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ABSTRACT: The Hospital Organization Guidelines (HOG) recently recommended that Reference Hospitals create Post-Acute Rehabilitation Units (PARU). The authors describe the quality process of a PARU in a University Hospital (UH); this quality process had previously been used in a private rehabilitation hospital.
The authors wanted to evaluate the organization of the care provided in their PARU and compare the evaluation results with the results expected at the unit's creation five years earlier.
The evaluation indicators were set when the unit was created. These indicators allowed the evaluation of the appropriateness of admissions, the efficiency of the care path and the response to the patients' rehabilitation and intensive care needs.
The appropriateness of admission was found to be coherent with the typology of patients admitted (i.e., brain and spinal cord injured patients just discharged from intensive care units). The brain-injured care path was streamlined. The evaluation results raised several questions about the resources provided and about the different needs of post-acute care and rehabilitation.
Patient needs must be identified precisely if the weak links of the care path are to be reinforced. The indicators used must be capable of assessing both the quantity and the quality of care. If these indicators lack relevance, or if the health care organization responds incompletely to patient needs, it puts the efficiency of the whole system at stake.
Annals of physical and rehabilitation medicine 10/2010; 53(8):457-73.
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ABSTRACT: For the severe head injured patients, the way of going from coma to arousal is considerably different from one patient to the other, and it is not always easy to determine the appropriate moment for taking them out of intensive care, into rehabilitation. This is the reason why, instead of considering these two treatments as successive phases, it is better to consider them as a collaboration process. The objective of this paper is to describe the needs of this type of patients, by using the data gathered on a weekly basis in the medical data department of the Centre Médical de l'Argentière, on patients admitted in 2002 in the rehabilitation and post-intensive care departments. A typology can be defined with the association of three characteristics: several disabilities; physical, behavioural and relational impairments; need for a multidisciplinary rehabilitation team. This typology requires a specific rehabilitation treatment as from the acute phase of intensive care.
Annales Françaises d Anesthésie et de Réanimation 07/2005; 24(6):679-82. · 0.84 Impact Factor
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F Tasseau
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ABSTRACT: The ethical and legal problems posed by severe outcome of coma are complex and their analysis requires a multi-disciplinary approach. Three aspects have been particularly studied in this paper. The first is a reminder of the medical definitions of the concepts of vegetative state and minimally conscious state. The second focuses on the analysis of the ethical and legal debate of these conditions at an international level. Finally, the third concerns the wealth prospects, proposed, in France, by the circular letter dated May 3, 2002.
Annales Françaises d Anesthésie et de Réanimation 07/2005; 24(6):683-7. · 0.84 Impact Factor
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ABSTRACT: There is no specific legislation concerning pools and others medical hydrotherapy equipments relating hygiene and security rules. For this reason, the hydrotherapy pools use the public swimming pools legislation.
This article is based on literature review (database Medline and Embase--manual research).
This article offers a review of pool associated infections along with the description of the measures designed to minimise the possible transmission of infection during hydrotherapy activities such as: Technical measures: pool and premises conception, water treatments, feed tanks, air quality. Hygiene rules for patients and hospital staff and pathologies which are contra-indications to hydrotherapy activities. Microbiological and physico-chemical monitoring.
The infectious risk remains low with therapeutic pools. However, the development of specific legislation and surveillance should be enhanced.
All these measures are part of the quality assurance program that must be implemented to control the safety of these installations.
Annales de Réadaptation et de Médecine Physique 07/2004; 47(5):233-8.
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ABSTRACT: The starting point of the French conference of consensus concerning arousal after coma was to answer the following question: "How can we define the ways of going from coma to arousal and their clinical levels?
A team of readers have picked up in the literature one hundred and fifty papers, out of which fifty six have been analysed.
From this analysis, three points emerged: The concepts of coma and arousal; The conditions of evolution from coma to arousal; Various groups of patients depending on their expressing arousal. One could not find any consensual model concerning the different ways of going from coma to arousal. The variability of the technics and the changing validity of all scores did not allow the conditions of arousal to reach a satisfactory level of proof. The Glasgow Coma Scale (GCS) is the recognised standard for severe wakefulness' impairment, but it is not sensitive enough while patients' arousing. The Glasgow Outcome Scale (GOS) takes into account the patients' situations far later and does not include situations such as Minimally Conscious States (MCS). That's why we face multiple scores, either ordinal, or categorial, all tending to evaluate the slow levels of arousal.
Clinical findings concerning arousal are to be completed by non-clinical data. This would be greatly helpful to define appropriate management concerning individualized groups of patients. At this stage, another challenge for clinicians is to make the difference between emerging wakefulness and growing conscious activity.
Annales de Réadaptation et de Médecine Physique 12/2002; 45(8):439-47.
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F Tasseau
Acta neurologica Belgica 02/1994; 94(3):190-3. · 0.54 Impact Factor
