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OBJECTIVES: The Risk of Early Admission to the Intensive Care Unit (REA ICU) index is a clinical prediction model that was derived based on 4593 patients with community acquired pneumonia (CAP) for predicting early admission to the intensive care unit (ICU; i.e. within 3 days following emergency department [ED] presentation). This study aimed to validate the REA ICU index in an independent sample. METHODS: The authors retrospectively stratified 850 CAP patients enrolled in a multicenter prospective randomized trial conducted in Switzerland using the REA ICU index alternate clinical prediction models of severe pneumonia (SMART COP CURXO 80 and the 2007 IDSA/ATS minor severity criteria) and pneumonia severity assessment tools (the Pneumonia Severity Index [PSI] and CURB 65). Results: The rate of early ICU admission did not differ between the validation and derivation samples within each risk class of the REA ICU index ranging from 1.1 to 1.8 in risk class I to 27.1 to 27.6 in risk class IV. The areas under the receiver operating characteristic (ROC) curve were 0.76 (95 confidence interval [CI] = 0.70 to 0.83) and 0.80 (95 CI = 0.77 to 0.83) in the validation and derivation samples respectively. In the validation sample the REA ICU index performed better than the pneumonia severity assessment tools but failed to demonstrate an accuracy advantage over alternate prediction models in predicting ICU admission. CONCLUSIONS: The REA ICU index reliably stratifies CAP patients into four categories of increased risk for early ICU admission within 3 days following ED presentation. Further research is warranted to determine whether inflammatory biomarkers may improve the performance of this clinical prediction model.

Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures.The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5%.During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14p 100,000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0.43 (p0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100,000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21% of recorded suicide attempts in 1998 and in 10% of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38.The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution: our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.

French military troops based in Kosovo are exposed to Tick-Borne Encephalitis (TBE) biorisk. An efficacious vaccine is available to prevent this disease, burdened by high morbidity and mortality. The epidemiologic features of TBE in Kosovo are unprecise. To help the French Department of Defense to make a decision about immunization against TBE, we performed a cost-benefit analysis.By a Bayes'analysis decision, we have estimated the net benefits for a three-injection vaccine program versus absence of vaccination, for all French military troops based in Kosovo. Time expectancy was 4 years. Through the review of several medical reports, we have estimated the useful parameters for this study: morbidity incidence rate, mortality rate, sequelae rate, efficacy vaccine and side effects. We have chosen as initial hypothesis a sero-conversion rate of 1,080 per 100,000 men-by-year. Human life was valorized in francs, by calculating the allowance paid by Department of Defense to the family in case of death or for sequelae.Net benefits arised to 2.17 millions of francs. The vaccine program cost was 25.0 millions of francs. 140 cases of encephalitis viruses were saved by vaccination. Nevertheless a sensibility analysis has shown that results are well reliable with TBE incidence rate.The break even point being close to the incidence rate of the initial assumption, the decision to vaccine all French military troops depends at the same time on a better knowledge of the incidence of the disease in Kosovo, but also of the number of potentially avoided cases of tick-borne encephalitis and of the programs of vaccination concerning this disease of the other countries forming the United Nations Organization forces.

Following 1996 legislation requiring French hospitals to assess patient satisfaction, this study developed and validated a brief French-language multidimensional questionnaire designed to measure outpatient satisfaction with hospital visits and compared data quality for two patient-satisfaction survey methods.Authors developed a 19-item questionnaire following a strict procedure (identification of dimensions to explore, formulation, and selection of items).Validation data were obtained from patients of six outpatient clinics in a teaching hospital.586 consenting eligible patients were randomized to receive the questionnaire 2 weeks after their visit with one of two survey methods: a mailed self-administered questionnaire or a telephone interview.The response rate (79%) was not significantly different between the two survey methods. The risk of having one or more missing values was higher in the mail survey group (odds ratio, 1.65; 95% confidence interval, 1.03-2.63), but mail respondents were less likely to use the "extremely positive" response category. Principal component analysis identified four factors that accounted for 56% of the variance: interpersonal skills and information transfer, physical surroundings, convenience, and appointment delay. Patients' comments on open-ended questions validated the semantic content of the factorial construct. The internal consistency coefficient was greater than 0.70 for three of four subscales. Patient background characteristics accounted for less than 10% of the factorial score variance. Patient satisfaction was correlated with age, type of visit, and, to a lesser extent, gender and education level.This easily administered, multidimensional out-patient-satisfaction questionnaire provided encouraging preliminary psychometric characteristics.

Assessment of hospital patient satisfaction is henceforth a statutory obligation in France. The purpose of this study was to define the main settings of patient satisfaction surveys and to describe methods for assessing patient satisfaction, through a literature review. Published works have mainly been based on experts opinions; few studies have used appropriate methodology. On the whole, their authors consider that patient satisfaction assessment should provide a useful feedback to the quality improvement system of hospitals. Surveys should associate qualitative and quantitative techniques and analysis of patient complaints and letters. Patient satisfaction surveys should not be separated from theoretical work on the foundations of this concept and its measurement.

To evaluate the quality of prescription writing at a university hospital in France.Each of the 42 medical, surgical, and intensive-care departments were invited to participate in the study. The initial medication orders were reviewed for 866 patients, resulting in 3,254 medications prescribed. One prescription per patient was reviewed for a total of 866 patients, presenting 3,254 medications.Of the 866 prescriptions reviewed, 95.5% were dated. Patient identification was complete in 35.3%. The prescriber was identified properly by both full name and signature in 7.5% of prescriptions. Medication information was complete in only 24% of cases.This study showed that prescriptions were not written correctly. Results of this study have been disseminated, and education has begun on proper prescription practice.