[Implementation of computerized phisician order entry in a hospital setting: what are the keys to success?]. / Implémentation de la prescription informatisée en milieu hospitalier: quelles sont les clés d'un déploiement réussi ?

INTRODUCTION: A software of computerized physician order entry [CPOE] was developed by a data-processing company in collaboration with the Mont-Godinne University Hospital By 2006, parallel to the evolution of the software, the progressive implementation of CPOE was carried out, and currently covers 16 wards, the emergency room, the recovery rooms and the center of medical care [day hospital] as well as the day surgical center OBJECTIVES: Complete computerization of the drug supply chain, including the regulation by the physician, the pharmaceutical validation, the delivery and the follow-up of stocks by pharmacy, the validation of the administration by the nurse and the tariffing of the drugs. METHOD AND RESULTS: In 2006, a working group was created in order to validate specifications allowing the development of a software of CPOE, Linked to the computerized medical record. A data-processing company was selected in order to develop this software. Two beds were computerized in the pneumology ward, in order to test and validate the software. From 2007 to 2009, 3 additional wards were computerized [geriatrics, neurosurgery, revalidation]. A steering committee of CPOE, composed of various members (direction, doctors, pharmacists, nurses, data processing specialistsl is created. This committee allows the installation of the means necessary to the deployment of CPOE in the Institution. Structured teams for the deployment are created: medical and nurse coaches. From 2009 to 2012, the deployment of the software is carried out, covering 16 wards, the emergency room, the recovery room and the day-hospitals. CONCLUSION: The computerization of the drug supply chain is a challenge which concerns the institutional level. The assets of our hospital and our project were: - a strong management committee, making of this project a priority entering the strategical planning of the institution; - a steering committee allowing each type of actor to express his needs, and of prioriser requests; - a closer medical coaching; - teams of nurses coaches, accompanying each ward, during and after the deployment; - a dynamic IT team allowing a relay between the Institution and the data-processing company. These points appeared essential and are as many keys for a successful deployment.

[Physical and chemical stability of fortified ophtalmic ready-to-use solutions: review of literature]. / Stabilité physico-chimique de solutions ophtalmiques renforcées prêtes à l'emploi : une revue de la littérature.

INTRODUCTION: Ophtalmic infections and inflammations are often encountered during hospitalization. They require the preparation of "fortified" ophtalmic solutions, i.e. pharmaceutical ophtalmic solutions which are hyperconcentrated in active substance. The data of physicochemical stabilities are modified and it is therefore essential to gather the results of the various publications devoted to this subject. METHOD: In 2006, an initial literature review was undertaken to identify the molecules mostly used in the preparation of fortified ophtalmic solutions in hospital. A second review of the literature in 2010 has enriched the knowledge about it. RESULTS: Two new drugs have entered the summary table: amikacin and ticarcillin disodium. Date on 12 molecules already known in 2006 were updated to improve clinical practices. A review of the literature was undertaken in order to collect the results of the molecules mostly used for the preparation of the fortified ophtalmic solutions in hospitals. A summary table, indicating the active substance, its concentration, the assay method, the storage temperature and physicochemical modifications, presents all the results. CONCLUSION: This review of literature makes it possible to match stability and validity period to these preparations.

Quantitative characterisation of ballistic cartridge cases from micro-CT.

Evaluation of cartridge cases is essential within forensic ballistic analysis and is used in an attempt to establish a connection to the weapon used to fire it. This study consists of two experiments. The aims of Experiment 1 were to establish whether micro-CT is appropriate and repeatable for ballistic cartridge case analysis and if measurements can be extracted repeatably and reliably. Experiment 2 aimed to compare cartridge cases from two weapons to establish the magnitude of variation within and between weapons. A total of 48 cartridge cases fired by two distinct weapons were collected and micro-CT scanned to a high resolution. One randomly selected cartridge was scanned ten times under the same conditions to ensure repeatability of the scanning conditions in Experiment 1. Three novel measurements to quantitatively assess the firing pin impressions were proposed in Experiment 1 and comparatively analysed from two weapons in Experiment 2. Experiment 1 showed that micro-CT is an effective and highly repeatable and reliable method for 3-dimensional imaging and measurement of ballistic cartridge cases. Furthermore, high agreement for inter-rater reliability was found between five raters. Quantitative micro-CT analysis of the firing pin impression measurements in Experiment 2 showed a significant difference between the two studied weapons using Welch's t-test (p < 0.01). This study shows the advantage and reliability of utilising micro-CT for firing pin impression analysis. Quantitation of the firing pin impression allows distinction between the weapons studied. With expansion to further weapons, application of this methodology could complement current analysis techniques through classification models.

