Showing papers by "Bertrand Yersin published in 1997"

Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations : comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia

Abstract: Objectives To determine and compare the respective concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, soluble TNF receptors, nitrite/nitrate (NO2 sup -/NO3 sup -), and procalcitonin in the plasma of patients with septic shock, cardiogenic shock, and bacterial pneumonia without

[Temporary medicosocial admission: alternative to hospitalization of elderly persons?].

Abstract: The orientation of elderly patients, temporarily disabled, to acute care beds is inappropriate because of its adverse effects on functional status and its costs. The creation of short-stay units (SSU) in nursing homes provides an alternative to acute care hospitalization. The aim of this retrospective study, involving the first 64 patients oriented to the SSU from the emergency center, was to evaluate this new health care network. The analysis was focused on the rate of appropriate orientation (site of living at four month; subsequent medical events), as well as the functional quality of this health care network. Information were collected from medical records of the 64 patients oriented to SSU and 64 sex- and age-matched patients admitted during the same period, and the opinion of the network's partners. The mean age of patients and controls was 82 years. Four months after admission to the SSU, the orientation was considered appropriate in 58% of the cases (living at home without subsequent hospitalization), doubtful in 8%, and inappropriate in 33%; 27% of patients and 13% of controls were living definitely in nursing homes (p < 0.1). No medical or social characteristics was correlated to inappropriate orientations. In conclusion, the creation of SSU may be considered as an improvement in the care of elderly patients. The main problem of this orientation was the high percentage of patients living permanently in a nursing home four months later. Accurate assessment's tools capable to predict the subsequent decrease of the functional status should be used in the daily practice in order to improve the orientation of elderly patients.

Hébergement médico-social temporaire: Alternative à l'hospitalisation de personnes âgées?

Abstract: L'hospitalisation en soins aigus de patients âges souffrant d'une perte momentanee d'autonomie est inappropriee, en raison de ses effets pervers sur l'etat fonctionnel du patient, et du cout de tels sejours. La creation de lits d'hebergement medico-social temporaire (HMST) permet une reorientation rapide des patients et un desengorgement des lits hospitaliers. La presente etude, concernant 64 patients reorientes vers des lits d'HMST, a eu pour but d'evaluer cette nouvelle structure, en terme d'adequation d'orientation (evenements medicaux subsequents, devenir a 4 mois) et de qualite fonctionnelle de la chaine de soins. Des informations standardisees furent recoltees retrospectivement a partir du dossier medical des 64 cas et d'un groupe de 64 controles aux caracteristiques identiques admis aux urgences durant la meme periode, et de l'avis des partenaires de la chaine de soins. L'âge moyen fut de 82 ans. A 4 mois l'orientation initiale fut jugee adequate (vie a domicile sans affection intercurrente) dans 58% des cas, douteuse dans 8% et inadequate dans 33%. La frequence d'hebergement definitif en EMS a 4 mois fut superieure pour les cas (27% vs 13%; p<0.1). Aucune caracteristique medicale ou medico-sociale n'etait associee a l'orientation inadequate. En conclusion, la creation de lits d'HMST est une amelioration de la chaine de soins pour les patients âges. La limitation principale de cette orientation est le pourcentage eleve de cas qui, 4 mois plus tard, necessitent un hebergement medico-social definitif. Des outils plus perfectionnes que l'examen medical usuel doivent etre identifies, qui permettent d'anticiper la perte d'autonomie, et donc de faciliter l'orientation adequate des patients.