In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0-1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0-0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

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BackgroundPrimary care patients are often cited as a cause of Emergency Department overcrowding (ED). The aim of this study was to evaluate a physician led redirection procedure of selected patients towards an out of hours general practice (OHGP) in an Emergency Department with 55,000 admissions per year.MethodsObservational monocentric study over a period of 2 months. Every patient redirected to the OHGP was included and subsequently contacted by telephone to answer a standardized questionnaire, in order to measure:Redirection rate over the entire period and during weekdays or weekends/holidayRate of redirected patients who went to the OHGPRate of redirected patients who consulted in an ED in the next 72 h for the same reasonRedirected patients’ satisfaction rateResultsDuring the study period 9551 patients presented to the ED, of which 288 were redirected towards the OHGP (3%). The redirection rate was 1.9% during weekdays and 5.7% during weekends/holiday (p < 0.001). Of the redirected patients, 77% answered the telephone interview.Ninety percent of these patients consulted the OHGP. The main reasons for not consulting were: unduly long wait, opening hours not suitable, too costly. The rate of redirected patients who consulted in an ED in the following 72 h for the same reason was 4.1%. The satisfaction rate was 79.6% among interviewed patients.ConclusionsA physician led procedure to redirect selected patients from the ED towards an OHGP results in a low redirection rate, unlikely to have a significant effect on ED patient flow. However, the procedure is safe and well accepted by a majority of patients.

Aux débuts du parlant, entre 1927 et 1930, deux grandes sociétés intégrées de cinéma se constituent autour d'anciennes entreprises glorieuses, Pathé et Gaumont. Le succès du cinéma parlant apparaît alors comme une chance de renouer avec la splendeur passée du cinéma français. La forte progression des recettes 1 entre 1929 et 1931 (+56 %) explique l'importance des investissements consentis pour l'adaptation du parc de salles à la nouvelle technologie. D'ambitieux programmes de production de films sont engagés, des studios sont équipés pour accueillir les tournages. L'industrie cinématographique française trouve une nouvelle vigueur. Mais en deux ans, la conjoncture semble se retourner, les audacieux qui avaient beaucoup emprunté dépendent des banques et du marché financier qui restent méfiants et réservés. La Banque Nationale de Crédit, qui avait organisé la fusion de Gaumont, Aubert-Franco-Film et Continsouza, se trouve elle-même en liquidation et fonctionne avec des avances du Trésor. Dès 1932, l'État se retrouve principal créancier de la Gaumont-Franco-Film-Aubert (GFFA) par l'intermédiaire de la Banque Nationale de Crédit en liquidation. Cette situation contraint le ministère des Finances à étudier toutes les solutions susceptibles de sauver l'entreprise. Les experts chargés d'étudier les possibilités de relance de la GFFA conduisent à mettre en cause l'organisation du cinéma français. Ces représentants de grandes entreprises françaises préconisent une intervention de l'État pour organiser le marché, protéger les producteurs français et encourager la qualité. Dix-huit mois plus tard, l'ancien ministre Maurice Petsche élargit la perspective et propose un plan de réforme au nom de la commission des finances de la Chambre des députés. Faire face à la concurrence étrangère en encourageant la qualité, en confiant à l'État une mission d'aide, d'organisation et de surveillance du secteur, les auteurs de ces Aux origines de « l'exception culturelle française » ? Des études d'experts a... 1895. Mille huit cent quatre-vingt-quinze, 44 | 2004

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