Les patients trachéoventilés au long cours nécessitent une assistance ventilatoire en continu. En dehors de la phase initiale et des épisodes morbides aigus, ces patients peuvent bénéficier d'une prise en charge spécifique en secteur de soins de suite et de réadaptation (SSR) pour des prises en charge de rééducation, de convalescence ou de répit. Nous avons souhaité étudier la validité des données du PMSI-SSR sur un échantillon de ces patients.Nous avons tout d'abord comparé les données du PMSI-SSR des patients avec les informations contenues dans leur dossier médical (observation médicale et dossiers de soins). Puis, nous avons soumis pour évaluation aux producteurs de soins des établissements étudiés la description des modalités de prise en charge des patients selon le PMSI-SSR.La comparaison des données avec les dossiers des patients a permis de vérifier que l'étiologie et la manifestation morbide principale étaient correctement codées pour 86 % et 94 % des séjours respectivement. Les actes médicaux étaient correctement codés dans 77 % des cas contre 39 % des cas pour les actes de rééducation et réadaptation. Dans 55 % des cas, les actes de rééducation et réadaptation étaient absents des dossiers. Les producteurs de soins ont jugé que pour 30 % des actes de rééducation et réadaptation, le PMSI-SSR sous-estimait la fréquence de réalisation de l'acte. Dans 34 % des cas, des actes de rééducation et réadaptation étaient considérés comme réalisés par les producteurs de soins, mais n'étaient pas codés au sein du PMSI SRR.Tandis que les principales caractéristiques des patients étaient bien reportées dans le recueil PMSI-SSR, la réalisation de nombreux actes de soins était sous-estimée avec un défaut de traçabilité dans le dossier médical. Il s'agissait principalement d'actes réalisés de manière très fréquente chez ces patients trachéoventilés au long cours (par exemple la réalisation de sondages urinaires, de mobilisations articulaires, d'entretiens avec les familles).Long-term intratracheal ventilated patients need continuous artificial ventilation support. After the acute periods, these patients may benefit from dedicated follow-up in rehabilitation care centers. In this paper, we aimed to study the validity of the data provided by a French diagnosis-related group (DRG) information system.For a sample of intratracheal ventilated patients in two rehabilitation units, we compared the data provided in the DRG information system with the data available in the medical charts. Furthermore, we asked the medical, nursing and allied health staff to assess the data provided by the French DRG information system.The diagnosis was found accurate for 86% of hospital stays. In the DRG information system, 77% of the medical care, and 39% of the nursing and allied health care were mentioned correctly. Overall, 55% of the nursing and allied health care procedures in the DRG information system were not reported in the medical charts. The healthcare providers estimated that the frequency of the care provided was underestimated in the DRG information system for 30% of the nursing and allied health care.The patients' main characteristics were found correctly reported in the DRG information system. However, the diversity and the frequency of the care provided were underestimated. These underestimates were mainly related to care frequently provided in these patients (for example, urinary catheterization, massages, counseling for relatives).

Summary Objectives: To propose an objective approach in order to determine the number of beds required for a hospital department by considering how recruitment fluctuates over time. To compare this approach with classical bed capacity planning techniques. Methods: Asimulated data-based evaluation of the impact that the variability in hospital department activity produces upon the performance of methods used for determining the number of beds required. The evaluation criteria included productive efficiency measured bythe bed occupancy rate, accessibility measured by the transfer rate of patients due to lack of available beds and a proxy of clinical effectiveness, by the proportion of days during which there is no possibility forunscheduled admission. Results: When the variability of the number of daily patients increases, the Target Occupancy Rate favors productive efficiency at the expense of accessibility and proxy clinical effectiveness. On the contrary, when the variability of the department activity is marginal, the Target Activity Rate penalizes the proxy of clinical effectiveness, and the Target Occupancy Rate under-optimizes productive efficiency.The method we propose led to a superior performance in terms of accessibility and proxy of clinical effectiveness at the expense of productive efficiency. Such a situation is suitable for intensive care units. In the case of other departments, a weighting procedure should be used to improve productive efficiency. Conclusions: This approach could be considered as the first step of a family of methods for quantitative healthcare planning.

OBJECTIVE:The aim of this retrospective study was to identify the risk factors for catheter-associated bloodstream infection (CABSI) in neonates.METHOD AND RESULTS:Fifteen episodes of CABSI occurred in 108 central catheters over a period of one year (2002). The univariate analysis risk factors were birth weight (1.064 vs 1.413 g; P<0.001), gestation age (28 vs 31 weeks; P<0.001), blood transfusion (8/15 vs 3/34; P<0.01), corticosteroids (7/15 vs 3/34; P<0.01), nasal CPAP duration (13.6 vs 2 days; P<0.01). Nasal CPAP duration was the only risk factor independently associated with CASBI (OR=1.2, 95% confidence interval=1.09-1.5) in the multivariate logistic regression analysis.CONCLUSIONS:The risk of infection associated with low birth weight is multifactorial suggesting that host-related factors are important. Prevention remains difficult and a policy of strict aseptic catheter care must be promoted.

