[Education for chronic cardiologic diseases in a transversal multidisciplinary unit: the experience of a general hospital center]. / Education des maladies chroniques en cardiologie au sein d'une unité transversale d'éducation multidisciplinaire: expérience d'un centre hospitalier général.

Treatments for congestive heart failure, hypertension and cardiovascular risk have significantly changed and have become more complex. The have also become more and more effective thanks to the results of great clinical studies that have enabled European and North-American societies to issues recommendations. The observance of the pharmacological and non-pharmacological treatments requires the education of patients and their family following guidelines that have been clearly defined by the European Society of Cardiology. This education, in which the technic of communication is very important, is common to a lot of chronic diseases and requires adequate material and human resources in order to have an optimal quality of treatment. In a society in which spending is on rise, getting such resources is not easy. However, putting in common resources of several departments can be a good solution. The experience of the Hospital Center of Douai (France) lead to the creation of a Transversal Education Unit at the end of the year 2003. This unit centralizes the efforts of several departments of care like pneumology, pediatrics, diabetology, nutrition and cardiology and allows patients suffering from co-morbidities to have access to various programs of this unit.

[Contribution to the study of the management of extremely premature infants in metropolitan France (with the exception of Ile-de-France)]. / Contribution à l'étude de la prise en charge des grands prématurés en France métropolitaine (à l'exception de I'Ile-de-France).

BACKGROUND: Regionalization of perinatal care is one of the purposes of the last 'Plan du Gouvernement pour la Périnatalité' (French Government's Perinatal Project). The aims of the study are first to investigate the site of admission of the very low birth weight infants and secondly to analyze postnatal transfer policies. POPULATION AND METHODS: Neonatal units in France (excluding Ile-de-France area), using exogenous surfactant were asked for their number of intensive care costs (1-5, 6-10, more than 10) and for the yearly rate of admission preterms less than 33 weeks gestational age. They were also classified as academic or not. RESULTS: One hundred and six out of 129 units participated. Ten units were excluded because they did not use surfactants. Among the 71 non academic units, the number of intensive care cots was less than six in 57/71 (80%) vs 1/25 (4%) in the academic units. There was no relationship between the number of admission and transfer policy. In 29 units with less than six cots, and in 20 of those with 20 admissions or less, transfer occurred exceptionally or never. CONCLUSIONS: The concept of "critical mass", usually recommends to ensure expertise, is not warranted in most French neonatology units. It is worrisome to state that many small units do not transfer any children or do it for a limited number. On the other hand, a majority of the infants transferred post-natally could have drawn benefit from in utero transfer. From these data, it is possible to assume that regionalization of perinatal care is far from achieved in most parts of the French territory.

[Hypoxic-ischemic encephalopathy of the full term newborn. Contribution of the electroencephalogram and trans-fontanelle echography to the prognostic evaluation. Report of 29 cases]. / Encéphalopathie anoxo-ischémique du nouveau-né à terme. Apport de l'électroencéphalogramme et de l'échographie transfontanellaire à l'évaluation pronostique. A propos de 29 observations.

This study was aimed at assessing by EEG recording and cranial imaging the cerebral function of 29 full term newborns presenting with hypoxic-ischemic encephalopathy and at establishing a correlation between the results and the neurological outcome. A correlation between the Sarnar's classification and the neurological outcome was observed, except for the intermediate grade. In this case, impairment of the EEG was variable and neurological prognosis was sometimes evidenced by cranial imaging. Unfavorable neurological outcome occurred when thalamic lesions were present, independently of clinical signs and EEG abnormalities.