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Future hospital accreditation could take into account the quality of medical files. The objectives of this study is to test a method for auditing and evaluating the quality of the handing of medical files. We conducted a retrospective regional audit based on the frame of reference the National Agency for Medical Development and Evaluation, by using a sample of cases, stratified by establishment. In our region, the global budgets of 47 public and private hospitals participating in the public hospital service, are adjusted while keeping in mind the medicalised activity data (PMSI). This audit was proposed to the doctors of the Department of Medical Information on the occasion of the regulatory PMSI quality control. A total of 467 questionnaires were given by 39 of the 47 sollicited hospitals (83%). The methodological aspects (questionnaire, cooperative approach...) are discussed. The make-up of medical files can alos be improved by raising the percentage of the presence of important data or documents such as the reason for admission (74.1%), the surgery report (83.2%), and the hospitalisation report (66.6%). A system for classifying the paraclinical results is shared and systematic throughout the service or hospital in only 73.2% of cases. The quality of the handing of medical files seems problematic in our hospitals and actions for improving the quality should be undertaken as a priority.

The clinical audit method based on a retrospective analysis of medical files can be used to assess hospital health care. The reliability of the results obtained depends on the validity of the data in the file and its completeness. The aim of this work was to assess the quality of this information source.The simplified ANDEM/ANAES from was proposed to 47 medical information departments of public and private hospitals participating in the public health care service in the Provence-Alples-Côte d'Azur region. The audit was conducted on a sample of hospital stays during a regular 6-month quality control assessment of hospital health care activity.Analysis of the 467 forms returned by 39 hospitals, showed that the quality of medical file recordings should be improved as a large amount of data or important documents were missing: reason for hospitalization (recorded on 74.1% of files), operation report (found in 83.2% of files) and discharge summary (found in 66.6% of files).Clinical audits would be compromised in certain hospitals by the use of medical files. Efforts to improve the quality of hospital medical files should be a priority.

Analysis of twenty five personal observations of septic osteoarthritis compared with information from the literature led the authors to the following conclusions: 1) Diagnosis of septic osteo-arthritis must be considered when confronted with a picture of acute or subacute arthritis generally inflamed with variable fever, raised sedimentation rates and frequently polymorph neutrophilia, above all especially if there are particular antecedents (local trauma or intra-articular injection, conditions which favor infections: diabetes, alcoholism, impaired immunity, corticosteroid therapy or various therapeutic immuno-suppresives). 2) It may be established on absolute criteria (isolation of the organism at the site of the lesions) or, in the absence of direct bacteriological evidence, by a body of evidence amongst which 4 arguments are of particular value: identification of a pathogenic organism in one or more blood cultures and/or at the site of a closed infection, postive serology and particularly elevation of the antistaphylolysine titres, rapid-onset radiological changes of destruction and/or reconstruction. plus hypercellularity of the fluid greater than 100,000 cells/mm3. 3) Medical treatment sometimes includes local treatment (joint aspiration, local injection of antibiotics) and in all cases immobilisation during the acute phase and systemic antibiotics. The latter will vary according to the organism responsible and its sensitivity. It seems useful to continue this for twelve weeks at the minimum in the normal form, initially making use of the combination of 2 antibiotics and preferably using continuous perfusion and/or intramuscular routes during the first half of treatment. 4) The consistently good results of such medical treatment seem to limit considerably the place of surgery for which the indications have become rare during the acute phase and even more so at later stages.

The effectiveness of tiapride on psychic disorders was studied in 30 chronic alcoholics by assessing four parameters: sleep disturbances, mood disorders, conduct disturbances, and tremor. In a daily dosage of 600 to 900 mg tiapride proved particularly effective on insomnia, anxiety, passivity and tremor, without adverse side-effects. This drug seems useful for controlling psychic disorders in alcoholics and for motivating acceptance of a detoxification program.

The authors report the case of a 21 years old man, with sex-linked agammaglobulinemia, who presents a presumed viral hepatitis, followed two years. The evolution, does yet fear a progressive cirrhosis. About this report and analysis of literature, frequency, evolution and pathophysiologic hypothesis, particularly the lymphocyte T role, are also discussed as the problem of hepatitis prevention of these subjects, who receive gammaglobulin injections.

Four members of the same family (2 male and 2 female) with normal thyroid function were found to have decreased total T3 and total T4, elevated response to the T3 test and low free thyroxin index. Such biological changes result from a deficiency in carrier protein and should be distinguished from nearly similar abnormalities observed in low T3 syndrome and hypothyroidism. Whilst gonosomal transmission through the X chromosome of thyroxin-binding protein deficiency seems well established, our findings show that another mechanism, i.e. dominant autosomal heredity, is practically certain.

A case of Zollinger-Ellison due to hyperplasia of antral gastrin cells in a 11 year-old child is reported. Only 49 cases of this syndrome in children have been published. The diagnosis (gastrin stimulation test, immunohistochemical detection of endocrine cells and therapeutic strategy are outlined).