Departments In France Research Articles

Performance assessment of a chest pain unit: Preliminary 2-year experience in the European Georges Pompidou Hospital

Chest pain units (CPUs) are very popular in the USA for the triage of low-to-intermediate-risk chest pains. However, CPUs do not yet exist in France. To determine the prevalence and clinical characteristics of patients admitted to a new CPU in France, and to assess the quality of care with regard to identification and exclusion of an acute coronary syndromes (ACS). This prospective study included 906 consecutive patients with non-traumatic chest pain admitted to our CPU between September 2006 and August 2008. Patients were managed according to their probability of presenting with an ACS. Clinical characteristics, diagnostic tests, final diagnosis, destination and length of stay were recorded. We also assessed the 30-day outcome of patients in whom an ACS was excluded. Of the 906 patients, 27.9% had an ACS (1.3% with and 26.6% without ST-segment elevation, respectively). Non-ischaemic cardiac aetiologies and non-cardiac aetiologies were found in 123 (12.6%) and 63 (7.0%) patients, respectively. A final diagnosis of chest pain of undetermined origin was made in 51.5% of patients; among these, 17 (6.5%) patients were re-admitted to the CPU between September 2006 and September 2007. Thirty-day follow-up revealed that only one patient had subsequent confirmation of coronary artery disease requiring further hospitalization. This prospective study reports the first experience of a CPU in a cardiology department in France. Our preliminary results suggest that our CPU can exclude an ACS safely. Further studies are warranted to assess the value of CPUs in France.

Observer le travail: Histoire, ethnographie, approches combinées (review)

Reviewed by: Observer le travail: Histoire, ethnographie, approches combinées Jennifer J. Davis (bio) Observer le travail: Histoire, ethnographie, approches combinées. Edited by Anne-Marie Arborio et al. Paris: Éditions La Découverte, 2008. Pp. 351. €29. This volume unites eminent sociologists and historians from both sides of the Atlantic in a consideration of work. In part 1, the contributors observe people at work in a wide range of arenas, past and present: government offices, family firms, factories, museums. They illuminate the ways in which specific methods from ethnography or history—such as archival research, or narrative descriptions of work practices—have sharpened their analyses of workplaces and practices. But they are not content only to consider the techné of workers in these various arenas. In parts 2 and 3, the divergent disciplinary technés of ethnography and history themselves come under the microscope. Part 2 gives voice to six different authors’ testimonies about the benefits and hazards of interdisciplinarity. Part 3 provides recommendations for institutional changes that will work to effect an increased integration of historical and ethnographic methods. Only two of the six editors are historians, and historians authored only four of the seventeen chapters. This results in a conversation more dominated by sociology than the editors seem to have envisioned. While both historians and sociologists of labor seek to understand work and its significance within individuals’ lives and human society, the two disciplines cultivate drastically different methods—as Pierre Fournier, Nicolas Hatzfeld, Cédric Lomba, and Séverin Muller note in a marvelous introduction. The editors assume that each discipline stands to learn from the other, and the contributions to their volume provide overwhelming evidence in support of interdisciplinarity. The introduction emphasizes history’s rigorous methods for reading texts, and the discipline’s penchant for calling attention to specific sources. This is contrasted with the tendency of the social sciences to veil sources, often for ethical reasons. The editors suggest that, despite these concerns, ethnographers might still adopt historians’ tactics to more closely interrogate their sources’ assumptions and biases. They define ethnography as an “auxiliary science” cultivated by anthropologists and sociologists to engage in the “thick description” of living societies. Ethnographers engage in direct observation of their subjects and collect both interviews and material objects produced by the practices in question. Ethnography urges the researcher to consider his own role within the work site, and to evaluate how the research conditions influenced the findings. This level of reflexivity would greatly benefit historians in considering their own place in their research. Some of the finest chapters in this book are by traditionally trained sociologists who have taught themselves historical methods to conduct [End Page 980] archival research, interrogate texts, and evaluate sources. In so doing, they provide models for rigorous interdisciplinary methodology. Lomba, for example, urges his fellow sociologists to consider using archives and documents in their research. According to Lomba, documentary analysis is not taught in sociology departments in France and is only rarely integrated into published sociological studies. His own research centers on studying the work practices and organization of business firms, and the careful reading of the firms’ internally produced documents provides an important component of his analysis. Similarly, Léonie Hénaut’s study of changing work practices among art-restoration professionals at the Louvre relies on interviews and direct observation alongside analysis of archival documents. These studies produce careful ethnographies of business or museum work that are sensitive to how these work sites have changed over time. The editors have done a great service in collecting such a dramatic range of workplaces, including the workplaces of scholars of work. I do, however, have a few reservations about their neglect of ethnography in history. Particularly strong in the American academy, the “new cultural history” of the 1970s and 1980s introduced ethnographic practices into history. The editors make little mention of this longstanding interdisciplinarity and its consequences for the fields of history and sociology. In addition, I regret that this text glosses over some of the profound criticisms of both ethnographic and historical methods to emerge in the past generation. Ethnographers have participated in a systemic questioning of the cultural prejudices and researcher’s...

