Unlike Anglo-Saxon countries, the rate of preventable readmissions is not a national quality indicator in France. In the context of the European research project Performance Assessment Tool for quality improvement in Hospitals (PATH), this pilot study provides a tool for health professionals to more easily identify preventable readmissions in order to analyze their causes. The objective of this work was to show the reliability of this tool.We compared the rate of preventable readmissions occurring within 30 days, for a given disease, collected by analyzing medical reports (the gold standard rate of this study) to the rates of preventable readmissions occurring within 30 days, measured from algorithms using data from the French Programme of Medicalization of Information Systems (PMSI). The data were derived from PMSI data of the Lariboisiere-Fernand-Widal Hospital, a university hospital in Paris.The community-acquired pneumonia gold standard rate of preventable readmissions occurring within 30 days was 6.3 %. Five algorithmic tools were used and measured rates between 2.9 % and 7.9 %. The positive likelihood ratios of these tools range from 8 to 308.This work presents a tool aimed at the health professionals that takes into account the diversity and complexity of the causes of avoidable readmissions, resulting from the quality of medical practice, the variability of the organization of hospital pathways and the links with ambulatory care.À la différence des pays anglo-saxons, le taux de réadmissions évitables n'est pas un indicateur de qualité utilisé en France. Dans le cadre du projet de recherche européen Performance Assessment Tool for improvement quality in Hospitals (PATH), cette étude pilote propose un outil destiné aux professionnels de santé pour repérer plus facilement les réadmissions évitables afin d'en analyser les causes. L'objectif de ce travail était de présenter la fiabilité de cet outil.Le taux de réadmissions évitables survenues dans les 30 jours, pour une maladie donnée, a été mesuré par retour aux dossiers (taux gold standard de l'étude). Ce gold standard a été comparé aux taux de réadmissions évitables survenues dans les 30 jours mesurés à partir d'algorithmes utilisant les données du Programme médicalisé des systèmes d'information (PMSI) français. Les données ont été issues des données PMSI 2007 du groupe hospitalier Lariboisière-Fernand-Widal, hôpital universitaire parisien de l'Assistance Publique–Hôpitaux de Paris.Le gold standard du taux de réadmissions évitables à 30 jours de la « pneumopathie communautaire » de l'établissement a été mesuré à 6,3 %. Cinq outils algorithmiques automatisés ont permis de mesurer des taux de réadmissions évitables à 30 jours entre 2,9 % et 7,9 %. Les rapports de vraisemblance positifs de ces outils ont été mesurés entre 8 et 308.Ces travaux proposent un outil destiné aux professionnels de santé à même d'analyser la diversité et la complexité des causes des réadmissions évitables, résultant à la fois de la qualité des pratiques médicales, de l'organisation du parcours de soins du patient à l'hôpital et des liens avec le système ambulatoire.

