CLINICAL EVALUATION OF A SPECIFIC BENZODIAZEPINE ANTAGONIST (RO 15-1788): Studies in Elderly Patients after Regional Anaesthesia under Benzodiazepine Sedation

The efficacy, usefulness and side effects of RO 15-1788 (RO), a specific benzodiazepine (BZD) antagonist, have been evaluated. Sixty-two patients (ASA l-lll, mean age 72±9 yr) scheduled for urological surgery under regional anaesthesia and BZD sedation received placebo or RO in a randomized, double-blind fashion at the end of the procedure, folio wing sedation with midazolam. When compared with placebo, RO improved alertness and collaboration for 15 min, and suppressed anterograde amnesia for 60 min. No major side effect was noted, although five patients became anxious after administration of RO. Two cases of a paradoxical reaction to midazolam were treated successfully by R

Grands consommateurs des services d'urgence, un défi pour le système de santé : une mise au point

Dans de nombreux pays, on assiste à une augmentation importante de la fréquentation des services d’urgences des hôpitaux, entraînant un risque accru d’encombrement de ces services et, potentiellement, un risque pour la santé des patients consultants. Les causes possibles de tels encombrements sont multiples : fréquemment mentionnés sont les patients consultant plusieurs fois par année, les grands consommateurs des services d’urgence. Selon la littérature, ils représentent 3,5 % à 7,7 % des patients et 12 % à 18 % des consultations. Ils correspondent, comparativement aux patients usagers occasionnels de services d’urgence, plus fréquemment à des personnes souffrant de troubles psychiques, présentant des maladies chroniques multiples, dépendantes à une substance ou de conditions socioéconomique modestes. Les raisons les plus fréquemment citées par les grands consommateurs, comme motifs de consultation, sont la gravité perçue de leur maladie et l’offre limitée d’alternatives à une consultation d’urgence. Ils se sentent, par ailleurs, régulièrement discriminés et stigmatisés lors de leur prise en charge. Plusieurs types d’interventions, rapportées dans la littérature, permettent soit de réduire le nombre de consultations par des grands consommateurs, soit de mieux prendre en charge ces patients. Citons les interventions portant sur l’amélioration de la littératie de santé des grands consommateurs ; celles axées sur leur réorientation préhospitalière par du personnel soignant ; celles visant une limitation de l’accès aux services d’urgences par un système de gate-keeper ou par des incitatifs économiques ; celles assurant un accès à des soins communautaires facilités, par exemple par la mise en place de structures de soins de bas-seuil ; celles enfin, particulièrement efficaces, mettant l’accent sur la coordination des soins entre prise en charge hospitalière et communautaire, telle que le case-management

Developing a health and human rights training program for french speaking Africa: lessons learned, from needs assessment to a pilot program

<p>Abstract</p> <p>Background</p> <p>The importance of human rights education has widely been recognized as one of the strategies for their protection and promotion of health. Yet training programs have not always taken into account neither local needs, nor public health relevance, nor pedagogical efficacy.</p> <p>The objectives of our study were to assess, in a participative way, educational needs in the field of health and human rights among potential trainees in six French-speaking African countries and to test the feasibility of a training program through a pilot test. Ultimately the project aims to implement <it>a health and human rights training program most appropriate to the African context</it>.</p> <p>Methods</p> <p><it>Needs assessment </it>was done according to four approaches: Revue of available data on health and human rights in the targeted countries; Country visits by one of the authors meeting key institutions; Focus group discussions with key-informants in each country; A questionnaire-based study targeting health professionals and human rights activists.</p> <p><it>Pilot training program</it>: an interactive e-learning pilot program was developed integrating training needs expressed by partner institutions and potential trainees.</p> <p>Results</p> <p>Needs assessment showed high public health and human rights challenges that the target countries have to face. It also showed precise demands of partner institutions in regard to a health and human rights training program. It further allowed defining training objectives and core competencies useful to potential employers and future students as well as specific training contents.</p> <p>A pilot program allowed testing the motivation of students, the feasibility of an interactive educational approach and identifying potential difficulties.</p> <p>Conclusion</p> <p>In combining various approaches our study was able to show that training needs concentrate around tools allowing the identification of basic human rights violations in the health system, the analysis of their causes and coordinated responses through specific intervention projects.</p

Puzzle based teaching versus traditional instruction in electrocardiogram interpretation for medical students – a pilot study

<p>Abstract</p> <p>Background</p> <p>Most medical professionals are expected to possess basic electrocardiogram (EKG) interpretation skills. But, published data suggests that residents' and physicians' EKG interpretation skills are suboptimal. Learning styles differ among medical students; individualization of teaching methods has been shown to be viable and may result in improved learning. Puzzles have been shown to facilitate learning in a relaxed environment. The objective of this study was to assess efficacy of teaching puzzle in EKG interpretation skills among medical students.</p> <p>Methods</p> <p>This is a reader blinded crossover trial. Third year medical students from College of Human Medicine, Michigan State University participated in this study. Two groups (n = 9) received two traditional EKG interpretation skills lectures followed by a standardized exam and two extra sessions with the teaching puzzle and a different exam. Two other groups (n = 6) received identical courses and exams with the puzzle session first followed by the traditional teaching. EKG interpretation scores on final test were used as main outcome measure.</p> <p>Results</p> <p>The average score after only traditional teaching was 4.07 ± 2.08 while after only the puzzle session was 4.04 ± 2.36 (p = 0.97). The average improvement after the traditional session was followed up with a puzzle session was 2.53 ± 1.94 while the average improvement after the puzzle session was followed with the traditional session was 2.08 ± 1.73 (p = 0.67). The final EKG exam score for this cohort (n = 15) was 84.1 compared to 86.6 (p = 0.22) for a comparable sample of medical students (n = 15) at a different campus.</p> <p>Conclusion</p> <p>Teaching EKG interpretation with puzzles is comparable to traditional teaching and may be particularly useful for certain subgroups of students. Puzzle session are more interactive and relaxing, and warrant further investigations on larger scale.</p

L'hyperthermie maligne. [Malignant hyperthermia]

Malignant hyperthermia is a serious anesthetic complication, presenting with various manifestations, with high mortality and morbidity. There are several incomplete and abortive forms, and the clinicians must be aware of the possibility of malignant hyperthermia, and recognize the first signs of the hyperthermic crisis hyperthermia, hypermetabolism and muscular rigidity. Screening is performed by in vitro contracture testing on a muscular biopsy. Treatment is based on discontinuation of triggering agents and dantrolene administration, as well as supportive care. Cellular investigations demonstrate that the malignant hyperthermia crisis presents as an intracellular flooding with calcium, leading to an abnormal muscular contracture. Several mutations in particular involving the ryanodine receptor gene have been linked to malignant hyperthermia