[Impact of the law of the 4 March 2002 relative to patients' rights on request for medical information received in a medical dispatching center and mobile intensive care unit (Samu 93)]

INTRODUCTION

Law of the 4 March 2002 allowed patient's access to his medical record. This law could increase the number of requests in medical dispatching centers and prehospital intensive care units.

OBJECTIVE

The aim of this study was to evaluate the impact of this law on the number of requests for medical information received in our unit.

METHODS

Since the promulgation of the law, from March to December 2002, medical requests were prospectively collected and classified in categories including request for transmission of medical record. Requests received before the law, from January 2000 to February 2002 were classified according to the same items. Number of requests received during the two periods were compared according to the total number of medical record managed in our medical dispatching center and prehospital intensive care unit.

RESULTS

The total number of requests for medical information significantly increased since the law of March 2002 (results are expressed as cases per month per 10 000 record: 4.8 +/- 2.5 vs. 8.0 +/- 4.5; p = 0.04). Specific request for transmissions of medical record significantly increased since the law (1.3 +/- 1.6 vs. 3.0 +/- 3.0; P = 0.046). This increase was progressive and constant since March 2002.

DISCUSSION

Physicians and patients should take in consideration consequences of this law. Physician should be vigilant with the quality of their medical dossiers. Interpretation of this law and its ethics consequences will probably be discussed again as one should not exclude perverse impact of this law. In effect, insurances and mutual insurances companies could find in this law a way to obtain medical information, such as circumstances of death, previously unavailable.

CONCLUSION

The law of 4 March 2002 relative to patients' rights significantly increased number of requests for medical information received in our dispatching center and prehospital intensive care unit.

Surface nuclear magnetic relaxation and dynamics of water and oil in granular packings and rocks

Low field proton nuclear spin-relaxation at variable magnetic field strength and temperature provides surface dynamical parameters such as surface diffusion coefficients, activation energies, time of residence and coefficient of surface affinity. These parameters were extracted from measurements on grain packs and natural oil-bearing rocks. On grain packs, we show first that changing the amount of surface paramagnetic impurities leads to striking different relationships between the pore-size and the relaxation times T1 and T2. These relationships are well supported by fast-diffusion (surface-limited) or slow-diffusion relaxation models. Surface relaxivity parameters rho1 and rho2 are deduced from the pore size dependence in the fast-diffusion regime. Then, we evidence the frequency and temperature dependence of the surface relaxivity rho1 by field cycling NMR relaxation and relevant theoretical models. The typical frequency dependence found allows an experimental separation of the surface and bulk microdynamics in granular packings and petroleum rocks and the determination of the above mentioned surface dynamical parameters. Finally, we present the first field cycling nuclear spin relaxation experiments performed in water/oil saturated petroleum rocks. We believe that these experiments give new information about the surface localization of these two saturating liquids in pores.

Quantitative evaluation of porous media wettability using NMR relaxometry

We propose a new method to determine wettability indices from NMR relaxometry. The new method uses the sensitivity of low field NMR relaxometry to the fluid distribution in oil-water saturated porous media. The model is based on the existence of a surface relaxivity for both oil and water, allowing the determination of the amount of surface wetted either by oil or by water. The proposed NMR wettability index requires the measurement of relaxation time distribution at four different saturation states. At the irreducible water saturation, we determine the dominant relaxation time of oil in the presence of a small amount of water, and at the oil residual saturation, we determine the dominant relaxation time of water in the presence of a small amount of oil. At 100% water and 100% oil saturation, we determine the surface relaxivity ratio. The interaction of oil with the surface is also evidenced by the comparison of the spin-lattice (T1) and spin-locking (T1rho) relaxation times. The new NMR index agrees with standard wettability measurements based on drainage-imbibition capillary pressure curves (USBM test) in the range [-0.3-1].

