[Benefits of a healthcare network in the management of cardiovascular disease: HTA Vasc, an innovation in the Nord Pas de Calais region]. / Apport d'un réseau de santé dans la prise en charge des maladies cardiovasculaires: HTA Vasc, une innovation dans la région Nord-Pas-de-Calais.

Created in 2004, the HTA vasc healthcare network intensified detection, multi-disciplinary management and follow up of atheromatous cardiovascular disease and complicated hypertension in the Nord Pas de Calais region. The participating doctors gave their patients a Patient Dossier, as a function of predefined inclusion criteria (patients at elevated cardiovascular risk, as defined by the Haute Autorité de Santé (Higher Authority of Health) stratification. The dossier was presented in the form of a file containing all the information needed to optimise multi-disciplinary management, while at the same time reinforcing therapeutic compliance by patients. Therapeutic education workshops were organised, in order to complement the existing service. In parallel, HTA vasc set up a pilot medical education programme for vascular rehabilitation in six hospitals in the region. HTA vasc also established partnerships with other healthcare networks in the region. A patients' association 'Notre Coeur, Nos Artères', (Our Hearts, Our Arteries) was created in September 2006. About 250 healthcare professionals had joined the network by the end of January 2006, an increase of almost 40% over the year. More than two thirds were independent doctors, and they included cardiologists, neurologists, nephrologists, diabetologists, general practitioners, radiologists, cardiovascular surgeons, rehabilitation doctors, paramedics and pharmacists. More than 260 patients received a follow up dossier. The results of a survey carried out in May 2006 showed a high level of satisfaction: 82% of patients considered the Patient Dossier to be useful and appropriate; 78% of the healthcare professionals stated that the network was of help in the management of patients. HTA vasc received the scientific support of the Sociétés Françaises de Médecine Vasculaire, d' Hypertension Artérielle (French Societies of Vascular Medicine and Hypertension), and the Vascular Group of the Société Française de Cardiologie, with an external audit of the tools and activities undertaken in the region.

[Outcome predictive factors at six months for patients over 75 years admitted for emergency care]. / Facteurs prédictifs du devenir à 6 mois des personnes de plus de 75 ans admises en urgence à l'hôpital.

A sample of 199 elderly patients (over 75) admitted to emergency care sections of the Marne's (French department) public hospitals were monitored over six months. The purpose of this study was to assess the factors predicting death or institutionization of elderly patients, in order to improve patient care. Surveys were carried out to collect information on health, standards of living, family surrounding and background, social support and level of dependence. After 6 months, 63 (32%) have died and 19 (12.5%) have been directed to institutions. Risk of death factors are primarily connected with the environment. The risk was multiplied by three for patients placed in institutions and absence of children's visit increased the risk by seven. Dependence was also a risk factor. On the other hand, age and clinical diagnosis had little effect. Risk factors for institutionalization were: admission over the week end (OR = 29), non-accompanied (OR = 31), altered mental abilities (OR = 14), absence of children's visit (OR = 22). These predictors will render possible the rapid identification of high risk patients in every day practice. The improvement of gerontological competences in emergency care sections should enable quicker, more inclusive and adapted care. Measures to stimule or substitute for the failing natural relational network of elderly patients are also needed.

[The epidemiological surveillance network for nosocomial invasive aspergillosis of the Assistance Publique-Hôpitaux de Paris]. / Le réseau de surveillance épidémiologique de l'aspergillose invasive nosocomiale de l'Assistance Publique-Hôpitaux de Paris.

Since January 1990, a epidemiology surveillance network has been set up by the Paris hospitals for nosocomial invasive aspergillosis. The network includes 39 high risk clinics (haematology, bone marrow graft, organ transplantation) in 19 hospitals. Over the first 3 years of surveillance (1990-1992), 132 cases of aspergillosis have been registered as probably invasive and nosocomial. The incidence of nosocomial invasive aspergillosis invasive aspergillosis has been estimated at 1.16 per 1,000 patient-days in haematology wards, at 4.56% in bone marrow graft and at 1.57 in liver transplantation. Mortality was 57% for all cases registered and 75% for bone marrow transplant patients; 97% of these patients were immunodepressed. Room air filtration with an absolute filter system had been installed for only 32% of the patients at diagnosis of invasive nosocomial aspergillosis. Work areas were in the environment of 68% of the cases reported. Surveillance led to the establishment of incidence and mortality data and emphasized the importance of the problem in terms of public health. In addition, three main elements were recognized concerning the disease: the number of immunodepressed patients in increasing in the hospitals, room air filtration equipment is inadequate, unavoidable work areas in hospitals have a significant effect. A practical guide for the prevention of invasive nosocomial aspergillosis in case of work areas in the hospital was published in 1993. Nevertheless, the proposed measures must be integrated into a global prevention strategy to eliminate sources of contamination and improve food facilities, architecture, air conditioning, internal organization and personnel training in high risk clinics.

[Integrated struggle against aspergillosis at the level of a single hospital or a hospital cluster]. / Lutte intégrée contre l'aspergillose au niveau d'un hôpital ou d'un groupement hospitalier.

Invasive nosocomial aspergillosis (INA) has become an increasing public health problem in hospitals whose inpatients are severely immunocompromised, i.e. in case of aplasia, bone marrow or organ transplants. The hospital's responsibility is engaged, all the more so since numerous INA cases have been reported during hospital construction work. Prevention measures must be implemented at the time of high risk activities (bone marrow graft, transplantation) or as soon as predisposed patients (aplastic) are admitted in hospitals. In case of hospital construction work, those measures must be adapted to the type of work and to the localization of the exposed patients. The first step of an integrated control strategy is to identify the aspergillus risk units in the hospital according to the immunocompromised state of their patients. The second step consists in the implementation, for those units, of effective protection measures concerning the control of hospital contamination sources, the patient's food, the architecture, the air treatment facilities, the staff organization and training. The third step is to apply a triple surveillance: epidemiological for the disease, technical for the air treatment facilities, mycological for the patients environment. In case of construction work, in or near the hospital, an evaluation of the Aspergillus risk level according to the construction work plan must be undertaken for each high risk unit. This risk level conditions the specific measures which have to be implemented. In the network of epidemiological INA surveillance of the Assistance Publique hospitals in Paris, those measures have been published as a recommendation guide.

[Validity of death certificates in the study of ischemic heart diseases]. / Validité des certificats de décès pour l'étude des cardiopathies ischémiques.

Mortality rates for ischaemic heart disease, as estimated from death certificates, show highly significant differences between countries. In order to study the validity of mortality rates for ischaemic heart disease, the authors, involved in the MONICA project, have compared the results obtained from the conventional death certificate code with the data collected in a complementary enquiry conducted for all deaths possibly due to ischaemic heart disease. Three hundred and thirty patients, aged from 25 to 64 years, belonging to the urban community of Lille, and who died between October 1 and December 31, 1984, were included in this study. The sensitivity of the death certificate for the diagnosis of ischaemic heart disease was 77.9 percent and its specificity was 95.9 percent. The concordance rate between death certificate and complementary enquiry was not modified by age, sex, socio-professional category, family situation, place of death and doctor who signed the certificate. The complementary study proved impossible in 31.8 percent of the cases, usually because the doctor who signed the death certificate was not fully conversant with the patient's condition. Our results therefore confirm that death certificates are valid to study mortality from ischaemic heart disease.