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Rationale and aims Hospital pharmacy aims at optimizing pharmaceutical care practice. Classically, assessing patient's satisfaction is required. Same manner, for a service provider such as a hospital pharmacy, it is necessary to evaluate the satisfaction of its customers: physicians, nurses and pharmacy staff. The aim of this paper was to assess user satisfaction with an individualized dispensing system. Method A survey including 14 close-ended and 1 open-ended questions was repeated at several years' distance in a French military teaching hospital. Questionnaires were administered anonymously to the different actors involved: physicians, nurses, pharmacy staff. Results Fifty-seven users of an individualized dispensing system (29 nurses, 18 physicians and 10 pharmacy staff) were included in the survey. At the level of the establishment, users' opinion about the system was positive. None of the dimensions studied concerning the pharmaceutical service was rated negatively. Overall user opinion about the computer system was the only parameter rated negatively. In total, most dimensions were judged satisfactory: confidence in the individualized dispensing system, time of delivery at the care unit, impact on cost control, quality of the presentation of unit doses and performance of respondents. The benefit for the patients was judged very satisfactory. The workload involved, the frequency and severity of errors, the serviceability of the information processing system and its impact on patient safety were judged fairly satisfactory. Finally, the quality of pharmaceutical information was rated average. Conclusions An evaluation of a service or a practice should include an assessment of how well the service meets the needs of the user and how well the service is provided. A comprehensive, reliable and valid instrument for assessing user's satisfaction with individualized dispensing system is then available in our hospital. This paper demonstrated the interest of using simple and robust tools in professional practice. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries ( United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. Methods We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). Results and conclusions The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The objective was to measure the quality of clinical practice for the management of cystitis in adult women in general practice by collaborating with quality circles and the regional centre for antibiotic counsel. Method: This descriptive cross‐sectional study was performed in 2018 in Normandy, France. A questionnaire composed of clinical vignettes was used to evaluate practices of general practitioners (GPs) with regard to cystitis classified into four categories: simple, at risk of complication, recurrent, and caused by multidrug‐resistant bacteria. The 2017 French Infectious Diseases Society's guidelines were used as a reference. Results: A total of 142 GPs participated in the study (45.5% of the solicited). Fosfomycin‐trometamol and pivmecillinam were cited as first‐line treatments for simple cystitis by 134 (94%) and 38 (27%) participants, respectively. For at risk of complication cystitis, the treatments cited were cefixime by 64 participants (45%), ofloxacin by 50 (35%), pivmecillinam by 49 (35%), fosfomycin‐trometamol by 38 (27%), nitrofurantoin by 36 (25%), and amoxicillin‐clavulanic acid by 28 (20%). Mean compliance rates were 85% for simple cystitis, 39% for at risk of complication cystitis, 60% for recurrent cystitis and 14% for cystitis caused by multidrug‐resistant bacteria. Two criteria had less than 10% of the compliant answers: comprehensive knowledge of cystitis complication risk factors (9%) and positivity thresholds of urine cultures (10%). Conclusions: In this study, diagnostic means, follow‐up testing, and simple cystitis treatment (with fosfomycin predominantly mentioned) were broadly compliant. The use of critical antibiotics was too frequent for at risk of complication cystitis. There may be a need to improve the knowledge of professionals on antibiotic resistance and appropriate antibiotic use. [ABSTRACT FROM AUTHOR]