Prevention of overweight in preschool children: results of kindergarten-based interventions

Given the increasing prevalence of pediatric obesity, we evaluated two kindergarten-based strategies for reducing overweight in preschool children in the Haute-Garonne Department in France. Kindergartens (n=79) were randomly assigned to one of the two strategies and followed for 2 years. In the first group (Epidémiologie et prévention de l'obésité infantile, EPIPOI-1), parents and teachers received basic information on overweight and health, and children underwent screening to identify those with overweight (body mass index (BMI) > or = 90th percentile) or at risk for overweight (BMI between 75 and 90th percentile), who were then followed up by their physicians. EPIPOI-2 children, in addition, received kindergarten-based education to promote healthy practices related to nutrition, physical activity and sedentary behaviors. Data on control children from non-intervention kindergartens (n=40) were retrieved from medical records at the Division of School Health. At baseline, groups differed significantly on age and school area (underprivileged/not). Owing to a significant interaction between school area and group, analyses were stratified by school area. At baseline, groups did not differ on overweight prevalence and BMI z-scores for any school area. After intervention, prevalence of overweight, BMI z-score and change in BMI z-score were significantly lower in intervention groups compared with controls in underprivileged areas. Using multilevel analysis adjusted for potential confounders, a significant effect on overweight prevalence at the end of the study was noted for EPIPOI-1 in underprivileged areas only (odds ratio and 95% confidence interval: 0.18 (0.07-0.51). In non-underprivileged areas, the gain in BMI z-score was lower in EPIPOI-2 group compared with control and EPIPOI-1. Our results suggest that simple measures involving increasing awareness on overweight and health, and periodic monitoring of weight and height with follow-up care when indicated, could be useful to reduce overweight in young children from underprivileged areas. A reinforced strategy with an education component, in addition, may be indicated in children in non-underprivileged areas.

Inter‐observer agreement in clinical decision‐making for abnormal cardiotocogram (CTG) during labour: a comparison between CTG and CTG plus STAN

To compare inter-observer agreement for clinical decision-making with cardiotocography (CTG) and combined CTG with ST-segment analysis (STAN). Experimental study. Three hospital obstetrics departments in France. Thirty randomly selected nonreassuring CTG recordings during labour of women with singleton term pregnancies in cephalic position. Seven obstetricians independently assessed the tracings, displayed in a random order on their computers, on two separate sessions, the first without and the second with STAN information. The observers received clinical information about the labour as the tracings continued and were asked whether they would intervene. For analysis, we considered that intervention was justified for the neonates with pH < 7.05 and that nonintervention was justified for those with a pH > 7.10 after spontaneous delivery. Kappa values and rates of inter-observer agreement for intervention and for nonintervention. Kappa for inter-observer agreement was 0.50 (0.29-0.69) with CTG, and 0.67 (0.48-0.81) with CTG + STAN. The rate of inter-observer agreement for the decision to intervene was 73% (68-77%) with CTG and 70% (66-75%) with CTG + STAN (P = 0.4), and for the nonintervention decision it was 48% (42-54%) and 69% (64-74%), respectively (P < 0.0001). The rate of agreement for justified intervention was 94% (91-97%) with CTG and 85% (80-90%) with CTG + STAN (P < 0.001) and for justified nonintervention, 56% (48-63%) with CTG and 84% (79-89%) with CTG + STAN (P < 0.0001). In cases with abnormal CTG, ST analysis may improve consistency in clinical decision-making and decrease unnecessary interventions, but may also lead on rare occasions to unjustified decisions not to intervene.

Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France

BackgroundThe health impacts of heat waves are serious and have prompted the development of heat wave response plans. Even when they are efficient, these plans are developed to limit the health effects of heat waves. This study was designed to determine relevant indicators related to health effects of heat waves and to evaluate the ability of a syndromic surveillance system to monitor variations in the activity of emergency departments over time. The study uses data collected during the summer 2006 when a new heat wave occurred in France.MethodsData recorded from 49 emergency departments since July 2004, were transmitted daily via the Internet to the French Institute for Public Health Surveillance. Items collected on patients included diagnosis (ICD10 codes), outcome, and age. Statistical t-tests were used to compare, for several health conditions, the daily averages of patients within different age groups and periods (whether 'on alert' or 'off alert').ResultsA limited number of adverse health conditions occurred more frequently during hot period: dehydration, hyperthermia, malaise, hyponatremia, renal colic, and renal failure. Over all health conditions, the total number of patients per day remained equal between the 'on alert' and 'off alert' periods (4,557.7/day vs. 4,511.2/day), but the number of elderly patients increased significantly during the 'on alert' period relative to the 'off alert' period (476.7/day vs. 446.2/day p < 0.05).ConclusionOur results show the interest to monitor specific indicators during hot periods and to focus surveillance efforts on the elderly. Syndromic surveillance allowed the collection of data in real time and the subsequent optimization of the response by public health agencies. This method of surveillance should therefore be considered as an essential part of efforts to prevent the health effects of heat waves.

Prevalence of nephrogenic systemic fibrosis in renal insufficiency patients: Results of the FINEST study

Purpose Nephrogenic systemic fibrosis (NSF) is characterized by widespread tissue fibrosis, mainly affecting the skin. Gadolinium chelates have been implicated in the onset of NSF in patients with renal impairment (RI). The FINEST study (FIbrose Néphrogénique SysTémique) was designed to determine the prevalence of NSF after magnetic resonance imaging (MRI) in French RI patients. Materials and methods We studied all patients with RI who had at least one MRI examination during a one-year period, with or without gadolinium chelate administration. Data were collected retrospectively from 9 Nephrology Departments in France, and included sex, age, renal function, type of gadolinium administered, and subsequent cutaneous disorders. If a patient presented a cutaneous disorder, a skin biopsy was performed to confirm the diagnostic. Results The 308 eligible patients had a mean age of 59.9 years, 59% were men, and 54% had stage 5 RI. 75% of those 308 patients received a Gadolinium chelate. Among those patients who received a gadolinium chelate, 76% received gadoterate, 20% gadopentetate, 3% gadodiamide and 1% gadobenate. No cutaneous disorders were recorded after MRI. Conclusion These results confirm that NSF is a rare disease. Based on a reported frequency, ∼3.5% in patients with glomerular filtration rate <30 ml/min/1.73 m 2), some cases should have been observed in our study which included 308 patients. Most patients received gadoterate, a macrocyclic gadolinium chelate for which no case of NSF has been observed worldwide. This suggests that more stable macrocyclic agents may be less likely to induce NSF.

Departmentalization, migration, and the politics of the family in the post-war French Caribbean

This article examines the ways in which metropolitan French officials attempted to deal with the “population problem” in Martinique and Guadeloupe after they became overseas departments (DOMs) of France in 1946. Warning of a demographic crisis in the Antilles, French administrators targeted what they saw as a loose family structure and promoted European family values of Christian marriage and a stable nuclear family. The government justified smaller social subsidies to citizens of the new DOMs by citing the supposedly problematic nature of the Caribbean family and its difference from the French norm. In 1963 the government initiated a wave of emigration to the metropole through an agency called BUMIDOM which was to decrease birth rates in the Antilles and provide much-needed unskilled labor in France itself. Although the impact of emigration on the birthrate is unclear, one lasting legacy of this period was the acute sense of injustice many Antilleans felt at being treated unequally by the state. While birth rates have gone down in the DOMs it had little to do with the acceptance of European family models.

