[Effectiveness of a short-stay observation unit in a pediatric emergency department]. / Utilité d'une unité d'hospitalisation de courte durée aux urgences pédiatriques.

UNLABELLED: Short-Stay Observation Units (SSOUs) in paediatric emergency departments are effective in reducing inpatient admissions but can also generate excessive short-stay hospitalisations. The aim of the study was to evaluate both these consequences and the different missions of SSOUs. METHODS: This prospective study included all children admitted in a 10-bed-medico-surgical SSOU of a tertiary-care paediatric emergency department from September 4, to October 31, 2001. At the time of SSOU admission, the physician indicated the purpose of the admission and which decision he would have made in the absence of a SSOU. RESULTS: Five hundred and nine children (median age = 4 years, chronic disease: 26%, trauma: 34%) were included, accounting for 15% of admissions. The mean length of stay was 14 +/- 8h. The decision in the absence of a SSOU would have been: inpatient hospitalization (77%), transfer to another hospital in the absence of inpatient room vacancy (7%), discharge home (10%), prolonged waiting in the emergency ward (4%), do not know or not indicated (2%). The SSOU admission was deemed appropriate in 81%: discharge home within 24h was likely in 65% and the final orientation of the child was uncertain in 16%. The admission was debatable in 13% and inappropriate in 6%. Sixty six per cent of children were discharged home. CONCLUSION: The SSOU reduced inpatient hospitalisations, generated few inappropriate short stay hospitalisations, and seemed particularly efficient for paediatric diseases. Proposed indicators should allow inter-hospital comparisons.

Proximodistal gradients of the postjunctional folds at the frog neuromuscular junction: a scanning electron microscopic study.

Frog endplates were studied with the scanning electron microscope following the removal of the presynaptic terminal by collagenase and acid treatments. Endplates had 2-14 branches of primary cleft. The longest branches were parallel to the muscle fiber. Short branches oblique or perpendicular to the muscle fiber were also present near the central region of the endplates. The openings of postjunctional folds in the primary cleft were clearly visible at the bottom of the primary cleft and could be counted and measured. The longest primary cleft branches of each endplate were divided into segments of 20 microns (length corrected for shrinkage). The number of postjunctional folds per micrometer of primary cleft, the average postjunctional fold length (i.e. across the primary cleft) and the total postjunctional fold's length per micrometer of primary cleft were evaluated for each 20-microns segment of primary cleft. Negative proximodistal gradients were observed for these three parameters for the long branches of primary cleft, i.e. values were higher in the proximal region (near the motor axon) than in the distal region. These postsynaptic gradients probably reflect similar or smaller proximodistal presynaptic gradients for the active zones along the nerve.