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Biomedical subjects

A F Allaz

Publications and source records attributed to A F Allaz.

36 records · Page 2Linked to original sources
PubMed1996

[Patient transfer between 2 hospital services: informing patients].

In order to determine what inpatients transferred to another inpatient care facility know about their health problems, the motives for their transfer, and the level of agreement between patients and physicians on these issues, we conducted a semi-structured interview and a content analysis of the transfer letter of 64 consecutive patients transferred from an academic internal medicine unit to a related intermediate care internal medicine unit with a vocation of rehabilitation and psychosocial care. After a mean length of stay of 18.5 +/- 11 days, 31% of patients did not know their medical diagnosis and only 54% knew at least one motive of transfer they agreed with. Only 48.5% of patients described a motive of transfer which was also found in their transfer letter. Doctors and patients disagreed on a psychosocial motive for transfer for 15.5% of patients. 14% of patients were opposed to their transfer and 7% did not know why they were transfered. Finally 22% of transfer letters were not informative enough to allow comparison. We conclude that at the time of their transfer a large number of patients lack adequate information on their diagnosis and on the reasons for their transfer.

Aged↗
PubMed1995

Mental health and choice between managed care and indemnity health insurance.

OBJECTIVE: Populations enrolled in various health insurance plans may differ in their health care needs. Whether mental health affects choice among competing health plans is not clear. This study examined self-selection by participants in a Swiss indemnity insurance plan that was transformed into a managed care organization that controlled access to specialists through gatekeeping and restricted coverage for psychiatric treatments. METHOD: Information regarding past use of health services and health status was provided by 421 persons who joined the new managed care organization and 222 nonjoiners. The mental health and somatic health characteristics of these two groups were compared. RESULTS: In the year preceding the creation of the managed care organization, the nonjoiners had made on average 2.3 more visits to psychiatrists than the joiners but 0.0 to 0.6 more visits to other physicians. The nonjoiners were more likely to have used psychoactive medications but not other medications. The rates of treatment for depression were similar in the two groups. The joiners reported significantly lower mental health status, but not somatic health status, than the nonjoiners. CONCLUSIONS: Both mental health status and past use of mental health services strongly affected choice of health insurance plan. The effects of somatic health and use of somatic health services on selection were consistently weaker. People who join managed care organizations may have substantial uncovered needs for psychiatric care. Minimum mandatory benefits for mental health care may be an effective countermeasure to unequitable self-selection.

Adolescent↗
PubMed1994

[Absence from work and illness behavior in patients with chronic pain].

Factors relating to working status, i.e. whether the subject is still at work or on workmen's compensation, have been studied in chronic pain patients. Sociodemographic and pain variables were not correlated with absence from work, nor was diagnosis. However, beliefs and attitudes concerning pain differed between patients still working and those on workmen's compensation. In chronic pain patients medical attention should focus not only on description of symptoms but also on the "illness behaviour" dimension.

Absenteeism↗
PubMed1994

[Predictive factors of resistance to treatment of neuropathic pain].

The aim of this retrospective study was to examine factors related to symptomatic pain treatment in 992 hospitalized patients referred to the pain clinic. These patients accounted for 1440 different pains (1.5 pains/patient), of nociceptive (59%), or neuropathic (24%) origin, a combination of both (16%) and of unidentified (1%) origin. Patients resistant to therapy did not differ from nonresistant patients (62%) in terms of age, sex, or number of pains. Although recommended pharmacological treatments were pursued, the neuropathic origin of pain was a factor in resistance to treatment. Among the neuropathic pains resistant to treatment (42%) a central nervous origin is more frequently found. Resistance to pain was more frequently encountered after strokes, primitive tumor of the central nervous system or traumatic plexopathy, whereas peripheral lesions of the nervous system were more easily controlled by symptomatic treatment. This study shows that central neuropathic pain is more frequently associated with resistance to recommended pharmacological symptomatic treatments. This observation underlines the limits of conventional medical therapy.

Analgesia↗
PubMed1994

[Evaluation of chronic pain in geriatric patients].