Prevalence, motives and patterns of anticipated radiograph ordering by nurses in accident and emergency departments in France

Background:Although common in many countries, anticipated ordering of radiographs by nurses in Accident and Emergency Departments (AEDs) remains illegal in France. Despite this, some evidence suggests that it is implemented...

SEROLOGIC SURVEY FOR SELECTED VIRAL PATHOGENS IN FREE-RANGING ENDANGERED EUROPEAN MINK (MUSTELA LUTREOLA) AND OTHER MUSTELIDS FROM SOUTH-WESTERN FRANCE

To investigate the possible role of selected pathogens in the decline of endangered European mink (Mustela lutreola) populations and the potential for these pathogens to affect mink survival, a serologic survey was conducted using serum samples collected from March 1996 to March 2003 in eight departments of south-western France. In total, 481 free-ranging individuals of five mustelid species (including the European mink) were tested. Sympatric mustelids can serve as sentinels to determine the presence of antibodies to viruses in the study area that could potentially infect mink. Antibodies to Canine distemper virus (CDV) were detected in all species; 9% of 127 European mink, 20% of 210 polecats (Mustela putorius), 5% of 112 American mink (Mustela vison), 33% of 21 stone marten (Martes foina) and 5% of 20 pine marten (Martes martes). Antibody prevalence was significantly higher in stone marten and polecats, possibly because their ranges overlap more closely with that of domestic species than that of the other species tested. Antibodies to Canine adenovirus were detected in all species but the pine marten; antibody prevalence estimates ranging from 2% to 10%. Antibodies to canine parainfluenza virus were detected in 1% of European mink, 1% of American mink and 5% of tested polecats but were not detected in Martes species. Antibodies to Rabies virus (RV) were detected in three animals, possibly because of interspecies transmission of bat lyssaviruses as the sampling area is considered to be free of RV, or to a lack of test specificity, as antibody titers were low. The high antibody prevalence to potentially lethal CDV suggests that this pathogen could have significant effects on the free-ranging populations and has implications for the conservation efforts for the endangered European mink.

Corrigendum to “Guideline on antiplatelet and anticoagulation management in cardiac surgery” [Eur. J. Cardiothorac. Surg. 34 (1) (2008) 73–92

Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiac Surgery, Vicenzo Hospital, Italy d Institute of Cardiology, La Pitie-Salpetriere Hospital, Paris, France Department of Cardiothoracic Surgery, University Hospital of Liege, Liege, Belgium Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden Department of Cardiothoracic Surgery, Papworth Hospital, CB23 3RE, Cambridge, UK

The failure of colonial ‘distancing’: Changing representations of the 2005–06 chikungunya epidemic in Réunion, France

In 2005–06, the Indian Ocean island of Réunion, an overseas department of France, experienced a massive epidemic of the mosquito‐borne viral infection chikungunya. Public health authorities in metropolitan France were arguably slow to react, and we explore their representations and management of the epidemic in the context of tropicality and colonial discourse. We analyse official reports on the epidemic from the bulletins of the Institut de Veillance Sanitaire (Institute for Health Surveillance) for changes in representations of risk posed by chikungunya to metropolitan France, in the emphasis on control measures for the epidemic and in descriptions of chikungunya case symptomatologies, and compare these with parallel representations of another epidemic, flu, already known in metropolitan France. Our findings illustrate that official responses to chikungunya at the beginning of the epidemic are suggestive of a centred tropicality: there is no perceived risk to metropolitan France because of its nontropical climate; thus, there is no justification for costly control measures for a disease inevitable in the tropics; and therefore the symptoms of French nationals in overseas departments in the tropics can be described in detached terms so as to generate knowledge about the disease. However, this ‘distancing’ fails with the perceived risk to metropolitan France towards the end of the epidemic in late 2006, when representations are more consistent with a decentred tropicality: the concept of a protective metropolitan French climate is abandoned; the need for a whole‐of‐society involvement in control measures is accepted; and symptoms are described using more inclusive language. Similar changes are not found in official reports on the flu epidemic.

