Estimation des coûts engendrés par l'occupation inappropriée des lits de soins aigus du CHUV par des patients en attente de placement

[Table des matières] 1. Pourquoi s'intéresser à l'occupation inappropriée des lits de soins aigus au CHUV ?. - 1.1. Etat des lieux. - 1.1.1. Les chiffres du CHUV. - 1.1.2. La cellule de gestion des flux de patients. - 1.1.3. L'unité de patients en attente de placement. - 1.1.4. La pénurie de lits dans les EMS vaudois. - 1.1.5. Le vieillissement de la population vaudoise. - 1.2. Evidences nationales et internationales. - - 2. Estimation des coûts. - 2.1. Coûts chiffrables. - 2.1.1. Perte financière directe. - 2.1.2. Coûts des transferts pour engorgement. - 2.1.3. Coût d'opportunité. - 2.2. Coûts non chiffrables. - 2.2.1. Patients. - 2.2.2. Personnel médical. - 2.2.3. CHUV. - - 3. Propositions. - 3.1. Prises en charge alternatives. - 3.1.1. Les réseaux intégrés de services aux personnes âgées. - 3.1.2. Les courts séjours gériatriques. - 3.1.3. Autres solutions. - 3.2. Prévention. - 3.2.1. Prévention des chutes. - 3.2.2. La prévention par l'information aux personnes âgées. - 3.2.3. La prévention par l'information à l'ensemble de la population

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

Data were prospectively obtained from exclusively breast-fed healthy term neonates at birth and from healthy mothers with no obstetric complication to determine risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants. Thirty-four neonates with a weight loss > or = 10% were diagnosed between April 2001 and January 2005. Six of 18 infants who were eligible for the study had hypernatremia. Breast conditions associated with breast-feeding difficulties (P < 0.05), primiparity (P < 0.005), less than four stools (P < 0.001), pink diaper (P < 0.001), delay at initiation of first breast giving (P < 0.01), birth by cesarean section (P < 0.05), extra heater usage (P < 0.005), extra heater usage among mothers who had appropriate conditions associated with breast-feeding (P < 0.001), mean weight loss in neonates with pink diaper (P < 0.05), mean uric acid concentration in neonates with pink diaper (P < 0.0001), fever in hypernatremic neonates (P < 0.02), and the correlation of weight loss with both serum sodium and uric acid concentrations (P < 0.02) were determined. Excessive weight loss occurs in exclusively breast-fed infants and can be complicated by hypernatremia and other morbidities. Prompt initiation of breast-feeding after delivery and prompt intervention if problems occur with breast-feeding, in particular poor breast attachment, breast engorgement, delayed breast milk "coming in", and nipple problems will help promote successful breast-feeding. Careful follow-up of breast-feeding dyads after discharge from hospital, especially regarding infant weight, is important to help detect inadequate breast-feeding. Environmental factors such as heaters may exacerbate infant dehydration.

Un modèle global et intégré de la performance : application à l’urgence d’un hôpital au Mexique

À cause de la nature complexe et non linéaire de leurs opérations, les salles d’urgence (SU) constituent des entités organisationnelles uniques dans le domaine de la santé. Les SU subissent des pressions accrues résultant des dynamiques des sociétés contemporaines et de leurs systèmes de santé, et font face ainsi à des défis uniques comme l’engorgement. Contrairement aux croyances dominantes sur le phénomène, le présent travail de recherche établit que ce problème est en réalité une manifestation de pauvre performance systémique plutôt qu’une faillite opérationnelle. Alors, pour les SU, la performance organisationnelle relève une importance incontestable. En effet, l’étude de la performance organisationnelle est un sujet de recherche qui intéresse de nombreux chercheurs des services de santé. Il s’agit, néanmoins, d’un concept historiquement difficile à définir à cause de son caractère complexe, multidimensionnel et paradoxal. Le modèle EGIPSS, basé sur la théorie de l’action sociale de Parsons, est capable de saisir cette complexité et constitue un cadre conceptuel robuste et exhaustif, pouvant s’adapter à des contextes divers. Ce mémoire adopte le modèle EGIPSS pour présenter un outil global et intégré d’évaluation de la performance organisationnelle de la salle d’urgences de l’Hôpital Général Régional 46 à Guadalajara, au Mexique. Cet instrument est conçu pour prendre en compte spécifiquement les particularités propres des SU, ainsi que les caractéristiques organisationnelles uniques de l'Hôpital Général Régional 46. Enfin, le développement de ce projet de mémoire contribue aux efforts d’amélioration continue de la performance de cet établissement, et enrichit les connaissances sur les urgences en tant qu’unités organisationnelles.

