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Le statut d'infirmière en pratique avancée (IPA) a été créé en France par la loi du 26 janvier 2016. Les IPA sont des infirmières de niveau Master qui ont acquis des connaissances théoriques et des compétences cliniques et de prises de décisions complexes. Elles sont habilitées à travailler aussi bien en ambulatoire au sein d'une équipe de soins primaires coordonnée par le médecin ou en assistance d'un médecin spécialiste ou en établissement de santé. En période de pénurie aggravée de médecins, l'accès direct aux IPA a été instauré dans les établissements de santé et des structures d'exercice coordonné par la loi du 19 mai 2023, toujours dans le cadre d'un protocole d'organisation avec un médecin. Le développement des IPA est un changement de paradigme dans l'exercice de la médecine, favorisant la coopération entre professionnels dans le cadre des parcours de soins des patients. L'IPA pourrait favoriser un meilleur accès aux soins en participant à la prise en charge organisée des patients. Cependant, il existe des freins organisationnels et financiers à la mise en œuvre de la pratique infirmière avancée et également certaines réticences de la part des médecins et des patients. En rhumatologie, les IPA sont actuellement très peu nombreuses bien qu'il existe des preuves du bénéfice des IPA dans la prise en charge des maladies ostéoarticulaires. The status of advanced practice nurses (APN) was created in France by the law of 26 January 2016. The APNs are Master-level nurses who have acquired theoretical knowledge, clinical skills, and complex decision-making skills. They are qualified to work as part of a primary care team coordinated by a physician or in support of a specialist, or in health establishments. At a time when there is a severe lack of physicians, direct access to APNs has been introduced in health establishments by the law of 19 May 2023, still within the framework of an organisational protocol with a physician. The development of APNs represents a paradigm shift in medical practice, encouraging cooperation between professionals as part of patients' care pathways. The APNs could promote better access to care by participating to organised management of the patients. However, there are some organisational and financial barriers to implementing advanced nursing practice, as well as a certain reluctance from physicians and of patients. In rheumatology, there are currently very few APNs, although there is evidence of the benefits of APNs in the management of rheumatic and musculoskeletal diseases. [ABSTRACT FROM AUTHOR]

The organisation of the care pathway for patients receiving treatment with chimeric antigen receptor T cells meets strict standards. Here we describe the regulations in France, how this pathway can be enhanced and its current limitations. [ABSTRACT FROM AUTHOR]

Le nombre de médecin est aujourd'hui en France très insuffisant pour faire face à la demande croissante de soins des patients. Le vieillissement de la population, le nombre croissant de pathologies chroniques, les inégalités d'accès aux soins dans les territoires sont autant d'enjeux à considérer. En optimisant le parcours de soins, et en favorisant l'interdisciplinarité ; en intégrant les évolutions du numérique en santé, dossier médical partagé, nouveaux outils numériques, télésanté ; et en s'appuyant sur le maillage territorial des officines pharmaceutiques en misant sur le pharmacien d'officine comme acteur de santé publique de proximité, la France cherche à rendre plus efficient son système de santé dans les territoires, palliant ainsi au manque de médecins. The number of doctors in France today is far too low to meet the growing demand for patient care. An ageing population, a growing number of chronic pathologies and inequalities in access to care across the country are just some of the issues to be considered. By optimizing the care pathway, and promoting interdisciplinarity; by integrating digital health developments, such as shared medical records, new digital tools and telehealth; and by relying on the territorial network of pharmacies, banking on the dispensing pharmacist as a local public health player, France is seeking to make its healthcare system more efficient in the regions, thereby making up for the shortage of doctors. [ABSTRACT FROM AUTHOR]

En lien avec la feuille de route interministérielle sur l'obésité (2019-2022), la Haute Autorité de Santé (HAS) a publié en 2022 un guide pour optimiser le parcours de soins de l'enfant et de l'adolescent en situation de surpoids ou d'obésité et ainsi accompagner les professionnels de santé dans sa mise en œuvre. Ce guide insiste tout particulièrement sur l'importance de la surveillance de l'indice de masse corporelle (IMC) tout au long de l'enfance à chaque occasion afin d'optimiser le dépistage du surpoids et de l'obésité. En cas d'excès pondéral avéré, il détaille l'importance de l'évaluation multidisciplinaire de chaque situation avec la prise en compte des différents aspects (contexte socioculturel, psychoaffectif entre autres) et les leviers que les professionnels peuvent utiliser tout au long du parcours de soins qui doit être coordonné, gradué et inscrit dans la durée pour espérer être efficace. In link with the interministerial plan for obesity (2019-2022), the French National Authority for Health (HAS) has published in 2022 a guide to optimize the care pathway for overweight and obese children and adolescents to support healthcare professionals in its implementation. The guide particularly emphases on the importance of calculating Body Mass Index (BMI) throughout childhood, at every opportunity, to optimize screening for overweight and obesity. In case where excess weight has been established, it details the importance of multidisciplinary assessment of each situation, with considering several important aspects (socio-cultural, psycho-affective, etc.) and detailing the levers that professionals can use throughout this care pathway that must be coordinated and graduated on the long-term manner if it is to be effective. [ABSTRACT FROM AUTHOR]

[Display omitted] La survenue de fractures osseuses est fréquente dans la population âgée et chez les patients atteints d'un cancer, en particulier ceux qui présentent des métastases osseuses. L'incidence croissante du cancer liée au vieillissement de la population constitue un enjeu sanitaire majeur, y compris pour la santé osseuse. La prise en charge des patients âgés atteints d'un cancer doit prendre en compte l'hétérogénéité et les spécificités de cette population. Les outils de dépistage disponibles tels que le G8 et le VES13 tout comme l'évaluation gériatrique approfondie (EGA) ne couvrent pas les informations liées à la santé osseuse. Une évaluation des complications osseuses sera indiquée en fonction des syndromes gériatriques identifiés comme les chutes, les antécédents du patient et le plan de traitement oncologique. Certaines thérapies anticancéreuses ont un impact délétère sur le remodelage osseux et exposent au risque d'ostéoporose. L'hypogonadisme, induit par l'hormonothérapie et certaines chimiothérapies, est le principal facteur à l'origine d'une diminution de la densité minérale osseuse. Les thérapies oncologiques présentent également un risque de toxicité directe (chimiothérapie, radiothérapie ou corticostéroïdes) ou indirecte via les troubles électrolytiques (certaines chimiothérapies ou inhibiteurs de tyrosine-kinase) sur le remodelage osseux. La prévention des complications osseuses relève d'une prise en charge pluridisciplinaire. Certaines interventions proposées dans le cadre de l'EGA visent à améliorer la santé osseuse et réduire le risque de chute. Cette démarche est également fondée sur le traitement de l'ostéoporose et la prévention des complications associées aux métastases osseuses. La prise en charge des fractures, qu'elles soient liées ou non aux métastases osseuses, fait référence au concept d'orthogériatrie. Le rapport bénéfices-risques de l'opération, l'accès aux techniques mini-invasives, la pré-habilitation ou réhabilitation ainsi que le pronostic lié au cancer et aux syndromes gériatriques sont également pris en compte. La santé osseuse est une dimension essentielle en oncogériatrie. L'évaluation du risque osseux devrait faire partie intégrante de l'EGA en routine clinique et des outils spécifiques d'aide à la décision thérapeutique devront être développés. La prise en charge des complications osseuses doit être assimilée au parcours de soins du patient et l'approche oncogériatrique pluridisciplinaire se doit de prévoir une expertise rhumatologique. The occurrence of bone fractures is frequent in the elderly population, and in cancer patients, especially with bone metastases. The growing incidence of cancer associated with an aging population implies important health challenges, including bone health. Decisions on cancer care in older adults have to take into account older adults' specificities. Screening tools as G8 or VES 13 and evaluating tools as comprehensive geriatric assessment (CGA) do not include bone-related items. Bone risk assessment is indicated according to identification of geriatric syndromes such as falls, history, and the oncology treatment plan. Some cancer treatments disrupt bone turnover and decrease bone mineral density. This is mainly caused by hypogonadism, induced by hormonal treatments and some chemotherapies. Treatments can also cause direct (i.e. chemotherapy, radiotherapy or glucocorticoids) or indirect toxicity through electrolyte disorders (i. e. some chemotherapies or tyrosine kinase inhibitors) on bone turnover. Bone risk prevention is multidisciplinary. Certain interventions proposed in the CGA aim to improve bone health and reduce the risk of falling. It is also based on the drug management of osteoporosis, and the prevention of complications from bone metastases. Management of fractures, related or not to bone metastases, relates to the concept of orthogeriatrics. It is also based on the benefit-risk ratio of the operation, access to minimally invasive techniques, prehabilitation or rehabilitation, but also the prognosis related to cancer and geriatric syndromes. Bone health is essential in older cancer patient's care. Bone risk assessment should be part of CGA in routine use and specific decision-making tools should be developed. Bone event management must be integrated throughout the patient's care pathway and onco-geriatrics multidisciplinarity should include rheumatological expertise. [ABSTRACT FROM AUTHOR]