Phenotypic variability of aprataxin gene mutations

The clinical and genetic features of three non-Portuguese and non-Japanese patients with aprataxin gene mutations are reported. Patient 1 came from Italy and presented with typical ataxia with ocular motor apraxia (OMA). She was homozygous for the W279X nonsense mutation, which is associated with the Portuguese founding haplotype. Patients 2 and 3 were French siblings and did not present with either OMA or hypoalbuminemia. They were compound heterozygous for the nonsense W279X mutation and a missense K197Q mutation.

[Epidemiology of SARS: mission of the emergency medical department of the French Hospital of Hanoi]

During the epidemic of severe acute respiratory syndrome (SARS) that occurred in Vietnam in March 2003, the French Ministries of Health and Foreign Affairs dispatched a mission composed of personnel from the emergency medical assistance department (French acronym, SAMU) and one virologist from the Pasteur Institute to the French hospital in Hanoi. The purpose of this mission was to reinforce the local medical staff, to bring medical equipment, and to assist in identifying the cause of the SARS epidemic. Most of the 39 cases observed involved health care personnel working at the hospital. Six including 5 who died presented severe manifestations. Application of strict empirical measures of isolation, hygiene, and personal protection allowed containment of the SARS outbreak in Hanoi.

[Emergency preparedness based on coherent integration of crisis response resources: workshop on mass casualty management in Bethlehem in June 1999]

In June 1999, the Humanitarian Action Division of the Foreign Affairs Department organized a training course on the mass casualty management within the framework of religious festivities related to the Bethlehem 2000 project. This initiative was undertaken at the request of the Palestinian Authority and the General Consulate of France in Jerusalem. Palestinian and French specialists in the field worked together in three workshops devoted to rescue, search and first aid; medical outposts and triage; and emergency and surgical care in referring hospitals.

Surface nuclear magnetic relaxation and dynamics of water and oil in macroporous media

Proton nuclear spin-relaxation studies on water- or oil-saturated granular packings and limestone rocks allow estimating surface molecular dynamical parameters. Measurements were performed at various conditions of temperature, magnetic field strengths, and pore size. We show by low field NMR relaxation that changing the amount of surface paramagnetic impurities leads to striking different pore-size dependences of the relaxation times T1 and T2 of liquids in pores. These dependences are well supported by surface-limited or diffusion-limited relaxation models. Surface relaxivity parameters rho(1) and rho(2) are deduced from the pore-size dependence in the surface-limited regime. We evidence the frequency and temperature dependence of the surface relaxivity rho(1) by field cycling NMR relaxation and relevant theoretical models. The typical frequency dependence found allows an experimental separation of the surface and bulk microdynamics in porous media. Several surface dynamical parameters, such as diffusion coefficients, activation energies, time of residence, and coefficient of surface affinity, were therefore determined. The methods presented here give a powerful analysis of the surface microdynamics of confined liquids, which can be applied to the study of oil-bearing rocks.

The neuroprotective activity of 8-alkylamino-1,4-benzoxazine antioxidants

Antioxidant 8-alkylamino-1,4-benzoxazines, (R,S)-(3-tert-butyl-8-phenylethylamino-3,4-dihydro-2H-1,4-benzoxazin-5-yl) (phenyl) methanone (S 24429) and (R,S)-(3-cyclopentyl-8-benzylamino-3,4-dihydro-2H-1,4-benzoxazin-5-yl) (phenyl) methanone (S 24718), were prepared according to a two-step one-pot electrochemical procedure. These compounds had been selected from a previous study of structure/activity. Both compounds (1-100 microM) prevented the fall in ATP levels caused by 24 h of hypoxia in astrocytes. Both compounds (1 and 10 mg/kg i.p.) were powerful neuroprotective agents in protecting against the lesions induced by 15 microg S-bromo-willardiine injected into the cortex or white matter of 5-day old mice pups. In contrast, exifone, an antioxidant compound, was inactive at these doses. S 24429 and S 24718 appear to be novel neuroprotective agents, which are effective in a model of brain damage mimicking the lesions underlying cerebral palsy.