[UNICEF against the tsunami]. / L'Unicef face au tsunami.

The southeast Asian tsunami that caused massive death and destruction in December 2004 was met by an extraordinary outpouring of international generosity. Recovery work was initially slowed by a variety of problems including poor administrative organization, lack of coordination between partners, and legal impediments. However, it is now largely completed. UNICEF worked hard to ensure that available funds were used to "build back better".

Multiplexed Elispot assay.

Micron scale latex beads are well established as highly biocompatible reagents. Imbibing two fluorescent dyes into the interior of the beads enables the creation of a family of combinatorially colored labels. Previous use of such beads, in flow cytometry for example, has focused on beads of approximately 5 microm diameter. We show here that 280 nm combinatorially labeled particles can be used to create ELISA-style assays in 200 microm scale virtual wells, using digital microscopy as the readout. The utility of this technique is illustrated by profiling the secreted cytokine footprints of peripheral blood mononuclear cells in a multiparametric version of the popular Elispot assay. Doing so reveals noncanonical classes of T lymphocytes. We further show that the secreting cell type can be concurrently identified by surface staining with a cell type specific antibody conjugated to the same multiplexed beads.

Gut microbiota modulation with norfloxacin and ampicillin enhances glucose tolerance in mice.

Recent data suggest that the gut microbiota plays a significant role in fat accumulation. However, it is not clear whether gut microbiota is involved in the pathophysiology of type 2 diabetes. To assess this issue, we modulated gut microbiota via antibiotics administration in two different mouse models with insulin resistance. Results from dose-determination studies showed that a combination of norfloxacin and ampicillin, at a dose of 1 g/L, maximally suppressed the numbers of cecal aerobic and anaerobic bacteria in ob/ob mice. After a 2-wk intervention with the antibiotic combination, both ob/ob and diet-induced obese and insulin-resistant mice showed a significant improvement in fasting glycemia and oral glucose tolerance. The improved glycemic control was independent of food intake or adiposity because pair-fed ob/ob mice were as glucose intolerant as the control ob/ob mice. Reduced liver triglycerides and increased liver glycogen correlated with improved glucose tolerance in the treated mice. Concomitant reduction of plasma lipopolysaccharides and increase of adiponectin further supported the antidiabetic effects of the antibiotic treatment in ob/ob mice. In summary, modulation of gut microbiota ameliorated glucose tolerance of mice by altering the expression of hepatic and intestinal genes involved in inflammation and metabolism, and by changing the hormonal, inflammatory, and metabolic status of the host.

French translation and validation of the "Anterior Knee Pain Scale" (AKPS).

PURPOSE: To linguistically and cross-culturally translate the Anterior Knee Pain Scale into French and to evaluate the reliability and validity of this translated version of the questionnaire. METHODS: The translation part was performed in six stages, according to international guidelines: (i) two initial translations from English to French; (ii) synthesis of the two translations; (iii) backward translations into the original language; (iv) expert committee to compare the backward translations with the original questionnaire; (v) pre-final version testing and (VI) expert committee appraisal. To validate the French version of the Anterior Knee Pain Scale, we assessed its validity, reliability and floor/ceiling effects. To do this, volunteer patients from the French part of Belgium and from France, with patellofemoral pain were asked to answer the French version of the Anterior Knee Pain Scale at baseline and after 7 days, as well as the generic SF-36 questionnaire. RESULTS: The Anterior Knee Pain Scale was translated without any major difficulties. A total of 101 subjects aged 34.5 ± 11.4 years (58.4% of women) were included in this study. Results indicated an excellent test-retest reliability (Intra-class correlation coefficient (ICC) = 0.97, 95%CI: 0.96-0.98), a high internal consistency (Cronbach's alpha = 0.87), a consistent construct validity (high correlations with the SF-36 questionnaire were found with domains related to physical function (r = 0.80), physical role (r = 0.70) and pain (r = 0.64)) and low or moderate correlations with domains related to mental health (r = 0.26), vitality (r = 0.32) and social function (r = 0.41). Moreover, no floor/ceiling effects have been found. CONCLUSIONS: A valid French version of the Anterior Knee Pain Scale is now available and can be used with confidence to better assess the disease burden associated with patellofemoral pain. It was successfully cross-culturally adapted into French. Implications for rehabilitation The results on psychometric properties of the French Anterior Knee Pain Scale are comparable with six validated versions obtained for the Finnish, the Turkish, the Chinese, the Dutch, the Thai and the Persian populations. The French translated version of the Anterior Knee Pain Scale is a reliable and valid instrument for assessing the functional limitations associated with patellofemoral pain. The test-retest reliability of the French Anterior Knee Pain Scale was excellent, the internal consistency was high and the construct validity was consistent. There were no floor/ceiling effects.

