Heliyon

Purpose: Restraint is often used when administering procedures to children. However, no metrologically scale to measure the restraint intensity had yet been validated. This study validated the metrological criteria of a scale measuring the restraint intensity, Procedural Restraint Intensity in Children (PRIC), used during procedures in children. Design and methods: The PRIC scale performance was measured by a group of 7 health professionals working in a children's hospital, by watching 20 videos of health care procedures. This group included 2 physicians, 1 pediatric resident, and 4 nurses. The intra-class correlation coefficients were calculated to evaluate the inter-rater and test-retest reliability and the construct validity with the correlation between PRIC scale and a numerical rating scale. Results: One hundred and forty measurements were made. Inter-rater and test-retest correlation coefficients were 0.98 and 0.98, respectively. The 2 scales were positively correlated with a Spearman coefficient of 0.93. Conclusions: This study validated the Procedural Restraint Intensity in Children (PRIC) scale in metrological terms with some limitation. However, there is not gold standard scale to precisely validate the reliability of this tool and this study has been conducted in "experimental" conditions. Nevertheless, this is the first scale measuring the intensity of physical restraint with a metrological validation. The next step will be to validate it in real clinical situations

Trends in reasons for emergency calls during the COVID-19 crisis in the department of Gironde, France using artificial neural network for natural language classification

Abstract Objectives During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. Methods We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports. Results The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems. Discussion The first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising. Conclusion The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile.Surveillance épidémiologique de la période pandémique covid-19 par classification automatique en temps réel des notes cliniques des centres d'appels d'urgence du 15 à l'aide de réseaux de neurones artificiels de type Transformer

Trials

BACKGROUND: Recent data suggest that 10-20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized control trial suggested that this condition may be induced by the stress experienced during the event or emergency room (ER) stay and can be prevented in up to 75% of patients with a single, early, short eye movement desensitization and reprocessing (EMDR) psychotherapeutic session delivered in the ER. The protocol of the SOFTER 3 study was designed to compare the impact on 3-month PCLS of early EMDR intervention and usual care in patients presenting at the ER. Secondary outcomes included 3-month post-traumatic stress disorder, 12-month PCLS, self-reported stress at the ER, self-assessed recovery expectation at discharge and 3 months, and self-reported chronic pain at discharge and 3 months. METHODS: This is a two-group, open-label, multicenter, comparative, randomized controlled trial with 3- and 12-month phone follow-up for reports of persisting symptoms (PCLS and post-traumatic stress disorder). Those eligible for inclusion were adults (>/=18 years old) presenting at the ER departments of the University Hospital of Bordeaux and University Hospital of Lyon, assessed as being at high risk of PCLS using a three-item scoring rule. The intervention groups were a (1) EMDR Recent Traumatic Episode Protocol intervention performed by a trained psychologist during ER stay or (2) usual care. The number of patients to be enrolled in each group was 223 to evidence a 15% decrease in PCLS prevalence in the EMDR group. DISCUSSION: In 2012, the year of the last national survey in France, 10.6 million people attended the ER, some of whom did so several times since 18 million visits were recorded in the same year. The SOFTER 3 study therefore addresses a major public health challenge. TRIAL REGISTRATION: Clinical Trials. NCT03400813 . Registered 17 January 2018 - retrospectively registered

A thermally self-sustained micro-power plant with integrated micro-solid oxide fuel cells, micro-reformer and functional micro-fluidic carrier

Low temperature micro-solid oxide fuel cell (micro-SOFC) systems are an attractive alternative power source for small-size portable electronic devices due to their high energy efficiency and density. Here, we report a thermally self-sustainable reformer – micro-SOFC assembly. The device consists of a micro-reformer bonded to a silicon chip containing 30 micro-SOFC membranes and a functional glass carrier with gas channels and screen-printed heaters for start-up. Thermal independence of the device from the externally powered heater is achieved by this exothermic reforming reaction above 470 °C. The reforming reaction and the fuel gas flow rate of the n-butane/air gas mixture controls the operation temperature and gas composition on the micro-SOFC membrane. In the temperature range between 505 °C and 570 °C, the gas composition after the micro-reformer consists of 12 vol% to 28 vol% H2. An open-circuit voltage of 1.0 V and maximum power density of 47 mW/cm2 at 565 °C is achieved with the on-chip produced hydrogen at the micro-SOFC membranes

