Despite clear average improvement, surgeons tended to give overly optimistic predictions that were not correlated with patient outcome. For patients receiving a treatment not meeting explicit criteria of appropriateness, more optimistic physician expectation was associated with better improvement of psychological dimensions. Besides prognostic ability, the influence of physician expectation on patient outcome is discussed and the concept of "curabo effect" (differentiated from "placebo effect") proposed.

Clinical studies carry with them a paradox: The more obviously efficient an intervention is, the more ethical problems its trials pose. This article discusses the ethical problem of breached equipoise principle because of the perceived effectiveness of a nonblindable verbal technique, crisis dialogue (CD). CD is designed to help establish a therapeutic relationship with persons in a suspected psychotic state. In a pilot randomized controlled study in Yverdon, Switzerland (usual treatment vs. usual treatment + CD), after inclusion of 30 patients, clinicians expressed a consensual opinion that CD was effective in most cases. Following their opinion, the joint clinical and research team decided that the study had to be discontinued and that CD should be tried with all patients for ethical reasons. This poses an ethical problem with potential far-reaching consequences: In this interrupted study, differences between groups in terms of clinical outcome (Brief Psychiatric Rating Scale, Clinical Global Impression), therapeutic alliance (Working Alliance Inventory, Difficult Doctor–Patient Relationship Questionnaire), and patient satisfaction were consistent in favoring CD, but these differences did not reach statistical significance in most measurements. The early interruption of the study because of perceived effectiveness of the intervention can be seen as unethical as well because chances were high that a larger sample would have shown more conclusive results, allowing for faster introduction of CD in various clinical settings with corresponding improvement of patient care.

Background: Nosocomial pathogens are transmitted by contamination of surfaces causing healthcare-associated infections (HAI). The impact of locally produced disinfectant with operational training as a means to improve hygiene in resource-limited healthcare facilities and prevent HAI was evaluated. Method: In Burkina Faso, 4 types of electro-chlorinator devices that convert salt and water into sodium hypochlorite through electrolysis were installed in 26 healthcare facilities distributed across 3 sanitary districts. The program was evaluated at 4 months and 11 months and performance compared with a control group. Results: After 11 months, over 90% of the facilities applied 8 of the 11 essential hygiene practices defined by the Ministry of Health, compared to 20% in the control group. 61.5% of the healthcare facilities improved the chlorine concentration of their sodium hypochlorite solutions, reaching an average concentration of 5.1 g/L compared to an average of 2.1 g/L in the control group. Additionally, a cost-benefit analysis demonstrated that locally produced sodium hypochlorite led to daily savings ranging between 2.7 and 53 euros depending on the device compared with the purchase of chlorine tablets. Conclusion: Results, therefore, suggest that electro-chlorinator devices in addition to hygiene sensitization can be a simple, cost-effective and tailored intervention to reduce the prevalence of HAI in low-resource settings.

Background: The effect of spirulina (Arthrospira platensis), on haemoglobin and serum ferritine was tested in young women aged between 18 and 21 years and presenting an iron-deficiency anemia. Methods: According to the allocation group, each participant daily consumed one placebo snack bar or one snack bar supplemented with 3 g of spirulina. At baseline, day 45, 60, and 90 after the first bar was consumed a complete blood count, serum ferritin, pregnancy test, and physical examination were performed. Results: Anemia prevalence was found to be 33.7% among the age range tested in Mumbai. In total, 181 women were screened, 61 of them were randomized and allocated into the two groups and finally 47 young women completed the study. Conclusions: Spirulina or placebo snack bars were well tolerated. However, we did not observe significant changes in serum ferritin and hemoglobin in both groups at the end of the study.

ObjectiveTo assess the teaching of a method, the “Crisis Dialogue” (CD), designed to improve the therapeutic relationship during the first days of care for acute psychosis - hence the outcome. The “Crisis Dialogue” is fundamentally different from usual “empathetic” speech in that it provides tools meant to help de-construct the delirium. The underlying theory is induced from patients’descriptions of the onset of the psychotic crisis and uses the concepts of generalised concern, dys-mimetism and undifferentiation of the self. This dense and precise verbal technique requires 3 minutes of the consultation time and is meant to complement usual work in emergency psychiatry.MethodCD was taught to all health professionals of 3 emergency psychiatry wards and assessed in an exploratory multiple study (n = 105 patients) including case series, “before-and-after” comparisons and a pilot randomised controlled trial (RCT).ResultsIn the case series, no adverse reaction was reported and most clinicians expressed satisfaction with CD use. In the “before-and-after” study, duration of hospital stay after CD implementation was shorter (median 46 days) than before (61 days)(p = 0.01). In the RCT, all measured indicators were equal to or better with CD, most significant with the model including Working Alliance Inventory, Difficult Doctor- Patient Relationship and patient perception of reassurance (p=0.02).ConclusionIn this pilot study, the CD appears as a promising aid for the establishment of a good therapeutic relationship in the first days of care for acute psychotic patients. It may also have a positive impact on patient progress.