This retrospective study considers the influence of chronological age on the perception and consequential effects of chronic non-cancer pain in 203 patients referred to an ambulatory pain clinic. One patient in four (50) was 65 years or older. Pain had existed for more than a year in 66%. It was referred to an "unbearable" by 54% of elderly adults vs 44% (NS) of the younger adult population, and as "intense" by 61% vs 44% (p < 0.05). A higher proportion of neurogenic pain (54% vs 26%, p < 0.05) could explain this significant difference. Cognitive factors could also have amplified the painful syndrome since 59% (vs 54%) of the elderly considered they had received insufficient information on the potential consequences of their painful condition. However, despite a higher occurrence of other severe illnesses in the elderly (52% vs 35%, p < 0.05), they appear to worry less about their health problems (58% vs 78%, p < 0.01). Finally, in spite of increased severity of pain in the elderly, depression scores and consequential effects are similar in the two populations. In conclusion, the intensity of chronic pain appears to be more severe in the elderly, perhaps due to its more frequent neuropathic origin. Nonetheless, its repercussions on daily life activity seem no worse than for younger adults, and could reflect better coping strategies towards chronic pain.

Activities of Daily Living↗
PubMed1994

[Dance training and eating disorders].

Medical history, eating habits, weight, current symptomatology and EDI (Eating Disorders Inventory)-scores of 41 bulimic female patients with and without past training in dancing, who came for treatment to an outpatient clinic, were compared. It was found that both groups of patients were not different for age, age at beginning of bulimia, actual as well as minimal and maximal BMI (Body mass index), length and severity of symptomatology, frequency of bulimic behaviors, and scores on the subscales of the EDI, but it should be noted that these similarities might be in relationship with some methodological shortcomings. Considering the prevalence of bulimia nervosa in women and the high frequency of ballet and sports training in teenagers, some hypotheses about the possible influence of strenuous physical exercise in childhood on the symptomatology and some psychological traits in adults with anorexia nervosa, bulimia nervosa, or binge-eating disorder are presented. Further studies, including standardized scales and larger samples, are necessary.

Adolescent↗
PubMed1992

[Use of conventional and complementary medical care in patients with chronic non-cancerous pain].

The use of medical care was surveyed among 157 chronic pain patients. Half of them had consulted more than 6 and up to 17 specialists in "conventional" medicine for their pain problem. Moreover, 46% had used "complementary" medicine. They had tried many different "alternative" therapies in 40% of the cases. The users of "complementary" medicine, mostly females, also sought care from a significantly higher number of "conventional" therapists, had more physiotherapy, took drugs more frequently and had tried a larger number of different medications, even though their pain characteristics were similar to those of the other patients studied. Interestingly, they remained significantly more active professionally than patients who had never used "complementary" medicine. These characteristics could be attributed to a more active manner of coping with chronic pain.

Adaptation, Psychological↗
PubMed1992

[Prevalence of smoking in hospital personnel and future teachers].

We have surveyed the prevalence of smoking habits and the opinions about it's regulation among 192 students in two different schools (a teachers' and a nursing school) and among 320 employees of the University Hospital of Geneva. Smoking prevalence varies depending on the profession and sex, and remains high considering the level of education of the surveyed population. Among the future school teachers 23% are smokers. In the hospital, the smoking prevalence is 25% in the health professionals and 32% in the administrative and technical staff. As many as 46% of the future nurses are smoking. Obviously much still needs to be done in order to decrease the number of smokers among the health professionals. The majority of the employees questioned, both smokers and non-smokers, were in favor of regulating smoking in the workplace. 91% of the hospital staff, and 86% of the smokers among them, favored a smoke free hospital policy. Restriction of tobacco use in the workplace should be implemented particularly when it is the wish of a majority of employees.

Female↗
PubMed1991

[Variations in body weight and feeding behavior in internal medicine].

We have identified an eating disorder in 13% of women hospitalized on a medical ward for various reasons. These as well as obese patients undergo wide fluctuations of weight sometimes exceeding 30% of their present weight. Surprisingly, even in the absence of eating disorders, the changes in weight during adulthood are marked (22% of present body weight). Weight history should be included systematically in the medical history, since it can underscore concern over weight or even an unrecognized eating disorder.

Adolescent↗
PubMed1990

[Between nihilism and fanaticism: the ethics of prevention].

Opinions diverge on the ethics of preventive medicine. A balance needs to be struck between nihilism (doing nothing) and fanaticism (doing too much). The authors consider the ethical aspects of preventive medicine from the practising physician's viewpoint. Various aspects can be identified: SCIENTIFIC AND METHODOLOGICAL: Like any medical act, preventive practice relies on good scientific data. The epidemiologic studies should be clinically relevant and their recommendations must be interpreted critically before being incorporated into clinical practice. It should not be forgotten that we are dealing with patients and their behaviour. Tactful dialogue and personalized intervention are essential. DEONTOLOGICAL: Modern medicine is oriented toward health maintenance and promotion, thus including prevention. Although the community has drawn obvious benefits from preventive practices such as the use of vaccines, prevention must not be allowed to become a medical tyranny. Respect for the individual should remain its central concern. ETHICAL: The "meaning of life" must not be forgotten. Factors such as quality of life should always be kept in mind in measuring the benefits of prevention. By providing objective information and tailored counselling, the aim of prevention is to encourage expression of the individual's own responsibility for her/his own health. FINANCIAL: Preventive medicine is not covered by health insurance schemes. Cost-benefit analysis should consider not only the economic aspects of prevention but also its positive impacts on the entire social field. SOCIAL AND CULTURAL: The findings of epidemiologic studies must be adapted to precise socio-cultural environments. In our culture, for example, caregivers should be the first to practise what they preach. It must also be remembered that at the present time the basic preventive measures are still not accessible to everyone.