These proposed recommendations have been issued as part of an innovative approach based on an individualised, structured and coordinated patient pathway to engage patients in specific implanted neurostimulation (NSI) management for pain relief in the context of certain chronic pain conditions. This pathway necessarily involves chronic pain structures (SDC) and implantation centres (CI). This work takes the form of recommendations at several levels. We will distinguish between what is required, what is expected and what is desired in terms of good practice, depending on local and regional resources, in order to ensure optimal quality of care. [ABSTRACT FROM AUTHOR]

Le Centre Psychiatrique d'Orientation et d'Accueil, est le plus grand centre d'urgences psychiatriques français, avec plus de 10 000 consultations par an. L'objectif de notre étude observationnelle rétrospective est de décrire la population des patients de 15 à 18 ans (18 ans exclus) consultant dans notre centre (motifs de consultation, diagnostics psychiatriques, décision d'orientation en précisant vers quelles structures ces mineurs sont orientés) et de proposer un modèle prédictif de décision d'hospitalisation. Tous les patients consécutifs âgés de plus de 15 ans et de moins de 18 ans consultant au CPOA entre le 1er janvier 2017 et le 31 décembre 2021 ont été inclus dans l'étude. Les caractéristiques de notre échantillon sont décrites en termes de proportions pour les variables qualitatives et de moyennes et d'écarts types, pour les variables quantitatives. La probabilité d'être hospitalisé a été modélisée sur l'ensemble de l'échantillon à l'aide d'un modèle Probit multivarié, pour lequel ont été vérifiées les hypothèses de validité. Nous avons répertorié 2712 passages correspondant à 1873 patients inclus dans notre étude (âge moyen = 16,2 ± 0,72, 54 % de filles) soit à 5,2 % en moyenne de la file active totale. Les principaux motifs de consultation ont été les idéations dépressives (22 %), les angoisses (19 %), et les idées suicidaires (18 %). Les troubles psychiatriques les plus fréquemment diagnostiqués selon la 10e révision de la Classification Internationale des Maladies ont été F30–39 (troubles de l'humeur) (34 %), F40–48 (troubles névrotiques, troubles liés à des facteurs de stress et troubles somatoformes) (24 %) et F60–69 (trouble de la personnalité et du comportement) (11 %). Parmi les patients relevant d'une indication d'hospitalisation, soit 27 % au total, 85 % ont été orientés sur des structures pour adultes et moins de 12 % sur des structures d'hospitalisation dédiées à l'adolescent, alors que parmi les patients orientés en ambulatoire, soit 65 % au total, seulement 11 % ont été dirigés sur des consultations pédopsychiatriques. Un âge plus élevé, une tentative de suicide la semaine précédant le passage aux urgences psychiatriques, des conduites et idées suicidaires, des comportements hétéro-agressifs, d'agitation ou d'excitation psychomotrice, des idées délirantes, une errance, une fugue ou un voyage pathologique ainsi qu'un diagnostic de type F20–F29 (Schizophrénie, trouble schizotypique et troubles délirants) et F30–F39 sont des facteurs significativement prédictifs d'une indication d'hospitalisation. L'hospitalisation en psychiatrie des adolescents consultant aux urgences psychiatriques est un problème majeur. Les facteurs prédictifs sont des indicateurs d'une nécessité absolue de soins immédiats renforcés avec hospitalisation. Malheureusement le manque de structures dédiées aux adolescents sont tels que trois quarts des adolescents se retrouvent hospitalisés en structures pour adultes, et ce qui n'est pas adapté ni acceptable. The CPOA (Centre Psychiatrique d'Orientation et d'Accueil) is the largest psychiatric emergency center in France, with more than 10,000 consultations per year. The aim of our retrospective observational study is to describe the population of patients aged 15 to 18 years (18 years old not included) consulting our center (reasons for consultation, psychiatric diagnoses, referral decision by specifying the structures to which these minors are referred) and to describe a predictive model for the decision to hospitalize. All consecutive patients aged over 15 and under 18 consulting in the CPOA between January 1, 2017 and December 31, 2021 were included in the study. The characteristics of our study sample are described in terms of proportions for qualitative variables and with means and standard deviations for quantitative variables. The probability of being hospitalized was modeled on the entire sample using a multivariate Probit model for which the hypotheses of validity were tested. We have recorded 2712 visits, corresponding to 1873 patients included in our study (mean age = 16.2 ± 0.72, 54% girls), i.e. an average of 5.2% of the total patients. The main reasons for consultation were depressive ideations (22%), anxiety (19%), and suicidal thoughts (18%). The most frequently diagnosed psychiatric disorders according to the 10th revision of the International Classification of Diseases were F30-39 (mood disorders) (34%), F40-48 (neurotic, stress-related and somatoform disorders) (24%) and F60–69 (personality and behavioral disorders) (11%). Among the patients with an indication for hospitalization, i.e. 27%, 85% were admitted in adult units and fewer than 12% in adolescent specific units, while among the patients with an outpatient care, i.e. 65% in total, only 11% were referred to child psychiatry consultations. An older age, a suicide attempt in the week preceding the visit to the psychiatric emergency department, suicidal behaviour and suicidal ideations, hetero-aggressive behaviour, psychomotor agitation or excitement, delusions, wandering, running away or pathological travel, and a diagnosis of type F20–F29 (Schizophrenia, schizotypal disorder and delusional disorders) and F30–F39 were significantly predictive of a decision to hospitalize. Psychiatric hospitalization of adolescents consulting due to psychiatric emergencies is a major problem. The predictive factors for hospitalization reflect an absolute need for immediate care. Unfortunately the lack of structures dedicated to adolescents is such that three quarters of adolescents end up hospitalized in adult structures, which is neither appropriate nor acceptable. [ABSTRACT FROM AUTHOR]

Deafness is the most common sensory disability: it primarily causes language delay, as well as communication and cognitive disorders. In France, it has been subject to systematic neonatal screening since 2014. Cochlear implants have revolutionized its management by providing access to spoken language for severe to profound hearing impairments - however, the benefits are inversely proportional to the age of implantation. The objective of this article was to demonstrate the difficulty of reconciling the theoretical healthcare journey of a deaf child in a cochlear implant project before the age of 1, which involves numerous consultations, the implementation of hearing aid, and speech therapy rehabilitation, with the actual experiences of families (acceptance of the diagnosis, completion of various assessments, administrative difficulties, etc.). Therefore, it is essential to offer psychological and speech therapy support to the family and assist them in social procedures. [ABSTRACT FROM AUTHOR]

During several decades, patients with haemophilia have been treated using FVIII and FIX concentrates by haematologists working in specialized comprehensive haemophilia care centres. In the last fifteen years haemophilia treatments have been tremendously improved and novel treatment options have been developed. Gene therapy is one of these innovative approaches and will soon be available on the market. The European Association for Haemophilia and Allied Disorders and the European Haemophilia Consortium recently described a new healthcare setting for the management of patients who will receive gene therapy. This hub-and-spoke model aims to ensure the safe administration and monitoring of gene therapy by expert comprehensive haemophilia care centres, in close collaboration with the proximity haemophilia treatment centres where the patient is followed up. Any adverse events should be managed by both the expert "hubs" in collaboration with the spoke centre to provide the timeliest state-of-the-art treatment and management options to patients receiving gene therapy. All adverse events and efficacy data should be reported lifelong to a centralised registry. French reference centre for haemophilia and the patient's organization AFH worked together to adapt the European Hub and spoke model to the existing infrastructures and organization for rare bleeding disorders in France. This review describes the haemophilia patient's journey for gene therapy in France. [ABSTRACT FROM AUTHOR]

There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients. From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge. The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients. This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations. [ABSTRACT FROM AUTHOR]

