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To describe a cohort of pregnant women having suffered an out-of-hospital cardiac arrest (OHCA) and to compare them with nonpregnant women of childbearing age having suffered OHCA.Study data were extracted from the French National OHCA Registry between 2011 and 2021. We compared patients in terms of characteristics, care and survival.We included 3,645 women of childbearing age (15-44) who had suffered an OHCA; 55 of the women were pregnant. Pregnant women were younger than nonpregnant victims (30 vs. 35 years, p = 0.006) and were more likely to have a medical history (76.4% vs. 50.5%, p 0.001) and a medical cause of the OHCA (85.5% vs. 57.2%, p 0.001). Advanced Life Support was more frequently administered to pregnant women (98.2%, vs. 72.0%; p 0.001). In pregnant women, the median time of MICU arrival was 20 minutes for the Medical Intensive Care Unit with no difference with nonpregnant women. Survival rate on admission to hospital was higher among pregnant women (43.6% vs. 27.3%; p = 0.009). There was no difference in 30-day survival between pregnant and nonpregnant groups (14.5% vs. 7.3%; p = 0.061). Fetal survival was only observed for OHCAs that occurred during the pregnancy second or third trimester (survival rates: 10.0% and 23.5%, respectively).Our results show that resuscitation performance does not meet European Resuscitation Council's specific guidelines on OHCA in pregnant women. Although OHCA in pregnancy is rare, the associated prognosis is poor for both woman and fetus. Preventive measures should be reinforced, especially when pregnant women have medical history.

Out-of-hospital cardiac arrest (OHCA) in children is associated with a low survival rate. Conclusions in the literature are conflicting regarding the best way to handle ventilation. The purpose of this study was to assess the impact of two airway management strategies, endotracheal intubation (ETI) vs. supraglottic procedure, during cardiopulmonary resuscitation (CPR) on 30-day survival in paediatric OHCA.This was a retrospective, observational, multicentre, registry-based study conducted from July 2011 to March 2018. All paediatric OHCA patients under 18 years of age and managed by a mobile intensive care unit were included. The primary endpoint was 30-day survival in a weighted population (based on propensity scores).Of 1579 children, 1355 (85.8%) received ETI and 224 (14.2%) received supraglottic ventilation during CPR. We observe a lower 30-day survival in the ETI group compared to the supraglottic group (7.7% vs. 14.3%, absolute difference, 6.6 percentage points; 95% confidence interval [CI], 2.3-12.0; propensity-adjusted odds ratio [paOR], 0.39; 95% CI, 0.25-0.62; p 0.001), and also a poorer neurological outcome (paOR, 0.32; 95% CI, 0.19-0.54; p 0.001). However, we did not identify any significant association between airway management strategy and return of spontaneous circulation (paOR, 1.15; 95% CI, 0.80-1.65; p = 0.46).The findings of this large cohort study suggest that ETI in paediatric OHCA, although performed by trained physicians, is associated with a worse outcome, regardless of traumatic or non-traumatic aetiology.

International audience; Aims: There are large differences between emergency medical systems, which may account for variability in outcomes. We seek to compare prehospital organizations, response modes, patient characteristics and outcomes after out-of-hospital cardiac arrest, between France and Canada, and discuss the need for the first European-North American prehospital research network on out-of-hospital cardiac arrest.Methods: Preliminary comparative description of data drawn from two nation-wide, population-based, Utstein-style prospectively implemented registries for out-of-hospital cardiac arrest in France and Canada (France: RéAC, Canada: CanROC), covering approximately 80 million people, and soon to be participating in an international research network in 2020.Results: Since creation, 103,722 cases were included in France and approximately 99,317 in Canada. Data used in this work were drawn from 2011 to 2016, and comprised around 33,688 adult, non-traumatic, treated cases in Canada, and 55,358 in France, leading to estimated incidence rates of 75.3/100,000 inhabitants in France and 83/100,000 in Canada. In both countries, out-of-hospital cardiac arrest predominantly occurred in male patients, in their late sixties, at home, of presumed cardiac aetiology. Bystander cardiopulmonary resuscitation was provided in half of the cases. First assessed cardiac rhythm was shockable in 16% (France) vs. 22% (Canada). Professional resuscitation was attempted in 82% (France) and 60% (Canada). Prehospital organizations and response modes differed in the constitution of responding teams (France: physician-led advanced life support, Canada: trained paramedics), in response time intervals (call to first professional responders' arrival at scene 6.5 min (interquartile range IQR [5.2-8.3]) (Canada) vs. 10 min [7-15] (France)), in on-scene interventions, type of referral at hospital (France: systematic bypass of emergency department, tertiary hospital first, Canada: occasional bypass, mainly closest hospital first), and in outcomes (overall survival at hospital discharge in France: 5% vs. Canada: 11%).Conclusion: Despite similarities in some out-of-hospital cardiac arrest Utstein variables, several differences exist between French and Canadian prehospital systems, and ultimately, between outcomes. The creation of the ReACanROC research network will facilitate the conduction of further analyses to better understand predictors of this variability.