[Hantavirus infections]. / Infections a hantavirus.

Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain further knowledge on the epidemiology of this anthropozoonosis.

The frontline of HIV1 diffusion in the Central African region: a geographical and epidemiological perspective.

The geographical analysis of the main data on the HIV1 epidemic in Central Africa shows a frontline which has not moved significantly since 1985. The absence of a progressive increase between the countries, demonstrating a discontinuity in space, combined with the observed human and physical continuity within the areas, raises several questions. Are the low-rate areas facing only a simple delay in the diffusion, or is there a real difference between the epidemiological patterns of HIV1 in the two areas? The last hypothesis would impose a revision of the concept of an homogeneous pattern in the epidemiology of HIV1 in Africa. The need for further research is emphasized with the aim of precisely targeting preventive intervention.

PIP: Interventions against HIV and AIDS are typically designed and implemented to target 1 or more of 3 epidemiological patterns found in countries worldwide. Given the heterogeneity of infection and prevalence observed within certain regions and communities, the available knowledge of HIV epidemic patterns needs to be broadened through a multidisciplinary approach which includes an analysis of geographical concepts and boundaries. Geographical analysis of main data on the HIV-1 epidemic in central Africa reveals a frontline which has not moved significantly since 1985. This phenomenon leads one to question reasons for the absence of a progressive increase between countries in the context of human and physical continuity across areas Speculation exists over whether diffusion to low-rate areas is simply delayed or whether a real difference exists between epidemiological patterns. Evidence indicates that the HIV epidemic is heterogeneous throughout Africa and follows different diffusion patterns from 1 ecosystem to another. While HIV is spread regionally primarily through heterosexual networks, it is also feasible that other unexplored routes of transmission may play a role at least during the early phases of the epidemic and may be associated with other causative cofactors. A threshold phenomenon could also be at work in which epidemic waves are set forth after building to critical values of seroprevalence among fringe groups. These phenomenon most likely combine to explaining the observed differing patterns of diffusion in central Africa. Research is needed to better understand prevailing patterns of infection and develop appropriate preventive interventions.

Chronic Q fever: diagnosis and follow-up.

Sera from 40 patients (25 men, and 15 women) with clinical features compatible with the diagnosis of chronic Q fever were received. Total or partial clinical data were available. All of them had serological evidence of chronic Q fever (IgG class anti-phase I titer greater than 800). The final diagnosis was vascular infection in four cases (with two positive cultures for Coxiella burnetii), bone infection in two patients (one positive culture), chronic hepatitis in one patient, and endocarditis in 32. The last patient had an isolated fever with a chronic Q fever serologic profile. Among the 32 with endocarditis, valve replacement was performed in 59%, and valve cultures were positive in 14/18 patients. Twenty-nine of these patients had previously known valvulopathy; 23 were exposed to cattle, sheep or goats; and four had an immunocompromised situation. Ten patients died; two before any treatment, five of cardiac failure during or a few weeks after surgery, and three during the medical treatment. For antibiotic treatment, tetracycline alone was employed in seven cases. For the other patients, combined therapy including tetracycline and another drug (rifampin, fluoroquinolones, cotrimoxazole, or erythromycin) was initiated. Three patients were considered to be completely cured.

Immunological studies in amebiasis: isotypic characterization of specific antibodies by enzyme-linked immunofiltration assay.

Fifty sera from 17 cases of invasive amebiasis (15 hepatic localizations, 1 ameboma, 1 diffused colic localization) were studied by enzyme-linked immunofiltration assay (ELIFA). IgM and IgE anti-Entamoeba histolytica were detected in 10 and 15, respectively, of the 17 patients studied. IgM and IgE antibodies were found simultaneously in 10 cases; these 2 isotypes were only recognized twice in the same serum by the same antigenic components. During post-therapy monitoring, in less than 90 days IgE or IgM-Ab regressed completely in half the cases. If they appeared or reappeared after the third month, prognosis was bad. In addition to its value for diagnosis and prognosis, the ELIFA allowed us to detect the functional antigenic components revealed more particularly by some IgG, IgM, IgE, or IgA antibodies.

Immunological study of hydatidosis. I. Evaluation of immunoelectrodiffusion tests and enzyme-linked immunoelectrodiffusion assay (ELIEDA) in human hydatidosis.

The comparative sensitivity, specificity and rapidity of immunoelectrodiffusion (IED) on cellulose acetate membranes and of immunoelectrophoresis (IEP) on agarose gel, were evaluated in the diagnosis of hydatidosis. Pooled crude fluid from several cattle hydatis cysts was used as antigen in tests on 1,750 non-hydatis and 400 hydatis sera obtained from patients with hepatic, pulmonary, splenic, peritoneal and cerebral hydatidosis before and after surgery. Coupled to a specific human reference serum for arc 5, IED shows a specificity comparable to that of IEP but its sensitivity is slightly higher and the amount of antigen needed is very small. The appearance of a typical "gloved finger" pattern in sera from patients with ruptured cysts emphasizes the interest of quick results (3 hours) obtained by this method. In order to increase the sensitivity of IED and to define the class of immunoglobulins involved in the antigen-antibody reaction, we have coupled this method to an enzymatic technique. The immune complexes precipitated by IED were treated with peroxidase-labelled antibodies specific to each class of human immunoglobulins. The specificity of this enzyme-linked immunoelectrodiffusion assay (ELIEDA) permits one to follow the immunologic evolution of hydatidosis and to identify IgM in ruptured hepatic cysts and IgA in pulmonary cysts.

[Animal bites. Epidemiology and infection risks]. / Morsures d'animaux. Epidémiologie et risques infectieux.

A review of 5,116 cases of animal bites (587 of which were studied prospectively) has shed some light on their epidemiological aspects and on the risk of infection they carry. It has also led to a more objective assessment of the real effect of the therapeutic and prophylactic measures usually applied in such cases. The most frequent wounds are those of the hands and face, the former rising an infectious problem, the latter a predominantly cosmetic problem. The overall risk of infection is 30 per cent, but it is increased, notably as regards pasteurellosis, in the case of cat bite. Precise and simple rules concerning the prevention of this risk cannot easily be given, but it seems that the systematic antibiotic treatment initially prescribed has not clearly proved effective. Similarly, early sutures do not significantly increase the risk of infection.

[Should NSAID/corticoids be considered when treating erysipelas?]. / Existe-t-il une place pour les AINS/corticoïdes dans la prise en charge de l'érysipèle?

Using non-steroidal anti-inflammatory drugs (NSAID) in association with a suitable antibiotherapy in the treatment of erysipelas, is still being largely discussed in medical publications. When compared to other fields of medicine, here their use might be justified by their ability to reduce local inflammation processes, to relieve patients more quickly, and to prevent potential sequels due to an inflammatory process. Numerous reports have suggested an association between the use of NSAID and the progression of an invasive streptococcal infection, particularly necrotizing fasciitis. The exact mechanism is still unclear. No controlled survey (NSAID versus placebo) checking the efficiency and the safety of these treatments is currently available. Only one comparative study showed a gain of one single day for prednisolone The prednisolone-treated patients had a shorter median length of hospital stay (5 days vs. 6) than the placebo-treated ones. The median treatment time with intravenous antibiotics, in the placebo group, was 1 day longer than in the prednisolone group. The occurrence of side effects was not higher in the prednisolone group. If this currently available data is not sufficient to establish a relationship between severe infectious complications and the use of NSAID, one should be cautious when using them to treat erysipelas, since their efficiency has not been positively proved.

[Ancient serological traces of infections by the human immunodeficiency virus HIV-1 and HIV-2 in sub-saharan Africa. A different geography]. / Traces sérologiques anciennes des infections par le virus de l'immunodéficience humaine VIH-1 et VIH-2 en Afrique Sud-Saharienne. Une géographie différente.

Despite of some heavy methodological limitations, the analysis of some serological data collected before 1985 allows to establish the selective regional distribution of the two infections. HIV-2 is prevalent in the West African sites which are studied and he has been observed since the sixties. The foci and the sporadic cases of the HIV-1 which are known are localized principally in the East-Central Africa. (Research done under the sponsorship of the A.N.R.S. (Paris)).

[Epidemiologic distribution of HIV2 human immunodeficiency virus infection in sub-Saharan Africa]. / L'espace épidémiologique de l'infection par le virus de l'immunodeficience humaine VIH2 en Afrique Sud Saharienne.

