[Dose constraints to organs at risk for conformational and stereotactic radiotherapy: Small bowel and duodenum]. / Contraintes de doses aux organes à risque en radiothérapie conformationnelle et stéréotaxique : intestin grêle et duodénum.

Radiotherapy of abdominopelvic primary or secondary lesions in conformational or stereotactic techniques is in full development. The small bowel is highly sensitive to irradiation and is the main organ at risk limiting prescription doses. This literature review aims to define the dose constraints to the small bowel and the duodenum in conformational and stereotactic body radiotherapy. The small bowel including the duodenum, jejunum and ileum is delineated on the simulation scanner. The radio-induced intestinal toxicities are acute related to the cellular depopulation of the intestinal mucosa, and late of more complex pathophysiology associating depletion in stem cells, microangiopathy, chronic inflammation and fibrosis. The main predictive factor of intestinal toxicity is the dose-volume ratio. In conformational radiotherapy, the dose constraints to the duodenum are: V25Gy<45% and V35Gy<20%. The jejunum and ileum dose constraints are for delineation by intestinal loop or peritoneal cavity respectively: V15Gy<275mL or V15Gy<830mL and V45Gy<150mL. In stereotactic body radiotherapy, small bowel dose constraints depend on fractionation and are defined on a small volume and on a maximum dose at one point. Intestinal toxicity is also dependent on factors intrinsic to the patient and radiosensitizers such as targeted therapies or chemotherapies. With the development of new techniques allowing dose escalation on the tumour and the development of inverse planning, the definition of dose constraints to the small bowel is essential for current practice.

[An analysis of the organization, profile of the clientele and pathologies managed in the urology division of the Public Assistance-Hospital of Paris. A 15-day cross-sectional survey of 10 services]. / Analyse de l'organisation, du profil de clientèle et des pathologies prises en charge en consultation d'urologie à l'Assistance Publique-Hôpitaux de Paris. Enquête transversale de 15 jours dans 10 services.

A cross-sectional study was carried out in ten urology departments over a two-week period. Three categories of data were collected concerning socio-economic status and epidemiological profiles and management of the patients. The results are presented with comparative analysis of performance of the clinics, and the epidemiological data are analysed with reference to the inpatient case mix.

[Hospitalization of foreign residents living abroad at the Assistance Publique--hospitals of Paris (1981-1988)]. / Hospitalisation des étrangers résidant à l'étranger à l'Assistance Publique--hôpitaux de Paris (1981-1988).

In 1988, 10,386 foreign patients living abroad were hospitalized in the public Hospitals of "Assistance Publique" in Paris. Specific statistical methods starting from an anonymous file of patients, made it possible to study these hospital stays in terms of patients for each year between 1981 and 1988. Several factors are described: the various origins of the hospitalized patients; the overall decrease in the number of hospitalized patients during the period taken into account, with a detailed analysis for certain nationalities; the comparatively higher rate of tumors and cardiovascular diseases; the distribution of patients by diseases and by geographical origin. These data are in keeping with those of a recent survey on morbidity carried out by the Department of Health.

[Endocrinology in Paris Public Assistance hospitals. Development of hospitalization activity from 1981 to 1990]. / L'endocrinologie à l'Assistance Publique-Hôpitaux de Paris. Evolution de l'activité d'hospitalisation de 1981 à 1990.

An analysis of data of thirteen endocrinology wards gives an overview of hospital activity and epidemiological profiles for a ten-years period. The decrease of the A.L.O.S., the extra-regional recruitment and the shift of in-patient care toward day care show the development of specialization of this discipline.

Results of a comparative study of in-patient satisfaction in eight hospitals in the Paris region.