Background Pulmonary embolism (PE) represents 2% to 5% of all causes of out-of-hospital cardiac arrest (OHCA) and is associated with extremely unfavorable prognosis. In PE-related OHCA, inconsistent data showed that thrombolysis during cardiopulmonary resuscitation may favor survival. Methods This was a retrospective, observational, multicenter study from July 2011 to March 2018. All adults with OHCA, treated by a mobile ICU and with a diagnosis of PE confirmed on hospital admission, were included. The primary end point was 30-day survival in a weighted population. Results Of the 14,253 patients admitted to hospitals, 328 had a final diagnosis of PE and 246 were included in the analysis. In the group that received thrombolysis during resuscitation (n = 58), 14 (24%) received alteplase, 43 (74%) received tenecteplase, and one (2%) received streptokinase. Thirty-day survival was higher in the thrombolysis group than in the control group (16% vs 6%; P = .005; adjusted log-rank test) but the good neurologic outcome was not significantly different (10% vs 5%; adjusted relative risk, 1.97; 95% CI, 0.70-5.56). Median duration of stay in the ICU was 1 (0-5) day for the thrombolysis group and 1 (0-3) day for the control group (P = .23). Conclusions In patients with OHCA with confirmed PE and admitted with recuperation of spontaneous circulation in the hospital, there was significantly higher 30-day survival in those who received thrombolysis during cardiopulmonary resuscitation compared with patients who did not receive thrombolysis.

Introduction The targets for vital parameters following return of spontaneous circulation (ROSC) from an out-of-hospital cardiac arrest (OHCA) are based on studies carried out predominantly in intensive care units. Therefore, we studied the pre-hospital phase. Method We included all adult OHCA from the French OHCA Registry. Vital parameters [peripheral oxygen saturation level (SpO2), end-tidal carbon dioxide (ETCO2) and systolic blood pressure (SBP)] documented during the pre-hospital phase by mobile medical team, were evaluated with regard to the neurological outcome on day 30 (classified as good for Cerebral Performance Category (CPC) 1 − 2, and poor for CPC 3 − 5 or death). Results When compared with a reference range of 94–98%, SpO2 values less than 94% were associated with a worse outcome on univariate analysis [relative risk (RR) = 1.108(1.069 − 1.147)]. An SpO2 of 99 − 100% did not appear to be harmful [RR = 0.9851(0.956–1.015)]. ETCO2 values that deviated from the reference of 30 − 40 mmHg were associated with a worse outcome on univariate analysis [ 50, RR = 1.136(1.085 − 1.179)]. When compared with a reference range of 100 − 130, higher or lower values of SBP were associated with a worse outcome on univariate analysis [ 160, RR = 1.168(1.126 − 1.208)]. The multivariate analysis yielded similar results. Conclusion In comatose patients who have achieved ROSC after OHCA, vital parameters in the pre-hospital phase appear to have a real impact on the 30-day neurological outcome. We found that an SpO2 ≥ 94%, an ETCO2 of 30 − 40 mmHg, and an SBP of 100 − 130 mmHg were associated with a better prognosis.

The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low, generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion, may improve this outcome. The main objective of the present study was to determine whether patients with immediate coronary angiography at hospital admission (CAA) had a better outcome than patients without immediate CAA.This cohort analysis study was based on data extracted from the French National Cardiac Arrest registry (RéAC). To control for attribution bias, patients were matched using a propensity score, which included age clusters, low flow and no flow delays, initial rhythm and bystander cardiopulmonary resuscitation (CPR). The main endpoint was survival at day 30 (D30). Secondary endpoint was neurological recovery of survivors assessed by the Cerebral Performance Category (CPC) scale, with CPC 1 and 2 at D30 considered as a favorable outcome.From July 1st, 2011 to October 1st, 2016, 63394 OHCA were registered in the database, of which 39444 were of an unknown or suspected cardiac origin. After on-site resuscitation by a mobile medical team, 7584 patients were transported to a hospital facility. Among these patients, 4046 were retained in the analysis after matching for the aforementioned factors and constituted into 2 groups: immediate coronary angiography (iCAA) group (n = 2023) and non-immediate coronary angiography (niCAA) group (n = 2023). The survival rate at D30 after matching was 43.3% in the iCAA group versus 34.5% in the niCAA group (OD = 0.66 [0.58; 0.75], p 0.001). In the iCAA group, (n = 707) 36% of the patients at D30 were CPC 1-2 comparatively to (n = 539) 27.3% in the niCAA group (p 0.01).Both the survival and proportion of patients with favorable neurological recovery were significantly higher in patients who underwent an immediate coronary angiography after a resuscitated OHCA. These observational results warrant further exploration of the benefit of this invasive strategy in randomized studies.