La maladie du foie gras non-alcoolique (en anglais, Non-Alcoholic Fatty Liver Disease , NAFLD) toucherait 26 % des hommes et 11 % des femmes, en France. La NAFLD est un continuum de lésions hépatiques allant de la stéatose simple à la stéatohépatite non-alcoolique (NASH), la NASH avec fibrose hépatique et parfois la cirrhose post NASH. La NAFLD est favorisée par un excès de poids (surpoids ou obésité) associé à des anomalies métaboliques systémiques touchant notamment le tissu adipeux et les muscles striés. Le traitement préventif et curatif de la NAFLD repose sur les mesures hygiéno-diététiques. Ces mesures ont prouvé leur efficacité en termes de résolution de la NASH et de stabilisation, voire de régression de la fibrose hépatique. La mise en place d'un programme d'activité physique adaptée (APA), par un professionnel compétent, contribue significativement à l'amélioration de l'état clinique indépendamment de la perte de poids. Au niveau moléculaire, la littérature actuelle souligne l'effet pléiotropique de cette prise en charge notamment par son action directe ou indirecte sur le métabolisme local (e.g. hépatique) et systémique, l'état inflammatoire systémique et l'activité rhéologique. Au-delà de ces répercussions physiopathologiques, le professionnel en APA accompagne le patient présentant une maladie chronique, ici la NAFLD, à induire un changement de mode de vie durable en s'axant sur son état motivationnel. Ces mesures sont bénéfiques tant chez l'adulte que chez l'enfant. Non-Alcoholic Fatty Liver Disease (NAFLD) is estimated to affect 26% of men and 11% of women in France. NAFLD is a continuum of liver damage ranging from, simple steatosis, to non-alcoholic steatohepatitis (NASH), NASH with liver fibrosis and sometimes post-NASH cirrhosis. NAFLD is favored by excess weight (overweight or obesity) associated with systemic metabolic abnormalities affecting particularly, adipose tissue and striated muscles. The preventive and curative treatment of NAFLD is based on hygienic and dietary measures. These measures have proven to be effective in terms of resolution of NASH and stabilization or even regression of liver fibrosis. The implementation of a program of adapted physical activity (APA), by a competent professional, contributes significantly to the improvement of the clinical state independently of weight loss. At the molecular level, the current literature emphazises the pleiotropic effect of this management, particularly through its direct or indirect action on local (e.g. hepatic) and systemic metabolism, the systemic inflammatory state and rheological activity. Beyond these pathophysiological repercussions, the APA professional accompanies the patient with a chronic disease, in this case NAFLD, to induce a sustainable lifestyle change by focusing on his or her motivational state. These measures appear to be beneficial for both adults and children. [ABSTRACT FROM AUTHOR]

Résumé: Les médecins généralistes ont des difficultés dans le suivi des patients âgés atteints de cancer, faute de communication avec l'hôpital. Le point de vue des infirmier(e)s diplômé(e)s d'État libéraux(les) (IDEL) n'a, quant à lui, pas été étudié dans la littérature alors qu'ils font partie des professionnels de soins primaires. Cette étude a donc pour objectif principal d'identifier les éléments qui influencent la continuité informationnelle entre l'hôpital et la ville du point de vue des IDEL à travers une méthodologie qualitative. Au total, 14 IDEL ont participé à cette étude. Il en ressort que le manque de support de transmission à destination des professionnels engendre une rupture dans la continuité des informations. Le patient âgé devient alors le vecteur d'informations. Les IDEL manquent de formation en oncogériatrie. Une clarification des rôles de chaque professionnel est nécessaire afin d'améliorer la continuité des soins en oncogériatrie. [ABSTRACT FROM AUTHOR]

Résumé: Les maladies inflammatoires chroniques de l'intestin (MICI) ont un pic d'incidence entre 20 et 30 ans, au moment où les personnes commencent à construire leur vie (vie de couple, travail, grossesse, acquisition d'un logement, etc.). Ces pathologies chroniques, autant handicapantes que tabou entraînent de réelles difficultés dans la vie quotidienne des patients. Les patients peuvent être amenés à démarrer des traitements nécessitant un apprentissage particulier afin de gagner en autonomie et certains vont avoir besoin d'un recours à des interventions chirurgicales. Les progrès de la médecine ainsi que les innovations thérapeutiques rendent la prise en charge des patients toujours plus complexe. De plus, ils doivent harmoniser la maladie et les soins avec leur vie familiale et professionnelle. Le parcours de soin correspond au juste enchainement, au bon moment des différentes compétences professionnelles, liées directement ou indirectement aux soins. Ce processus a pour objectif de répondre de la meilleure façon possible aux problèmes que rencontrent les patients ou les soignants au cours du processus de soins : il s'agit donc de l'orientation vers la solution thérapeutique jugée optimale lors de cette étape de vie, en prenant en compte le passé du patient et ses projets futurs. Les intervenants dans le processus de soin sont multiples mais comment faire en sorte que tous soient informés de la juste situation d'un patient à un moment donné et que leurs actions se coordonnent ? Le niveau de connaissance, d'implication des intervenants et d'accès à des nouvelles thérapeutiques des patients est variable ; comment agir pour donner à tous les patients les moyens d'avoir une prise en charge optimale ? Chronic Inflammatory Bowel Diseases have a peak incidence between 20 and 30 years old, when people begin to build their lives (married life, work, pregnancy, house acquisition, etc.). These chronic pathologies, as disabling as they are taboo, cause real difficulties in the daily lives of patients. Patients may have to start treatments requiring special training in order to gain autonomy and some will need to surgical interventions. Advances in medicine and therapeutic innovations make patient care ever more complex. In addition, they must harmonize their care with their family and professional life. The pathway care corresponds to the right sequence, at the right time, of the various professional skills, directly or indirectly linked to care. The objective of this process is to respond in the best way to a problem encountered by the patient or the caregivers during their care: it is therefore a question of orientation towards the therapeutic solution deemed optimal during this stage of life, taking into account its past and future plans. There are many people involved in the care process, but how can we ensure that everyone is informed of the reel situation of a patient at a moment and that their actions are coordinated? The level of knowledge, involvement of stakeholders and access to new therapies is variable; how to act to give all patients the means to have optimal care? [ABSTRACT FROM AUTHOR]