Using the method of self-administered questionnaires, patient satisfaction was measured in eight hospitals for both in-patient stays and out-patient visits, excluding emergency departments for which this method is not appropriate. According to the size of the ward, the in-patient satisfaction was assessed for a period of time, ranging from one to three months in order to obtain 110 questionnaires; for outpatients, the satisfaction was assessed for one week. On the whole, the study showed high satisfaction with the care provided by physicians and nurses (81% and 74% of patients were "very satisfied"), satisfaction with cleanliness and comfort (respectively 64% and 61%), and low satisfaction for quietness and for the time schedule and the quality of meals (respectively 48%, 52% and 40%). As far as comparisons between hospitals and between wards within a given specialty were made, a major result of the study was to point out the very great range of dispersion of satisfaction scores. For example, if the mean value of the satisfaction about comfort is 61% of patients "very satisfied", the extreme values for the set of eight hospitals are 35% and 70%. Another example may be given in general surgery specialty: if the mean value of the satisfaction for medical care is 78%, the extreme values for the set of seven wards are 68% and 86%. These results make clear that however encouraging the scores may be, the evidence of the variability is a powerful incentive to organize corrective actions.

[Analysis of endocrinology consultations in Paris public assistance hospitals: cross-sectional survey of 15 days in 10 departments]. / Analyse des consultations d'endocrinologie à l'assistance publique-hôpitaux de Paris: enquête transversale de 15 jours dans 10 services.

A cross-sectional study was carried out in ten endocrinology departments for a two-week period of time. Three categories of data were collected concerning socio-economic status and epidemiological profiles and management of the patients. The results are presented with comparative analysis of performance of the clinics, and epidemiological data are analysed with reference to the inpatient case mix.

[Analysis of the activities of the urology services of the Paris Public Assistance hospitals]. / Analyse de l'activité des services d'urologie à l'Assistance Publique de Paris.

From 1981 to 1987, urology in patient has shown the greatest increase of all surgical specialties in the Assistance Publique--Hôpitaux de Paris. For 10 urology departments, the number of patient stays increased from 14,800 to 19,300, while the ALOS decreased from 10.4 to 6.9 days. Case mix analysis reveals that lithotripsy (ESWL) explains one half of the increase observed, while cancer diagnosis and treatment and prostatic surgery explain the other half. Another change appears: the number of stays for congenital abnormalities has also slightly decreased.

[Hospitalizations for diseases of the respiratory system at public assistance hospitals in Paris in 1985]. / Les hospitalisations pour maladies de l'appareil respiratoire à l'assistance publique de Paris en 1985.

This study is an analysis of the reasons for hospitalisation for respiratory diseases in 1985 in the eleven departments of pneumology (SP) and departments of Internal Medicine (SMI) in the public hospitals in Paris. As well as epidemiological data systematically gathered on the discharge of the patients the number of stays for respiratory diseases, the mean duration of stay (DMS), sex, age and place of residence of the patients were studied. 59 diagnostic codes were considered as covering the overall pattern of respiratory pathology (OMS) classification at 3 levels 9th revision). Amongst those 24 were regrouped into 7 pathological groups considered as characteristic of the discipline of pneumology: asthma, chronic airflow obstruction (BPCO), malignant tumours of the respiratory tract, pulmonary embolism, respiratory infections, sarcoidosis and tuberculosis. There were 30,877 inpatient stays for respiratory disease identified, representing 6.6% of all hospitalisations in the medical service of the public hospitals. 41.1% of stays were in SP and 24% in SMI. 78% of the stays in SP were for respiratory diseases against 10-15% in SMI. In SP asthma represented an average of 11% of all hospitalisations for respiratory disease, BPCO was 13%, cancer 35% and pulmonary embolism 4%, sarcoidosis 2%, respiratory infections 8% and tuberculosis 8%; great variation were noted according to the different units which enabled a hospital profile to be identified and which gave the general orientation of a particular service. In SMI this profile was different: there was a smaller percentage of cancer cases and a higher level of infectious disease. The mean stay was shorter in SP than in SMI (10.4 v 13.8 days) for respiratory cases overall and whatever pathology that was studied.(ABSTRACT TRUNCATED AT 250 WORDS)

[A computerized medical record for the follow-up of hypertensive patients (author's transl)]. / Utilisation d'un dossier informatique pour la surveillance des malades hypertendus.