Background Even if age is not considered the key prognostic factor for survival in cardiac arrest (CA), some studies question whether cardiopulmonary resuscitation (CPR) in the elderly could be futile. Objective The aim of this study was to describe differences in out-of-hospital CA survival rates according to age stratification based on the French National CA registry (ReAC). The second objective was to analyze the differences in resuscitation interventions according to age. Methods We performed a retrospective cohort study based on data extracted from the ReAC. All 18,249 elderly patients (>65 years old) with non-traumatic CA recorded between July 2011 and March 2015 were included. Patients' ages were stratified into 5-year increments. Results Cardiopulmonary resuscitation (CPR) was started significantly more often in younger patients (p = 0.019). Ventilation and automated external defibrillation by bystanders were started without any difference between age subgroups (p = 0.147 and p = 0.123, respectively). No difference in terms of rate of external chest compressions or ventilation initiation was found between the subgroups (p = 0.357 and p = 0.131, respectively). Advanced cardiac life support was started significantly more often in younger patients (p = 0.023). Total CPR duration, return of spontaneous circulation, and survival at hospital admission and at 30 days or hospital discharge decreased significantly with age (p Conclusions This study found that survival in older persons decreased linearly by 3% every 5 years. However, this diminished rate of survival could be the consequence of a shorter duration and less advanced life support.

To evaluate the prevalence of advance directives and their impact on the management of out-of-hospital cardiac arrest (OHCA) victims.We analyzed data extracted from the French national registry of adult OHCA patients (RéAC). The data concerned the emergency medical services (EMS) of a Paris suburb over the period 01/01/2013 to 30/11/2015. The primary endpoint was the prevalence of advance directives. Secondary endpoints were the characteristics of the population, of cardiac arrest, and of basic life support as well as outcomes in patients with or without advance directives.Advance directives were available for 148/1985 (7.5%) of OHCA patients. Advanced life support was given to 35 patients with directives and 941 patients without (24% vs. 51%, p0.0001) with no significant difference in the characteristics of the support provided. Spontaneous recovery of cardiac activity was observed in 5 patients with directives and in 217 patients without (14% vs. 23%, p=0.3). Among patients with advance directives, only one was admitted to hospital. He/she died within 24h of admission.Advance directives were accessed by EMS for 7.5% OHCA patients. Despite their availability, advanced life support was provided to 24% of patients.

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...

Discipline Clinique. Introduction et but de l’etude La denutrition affecte 5 a 10 % des sujets âges vivant a domicile. Une intervention nutritionnelle pourrait engendrer des economies de couts. L’etude ENNIGME a compare les couts de sante chez les patients âges et denutris vivant a domicile en fonction de la prescription ou non de complements nutritionnels oraux (CNO). Materiel et methodes Cette etude observationnelle prospective multicentrique a inclus des patients âges de 70 ans et plus, denutris (criteres HAS) vivant a domicile. Les CNOs etaient prescrits par les medecins generalistes selon leur pratique habituelle. Les couts de sante et d’hospitalisations ont ete enregistres sur une periode de six mois. Les autres donnees recueillies etaient l’IMC, la perte de poids, l’appetit, les comorbidites, la dependance, la perception de l’etat de sante actuel, la qualite de vie et la compliance aux CNO. Resultats et analyse statistique Au total, 191 patients ont ete analyses. A l’inclusion, les 133 patients ayant recu des CNO etaient plus dependants (p Conclusion Cette etude observationnelle montre que les medecins generalistes prescrivent des CNO chez les sujets âges denutris les plus dependants et les plus anorexiques, avec le plus grand risque d’hospitalisation. La prescription de CNO ne genere pas de cout supplementaire et une bonne compliance au traitement (apports energetiques et protidiques eleves) est associee a une reduction du risque d’hospitalisation et des couts de sante.

Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. French SAMU experienced registers especially in the field of acute coronary syndrom. Our national register "ReAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use.

Objectifs Le risque de denutrition augmente avec l’âge, avec une prevalence atteignant 70 % chez les personnes hospitalisees, 40 % pour celles vivant en institution et seulement 4 a 10 % chez celles vivant a domicile. La prise en charge de la denutrition s’appuie en premiere intention sur des conseils nutritionnels, une aide a la prise alimentaire, l’enrichissement qualitatif de l’alimentation, et la prise de complements nutritionnels oraux (hyper-energetiques et/ou hyperproteines). L’objectif principal de cette etude est de comparer les couts de sante des sujets âges denutris vivant a leur domicile selon la prise ou non de CNO. Les objectifs secondaires sont d’evaluer le respect du traitement et des posologies de CNO, de determiner le seuil de prise de CNO a partir duquel un benefice clinique et/ou economique est statistiquement mis en evidence. Methodes ENNIGME est une etude observationnelle, prospective, comparative en medecine generale. Cinq cents medecins generalistes ont ete recrutes pour un objectif de 500 a 1000 patients. Il s’agit de patients vivant a domicile, âges de plus de 70 ans, avec un diagnostic de denutrition etabli sur les criteres HAS. Le choix de traiter ou non la denutrition appartient au medecin, CNO ou pas. Un suivi a six mois est realise, avec une evaluation a un ou trois mois. Le medecin recueille a l’inclusion la prise en charge nutritionnelle, l’autonomie du patient, la consommation de soins. Chaque patient renseigne un agenda de prise des traitements sur le premier mois. Le suivi recueille l’observance, la prise en charge nutritionnelle, les evenements cliniques et la consommation de soins. Une EVA de qualite de vie et un questionnaire EQ5D sont renseignes a chaque evaluation. Les informations economiques sont obtenues par le biais des releves assurance maladie et des comptes rendus d’hospitalisation. Sont collectes les couts d’hospitalisation, de prescription et d’observance des CNO consommes. Resultats L’etude est demarree depuis 2013, la participation effective des medecins generalistes s’avere difficile. Debut 2015, 340 patients etaient inclus et le taux de donnees de suivi a trois et six mois etaient respectivement de 51 % et 40 % mais devraient augmenter, l’etude etant toujours en cours. Les patients seront repartis en deux groupes en fonction de la quantite cumulee de CNO reellement consommee et une comparaison des couts de sante sera realisee. Le groupe CNO sera subdivise en deux sous-groupes (patients ayant une observance d’au moins la moitie de la quantite prescrite et patients avec une prise « non optimale » des CNO) afin d’analyser les seuils d’observance a partir desquels on observe un benefice economique. Les couts d’hospitalisations des groupes de patients definis seront compares en fonction des quintiles d’observance des CNO afin de determiner le niveau d’observance permettant une diminution des couts d’hospitalisation par rapport au niveau d’observance inferieur. Conclusion L’etude ENNIGME, realisee en situation d’observation du sujet âge denutri vivant au domicile, presente des originalites a souligner au niveau de la methodologie et de ses objectifs economiques. Les resultats permettront de mieux documenter l’interet des CNO dans la population âgee.

With the steady rise in the prevalence of overweight/obesity and its comorbidities in the pediatric population, it seems necessary to watch and stimulate the engagement of a majority of children in a regular physical activity. To do this, it seems crucial to know and handle properly the determinants or influences of the habitual physical activity (HPA) of children, especially when it is about overweight/obesity children. This article is an update and a review of existing data on the determinants of HPA with reference to overweight/obesity in childhood. Current data suggest that self-efficacy and physical competence are key motivators and solid anchor points for the initiation and engagement of children in a regular physical activity. In particular, for overweight/obese children, intervention strategies should first concentrate on improving these psychosocial dimensions around which other physiological components (capacity factors) and environmental (reinforcement factors) could revolve. These strategies should involve a multidisciplinary professional team (epidemiologists, actiphysists, teachers, physicians, psychologists, urban planners, local councillors) not only pursuing the same objective but with sufficiently varied skills to be effective at their respective levels.

Clinical decision support systems are a combination of software techniques to help the clinicians in their medical decision making process via functionalities ranging from basic signal analysis to therapeutic planning and computerized guidelines. The algorithms providing all these functionalities must be very carefully validated on real patient data and must be confronted to everyday clinical practice. One of the main problems when developing these techniques is the difficulty to obtain high-quality complete patient records, comprising data coming both from the biomedical equipment (high-frequency signals), and from numerous other sources (therapeutics, imagery, clinical actions, etc.). In this paper, we present an infrastructure for developing and testing such software algorithms. It is based on a bedside workstation where testing different algorithms simultaneously on real-time data is possible in the ward. It is completed by a collaborative portal enabling different teams to test their software algorithms on the same patient records, making comparisons and cross-validations more easily.