Coordination in childhood: modifications of visuomotor representations in 6- to 11-year-old children

This research investigated the development of visuomotor coordination in childhood, more specifically the conversion of visual information into motor sequences. Three groups of children (aged 6, 8 and 11 years) and a group of adults performed pointing movements without direct feedback from their arm displacements. Visual information, provided by a video camera, was disturbed by rotations of 0 degree, 45 degrees, 90 degrees, 135 degrees or 180 degrees. Six-year-old children showed poor accuracy for 180 degrees rotations. These results suggest that the youngest children use unidirectional representations to convert visual information into motor sequences. At 8 years of age, children showed a shift from unidirectional to bidirectional representations, as reflected by reduced errors for 180 degrees rotations. Eleven-year-old children and adults showed the same type of representations, i.e., bidirectional. However, as reflected by their slower movement time and slower modifications in temporal accuracy across trials, the oldest children have not yet reached maturation in their adaptive process when compared to adults.

New ways of probing surface nuclear relaxation and microdynamics of water and oil in porous media

The microdynamics of water and oil in macroporous media with SiO2 or CaCO3 surfaces has been probed at various temperatures by magnetic field-cycling measurements of spin-lattice relaxation rates. These measurements and an original theory of surface diffusion allow us to obtain surface dynamical parameters such as surface correlation times, residence times and diffusion coefficients. A coefficient of affinity of the liquids for the pore surface is deduced.

[Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication]

INTRODUCTION

Carbon monoxide detectors are currently used by the French prehospital medical teams. These detectors can also be used to measure expired breath carbon monoxide concentration. The interest of this measurement has never been studied.

OBJECTIVE

To evaluate interest of expired breath carbon monoxide concentration measurement in the management of prehospital carbon monoxide intoxication.

STUDY DESIGN

Patients with carbon monoxide poisoning were included during 1998.

PATIENTS AND METHODS

Four levels of clinical severity: no symptom, minor, medium or severe intoxication were defined. Carbon monoxide concentration were measured in the expired breath (COHbe) at the place of the intoxication and in blood samples collected at the place of the intoxication (COHbs) and at the hospital (COHbh).

RESULTS

209 patients were included, 144 had no symptom (55%), the value of COHbe was 11.6 +/- 7.5% (mean +/- DS) and the value of COHbh was 4.9 +/- 3.3%. 91 patients had minor intoxication (35%), the value of COHbe was 16.4 +/- 7.9% and the value of COHbh was 7.1 +/- 4.5%, 21 patients had sever or medium intoxication (8%) the value of COHbe was 26.4 +/- 17.7% and the the value of COHbh was 12.8 +/- 9.3%. Results for COHbh were obtained for only three patients. Relationship between symptoms and expired breath carbon monoxide and relationship between symptoms and carbon monoxide blood concentration on arrival at the hospital were significant (p < 0.05).

CONCLUSION

Measurement of expired carbon monoxide concentration, easy and quick to perform is correlated with clinical severity in carbon monoxide poisoning.

Visual context and the control of movements through video display

The aim of this experiment was to test the influence of target context on adaptation to scale perturbations introduced by a video display. Participants performed pointing movements without direct vision of their moving hand, although they could see their movements on a video display. Their perceived movements could be reduced, enlarged. or displayed at their actual size. Three target contexts were compared: dark surround, illuminated frame, and familiar object. Movements were executed with or without vision of hand displacement. Results showed that target context enhanced an allocentric coding of the movement, which improved movement execution. However, the effect of target context changed whether or not the displacement of the hand was available. Overall, the results suggest that target context allowed the extraction of dynamic information about movements, which is used to program and control movements. This suggests that target context could be used efficiently to improve spatial accuracy and speed in teleoperation learning. Potential applications include the reduction of difficulties encountered during teleoperation learning through the introduction of visual context.

