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Objective: Our objective was to improve the organization and management of care facilities for children suffering from cancer or leukaemia and to be aligned with the legislation in force in France., Methods: Our report is on the successive steps for the implementation of a quality assurance system, methods used, motivations, cost, difficulties encountered as well as the advantages obtained. In the Regional Centre for Paediatric Oncology (CRCP) at the CHU in Clermont-Ferrand, we launched a quality programme based on ISO9001/2000 standards. The implementation of the quality assurance system was conducted as a research project and an established medical project with the support of the Management Team. The mission was divided into several "processes", an approach consisting of considering the clinical service in terms of flow and successions of transformations (reception, care, support, accompaniment, etc.) which produce added-value (services and products adapted to the needs of the "customers": children, families, correspondents)., Results: We singled out ten physical processes or "job specializations" such as "diagnosis", "care" or "project for the child". The cartography which is the systematic representation of the processes and the interactions between them made it possible to draw up a global vision of the CRCP "care" activity., Conclusion: The ISO9001/2000 standard is a tool designed to help organization and management. The benefit obtained in implementing it in a clinic was perceived in organisational terms and lead to a true team spirit, a standardization of the professional practices and the enhancement of the role of each person. The advantages appear at three levels: the child and his/her family, the medical and paramedical teams, and the administrative supervisory bodies.

Background: Stroke is the most common cause of permanent disability in Europe and is a major public health problem. A recent significant therapeutic advance is the administration of recombinant tissue plasminogen activator (rtPA) for cerebral infarcts within three hours of symptom onset. French guidelines limit its use to patients in specialized stroke units. There is only one stroke unit in the region of Aquitaine, in Bordeaux, 200 km from Pau and too far to transfer patients within the necessary time. With the collaboration of our colleagues in Bordeaux we decided to assess whether stroke thrombolysis could be feasibly and safely administered in our district general hospital., Design: From September 2004 through August 2005, eligible patients received rtPA treatment in the emergency department. The National Institutes of Health Stroke Scale (NIHSS) was administered at admission, immediately after treatment, and 24 hours later. In January 2006, a prospective follow-up assessed the NIHSS, Modified Rankin Scale (MRS) and Barthel Index Score (BIS) for all subjects still alive and collected data about those who had died., Results: In all, 553 patients were admitted for stroke: 306 had cerebral infarcts and 25 (8.1%) were treated by intravenous thrombolysis. The mean age of the patients who received thrombolysis was 67 years (range: 33-80), and the sex ratio was 4/1 (20 men and 5 women). Mean delay from symptom onset to treatment was 150 min (range 105-180). The median NIHSS score was 13 (range 8-22) at admission, 10 (range 0-22) after treatment, and 7 the next day (range 0-22). Two patients (8%) died during the acute phase. On January 2006, after a median follow-up of 11.6 months (range: 6-16), 18 (72%) patients were still alive: 13 (52%) with good outcomes (MRS, 0-1) and 3 severely disabled and institutionalized (BIS, 0-50)., Conclusion: Our results show that thrombolysis is possible in Pau. The population in our catchment area has a good proportion of stroke patients eligible for thrombolytic treatment. Outcomes and mortality rate are consistent with experience elsewhere. The creation of a stroke unit should help improve prognosis while complying with management guidelines.