This text presents the results of an analysis of the distribution and evolution of the HIV2 infection in Africa South of Sahara. The serological data collected in selected groups of the population suggest that the virus is very rare in the East and the South of the continent, except in Mozambic where it is found everywhere, but on a low level. The infection is also rarely depisted in West-Central Africa; however an epidemic could affect the North of angola. HIV2 is probably an old host of some West African collectivities. Now the infection is often sporadic in the general population except in a little regional foci in Guinea-Bissau. On the contrary, high prevalences are observed in many groups of prostitutes. The epidemiological situation has been stable since 1985-86. At least in West Africa, the only new fact of the recent past could be that the infection became apparent to the physicians.

[Epidemiological feature of malaria in the Ivory Coast and Upper Volta area]. / Paysage épidémiologique du paludisme dans l'espace Ivoiro-Voltaïque.

Several steps of the malarial epidemiological chain depend upon the environment. In West Africa, environment had no constant patterns neither in space and nor even in time. Its major discontinuities introduce disparities, at various levels, in the conditions met by the parasite for its transmission. In return, these conditions induced disparities in the immunological resistance of people. The malarial epidemiological feature is the result of the discontinuities of the environment in the Ivory Coast and Upper Volta area of the resulting epidemiological disparities. It accounts for the various possible aspects of the disease among the human populations. Malarial epidemiological feature is not only useful to understand the present situation but it is a guide of great value for any action adjusted to the needs of this area. It is also a good way to appreciate the risks resulting of the evolutions, either spontaneous or voluntary, of the natural or human environment.

[HIV-2 infection in the world. A geographical perspective]. / L'infection par le VIH type 2 dans le monde. Une mise en question géographique.

The geographical distribution of HIV-2 is not fully understood. However, there is enough evidence to speculate about the origins and differentiation of this geographical pattern. Foci of infection probably developed in some African countries, such as Guinea-Bissau, Angola and Mozambique, in the 1970s. The decolonization of these countries led to the movement of people, and the virus, to historically associated countries such as Portugal, India and Brazil. In Ivory Coast, a focus was probably created due to the dismantling of the plantation economy, with all its demographic, cultural and social consequences. The virus was dispersed to countries close to the Guinea and Ivory Coast foci by the migration of workers and prostitutes. Thus, the diseases has spread from the Atlantic coast of Africa, where it was endemic-sporadic, to other more distant African countries and out of Africa into Europe and North America. The political emancipation of African countries is further increasing and diversifying human movements between countries. The infection has not created an epidemic, either within or outside Africa. This is due to the limited infectivity of the virus and the particular characteristics of the social and epidemiological system. The high-risk groups do not sustain an epidemic relay of the infection and subjects introducing the virus into new areas outside the African foci rarely set up a new autonomous circulation of the virus.

HIV-2 infection throughout the world. A geographical perspective

The geographical distribution of HIV-2 is not fully understood. However, there is enough evidence to speculate about the origins and differentiation of this geographical pattern. Foci of infection probably developed in some African countries, such as Guinea-Bissau, Angola and Mozambique, in the 1970s. The decolonization of these countries led to the movement of people, and the virus, to historically associated countries such as Portugal, India and Brazil. In Ivory Coast, a focus was probably created due to the dismantling of the plantation economy, with all its demographic, cultural and social consequences. The virus was dispersed to countries close to the Guinea and Ivory Coast foci by the migration of workers and prostitutes. Thus, the diseases has spread from the Atlantic coast of Africa, where it was endemic-sporadic, to other more distant African countries and out of Africa into Europe and North America. The political emancipation of African countries is further increasing and diversifying human movements between countries. The infection has not created an epidemic, either within or outside Africa. This is due to the limited infectivity of the virus and the particular characteristics of the social and epidemiological system. The high-risk groups do not sustain an epidemic relay of the infection and subjects introducing the virus into new areas outside the African foci rarely set up a new autonomous circulation of the virus.

[Is vesicular cholesterolosis a particular anatomo-clinical form of cholesterol lithiasis? Apropos of a case of cholesterol polyp manifested by an acute complication]. / La cholestérolose vésiculaire est-elle une forme anatomo-clinique particulière de la lithiase cholestérolique? A propos d'une observation de polype cholestérolique révélé par une complication aiguë.

A case of cholesterolic polyp, revealed by the formation of an infundibulo-cystic enclave, is reported, the polyp having the appearance of a cholesterolic calculus, but a pediculated one, and one acting as a calculus. The extreme rarity of this complication is emphasized. Despite the frequency of associated lithiasis, the cholesterolosis are included in a different framework from lithiasis, that of the cholecystoses that on histology show typical pure parietal lesions without inflammation. Findings in this atypical case suggest possible common pathogenic factors for the two affections, and raise a proposal for inclusion of cholesterolosis within the nosologic framework of lithiasis.