Trajectoire initiale des patients âgés et impact sur leur orientation après leur passage dans les services d’urgences. Résultats d’une enquête nationale

We have little information on the geriatric characteristics of elderly patients visiting the emergency departments (ED) in France. In order to develop an adapted prevention of the arrival of some elderly patients, the determinants of their arrival to the ED deserves to be better known. A one-day cross-sectional study was conducted in French ED. A standardized questionnaire was used for each patient over 80 years (Pts), specifying the sociodemographic characteristics, the circumstances of visit to and care received in the ED, and the orientation of the patients after consulting the ED. On a sample of 1298 Pts, health event leading to ED started at home in 63.8% of cases. When the patients initiated themselves the recourse to health care (RHC), they called less often a general practitioner (61.9% of cases) than when the RHC was triggered by their family (69.6%, p=0.01). When a health care professional initiated the RHC, it was a GP in more than 80% of cases. Return to residence was more frequent when the patient triggered the RHC (34.5% versus 22.9% for the family and 16.0% for the professional health care, p<0,001). The actor of the decision of arrival to the ED has an impact in the RHC, in resources utilisation, and on the patient's orientation after coming in ED. The results of this study may help to design strategies aiming at avoiding unnecessary ED consultations of elderly persons.

192: Who Reads the Electrocardiograms in Emergency Departments in France

The electrocardiograms (ECG) are routinely used in emergency departments (EDs). New recommendations on leads position have been published in 2007. The aim of our study was to know who mainly reads ECGs in EDs, to improve the communication on the recommendations. Correction NoticeAnnals of Emergency MedicineVol. 52Issue 1PreviewIn the April 2008 issue, in abstract 192 by Sende, Bongrand, Campos-Richard, et al (“Who Reads the Electrocardiograms in Emergency Departments in France”; page 529), on page 478, there was a translation error. In all instances where the word “reads” is used, (ie, “who mainly reads ECGs”) the correct term should have been “performs.” We apologize for this error. Full-Text PDF

Density Functional Theoretical Study on the Proton Migration in Radical Cations of Substituted Cytosine:Guanine Pair

Department of Nanomedical Engineering, Pusan National University, Miryang 627-706, Korea. E-mail: sungu@pusan.ac.kr BK21 Nano Fusion Technology Team, Pusan National University, Miryang 627-706, Korea Department of Materials Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 500-712, Korea LEMA, Universite Francois Rabelais, Tours 37200, France Department of Nanosystem and Nanoprocess Engineering, Pusan National University, Miryang 627-706, Korea Department of Horticultural Bioscience, Pusan National University, Miryang 627-706, Korea Received December 10, 2007

Predictors of student Internet use: data from three developing countries1

Training, organizational support, attitude and national culture were explored in relation to college students’ Internet usage. Samples were drawn from India, Mauritius and Reunion Island (an overseas Department of France). Each nation differs culturally from the others. Questionnaire data was collected on students’ Internet usage as well as the predictor variables. Data was analyzed using hierarchical multiple regression. The country groups were dummy‐coded. Results suggested that attitude, training and university support were positively related to students’ Internet use. Non‐significant interaction terms suggested that these relationships did not change according to country sample. The present findings are consistent with previous reports using samples from Western, economically developed countries.

