[Hospitalisations Related To Burns In France. Analyses Of 2019's National Data Base]. / Hospitalisations Pour Brûlure En France. Données 2019 Extraites De La Base PMSI Nationale.

Thanks to the Medical Information Service of our institution, we obtained the data on burns during 2019, saved in the national database. We found 10,913 reports, among them 10,347 metropolitan and 566 overseas. When compared to the French population on January 1st 2020, the incidences were 16 (global population); 15.7 (metropolitan) and 27.1 (overseas)/100,000 inhabitants respectively. The majority (62.95%) of the patients were taken care of in Burn Centres (BCs). However, 4,043 patients were never seen by a burn specialist. Nevertheless 88.54% of skin grafts were performed in BCs and 71.86% of the burns with high seriousness (levels 3 and 4) were in BCs. One hundred and seventy-nine patients (1.64%) died. For the first time, we obtained the intensive care activity, through the scoring actions. Intensive care was held for 958 patients (8.96%), 90.81% of them in a BC. Only 28.57% were associated with major (>30% BSA) burns, but these major burns accounted for 63.78% of the organ failure treatments.

Economic challenges of using innovative medical devices in major public health pathologies: Example of acute ischemic stroke management by mechanical thrombectomy.

BACKGROUND: Activity-based Funding can induce financial imbalances for health institutions if innovative medical devices (MD) used to perform acts are included in Diagnosis Related Groups (DRG) tariff. To be reimbursed in addition to the DRG tariff, innovative MD must have received a favorable evaluation by the French National Authority for Health (Haute Autorité de Santé) and be registered on the positive list. The aim of this study was to evaluate the expenses and incomes generated by each scenario (before and after the reimbursement of MD), and the financial reports. This study concerned the management of ischemic stroke by mechanical thrombectomy devices, in high-volume French hospital. METHODS: All patients who have had an acute ischemic stroke and admitted to the interventional neuroradiology unit between January 2016 and December 2017 were included retrospectively in this monocentric study. They were divided into four subgroups based on the severity of the DRG. The cost study was carried out using the French National Cost Study Methodology adjusted for the duration of the stays and by micro-costing on MD. RESULTS: A total of 267 patients were included. Over the study period, the average cost of the hospital stay was €10,492±6364 for a refund of €9838±6749 per patient. The acts performed became profitable once the MD were registered on the positive list (€-1017±3551 vs. €560±2671; P<0.05). Despite this reimbursement, this activity remained in deficit for DRG lowest severity (level 1) patients (€-492±1244). Specific MD used for mechanical thrombectomy represented 37% of the total cost of stay. CONCLUSION: The time required to evaluate MD reimbursement files is too long compared to their development. As a result, practitioners are in difficulty to be able to carry out acts according to the consensual practices of their learned societies, without causing any financial deficit of their institutions.

[Hospital production cost of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression]. / Coût de production hospitalier de la stimulation magnétique transcrânienne répétée (rTMS) dans le traitement de la dépression.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is an effective and well-tolerated treatment in resistant depression with mild to moderate intensity. This indication has not yet been approved in France. The cost and medico-economic value of rTMS in psychiatry remains unknown. The aim of this preliminary study was to assess rTMS cost production analysis as an in-hospital treatment for depression. METHODS: The methodology, derived from analytical accounts, was validated by a multidisciplinary task force (clinicians, public health doctors, pharmacists, administrative officials and health economist). It was pragmatic, based on official and institutional documentary sources and from field practice. It included equipment, staff, and structure costs, to get an estimate as close to reality as possible. First, we estimated the production cost of rTMS session, based on our annual activity. We then estimated the cost of a cure, which includes 15 sessions. A sensitivity analysis was also performed. RESULTS: The hospital production cost of a cure for treating depression was estimated at € 1932.94 (€ 503.55 for equipment, € 1082.75 for the staff, and € 346.65 for structural expenses). CONCLUSION: This cost-estimate has resulted from an innovative, pragmatic, and cooperative approach. It is slightly higher but more comprehensive than the costs estimated by the few international studies. However, it is limited due to structure-specific problems and activity. This work could be repeated in other circumstances in order to obtain a more general estimate, potentially helpful for determining an official price for the French health care system. Moreover, budgetary constraints and public health choices should be taken into consideration.

[Epidemiologic description of amyloidosis diagnosed at the University Hospital of Rennes from 1995 to 1999]. / Epidémiologie descriptive des amyloses diagnostiquées au CHU de Rennes de 1995 à 1999.

INTRODUCTION: The frequency of amyloidosis is not well known in France. We compiled a register of amyloidosis diagnosed from 1995 to 1999 in the University Hospital of Rennes. PATIENTS AND METHODS: This retrospective study was performed between 01 January 1995 and 31 december 1999. Diagnosis was assessed on positivity of red Congo by anatomopathology. Immunohistochemistry allowed the definition the type of amyloidosis. Clinical data, staging and outcome of patients were analysed. RESULTS: Forty-three amyloidosis were diagnosed (27 women, 16 men) with an incidence of 8,6 new cases per year. Mean age was 63.7 years. Five diagnosis were realised in 1995, six in 1996, six in 1997, 12 in 1998, 14 in 1999. Twenty amyloidosis were AL type (46.5%), seven AA (16.3%), 1 beta2 microglobulin type, 15 (35%) remained of undetermined type. Thirty-three amyloidosis (77%) were systemic, 10 were localized to one organ (23%). When diagnosis was made, biopsies concerned affected organs in 86% of the cases, accessory sites (labial salivary glands, bone marrow) in only 14% of the cases. Twenty-five patients died (58%). Two deaths were treatment-related, 16 to amyloidois, seven patients died of another complaint. CONCLUSION: Increased incidence of amyloidosis needs to be confirmed. We emphasize the importance of immunohistochemical typing on frozen samples, the value of accessory biopsies and the need for complete extension staging.

[Acting out and psychoactive substances: alcohol, drugs, illicit substances]. / Passage à l'acte et substances psychoactives: alcool, médicaments, drogues.

In humans, some psychotropic agents (alcohol, drugs, illicit substances) have been suggested to play a role in the occurrence of major behavioural disorders, mainly due to the suppression of psychomotor inhibition. Behavioural disinhibition is a physiological mechanism which allows humans to behave appropriately according to a given environmental situation. The behavioural disinhibition induced by either therapeutic dosage or misuse involves the loss of restraint over certain types of social behaviour and may increase the risk of auto or hetero-aggression and acting out. The increased use of psychotropic agents in recent years and the occurrence of unwanted effects are worrying and must be detected and evaluated. The objective of the present study was to establish a causal relationship between psychoactive substance use and occurrence of major behavioural disorders, such as paradoxical rage reactions and suicidal behaviour, based on a literature analysis. It consisted of reviewing reports of drug-induced violent reactions in healthy volunteers and demonstrating, where possible, a cause-effect relationship. Patients with schizophrenia and psychopathic personalities were not included in our study since psychiatric comorbidity could influence behavioural responses. Psychotropic agents included drugs, licit and illicit substances already associated with violence in the past. Many reports used the "Go/No Go test" to evaluate the disinhibiting effect of psychotropic substances; this allows the "cognitive mapping" of drugs. The results suggest that only alcohol, antidepressants, benzodiazepines and cocaïne are related to aggressive behaviour. The best known precipitant of behavioural disinhibition is alcohol, which induces aggressive behaviour. However, there are large differences between individuals, and attentional mechanisms are now recognised as being important in mediating the effects of alcohol. Suicidal tendency as an adverse antidepressant reaction is rare, especially with atypical antidepressants. However, the risk of acting out exists and the responsibility of antidepressant agents in the genesis of suicidal tendencies is now established. The disinhibiting effects of benzodiazepines are well-known and proven by clinical trials. It's a "model" of acting out, and the causal relationship is undeniable. That cocaïne is related to violent behaviour is demonstrated by its pharmacological actions on CNS. The chronic use of cocaïne induces "a limbic dyscontrol syndrome" based on the altered activity of limbic structures. On the contrary, we could not demonstrate a causal relationship between aggression and either cannabis, ecstasy or phencyclidine. Cannabis abusers look particularly for euphoria and relaxing effects. Aggression as an adverse cannabis reaction is very rare and occurs in most cases in association with other drugs and in predisposed individuals. Ecstasy use may lead to long-term alterations of neuronal function in the human CNS and cause psychiatric disorders. However, there is insufficient information about long-term use of ecstasy to estimate its role in the occurrence of behavioural disorders. Clinical and forensic assumptions about phencyclidine and violence were not warranted. However, the substance-effect relationships can be criticized in the case of alcohol, antidepressants, benzodiazepines and cocaïne. In fact, individual, social and psychiatric factors exert an influence on behaviour that is superior to the pharmacological effect of psychotropic agents. The most important parameter in drug-induced behavioural disinhibition is dosage, but mode of administration is also important. In addition, polysubstance abuse is very common. Substances may be taken simultaneously and alcohol is frequently combined with drugs. The combinations of substances result in multiple interactions, and very little is known about the effects of these interactions on violence in humans. Co-occurrence of substance abuse and other mental disorders is also very frequent. Multiple substance abuse should be avoided, because potential interactions between two or more drugs are more likely to cause violent behaviour. In the future, a specific treatment of these deleterious phenomena will have to be considered in order to reduce drug-induced iatrogenic behavioural disorders.

Comparative effects of pharmacotherapy on the maintenance of cognitive function.

The quality of human cognitive performance appears today as one of the main components of quality of life, whatever the age. Ageing by itself and most of the diseases affecting the central nervous system alter higher brain functions such as memory, vigilance and attention. Dementia is the most acute example, with a cascade of behavioral and psychological consequences (BPSD), which are the main cause of the caregiver's burden and need specific pharmacotherapy. In this respect, the problem will be the choice of the best drug in situations such as wandering, agitation, violence, and screaming. The psychotropics, however, should not deteriorate the already disturbed cognition of the patients. This is the reason why we propose to establish for each drug, and notably for the antipsychotics, a precise and exact "cognitive mapping"; in other words, to measure the effects of drugs on the different components of cognition. The results of such studies will be predictive of the future phase III clinical trials and therapeutic responses. As an illustration of this approach we shall relate two studies, TIATEM (phase I) and TIAGE (phase III/IV), leading to the determination of a good cognitive safety profile of an atypical neuroleptic drug, tiapride.

[An experience in teaching pharmacology on the internet]. / Une expérience d'enseignement de la pharmacologie par Internet.

Internet and Intranet are omnipresent in the University world. We developed an easy-access website (www.med.univ-rennes1.fr/etud/pharmaco) devoted to teaching pharmacology and report here our experience after 4 years of use. Our objective was to determine the value of this new teaching tool in the medical coursus. The site is entirely free and presents approximately 50 topics and diaporamas discussing various themes: the cell, the receptor, general pharmacology, clinical research, population research, drug classes, etc. Harbored by the Medical Informatics Laboratory of the University of Rennes Medical School, this site serves as a reference for medical students and others. More than 100 visits are recorded daily, approximately half from visitors outside France. The advantages of this new teaching tool, which operates within the framework of a Virtual Medical University project, are evident for students and professors alike. Its impact on the quality of drug therapy by future doctors remains to be determined.

[Psychiatry and clinical research. A dialogue with hospital directors]. / Psychiatrie et recherche clinique. Dialogue avec les directeurs d'hôpitaux.

Clinical research must be considered as a main and compulsory medical activity which has to be promoted on a European level. Some difficulties appear to be specific to mental diseases and may represent obstacles or a reason not to participate in clinical research. In fact, financing, grants, organizations and research centers do exist and should push forward clinical research in psychiatry. Human and cultural factors may explain why so few breakthroughs have occurred in France in the considered field. Incentive politics as well as avoidance of technical and frequently definitive errors must be proned and issue from a deep analysis of how leading teams are organized and operate.