Déterminer les facteurs associés aux réadmissions chez les patients hospitalisés en psychiatrie à Bingerville.Il s'agit d'une étude rétrospective menée à partir des dossiers de 436 patients hospitalisés pour la première fois en 2001 à l'hôpital psychiatrique de Bingerville. Nous avons appelé réadmission toutes les réhospitalisations survenues 15 jours après la sortie déclarée du patient au bureau des entrées. Les patients réadmis au moins une fois entre le 1er janvier 2001 et le 31 décembre 2006 ont été comparés aux sujets non réhospitalisés, selon leurs caractéristiques sociodémographiques et cliniques, en utilisant le test de Khi2.Quatre-vingt-dix-huit patients ont été réadmis au moins une fois. Plus de la moitié (69,4 %) des réadmissions ont eu lieu au cours des deux années suivant la fin de la première hospitalisation à Bingerville. La récurrence des symptômes psychiatriques en était la cause dans 94,9 % des cas. Les caractéristiques des patients qui ont été associées significativement à la survenue d'une réhospitalisation étaient : un âge inférieur à 21 ans (p = 9 × 10−4), avoir les deux parents vivants (p = 3 × 10−2), être le cadet de la fratrie utérine (p = 10−3), un diagnostic de troubles de l'humeur (p = 0,046) et un suivi ambulatoire après la fin de la première hospitalisation excédant 26 semaines (p = 4 × 10−3).Lorsqu'elles sont rapprochées et multiples, les réadmissions sont responsables d'une mauvaise insertion sociale des patients. La connaissance des facteurs favorisant ces réhospitalisations est utile à la prévention de cette conséquence.To ascertain the factors related to patients' psychiatric readmissions at Bingerville.It was a case-control study built on 436 files of patients who had been hospitalized for the first time in 2001 at Bingerville's psychiatric hospital. We called readmission all rehospitalization arisen 15 days after the end of the previous hospital stay. Sociodemographic and clinical characteristics of the patients who had been readmitted for at least a fold within 1st January 2001 and 31st December 2006 were compared to those who had not been readmitted during this period, by using the Chi-square test.Patients admitted for the first time at Bingerville psychiatric hospital were in majority less than 44 years old (87.8%) with mean age at 31.1 ± 10.9 years. More than half of them, had male gender (61.9%), was single or widowed or separated (70.6%), without a kid (55.5%). Numerous of them were not educated above secondary school (95.4%). In these first admitted patients, 50.9% did not earn a wage, 68.8% lived in Abidjan. Those who had both their mother and father alive represented 53.9% of the study sample. About two-third of the patients were younger in their siblings, as well in father's children as in mother's. Regarding the clinical features, schizophrenia and other psychotic disorders (59.2%) were the most frequent diagnosis, followed by mood disorders (19.0%). These mental disorders started during the month before first psychiatric hospitalization at Bingerville (47.2%). The majority (74.5%) of these patients were hospitalized 30 days at most. They were discharged with medical advice (85.8%) and less than two drugs prescribed (66.3%). The aftercare treatment did not last more than 26 weeks for most of the patients (79.6%). Readmission occurred at least a fold in 22.5% of the subjects, in majority during the first 2 years after being discharged in 2001 (68.4%). Patients characteristics related to readmission during the 6 years of study period were: being less than 21 years old (p = 9 × 10−4), younger in the siblings of mother's children (p = 10−3), having both mother and father alive (p = 3 × 10−3), a mood disorder diagnosis (p = 0.046) and a length of aftercare treatment exceeding 26 weeks (p = 4 × 10−3).When they are repeated and closer, readmissions can worsen patients' social reinsertion. The knowledge of factors related to these rehospitalizations is useful to prevent this consequence.

Nociceptin/orphanin FQ (N/OFQ) is involved in many behavioural patterns; in particular, it exerts a modulating effect on nociception. Like other proposed antiopiates, nociceptin/orphanin FQ has been shown to have analgesic, hyperalgesic as well as antianalgesic properties. Among the various effects proposed on nociceptive sensitivity at supraspinal level, the antagonistic activity toward morphine analgesia seems to be of interest. Therefore, we decided to investigate whether nociceptin/orphanin FQ and [Arg14, Lys15] nociceptin/orphanin FQ (R-K, a nociceptin analogue) can have the same effect on the analgesia produced by nonopioid analgesics. In this study, we examined the antianalgesic effect of nociceptin/orphanin FQ and its analogue R-K on paracetamol-induced analgesia and evaluated by means of the hot plate test in rats. Nociceptin/orphanin FQ was intracerebroventricularly administered, and, after 5 min, a dose of 400 mg/kg paracetamol was injected intraperitoneally, 30 min before the hot plate test. Nociceptin/orphanin FQ and R-K showed a dose-dependent antagonism on the antinociceptive effect of paracetamol, and the activity of both drugs was significantly reduced by the antagonist [Nphe1] Arg14, Lys15–N/OFQ–NH2 (UFP-101). These data indicate that nociceptin/orphanin FQ and R-K have an antianalgesic effect on the analgesia produced by a nonopioid analgesic drug, like paracetamol, that seems to develop within the brain.

La force électromotrice de piles de concentration du type: Al (pur)/ A13+ (dissous dans un mélange eutectique KCl-LiCl)/X-Al (xAl, T) où X ≡ Sn ou Te, a été mesurée en fonction de la température et de la fraction molaire xAl en aluminium. Les valeurs des fonctions thermodynamiques de formation des alliages liquides Al-Sn (0,10 < xal < 0,95; 630 K < T < 1250 K) et Al-Te (0 < xAl < 0,20; 700 K < T < 820K) en ont été déduites.

Divided films allow the measurement of supercooling fields which provide by extrapolation correct values for the κ0 parameter of pure Al, in contrast with other results on perpendicular critical fields close to Tc.

A new technique (division of the film into very many small squares) allows the observation of supercooling and superheating of superconducting layers under both parallel and perpendicular fields. The possible existence of “edge” nucleation in thick films, analogous to surface nucleation for semiinfinite samples, is shown. The superconducting parameters determined for films extrapolate correctly to known bulk values. Critical thicknesses for passage from type I to type II behavior agree with theoretical predictions. Nonlocal corrections to the penetration depth allow one to explain deviations from the Gorkov-Goodman relation for bulk metals.

Division of a thin film into an array of small squares allows the observation of superconducting metastable states.