[Medical emergency care units in France]. / Les maisons médicales de garde en France.

UNLABELLED: The objective of this article is to take inventory of the different medical emergency care units in France as of June 30, 2003, and to describe their main characteristics. METHODOLOGY: A telephone survey was conducted which posed questions based on a standard questionnaire to the Regional Unions of Liberal Doctors, the County Advisory Boards of the Medical Orders, and the directors and managers of the existing emergency care units. RESULTS: 97 medical safe houses were inventoried, 46 of which were operational and 51 which were in development. The Ile-de-France region is the region with the highest concentration of these units either operating or under construction. A large majority of the emergency care units were created since the year 2000, and half of them are located within health care centres and the other half into separate cells either close or distant from existing health care centres. More than half of them have no other staff aside from doctors, whilst the others comprise a spectrum of personnel including secretaries, nurses, and social assistants amongst others. More than half of the doctors are paid at the cost of each consultation and per treatment and do not have a technical platform at their disposal. Usually, these emergency care units are open all night during the week and on the weekends. One-third of them collaborate with the emergency centre and ambulance service (those who respond to calls to 15) and three-quarters of them are funded by the city's Assistance Fund for the Quality of Care. CONCLUSION: It would seem advantageous that a Charter for operation and management of these establishments be drafted and implemented in order standardise these types of structures and that their supervisors implement a national and regional follow-up mechanism for the establishments in order to better evaluate the evolution in terms of health care organisation, in particular with respect to raising the level and capacity of response.

[Attitude and behavior of health services users in the face of real or perceived emergencies]. / Attitudes et comportement des usagers face à une urgence réelle ou ressentie.

OBJECTIVES: To perform an opinion poll of users of normal health care, excluding emergency care, and also to identify populations which have required emergency care and to clarify the parameters which influence user decisions. METHODS: A transversal descriptive survey of users of Primary Medical Assurance Centres (Caisse Primaire d'Assurance Maladie) in the catchment area of the Hôpital Nord in Marseilles, France, on a given day (7 days in total). Data were gathered using a standardised questionnaire based on the following topics: socio-demographic profile of interviewed participants, patient attitude toward general practitioners' care, the reaction to a situation felt to be urgent and for which they resorted to emergency services. RESULTS: Interpretation of the results from 253 completed questionnaires demonstrated that users are mainly young, underprivileged, females, but who are not excluded from the health care system (good social security cover and marked presence of a family doctor). User behaviour differs according to the moment at which the problem arises (working hours, outside working hours) and depending on the degree of urgency perceived. ARISE OF DEMAND: In the most of cases, the patient consults emergency services for himself/herself. He/She takes the decision without prior consultation with a physician, within one hour of the problem arising, whether the problem is perceived as urgent or life-threatening, and arrived there under his/her own means. The main reason given is the access to emergency services without appointment and the principal medical reasons were for injuries and pain. CONCLUSION: This study demonstrates that users have a coherent approach depending on physician's consulting hours and according to user's perception of the emergency. On the other hand it is clear that users lack information concerning available after-hours care and the physicians night-duty organisation.

Focal ultrasound lesions in liver cirrhosis diagnosed as regenerating nodules by fine-needle biopsy. Follow-up of 12 cases.

In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.

Clinical suspicion of pancreatic neoplasm: does echo-guided fine-needle biopsy modify patient management?

The following parameters were retrospectively evaluated in 64 patients with suspected pancreatic neoplasm: (1) time required to obtain cytohistologic diagnosis, (2) days in hospital, (3) number and type of surgical operations, and (4) total hospital costs. Echo-guided fine needle biopsy (FNB) was performed on 34 patients (FNB group) and in a further 30 patients diagnostic workup did not include percutaneous biopsy (laparotomy group). Both diagnostic and hospital stay were shorter (8 and 7 days, respectively) in the FNB group than in the laparotomy group. In the FNB group, surgery was avoided in 18 patients, while in the laparotomy group 18 explorations proved diagnostic alone. Finally, FNB was shown to reduce hospital costs by 23%.

Real-time ultrasound guided renal biopsy in diffuse renal disease: 114 consecutive cases.

The usefulness of real-time ultrasonography as a guidance method in performing percutaneous renal biopsy is evaluated on the basis of a series of 114 patients with diffuse nephropathies. Sufficient renal tissue for light microscopy was obtained in 102 patients (89.5%) and enough for electron microscopy in 93 patients (81.6%) and for fluorescence microscopy in 91 patients (79.8%). A final histological diagnosis was possible in 106 patients (93%). The high diagnostic rate, the reduction in the contraindications to the procedure, the lack of major postbiopsy complications, and the cost effectiveness probably make realtime ultrasound scanning the method of choice when performing renal biopsy in patients with diffuse nephropathies.