ETUDE PROSPECTIVE DE L'EFFET DU BOUCHON DE CERUMEN SUR LA MESURE DE LA TEMPERATURE TYMPANIQUE DANS UNE POPULATION DE 138 PATIENTS DE PLUS DE 75 ANS

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Interface ville-hôpital d'un court séjour gériatrique vue à travers la demande téléphonique, la lettre du médecin traitant lors de la demande d'admission et à travers le compte rendu hospitalier de sortie

Il s'agit d'un travail rétrospectif de 175 dossiers consécutifs (âge moyen 85 ans), ciblé sur l'étude descriptive de l'interface ville-hôpital-ville du court séjour gériatrique de l'hôpital notre dame de bon secours à paris 14ème, via l'analyse de : - la fiche d'appel téléphonique pour demande d'admission - la lettre du mt - le chr de sortie. Les items clés du travail en réseau gérontologique sont recueillis : l'âge et le sexe, la date d'appel, la durée d'attente, le motif de recours à l'hospitalisation, la date d'admission, la provenance, le diagnostic principal, les antécédents, le diagnostic retenu, la durée de séjour, l'entourage social, la date de sortie, le mode de sortie, la continuité des soins et d'aides à domicile. Cette approche statistique conduit aux résultats suivants : - la plupart des admissions sont accompagnées d'une lettre de mt ou du sau : 67% venant des mt de paris et 30% des hauts-de-seine 92. - le motif d'admission est majoritairement médical plutôt que social : 85% des patients ont de réel problème de santé dont 67% des patients présentent une polypathologie. - le court séjour (umig-ndbs) a pu répondre à la majorité des demandes d'urgence : 80% d'admissions directes ou de durées d'attente courtes (0 à 2 jours). - la plupart des patients ont pu regagner leur lieu de vie antérieur : 60% de retours à domicile (11% avec suivi intensif au domicile), 27% de retours à la m.r. Avec suivi hdj et rééducation dont un cas avec l'aide sociale. 4% sont institutionnalisés - le crh de sortie a accompagné la plupart des sorties. Ces résultats, marquant la la continuité des soins entre l'hôpital et la ville, sont l'illustration d'un travail en réseau de proximité.It is about retrospective work of 175 consecutive files (average age of 85 years), targeted at the descriptive study of the interface city-hôpital-city of paris' notre-dame-de-bon-secours hospital's geriatric short stay via the analysis of : - index card of phone call for admittance's request - regular physician's letter - hospital exit report. The key items of the work in gerontologic network collected are : age and sex, date of phone call, duration of wait, motive for appeal to the hospitalization, date of admittance, local origin, main diagnosis, antecedents, reserved diagnosis, duration of stay, social circle of acquaintances, exit date, exit mode, continuance of care and helps at home. This statistical approach leads to the following results : - most of the admittances are accompanied with a letter of the regular physician or of the er : 67% coming from physician of paris and 30% of hauts-de-seine 92. - motive for admittance is mainly medical rather than social : 85 % of the patients have real problem of health among which 67 % of the patients present polypathology. - this geriatic short stay was able to answer the majority of the emergency demands : 80% of direct admittances or short wait duration (0 to 2 days). - most of patients gets back to their previous place of life: 60% return at home (11% with extensive coverage at home), 27% of returns at the nursing home with follow-up, day hospital and rehabilitation (1 case with social assistance). 4 % are institutionalized. - the hospital exit report accompanied most of the exits. These results, marking the continuance of care between hospital and the city, are the illustration of a work in a proximity network.PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Oil palm fertilization guide

International audienceIntended as guide for designing the fertilization system in oil palm plantations, this book explains in clear language how to define fertilizer recommendations for each plantation, considering the specific characteristics of each site.The authors present the principles for interpreting the results of plant tissue analysis, mainly leaflets, taking into account the influence of factors specific to each plantation (age, plant material, climate, soil). They detail how to experimentally determine site-specific reference levels of mineral elements and sampling rules for monitoring the nutritional status of the plantation. Priority is given to the most specific facies (soil, plant material) of the planted areas rather than to an average representation of the plots.This guide explains how to create fertilization schedules to achieve optimal leaf contents from experimentation, and to compare these data with information from geographic information systems. This decision support system is designed to be valid in all situations.In addition to the economic optimization of fertilization, environmental concerns are considered: soil health and absorption efficiency must be integrated into the fertilization strategy by optimizing cultivation practices for fertilizer application and organic matter management.This guide is illustrated by numerous examples from trials in various soil, climate and plant material conditions in Africa and Latin America

Quality of life and utility decrement associated with Clostridium difficile infection in a French hospital setting

Abstract Background Clostridium difficile infection (CDI) is associated with a substantial Quality of life impact on patients that has not been so far measured with a generic validated instrument. Methods A prospective study was performed in 7 French acute-care settings in patients presenting with a bacteriologically-confirmed CDI. The EQ-5D-3 L was filled in by patients at 7 ± 2 days after CDI diagnosis to describe their state of health at that date as well as their state of health immediately before the CDI episode (baseline). Individual utility decrement was obtained by subtracting the corresponding utilities. The Quality Adjusted Life Year (QALY) loss was calculated by multiplying the days spent from baseline to the date of the interview, by the decrement of utility. A multivariate analysis of variance of the utility decrement according to CDI and patients characteristics was performed. Results Eighty patients were enrolled (mean age: 69.4 years, 55% females). The utility scores dropped from a mean 0.542 (SD: 0.391) at baseline to 0.050 (SD: 0.404) during the CDI episode with a mean adjusted utility decrement of 0.492 (SD: 0.398) point. This decrement increased significantly with CDI severity (Zar score ≥ 3) (p = 0.001), in patients with a positive baseline utility (p = 0.032), in women as compared to men (p = 0.041) and in patients aged more than 65 years (p = 0.041). No association with the Charlson index was found. The associated QALY loss not integrating the excess mortality was 0.028 (SD: 0.053). Conclusions The impact on quality of life of CDI episodes is major and translates in a substantial QALY loss despite their short duration

Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study

International audienc

CAESAR: a new tool to assess relatives' experience of dying and death in the ICU

International audienc

Complicated grief after death of a relative in the intensive care unit

International audienc

Empirical antibiotic therapy modalities for Enterobacteriaceae bloodstream infections in older patients and their impact on mortality: a multicentre retrospective study

International audiencePurpose: Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival.Methods: This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression.Results: Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality.Conclusion: While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality