Epidémiologie de la psychiatrie de consultation-liaison du Centre Psychosocial Neuchâtelois dans le service de Médecine interne de l'Hôpital de la Chaux-de-Fonds en 1994 et 1998 : Interactions et régulations

Résumé La psychiatrie de consultation-liaison (CL) connaît depuis une décennie un essor majeur en Europe sous l'impulsion des recherches multicentriques du groupe European Consultation Liaison Psychiatry - ECLVV (Huyse). En Suisse, la discipline reste à développer par manque de consultants spécialisés selon le rapport 2000 de l'Association des professeurs titulaires de chaires. Néanmoins une harmonisation progressive des standards européens de documentation et d'évaluation apparaît progressivement, notamment dans les travaux du Service de Psychiatrie de Liaison du Centre Hospitalier Universitaire Vaudois. Afin d'améliorer sa pratique de consultation-liaison qui restait jusqu'alors frustrante par un sentiment de débordement et d'absence de feed-back des interventions, le Centre Psychosocial Neuchâtelois de La Chaux-de-Fonds (CPS) a constitué une base de données informatisée de CL à des fins de recherche-action selon les recommandations du groupe ECLVV. Nous avons comparé les valeurs de prévalence de notre activité de CL dans le service de médecine interne de l'Hôpital de La Chaux-de-Fonds en 1994, année du début de l'informatisation des données du CPS, et en 1998, année des plus récents résultats exploitables. La taille de l'échantillon était de 78 cas pour 1994 et de 108 cas pour 1998. Les résultats de notre étude épidémiologique rétrospective et descriptive montraient une augmentation en volume des demandes de CL, une diversification et une complexification des cas. Cette charge croissante sur la psychiatrie de consultation-liaison s'observait également dans les données de la littérature. La réponse psychiatrique du CPS montrait une modestie de moyens et du pragmatisme dans le style des interventions. Ces dernières étaient essentiellement de nature de psychiatrie générale et d'urgence, focalisée sur les tentatives de suicides. Les tentamens, ici comme ailleurs, restent le noyau dur de toute pratique de psychiatrie à l'hôpital général. L'état de lieu de notre pratique de consultation-liaison issu de ce travail a permis de créer une base de données simplifée étendue à l'ensemble des demandes de consultation au CPS afin de réguler le flux de toutes ses interventions face aux demandes toujours croissantes. Dans ce sens, notre étude a montré la nécessité de formaliser les demandes de consultation psychiatrique à l'hôpital général afin d'optimaliser les réponses des consultants.

Anomalous crystallization of hydrogenated amorphous silicon during fast heating ramps

Thermal crystallization experiments carried out using calorimetry on several a-Si:H materials with different microstructures are reported. The samples were crystallized during heating ramps at constant heating rates up to 100 K/min. Under these conditions, crystallization takes place above 700 C and progressively deviates from the standard kinetics. In particular, two crystallization processes were detected in conventional a-Si:H, which reveal an enhancement of the crystallization rate. At100 K/min, such enhancement is consistent with a diminution of the crystallization time by a factor of 7. In contrast, no systematic variation of the resulting grain size was observed. Similar behavior was also detected in polymorphous silicon and silicon nanoparticles, thus showing that it is characteristic of a variety of hydrogenated amorphous silicon materials.

Patients satisfaction in an academic walk-in centre: a new model of residents training achieved by family doctors.

BACKGROUND: Walk-in centres may improve access to healthcare for some patients, due to their convenient location and extensive opening hours, with no need for an appointment. Herein, we describe and assess a new model of walk-in centre, characterised by care provided by residents and supervision achieved by experienced family doctors. The main aim of the study was to assess patients' satisfaction about the care they received from residents and their supervision by family doctors. The secondary aim was to describe walk-in patients' demographic characteristics and to identify potential associations with satisfaction. METHODS: The study was conducted in the walk-in centre of Lausanne. Patients who consulted between 11th and 31st April were automatically included and received a questionnaire in French. We used a five-point Likert scale, ranging from "not at all satisfied" to "very satisfied", converted from values of 1 to 5. We focused on the satisfaction regarding residents' care and supervision by a family doctor. The former was divided in three categories: "Skills", "Treatment" and "Behaviour". A mean satisfaction score was calculated for each category and a multivariable logistic model was applied in order to identify associations with patients' demographics. RESULTS: The overall response rate was 47% [184/395]. Walk-in patients were more likely to be women (62%), young (median age 31), with a high education level (40% of University degree or equivalent). Patients were "very satisfied" with residents' care, with a median satisfaction score between 4.5 and 5, for each category. Over 90% of patients were "satisfied" or "very satisfied" that a family doctor was involved in the consultation. Age showed the greatest association with satisfaction. CONCLUSION: Patients were highly satisfied with care provided by residents and with the involvement of a family doctor in the consultation. Older age showed the greatest positive association with satisfaction with a positive impact. The high level satisfaction reported by walk-in patients supports this new model of walk-in centre.

