[New method to regulate unscheduled urgent care : the ODISSEE interactive self-triage platform]. / Nouvelle approche de régulation de la demande de soins non planifiés : l'application interactive d'auto-triage ODISSEE.

The regulation of the unscheduled care takes part of the different methods engaged to better organize the global demand for unscheduled urgent care among the different levels of care. Indeed, the first level of care equally with the emergency departments are facing major patient inflows often exceeding their available resources. Technological advances in healthcare and spreading of medical information reveal themselves as precursors of new adaptive strategies and daily challenges. The creation of an interactive app for patients self-triage through the different levels of care involves those different concepts. We created a new interactive platform, the ODISSEE mobile application (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), to allow patient's self-triage to the best level of care. The protocols used were directly based on a previously validated tool with a 5-year experience in our institution, the SALOMON algorithm (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne). Establishment of interactive self-triage platform to guide patients to the best level of care could potentially be a promising tool to improve the regulation of unscheduled urgent care.

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En effet, tant la première ligne de soins que les services d'urgence font face à des flux de patients conséquents, saturant fréquemment les ressources qu'ils possèdent pour y répondre. L'apparition de nouvelles technologies et l'entrée dans la pratique courante de la diffusion de l'information médicale se sont révélées être des précurseurs de nouvelles stratégies adaptatives, mais également de nouveaux défis quotidiens. La création d'une application interactive permettant l'auto-triage du patient vers la ligne de soins la plus appropriée fait intervenir ces différents concepts. Nous avons donc développé une plateforme interactive, l'application ODISSEE (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), permettant au patient d'autoévaluer la gravité de son problème et de bénéficier d'un conseil avisé sur le niveau de soins à envisager. Les protocoles utilisés sont directement issus d'un outil créé précédemment dans notre institution et ayant fait ses preuves durant 5 années d'utilisation, l'outil SALOMON (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne). La création d'un système interactif d'auto-triage du patient le guidant vers le niveau de soins le plus approprié pourrait être une méthode prometteuse pour la régulation de la demande de soins non planifiés.

[Hemorrhagic moyamoya disease]. / Le cas clinique du mois. Complication hémorragique d'une forme sévère de maladie de moyamoya.

Moyamoya disease is a rare cerebral vasculopathy. Disease onset is mainly sudden presenting as an ischemic stroke but also sometimes as a brain hemorraghe. Cerebral angiography is the gold standard to confirm the diagnosis. Different therapeutic approaches have been described such as conservative management or endoscopic and surgical approaches. We report the case of a young patient who was diagnosed with a brain hemorraghe following a sudden loss of consciousness.

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d'un accident vasculaire ischémique ou, dans certains cas, hémorragique. L'artériographie est l'examen de choix pour confirmer le diagnostic. Différentes approches thérapeutiques ont été proposées, qu'elles soient médicamenteuses, endoscopiques ou chirurgicales. Nous présentons le cas d'une jeune patiente chez qui un diagnostic de maladie de moyamoya a été posé dans le décours d'une hémorragie cérébrale avec altération rapide de l'état de conscience.

[SALOMON, a collaboration model between primary and secondary care for nocturnal emergency calls]. / SALOMON, un modèle coopératif entre la première et la seconde ligne de soins pour les appels d'urgence nocturnes.

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.

L'objectif de notre étude est d'apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous proposons, à cet effet, la mise en place d'une interface de régulation des appels en période critique (nuit profonde) au moyen d'un outil algorithmique original dénommé SALOMON («Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne¼). En fonction du degré de gravité supputé, la plateforme propose l'orientation optimale du patient parmi quatre options possibles : renvoi de la demande vers le centre d'appel unifié 112 et prise en charge par les moyens de l'Aide Médicale Urgente (AMU), orientation du malade vers un service d'urgence spécialisé (SUS) de son choix pour une Mise Au Point Hospitalière (MAPH), mise en Contact avec le Médecin Généraliste de garde (CMG) ou enfin prise en charge par une Visite Différée (VD) via le médecin de famille. Après une description de l'outil, nous présentons l'étude de faisabilité qui a porté sur une période de 12 mois. Cette étude préliminaire était destinée à vérifier la robustesse de SALOMON avant de prévoir, le cas échéant, sa diffusion au sein d'une zone plus vaste. Les résultats préliminaires suggèrent une grande fiabilité de SALOMON. Nous avons également observé que son utilisation était associée à un réel état de satisfaction de l'ensemble des acteurs impliqués, qu'ils aient été infirmiers dispatcheurs ou médecins généralistes. Sous réserve d'une étude à plus grande échelle, les bénéfices actuellement notés en matière d'épargne de ressources humaines durant la garde de première ligne ont rapidement entraîné la fusion de deux zones de garde.

