Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial.

The treatment duration of acute uncomplicated pyelonephritis (AUP) is still under debate. As shortening treatment duration could be a means to reduce antimicrobial resistance, we aimed to establish whether 5 days of antibiotic treatment is non-inferior to 10 days in patients with AUP. We performed an open-label prospective randomized trial comparing 5 days to 10 days of fluoroquinolone treatment for AUP.

Variability of intensive care admission decisions for the very elderly.

Unlabelled: Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes.

Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia.

Background: The use at bedside of C-reactive protein (CRP), procalcitonin (PCT) or mid-regional pro-atrial natriuretic peptide (ANP) has been advocated to help management of patients with community-acquired pneumonia (CAP) in emergency medicine.

Objective: To assess the effectiveness of CRP, PCT, and ANP measures in assisting emergency physicians deciding hospital admission for CAP with low risk of complication.

Design: Multicenter, prospective, observational study with blind evaluation.

Offline exhaled nitric oxide in emergency department and subsequent acute asthma control.

Background: Few studies have evaluated exhaled NO measurement during acute asthma.

Objectives: To evaluate exhaled NO fraction (FE(NO)) and peak expiratory flow (PEF) time-courses during acute asthma treatment (beta 2-agonist plus systemic steroid) and to assess whether FE(NO) time-course predicts subsequent asthma control.

Methods: Sixty-five asthmatic patients (mean +/- SD, 34 +/- 10 years) were prospectively enrolled in three Emergency Departments.

Risk factors for heat related death during the August 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the Hôpital Européen Georges Pompidou.

Objectives: This study sought to determine the risk factors for short term mortality in the victims of the heat wave of August 2003 in France from among patients evaluated in our emergency department (ED). It was hypothesised that age, temperature, and some long term therapies and pre-existing pathologies were factors associated with short term mortality.

Methods: A retrospective analysis of a seven day period.

Multidetector-row computed tomography in suspected pulmonary embolism.

Background: Single-detector-row computed tomography (CT) has a low sensitivity for pulmonary embolism and must be combined with venous-compression ultrasonography of the lower limbs. We evaluated whether the use of D-dimer measurement and multidetector-row CT, without lower-limb ultrasonography, might safely rule out pulmonary embolism.

Methods: We included 756 consecutive patients with clinically suspected pulmonary embolism from the emergency departments of three teaching hospitals and managed their cases according to a standardized sequential diagnostic strategy.

[Emergency admission of eighty year-old and older patients. Characteristics and health care channels].

Objectives And Methods: The primary objective of this study was to describe characteristics and health channels of all octogenarians admitted during a 12 weeks period from two emergency units (EU) (A and B). To do so, an investigator collected data from each EU from the patients and medical teams. The secondary objective was to compare health channels between the two EU.

Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up.

The outpatient population using the emergency department (ED) is increasing and so is the risk of not admitting people who need it. There is, thus, one important question: are the services delivered appropriate to the needs of these ED outpatients? Follow-up of non-admitted patients after a visit to the ED is a prerequisite for the evaluation of these health services. A multicentric follow-up study was thus performed in order to assess the possibility of contacting outpatients after a visit to the ED.

[Hepatic amebiasis: an unusual clinical presentation].

Background: Painful liver enlargement with fever are common signs of hepatic ambiasis. Exceptionally, atypical signs may also occur including symptoms suggesting renal sepsis.

Case Report: An 18-year-old woman from the New Caledonia was hospitalized in metropolitan France for suspected right-sided acute pyelonephritis.

Predicting the outcome in elderly patients of hospital admission for acute care in Paris, France: construction and initial validation of a simplex index.

Objective: To develop a simple index able to identify at an early stage those elderly patients at high risk of requiring discharge to a residential or nursing home after admission to hospital for acute care. For these patients, early discharge planning might lead to a more effective management and reduce the length of hospitalisation.

Design, Setting, And Patients: This was a prospective study conducted in two teaching hospitals in Paris, France.

Using the hospital emergency department as a regular source of care.

Objectives: to evaluate the proportion of the patients who report the emergency department as their regular source of care and to describe the demographics and health status of this population.

Design: A cross-sectional study was performed at the emergency department in two hospitals (around 12,000 visits per year each). Subjects were interviewed using a standardised questionnaire, before and after the emergency department visit.

Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect?

Objectives: The goal was to describe the use of the medical emergency department as a source of non-urgent medical care in order to assess unmet health care needs among its users. The specific objectives were thus to assess the proportion of emergency department visits for non-urgent medical care and to describe those who used the department for this reason.

Design: A cross sectional study was performed at the emergency department in two hospitals (around 12,000 visits per year each).

[Stunned myocardium or hibernating myocardium? Apropos of a case].

The authors relate a case report of unstable angina pectoris accompanied by a well-documented stunned myocardium phenomenon. Stunned and hibernating myocardium resulting from an acute or chronic coronary ischaemia on the myocardium are notions which widely govern revascularisation indications, especially after a myocardial infarction. At present, their detection is based on isotopic methods and stress echocardiography.

Appropriateness of admissions: the French experience.

The French studies using the Appropriateness Evaluation Protocol (AEP) were developed within the framework of medical audit by local teams, analysing their own practice, in order to improve the quality of care. Four studies were analysed in this review. They were performed in emergency departments and data were collected concurrently.

Returning home after acute hospitalization in two French teaching hospitals: predictive value of patients' and relatives' wishes.

Identifying elderly patients who are unable to return home immediately after acute hospitalization is difficult. For these patients, early planning of discharge might reduce the length of hospitalization. We conducted a cohort study to investigate the roles of patients' characteristics and patients' and principal carers' wishes about patients returning home in predicting the outcome of hospitalization for 510 patients aged 75 years or more admitted to acute medical care units via the emergency departments of two teaching hospitals in Paris (France).

[Hospital discharge planning and length of hospital stay in elderly patients admitted through the emergency department].

A prospective study was organized in two teaching hospitals in Paris, including 426 elderly patients aged 75 and more, who had been hospitalized through the medical emergency department. The goal of the study was to assess the influence of difficulties of orientation at discharge on the length of stay, independently of other risk factors. The mean length of stay was 18.

[Outcome of patients with Eisenmenger syndrome. Apropos of 62 cases followed-up for an average of 16 years].

In an era when heart-lung transplantation offers a therapeutic option for patients with Eisenmenger's syndrome, it is important to assess the natural history of this condition. With this objective the authors studied 62 patients followed-up by the same cardiologist. The average follow-up period was 16 years, but 22 patients were followed up for over 20 years.

Appropriateness of admission in an emergency department: reliability of assessment and causes of failure.

The validity of a modified version of the appropriateness evaluation protocol was assessed in a sample of patients aged 15 and over admitted by means of the emergency department of one of the Paris hospitals. As measured among 371 patients, the reliability of the indicator was high. The prevalence of inappropriate admissions (IA) was found to be 20% using the expert opinions and 25% the instrument.

[54 cases of infectious endocarditis seen in 32 years in a population of 2038 congenital heart diseases].

A longitudinal study of a 32-year period (1954-1987) involving 2038 patients with congenital heart defects followed by the same physician yielded 54 cases of infective endocarditis (IE). Complex cyanogenic cardiopathies were particularly exposed to the risk of infection (8.2 IE for 1000 patient-years), then came ventricular septal defects (2.