to aspirin without changing the dosage, while only one of the 31 initially sensitive patients became biochemically resistant. CONCLUSION: the existence of a medium term intra-individual variability in the antiplatelet response to aspirin in coronary patients underlines the importance of biochemical surveillance in these high vascular risk patients.