Role of the feedforward command and reafferent information in the coordination of a passing prehension task

The performances of a deafferented patient and five control subjects have been studied during a self-driven passing task in which one hand has to grasp an object transported by the other hand and in a unimanual reach-to-grasp task. The kinematics of the reach and grasp components and the scaling of the grip aperture recorded for the self-driven passing task were very similar in controls and the deafferented subject (GL). In contrast, for the unimanual task when vision was absent, GL's coordination between reaching and grasping was delayed in space and time compared with the control subjects. In addition, frequent reopening of the grip was observed in GL during the final closure phase of the unimanual prehension task. These results support the notion that afferent proprioceptive information resulting from the reaching movement - which seemed to be used to coordinate reaching and grasping commands in the unimanual task - is no longer necessary in the self-induced passing task. Finally, for the externally driven passing task, when the object was passively transported by the experimenter, the coordination was consistently modified in all subjects; grip aperture onset was delayed, thus asserting a specific contribution of the central command or feedforward mechanisms into the anticipation of the grasp onset observed in the self-driven passing task. The origin and nature of the information necessary for building up the feedforward mechanisms remains to be elucidated.

How efficient are central mechanisms for the learning and retention of coincident timing actions?

We compared the adaptive strategy and retention capacity of a deafferented subject and control subjects when intercepting, with a sliding-throw, an apparent movement coming at various speeds. Subjects were submitted to five practice sessions (30 trials per session) and to a retention test. The throwing kinematics was analysed, and spatial and temporal performance errors were measured. With practice, the deafferented subject showed modifications in movement initiation strategies and throwing patterns. With a slow apparent movement, the deafferented subject's initial behavior was characterized by short movement initiation and movement times. With practice, she showed an important increase in movement time in session 5, allowing longer visual control and leading to better temporal and spatial accuracy than that shown in session 1. In the retention session, the deafferented patient showed a late movement initiation strategy, similar to that of the control subjects. This increased movement initiation time was accompanied by an improved temporal accuracy compared to the deafferented subject's early results. However, spatial accuracy improvement was labile and could not be maintained over the retention interval. At the fast speed, all temporal components of the response, namely, movement initiation time (MIT), movement time (MT), and disk travel time (DTT), were similar for the deafferented and control subjects. Overall, the deafferented subject reduced her temporal error through practice, though without attaining the control subjects' accuracy. However, with a fast-moving stimulus, she showed a deteriorated spatial accuracy, even doubling her spatial errors at retention. In brief, the deafferented subject achieved proper temporal (perceptivo-cognitive) lasting control of her interceptive action, whereas spatial (sensorimotor) regulation raised mnemonic problems.

Deafferentation and pointing with visual double-step perturbations

The capability of reprogramming movement responses following changes in the visual goal has been studied through the double-step paradigm. These studies have shown that: (a) continuous internal feedback-loops correct unconsciously the dynamic errors throughout the movement; (b) proprioceptive information and/or the efference copy have a privileged status among central processes, insuring on-line regulation of the initial motor commands; and (c) generation of the motor program starts after target presentation, and is continuously updated in the direction of the current internal representation of the target, at least until the onset of hand movement. This main corrective process of the initial program appears to be basically independent of visual reafference from the moving hand. However, the agreement with the possibility of a visuomotor loop, based on the comparison of the new updated representation of the target position and on the information from the moving hand, has not determined whether the correcting process is proprioceptive feedback dependent, or whether internal feedback-loops (efferent copies) are responsible for quick corrections of unfolding motor responses. To answer this question, the present experiment investigated the pointing behavior of a deafferented subject, using a double-step paradigm under various conditions of visual feedback and movement initiation. Overall, the present study (a) clearly showed the capacity of the motor system to modify and correct erroneous trajectories on the mere basis of internal feedback-loops and (b) emphasized the crucial role played by the target jump/arm triggering delay and the importance of the eye efferent copy for providing information about the spatial goal of the movement.