[Diagnosis of cannabinoid hyperemesis : update on the cannabis-shower syndrome]. / Diagnostic de l'hyperémèse cannabinoïde : le point sur le syndrome "cannabis-douche".

Sometimes, the emergency department is confronted with cases of repetitive vomiting and abdominal pain without organic causes. These patients come back again and again for this problem. All diagnostic tests are systematically negative. A well conducted history taking reveals a chronic cannabis addiction and the disappearance of symptomatology by taking hot showers. This presentation is pathognomonic of the cannabinoid hyperemesis syndrome.

La pratique aux urgences nous confronte, de temps à autre, à des cas de vomissements incoercibles et de douleurs abdominales sans substrat organique retrouvé. Ces patients se présentent généralement de manière répétée pour ces symptômes. Les examens complémentaires réalisés aux urgences n'apportent classiquement aucune information. Une anamnèse quelque peu poussée met finalement en évidence une consommation chronique de cannabis et le soulagement de la symptomatologie par la prise de douches chaudes. Cette présentation est pathognomonique du syndrome d'hyperémèse cannabinoïde.

Impact of the contamination level and the background flora on the growth of Listeria monocytogenes in ready-to-eat diced poultry.

UNLABELLED: The food safety criteria that have been incorporated in European regulation (EC) No2073/2005 (Official Journal of the European Union L, 338, 2005, 1), for Listeria monocytogenes in ready-to eat (RTE) foods, specify a maximum allowable concentration of 100 CFU g(-1) or ml(-1) . Some factors such as pH, salt and modified atmosphere packaging (MAP) are used to prevent the growth of L. monocytogenes in order to comply with the limit. Interactions between background microflora (BM) and L. monocytogenes may limit the growth of L. monocytogenes. The aim of this study was to investigate the mechanisms behind the observed inhibition by natural BM of the growth of L. monocytogenes in ready-to-eat diced poultry meat whose pH and water activity were favourable to its growth. The dynamics of L. monocytogenes and natural BM were therefore monitored in mono-culture and co-culture experiments with various combinations of contamination levels. In the absence of BM, the growth potential of L. monocytogenes depended only on the initial inoculum. With both BM and L. monocytogenes, whatever the combination of concentrations studied, the growth potentials of L. monocytogenes were lower than in a mono-culture through a partial Jameson effect. Thus, the use-by date of this product can be optimized by using models that take into account interactions with BM. SIGNIFICANCE AND IMPACT OF THE STUDY: The study of the growth of Listeria monocytogenes in a diced poultry meat, a matrix whose pH and water activity characteristics are favourable to L. monocytogenes growth, showed that it was inhibited by natural background microflora. This highlights the importance of knowing the product's composition, and in particular the natural background microflora, which can impact the use-by date.

[A case of autoinjection of vaseline under penis skin]. / A propos d'un cas d'auto-injection pénienne de vaseline.

We report the case of a 24-year-old rumanian patient who came to the emergency department complaining of glans penis pain and tight phimosis; he claimed to have undergone an injection of vaseline under penis skin. We review the literature on various nonmedical practices of penile foreign body injection to enlarge and thicken the penis.

[Medical regulation and rescue chains; the issue of primary-secondary transfers. The Belgian model and its application in the province of Liege]. / La Régulation médicale et la chaîne de secours. La problèmatique des transferts primo-secondaires Le modèle Belge en général et son application en province de Liège en particulier.

Medical regulation represents an essential tool for emergency medical assistance. Even if it is essentially based on a 1964 law, our medical regulation is constantly evolving to meet the present needs and to follow the medical and technological advances. In this article, we shall outline its major components and evoke some long-awaited developments in the field of public health.

Intraoperative consultation in digestive surgery. A consecutive series of 800 frozen sections.