Culture↗
PubMed1990

[Whipple's disease. Involvement of the small intestine with submucosal presentation].

An unusual case of Whipple's disease is described; the involvement was restricted to the sub-mucosa of the large and small intestine, but the mucosa was spared. The involvement was characterized by the presence of large eosinophilic PAS positive histiocytic cells in the sub-mucosa. A Ziehl-Neelsen stain allowed to rule out an atypical mycobacterial infection. In the axillary lymph node removed previously, a retrospective survey demonstrated the presence of large histiocytic cells containing granular PAS positive material. The diagnosis of Whipple's disease of the large and small intestine with lymph node involvement was confirmed by the response to therapy followed by a new biopsy control. It appears from our observation that in Whipple's disease, an attentive examination of the sub-mucosal tissue may allow to discover more cases of this condition, even when the mucosa appears normal.

Aged↗
PubMed1983

[Continuous electrocardiography monitoring during esophago-gastro-duodenoscopy].

Continuous ECG recording has been carried out during oesophagogastroduodenoscopy without premedication in 44 unselected patients. 8 of whom had cardiac diseases. Thirty-six had sinus tachycardia. Supraventricular and ventricular ectopic beats occurred in 11 patients, 5 of whom had cardiopathy. Two patients without known cardiac disease or rhythm disturbance developed a transient attack of paroxysmal atrial fibrillation. In both cases the fibrillation occurred against the background of a slow basal sinus rhythm which was considered to be the result of vagal stimulation. All arrhythmias were transient and symptom-free, but their occurrence poses problem of the indication for premedication before upper gastrointestinal endoscopy.

Adolescent↗
PubMed1981

[Pharmacokinetic study of a cephalosporin, cefoperazone, in liver failure].

The pharmacokinetics of cefoperazone, a semi-synthetic cephalosporin for parenteral use with a spectrum covering P. aeruginosa, E. cloacae, indole-positive Proteus and S. Marcescens, was studied after a 2-h intravenous infusion of 2 g of the drug in 6 patients with moderate liver function impairment (viral hepatitis in 4 cases, alcoholic fatty liver and cirrhosis in 2 cases). At the end of the infusion, mean serum concentrations (determined by a bioassay) were 208 microgram/ml in the patients and 134 microgram/ml in healthy volunteers. The half-life was 4.3 h in patients and 1.6 h in healthy volunteers. Volume of distribution and renal clearance were similar in the two groups. Extrarenal clearance of cefoperazone was lower in the patients (7.3 ml/min) than in the control group (59.4 mg/min). Urinary excretion of biologically active drug was markedly increased in the patients (79% of the dose) compared with healthy volunteers (24%). This study provides evidence that liver function impairment increases with both the apparent half-life of elimination and the urinary excretion of the drug. The results raise the question of the desirability of cefoperazone dosage adjustment in patients with hepatic diseases.

Adult↗
PubMed1979

[Pharmacokinetics of a new cephalosporin, cefoperazone].

Cefoperazone is a semi-synthetic cephalosporin for parenteral use with an extended antibacterial spectrum covering Pseudomonas aeruginosa, Enterobacter cloacae and Serratia marcescens. Its pharmacokinetic properties were studied in 8 healthy subjects after 2 intravenous infusions of 2 g of the drug at a 12-hour interval. The mean peak serum concentrations were 134 +/- 16 microgram/ml and 143 microgram/ml. Cefoperazone was shown to possess a long half-life for a cephalosporin (1.7 hours). In our concentration range the drug is 90% protein bound. The apparent volume of distribution was a mean 11.4 liters and the renal clearance 18 ml/min. The cumulative urinary excretion was small, viz. 23% in 12 hours, indicating that there should be no need to modify the dosage regimen in renal failure. Comparison of in vitro studies with the pharmacokinetic properties show that 2 g cefoperazone given intravenously twice a day should inhibit most sensitive bacteria.

Bacteria↗