Purpose: The purpose of the study was to present a methodological approach enabling the comparison of clinical and economic performances of intensive care units and a graphical visualization based on these 2 dimensions. Patients and Methods: A retrospective analysis of a database of 666 patients admitted in intensive care units over a period of 2 consecutive months. Results: Calculation of clinical performance is based on the difference between the mortality observed and forecast from the Simplified Acute Physiology Score version 2. The evaluation of resource consumption is carried out from the measure of medical and paramedical care workload. These 2 scores are modeled on the basis of the length of stay and the severity state of the patient. The economic performance is calculated on the basis of the difference between the resource consumption observed and forecast. The graphs are constructed by taking up as coordinates the values of the clinical and economic performances of each center. Conclusion: These graphs enable the identification of the most deviating intensive care units to study, for example, their organizational, technical, or human resource setup accounting for their position.

Resume La traumatologie est un probleme majeur de sante publique. Le polytraumatisme de l’enfant constitue la premiere cause de deces chez les plus d’un an. En France, le PTS est le score de « triage » le plus utilise en pre-hospitalier. Il est souvent couple au score de Glasgow. L’objectif de l’etude est l’evaluation de l’interet predictif du PTS en terme de morbi-mortalite. Il s’agit d’une etude retrospective de 108 dossiers du SAMU de Lille, sur une periode de 5 ans, et dont le suivi a ete realise selon la filiere d’orientation. La survie est analysee a J0, J8, J28 et 1 an. Les sequelles ont ete classees selon l’echelle d’autonomie de Glasgow. Les tests du χ2, de Mann-Whitney et de Kruskal-Wallis ont ete utilises. La population etudiee compte 60 % de garcons ; l’âge moyen est de 8 ans. Les accidents de la voie publique representent la circonstance principale (73 %). Le traumatisme crânien, seul ou associe, est la lesion preponderante, grevee d’une forte mortalite et responsable de lourdes sequelles. Au total, 21 deces sont survenus. Il existe une relation significative entre le PTS et la mortalite a J0, J8, J28 (p = 0,000), mais pas en fonction des lesions observees (p = 0,173) A un an, le PTS a montre son interet en terme de mortalite, mais il reste modeste pour l’appreciation du deficit mineur, du coma vegetatif et du retour ad integrum. Il ne permet guere d’analyser les lesions qui conditionnent le handicap.

The Raman spectra of the hexagonal (β) and cubic spinel (γ) forms of Ge3N4, newly obtained by high-pressure synthesis, have been measured and are compared with zone-center phonon frequencies calculated using first principles methods in a plane wave pseudopotential local density approximation. The observed and calculated phonon frequencies are in excellent agreement and we use the calculated values to perform mode assignment for both the phases. Both phases show all the expected Raman active modes.

The stoichiometry of boron suboxide (B6O1−δ) synthesized from mixtures of boron and boron oxide (B2O3) at high pressure lies closer to the nominal composition (δ=0) than materials obtained at atmospheric pressure. The materials obtained in the high pressure syntheses in the presence of molten B2O3 also have a higher degree of crystallinity than for sintered powders. For syntheses at temperatures of 1700–1800°C at pressures between 4 and approximately 5.5 GPa, the well-crystallized particles are dominated by icosahedral multiply-twinned particles up to approximately 40 μm in diameter. This unusual morphology is obtained by Mackay packing, i.e., by assembly of successive shells of icosahedral B12 units around a central icosahedral nucleus to give a multiply twinned particle in which each of the 20 elements has the R 3 m space group of the rhombohedral α-B structure. We examine the thermodynamic and kinetic factors associated with the development of this morphology during high pressure growth and use ab initio calculations to investigate the energetic driving forces for initiation of the Mackay packing around the central icosahedral nucleus.

