27 research outputs found

    Evaluation de l'activité des services d'accueil d'urgence adulte du C.H.U. de Toulouse en 1999

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    TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    La communication entre les médecins généralistes et les médecins du Service des urgences médicales de l'HÎpital Purpan (étude des lettres d'admission et de sortie)

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    TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    Impact de l'ouverture des maisons médicales de garde sur la fréquentation des services d'urgence (modalités de collaboration entre ces structures)

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    Un recensement des maisons mĂ©dicales de garde (MMG) a Ă©tĂ© effectuĂ© auprĂšs des conseils dĂ©partementaux de l'ordre des mĂ©decins. Une enquĂȘte a Ă©tĂ© effectuĂ©e auprĂšs de 79 MMG et des services d'urgence proches respectifs, portant sur des aspects fonctionnels des MMG (horaires d'ouverture, rĂ©gulation, visites) ; des aspects structurels et organisationnels (tableaux de garde, nombre de mĂ©decins participants, nombre de secteurs de permanence des soins couverts, participation financiĂšre des mĂ©decins au fonctionnement de la MMG) ; des aspects collaboratifs avec les services hospitaliers (partage des locaux, de services et de personnel mĂ©dical et non mĂ©dical, orientation des patients), et enfin d'efficacitĂ© (dĂ©sengorgement des services d'urgence, satisfaction respective des acteurs, impact sur la frĂ©quentation des S.U).TOULOUSE3-BU SantĂ©-Centrale (315552105) / SudocSudocFranceF

    Evolution de la fibrose pulmonaire au cours de la sclérodermie systémique (à propos de 15 patients)

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    TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

    Les outils pédagogiques pour le stage des résidents au cabinet du médecin généraliste français

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    Contexte : Ce n'est que depuis 1997 qu'un stage long (6 mois) au cabinet du mĂ©decin gĂ©nĂ©raliste est pratiquĂ© en France. Cette expĂ©rience rĂ©cente nous amĂšne Ă  faire le point sur les moyens pĂ©dagogiques pouvant ĂȘtre proposĂ©s aux maĂźtres de stage en formation pour aider le rĂ©sident tout au long des trois phases du stage (phase d'observation, de mise en situation, et enfin d'autonomie). But : Recenser et expliciter les diffĂ©rentes mĂ©thodes pouvant ĂȘtre mises en place au cabinet du mĂ©decin gĂ©nĂ©raliste pour faciliter la progression d'un stagiaire de 3e cycle. Sujets et matĂ©riel : A la suite d'une rĂ©union de rĂ©flexion avec les maĂźtres de stage de Midi-PyrĂ©nĂ©es, nous avons analysĂ© les diffĂ©rents outils pĂ©dagogiques utilisĂ©s au cours de ce type de stage, et dont nous exposons les avantages respectifs. RĂ©sultats et conclusion : moyens Ces pĂ©dagogiques, parfois trĂšs simples (carnet de stage), parfois plus sophistiquĂ©s (supervision directe par moyen vidĂ©o) peuvent Ă©clairer et servir les nouveaux maĂźtres de stage

    Using D-Dimer to Diagnose Painless Acute Aortic Dissection: A Case Report

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    Introduction. Aortic dissection is a cardiovascular emergency; the most frequent symptom is chest pain, but clinical presentation can be varied and atypical. Case Presentation. We report the case of a 66-year-old Caucasian male who presented a syncope immediately followed by a left-arm weakness while driving his car. Clinical examination was normal, but bilateral jugular vein distension was noted. Electrocardiogram and chest radiography were unremarkable. Among blood tests performed, troponin I test result was negative, and D-dimer test concentration was >4000 ng/mL. Since D-dimer test result was positive, chest computer tomography angiogram was performed and found a thoracic aortic dissection. Conclusion. Our case report shows that acute aortic dissection diagnosis is difficult and must be associated with the interpretation of various clinical signs and D-dimer measurement. It could be helpful for the emergency physician to have a pretest probability D-dimer like in pulmonary embolism diagnosis

    Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study

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    International audienceBackground Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding

    Memory impairment following intentional self-poisoning with benzodiazepines: Should we pay more attention to attention?

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    International audienceStudy hypothesis: In cases where patients attempt suicide through intentional self-poisoning, they often ingest drugs such as benzodiazepines that alter the central nervous system and memory. This is problematic, given that experts recommend the recovery of a patient’s cognitive capacity before any psychiatric assessment is conducted. A previous pilot study by our group showed that cognitive tests focusing on attention are the most valuable when it comes to determining whether sufficient cognitive recovery has occurred to ensure that patients will remember the assessment after intentional self-poisoning with benzodiazepines. The main aim of our study was to determine cognitive predictors of the recall of the psychiatric assessment after a suicide attempt. The second aim was to determine the threshold for episodic memory. Methods: We recruited 97 patients admitted for intentional self-poisoning. At the time of the psychiatric assessments, we quantified plasma benzodiazepine levels and performed a cognitive assessment. We then used a linear regression model to identify the associations in a control and a benzodiazepine group between cognitive functions and episodic memory scores obtained 24 hours after psychiatric assessment. Results: Our model accounted for 28% and 37%, respectively, of the variance in memory in the control and benzodiazepine groups. The most significant correlations were found for the Wechsler Adult Intelligence Scale coding test in both groups. In the control group, tests such as visual and verbal memory were also associated with recall. Conclusions: Benzodiazepines particularly affect memory by impairing what is remembered of attentional tests. These are, however, the most suitable cognitive tests for predicting recall of the memory assessment
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