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P0132 FAMILYQUEST: STRATEGIES FOR FAMILY HISTORY-TAKING IN MEDICAL PRACTICE
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 Conclusion: In cases of hospital-acquired VTE concordance with the thromboprophylaxis protocol was poor. To improve this we recommend education to increase awareness of the extent of VTE in medical patients and knowledge of the thromboprophylaxis protocol. In addition we suggest introduction of a thromboprophylaxis prescription chart to ensure every medical patient is considered for thromboprophylaxis.
P0130 NEUROCHEMICAL ALTERATIONS OF THE PRIMARY VISUAL AREAS IN EXPERIMENTAL MODELS WITH CYCLOPIA
Miguel Moyano 1 , Adrián Santos-Ledo 1 , Héctor Carreño 1 , Rosario Arévalo 1 , Ángel Porteros 1 , Javier Alonso 2 . 1 Department of Cell Biology and Pathology. Instituto De Neurociencias De Castilla Y Leon. University of Salamanca. Spain; 2 Internal Medicine. Hospital Virgen Del Puerto. Plasencia, Cáceres. Spain Introduction: ethanol intake by pregnant women can cause fetal alcohol syndrome. One of the most serious consequences is cyclopia, originated by lack of the splitting of the eyes. The cyclopic phenotype is easily induced on zebrafish embryos by ethanol treatment. The same phenotype appears on mutant animals cyc m294. Objectives: the purpose of our research is to analyze the changes in the neurochemical organization of primary visual areas during development of both ethanol induced cyclopic specimens and cyc m294 mutants. Materials & methods: the study was carried out with three days postfertilization embryos in three research groups: wild-type, treated with 1.5% ethanol and cyc m294 non treated mutants. We analyzed the distribution of calretinin, tirosyne-hydroxylase and pax6 with the inmunohistochemical ABC method. All the procedures followed the European directives (86/609/EEC and 2003/65/EC) and the Spanish legislation (RD 1201/2005, BOE 252/34367-91, 2005) for the use and care of animals in research. Results: we have observed expression of the analyzed markers in the primary visual areas: retina, preoptic area, thalamus, pretectum and optic tectum. The expression of calretinin presents some differences between wild-type animals and both cyclopic models, like bigger expression in the pretectum and optic tectum in wild-type animals. The expression for tyrosine-hydroxylase and pax6 is very similar in the different zones, without significant variations between the experimental groups. Discussion & conclusion: we can conclude that the alterations observed in the cyc m294 mutants are comparable to those developed by the ethanol-treated embryos, and they could be used as analogous experimental models in the study of the visual morphogenesis and its alterations. Keywords: cyclopia, fetal alcohol syndrome, neurochemistry. Supported by: Fundación Medica Mutua Madrileña, Junta de Castilla y León (SAN673/SA17/08, SA114A08, SA036A07) and Fundación Samuel Solórzano Barruso.
P0131 IMPROVING ADHERENCE TO GLYCEMIC CONTROL GUIDELINES THROUGH EDUCATION
Javier Ena 2 , Rosa Casañ 2 , Teresa Lozano 2 , Angela Leach 2 , Josep Tomas Algado 2 , Francisco J. Navarro-Diaz 2 . 1 Hosp. Marina Baixa. Villajoyosa. Alicante. Spain Introduction: Educational methods that encourage physicians to adopt clinical practice guidelines are needed. According to current recommendations serum glucose should be maintained below 180 mg/dL (8.9 mmol/L) in patients admitted to hospital general wards. Objectives: To evaluate the effect of an educational strategy to increase physicians’ adherence to specialty society-endorsed practice recommendations. Materials & methods: The educational strategy promoted 8 recommendations for evaluation and management of diabetes in hospitalized patients that were endorsed by the American Diabetes Association. It included a 15 min. presentation, posters display and distribution of pocket-guides. The educational strategy was evaluated by means of a questionnaire addressed to physicians. We analyzed process and outcome variables before intervention, at 3-month and at 9-month after intervention. To assess adherence to recommendations we reviewed data from 138 clinical records (46 consecutive clinical records reviewed at each study period) of patients with type 2 diabetes admitted to the Department of Internal Medicine of a 280-bed hospital. Results: the questionnaire survey answered by 33 physicians (48%) showed total agreement with the proposed programme. The programme caused significant reductions in the use of oral hypoglycemic agents (44% vs. 9% vs.