Objective. - The aim of this retrospective study was to identify the risk factors for catheter-associated bloodstream infection (CABSI) in neonates.Method and results. - Fifteen episodes of CABSI occurred in 108 central catheters over a period of one year (2002). The univariate analysis risk factors were birth weight (1.064 vs 1.413 g; P < 0.001), gestation age (28 vs 31 weeks; P < 0.001), blood transfusion (8/15 vs 3/34; P < 0.01), corticosteroids (7/15 vs 3/34; P < 0.01), nasal CPAP duration (13.6 vs 2 days; P < 0.01). Nasal CPAP duration was the only risk factor independently associated with CASBI (OR = 1.2, 95% confidence interval = 1.09-1.5) in the multivariate logistic regression analysis.Conclusions. - The risk of infection associated with low birth weight is multifactorial suggesting that host-related factors are important. Prevention remains difficult and a policy of strict aseptic catheter care must be promoted. (C) 2006 Elsevier SAS. Tons droits reserves.

Objective: The number of acute hospital beds is determined by health authorities using methods based on ratios and/or target bed occupancy rates. These methods fait to consider the variability in hospitalization demands over time. On the other hand, the implementation of sophisticated models requires the decision concerning the number of beds to be made by an expert. Our aim is to develop a new method that is as simple to use as the ratio method while minimizing the roundabout approaches of these methods.Method: A score was constructed with three parameters: number of transfers due to Lack of space, number of days with no possibility for S unscheduled admissions and number of days with at least a threshold of U unoccupied beds. The optimal number of beds is the number for which both the mean and the standard deviation of the score reach their minimum. We applied this method to two internal medicine departments and one urological surgery department and we compared the solutions proposed by this method with those put forward by the ratio method.Results: The solutions proposed by this method were intermediate to those calculated by the local and national length of Stays ratio methods. Simulating an unusual increase in admission requests had no consequence on the bed number selected, indicating that the method was robust.Conclusion: Our tool represents a real alternative to the ratio methods. A software has been developed and is now available for use. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Objective: Most methods used to estimate ICU bed needs rely either on simple formulas that do not consider the actual needs of the population or on simulations that are too specific to be applicable to all hospitals. We sought to develop a universally applicable nonparametric method. Design and setting: For each day, the number of immediate patient transfers to other ICUs because of a full unit and the number of patients treated in the ICU were collected. The number of beds needed was selected according to the minimization of both the mean and the variance of three parameters (accessibility, safety, and efficiency). This method was applied to the ICU of a general hospital. Robustness of the model was assessed using outliers. Main results: During the 5-month study period, 215 ICU stays were collected. The method selected a ten-bed model whereas length-of-stay ratio and case-mix methods selected a twelve- and height-bed models respectively. An unusual increase in admission requests had no consequence on the bed number selected, indicating that the method was robust. None of the parameters were dependent on specific ICU characteristics, establishing that this method is applicable to any type of hospital ward. Conclusion: Our model is reliable for determining the number of beds needed in any type of ICU and can be used by all ICU managers. The software is available.

This chapter addresses the architecture mapping of a complex non-linear diffusion algorithm for use in vision applications. It shows the way through which manually applied transformations allow the final architecture to be modular and have a low communication bandwidth. The algorithm exhibits several parameters and has to be partly programmable. Real-time execution for a particular parameter set is, however, required. Starting point for this design is a set of affine recurrence equations. For this abstract specification, difficult task of finding a globally optimized architecture with fully matched throughput is tackled while avoiding an explosion of the search space. Real-time signal processing (RSP) applications as in video, speech, and image processing require a mapping methodology, which is optimized to throughput and not to latency. This demand contrasts with most other current array synthesis approaches that allow transforming regular algorithms from affine (ARE) or uniform recurrence equation (URE) form into efficient regular array architectures (RAA's). To allow pipelined processing elements (PEs) and multi-dimensional algorithms, changes are needed to the uniform mapping and projection approach. This paper discusses a manually applied formal design methodology resulting in a modular and programmable regular architecture implementing an image diffusion algorithm. It involves initial algorithm transformations, 1D or 2D placement mapping, multi-dimensional scheduling, local processing element (PE) design, and scheduling and low-level scheduling. All these steps are embedded in an iterative decision process with pruning due to ordering of the decisions and gradual refinement of the cost functions used to differentiate alternatives.