Hexagonal boron nitride (hex BN) containing significant amounts of C and O substituting for N (hex BCNO) was synthesized at 75 kbar and 1700°C from mixtures of C, B2O3, and amorphous B contained in a hex BN crucible. Hex BCNO is a minor constituent of the product and occurs as small

Introduction et but de l’etude Le risque de denutrition augmente avec l’âge, avec une prevalence atteignant 70 % chez les personnes hospitalisees, 40 % pour celles vivant en institution et seulement 4 a 10 % chez celles vivant a domicile. La prise en charge de la denutrition s’appuie en premiere intention sur des conseils nutritionnels, une aide a la prise alimentaire, l’enrichissement qualitatif de l’alimentation, et la prise de complements nutritionnels oraux (hyper-energetiques et/ou hyperproteines). L’objectif principal de cette etude est de comparer les couts de sante des sujets âges denutris vivant a leur domicile selon la prise ou non de complements nutritionnels oraux (CNO). Les objectifs secondaires sont d’evaluer le respect du traitement et des posologies de CNO, de determiner le seuil de prise de CNO a partir duquel un benefice clinique et/ou economique est statistiquement mis en evidence. Materiel et methodes L’etude proposee est observationnelle, prospective, comparative en medecine generale. 500 medecins generalistes ont ete recrutes pour un objectif de 500 a 1 000 patients. Il s’agit de patients vivant a domicile, de plus de 70 ans, avec un diagnostic de denutrition etabli sur les criteres HAS. Le choix de traiter ou non la denutrition appartient au medecin, CNO ou pas. Un suivi a 6 mois est realise, avec une evaluation a 1 ou 3 mois. Le medecin recueille a l’inclusion la prise en charge nutritionnelle, l’autonomie du patient, la consommation de soins. Chaque patient renseigne un agenda de prise des traitements sur le premier mois. Le suivi recueille l’observance, la prise en charge nutritionnelle, les evenements cliniques et la consommation de soins. Une EVA de qualite de vie et un questionnaire EQ5D sont renseignes a chaque evaluation. Le medecin recueille les donnees de consommation de soins par l’interrogatoire, consulte les releves d’assurance maladie en presence du patient (ou en demande une copie), et transmet les compterendus d’hospitalisation anonymises. Les informations economiques sont obtenues par le biais des releves assurance maladie et des CR d’hospitalisation. Sont collectes les couts d’hospitalisation, de prescription et d’observance des CNO consommes. En cas d’absence de retour des patients, ceux-ci sont contactes directement par telephone par une equipe independante. Resultats et Analyse statistique L’etude ENNIGME est demarree depuis 2013, la participation effective des medecins generalistes s’avere difficile. En septembre 2014, 340 patients etaient inclus, le taux de donnees de suivi a 3 mois et 6 mois etaient respectivement de 51 % et 40 % mais devraient augmenter puisque l’etude est toujours en cours. Les patients seront repartis en deux groupes en fonction de la quantite cumulee de CNO reellement consommee et une comparaison des couts de sante sera realisee. Le groupe CNO sera subdivise en deux : un sous-groupe de patients ayant une observance d’au moins la moitie de la quantite prescrite (estime entre 50 % et 70 %), et un autre concernant les patients avec une prise « non optimale » des CNO. L’interet de cette dichotomie sera d’analyser les seuils d’observance a partir desquels on observe un benefice economique. Les couts d’hospitalisations des groupes de patients definis seront compares en fonction des quintiles d’observance des CNO afin de determiner le niveau d’observance permettant une diminution des couts d’hospitalisation par rapport au niveau d’observance inferieur. Conclusion L’etude ENNIGME, realisee en situation d’observation du sujet âge denutri vivant au domicile, presente des originalites a souligner au niveau de la methodologie et de ses objectifs economiques. Les resultats permettront de mieux documenter l’interet des CNO dans la population âgee. Remerciements : L’etude est realisee avec le soutien des ENTREPRISES DE LA NUTRITION CLINIQUE (ENC) pour le SYNDICAT FRANCAIS DE LA NUTRITION SPECIALISEE (SFNS), et du groupe ALLIANCE7.

We synthesized severalα-rhombohedral B-rich materials belonging to the B–C–N–O system using a multianvil press. B–C–O materials were prepared by reacting mixtures of B, C, and B2O3in the 5 to 7.5 GPa pressure range and at a temperature of 1700°C. Powder X-ray diffraction and parallel electron energy-loss spectroscopy with a transmission electron microscope showed that the BxCyOzphases obtained are based on theα-rhombohedral B structure. Crystals of composition B6C1.1O0.33to B6C1.28O0.31ranging in size from 1 to 20 μm were grown. Small transparent lustrous red cleavage flakes were obtained for stoichiometries close to B6O. The growth of boron carbide nanorods was also observed in some of the run products. We report the first conclusive bulk synthesis of a new boron nitride, B6N1−x, obtained by reacting B and hexagonal BN at 7.5 GPa and 1700°C. The structure of this compound is derived from that ofα-rhombohedral B (space groupeR 3 m) and the refined hexagonal cell parameters areah=5.457 A andch=12.241 A.

