Prevention of potentially inappropriate medication in internal medicine patients: A prospective study using the electronic application PIM-Check.

WHAT IS KNOWN: Potentially inappropriate medication (PIM) is a risk factor for drug-related problems (DRPs) and an important inpatient safety issue. PIM-Check is a screening tool designed to detect PIM in internal medicine patients. OBJECTIVE: This study aimed to determine whether PIM-Check could help to identify and reduce DRPs. METHOD: Prospective interventional study conducted on patients admitted to internal medicine wards in a university hospital between 1 September 2015 and 30 October 2015. Adult patients were included if they were hospitalized for more than 48 hours. Patients received either usual care (period 1 = control) or usual care plus medication screening by the wards' chief residents using PIM-Check (period 2 = intervention). An expert panel, composed of a clinical pharmacist, a clinical pharmacologist and two attending physicians in internal medicine, blinded to patient groups, identified DRPs. RESULTS: A total of 297 patients were included (intervention: 109). The groups' demographic parameters were similar. The expert panel identified 909 DRPs (598: control; 311: intervention). The mean number of DRPs per patient was similar in the control (3.2; 95% CI: 2.9-3.5) and intervention groups (2.9; 95% CI: 2.4-3.3) (P = .12). PIM-Check displayed 33.4% of the 311 DRPs identified in the intervention group. WHAT IS NEW AND CONCLUSION: In this study, PIM-Check had limited value, as the average number of DRPs per person was similar in both groups. Although one-third of DRPs counted in intervention group had been identified by PIM-Check, this did not lead to a reduction in DRPs. This lack of impact of PIM-Check on drug prescription may be explained by the number of alerts displayed by the application and hospital physicians' reluctance to modify the treatments for chronic conditions previously prescribed by general practitioners.

Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials comparing any intubation device with the Macintosh laryngoscope in human subjects with cervical spine immobilization. The primary outcome was the risk of tracheal intubation failure at the first attempt. Secondary outcomes were quality of glottis visualization, time until successful intubation, and risk of oropharyngeal complications. RESULTS: Twenty-four trials (1866 patients) met inclusion criteria. With alternative intubation devices, the risk of intubation failure was lower compared with Macintosh laryngoscopy [risk ratio (RR) 0.53; 95% confidence interval (CI) 0.35-0.80]. Meta-analyses could be performed for five intubation devices (Airtraq, Airwayscope, C-Mac, Glidescope, and McGrath). The Airtraq was associated with a statistically significant reduction of the risk of intubation failure at the first attempt (RR 0.14; 95% CI 0.06-0.33), a higher rate of Cormack-Lehane grade 1 (RR 2.98; 95% CI 1.94-4.56), a reduction of time until successful intubation (weighted mean difference -10.1 s; 95% CI -3.2 to -17.0), and a reduction of oropharyngeal complications (RR 0.24; 95% CI 0.06-0.93). Other devices were associated with improved glottis visualization but no statistically significant differences in intubation failure or time to intubation compared with conventional laryngoscopy. CONCLUSIONS: In situations where the spine is immobilized, the Airtraq device reduces the risk of intubation failure. There is a lack of evidence for the usefulness of other intubation devices.

[Emergency medicine: updates 2012]. / Médecine d'urgence.

We review some of the most influential papers from 2012 in the different aspects of emergency medicine, such as prehospital medicine, resuscitation, early diagnosis and timely ED discharge and treatment. In particular, intramuscular benzodiazepines have been shown to be efficient in prehospital status epilepticus, epinephrines usefulness in cardiopulmonary resuscitation has been challenged, colloids have been shown to be deleterious in the treatment of severe sepsis and septic shock, the time window for thrombolysis in acute stroke will probably be extended, acute pyelonephritis treatment duration can be decreased, new D-dimers thresholds for older patients may prevent further diagnosis tests, and hs-Troponin may allow earlier discharge of low coronary risk patients.