AIM: To assess indications and quality of frozen sections in digestive surgery. PATIENTS AND METHODS: All the frozen sections from the department of digestive surgery from Amiens hospital performed between 01/07/2006 and 01/07/2010 were assessed. Assessment of frozen section forms, reading of pathology reports, and reviewing of frozen section slides were performed. RESULTS: Eight hundred frozen sections were performed in 349 patients. From one to 14 surgical specimens were sent for frozen section (mean 2.3). Frozen sections were performed in 77% of the cases for cancer surgery (n=268), most of the time pancreatic surgery (28.4%) and liver surgery (24.6%). Frozen sections were performed in 69% of the cases for diagnosis, in 29% of the cases to assess surgical margins and in 2% of the cases to assess if tissue specimen was appropriate for pathological diagnosis. Frozen sections were sent all days of the week (except Saturday and Sunday), during all the year, between 8 H 30 and 17 H 15. Thirty-seven percent of the cases were sent between 12 H and 14 H. Response time was 15 minutes (3 to 57 minutes). Rate of differed diagnoses was 2%. Rate of discordant diagnoses was 3.4%. CONCLUSION: Frozen section is a rapid and accurate tool in digestive surgery. Local adjustment of the organization of the Pathology Department could enhance the rapidity and the quality of pathology diagnoses.

[Hemolytic uremic syndrome with an atypical presentation]. / Syndrome hémolytique et urémique: à propos d'une présentation atypique.

The hemolytic uremic syndrome (HUS) is rare and of guarded prognosis in adults. It expresses a renal thrombotic microangiopathy. We report the case of a young patient whose clinical presentation and exploration make a diagnosis of HUS likely. The atypical presentation provides an opportunity not only to discuss all diagnostic elements based on recent pathophysiological hypotheses, but also to highlight recommendations for the management of this severe disease.

[How I treat... paracetamol poisoning]. / Comment je traite... une intoxication au paracétamol.

Drug self-poisoning is a common cause of admission in ED. Among various incriminated substances, paracetamol is often implicated and presents a severe toxicity. We briefly describe the epidemiology and physiopathology of paracetamol self-poisoning. We then clarify the diagnostic elements, thresholds of toxicity, indications for treatment and different available therapeutic guidelines.

[The question of secondary medical transfer in Belgium: the experience conducted at the University Hospital Center of Liège]. / Problématique Liée aux transferts médicalisés secondaires en Belgique: l'expérience développée au CHU de Liège.

Evaluation of the aid of an emergency mobile unit to transfer monitorized patients to a University hospital, in the political context of regional care network offering highly qualified but restricted tertiary area centres, and an open prospective study conducted over the 5 first months in 2006. The call regulation was assessed by the emergency physician of the transfer team and all missions were concluded with an evaluating report. An amount of 197 requests were taken into account from which 80 % were addressed between 8 am and 8 pm. The mean average time interval for missions was 59 minutes (base to base) and the distance covered was 20.7 km as a mean. In essence, indications for medical secondary transfer regarded patients in need for acute coronary care (42.6%), specific intensive care (26.4%) and neurosurgical interventions (19.3%). We noted that endotracheal intubation occurred in only one case. Mortality during such a transfer activity was absent. Medical transfer unit allows the development of specific high qualified network resources owing to the secondary addressee of patients. However, the weak incidence of complication questions the practice of systematic medical accompanying during such transfers.

[Coronary dissection and non-penetrating chest trauma]. / Dissection coronaire et traumatisme thoracique fermé.

The occurrence of an acute myocardial infarction after non-penetrating chest trauma is an extremely rare complication. We report a case of dissection of the left anterior descending artery in a 43 year old man after being punched in the chest. Using data from a literature search relish revealed 76 cases; we review the characteristics of the pathology and its incidence. We also characterize its etiology, anatomy and path physiology. We then consider the diagnostic and therapeutic implications.

[Clinical case of the month. Acute methanol intoxication]. / Le cas clinique du mois. Intoxication aiguë au méthanol.

We report a fatal methanol intoxication and discuss its physiopathology, diagnosis and treatment.

[Diagnosis of primary hyperparathyroidism: role of scintigraphy]. / Mise au point d'une hyperparathyroïdie primitive: apport de la scintigraphie.

We report a case of hyperparathyroidism whose diagnosis was suspected by a clinical history and confirmed by routine laboratory tests. Scintigraphy has permitted to localize a focalized lesion corresponding to an adenoma endocrinopathy. The new developments of this imaging technique will be discussed further. Some aspects of physiopathology will be briefly considered and a therapeutic algorithm will be proposed.