Développer et valider des recommandations françaises à destination des professionnels de santé prenant en charge les patients présentant une lombalgie commune avec ou sans radiculalgie. Afin de synthétiser la littérature existante, un rapport d'élaboration a été créé à partir d'une revue systématique des méta-analyses publiées sur la lombalgie entre 2015 et 2018 ainsi que des recommandations internationales publiées entre 2013 et 2018, pour synthétiser l'état des connaissances scientifiques. Un groupe d'experts multidisciplinaire comprenant 17 professionnels de santé impliqués dans la prise en charge de la lombalgie et 2 représentants des patients a été constitué. Ce groupe a élaboré des recommandations préliminaires ainsi qu'un parcours de soins. Après consultation de 25 institutions académiques, une version définitive des recommandations et de l'arbre décisionnel a été validée. Pour chaque recommandation, un accord entre experts a été évalué par la méthode RAND/UCLA. Le groupe d'experts a rédigé 32 recommandations préliminaires, dont un parcours de soins, qui a été modifié après consultation des institutions académiques. Le consensus du groupe d'experts multidisciplinaire a été évalué pour chaque recommandation finale : 32 recommandations ont été évaluées comme appropriées ; aucune n'a été évaluée comme incertaine ou inappropriée. Une approbation forte a été obtenue pour 27 recommandations et faible pour 5. Ces nouvelles recommandations introduisent plusieurs concepts dans la prise en charge de la lombalgie, notamment la nécessité d'identifier précocement les lombalgies à risque de chronicité afin de permettre une prise en charge accélérée et si nécessaire pluridisciplinaire. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude était de décrire le parcours de soins des enfants de 18 à 30 mois à risque élevé de troubles du spectre de l'autisme (TSA) suivis en protection maternelle et infantile (PMI) dans les Bouches du-Rhône. L'objectif secondaire était d'évaluer la faisabilité du dépistage systématique des TSA en consultation de PMI. Les enfants inclus dans l'étude descriptive du parcours de soins avaient 18 à 30 mois et un risque élevé de TSA au M-CHAT-R. Les données de la consultation de dépistage, 6, 12 et 24 mois après leur consultation ont été recueillies rétrospectivement. Pour l'étude qualitative transversale, des entretiens ont été menés auprès de médecins de PMI. Parmi les 2458 enfants dépistés entre septembre 2015 et décembre 2018, 76 enfants (3,1 %) avaient un risque élevé de TSA (M-CHAT-R ≥ 8). Ils ont bénéficié rapidement de mesures de socialisation, pour atteindre une importante intégration en école ordinaire. Le délai médian de consultation d'un médecin spécialiste à partir du dépistage était de 81 jours [40 ; 145]. Les principaux freins au dépistage systématique des TSA exprimés par les médecins de PMI étaient : le temps nécessaire au dépistage, la barrière de la langue, les difficultés de compréhension, l'offre de diagnostic et de soins limitée. Des leviers spécifiques au contexte de consultation de PMI ont été rapportés. De nombreuses actions peuvent être entreprises entre les âges de deux et trois ans pour ces enfants dépistés à risque élevé de TSA en PMI. The objective of this study was to describe the care pathway, socialization, and the modalities of scholarization of children aged 18 to 30 months at high risk of Autism Spectrum Disorders (ASD) followed in Maternal-Child Health Services (PMI) in the Bouches du-Rhône area in France. The secondary objective was to evaluate the feasibility of systematic screening for ASDs in PMI consultations. A mixed observational (quantitative-qualitative) study was carried out in the Bouches-du-Rhône department in France. The children included in the care pathway descriptive study were 18 to 30 months of age and at high risk for ASD at the M-CHAT-R (M-CHAT-R ≥ 8). Data from the screening visit, and 6, 12 and 24 months thereafter were collected retrospectively. For the cross-sectional qualitative study, interviews were conducted with PMI medical practitioners. From September 2015 to December 2018, of the 2458 children screened, 76 children (3.1%) were at high risk for ASD (M-CHAT-R ≥ 8) and the socialization of these children was initially poor since it was done only within the family (69% at the time of screening). These children quickly benefited from socialization measures, achieving a significant integration into regular school. Indeed, the schooling rate was very high at 24 months after the screening since 89% of the children were enrolled in school, most in regular schools, with human support. The care provided by a speech therapist, a psychomotrician or a psychologist increased over time. However, the speech therapist's follow-up was a little later than that of the psychomotrician. The median time to see a child psychiatrist or neuropaediatrician or pediatrician from screening was 81 days [40; 145]. Nine interviews were conducted with the referring PMI medical practitioners in the Bouches-du-Rhône department. The main barriers to routine screening for ASDs expressed by PMI medical practitioners were: the time required for screening, language and comprehension barriers, and limited diagnostic and care options. Levers specific to the PMI consultation setting were reported. This study provides a glimpse of certain characteristics of the care, socialization and schooling pathway of these very young children, which is little documented to date in France. In view of the elements resulting from the interviews, as well as the large number of children having been screened over three years (n = 2458), the feasibility of systematic screening for ASD at 18–30 months in the context of consultations with PMIs in the department seems to be established. Although specialized care management is confronted with structures, and the time frames described and studied were long, many actions can be undertaken between the ages of two and three years for these children. [ABSTRACT FROM AUTHOR]

Introduction: Emergency Department (ED) overcrowding is a major healthcare issue. The purpose of this study is to determine the causes of emergency department overcrowding and to evaluate intra-hospital transfer after initial treatment. Methods: we conducted a 1-year prospective study at the Emergency Reception Service of the Gabriel Touré University Hospital. All patients admitted to the Emergency Reception Service and belonging to classes 3, 4, 5 of the Clinical Classification of Emergency patients (CCEP) and whose length of stay in the department was greater than or equal to 24 hours were included in the study. Patients consulting the Emergency Department and classified as CCMU classes 1, 2, patients without a well-established medical record and patients who died before treatment were excluded by the study. Results: we recorded 19.571 calls to the emergency service, including massive influxes (a remarkable 44 times, 570 patients). Bed occupancy rate was 108.03% in our department; at the same time, the average bed occupancy in the Hospital was 56%. According to the CCEP classification, 83.75% of patients were CCEP3. Patients with neurological disorders were 557. Patients with a trauma accounted for 56.7%, compared with 49.2% of medical disorders encountered. Conclusion: the average length of stay was 63.59 hours, with a maximum length of 45 days. More than a quarter of the reasons for delayed intra-hospital transfers were due to the need for specific surveillance or specific treatments that were not feasible in conventional hospitalization. [ABSTRACT FROM AUTHOR]

The increase of chronic and complex medical disorders challenges actors in the health care system and affects the entire health care system in Switzerland. Through an interprofessional exchange between medical and health care professionals, the individual needs of patients can be better addressed, which has a positive impact on patients' treatments. To prepare students of the Bachelor of Medicine at ETH Zurich for these challenges, the ETH has designed a specific course together with four educational institutions, which is oriented towards the interprofessional, patient-centred supply chain. The aim of this interprofessional module is, that Bachelor of Medicine students, as well as Pharmacy and Nursing students, acquire knowledge about the other areas of responsibility and competences, and at the same time get to know the interfaces of interprofessional cooperations. [ABSTRACT FROM AUTHOR]

Résumé: Fortement encouragée par les arrêtés de 2018 qui définissent les actes de télémédecine pris en charge par l'Assurance Maladie, la téléconsultation médicale s'est ancrée dans la pratique des médecins généralistes notamment à la faveur du confinement et de l'état d'urgence sanitaire. La téléconsultation a été utile pour éviter des prises de risque vis-à-vis de la COVID-19, pour assurer la surveillance des patients atteints de maladies chroniques ou pour améliorer l'accès aux soins. Au quotidien, à côté de ces avantages, il existe aussi des aléas de fonctionnement et des inconvénients qui méritent d'être évalués. Il faut s'interroger sur les conséquences de « cette autre façon de pratiquer la médecine » avec l'absence de l'examen clinique et la modification de la relation médecin-malade. Strongly encouraged by the health law of 2018th which determined the acts of Teleconsultation assumed by Assurance Maladie, the medical consultation has been implemented in practice of general medicine during home confinement and state of health emergencies. The teleconsultation has been useful to avoid any excessive risk taking with COVID-19, to provide monitoring of chronic diseases or to improve accessibility to health services. Day to day, beside these advantages, there are also some hazards of operating mode and inconvenience which must be evaluated. It is important to think about the consequences about the other way to practice medicine with the absence of physical examination and with the modification of the relationship between doctor and patient. [ABSTRACT FROM AUTHOR]

This article aims to describe, on a historical basis, the evolution of the concept of "health care pathway" for chronic patients in France, and to explore new possible horizons in the context of the recent public policies. [ABSTRACT FROM AUTHOR]

L'institution militaire a développé une politique d'accompagnement des blessés à travers la mise en place d'un parcours de soins et d'un parcours administratif balisés, allant du dépistage du trouble stress post-traumatique (TSPT) ou des problématiques de harcèlement et de souffrance au travail (numéro vert Écoute Défense) à la reconnaissance de l'imputabilité de la blessure en service conduisant à des indemnisations (pension militaire d'invalidité, jurisprudence Brugnot, fonds de prévoyance, garanties des assurances privées), en passant par la réhabilitation du blessé avec le soutien des cellules blessés des différentes armées (stages de réhabilitation par le sport), jusqu'à la réintégration professionnelle (stages d'immersion en entreprise, congés de reconversion, création d'entreprises) avec le dispositif Défense Mobilité pour la reconversion professionnelle. Dans cette seconde partie d'entretien, le PSYHC Laurent Brulin et l'assistante de service sociale Delphine Breuil évoquent le parcours administratif des blessés, les différents stages de réhabilitation par le sport et la question de la réinsertion professionnelle des militaires blessés. The military institution has developed a policy of supporting the wounded through the establishment of a care plan and a marked administrative path, ranging from screening for PTSD or problems of harassment and suffering at work (tall free call Écoute Défense) to the recognition of the imputability of the injury in service leading to compensation (military invalidity pension, Brugnot case law, contingency funds, private insurance guarantees, through the rehabilitation of the injured with support from injured cells of the various military Armies branches (rehabilitation training through sport) up to professional reintegration (company immersion courses, retraining leave, business creation) with the defense mobility system for professional retraining. In this second part of the interview, the PSYHC Laurent Brulin and social service assistant Delphine Breuil evoke the administrative path of the wounded, the various rehabilitation courses through sport and the question of the professional reintegration of injured soldiers. [ABSTRACT FROM AUTHOR]

Résumé: Peu de visites de pré-reprises réalisées par les médecins du travail lors d'arrêt maladie supérieur à trois mois sont à l'initiative des généralistes. Cet article explore les freins perçus par les médecins généralistes, les médecins du travail et les médecins-conseils dans la mise en place de la visite de pré-reprise et dans la communication autour de cette visite. L'étude montre qu'il est nécessaire de mieux informer les généralistes et les salariés de l'intérêt d'initier une visite de pré-reprise précocement et de développer les outils de communication entre les médecins généralistes, les médecins du travail et les médecins-conseils, tout trois acteurs dans la prévention de la désinsertion professionnelle. Few pre-recovery visits by occupational physicians during sick leave of more than 3 months are initiated by GPs. This article explores the obstacles perceived by GPs, occupational physicians and medical officers in setting up the pre-recovery visit and in the communication around this visit. The study shows that it is necessary to better inform GPs and employees of the benefits of initiating a pre-recovery visit at an early stage and to develop communication tools between GPs, occupational physicians and medical officers, all three players in the prevention of professional withdrawal. [ABSTRACT FROM AUTHOR]

• L'arthrite juvénile idiopathique (AJI) est la forme la plus courante d'arthrite chronique de l'enfant. L'orientation vers un rhumatologue pédiatre est fréquemment retardée, ce qui peut avoir des répercussions négatives sur le pronostic à long terme. • Ce travail confirme que le délai entre l'apparition des premiers symptômes et la première consultation de rhumatologie pédiatrique est plus court en France que dans d'autres pays, mais reste cependant trop long. • Les patients atteints d'AJI systémique, dont le pronostic à court terme est le moins favorable, sont ceux pour lesquels le délai avant orientation est le plus court, tandis que ceux atteints d'ERA ont le plus long délai. • Cette étude souligne le rôle central des services d'urgences et décrit la très mauvaise orientation des patients par les médecins de premier recours vers les rhumatologues pédiatres. • Les rhumatologues pédiatres devraient dispenser une formation élémentaire sur l'AJI à l'intention des médecins de premier recours et un accès direct rapide à un service de rhumatologie pédiatrique devrait être mis en place lorsqu'une AJI est suspectée. Une meilleure connaissance du parcours de soins des patients atteints d'arthrite juvénile idiopathique (AJI) est nécessaire. L'objectif de cette étude était de décrire et d'analyser la période écoulée entre l'apparition des symptômes et la première consultation en rhumatologie pédiatrique (RP) ainsi que le parcours de soins d'enfants présentant une AJI incidente dans deux centres de compétence français. Entre octobre 2009 et octobre 2017, les nouveaux patients atteints d'AJI ont été inclus dans la cohorte des arthrites juvéniles idiopathiques de l'observatoire Auvergne-Loire. Nous avons collecté les données relatives au parcours de soins, à l'apparition des symptômes et aux résultats biologiques et cliniques de la première évaluation dans le service de RP. Au total 111 enfants ont été inclus. Le délai médian avant la première consultation de RP était de 3,3 mois [intervalle interquartile (IQR) 1,3–10,7] et présentait une différence significative selon le sous-type d'AJI. Après exclusion des cas d'AJI systémique, la survenue des symptômes à un âge plus avancé et la présence d'une enthésite ou de douleurs articulaires ont été associées de manière significative à un délai plus long avant la première consultation de RP ; à l'inverse, la présence de gonflement articulaire ou de boiterie et des anomalies de la VS ou de la CRP ont été associées à un délai plus court. Le nombre médian de praticiens consultés était de 3 [IQR 3–4]. Les enfants avaient été adressés à un centre de RP par un orthopédiste dans 64 % des cas, un pédiatre dans 50 % des cas, un urgentiste dans 27 % des cas et un médecin généraliste dans 25 % des cas. Même si l'AJI non systémique n'est pas une urgence, 45 % des enfants ont été orientés vers un service d'urgences. Bien que court par comparaison avec d'autres pays, le délai jusqu'à la première consultation de RP reste trop long. Les rhumatologues pédiatres doivent proposer une formation élémentaire sur l'AJI aux médecins de premier recours et organiser un accès direct rapide à un service de RP pour chaque suspicion d'AJI. [ABSTRACT FROM AUTHOR]

Résumé: Au travers de l'analyse qualitative et quantitative du dispositif de médecine générale est éclairée la position d'interface médicale et sociale spécifique et celle d'acteur de santé mentale du médecin généraliste traitant. Parmi les constats négatifs beaucoup sont reliés aux faiblesses des choix de santé publics et aux défauts structurels d'organisation et de régulation du système de santé français. Dans les reformes en cours, le développement du dispositif du médecin traitant et des parcours de soins coordonnés est décrit comme levier essentiel pour des améliorations nécessaires. Through qualitative and quantitative analysis of general medicine and primary care the specific medical and social task of the GP, with its high commitment in mental health, is underlined. Many of the negative findings are related to weaknesses in public health choices and structural defects in organization, as well as the regulation of the French health system. In the current reforms, the development of the devices available to the general practitioner and co-ordinated approach in treatment are described as an essential lever for necessary improvements. [ABSTRACT FROM AUTHOR]

Depuis la première procédure réalisée en 2002 par Alain Cribier, le remplacement valvulaire aortique percutanée ou TAVI a révolutionné la prise en charge du rétrécissement aortique avec une augmentation constante du nombre de procédures réalisées à travers le monde. L'évolution de la technique et du matériel associée à l'expérience grandissante des opérateurs et des équipes se sont accompagnées d'une diminution drastique des complications chez des patients à risque chirurgical de moins en moins important. En parallèle, la procédure s'est considérablement simplifiée, réalisée de plus en plus sous anesthésie locorégionale, avec abord fémoral percutané, abord radial secondaire, implantation de la prothèse sans prédilatation, stimulation sur guide placé dans le ventricule gauche et sortie précoce du patient. Ainsi, le TAVI « simplifié », adopté dans la plupart des centres de nos jours, est une véritable révolution de la technique originelle. Cependant, proposer un TAVI simplifié doit obligatoirement s'accompagner en amont d'une sélection rigoureuse des patients pouvant bénéficier d'une procédure minimaliste afin d'en garantir la sécurité. After a first procedure carried out in 2002 by Pr Cribier's, Transcatheter Aortic Valve Replacement or TAVR revolutionized the management of aortic stenosis with a constant increase in the number of procedures performed worldwide. Experience of operators and teams and evolution of the technique has been accompanied by a drastic reduction in complications in patients at lower surgical risk. In parallel, the procedure was considerably simplified, carried out more and more under local anesthesia, with percutaneous femoral approach, secondary radial approach, prosthesis implantation without predilatation, rapid pacing on left ventricle wire and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. [ABSTRACT FROM AUTHOR]

Ces dernières années, la prise en charge de la maladie thromboembolique veineuse (MTEV), incluant les thromboses veineuses profondes (TVP) et les embolies pulmonaires (EP), tend à se modifier. Une possibilité de prise en charge ambulatoire, exclusive ou après un court séjour hospitalier (moins de 24 h), est ainsi proposée par certaines sociétés savantes, principalement les EP à faible risque (simplified pulmonary embolism severity index = 0) et certaines EP à risque intermédiaire, pour certains patients (sujet jeune, sans comorbidité, ayant compris la maladie et le traitement anticoagulant, et non socialement isolés). C'est dans ce contexte qu'un groupe de travail pluridisciplinaire, regroupant des médecins de diverses spécialités, exerçant à l'hôpital ou en ville et impliqués dans la MTEV, a été créé dans notre région (Alsace) avec pour objectif de travailler sur le parcours de soin de la MTEV, surtout sur la prise en charge ambulatoire, et de proposer des recommandations pour les médecins exerçant en ville. Ces dernières font apparaître que la prise en charge de la MTEV, outre qu'elle doit cibler un phénotype bien précis de patients, doit reposer, en cas de prise en charge ambulatoire et en ville, un parcours de soins organisé, structuré et coordonné (« optimisée » ou « optimale »). [ABSTRACT FROM AUTHOR]

Management of childhood acute lymphoblastic leukemia, the most common cancer in childhood, is based on specialized oncology treatment teams, included in well-structured regional network. As soon as the diagnosis is established, the patient is hospitalized in a referral centre for childhood cancer, which works in close collaboration with community hospitals and has partnerships with other health care facilities to enable continuous and integrated care for patients and their families. The quality of patients cares rely heavily on the coordinated implementation of health professionals: medical doctors, dieticians, physiotherapists, psychologists, oncology nurse coordinators, and also social workers. [ABSTRACT FROM AUTHOR]

Highlights To quantify the consultations and medical procedures to be planned in a large cohort of HIV-infected patients, we built an algorithm using parameters required for the application of the national guidelines for the management of HIV-infected individuals. This study highlights the large number of consultations and procedures to be carried out during one year of follow-up and emphasizes the benefits of a patient-focused multidisciplinary management within a single facility, especially for aging and/or psychologically or socially deprived patients. Besides the computerization of patients' medical records, physicians involved in the management of HIV-infected individuals must develop algorithms to determine the required procedures according to the patient's profile. Abstract Objectives To quantify within a cohort of HIV-infected individuals the number of medical visits and procedures to be carried out according to comorbidities and risk factors to implement a personalized care pathway. Patients and methods Retrospective study of 915 patients consulting from January 1 to December 31, 2016 at an outpatient unit of multidisciplinary consultations, using an electronic patient record. We built an algorithm using parameters required for the application of the national guidelines for the management of HIV-infected individuals. The frequency of comorbidities was measured according to gender, transmission risk group, and nadir CD4 (< or > 200/mm3). Results Patients were mostly men (median age: 52 years), of whom 16% were aged ≥ 60 years. Viral load was < 40 copies/mL in 93.5% of treated patients and CD4 cell count ≥ 500/mm3 for 73%. Overall, 74.5% of patients had at least one comorbidity. The number of comorbidities was similar in men and women but was significantly higher in patients with a nadir CD4 <200/mm3 and increased with age (irrespective of gender). The minimum number of consultations to be scheduled per year was 8123: 70% for the management of comorbidities with an average of six consultations/year/patient. Overall, 53% of patients should attend a proctology consultation. The minimum number of paramedical procedures to be performed was 5115. Conclusion The implementation of a personalized multidisciplinary management within a single facility seems to be a suitable care model to address the needs of HIV-infected individuals. [ABSTRACT FROM AUTHOR]

En lien avec la feuille de route interministérielle sur l'obésité (2019-2022), la Haute Autorité de Santé (HAS) a publié en 2022 un guide pour optimiser le parcours de soins de l'enfant et de l'adolescent en situation de surpoids ou d'obésité et ainsi accompagner les professionnels de santé dans sa mise en œuvre. Ce guide insiste tout particulièrement sur l'importance de la surveillance de l'indice de masse corporelle (IMC) tout au long de l'enfance à chaque occasion afin d'optimiser le dépistage du surpoids et de l'obésité. En cas d'excès pondéral avéré, il détaille l'importance de l'évaluation multidisciplinaire de chaque situation avec la prise en compte des différents aspects (contexte socioculturel, psychoaffectif entre autres) et les leviers que les professionnels peuvent utiliser tout au long du parcours de soins qui doit être coordonné, gradué et inscrit dans la durée pour espérer être efficace. © 2023 Société francophone nutrition clinique et métabolisme (SFNCM). Publié par Elsevier Masson SAS. Tous droits réservés. In link with the interministerial plan for obesity (2019-2022), the French National Authority for Health (HAS) has published in 2022 a guide to optimize the care pathway for overweight and obese children and adolescents to support healthcare professionals in its implementation. The guide particularly emphases on the importance of calculating Body Mass Index (BMI) throughout childhood, at every opportunity, to optimize screening for overweight and obesity. In case where excess weight has been established, it details the importance of multidisciplinary assessment of each situation, with considering several important aspects (socio-cultural, psycho-affective, etc.) and detailing the levers that professionals can use throughout this care pathway that must be coordinated and graduated on the long-term manner if it is to be effective. © 2023 Société francophone nutrition clinique et métabolisme (SFNCM). Published by Elsevier Masson SAS. All rights reserved. [ABSTRACT FROM AUTHOR]

French health authorities recommend implementing a strong coordination between general practitioners and office-based cardiologists for the care and management of patients with chronic heart failure. The aim of this study was to describe the characteristics of patients with chronic heart failure who were infrequently referred to an office-based cardiologist (either first time referral or last visit more than 12 months before study inclusion) by a general practitioner or other healthcare professional versus those who were regularly followed by a general practitioner and an office-based cardiologist (at least one visit to an office-based cardiologist in the last 12 months). This was a non-interventional, cross-sectional study, conducted among office-based cardiologists in France during a single study visit. Descriptive statistics were performed. 1460 patients were included in the study with 37.1% in the group infrequently referred to an office-based cardiologist and 62.9% in the regularly followed group. The patients who were infrequently referred to an office-based cardiologist had relatively less heart failure with reduced ejection fraction (29.2% versus 36.6%), less prior chronic heart failure hospitalization (15.9% versus 31.4%), and less atrial fibrillation and ischemic heart failure as comorbidities (40.2% versus 50.5% and 39.3% versus 50.1%, respectively) than patients who were regularly followed by an office-based cardiologist and a general practitioner. They also received less clinical exams (25.5% versus 97.4%) and pharmacological (89.3% versus 98.4%) and non-pharmacological (17.3% versus 27.1%) heart failure treatments before the study visit. This study suggested that patients regularly followed by a general practitioner and an office-based cardiologist had globally a more severe chronic heart failure and a better medical monitoring and follow-up than other patients. [ABSTRACT FROM AUTHOR]

This text is an account of the experiences the mother of an autistic child, herself a psychiatrist, went through. Drawing on the difficulties caused by ideological conflicts surrounding this condition, emphasis is laid on encounters which offered guidance both in choices made for this child and for questions concerning the affection. This entailed being involved in associations which aim to inflect autism policies based on the exclusivity of certain methods, in order to maintain diversity which is essential to the understanding of this group of complex and varied affections. [ABSTRACT FROM AUTHOR]

Hypertension in pregnancy has several forms that differ by their mechanisms and their consequences for mothers and fetus. Chronic hypertension is defined by systolic blood pressure (SBP) ≥ 140mm Hg or diastolic blood pressure (DBP) ≥ 90mm Hg before pregnancy or before the 20th week of amenorrhea. Gestational hypertension is defined by SBP≥140mmHg or DBP ≥ 90mm Hg during or after the 20th week of amenorrhea. Pre-eclampsia is the occurrence of hypertension and proteinuria after 20 weeks of amenorrhea. Severe pre-eclampsia is accompanied by clinical signs and symptoms indicating visceral pain. A pre-eclampsia develops in 1-2 % of pregnancies, but much more frequently (up 34 %) in the presence of risk factors. High blood pressure during pregnancy remains, by its complications, the leading cause of maternal morbidity and mortality. Although symptomatic management has improved, there is currently no specific curative treatment, and only childbirth and delivery of the placenta, usually prematurely, alleviate the mother's symptoms. In the first six months of pregnancy, the primary goal of treatment is to prevent the complications of severe hypertension. Initiation of antihypertensive drug treatment is recommended in pregnant women with severe hypertension. Initiation of antihypertensive drug treatment should also be considered in pregnant women at high cardiovascular risk with moderate hypertension. A SBP goal <160 and a DBP goal between 85 and 100mm Hg is recommended in pregnancy. During the long-term followup, American and European scientific societies, French society of hypertension and French national college of gynecologists-obstetricians have recognized hypertension in pregnancy and pre-eclampsia as specific emerging risk of women. Pre-eclampsia is a specific risk factor of chronic hypertension, of coronary events, of stroke, of chronic renal failure and a specific risk factor of cardiovascular mortality. Paradoxically, information of these women at risk is insufficient to ignorance and lack of awareness among health professionals. The education of women has become a major issue of prevention, developing specific consultation after delivery, encouraging them to optimize their lifestyle with a coordinated follow-up. In the end, the implementation of structured care pathway, further monitoring of these women, aims to improve the practices of health professionals. This is what drove the French Society of Hypertension, in partnership with the French National College of Gynecologists-Obstetricians, to develop a consensus proposing easy-to-use guidelines. [ABSTRACT FROM AUTHOR]

According to WONCA (World Organisation of Family Doctors), 99.5% of French people choose a GP as their treating physician, who is the family doctor and responsible for providing overall and continuous care. The GP is confronted with "cancer" on a daily basis, multiple times. The lack of involvement from GPs in the French National Cancer Plan I was corrected in Cancer Plan II and further increased in Cancer Plan III with the creation of the end of treatment consultation appointment, which enabled the PCPP to be initiated and that could be performed by the patient's treating physician. The natural history of the developments in cancer treatments, coupled with economic restrictions as the result of an explosion in chronic illness required a total rethink of how care is structured and a repositioning of the role of the GP. The PCPP model proposed by the French Cancer Plan II and INCA (National Cancer Institute) corresponds to a reference job description and a GP decision-making model. A practical tool making the daily tasks of treating physicians easier, it provides training beyond information regarding patient care. [ABSTRACT FROM AUTHOR]

At the Valence hospital centre, patients presenting with mental vulnerability are cared for using the same process as medical risk pregnancies. This study is based on the early screening of medical conditions and psychological and social instability issues. Using guidance material (Simplified brochure on HAS guidance criteria, vulnerability score, screening for mental instability, early prenatal support, etc.), community healthcare professionals locate, guide and classify patients. The care pathway is verified by the registration committee, and the coordinating midwife, in association with the patient and the community healthcare professional, organises and schedules the appointments at the establishment. The complex files are coordinated by the pregnancy medical staff or network, or are taken up and assessed subsequently at morbidity and mortality reviews or case re-assignments. The multidisciplinary work, coordinated between the community and the hospital, provides security and consistency for both patients and professionals. [ABSTRACT FROM AUTHOR]

Résumé Contexte Les maladies cardiovasculaires (CV) restent la première cause de mortalité chez la femme. Une piste d’amélioration est de développer des parcours cardio-gynécologiques comme le circuit « cœur, artères et femmes » au CHRU de Lille, destinée aux femmes à risque CV. Méthode Cette étude observationnelle a évalué la pertinence du circuit à partir d’une population de 191 femmes hospitalisées pour bilan « vasculaire » ( n = 55) ou « hypertension artérielle (HTA) » ( n = 136) du 1 er janvier au 31 décembre 2013. L’objectif a été d’étudier leurs profils cliniques et leurs prises en charge. Résultats Toutes les femmes étaient à haut risque CV (38 % à très haut risque). Âgées en moyenne de 52 ans, une femme sur 3 avait un antécédent d’hypertension ou de diabète gestationnel, 1 sur 2 était ménopausée. Les estro-progestatifs ont été interrompus chez 12 femmes. Six sur 10 n’avaient pas de suivi gynécologique. Cent quatre-vingt-six femmes étaient hypertendues (HTA nocturne dans 73 % des cas ; non dipping dans 1 cas sur 2 ; 15 nouveaux diagnostics). Le dépistage du syndrome d’apnée du sommeil était positif 1 fois sur 2. Les traitements ont été optimisés, notamment la trithérapie chez les patientes athéromateuses, passant de 30 % à 46 % ( p = 0,0005). Le courrier de synthèse a été transmis au gynécologue dans 18 % des cas. Conclusion Ce bilan à 1 an souligne l’utilité du circuit « cœur, artères et femmes » avec un réajustement des prises en charge et une sensibilisation de tous à l’opportunité d’un suivi coordonné. Introduction Cardiovascular diseases remain the first cause of death in women. To improve women's health cardiologists and gynaecologists should work together on women's specific cardiovascular risk factor. Method Our study evaluated a care pathway named “heart, arteries and women”. One hundred and ninety-one women were included for vascular ( n = 55) or hypertensive ( n = 136) explorations from January the first to December the 31st of 2013. We studied their clinical presentation and medical management. Results All women were at high cardiovascular risk (38% of them at very high risk). The average age was 52 years old. A woman on three had experienced high blood pressure or diabetes during pregnancy. One on two was postmenopausal woman. We stopped twelve estrogen-progesterone contraceptions; 60% didn’t have gynaecological follow-up; 146 had high blood pressures (73% at night, 50% had no dipping blood pressure profile and 15 were newly diagnosed for hypertension). Sleep apnoea syndrome was suspected in half women. Medical therapies were optimized especially for women with atheroma in which 30 to 46% were properly treated ( P = 0.0005). Only 18% of the gynecologists received conclusive reports. Conclusion At one year, our care pathway “heart, arteries and women” allowed to optimize medical therapy and clinical management. Everyone should be aware of this program. [ABSTRACT FROM AUTHOR]

Résumé L’audit du patient traceur est une méthode d’évaluation introduite par la Haute autorité de santé (HAS) dans la certification V2014. Celle-ci est non obligatoire dans les centres privés de radiothérapie. Dans notre démarche d’amélioration continue de la qualité et afin d’améliorer la prise en charge de nos patients, la direction de notre établissement a décidé d’utiliser cette méthode afin d’évaluer ses pratiques et d’impliquer les professionnels au cœur de la démarche. The “tracer patient” audit is an evaluation method introduced by the French health authority in the V2014 certification. This is not mandatory in private radiotherapy centres. In our continuous quality improvement approach and in order to improve the management of patient care, the management of our radiation therapy centre has decided to use this method to evaluate our medical practice and to engage healthcare professionals at the core of this approach. [ABSTRACT FROM AUTHOR]

Résumé Propos Les permanences d’accès aux soins de santé (PASS) sont un dispositif qui permet aux patients vulnérables économiquement, sans couverture sociale de se faire soigner. Il existe peu de données sur le profil des patients fréquentant ces centres à Paris. L’objectif de cette étude est de décrire le profil socio-démographique et sanitaire de ces patients et d’analyser les motifs de leur recours à ce type de structure. Méthodes Il s’agit d’une étude descriptive transversale par questionnement direct des patients s’étant présentés à la consultation de 5 PASS de centres hospitalo-universitaires parisiens entre avril et mai 2008. Résultats Au total, 581 patients ont été inclus. L’âge moyen était 42 ans, 65 % étaient des hommes. Seulement 50,9 % déclaraient avoir un salaire et 38,4 % bénéficiaient de la sécurité sociale de base. La moitié des patients n’avaient pas de domicile fixe et la majorité (80 %) était d’origine étrangère. Les principaux motifs évoqués pour consulter une PASS étaient l’existence de consultations sans rendez-vous, des raisons financières et un suivi dans le même hôpital. Plus de la moitié avaient une maladie chronique alors que seulement un tiers d’entre eux bénéficiaient d’un suivi médical. Un problème psychologique ou psychiatrique était identifié chez 17 % des patients. Le pronostic vital, en l’absence de traitement, classé en 3 stades bon, moyen ou mauvais, était considéré comme moyen ou mauvais chez 48,7 % d’entre eux. Conclusion La population reçue dans les PASS est en situation de précarité évidente, de plus ces patients sont porteurs de pathologies plus lourdes que dans la population générale. Purpose In the context of the French National Health Service, a free access to healthcare facilities (the PASS: “permanence d’accès aux soins de santé”) has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics. Methods This descriptive cross-sectional study was conducted between April an May 2008, in 5 PASS clinics from academic tertiary hospitals in Paris. Descriptive data on patient were collected by general practitioners at the end of their consultations. Results This study included 581 patients. The mean age was 42 years, and 65% of patients were males. Only 50.9% declared a salary income and 38.5% had a health insurance. Half of the patients were homeless, and 80% were migrants. The main reasons to visit these health facilities were direct access (no appointment needed), being in financial difficulty and having a medical record in the same hospital. Half of the patients had one chronic disease at least, while only a third of them saw regularly a physician. A total of 834 diseases were found among the 581 patients, including 411 chronic diseases, and 17% of the patients had a psychologic or a psychiatric disorder. Prognosis was divided in three grades: good, low and poor. Almost a half of the patients were considered by the doctor as having a low or a poor prognosis if they would not receive a therapy. Conclusions The findings of this study suggest that the PASS carry out their mission: most of the patients frequenting these facilities live under poor conditions and are in poor health status compared to the patients having access to conventional outpatient services. [ABSTRACT FROM AUTHOR]

Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at "CV risk" or at "optimal health status" if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 who want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women can also be a powerful medium of prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path "heart, arteries and women" of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women. [ABSTRACT FROM AUTHOR]

Introduction: One of the goals of the French Cancer Plan 2009-2013 is to strengthen the role of the general practitioner at each stage of the patient's care. As part of its mission in informing health professionals on prevention, the French National Cancer Institute, INCa, implements a barometric survey to better assess the knowledge and practices of GPs on the early detection of skin cancer. Method: This survey was achieved in two steps, in October 2009 and 2011, by phoning a sample of 600 representative GPs, constructed according to the quota method. Results: A large majority of the GPs believe they have the necessary knowledge on the prevention and early detection of these cancers (81%) and thus feel comfortable answering questions from patients (87%). However a further analysis reveals that they consider their knowledge to be in need of upgrading. They express a strong demand for information and training. In terms of practice, if the examination of the patient's skin is usual, it is not always fully carried out by the GP. Self-examination for patients identified at risk is not systematically demonstrated (57%). GPs are especially attentive to the color (83%) or the evolution of a nevus (60%), less to other elements of the ABCDE rule. In case of doubt, when noticing a suspicious skin lesion, the GP addresses his patient to the dermatologist (96%). The care management of patients, as established by the French National Health Insurance, was well accepted and did not change the GPs' practices. Conclusions: The results of the 2009 survey are comparable with those of 2011. Current actions, carried out in partnership with GPs on this topic, would benefit from a reinforcement of concerted information actions and continuing education. [ABSTRACT FROM AUTHOR]

Aim: A better understanding of breast cancer patients' perceptions about their general practioners (GP) roles in the intercure management, so as to identify the obstacles to GPs intervention, while the public will, the epidemiology and the medical demography trend towards the need to involve GPs. Procedure: A multicentric retrospective study through 4 exploratory interviews followed by a questionnaire sent by internet to 76 breast cancer diagnosed women, undergoing chemotherapy within the 5 past years and having a GP. The results were processed through ÉpiInfo™; tests khi2 and Fisher exact. Results: The sample has been revealed particular by its high socio-educative level and by its exclusive choice for the gynecologist as primary care request for gynecological problems. The relationship with the general practitioner was judged positive. Concerning the chemotherapy-induced side effects during chemotherapy phase, the oncologist was considered as the primary care request (46%) and the general practitioner came in second care request (34.2%), preferentially for pain management (statistical trend). For 13.2% of patients, the doctor with particular practice was identified as a significant intercure participant, mainly for the pain management (statistical trend). Regarding chemotherapy-induced psycho-affective disorders, the general practitioner was the primary intercure care request (32.9%). Concerning the gynecologist, he was totally excluded from the chemotherapy follow-up, as for the chemotherapy-induced side effects (1.3%) than for the psycho-affective troubles (2.6%). Concerning the preferential general practitioner/oncologist couple, the study objectivized a coherence in the choice of these two participants, as in the patients representations of the idealistic intercure request (general practitioner: 27.6% and oncologist: 60.5%) than for the real performed medical request (general practitioner: 34.2% and oncologist: 46%). The study showed that the general practitioner was even more considered as the primary care request doctor during intercure when he was invested as a diagnosis actor. The study did not show up any choice competitivity between the oncologist and the general practitioner in patients representation, which is coherent with the hierarchical organization of the current health care system. Conclusion: The generalization of these conclusions would need a study based on a wider and more representative sample of breast cancer affected patients, integrating all the social classes and the rural areas. [ABSTRACT FROM AUTHOR]

Abstract: Therapeutic education is not a recent idea. It arouses renewed interest thanks to the article 84 of French law no. 2009-879 from July 21, 2009 reforming the hospital and concerning patients, health and territory. This article inserts in the public health code no less than five articles devoting patient therapeutic education. Nevertheless, the conditions imposed by the legislator raise questions, which should be outstripped in favor of a widespread implementation of integrated care pathways in which therapeutic education is enclosed. In France, internists should be involved in the development of new programs of therapeutic education in the field of rare diseases, especially systemic autoimmune diseases. A pilot project for systemic lupus erythematosus is ongoing, before an expected geographic extension through referent centers, as well as the progressive development of additional programs aiming all rare diseases. Content, funding and evaluation are key points that remain to be defined. [Copyright &y& Elsevier]

Abstract: This document is part of the “Care pathways in physical and rehabilitation medicine” series developed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Physical and Rehabilitation Medicine Federation (FEDMER). For a given patient profile, each concise document describes the patient''s needs, the care objectives in physical and rehabilitation medicine, the required human and material resources, the time course and the expected outcomes. The document is intended to enable physicians, decision-makers, administrators and legal and financial specialists to rapidly understand patient needs and the available care facilities, with a view to organizing and pricing these activities appropriately. Here, patients with shoulder instability requiring surgical stabilization are classified into five care sequences and two clinical categories, each of which are treated according to the same six parameters and by taking account of personal and environmental factors (according to the WHO''s International Classification of Functioning, Disability and Health) that may influence patient needs. [Copyright &y& Elsevier]

Abstract: This document is part of the “Care Pathways in Physical and Rehabilitation Medicine” series developed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Physical and Rehabilitation Medicine Federation (Fedmer). For a given patient profile, each concise document describes the patient''s needs, the care objectives in physical and rehabilitation medicine, the required human and material resources, the time course and the expected outcomes. The document is intended to enable physicians, decision-makers, administrators and legal and financial specialists to rapidly understand patient needs and the available care facilities, with a view to organizing and pricing these activities appropriately. Here, patients with acute proximal humeral fracture requiring shoulder hemi-arthroplasty are classified into four care sequences and two clinical categories, both of which are treated according to the same six parameters and by taking account of personal and environmental factors (according to the WHO''s International Classification of Functioning, Disability and Health) that may influence patient needs. [Copyright &y& Elsevier]

Abstract: This document is part of a series of guidelines documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These reference documents focus on a particular pathology (here patients with severe TBI). They describe for each given pathology patients’ clinical and social needs, PRM care objectives and necessary human and material resources of the pathology-dedicated pathway. ‘Care pathways in PRM’ is therefore a short document designed to enable readers (physician, decision-maker, administrator, lawyer, finance manager) to have a global understanding of available therapeutic care structures, organization and economic needs for patients’ optimal care and follow-up. After a severe traumatic brain injury, patients might be divided into three categories according to impairment''s severity, to early outcomes in the intensive care unit and to functional prognosis. Each category is considered in line with six identical parameters used in the International Classification of Functioning, Disability and Health (World Health Organization), focusing thereafter on personal and environmental factors liable to affect the patients’ needs. [Copyright &y& Elsevier]

Abstract: This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. “Care pathways in PRM” is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients. [Copyright &y& Elsevier]

The second Cancer Plan launched in November 2009 by the INCa emphasizes the desire to not only strengthen the support for cancer patients during the active phase of treatment but also develop a Personalized care Program for After Cancer treatment (PPAC). This program, designed to fit into the continuity of the Personalized Care Program (PCP), is elaborated jointly by cancer specialists and general practitioners before being explained and given to patients at the end of the active therapy period. The approach, innovative and new for many health care stakeholders, aims at several goals: to ensure the best possible care for patients in terms of monitoring and evaluation of risk of relapse as well as in preventing the risk of second cancer and taking into consideration social aspects. In this context, the implementation of the PPAC needs to follow several steps: build the content, define a format and design thatmeet the requirements defined by the INCa and fulfill the expectations of all health care stakeholders including, in particular, general practitioners, who are at the heart of this program. However, beyond content and format, the modalities of PPAC implementation represent the most critical step. Success will depend upon physicians' involvement and commitment in carrying the processes, the proper definition of responsibilities, the fulfillment of health care stakeholders' expectations, the short- and long-term quality of follow-up, the proper management of changes induced by the PPAC as well as its monitoring and assessment. Success requires that we get commitment, listen, convince, respect but not impose. [ABSTRACT FROM AUTHOR]

Standardised geriatric assessment amply proves its value in the elderly by reducing the rates of mortality and hospital admission through the interventional measures that it generates. It also improves the survival of the elderly with metastatic cancer. Its everyday use by untrained teams remains problematic and timeconsuming. Screening tools are currently being validated. Modelling of standardised geriatric assessment might help to define the features, which are predictive of the toxicity of chemotherapy. The use of these tools poses the problem of coordination among the variety of personnel who are essential to ensure that the care pathway is optimal. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. Methods: A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. Results: Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the study’s follow-up period. Conclusion: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP. [Copyright &y& Elsevier]

The National cancer Institute, in partnership with the National league against cancer, produces Cancer Info, an information platform for patients and close relatives. Because qualitative information helps patients become actors of their care program, Cancer Info proposes reliable, accurate and up-to-date information, accessible through three complementary ways: a help line, a collection of free guides and a dedicated section on the INCa website. The contents, designed as a mirror image of the recommendations for health professionals, concern cancers, their treatments and life with cancer. In order to assess if Cancer Info meets its publics and their needs, Cancer Info has been evaluated through a large satisfaction survey. As decided in the Cancer Plan 2014-2019, the Institute also published a call for proposals for associations, in order to support and develop complementary information offers. [ABSTRACT FROM AUTHOR]

The fight against social and geographic inequalities is a key goal of the third French Cancer Plan (2014-2019). Achieving this goal requires addressing three issues: an improved observation and measurement of inequalities; the integration of inequality issues in the very design of actions for prevention, screening and healthcare; the identification of effective and transferable interventions, from an evidence base point of view. Reducing inequalities involves patients and virtually all stakeholders of the cancer control community. [ABSTRACT FROM AUTHOR]