Audit report on Sibley-Ocheyedan Community School District in Sibley, Iowa for the year ended June 30, 2011

Audit report on Sibley-Ocheyedan Community School District in Sibley, Iowa for the year ended June 30, 2011

Report on a special investigation of the Burlington Community School District and the Parent Teacher Organization at Grimes Elementary School for the period August 1, 2009 through June 30, 2011

Report on a special investigation of the Burlington Community School District and the Parent Teacher Organization at Grimes Elementary School for the period August 1, 2009 through June 30, 2011

Home Heating and Cooling, 2011

Every year, a typical family in the United States spends around half of its home energy budget on heating and cooling. In Iowa, that percentage can be higher, due to temperature extremes reached during the winter and summer months. Unfortunately, many of those dollars often are wasted, because conditioned air escapes through leaky ceilings, walls and foundations—or flows through inadequately insulated attics, exterior walls and basements. In addition, many heating systems and air conditioners aren’t properly maintained or are more than 10 years old and very inefficient, compared to models being sold today. As a result, it makes sense to analyze your home as a collection of systems that must work together in order to achieve peak energy savings. For example, you won’t get anywhere near the savings you’re expecting from a new furnace if your airhandling ducts are uninsulated and leak at every joint. The most energy-efficient central air-conditioning setup won’t perform to your expectations if your attic insulation is inadequate and can’t reduce solar heat gain to help keep your home cool. And planting the wrong types of trees or shrubs close to your home adversely can affect potential energy savings all year long.

Water Heating, 2011

Although there are many ways to cut you water heating bills, the all fall into two broad categories: reducing the amount of hot water you use and making your water heating system more efficient. Fortunately, there are several strategies that can help you consume less energy and save money - and still meet you hot water needs without sacrificing comfort or practicality. The booklet was designed to answer common questions about hot water systems and to provide you with the information necessary to make informed decision about a wide variety of topics, ranging from repairing hot water faucet leaks an insulation water supply pipes to installing low-flow shower heads and tuning you your existing water heather. You'll also find details on what to consider when it's time to go comparison shopping for a new water heater-including an evaluation of the alternatives to the common gas or electric storage tank unit that's found in the majority of homes in Iowa and across the country.

High-dose therapy and autologous hematopoietic stem cell transplantation in T-cell lymphoma : a single centre experience

Le diagnostic de lymphome représente 4% de tous les cancers et a une incidence particulièrement élevée dans les pays industrialisés. La proportion de lymphomes T, évaluée en Europe et aux Etats Unis, représente environ 5 à 10% des lymphomes. Alors que des progrès très sensibles ont été apportés dans la prise en charge et le pronostic des lymphomes B agressifs durant ces dernières décennies et en particulier depuis le début des années 2000 avec l'utilisation des anticorps anti-CD20 associés à la chimiothérapie, le pronostic des lymphomes T reste très décevant. La survie globale des lymphomes T à 5 ans est estimée entre 28% et 38%. Le bénéfice réel d'une chimiothérapie intensive suivie d'une autogreffe de cellules souches hématopoïétiques périphériques au terme d'un traitement de chimiothérapie d'induction dans le lymphome T périphérique reste débattu. Les résultats des rares études prospectives et des études rétrospectives à disposition sont discordants. Nous avons donc analysé rétrospectivement 43 patients successifs de mars 2000 à mars 2011, atteints de lymphome T, issus de notre base de données du programme autogreffe lausannois. Nos analyses statistiques permettent, sur la base d'un suivi médian de 63 mois, une estimation à 12 ans, de la survie globale de nos patients à 40%, de la survie sans progression à 34% et de la survie sans événement à 30%. Ces chiffres s'inscrivent parfaitement dans les résultats des études prospectives qui montrent un bénéfice de l'autogreffe dans le lymphome T. Parmi les différents paramètres pronostiques habituellement évalués, l'âge et l'absence de symptômes B au diagnostic sont les seuls paramètres statistiquement significatifs en analyse univariée dans notre cohorte. En effet, Les patients de moins de 50 ans et ceux qui ne présentent pas de symptômes B au diagnostic ont un meilleur pronostic. Nous concluons de cette analyse que les patients traités par chimiothérapie intensive et autogreffe de cellules souches hématopoïétiques périphériques ont une survie moyenne supérieure aux résultats rapportés dans la littérature avec des traitements de chimiothérapie conventionnelle de type CHOP. En effet, on estime à environ 50% les patients répondant à une chimiothérapie conventionnelle de type CHOP.

Report on a special investigation of the Sunrise Sunset Daycare of the Southeast Warren Community School District for the period September 1, 2010 through September 26, 2011

Report on a special investigation of the Sunrise Sunset Daycare of the Southeast Warren Community School District for the period September 1, 2010 through September 26, 2011

Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. METHODS: Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. RESULTS: Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. CONCLUSION: This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

Fifth Judicial District, Department of Correctional Services Facility and Site Study Final Report, December 12, 2008

The goal of the study is to locate a site appropriate for a 170 offender unit, based on an understanding of current needs, existing and proposed procedure and the longevity of existing facility use. The study is based on master-plan process. A framework on which multiple stages of infrastructure development can be based is initiated through the systemic study of infrastructure condition, infrastructure needs and treatment objectives.

Report on a special investigation of the Starmont Community School District for the period July 1, 1993 through November 30, 2010

Report on a special investigation of the Starmont Community School District for the period July 1, 1993 through November 30, 2010

Audit report on Clay Central/Everly Community School District in Royal, Iowa for the year ended June 30, 2011

Audit report on Clay Central/Everly Community School District in Royal, Iowa for the year ended June 30, 2011

Centre de la prostate: une approche multidisciplinaire pour une prise en charge globale du patient [Prostate cancer center: a multidisciplinary approach to accurately manage patients with prostate cancer]

The prostate cancer is a complex pathology involving oncological, functional and psychosocial items. The prostate's center of CHUV harmonize the know-how of urologists, oncologist, radiotherapists and clinical nurses to offer a global management to patients attempts by prostate cancer, from diagnosis to therapy and follow-up.

Audit report on Starmont Community School District near Arlington, Iowa for the year ended June 30, 2010

Audit report on Starmont Community School District near Arlington, Iowa for the year ended June 30, 2010