The authors present a computer system for hypertension control in a specialized department in Paris. The hypertension clinic performs the initial evaluation of the disease in ambulatory care or during a short hospitalization period. The general practitioner (GP) is mainly in charge of the long term follow-up. The objective of the system is to improve the communication between the patient, the clinic and the GP. Data are collected during each visit at the clinic. The computer is used to produce evolutive summary reports for each patient and to control the appointment system. Thus, the data processing system improves the quality of the individual follow-up and, at the same time, a medical data bank is available for epidemiological and pharmacovigilance studies.

[Dialysis-computer program. IV. Summary report. Epidemiology of complications]. / Programme dialyse - informatique. IV. Rapport cumulatif. Epidémiologie des complications.

The Diaphane-program instituted under the authority of the French Society of Nephrology has been steadily expanding since 1972. By December 1977, about 1500 patients treated in 30 public and private Dialysis Centres were followed up by this system. Full coverage of expenses is provided by the participating Centres. The statistical work presented in this report involves 1572 adult patients treated between June 1972 and December 1976 in 24 dialysis centres. The amount of collected data and the duration of the observation period permit to build up evolutive profiles of the population of patients treated in France by maintenance hemodialysis, of the various techniques and strategies used and of the main complications recorded in the patients. 1. Mean age of patients at start of dialysis is steadily increasing, from 40.1 years in 1972 to 48.2 years in 1976. 2. The predominance of male patients, constant over each year, may be explained by an increased proportion in man of chronic glomerulonephritis and renal vascular diseases. The sex-ratio in patients with chronic pyelonephritis is close to the one recorded in the French population. 3. The regular decrease of the mean plasma creatinine level at time of first dialysis recorded since 1972, is probably related to an earlier start of treatment. However, 10.6 per cent of the patients taken on treatment in 1975-1976 still had a plasma creatinine greater than or equal to 200 mg/100ml. 18.7 per cent had a diastolic blood pressure greater than or equal to 120 mmHg, and exsudative lesions at eye fundi examination were found in 33.5 per cent. The delay in initiating dialysis treatment may account for the frequency of early acute cardiopulmonary complications such as pulmonary oedema and pericarditis and also for the increase in the mortality rate recorded during the first year of treatment: 12.1 per cent instead of 6.2 per cent during the second year. This particularly relevant for the younger age group of patients. 4. There seems to be some social disparity concerning the detection of renal disease and the conditions under which dialysis treatment is started: chronic renal disease is detected at an earlier stage and dialysis treatment initiated for lower values of plasma creatinine and of diastolic blood pressure in patients belonging to the "higher income" group of population. 5. The percentage of patients dialysed twice a week is steadily increasing, whereas the average weekly dialysis time decreases, being about 15 hours in 1976. Day and evening dialysis replace overnight dialysis. Disposable flat-plate dialysers are used increasingly. 6. Episodes of hypotension and cramps are the incidents most frequently recorded during the dialysis sessions. Risk factors evidenced in the occurrence of hypotensive accidents are: the female sex, age greater than or equal to 55 years in males, orthostatic blood pressure drop at the end of previous dialysis, weight loss of more than 4 per cent of total body weight during dialysis...

CHRONOS: a data base management package for physicians and researchers.

This paper describes a general data base management package defined for medical applications. CHRONOS is a user-oriented system which has been designed for physicians to get periodical reports and for researchers to prepare statistical treatments. The basic principles of the data base and program organization are described: many possibilities are offered for data acquisition and specific efforts have been made in order to analyze easily the evolution of patients. Several medical applications are now operational with CHRONOS in fields as different as psychiatry and nephrology.