Resume Un nombre approprie d'infirmieres est un des prerequis indispensables pour assurer des soins de qualite. Le PRN 87 (projet de recherche en nursing) repose sur le recueil quotidien, a partir d'un plan de soins, de 118 actes de soins repartis en huit groupes et pouvant prendre 249 modalites. A chaque acte de soins est attribuee une valeur fixe fonction du temps requis (un point est egal a cinq minutes). Le PRN 87 est probablement l'indicateur de reference. Mais pour prevoir et gerer les ressources, un outil plus simple est necessaire. Le but de ce travail est d'elaborer un indicateur d'evaluation de la charge en soins infirmiers (CES) en reanimation, utilisable en routine. Une etude multicentrique comparant systeme Omega et PRN 87 (25 services - 735 patients) a permis de collecter, pour 103 patients (âge : 56 ± 17 ans; duree de sejour 9 ± 12,3 jours; IGS : 13 ± 7), le detail quotidien des actions de soins realisees pendant leur sejour. A partir d'un collectif de 732 scores PRN journaliers (score moyen 124 ± 47,8), un indicateur simplifie a ete elabore par la selection d'un nombre restreint d'actes de soins pour chacun des huit groupes constituant le PRN, de telle maniere a respecter le plan de soins (analyse en composantes principales et regression multiple pas a pas). Les actions retenues ont ete ensuite ponderees en realisant une regression multiple sur la base des scores PRN journaliers. Le modele obtenu comporte 35 actes de soins (PRN Rea). La correlation entre la CES obtenue par le PRN Rea et la CES mesuree par le PRN 87 est excellente (r = 0,98 ; p Le PRN Rea est un bon indicateur de la CES infirmiers en reanimation. Il permet d'evaluer la CES en utilisant un nombre restreint d'actes de soins. Cependant, la pertinence de cet outil, plus simple que le systeme PRN, doit etre evaluee par une etude de validation prospective et multicentrique surtout pour les services specialises.

Introduction La mise en place d’un defibrillateur automatique (DA) est souvent l’occasion d’une sensibilisation (formation) aux gestes qui sauvent. C’est autour d’un package « installation–information–formation » que doit se construire la politique de sante publique sur l’AC. L’objectif de notre etude est de montrer que cette mobilisation (exprime in fine par l’utilisation d’un DA) lorsqu’elle existe est une source de gain en termes de survie pour la victime. Materiel et methodes Etude prospective, comparative, multicentrique basee sur les donnees recueillies par le ReAC entre le 01/07/2011 et le 01/11/2014. Nous avons compare en termes de survie le groupe des patients en arret cardiaque medical (ACM) avec pose de DA sans CEE (G1) avec le groupe des patients en ACM avec un rythme non choquable et n’ayant pas beneficie de la pose d’un DA (G2). Resultats Parmi les 31 981 AC enregistres, 28 851 etaient des ACM. L’âge median est de 71 [52 ;82] ans et le noflow median est de 7 [1 ;13] min. Parmis les victimes, 64,3 % sont des hommes. L’AC survient majoritairement a domicile (74,1 %). Il y a un temoin dans 35,5 % des cas. Quarante-neuf pour cent d’entre eux mettent en place une RCP immediate dont 47,2 % sur conseil telephonique. La presence d’un DA est documentee dans 14,6 % et ils sont utilises dans 83,2 % des cas. Soixante-dix-huit pour cent des temoins posant le DA ont beneficie d’une formation dont 55,2 % de trois heures. Un choc est delivre dans 31,7 % des cas. Les patients G1 survivent mieux que les patients G2. On retrouve 32,6 % de RACS au sein du G1 vs 17,1 % (p Discussion L’interet d’une defibrillation precoce n’est plus a demontrer. Cette etude nous permet d’affirmer que la pose d’un DA (meme non suivie d’un CEE) influence de maniere significative la survie. L’utilisation d’un DA est l’expression finale de la mise en œuvre du package « installation–information–formation ». C’est pourquoi une formation est aussi necessaire qu’une information en raison du lien direct qui existe entre l’utilisation spontanee d’un DA et une formation a la RCP de base. Cependant, le fait que la presence d’un DA n’a ete observee que dans 14,6 % des cas confirme la necessite d’un recensement et d’une mise a disposition de l’information de geolocalisation.