S49
4%, p=0.000), in the use of insulin administered by sliding scale dosage (50% vs. 7% vs. 3%, p=0.000), and in the median pre-discharge glycemic values (185 mg/dl [10.19 mmol/L] vs. 153 mg/dl [8.43 mmol/L] vs. 161 mg/d [8.90 mmol/L], p=0.005), at three periods respectively. Basal-bolus administración of insulin increased significantly in the postintervention periods (17% vs. 85% vs. 99%, p=0.004). Hypoglycemia (Glycemia < 60 mg/dL [3.3 mmol/L]) episodes were similar among the three periods (0.30% vs. 0.70% vs. 1.07%, p=0.10). Discussion & conclusion: our educational strategy can improve physician adoption of practice guidelines. Keywords: Diabetes, Guidelines, Insulin basal-bolus
P0132 FAMILYQUEST: STRATEGIES FOR FAMILY HISTORY-TAKING IN MEDICAL PRACTICE
Jean-pierre Aubert, Cécile Jentner, Isabelle Aubin, Pascale Santana, Caroline Huas, Hervé Picard, Michel Nougairede, Alain Eddi, Nadine Coste. Department of General Practice, University Paris 7 Introduction: The strategies used to collect a patient’s family history have never been described nor assessed; therefore we defined and assessed five such strategies in medical practice. Objectives: Identify the best method to take a patient’s family history in medical practice. Materials & methods: Fifteen pairs ‘resident/general practitioner’ used three methods of history-taking, to assess both the duration of interrogation and the number of collected facts: a general question (G), the enunciation of pathologies looked-for in the family history (P), and the identification of the family members (F). Patients were randomized in two groups, one first interrogated with G then P then F and another first with G then F then P. Thus, five strategies could be compared: G, GP, GF, GFP, GPF. Results: 219 patients were interrogated. Mean duration of G strategy was 34 seconds; it was 2 minutes for GF and GP, 3’24” for GFP and 3’18” for GPF (n.s.). Mean number of facts collected was 1.4 with G, it was 4.6 with GP and 2.4 with GF. GP strategy collects significantly more facts than GF (p<10-3). There was no difference between GPF and GFP. The interrogation brought out significantly more facts in women than in men, whatever the chosen strategy. GP strategy was more effective than GF in the collection of the following facts: hypertension, phlebitis, hypercholesterolemia, obesity, psychiatric diseases and allergies. The efficiency of GF and GP strategies did not differ as regards cardiovascular diseases, diabetes, cancer. Discussion & conclusion: The collection of patient’s family history is an important issue in every clinical specialty. This study was conducted in the field of general practice; we suppose that similar results are to be found in other specialties but further studies have to be conducted in order to test this hypothesis. GFP and GPF strategies are the most effective and do not differ one from the other, but they are time consuming. If a two-step strategy is to be used in order to save time, then GP should be preferred to GF. Keywords: Family medical history taking, medical practice, medical history taking
P0133 SARCOIDOSIS -CAUSE OF HYPERCALCEMIA TO AN ELDERLY MAN-CASE REPORT
Stoian Marilena 1 , Udrea Gabriela 1 , Stoian Bogdan 1 , Stoica Victor 1 . 1 University of Medicine Carol Davila Bucharest; 2 Dr I Cantacuzino Hospital Introduction: The commonest causes of hypercalcaemia in an elderly man include: multiple myeloma, hyperparathyroidism, bone metastases and humoral hypercalcaemia of malignancy.Other less common causes include sarcoidosis, Addison s disease, drugs. Case report: A 71-year-old man presented with a 6-month history of lethargy, nausea, 10 kg weight loss and short term memory loss.He is currently under the urologists for prostatic adenoma. Physical examination revealed an elderly gentelmen with pulse rate 60/min and blood pressure 160/100 mmHg and no ather abnormalities findings than an irregular, enlarged prostate gland. A chest X-ray was normal. Biological examination showed anaemia, raised urea and serum creatinine and hypercalcaemia. A renal ultrasound was normal; urinalysis revealed blood 2+, protein +, glucose +, few white cells and some granular casts. A renal biopsy showed foci of lymphocitic tubulitis and a mild mononuclear interstitial infiltrate; focal peri-tubular interstitial calcification; several discrete non-necrotizing epithelioid granulomata comprised of epitheliod macrophages and Langerhans-type giant cells. A histological