Cutaneous Basophilia in the Resistance of Goats to Amblyomma cajennense Nymphs after Repeated Infestations

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Guinea Pigs Develop Cutaneous Basophilia after Repeated Infestations by Nymphs of the Tick Amblyomma triste

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aspectos clínicos, ultra-sonográficos e venográficos da tromboflebite jugular experimental em equinos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Morphological and enzymatic analysis of the midgut of Anopheles darlingi during blood digestion

The midgut of adult female Anopheles darlingi is comprised of narrow anterior and dilated posterior regions, with a single layered epithelium composed by cuboidal digestive cells. Densely packed apical microvilli and an intricate basal labyrinth characterize each cell pole. Before blood feeding, apical cytoplasm contains numerous round granules and whorled profiles of rough endoplasmic reticulum. Engorgement causes a great distension of midgut. This provokes the flattening of digestive cells and their nuclei. Simultaneously, apical granules disappear, the whorls of endoplasmic reticulum disassemble and 3 h post bloodmeal (PBM), nucleoli enlarge manyfold. An intense absorptive process takes place during the first 24h PBM, with the formation of large glycogen inclusions, which persist after the end of the digestive process. Endoproteases activities are induced after bloodmeal and attain their maximum values between 10 and 36 h PBM. At least two different aminopeptidases seem to participate in the digestive process, with their maximum activity values at 36 and 48 h PBM, respectively. Coarse electrondense aggregates, possibly debris from digested erythrocytes, begin to appear on the luminal face of the peritrophic membrane from 18 h PBM and persist during all the digestive process, and are excreted at its end. We suggest that these aggregates could contain some kind of insoluble form of haem, in order of neutralize its toxicity. (c) 2005 Elsevier Ltd. All rights reserved.

Action of permethrin on Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) semi-engorged females: Morpho-physiological evaluation of salivary glands

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Copulation is necessary for the completion of a gonotrophic cycle in the tick Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cytotoxic effects of permethrin in salivary glands of Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) semi-engorged females

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of fipronil (active ingredient of Frontline (R)) on salivary gland cells of Rhipicephalus sanguineus females (Latreille, 1806) (Acari: Ixodidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cytoplasmic RNA and nuclear changes detected cytochemically during the degeneration of salivary glands of the tick Rhipicephalus sanguineus (Latreille, 1806) (Acari, Ixodidae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Death by apoptosis in salivary glands of females of the tick Rhipicephalus sanguineus (Latreille, 1806) (Acari : Ixodidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Potential of the insect growth regulator, fluazuron, in the control of Rhipicephalus sanguineus nymphs (Latreille, 1806) (Acari: Ixodidae): Determination of the LD95 and LD50

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ticks (Acari : Ixodidae) parasitizing humans in an Atlantic rainforest reserve of Southeastern Brazil with notes on host suitability

While conducting projects on ticks from deer and on tick ecology in animal trails in an Atlantic rainforest reserve in Southeastern Brazil, researchers of our group were bitten by ticks several times. Some of these episodes were recorded. Three species of adult ticks attached to humans: Amblyomma brasiliense Aragauo, Amblyomma incisum Neumann, and Amblyomma ovale Koch. Eight nymphal attachments with engorgement on humans were recorded. From these, six molted to adults of A. incisum, one to an adult of A. brasiliense, and one had an anomalous molting, therefore the adult tick could not be properly identified. Local reactions to tick attachment varied among individual hosts from almost imperceptible to intense. Especially itching, but hyperemia and swelling as well, were prominent features of the reaction. Overall it can be affirmed that human beings can be a physiologically suitable host species for ticks in the Atlantic rainforest and that itching was an important if not the major component of the resistance to tick bite.