Elodie Sellier

Factors and outcomes associated with physicians' adherence to recommendations of infectious disease consultations for inpatients

OBJECTIVESnSolicited consultations constitute a substantial workload for infectious disease specialists (IDSs). The impact of physician adherence to recommendations on clinical outcomes following solicited IDS consultations has not been previously studied. The objectives of the study were to identify the factors associated with adherence and to determine whether adherence to recommendations was associated with better clinical outcomes.nnnMETHODSnA prospective study was conducted on 621 patients, aged > or = 18 years, hospitalized in a university-affiliated hospital in France, who received an IDS consultation between December 2007 and June 2008. The main outcome was early clinical improvement, and the secondary outcomes were length of stay and in-hospital mortality.nnnRESULTSnAdherence to the IDSs recommendations was 88.2% (548/621) for antimicrobial treatment and 72.2% (317/439) for diagnostic or monitoring tests. In a multivariable analysis, independent factors of adherence to therapeutic recommendations were a community-acquired infection [adjusted odds ratio (OR), 1.8; 95% confidence interval (CI), 1.1-3.0] and discontinuation or non-use of antibiotic treatment (adjusted OR, 9.7; 95% CI, 1.2-80.3). Adherence to recommendations for antibiotic treatment was associated with a higher rate of early clinical improvement (60.7% versus 43.9%, P = 0.01), shorter median length of stay (20 days versus 23 days, P = 0.03) and comparable in-hospital mortality (7.7% versus 5.5%, P = 0.50).nnnCONCLUSIONSnFactors associated with non-adherence must be anticipated by IDSs during consultations, because non-adherence leads to worse clinical outcomes. Further studies are needed to identify the interventions that could improve physician adherence to recommendations made during solicited consultations.

Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France.

OBJECTIVES: To identify risk factors for deep vein thrombosis (DVT) in older patients with restricted mobility or functional disability.

Prospective study of telephone calls to a hotline for infectious disease consultation: analysis of 7,863 solicited consultations over a 1-year period

To respond to the increasing requests of non-infectious disease physicians for access to infectious diseases expertise, a hotline was created in the infectious diseases consultation (IDC) unit of the Grenoble university-affiliated hospital (GUH). This study describes the patterns of solicited consultations provided by the hotline during a 1-year period. We conducted a prospective study of consecutive solicited IDCs requested by physicians in 2008. A total of 7,863 consultations were requested by physicians over 1xa0year; 4,407 (56.0%) by ambulatory physicians, 2,933 (37.3%) by GUH physicians, and 523 (6.7%) by physicians in public or private hospitals. The majority of consultations were requested via cell phone (58.7%). The main reasons for requesting a consultation were related to antimicrobial treatment for hospital-based physicians and prophylaxis for ambulatory physicians (pu2009<u20090.001). Recommendations to perform diagnostic or monitoring tests were less frequent in ambulatory medicine (16%) than in the GUH (59%) or other hospitals (63%, pu2009<u20090.001). The route of consultation for patients with nosocomial infections was more likely to be formal (pu2009<u20090.001). The activity of the IDC hotline attests to an important need for such expertise consultation, both in hospitals and in ambulatory medicine.

Compliance with recommendations and clinical outcomes for formal and informal infectious disease specialist consultations

The purpose of this study was to compare compliance with recommendations and clinical outcomes between formal and informal infectious disease specialist consultations. Six hundred twenty-seven consecutive adult inpatients who received an infectious disease consultation in a university-affiliated hospital were included. After adjusting for quintile of propensity score, we compared compliance with the consultant’s recommendations and clinical outcomes for 443 (70.7%) and 184 (29.3%) formal and informal consultations. Informal and formal consultations were associated with comparable levels of compliance with recommendations for antimicrobial treatment (86.5% vs 88.9%; adjusted odds ratio [aOR], 0.63; 95% confidence interval, 0.34–1.14; Pu2009=u20090.13) and diagnostic or monitoring tests (72.6% vs 72.0%; aOR, 0.91 [0.53–1.57]; Pu2009=u20090.73). The rates of early clinical improvement (58.2% vs 58.6%; aOR, 1.11 [0.70–1.74]; Pu2009=u20090.66), subsequent consultation (34.2% vs 36.3%; aOR, 0.80 [0.53–1.21]; Pu2009=u20090.29), in-hospital mortality (4.9% vs 8.4%; aOR, 0.55 [0.24–1.24]; Pu2009=u20090.15), and the median length of stay (23 vs 20xa0days; aOR of discharge, 0.90 [0.74–1.10]; Pu2009=u20090.30) did not differ depending on the type of consultation. This study provides observational evidence that informal consultations result in levels of compliance with recommendations comparable to formal consultations, without compromising patient safety. Further study is needed to refine the criteria for requesting or providing informal rather than formal consultations.

Interrater reliability study of cerebral palsy diagnosis, neurological subtype, and gross motor function

Aimu2002 To evaluate the interrater reliability of the inclusion in registries and classification of children with cerebral palsy (CP).

Evaluation of glycopeptide prescription and therapeutic drug monitoring at a university hospital

Abstract The aim of this study was to assess the appropriateness of glycopeptide prescription almost 15 y after the publication of the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines. We also assessed the adequacy of dose regimen and therapeutic drug monitoring (TDM). All glycopeptide prescriptions were collected during a 3-month prospective study and evaluated by 2 independent infectious diseases experts. Appropriateness of prescription was assessed according to local guidelines based on the HICPAC recommendations. A total of 154 prescriptions were evaluated: 77% (69.1–83.0) were appropriate and 36% (28.2–43.8) were adequate with regard to dose regimen and loading dose. Multivariate analysis showed greater appropriateness for vancomycin than for teicoplanin (p=0.01). There was a wide discrepancy among units (p=0.04). TDM was appropriately performed in 40% (32.3–47.7) of glycopeptide treatments. When required, dose regimen adaptations occurred in 58% of cases. In conclusion, we show a satisfactory appropriateness of glycopeptide prescription. However, the adequacy of dose regimens must be improved. Finally, TDM does not comply with recent recommendations in most cases.