P0130 NEUROCHEMICAL ALTERATIONS OF THE PRIMARY VISUAL AREAS IN EXPERIMENTAL MODELS WITH CYCLOPIA
Miguel Moyano 1 , Adrián Santos-Ledo 1 , Héctor Carreño 1 , Rosario Arévalo 1 , Ángel Porteros 1 , Javier Alonso 2 . 1 Department of Cell Biology and Pathology. Instituto De Neurociencias De Castilla Y Leon. University of Salamanca. Spain; 2 Internal Medicine. Hospital Virgen Del Puerto. Plasencia, Cáceres. Spain Introduction: ethanol intake by pregnant women can cause fetal alcohol syndrome. One of the most serious consequences is cyclopia, originated by lack of the splitting of the eyes. The cyclopic phenotype is easily induced on zebrafish embryos by ethanol treatment. The same phenotype appears on mutant animals cyc m294. Objectives: the purpose of our research is to analyze the changes in the neurochemical organization of primary visual areas during development of both ethanol induced cyclopic specimens and cyc m294 mutants. Materials & methods: the study was carried out with three days postfertilization embryos in three research groups: wild-type, treated with 1.5% ethanol and cyc m294 non treated mutants. We analyzed the distribution of calretinin, tirosyne-hydroxylase and pax6 with the inmunohistochemical ABC method. All the procedures followed the European directives (86/609/EEC and 2003/65/EC) and the Spanish legislation (RD 1201/2005, BOE 252/34367-91, 2005) for the use and care of animals in research. Results: we have observed expression of the analyzed markers in the primary visual areas: retina, preoptic area, thalamus, pretectum and optic tectum. The expression of calretinin presents some differences between wild-type animals and both cyclopic models, like bigger expression in the pretectum and optic tectum in wild-type animals. The expression for tyrosine-hydroxylase and pax6 is very similar in the different zones, without significant variations between the experimental groups. Discussion & conclusion: we can conclude that the alterations observed in the cyc m294 mutants are comparable to those developed by the ethanol-treated embryos, and they could be used as analogous experimental models in the study of the visual morphogenesis and its alterations. Keywords: cyclopia, fetal alcohol syndrome, neurochemistry. Supported by: Fundación Medica Mutua Madrileña, Junta de Castilla y León (SAN673/SA17/08, SA114A08, SA036A07) and Fundación Samuel Solórzano Barruso.
P0131 IMPROVING ADHERENCE TO GLYCEMIC CONTROL GUIDELINES THROUGH EDUCATION
Javier Ena 2 , Rosa Casañ 2 , Teresa Lozano 2 , Angela Leach 2 , Josep Tomas Algado 2 , Francisco J. Navarro-Diaz 2 . 1 Hosp. Marina Baixa. Villajoyosa. Alicante. Spain Introduction: Educational methods that encourage physicians to adopt clinical practice guidelines are needed. According to current recommendations serum glucose should be maintained below 180 mg/dL (8.9 mmol/L) in patients admitted to hospital general wards. Objectives: To evaluate the effect of an educational strategy to increase physicians’ adherence to specialty society-endorsed practice recommendations. Materials & methods: The educational strategy promoted 8 recommendations for evaluation and management of diabetes in hospitalized patients that were endorsed by the American Diabetes Association. It included a 15 min. presentation, posters display and distribution of pocket-guides. The educational strategy was evaluated by means of a questionnaire addressed to physicians. We analyzed process and outcome variables before intervention, at 3-month and at 9-month after intervention. To assess adherence to recommendations we reviewed data from 138 clinical records (46 consecutive clinical records reviewed at each study period) of patients with type 2 diabetes admitted to the Department of Internal Medicine of a 280-bed hospital. Results: the questionnaire survey answered by 33 physicians (48%) showed total agreement with the proposed programme. The programme caused significant reductions in the use of oral hypoglycemic agents (44% vs. 9% vs.
