Main barriers to effective implementation of stroke care pathways in France: a qualitative study.

Background: Stroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.

Methods: We selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities.

Contribution of the ethics committee of the French society of intensive care medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France.

French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors.

Hospital performance based on treatment delays: comparison of ranking methods.

Background: Reducing time-to-care is crucial in many acute and chronic diseases. Quality indicators based on target delays derived from guidelines are used to compare hospital performance but there is no accepted methodology for comparing performance when no target delay has been established.

Aim: To explore by different statistical methods the uncertainty in hospital comparisons that are based on delay indicators, when no target delay is available.

Symptom-to-needle times in ST-segment elevation myocardial infarction: shortest route to a primary coronary intervention facility.

Background: Primary percutaneous coronary intervention (PCI) is the preferred management for patients with acute ST-segment elevation myocardial infarction (STEMI) if performed in a timely manner by experienced providers. Patients can access a PCI facility by three routes: prehospital STEMI diagnosis by emergency medical services (EMS) and direct transport by EMS to a PCI facility (EMS-PCI); visit to a hospital emergency department (ED) followed by referral to an on-site PCI facility (ED-PCI); or transfer from the ED to a PCI facility in another hospital (ED-transfer-PCI).

Aims: To assess the implementation rate in France of the guidelines recommending that STEMI patients be transported by EMS to a PCI facility and to compare the times between symptom onset and PCI for these three routes.

The role of calling EMS versus using private transportation in improving the management of stroke in France.

Objective: To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation.

Methods: We focused on symptom onset-to-brain imaging times of ≤2 hours and ≤3 hours 30 minutes, assuming a one-hour interval between imaging and thrombolysis. Other variables were the patient's age, gender, stroke type, National Institutes of Health Stroke Scale (NIHSS) score, presence of an on-site stroke unit, and period of symptom onset.

Method for developing national quality indicators based on manual data extraction from medical records.

Developing quality indicators (QI) for national purposes (eg, public disclosure, paying-for-performance) highlights the need to find accessible and reliable data sources for collecting standardised data. The most accurate and reliable data source for collecting clinical and organisational information still remains the medical record. Data collection from electronic medical records (EMR) would be far less burdensome than from paper medical records (PMR).

Contribution of the ethics committee of the French Intensive Care Society to describing a scenario for implementing organ donation after Maastricht type III cardiocirculatory death in France.

French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors.

Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery.

Background: Because breast cancer is a major public health issue, it is particularly important to measure the quality of the care provided to patients. Survival rates are affected by the timeliness of care, and waiting times constitute key quality criteria. The aim of this study was to develop and validate a set of quality indicators (QIs) relative to the timeliness and organisation of care in new patients with infiltrating, non-inflammatory and metastasis-free breast cancer undergoing surgery.

Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients.

Background & Aims: To assess the medico-economic impact of malnutrition in patients who underwent surgery for colorectal cancer.

Methods: We performed post-hoc analyses of data from the Alves et al. prospective study.

[Development and validation of indicators relating to the quality of prevention and early management of postpartum haemorrhage (COMPAQ-HPST research project)].

Objectives: To develop and validate a set of quality indicators (QIs) relating to the prevention and early management of postpartum haemorrhage (PPH) in maternity wards. The ultimate aim was to use these QIs for hospital comparison and public diffusion of results.

Materials And Methods: In 2009, COMPAQ-HPST developed a set of five QIs from consensus guidelines with the aid of experts and professional associations, relating to: i) the prevention of PH (three QIs) and ii) the initial management of PPH (two QIs).

Poor prognosis nonseminomatous germ-cell tumours (NSGCTs): should chemotherapy doses be reduced at first cycle to prevent acute respiratory distress syndrome in patients with multiple lung metastases?

Background: Patients with extensive lung metastases from nonseminomatous germ-cell tumours (NSGCTs) and dyspnoea at presentation are at high risk of acute respiratory distress syndrome (ARDS) and death within the first weeks after chemotherapy induction. This syndrome is linked to acute intra-alveolar haemorrhage related to early tumour necrosis, which in turn, can be complicated by pulmonary infection promoted by neutropenia. The management of these patients was modified at Institut Gustave Roussy in 1997 to try to avoid this complication.

