[Bacteremia and French computerized disease surveillance system: financial valorisation of an infectious diseases specialist in a hospital]. / Bactériémies et Programme de médicalisation des systèmes d'information : valorisation financière de l'infectiologue à l'hôpital.

OBJECTIVE: Bacteremia surveillance is a mission assumed by the referent person for antimicrobial therapy. We propose an original financial valorization of this activity, using the computerized disease surveillance system (CDSS). MATERIAL AND METHODS: A database collecting community-acquired and care-associated bacteremia was created on January 1, 2009 at the Bethune Hospital, France, using EPI-Info software (EPI Data). This database was used to complete missing data (presence of bacteremia, origin [community-acquired or care-associated], site of infection) in CDSS codes of patients hospitalized in surgical and medical wards (410 beds) during 2009. Financial benefit was assessed by the difference of funds allocated on the basis of CDSS, before and after completion of the missing data. RESULTS: In 2009, 383 out of the 35,000 patients presented with bacteremia. When missing CDSS codes were added, a financial gain of 229,291 euros was obtained, concerning 64 patients. CONCLUSION: Bacteremia surveillance is a transversal task based on quality of care, which may have a positive financial impact. This study may be helpful for clinicians with transversal activities, for whom financial valorization is difficult to implement in the CDSS, particularly without hospitalization beds. The lack of complete notification in the CDSS may cause a substantial financial loss.

[Outbreak of vancomycin-resistant Enterococcus faecium (Van B) at the Bethune Hospital (France). Two point-prevalence surveys: May 2008 and January 2009]. / Epidémie à Enterococcus faecium résistant à la vancomycine de type Van B au centre hospitalier de Béthune (Pas-de-Calais). Réalisation de deux enquêtes de prévalence en mai 2008 et en janvier 2009.

OBJECTIVE: An outbreak of vancomycin-resistant Enterococcus faecium (E. faecium) occurred in the Bethune Hospital since March 2008 (two consecutive waves). To control this outbreak, two-point prevalence surveys were conducted in May 2008 and January 2009 in inpatients hospitalised more than 24 hours on previously non-affected wards. METHODS: In each ward, information was given to inpatients, administrative and medical data were collected, rectal swabs or stool samples were performed and cultured on chromogenic media. Data were anonymised, and Epidata software was used for the analysis. RESULTS: In May 2008, nine patients were found to be colonized with vancomycin-resistant E. faecium among the 239 patients evaluated (prevalence : 3.76%), and three new wards were affected: neurology ward, general surgical ward, and emergency department observation unit. In January 2009, only one patient, hospitalised in cardiac intensive care unit, was colonised among the 157 patients evaluated (prevalence 0.63%). CONCLUSIONS: These two-point prevalence surveys identified the reservoir of vancomycin-resistant E. faecium carriage, and were thus helpful to contain the two epidemic waves at the Bethune Hospital. A cohorting of the colonised inpatients was performed. Five secondary colonisation cases were detected among the 181 contact patients in May 2008, and no secondary case among 32 contact patients in January 2009.

[Obstetric analgesia: peridural analgesia versus combined spinal and peridural analgesia]. / Analgésie obstétricale: analgésie péridurale versus analgésie rachidienne et péridurale combinée.

OBJECTIVE: To compare the analgesic efficiency, side effects and obstetrical repercussions of epidural analgesia (EP) and combined spinal-epidural analgesia (CSE). STUDY DESIGN: Prospective, randomized, double or single-blind studies as required, approved by the ethical committee of the institution. PATIENTS: The study included 80 parturients, in active labour with a singleton in vertex presentation and a cervical dilatation of 3 cm or less, randomly allocated to receive either EP (n = 40) or CSE (n = 40). METHOD: In the EP group, sufentanil (20 micrograms) and 0.25% bupivacaine (6-8 mL) were injected into the epidural space. In those of the CSE group, sufentanil (10 micrograms) was first injected into the subarachnoid space, followed by an epidural injection of the same agents at the same quantities as for the EP group. Additional analgesia was obtained in both groups by top-ups of 6-8 mL of 0.25% bupivacaine at the request of the patients. Analgesia, course of labour, obstetrical outcome, and neonatal status were assessed. Statistical analysis was performed using Anova, chi 2 analysis, Yates' correction or Fisher's exact test, with a P < 0.05 considered as significant. RESULTS: Both groups had similar demographic and obstetric data. The onset of analgesia was more rapid in CSE group (8 +/- 11 min vs. 12 +/- 7 min, P < 0.05), however the duration was similar. Technical incidents were more frequent in the CSE group (30% vs. 7%, P < 0.05). The technique of analgesia did not influence the bupivacaine amounts required for its maintenance. The incidence of adverse effects were comparable with the exception of vertigo, which was more frequent in the EP group (57% vs. 28%, P < 0.05). The first stage of labour was increased by 30% in the CSE group (281 +/- 130 min vs. 216 +/- 97 min, P < 0.05), without significant prolongation of labour length. Durations of second stage and expulsion were similar in both groups, despite the administration of a lower dose of bupivacaine in the CSE group (33 +/- 17 mg vs. 46 +/- 12 mg, P < 0.05). The rates of instrumental deliveries and Caesarien sections were comparable. The Apgar scores were satisfactory at 5 min. CONCLUSION: In the early phase of labour, the CSE technique using intrathecal sufentanil has no significant benefit when compared to the EP technique using bupivacaine and sufentanil. In the CSE group, technical incidents were more frequent and the length of the first stage of labour was increased.