Homage to Aimé Césaire, 1913–2008

Homage to Aimé Césaire, 1913–2008 Ronnie Scharfman (bio) When Aimé Césaire died at the age of 94 in his native Martinique on April 17, the francophone world arguably lost the greatest contemporary poet of the French language. Césaire, the author of numerous volumes of poetry, as well as plays and essays, is perhaps best known as the coiner of the term négritude in his epic, groundbreaking poem Cahier d’un retour au pays natal (Return To The Native Land, 1939). He is also revered and beloved by his people, having been consistently reelected to serve as the mayor of Martinique’s capital, Fort-de-France, for 56 years, and as the Deputy from Martinique to the French Assembly for 48 years. Yet aspects of his dual career were also highly contested in his lifetime. His violent, hermetic, powerful French poetry, which he inflected to articulate a specifically Black Antillean subjectivity that denounced the crimes of slavery and the outrages of colonialism, was critiqued by the next generation of writers in the French West Indies—P. Chamoiseau, R. Confiant and J. Bernabé—for being too racially charged and too French at the expense of local Creole culture. Similarly, his urbanization projects as mayor were sometimes criticized for opting for modernity over tradition, and his cosponsoring of the 1946 law that made Martinique and Guadeloupe (along with French Guyana and Réunion) departments of France, with equal economic and legal rights as any other French departments, was harshly critiqued as pushing the island towards assimilation, rather than autonomy. Césaire himself realized soon after the vote in 1946 that départementalisation was a mistake, and it remained one of the regrets of his long career of political engagement. Although Césaire is now highly respected by both the French literary establishment and the public sector, to the extent that it was even suggested that he be buried in the Panthéon in Paris among France’s great luminaries (a dubious honor given his stance on French colonialism, and one which his family declined), he is hardly a household name in France. In America, a country that he visited only once, being a persona non grata as a member of the Communist party from 1945–1956, his poetry is known to Anglophone audiences thanks in large part to the admirable translation work of Clayton Eshleman and Annette Smith (The Collected Poetry; The Complete Lyric and Dramatic Poetry), which includes the Cahier. But it is perhaps his Discours sur le colonialisme (Discourse on Colonialism, 1950), a scathing indictment of the European West’s colonial ideology and policies, which has had the greatest impact on African-American readers of postcolonial texts. Although this very brief introduction points to a career both complex and contradictory, I would like to argue for the profound integrity and coherence of Césaire’s poetic project and, by extension, his political commitment. It is to his invaluable poetic contribution then, that I shall devote the remainder of this homage. Césaire himself often said, “If you want to understand my politics, ready my poetry.” [End Page 976] Who, then, was Aimé Césaire? Born on June 16, 1913 in Basse-Pointe, Martinique, Césaire was the 4th of 7 children of a modest family with ambitions for its children that included the valorization of the French (colonial) language as the language not only of freedom and upward mobility, but also as that of a great, universalist literary tradition. Even as a child, Césaire read Hugo and Voltaire, and became a passionate student of Rimbaud, Baudelaire, Mallarmé and Claudel. A brilliant student, Césaire won a scholarship to the Lycée Schoelcher in the capital, Fort-de-France, and his family moved so that he could pursue his secondary education there. Thus began an academic trajectory that was to bring Césaire to Paris in 1931 to prepare for the examinations to enter the prestigious Ecole Normale Supérieure. It would be an understatement to say that studying in Paris in the 30’s changed Césaire’s life. It was there that, paradoxically, far from his native land, he began to become aware...

Specific guidelines on wound and wound-bed management

Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK St George’s Vascular Institute, St George’s Healthcare NHS Trust, London, UK Department of Endocrinology, University Hospital of Malmo, Sweden Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, Arizona IWGDF, Heemstede, The Netherlands Service de diabetologie, Hopital Pitie-Salpetriere, Assistance Publique des Hopitaux de Paris, and Universite P et M Curie, Paris, France Department of Endocrinology, Lund University Hospital and Institution for Clinical Sciences in Lund, Sweden School of Healthcare Studies, Cardiff University, Cardiff, UK

How to combine hygiene and radiation protection for radiopharmaceuticals preparation? Analysis in France and propositions

Radiopharmaceuticals for intravenous administration are considered as sterile medicinal products. Their preparation in hospitals involves adherence to regulations on radiation protection as well as to sterility requirements for parenteral administration. These two basic aspects are often opposite, making the working conditions difficult to define. Official texts that have included hygiene and radiation protection do not precisely state how to combine these two aspects in practice. Thus, after an analysis of the bibliography available, this review will show that even if hospital radiopharmacy departments in France are not able to work in total aseptic environments, some measures can be taken in order to improve preparation conditions.