A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.

Purpose: An optimal target for glucose control in ICU patients remains unclear. This prospective randomized controlled trial compared the effects on ICU mortality of intensive insulin therapy (IIT) with an intermediate glucose control.

Methods: Adult patients admitted to the 21 participating medico-surgical ICUs were randomized to group 1 (target BG 7.

Nutritional risk factors in planned oncologic surgery: what clinical and biological parameters should be routinely used?

Background: Screening for malnutrition is recommended in hospitalized and planned surgical patients. The aim of this study was to analyze the feasibility and routine prognostic value of using the principal recommended nutritional screening and evaluation tools for cancer patients undergoing major surgery.

Methods: This study is a prospective, 3-month, multicenter observational trial recording weight loss, body mass index, albumin, transthyretin, and PG-SGA.

[Two cases of Bacillus infection and immunodepression].

Objective: Members of the genus Bacillus are Gram-positive bacilli, ubiquitous in the environment. When isolated in clinical practice, it is frequently considered as due to environmental contamination. Bacillus cereus is the most frequent species isolated in clinical practice, nevertheless other Bacillus spp.

Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients.

Objective: Although several advantages are attributed to tracheotomy in ICU patients requiring mechanical ventilation (MV), true benefits and the optimal timing of tracheotomy remain controversial. In this study, we compared early tracheotomy (ET) with prolonged intubation (PI) in severely ill patients requiring prolonged MV.

Design: Prospective, randomized study.

[Can children visit their relatives in an adult ICU?].

For the last three years, our oncology ICU (intensive care unit) has been opened to visiting children between 0 and 18 years. Our objective was to attempt to decrease the psychological burden in critically ill cancer patients and their children. We report here the evaluation of this new policy.

Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial.

Background: International guidelines for management of septic shock recommend that dopamine or norepinephrine are preferable to epinephrine. However, no large comparative trial has yet been done. We aimed to compare the efficacy and safety of norepinephrine plus dobutamine (whenever needed) with those of epinephrine alone in septic shock.

[Standards, Options and Recommendations 2005 for a good practice in enteral nutrition in oncology (summary report.)].

Context: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients.

Objective: To develop good practice guidelines for a good practice of enteral nutrition in oncology, in collaboration with three French learned societies involved in this area.

ESPEN Guidelines on Enteral Nutrition: Intensive care.

Enteral nutrition (EN) via tube feeding is, today, the preferred way of feeding the critically ill patient and an important means of counteracting for the catabolic state induced by severe diseases. These guidelines are intended to give evidence-based recommendations for the use of EN in patients who have a complicated course during their ICU stay, focusing particularly on those who develop a severe inflammatory response, i.e.

[Meningitis caused by Enterococcus faecalis during disseminated anguilluliasis].

Introduction: Disseminated anguilluliasis is a serious disease requiring early diagnosis and treatment. The occurrence of bacterial complications, especially meningeal, is generally due to Gram-negative bacteria from the gastrointestinal tract.

Case: A 52-year-old man from Guadeloupe, treated for T-lymphoma during the previous year by polychemotherapy, was hospitalized for meningitis.

Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports.

Purpose: Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU).

Patients And Methods: This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003.

Results: Two hundred nine critically ill allogeneic HSCT recipients were included in the study.

Enteral (oral or tube administration) nutritional support and eicosapentaenoic acid in patients with cancer: a systematic review.

The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs.

Incidence and clinical significance of anaerobic bacteraemia in cancer patients: a 6-year retrospective study.

Recent studies have shown that anaerobes account for 0.5-9% of all episodes of bacteraemia in hospitalised patients, with variations according to geographical location and demographic characteristics, most notably age, but few data are available for cancer patients. This study investigated retrospectively the incidence of anaerobic bacteraemia in cancer patients who received non-surgical treatment over a 6-year period at a tertiary oncology centre.