S49
4%, p=0.000), in the use of insulin administered by sliding scale dosage (50% vs. 7% vs. 3%, p=0.000), and in the median pre-discharge glycemic values (185 mg/dl [10.19 mmol/L] vs. 153 mg/dl [8.43 mmol/L] vs. 161 mg/d [8.90 mmol/L], p=0.005), at three periods respectively. Basal-bolus administración of insulin increased significantly in the postintervention periods (17% vs. 85% vs. 99%, p=0.004). Hypoglycemia (Glycemia < 60 mg/dL [3.3 mmol/L]) episodes were similar among the three periods (0.30% vs. 0.70% vs. 1.07%, p=0.10). Discussion & conclusion: our educational strategy can improve physician adoption of practice guidelines. Keywords: Diabetes, Guidelines, Insulin basal-bolus
P0132 FAMILYQUEST: STRATEGIES FOR FAMILY HISTORY-TAKING IN MEDICAL PRACTICE
Jean-pierre Aubert, Cécile Jentner, Isabelle Aubin, Pascale Santana, Caroline Huas, Hervé Picard, Michel Nougairede, Alain Eddi, Nadine Coste. Department of General Practice, University Paris 7 Introduction: The strategies used to collect a patient’s family history have never been described nor assessed; therefore we defined and assessed five such strategies in medical practice. Objectives: Identify the best method to take a patient’s family history in medical practice. Materials & methods: Fifteen pairs ‘resident/general practitioner’ used three methods of history-taking, to assess both the duration of interrogation and the number of collected facts: a general question (G), the enunciation of pathologies looked-for in the family history (P), and the identification of the family members (F). Patients were randomized in two groups, one first interrogated with G then P then F and another first with G then F then P. Thus, five strategies could be compared: G, GP, GF, GFP, GPF. Results: 219 patients were interrogated. Mean duration of G strategy was 34 seconds; it was 2 minutes for GF and GP, 3’24” for GFP and 3’18” for GPF (n.s.). Mean number of facts collected was 1.4 with G, it was 4.6 with GP and 2.4 with GF. GP strategy collects significantly more facts than GF (p<10-3). There was no difference between GPF and GFP. The interrogation brought out significantly more facts in women than in men, whatever the chosen strategy. GP strategy was more effective than GF in the collection of the following facts: hypertension, phlebitis, hypercholesterolemia, obesity, psychiatric diseases and allergies. The efficiency of GF and GP strategies did not differ as regards cardiovascular diseases, diabetes, cancer. Discussion & conclusion: The collection of patient’s family history is an important issue in every clinical specialty. This study was conducted in the field of general practice; we suppose that similar results are to be found in other specialties but further studies have to be conducted in order to test this hypothesis. GFP and GPF strategies are the most effective and do not differ one from the other, but they are time consuming. If a two-step strategy is to be used in order to save time, then GP should be preferred to GF. Keywords: Family medical history taking, medical practice, medical history taking
P0133 SARCOIDOSIS -CAUSE OF HYPERCALCEMIA TO AN ELDERLY MAN-CASE REPORT
Stoian Marilena 1 , Udrea Gabriela 1 , Stoian Bogdan 1 , Stoica Victor 1 . 1 University of Medicine Carol Davila Bucharest; 2 Dr I Cantacuzino Hospital Introduction: The commonest causes of hypercalcaemia in an elderly man include: multiple myeloma, hyperparathyroidism, bone metastases and humoral hypercalcaemia of malignancy.Other less common causes include sarcoidosis, Addison s disease, drugs. Case report: A 71-year-old man presented with a 6-month history of lethargy, nausea, 10 kg weight loss and short term memory loss.He is currently under the urologists for prostatic adenoma. Physical examination revealed an elderly gentelmen with pulse rate 60/min and blood pressure 160/100 mmHg and no ather abnormalities findings than an irregular, enlarged prostate gland. A chest X-ray was normal. Biological examination showed anaemia, raised urea and serum creatinine and hypercalcaemia. A renal ultrasound was normal; urinalysis revealed blood 2+, protein +, glucose +, few white cells and some granular casts. A renal biopsy showed foci of lymphocitic tubulitis and a mild mononuclear interstitial infiltrate; focal peri-tubular interstitial calcification; several discrete non-necrotizing epithelioid granulomata comprised of epitheliod macrophages and Langerhans-type giant cells. A histological