[Medical and economic evaluation of neonatal hospital at home structure]. / Évaluation médico-économique d'une structure d'hospitalisation à domicile de néonatologie.

BACKGROUND: Hospital at home (HAH) shortens hospitalization time by providing at-home hospital-level care. The aim of this study was to describe and assess the cost of the neonatal HAH stay and compare it to the incomes produced by activity-based payments during the 1st year of a neonatal HAH program. METHOD: Medical and economic cost study from the hospital's point of view. For children admitted to the neonatal HAH unit between May 2010 and May 2011, sociodemographic characteristics were identified, consumed resources evaluated, and costs compared to the incomes produced by activity-based payments. RESULTS: Over 75% of children admitted to neonatal HAHs were former preterm infants and 67% of stays included nutritional support. The average length of stay was 16.5 days (SD, 11). The 85 stays produced 152,582 euros of income, the median income was 1531 euros. The median cost of the HAH stay was 1945 euros, resulting in a loss of 45,518 euros for the hospital, but the filling rate was not at its maximum during this period of scalability (77%). Personnel was the most costly item (73% of the total cost) followed by general management and structural costs (20%). CONCLUSION: Economic aspects must be considered to preserve the financial viability of a HAH unit, but the secondary human benefits must be highlighted. A 100% occupation rate would nearly balance the neonatal HAH budget. However, fees must be adjusted to ensure the sustainability and development of these structures.

[Serious hemorrhages related to vitamin K antagonist treated by prothrombic complexes: retrospective study conducted in 2008]. / Hémorragies graves sous antivitamines K traitées par complexes prothrombiques : étude rétrospective en 2008.

PURPOSE: Vitamin K antagonist are widely used and clearly useful in the prevention of thrombotic and embolic events. However, they expose to hemorrhagic risk. The aim of this retrospective study was to describe the serious hemorrhagic events that occurred in patients treated with vitamin K antagonist and that required administration of prothrombotic complexes concentrates. METHODS: A comparative analysis of the file of the central pharmacy (that dispensed the prothrombotic complexes concentrates) and patient data of the department of medical information was perform to ascertain the population of patients having received some prothrombotic complexes concentrates. Then, hospitalization reports were consulted to select the patients having presented a severe bleeding while receveiving vitamin K antagonist. We collected patients' characteristics, bleeding location, INR values, emergency care, seriousness and medical issue. Imputability was determined with the French method of pharmacovigilance. RESULTS: In 2008, in Caen University hospital, 80 patients received prothrombotic complexes concentrates in the context of a serious hemorrhage due to vitamin K antagonist. Their mean age was 75years and the most common presentation was a neurological hemorrhage (38,7%). For 63,8% of the patients, there was an overdose in vitamin K antagonist. Twenty-two patients died during their hospitalization and 10 others presented later sequelas. None of the patients included in this study had been spontaneously declared to the pharmacovigilance. High imputability scores were positively correlated with INR (P=0.0002). CONCLUSION: Quality of emergency care of hemorrhagic events due to vitamin K antagonist could be improved with a better application of the professional recommendations and a spontaneous declaration to pharmacovigilance.

[Hospital hygiene and medical students]. / L'hygiène hospitalière et les étudiants en médecine.

OBJECTIVE: Training in hospital hygiene is essential to prevent nosocomial infections and to promote health care quality. A survey was made on Caen medical students for hand hygiene habits, personal medical equipment, and white coat cleaning as well as on their opinion concerning hospital hygiene training quality. DESIGN: An anonymous questionnaire was submitted to medical students in third, fourth, and fifth year of medical studies. RESULTS: Hygiene was "always" or "often" a priority (94%) when students were working in clinical areas. Nevertheless, nearly half of them (46%) were not aware of the difference between simple hand washing and antiseptic hand washing. The white coat was too large for 50% of students. The white coat was cleaned on average every 3.5 weeks. Only 40% students cleaned their stethoscope regularly and 23% their reflex hammer. At last, 66.5% of students were dissatisfied by hospital hygiene training judged insufficient and unfit for their practice. CONCLUSION: the medical students' general knowledge of hospital hygiene must be improved. Further initial training should improve practices.