Aging and postural control: postural perturbations caused by changing the visual anchor

OBJECTIVE

To determine the effect of modifying the stable visual anchor on the postural stability of older individuals. The visual anchor was changed by opening doors similar to those found in an elevator cage. Lighting intensities inside and outside the cage were varied to create increasing or decreasing luminosity conditions. The effect of adding a cognitive load (counting backwards) was also tested.

DESIGN

A controlled laboratory study.

SETTING

Tests performed in a balance laboratory.

MEASUREMENTS

Sensory and clinical measurements to insure the integrity of the central and peripheral nervous system. Measures of balance were derived from the recordings of the center of foot pressure. These measures included range and speed of the center of foot pressure.

PARTICIPANTS

Eight older, community-dwelling subjects and nine young subjects participated. A sensorimotor evaluation was used to insure that all older individuals were free from any pathologies affecting postural stability. All participants had a low score (indicating high balance confidence) on the Falls Efficacy Scale and no history of falls.

RESULTS

Older individuals were affected by modification of the stable visual anchor induced by the opening of doors similar to that of an elevator cage. They showed greater ranges of the center of foot pressure (COP) and speed of the COP after than before the opening of the doors. Furthermore, the increased ranges and speed were two to three times greater than that observed for the young subjects. A lighting intensity considered as comfortable for reading inside the elevator affected the overall postural stability of the older participants negatively. Counting backwards also decreased their overall stability.

CONCLUSION

Changing the stable visual anchor, as when exiting an elevator cage, could be a significant risk factor for older persons. Moreover, when combined with a cognitive load or lower lighting intensity inside the elevator cage, the negative effects on the postural stability of older persons are exacerbated.

Modulation of anticipatory postural adjustments in a reactive and a self-triggered mode in humans

Five subjects raised their preferred arm until horizontal in one of two experimental conditions: (1) in response to a visual signal (reactive condition), and (2) in a self-triggered condition. In both conditions, subjects were instructed to execute the movement at approximately 80% of their maximal velocity, such that all movements were nearly similar. EMG activity was recorded in a focal muscle (Anterior Deltoidus) and in three postural muscles (ipsi-lateral Gastrocnemius, contra-lateral Tensor Fascia Latae and ipsi lateral Semitendinosus) known to be activated prior to the focal muscle. Results showed greater anticipatory postural adjustments in the self-triggered than in the reactive condition for the three postural muscles. It is suggested that similar intentional movements can be triggered by different timing strategies.

Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study

STUDY OBJECTIVE

To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems.

METHODS

This study was performed in lle de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptive study involved completion of a questionnaire by the operator just after endotracheal intubation was performed.

RESULTS

Six hundred eighty-five (99.1%) of 691 consecutive prehospital intubations were performed successfully in the field. The orotracheal route was used in 96.0%, and no surgical approaches such as cricothyroidotomy were used. Mechanical complications occurred in 84 patients, at a rate of 15.9% for nonarrest patients and 8.1% for arrest patients. A wide variety of sedation protocols were used. Difficult intubations (10.8%) were comparable in incidence to the number seen in US emergency departments, not US prehospital systems. By the same token, intubation success rates (99.1%) were comparable to US EDs and much higher than US prehospital results.

CONCLUSION

The characteristics of French prehospital airway management differ significantly from those of other countries. These differences may be explained by differences in approach to prehospital management rather than differences of skill.

Target speed alone influences the latency and temporal accuracy of interceptive action

When intercepting a mobile object or an apparent movement, participants show a temporal bias. They are in advance when dealing with a slow-moving stimulus and late with a fast-moving one. We studied participants intercepting an apparent movement by sliding a disk on a table. Using a fast and a slow stimulus speed, we varied three factors: duration of presentation of the stimulus, distance covered by the stimulus, and speed context (constant or varied) of stimulus presentation. In addition to the temporal bias, spatial accuracy and kinematic measures were collected. The temporal bias created by speed was evident across all three factors. Speed, in addition to strongly determining the temporal bias, significantly affected the throwing strategy adopted by the participants, as revealed by latency, movement time, and disk trajectory duration.