Micro-solid oxide fuel cells running on reformed hydrocarbon fuels

Micro‐solid oxide fuel cell (micro‐SOFC) systems are predicted to have a high energy density and specific energy and are potential power sources for portable electronic devices. A micro‐SOFC system is under development in the frame of the ONEBAT project [1‐3]. In this presentation, we report on the fabrication and characterization of a sub‐system assembly consisting of a startup heater and a micro‐reformer bonded to a Si chip with electrochemically‐active micro‐SOFC membranes. A functional carrier including fluidic channels for gas feed and integrated heaters was bonded to a microreformer with an overall size of 12.7 mm x 12.7 mm x 1.9 mm [4‐7]. As a catalyst, a foam‐like material made of ceria‐zirconia nanoparticles doped with rhodium was used to fill the 58.5 mm3 reformer cavity. This micro‐reformer allows for high methane and butane conversion of > 90 % with a hydrogen selectivity of > 80 % at 550 °C in the reformer [7, 8]. A silicon chip with 30 free‐standing micro‐SOFC membranes (390 μm x 390 μm) with a thickness of less than 500 nm was bonded to the carrier‐reformer assembly described above. The micro‐SOFC membrane consisted of an yttria‐ stabilized zirconia thin film electrolyte. Both Pt‐based and ceramic‐based electrode materials were tested regarding the thermal stability and carbon poisoning at temperatures below 600 °C. The functional‐carrier mirco‐reformer micro‐SOFC assembly was electrochemically tested with hydrocarbon fuel between 300 °C and 600 °C. The fuel cell performance and the microstructural evolution of the anode are discussed as well

La kétamine en médecine d’urgence

La kétamine est un médicament de plus en plus utilisé en médecine d’urgence pour son action anesthésiante, sédative et analgésique. Si les deux premières indications s’appuient sur des preuves solides, la troisième repose sur des données plus controversées. Si les quelques données cliniques semblent montrer une efficacité antalgique de la kétamine dans ce contexte, les questions qui restent en suspens concernent sa place dans l’arsenal des antalgiques étant donné la fréquence élevée de ses effets indésirables. Une question de recherche en médecine d’urgence ouvrantencore des perspectives concerne la kétamine et son action antihyperalgésique qui pourrait permettre de limiter le risque de chronicisation de la douleur.Ketamine is a medication increasingly used in emergency medicine for its anesthetic, sedative and analgesic action. While the first two indications are based on solid evidence, the third is based on more controversial data. If the few clinical data seem to show an analgesic efficacy of ketamine in this context, the remaining questions concern its place in the analgesic arsenal considering the high frequency of its adverse effects. A research question in emergency medicine still opening perspectives concerns ketamine and its antihyperalgesic action which may allow to limit the risk of chronic pain

Douleur aiguë de l'adulte en médecine d'urgence extra hospitalière (prévalence et prise en charge)