[The physiopathology of migraine]. / Physiopathologie de la migraine.

Although the neurobiological causative factors are now beginning to be understood, to a large extent the complex mechanisms involved in migraine remain an enigma, with the appearance of a transient unilateral cephalic pain, possibly preceded by a protean aura and associated with several other symptoms. The factors involved include three clinical signs or symptoms, i.e., pain, the aura (focalized neurological and neurosensory signs), and accompanying symptoms (e.g., sensory, psychological, or digestive); and three anatomical sites, i.e., the brain, the meningeal or intracranial vessel and a peripheral cranial nerve, the trigeminus (V). Familial hemiplegic migraine (FHM) has led to a consideration of the genetic origin of ionic channel-dependent pathologies (channelopathies), while certain other arguments which are for the most part indirect favor the hypothesis of abnormalities, again possibly of genetic origin, in the central neurotransmitters (including serotonin), which are involved in the transmission of pain messages and in vasomotor control. However, the main point is that each of the sites involved has its specific pharmacopoeia, which can contribute towards the treatment of migraine.

[Rating scales and questionnaires in Parkinson's disease]. / Echelles et questionnaires dans la maladie de Parkinson.

Rating scales and questionnaires used as measurement tools in Parkinson's disease are carefully constructed with well-defined items. The validity of a scale is its capacity to provide the intended measurement. One can distinguish perceived, content, and criteria-based validity as well as construction and sensitivity to change validity. The reliability of a scale is the capacity of a scale to produce statistically equivalent data in comparable situations. Reliability is composed of the following qualities: interobserver reliability, test-retest reliability, and internal coherence. UPDRES, mood scales (Hamilton, MADRS, CES-D, BDI), scales assessing cognitive disorders (MATTIS, MMSE), and quality of life questionnaires designed specifically for Parkinson's disease (PDQL, PDA-39, PDq-8) or for the general population (SF-36, SIP, NHP) are used in routine practice, and are particularly useful for clinical research. The metrological properties of these scales are analyzed here.

Dynamic digital photorefractive memory for optoelectronic neural network learning modules.

Neural network modules based on page-oriented dynamic digital photorefractive memory are described. The modules can implement two different interconnection organizations, fan-out and fan-in, depending on their target network applications. Neural network learning is realized by the real-time memory update of dynamic digital photorefractive memory. Physical separation of subvolumes in the page-oriented photorefractive memory architecture contributes to the low cross talk and high diffraction efficiency of the stored interconnection weights. Digitally encoded interconnection weights ensure high accuracy, providing superior neural network system scalability. Module scalability and feedforward throughput have been investigated based on photorefractive memory geometry and the photodetector power requirements. The following four approaches to extend module scalability are discussed: partial optical summation, semiparallel feedforward operation, time partitioning, and interconnection matrix partitioning. Learning capabilities of the system are investigated in terms of required interconnection primitives for implementing learning processes and three memory-update schemes. The experimental results of Perceptron learning network implementation with 900 input neurons with digital 6-bit accuracy are reported.

Lneuro 1.0: a piece of hardware LEGO for building neural network systems.

Neural network simulations on a parallel architecture are reported. The architecture is scalable and flexible enough to be useful for simulating various kinds of networks and paradigms. The computing device is based on an existing coarse-grain parallel framework (INMOS transputers), improved with finer-grain parallel abilities through VLSI chips, and is called the Lneuro 1.0 (for LEP neuromimetic) circuit. The modular architecture of the circuit makes it possible to build various kinds of boards to match the expected range of applications or to increase the power of the system by adding more hardware. The resulting machine remains reconfigurable to accommodate a specific problem to some extent. A small-scale machine has been realized using 16 Lneuros, to experimentally test the behavior of this architecture. Results are presented on an integer version of Kohonen feature maps. The speedup factor increases regularly with the number of clusters involved (to a factor of 80). Some ways to improve this family of neural network simulation machines are also investigated.