Intervention targeted at nurses to improve venous thromboprophylaxis

To assess the effectiveness of an intervention targeting both physicians and nurses vs. physicians only in improving venous thromboprophylaxis for older patients. Cluster randomized trial. Fifty hospital-based post-acute care departments in France. Patients aged 65 years or older. A multifaceted intervention to implement a clinical practice guideline addressing venous thromboprophylaxis. The effectiveness outcomes were elastic stocking use, ambulation or mobilization under the supervision of a physical therapist and anticoagulant-based prophylaxis. Patient outcomes included deep vein thrombosis and anticoagulant-related adverse events. One department allocated to the intervention targeted at physicians only and seven departments allocated to the intervention targeted at both physicians and nurses dropped out of the study. Compared with the intervention targeted at physicians only (n = 497 patients), the intervention targeted at both physicians and nurses (n = 315 patients) was associated with a higher rate of mobilization (62 vs. 37%, P < 0.001) and comparable levels of elastic stocking (32 vs. 39%, P = 0.74) and anticoagulant (55 vs. 48%, P = 0.36) use. The rates of deep vein thrombosis (15 vs. 13%, P = 0.50), bleeding (1 vs. 1%, P = 0.99) and thrombocytopaenia (0 vs. 0.2%, P = 0.99) did not differ between the two groups. A multifaceted intervention targeting nurses in addition to physicians can increase the frequency of mobilization of older patients to prevent venous thromboembolism but does not alter the use of elastic stockings and anticoagulant. A differential drop-out of departments might have contributed to creating imbalances in baseline characteristics and outcomes in this study.

Enquête de prévalence et des pratiques de prise en charge des plaies chroniques dans 14 établissements gériatriques du Haut-Rhin

We carried out a survey to assess the prevalence of various therapeutic approaches for chronic wounds in 14 primary care and rehabilitation units (SSR) and long-term care units (SLD) in the Haut-Rhin department of France, and we attempted to gauge the interest of doctors and nursing staff in the creation of a Mobile Wound and Healing Unit (EMPC). Our anonymous transversal survey was based on the results of two questionnaires, one concerning patients and the other concerning medical and nursing staff. 96 of the 1 163 patients hospitalised at the time of our survey met the inclusion criteria. The global prevalence of sores was 8.3%, while that of bedsores was 6.4% and that of leg ulcers was 1.6%. There were no cases of wounds on diabetic feet. The study population was characterised by a M/F sex-ratio of 0.37, with mean age of 86 years for women and 76 years for men. The mean duration of bedsores was 6 months, compared with 14 months for leg ulcers and a relapse rate of 36% for bedsores and 52.6% for leg ulcers. In more than half of all cases the aetiology of the ulcers was not stated. Bacteriological samples were obtained in 7 cases. Wounds were generally cleansed using soap and physiological saline, with mechanical debridement being used in 4 cases. Hydrocolloids were the dressings used most widely for bedsores, while interfaces were most commonly used in leg ulcers. No topical antibiotics were prescribed. A pain evaluation scale was used in only 18 cases and topical anaesthetics were administered in one case prior to debridement of a leg ulcer. A bedsore risk evaluation scale was completed for 27 of the 75 of the patients presenting bedsores and special preventive mattresses were used for two-thirds of these patients. Twelve of 19 patients with leg ulcers had compression bandaging that was changed daily. Most doctors considered their knowledge of chronic wounds to be good, in contrast with nursing staff, 72% of whom judged their knowledge mediocre or insufficient. All the nursing staff and 11 of the 13 doctors expressed interest in the use of a specialised team for difficult cases. The main practices consistent with the recommendations were use of modern dressings, although the latter appeared to be changed too frequently, anecdotal use of antiseptic solutions, abandonment of use of topical antibiotics and nutrition management plans. Two-thirds of patients with leg ulcers wore compression bandages. However, improvements remain to be made concerning the use of topical anaesthetics, manual debridement, use of pain evaluation and bedsore risk scales, and assessment of the aetiology of leg ulcers. This survey, conducted prior to the creation of a mobile wound and healing unit based at the Colmar General Hospital, showed that doctors and nursing staff are extremely keen on the idea of specific training and practical advice concerning chronic wound management. It provided a clearer vision of the training requirements of SSR and SLD establishments in terms of chronic wound management.