[Interpretation of epidemiologic studies].
Explore the source record for details and available documents.
Data Interpretation, Statistical↗
Biomedical subjects
Pierre Lombrail
Publications and source records attributed to Pierre Lombrail.
[Information for the patient in hospitals: the implicit shared role among professionals].
OBJECTIVE: Perceived practices declared by physicians were assessed in order to determine the role of the different professionals in patient medical information, the communication methods and traceability practices used in patient files. Method Data were collected using an anonymous questionnaire sent by mail in April 2003 to the 794 physicians of the University Hospital of Nantes (France). RESULTS: The participation rate was of 38% (302 responses) and differed according to the medical categories: university professors (44%), young seniors (50%), hospital practitioners (43%) and practitioners under contract (21%). In outpatient departments, patient information was rarely shared between professionals: the senior practitioner only informed the patient in 80% of cases. In the case of hospitalisation, patient information concerned various health professionals: in general, senior practitioners, junior practitioners (50% of cases) and nursing staff (20 to 45%). Information for the patient was always oral, accompanied in 1/3 of cases by one or more documents. The traceability of the elements of information supplied to the patient was inadequate. CONCLUSION: This survey underlined the interest of the medical corps regarding information for the patient, and the important role played by junior practitioners and paramedical staff. Because they are all obviously implied in information supplied to the patient, quality improvement projects should target all the health professionals.
Adult↗
[Development of a tool for the identification of socially vulnerable hospital patients].
OBJECTIVE: To develop and assess the metrological properties of a simple to use tool to identify socially vulnerable outpatients. METHODS: A multidisciplinary group of professionals selected five characteristics identifying social vulnerability, integrated in a self-reported questionnaire, from which 5 criteria identify the socially vulnerable outpatients consulting the hospital. The metrological performance of the tool was assessed on a sample of randomly selected outpatients admitted to the emergency department and the results referred to the independent assessment of two social workers. The sensitivity and specificity of the tool were determined and ROC curves drawn. RESULTS: 222 patients were included, aged from 15 to 93 Years (mean: 53 Years), 59% of whom were men. 78% filled out the questionnaire on their own, while 22% required help, usually for physical or material reasons and 87% answered the five questions without any difficulty. The kappa coefficient of agreement between the two social workers was estimated at 0.94 (CI: 0.89-0.98). The sensitivity of the self reported questionnaire was of 70% (CI: 64-76) and its specificity of 77% (CI: 71-82). The ROC curves showed that the modified tool had a sensitivity of 80% (Sp: 67%). With only 2 characteristics, this sensitivity was of 76% (Sp: 73%). CONCLUSION: This tool, which is based on the advice of various experts, is valid and presents acceptable metrological properties. Once some simplifications have been made, the questionnaire could be used in routine in any patient consulting the hospital because it is acceptable, simple to use and can be rapidly filled-in.
Academic Medical Centers↗
Should self-assessment methods be used to measure compliance with handwashing recommendations? A study carried out in a French university hospital.
BACKGROUND: Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and self-assessment methods. METHODS: Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for 1 day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%). RESULTS: Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations. CONCLUSIONS: Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW. A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.
Adult↗
Beds Simulator 1.0: a software for the modelisation of the number of beds required for a hospital department.
The determination of the number of beds needed for a hospital department is a complex problem that try to take into account efficiency, forecasting of needs, appropriateness of stays. Health authority used methods based on ratios that do not take into account local specificities and use rather to support an economic decision. On the other side, the models developed are too specific to be applied to all type of hospital department. Moreover, all the solutions depend on the LoS (Length of Stay). We have developed a non parametric method to solve this problem. This modelisation was successfully tested in teaching and non teaching hospitals, for an Intensive Care Unit, two Internal Medicine and a surgical departments. A software easy to use was developed, working on Windows available on our website www.sante.univ-nantes.fr/med/stat/.
Bed Occupancy↗