Infectious disease specialist telephone consultations requested by general practitioners

Abstract Background: Infectious diseases (ID) make up a substantial part of a general practitioners (GPs) workload. GPs frequently solicit ID specialists requesting advice on managing their patients with ID. The objectives of this study were to examine GP reasons for soliciting ID consultations and to assess the GPs’ and specialists’ opinions of the ID consultation service. Methods: This was a prospective study of consecutive solicited ID consultations requested by GPs from the ID specialists of a 2200-bed university-affiliated hospital, conducted between October 2008 and March 2009. Data related to GP characteristics, their reasons for requesting the consultation, the recommendations given by the specialists, and the specialists’ perceptions of the exchange were collected. GPs were asked to report their adherence to recommendations and their perceptions of the consultations. Results: A mean of 57 telephone consultations per month were requested by GPs during the study period. ID specialist recommendations were related to antibiotic treatment (66.2%), diagnostic or monitoring tests (46.5%), and a subsequent formal consultation or hospitalization (29.6%). The reasons reported for GPs requesting an ID consultation were related to patient management (96.5%), rapidity of access (86.3%), and quality of care improvement (84.2%). GPs were satisfied with the telephone consultations in 97.9% of cases and ID specialists in 94.7%. Conclusions: Telephone consultations with ID specialists were widely appreciated by GPs, probably due to the accessibility of these specialists. Further study is needed to assess the effects of these telephone consultations on quality of care.

Utilisation du midazolam chez les patients hospitalisés : analyse des pratiques

To evaluate the prevalence and the characteristics of use of midazolam among hospitalized patients and to analyze physicians representation of this medicine. We conducted a retrospective study between 1st May and 22nd May 2011 in Grenoble University Hospital in France. All patients receiving midazolam during the study period were included, excepted if the prescription was performed in intensive care units, operating rooms or in pediatric units. Physicians from the different units were asked about the characteristics of patients receiving midazolam and about their practice concerning the use of midazolam. Forty-four patients were included, 82 % of whom having a cancer. The prevalence of prescription of midazolam was 3.3 % (44/1,323), 2.8 % (37/1,323) for anxiety relieving and 0.8 % (11/1,323) for sedation. The main refractory symptoms that justified the prescription were dyspnea (36.4 %), confusion (29.5 %), pain (27.3 %) and psychological suffering (27.3 %). Twenty-eight physicians were asked about their practice. The main representations of midazolam were the stop of active treatment (46.5 %) and premature cause of death (46.5 %). Practice of sedation is under-estimated by physicians as they have difficulties to differentiate anxiety relieving and sedation and they have difficulties to initiate a sedation. A guideline to help physicians using midazolam could improve practice.

Utilisation du midazolam chez les patients hospitalisés : analyse des pratiquesUse of midazolam in hospitalized patients: analysis of medical practice

To evaluate the prevalence and the characteristics of use of midazolam among hospitalized patients and to analyze physicians representation of this medicine. We conducted a retrospective study between 1st May and 22nd May 2011 in Grenoble University Hospital in France. All patients receiving midazolam during the study period were included, excepted if the prescription was performed in intensive care units, operating rooms or in pediatric units. Physicians from the different units were asked about the characteristics of patients receiving midazolam and about their practice concerning the use of midazolam. Forty-four patients were included, 82 % of whom having a cancer. The prevalence of prescription of midazolam was 3.3 % (44/1,323), 2.8 % (37/1,323) for anxiety relieving and 0.8 % (11/1,323) for sedation. The main refractory symptoms that justified the prescription were dyspnea (36.4 %), confusion (29.5 %), pain (27.3 %) and psychological suffering (27.3 %). Twenty-eight physicians were asked about their practice. The main representations of midazolam were the stop of active treatment (46.5 %) and premature cause of death (46.5 %). Practice of sedation is under-estimated by physicians as they have difficulties to differentiate anxiety relieving and sedation and they have difficulties to initiate a sedation. A guideline to help physicians using midazolam could improve practice.

CD-ROM continuous medical education model for the management of urinary tract infections in family practice

OBJECTIVESnThis study had for aim to assess the acceptability of a model for continuing medical education, to improve the implementation of best practice recommendations for family practice. The training focused on the management of community acquired urinary tract infections in adults. The secondary objective was to identify barriers in the implementation of these best practice recommendations.nnnMETHODSnWe conducted a prospective qualitative study. The intervention included an initial knowledge test, an audio-visual CD-ROM presentation, and a second knowledge test. After the session, family practitioners (FP) were asked to answer a face-to-face questionnaire in order to give their opinion on the training session. Ten FP, working in the Savoie and Isère sub-divisions in France, were included.nnnRESULTSnAll FP were satisfied with the e-learning training session. The element of the session, they best appreciated, was the audio-visual presentation. The comparison between initial and second test results showed a non-significant improvement of knowledge (P=0.07). The barriers, most frequently mentioned for knowledge and use of best practice recommendations, were: lack of time, content unfit for family practice, habits, and the very broad field of expertise required.nnnCONCLUSIONnFP accepted this model of continuing medical education. E-learning seems relevant to improve the implementation of best practice recommendations in family practice.