La douleur aiguë en médecine d urgence extrahospitalière est un évènement fréquent. Cependant il y a peu d études récentes d ampleur concernant ce symptôme dans ce contexte. L objectif est de déterminer la prévalence de la douleur aiguë de l adulte en médecine pré-hospitalière et d identifier les facteurs associés à l oligoanalgésie. Il s agit d une enquête prospective descriptive menée en 2007 sur une période de 11 mois au sein d un service mobile d urgence et de réanimation (SMUR) du service d aide médical d urgence (SAMU) de Seine Saint Denis. Les patients âgés de 16 ans ou plus et capables d auto évaluer leur douleur ont été inclus dans l étude. Pour chaque patient, le médecin transporteur devait remplir une fiche comprenant le diagnostic retenu, la présence ou non d une douleur, l intensité de la douleur et le traitement effectué.Sur les 2279 patients inclus, 947 (42%) ont été évalués comme douloureux. La douleur était intense à sévère pour 64% des patients. La traumatologie (82%) et la gynécologie-obstétrique (66%) étaient les catégories diagnostiques associées à un risque plus élevé de douleur. Ces mêmes pathologies ainsi que la cardiologie étaient associées à un risque plus élevé de douleur intense. Parmi les 1364 patients transportés par une unité mobile hospitalière (UMH), 48% étaient douloureux (71% présentaient une douleur sévère à intense). Un analgésique a été administré dans 73% des cas. Malgré tout 51% ont été soulagé et le taux de soulagement a été inférieur pour la traumatologie et la gynécologie obstétrique.Cette étude a mis en évidence une prévalence de la douleur pré- hospitalière de 42%, cependant ce taux varie beaucoup en fonction de l origine de la douleur. La prise en charge de la douleur reste insuffisante et le taux de soulagement reste encore trop faible.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Evaluation de la prescription des morphiniques par les médecins généralistes (prévalence de praticiens prescripteurs et facteurs de sous-prescriptions)

Les morphiniques sont des antalgiques puissants utilisés pour la prise en charge des douleurs intenses. Leur effet antalgique peut s'accompagner de différents effets indésirables parmi lesquels un risque de dépendance physique et d'addiction. En dépit de leur puissance d'action, les morphiniques ont pendant longtemps été sous utilisés par les praticiens. La crainte des phénomènes de dépendance et le manque de formation des praticiens ressortaient comme des facteurs influençant négativement la prescription des morphiniques. Ce travail repose sur une étude prospective menée en 2011 auprès de médecins généralistes français. Il a pour but d'évaluer la prévalence de médecins généralistes prescripteurs de morphinique, et de rechercher des facteurs associés à une restriction de cette prescription. L'existence d'une restriction de la prescription par crainte des effets secondaires a été utilisée pour définir un groupe de prescripteurs larges prescrivant des morphiniques systématiquement quand ceux ci sont indiqués, et un groupe de prescripteurs restreints limitant leur prescription dans des situations justifiant pour eux un traitement par morphinique. Ces deux groupes ont été comparés pour rechercher des facteurs associés à ce comportement. Sur les 66 praticiens ayant participé à l'étude, 91 %déclarent prescrirent des morphiniques. Vingt d'entre eux(30%) appartenaient au groupe des prescripteurs restreints. L'expérience antérieur de cas de dépendance chez des patients traités par morphiniques est associée à une restriction de la prescription avec un Odds Ratio de 3.6 [1.1 . . 12.0]. L'âge, le sexe et le mode d'exercice des praticiens, de même que l'expérience antérieur d'effets secondaires graves des morphiniques ne sont pas associés a la restriction de la prescription.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

La circulation de l'information médicale (évaluation du lien complexe ville-hôpital)

La communication et la circulation de l information médicale entre l hôpital et les médecins généralistes sont des enjeux majeurs de la qualité du système de soins. La législation et les autorités de référence multiplient les recommandations en ce sens. Nous avons voulu évaluer la réalité de cette communication réputée cahotique. Notre travail s est appuyé sur un questionnaire proposé à 50 médecins généralistes de Paris et de Seine Saint Denis, qui explore différents aspects de leur communication avec l hôpital les circuits, la quantité d informations reçues, le contenu de cette information et la qualité de celle-ci. Les résultats mettent en évidence une communication satisfaisante en terme quantitatif de façon gobale, mais qui n est ni constante suivant le motif de recours à l hôpital, ni efficace selon le type d informations. L absence de sentiment de collaboration ressenti par les médecins généralistes avec l hôpital est profondément ancré. Le projet du dossier médical personnel promet de pallier à certains écueils logistiques de la circulation de l information médicale mais ne suffira pas à réconcilier la rupture culturelle qui existe entre ces deux piliers du système de soins que sont l hôpital et les médecins généralistes.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF