Cte Hospital Intercommun Toulon La Sey

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care.
This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.
This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Upper aerodigestive tract neoplasms surgery results in important trauma, including swelling (oedemas) that can lead to respiratory tract obstruction and death from suffocation. To prevent this, protective tracheostomy is performed, allowing patients to breathe through a cannula during the critical phase. Although tracheostomy is reassuring, it presents complications, including swallowing disorders, refeeding delay and pulmonary infections. It generates anxiety for patients and can prevent them from communicating, which can affect their psychological well-being during hospitalization.
In Sainte Musse Hospital, patients who undergo upper aerodigestive tract neoplasms surgery are continuously monitored in intensive care unit. For some "at risk" patients, tracheostomy preparation is performed during operation with tracheal exposure but no incision. If dyspnea occurs, reanimators can quickly access to trachea and proceed to tracheostomy completion. This method, called PREPA-TRACH, avoids unnecessary tracheostomies while minimizing risks for the patients who would need it. Study purpose is to assess the security and reliability of this PREPA-TRACH protocol.

Heart failure poses a significant public health challenge due to its high prevalence and the substantial human and financial costs it generates. Furthermore, the lack of clear screening guidelines and challenges in accessing care and multi-professional coordination, contribute to diagnostic delays, leading more patients to seek care in more severe clinical states and requiring direct admission to emergency departments. There is therefore also a major organizational challenge in better managing the entry of patients into the healthcare system. This necessitates the development of structured heart failure screening strategies.
The 2021 European Society of Cardiology (ESC 2021) guidelines on heart failure screening prioritize the identification of at-risk individuals and the early detection of disease manifestations. They suggest that, in high-risk groups, tests such as echocardiography and biomarker measurement (NT-proBNP) should be used to detect heart failure at an early stage, even in the absence of symptoms. The guidelines also delineate specific biomarker thresholds and propose organizational frameworks with defined timelines to facilitate systematic screening.
The implementation of a heart failure screening pathway within primary care involving multi-professional cooperation is therefore warranted.
Stratifying screening based on risk factors and symptomatology is expected to enhance the positive predictive value of the screening process. Furthermore, evaluating the efficacy of this pathway is crucial for establishing a standardized, reproducible clinical protocol suitable for routine primary care practice.
This study is a prospective, multicenter, observational study conducted within the context of routine clinical care.