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Abstract: Objective: To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients’ safety. Data sources: A review of English and French articles in Medline database (1990–2011) related to MMC in the ICU. Keywords used: “morbidity (and) mortality conference(s)”, “intensive care unit”, “intensive/critical care medicine”. Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d’Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. Study selection: Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. Data extraction: Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. Data synthesis: Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. Conclusion: Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients’ mortality and morbidity. [Copyright &y& Elsevier]

Objective – We conducted a survey regarding the organization of medical rescue during major events (catastrophes with limited effects) occurring in urban areas (Paris and immediate suburbs). The goal of this work was to study the availability of on site medical help and the real needs.Study design – Retrospective survey.Methods – Thirty-eight major events were analysed between 1988 and 2000. The median number (25th–75th percentiles) of victims per event was 42 (21–68) (range 8 to 424).Results – The median percentage of true emergencies (TE) was 5% with regard to the total number of victims per event. Thirty minutes after the event, 92% of the sites had a number of physician-manned ambulances greater than the number of severe victims. The median time to first evacuation was 79 (62–102) min.Conclusion – Disasters with limited effect occurrence in Paris and its immediate suburbs are characterized by a small percentage of TE and by a constant oversupply of medical means onsite. These observations led us to propose a new organization of medical rescue during this type of catastrophe, abandoning the classical notion of forward medical command post (FMCP) for a collection point of medical services (CPMS) consisting all means of evacuation (physician-manned and other ambulances). Also, a new type of victim identification, based on hospital base-station medical direction is discussed in this paper. [Copyright &y& Elsevier]

Summary: Extensive evidence related to thromboembolism risk and its prevention are available to guide health care providers. The 8th ACCP Evidence-Based Clinical Practice Guidelines were published in June 2008. The chapter on venous thromboembolism prophylaxis is the result of the collaboration of six senior authors with expertise in thrombosis, surgery, medicine, and critical appraisal. The methodology and the philosophy of these guidelines are explained in this paper and the major recommendations dealing with perioperative thromboprophylaxis are summarized. [Copyright &y& Elsevier]