Recently, non-linear diffusion processes have been introduced to improve the performance of front-end vision. Their real-time implementation is extremely demanding on the hardware. An efficient and realistic realization needs an application-specific parallel architecture mapped onto a customized IC. An efficient parameterizable VLSI-architecture of a processor element used in a flexible linear array is introduced.

This paper presents a new approach to module generation. It is based on the observation that a function, realized by a module instance (e.g. a 16-bit multiplier) when restricted to a sub-function, can be realized by a reduction of the instance to a sub-instance (e.g. a 8-bit multiplier). This reduction is performed automatically by REDUSA. It offers important advantages in both the construction and verification aspects of module generators.

Describes the concepts and the status of the CATHEDRAL-II silicon compiler for digital signal processing systems. It is shown that efficient layout synthesis is possible, starting from a very high-level behavioural description of a system, owing to the careful definition of a target architectural design style and an application domain. An overview is presented of the different synthesis tools which have been or are being developed, both for architectural synthesis and optimisation, and for module and layout generation. With the underlying design methodology, the world of silicon design will become accessible to system engineers

This paper describes a Medical Information System (conversational in real-time). SIGMED, which is used in the French hospital of Angers. Its main feature is its original organization which (i) allows one to follow a patient's history in space and time with a limited number of medical items and the whole set of administration ones and makes it possible to carry and (ii) the possibility of various epidemiological studies relating to medical speciality records which contain all the medical information related to a patient's examination and/or hopitalization.

The article describes the status of work at IMEC on the Cathedral-II silicon compiler. The compiler was developed to synthesize synchronous multiprocessor system chips for digital signal processing. It is a continuation of work on the Cathedral-I operational silicon compiler for bit-serial digital filters. Cathedral-II is based on a "meet in the middle" design method that encourages a total separation between system design and reusable silicon design. The CAD system includes a rule-based synthesis program, a procedural program, and a controller synthesis environment. Processors are synthesized in terms of modules called from automated reusable module generators. Chip layout is done on a floor planner. An expert subsystem verifies correctness during silicon design and generates functional and timing models for verification at the module and chip levels.

Gate controlled diodes, MOS transistors with grounded gate, source and substrate and gate controlled pnn + structures are compared when used as a protective input device on p-channel MOS integrated circuits. For this purpose two pulse techniques are developed which allow an accurate determination of the dynamic resistance by minimizing the walk-out of the breakdown voltage during the measurement. While the breakdown voltage does not differ much for the different types of devices, the dynamic resistance however is found to be considerably lower for the MOS transistor than for both other devices. For these low values the series resistance of the drain and source diffusion is shown to constitute already an important contribution. The lower dynamic resistance of MOST's can be ascribed to parasitic bipolar transistor operation during breakdown. The identification of this mechanism leads to a simple model for the MOS transistor in breakdown which has been experimentally verified and confirmed. Guidelines for the definition of the source diffusion for an optimal protective functioning can be obtained from this model.

Phosphorus implantation, performed prior to the major standard process steps in p-channel technology, is used for a well controllable reduction of the breakdown voltage of planar diodes down to values which makes them suited as protection devices. In these devices the walk-out of the breakdown voltage, which is characteristic for the field-plated types of protective devices is almost completely eliminated. The dynamic resistance of the implanted diodes can be considerably reduced by providing a second p+diffusion which gives rise to parasitic bipolar transistor operation during breakdown. The dynamic resistance is found to be linearly dependent on the width of the space charge layer which is ascribed to microplasma phenomena occuring during breakdown. The overvoltages against which the new devices can offer protection when used in a distributed resistance configuration of 200-µm width, are shown to be in the 10-60-kV range.

Visco-elastic parameters of the bronchi system are represented by the viscous modulus and the recoil static pressure. In several generations, values of the cross-sectional area of the bronchi are defined at various moments by the results obtained with dynamical tracheo-bronchography. By means of these measures and the use of a model describing the air flow in elastic bronchi, a calculation procedure of the visco-elastic parameters has been established.

The oxalate group appears to be tetradentrate in many a complex of the lanthanide series. The results obtained for the N2O4 molecule have enabled us to apply the coincidence method for the correct attribution of the vibrational frequencies of the free oxalate ion (Vh symmetry). A complete survey, in normal coordinates of the C2O4M2 plane group having the same Vh symmetry (where M is the lanthanide atom and the oxalate group is tetradentate) could therefore be performed. All measured frequencies, in infrared absorption as well as in Raman diffusion could then be assigned for several oxalate compounds of the lanthanide series. Exact structural conclusions can be drawn from the results of this vibrational analysis.