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Durand A.-C.,University of Monastir | Palazzolo S.,University of Monastir | Tanti-Hardouin N.,University of Monastir | Gerbeaux P.,Service daccueil des urgences | And 2 more authors.
BMC Research Notes | Year: 2012

Background: For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of nonurgency. Results: Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency. Conclusions: Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated. © 2012 Durand et al.; licensee BioMed Central Ltd. Source

Beaudeux J.-L.,Hopital University Necker Enfants Malades | Laribi S.,Service daccueil des urgences
Annales de Biologie Clinique | Year: 2013

S100B is a small protein selectively synthesized by cerebral astro-glial cells. S100B participates physiologically in the regulation of intracellular free calcium levels, and exerts a neurotrophic activity on cerebral cells. The interest of S100B protein in clinical biology results from its physiological presence in biological fluids (cerebrospinal fluid, blood, urine) and from significant increased levels when an acute brain injury occurred, from vascular (intracra-nial hemorrhage, ischemic stroke) or traumatic (traumatic brain injury) origins. Thus, elevated plasma concentrations of S100B were significantly increased in patients with a minor, moderate and of course severe traumatic brain injury. By contrast, serum S100B levels remained unchanged in patients with negative craniocerebral tomography results, confirming the diagnostic value of this bio-marker. A prognostic value of the biomarker in the context of minor head injury is also reported. Source

Desmettre T.,Service daccueil des urgences
Revue des Maladies Respiratoires Actualites | Year: 2013

In France, spontaneous pneumothoraxes represent 78% of cases of pneumothorax in emergency units. The severity of pneumothorax varies from simple apical pneumothorax, to compressive suffocating pneumothorax. Treatment methods are multiple (abstention, monitoring, exsufflation, thoracic drainage, and thoracic surgery) with different treatment issues for the physician (recognized indication, feasibility and ease of technique, benefit/risk balance) and the patient (pain, efficiency, hospitalization). The indication of the first-line treatment of spontaneous pneumothorax is still not consensual between the thoracic drainage and the exsufflation. Although exsufflation is an efficient method, easy, simple, reproducible and with an economic benefit (length of stay) and recommended by BTS (British Thoracic Society), it is still rarely used in the treatment of spontaneous pneumothorax unlike conventional chest tube drainage which is associated with higher costs and more complications. The reasons for this limited use are the lack of: literature data, consensus and technical training of physicians. The EXPRED study, a prospective, randomized trial evaluating exsufflation versus drainage in first-line treatment of primary spontaneous pneumothorax, is underway. © 2013 Elsevier Masson SAS. Source

Raphael M.,Service daccueil des urgences
Annales Francaises de Medecine d'Urgence | Year: 2012

No clear evidence exists supporting the superiority of any one of the many methods used to reduce anterior shoulder dislocations. Success rates range from 70 to 90%, provided that the technique is perfectly controlled. The differences relate to the bio mechanical principle used, the position of the patient, the use of an assistant or equipment and the pain caused by the technique. Traction-countertraction techniques are associated with a high rate of fractures, nervous injury and vascular injury compared with other techniques and should be avoided. The choice depends on the practitioner's usual and presentation of the patient. Techniques that are quick, simple, painless and sure are ideal. They must be known and preferred whenever possible. © 2012 Société française de médecine d'urgence and Springer-Verlag France. Source

Decre D.,Laboratoire Of Microbiologie | Verdet C.,Laboratoire Of Bacteriologie | Emirian A.,Laboratoire Of Microbiologie | Le Gourrierec T.,Service daccueil des urgences | And 5 more authors.
Journal of Clinical Microbiology | Year: 2011

Severe infections caused by hypermucoviscous Klebsiella pneumoniae have been reported in Southeast Asian countries over the past several decades. This report shows their emergence in France, with 12 cases observed during a 2-year period in two university hospitals. Two clones (sequence type 86 [ST86] and ST380) of serotype K2 caused five rapidly fatal bacteremia cases, three of which were associated with pneumonia, whereas seven liver abscess cases were caused by K1 strains of ST23. Copyright © 2011, American Society for Microbiology. All Rights Reserved. Source

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