Rev Epidemiol Sante
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The purpose of this study was to assess early readmission as an indicator of quality of care, to estimate the frequency of avoidable emergency readmission in a French hospital, and then to describe the feasibility and contribution of routine use of this indicator. ⋯ Unforeseen early readmission can be an indicator of quality of the care taking process. It is however impossible to use the current database to classify with certainty readmissions as "unforeseeable" or "avoidable". Emergency unit readmission could offer a possible approach to measuring the frequency of unforeseen readmission. This ratio can provide caretakers with information concerning the quality of care and thus help in making decisions concerning reorganization for improvement.
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Rev Epidemiol Sante · Oct 2000
Review[Anesthesia and postoperative cognitive dysfunction in the elderly: a review of clinical and epidemiological observations].
Amnesic effects of anesthesia were first reported two hundred years ago, but the term postoperative cognitive dysfunction (POCD) has appeared only recently, covering a larger range of neuropsychological modifications resulting from surgical intervention. The clinical description of POCD is highly variable, ranging from concentration impairment to delirium. Significant short-term POCD is common in elderly persons, and can persist several months, varying both in time and intensity and affecting the full-range of cognitive functions (visual and auditory attention, primary and secondary memory, implicit memory, and visuospatial functioning). ⋯ We review the definition, epidemiology, etiology, pathophysiology and the clinical and public health implications of POCD. The effects of anesthetics are described in relation to ageing-related physiological changes. It is concluded that the complex interaction of etiological factors makes it difficult to determine at this point of time to what extent POCD may be attributed specifically to anesthetic agents.
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Rev Epidemiol Sante · Oct 1999
Comparative Study[Utilization of hospital emergency service for primary care (study at the Children's Hospital of Rabat, Morocco)].
Utilisation of emergency department (ED) for non-urgent problems, usually dealt with in first line health services (FLHS), has an impact both in terms of efficiency (ED care is more expensive than primary health care) and in terms of quality of care (due to ED overcrowding). This study describes the utilisation pattern of the ED at the Children's Hospital of Rabat (CHR) and assesses the appropriateness of ED utilisation. ⋯ Results confirmed the opinion of the CHR staff: most children admitted to the ED had health problems that should have been cared for at FLHS. Rationalisation of ED utilisation will depend on the health system's ability to supply acceptable and accessible care at FLHS.
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The need and demand for comparable comprehensive health data and health information is growing in Europe. Many countries have intensified development of their health information systems and health reporting. The World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and other international organizations collect health data and publish comparative health reports. ⋯ The HMP should support projects which pave the way for permanent EU health monitoring and its work should be clearly prioritised. Also, the expertise in health monitoring and the ability to steer the HMP and related EU developments should be strengthened. This can best be done by close collaboration with experienced expert institutes from the Member States, and by collaboration with WHO and OECD.
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Rev Epidemiol Sante · Mar 1998
[Information campaign on child care practices: measure of the effects on sleep position and sudden infant death syndrome].
To define the prevalence of the child care practices questioned in the sudden infant death syndrome (SIDS), especially the prone sleep position, before and after an information campaign. To evaluate the effects of this action on the postneonatal mortality. ⋯ The sleeping position which is the main factor questioned in SIDS was modified, and the postneonatal mortality decreased. The specific action conducted for the present epidemiological research is probably not the only contributor in these positive results.