Introduction Les arrets cardiaques resultant d’une pendaison (ACP) sont une des causes majeures d’arret cardiaque traumatique. Leur survie est reconnue catastrophique (Deasy 13). Cette etude a pour enjeu de mettre en lumiere les caracteristiques des patients survivant avec un bon pronostic neurologique. Materiel et methodes Etude prospective, comparative, multicentrique basee sur les donnees recueillies par le ReAC entre le 01/07/2011 et le 01/11/2014. Resultats Au total, 1467 patients ont ete inscrits dans le cadre d’un ACP. Trente-deux pour cent des interventions a mene une decouverte de cadavre. L’etude a donc porte sur 996 individus. L’âge des patients survivants avec un bon CPC (S+) n’etait pas different des autres patients (S–) (46 vs 49 ans ; p = 0,446). Quatre-vingt-treize pour cent des S+ etaient des hommes (vs 77,0 % ; p 5 min contre 24 % des S– ( p –3 ). Une RCP immediate etait mise en place sur la moitie des S+ vs 26,9 % des S– ( p –3 ). Le premier rythme observe par le SMUR etait une RACS dans 78,6 % chez les S+ vs asystole dans 94,8 % des S– ( p –3 ). Le delai moyen d’arrivee du SMUR etait plus court chez les S+ (19 vs 21 min ; p = 0,046) ainsi que le delai moyen de RACS (3 vs 18 min ; p –3 ). Les patients S+ etaient majoritairement des hommes (92,9 %). Treize (92,9 %) ont eu un retour d’activite cardiaque spontanee sur place. Le dernier patient etait en fibrillation ventriculaire et transporte sous planche a masser. Parmis les 14 survivants avec un bon pronostic neurologique, 11 n’avaient pas garde de sequelles (CPC1), 3 avaient de legeres sequelles (CPC2). Discussion La survie des patients en ACP est faible mais non negligeable. Une reanimation la plus prompte possible est un element essentiel de la survie. Des mesures de prevention doivent egalement etre mises en place.

Introduction Les aeroports sont des lieux d’experimentation ou l’efficacite (voire l’efficience) de l’installation des defibrillateurs automatiques (DA) en libre acces a ete tres largement testee. Soumis a un grand volume de passage et souvent a un maillage fin de la zone en equipements (DA), l’objectif de notre etude est d’etudier les prises en charge des AC dans ces lieux publics aux caracteristiques specifiques. Materiel et methodes Etude prospective, comparative, multicentrique basee sur les donnees recueillies par le ReAC entre le 01/07/2011 et le 01/11/2014. Resultats Nous avons analyse 78 ACA. On compte 83,3 % d’hommes. L’âge median est de 63 (52–70) ans. Ils sont a 93,6 % d’origine medicale et 30 % des patients avaient des antecedents de maladies cardiovasculaires. Le delai median d’arrivee des SP est de 5 (1–10) min et le delai median d’arrivee du SMUR est 20 (12–30) min. 65,6 % des victimes d’AC a l’aeroport avaient une duree de no-flow inferieure a 5 minutes. Les trois quarts des patients etaient pris immediatement en charge par un temoin dont 53,8 % beneficiaient de la mise en place d’un DA. 23,1 % d’entre eux ont recu un CEE. Une RCP pompier a ete mise en place dans 84,6 % des cas. Le premier rythme observe ; a l’arrivee du SMUR etait un rythme non choquable dans 60 % des cas, un rythme choquable dans 13,3 % des cas et 26,7 % des patients avaient repris une activite cardiaque spontanee. Une RCP specialisee par le SMUR etait mise en œuvre chez 87,2 % des ACA. 37,2 % des victimes ont eu une RACS. 34,6 % etaient vivants a l’admission a l’hopital. 2,6 % etaient sous MCE automatique. A J+30, 14,1 % des patients avaient survecu dont 81,9 % avec un bon pronostic neurologique (CPC 1 ou 2). Parmi eux, 27,3 % ont beneficie de l’implantation d’un defibrillateur. La cause cardiaque de l’arret a ete retenue dans 28 % des cas. 45,5 % des survivants sont retournes immediatement a domicile a la sortie de reanimation, 27,3 % ont ete accueillis en soins continus, 18,2 % ont change de service ou d’hopital et 9,1 % sont partis en readaptation. Discussion Les victimes d’arret cardiaque a l’aeroport sont tres souvent prises en charge rapidement par les temoins, les SP et les equipes du SMUR. Elles beneficient plus souvent que dans la population generale d’une defibrillation initiee par les temoins. La rapidite de mise en œuvre des differents maillons de la chaine de survie est un facteur clef d’amelioration du pronostic du patient.