[Emergency medicine: updates 2011]. / Médecine d'urgence.

Emergency medicine physicians aim to stabilize or restore vital functions, establish diagnosis, initiate specific treatments and adequately orientate patients. This year, new evidences have improved our knowledge about diagnostic strategy for patients with acute non traumatic headache, treatment of acute atrial fibrillation and outpatient management of acute pulmonary embolism. Reducing injection pain of local anesthetics, reducing irradiation by using alternative diagnostic tools in appendicitis suspicion, and identification of trauma patients who benefit from tranexamic acid administration are other illustrations of the efforts to improve efficacy, safety and comfort in the management of emergency patients.

[Electrical injuries]. / Les accidents d'electrisation.

Electrical injuries can have serious multisystemic consequences and have to be evaluated regardless of the extent of skin injuries. Emergency department treatment is complex with simultaneous use of ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Trauma Life Support) algorithms, and with particular attention given to fluid resuscitation and musculoskeletal damage management. Beyond the recognized intensive care admission criteria like polytrauma or severe bums, documented arrhythmia or abnormal ECG on initial evaluation, loss of consciousness and high voltage electrical injuries (> 1000 V) each prompt a minimum of 24 hours cardiac monitoring. In addition, severely burned patients should be promptly transferred to specialized facilities.

[Emergency medicine: update 2010]. / Médecine d'urgence.

Several scores with predictive value for morbidity or mortality have been published this year. Their current purpose is to improve the direction of admissions and lengths of stay in hospital. Their use permits more directed care, especially for the elderly, and therefore could improve the proper orientation and admission of patients. Also this year, certain procedures are undergoing evaluation, namely: new assays for troponin, and non-contrast CT in the diagnosis of acute appendicitis. Furthermore in the therapeutic realm: the importance of cardiac massage and the advantages of therapeutic hypothermia in cardiac arrest, and the efficacy of oxygen therapy in cluster headache.

[Emergency medicine: update 2009]. / Médecine d'urgence.

Emergency medicine is a cross-discipline characterized by its ability to identify critical threats, as well as its ability to prioritize investigations and identify appropriate treatments. Recent publications have been published on upper gastrointestinal haemorrhage, elbow fracture or brain haemorrhage, to optimize and standardize the investigations. In parallel, conditions such as cardiopulmonary arrest, spontaneous pneumothorax or stroke, benefit from recent therapeutic advances. However, emergency physicians and primary care physicians must remain critical of the numerous medical publications, as evidenced by the contradictory results concerning the interaction between proton pump inhibitors and clopidogrel.

[How to reduce reperfusion time in ST elevation myocardial infarction?]. / Comment réduire le délai de reperfusion dans l'infarctus du myocarde avec sus-décalage du segment ST?

For patients with ST elevation myocardial infarction (STEMI), most hospitals do not achieve recommended reperfusion time delay. The goal of this article is to discuss the several strategies allowing to reduce delay to reperfusion (e.g., pre-hospital ECG, early activation of catheterisation laboratory), in order to help each institution to develop its own protocol.

[Beta-blockers and obstructive pulmonary diseases: such an odd couple?]. / Beta-bloquants et obstruction bronchique: un si mauvais ménage ?

Chronic obstructive pulmonary disease is a frequent medical condition, mainly triggered by smoking. COPD patients often suffer from heart diseases that can benefit from beta-blocker therapy. However, fear from triggering latent bronchospasm, or from worsening it, leads to under-prescription of these agents. Adequate patient selection is, thus, crucial. Prescription of a cardio-selective beta-blocker is not only reasonably safe in stable COPD patients but it is also beneficial in terms of mortality in those patients with comorbid cardiac diseases. Use of beta-blockers is contra-indicated in the case of decompensated COPD with severe bronchospasm or in poorly controlled asthma. In all cases, close clinical and, sometimes, functional monitoring is mandatory.