[Errors in the measurement and interpretation of pulmonary artery pressure values evaluated by the Swan-Ganz method]. / Erreurs de mesure et d'interprétation des valeurs des pressions artérielles pulmonaires évaluées selon la méthode de Swan-Ganz.

The data collected by way of the catheter has for goal to give a better therapeutic treatment and is therefore directly related to the quality of the analysis of the signal. The fidelity of the measurements depend on the performance of the material used and also to other distortions linked to their utilization. In intensive care and in perioperative resuscitation, the interpretation must also take into account the possible interference from physiopathologic mechanisms which are sometimes very complex and can modify results in a number of situations both clinical and therapeutic and in particular when they are accompanied by vascular and respiratory perturbations.

[The detection of thromboembolism in orthopedic traumatology: the value and limitations of D-dimer determination by the latex method]. / Détection thromboembolique en orthopédie traumatologie: intérêt et limite du dosage du D-dimère par la méthode au latex.

We studied the usefulness of plasma D-dimer determination by a latex agglutination test used as a deep venous thrombosis (DVT) detection method in patients undergoing recent orthopaedic or traumatologic surgery. Asymptomatic patients with a level of D-dimer up to 1.5 micrograms/ml suffered phlebographic venous thrombosis in 49.3% of the cases. Because a predictive value of negative test of 0.77 the latex assay cannot be recommended for screening in symptomatic DVT. However, post operative measurement of cross linked fibrin derivatives in plasma may play a role in the selection of asymptomatic patients for venography.

[Transcutaneous electric stimulation of the brain: a comparative study of the effects of its combination with peridural anesthesia using bupivacaine-fentanyl during obstetrical analgesia]. / Electrostimulation cérébrale transcutanée: étude comparative des effets de son association à l'anesthésie péridurale par bupivacaïne-fentanyl au cours de l'analgésie obstétricale.

In order to test the effectiveness of Anesthelec (transcutaneous cranial electrical stimulation with Limoge currents) during labour and delivery, a randomized study was carried out in 120 primiparous women with extradural anaesthesia during active labor. Combination of transcutaneous cranial electrical stimulation with epidural bupivacaine administration has been showed to provide a 20% pain relief prolongation of the first bupivacaine injection. Statistical studies of drug requirement during labor, of cervical dilatation duration, of mode and duration of delivery and of analgesia quality showed no beneficial additive effect of electrical stimulation for obstetrical analgesia when extradural anaesthesia is performed.

[An open study on the efficacy and tolerance of a low molecular weight heparin (CY 216) in the therapeutic treatment of deep venous thrombi in orthopedics]. / Etude ouverte de l'efficacité et de la tolérance d'une héparine de bas poids moléculaire (CY 216) dans le traitement curatif des thromboses veineuses profondes en orthopédie.

A prospective clinical trial was performed to evaluate the efficacy and safety of a low molecular weight heparin (nadroparine, CY 216) in the treatment of patients with deep venous thrombosis following recent orthopaedic surgery or trauma. Forty-three patients received nadroparine subcutaneously, 100 IU AXa.kg-1 every 12 hours for a period of 10 days. A quantitative assessment of deep vein thrombosis was made according Marder's scoring after 10 days of treatment. A substantial lysis was observed in 73 per cent and a revascularisation in 52 per cent of the patients. These results are statistically significant, although not correlated with the clinical symptoms and the size of the thrombi. Tolerance was assessed on the rate of bleeding events: a minor bleeding occurred in 6 per cent of the patients. Laboratory adjustment was performed in 8 per cent of the cases. The results of this study suggest that nadroparine administered subcutaneously at a fixed daily dose of 200 IU AXa.kg-1 is as efficient and safe as unfractionated heparin in the treatment of early venous thrombosis following orthopaedic surgery or trauma.