Rationale, aim, and objective: "Periodontal medicine" is based on evidence of interactions between periodontal disease and overall health. The aim of the present study was to assess awareness of oral‐systemic disease relationship among French general practitioners (GPs) and clarify how this influences their practices in a wider effort to better integrate oral health concerns into global health care delivery. Method: GPs registered in the north of France were invited to complete an online self‐administered questionnaire through local divisions of the French Medical Board. The questionnaire was divided into four sections: socio‐demographic aspects, knowledge, practices, and an overview. Results: The questionnaire was completed by 253 GPs. Among these, 75% were aware of the association between periodontitis (PD) and diabetes, and 53% to 59% were aware of the impact of PD on cardiovascular diseases, inflammatory bowel diseases, and respiratory infections. Few GPs identified PD as a possible risk factor of rheumatoid arthritis and Alzheimer disease (35.18% and <15%, respectively); 74.31% of GPs reported never asking their patients about their periodontal health. However, a personal history of PD and professional experiences seem to influence the medical practices of GPs to include oral examination. GPs largely self‐rated their knowledge of the oral‐systemic disease connection as being insufficient and were favourable to completing an up‐to‐date training course (86.56%). Conclusion: French GPs' knowledge about the association of PD with systemic diseases seems to be fair, but discrepancies in their daily clinical routine were found. Promisingly, a positive attitude was observed towards improving their knowledge of oral‐systemic diseases link. These results indicate the importance to reinforce collaboration between medical doctors and oral health care specialists. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The article looks at how, during consultations, pregnant women identified as presenting an increased risk of giving birth to a child with an impairment, and practitioners in the field of prenatal diagnosis, decide whether or not to accept the risk of a miscarriage and proceed with a diagnostic examination. Methods: We conducted 63 observations of consultations in France and 22 in England. Participants were women for whom an elevated risk of abnormality had been identified and the practitioners involved in their care. Our analytical approach consisted in suspending the normative concepts of nondirectiveness and autonomy, and in drawing on Goffman's (1974) notion of "frame" to take account of the experiential and structural aspects that the protagonists bring into the (inter)actions. Results: We identified four frames: medico‐scientific expertise, medical authority, religious authority, and compassion. Observation of the ways in which the frames intertwine during consultations revealed configurations that facilitate or hinder the fluidity of the interactions and the decision‐making process. The medico‐scientific expertise frame, imposed by the guidelines, heavily dominated our observations, but frequently caused distress and misunderstanding. Temporary or sustained use of the compassion and/or medical authority frames could help to repair the discussion and create the conditions that enable women/couples to reach a decision. Variations in configuration highlighted the differences between practitioners in the two countries. Conclusions: Combining frames allows protagonists to exert reflective abilities and to maintain/restore interactions. The frame analysis promotes a vision of autonomy that is sociological, relational, and processual. The frames are anchored in different structural conditions in England and France. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims and objectives: Care quality is a primary concern in health field. In France, the care practice report card (CPRC) is compulsory for practitioners. It is the first step towards the culture of excellence. In this context, practitioners have to assess and improve their practices. Competent authorities define registries as reliable sources for CPRC. The first aim of this work is to describe how we designed and built a universally transposable CPRC model based on an Utstein‐style cardiac arrest registry. The second aim is to measure the adherence of practitioners to this approach and to show how such a tool can be used in real situation. Methods: Our report card is adapted from in‐hospital CA care quality and safety indicators. We built a 2‐section grid. The first part described the quality and completeness of the analysed data. The second part distinguished medical and traumatic CA and assesses care practices. We analysed the practitioners' adherence thanks to a satisfaction survey. Finally, we presented a CPRC case study. Results: This tool was tested in 92 centres gathering 8433 patients. The satisfaction survey showed that this CPRC was well accepted by emergency professionals. We presented an implementation example of this tool in a centre in real‐life situation. Conclusions: We designed and implemented a fully automated CPRC tool routinely usable for Utstein‐style CA registries. This CPRC is easily transferable in all other Utstein CA registries. The debriefing report source codes are freely distributed upon request. This tool enables the care assessment and improvement. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives In non-critically ill patients, the use of an insulin syringe pump allows the management of temporary situations during which other therapies cannot be used (failure of subcutaneous injections, awaiting advice from the diabetes team, emergency situations, prolonged corticosteroid therapy, initiation of an artificial nutrition, need for a fasting status, etc.). To manage the risks related to this «never event», the use of a standard validated protocol for insulin administration and monitoring is an essential prerequisite. To this end, a multidisciplinary approach is recommended. Method With the support of our subcommission « Endocrinology- Diabetology», we proceeded with a «step-by-step process» to create such a standardized protocol: (1) review of all existing protocols in our hospital; (2) overview of the literature data concerning insulin infusion protocols developed by multidisciplinary teams in France and abroad; (3) development of a standardized protocol for non-intensive care unit patients, respecting the current recommendations and adapting it to the working habits of health teams; and (4) validation of the protocol Results Two protocols based on the same structure but adapted to the health status of the patient have been developed. The protocols are divided in to three parts: (1) golden rules to make the use of the protocol appropriate and safe; (2) the algorithm (a double entry table) corresponding to a dynamic adaptation of insulin doses, clearly defining the target and the 'at risk situations'; and (3) practical aspects of the protocol: preparation of the syringe, treatment initiation and traceability. The protocols have been validated by the institution. Conclusion Our standardized insulin infusion protocol is simple, easy to implement, safe and is likely to be applicable in diverse care units. However, the efficiency, safety and the workability of our protocols have to be clinically evaluated. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives High-alert medications ( HAMs) are medications that are associated with a high risk of serious harm if used improperly. The objective of this study was to identify paediatric HAM used in our institution and to identify safety measures for their use. Methods The list of HAM and the list of safety measures that were introduced in our department were based on (1) a literature search; (2) a survey of health care professionals in our department including doctors, head nurses, nurses and pharmacists; and (3) the drug steering committee. Results We found four lists of HAM based on a literature search, including 27 classes of pharmaceutical agents, and 63 common drug names. The response rate of the survey was 20.7% (230 of 1113). Some of the HAMs included in our list were not identified by the literature search. These included neuroleptic drugs, anti-malarial agents, antiviral agents, anti-retroviral agents and intravenous acetaminophen. The drug steering committee selected 17 HAM and highlighted 53 safety measures involving seven broad aspects of pharmacological management. Conclusions This project was part of the new safety strategies developed in a paediatric hospital. We set out to make a list of HAM relevant to paediatrics with additional safety measures to prevent medication errors associated and a 'joker' system. The various safety measures, such as double-checking of HAM prescriptions, should be reviewed during the year following their implementation. This list, which was developed in our hospital specifically for use in paediatrics, can be adapted for use in other paediatric departments. [ABSTRACT FROM AUTHOR]

Information regarding the International Advanced Seminar in the Philosophy of Medicine (IASPM) held in Paris, France from June 20 to 22, 2013 is presented. Topics discussed include the diagnosis and medical decision making in the clinic, the relation of philosophy of medicine to social science and medical humanities, and the links between philosophy of medicine and biology. The event featured scholars in the philosophy of medicine including Norbert Paul, Armand Dirand, and Ashley Kennedy.

Rationale, aims and objectives To assess the impact of an automated drug distribution system on medication errors ( MEs). Methods Before-after observational study in a 40-bed short stay geriatric unit within a 1800 bed general hospital in Valenciennes, France. Researchers attended nurse medication administration rounds and compared administered to prescribed drugs, before and after the drug distribution system changed from a ward stock system ( WSS) to a unit dose dispensing system ( UDDS), integrating a unit dose dispensing robot and automated medication dispensing cabinet ( AMDC). Results A total of 615 opportunities of errors ( OEs) were observed among 148 patients treated during the WSS period, and 783 OEs were observed among 166 patients treated during the UDDS period. ME [medication administration error ( MAE)] rates were calculated and compared between the two periods. Secondary measures included type of errors, seriousness of errors and risk reduction for the patients. The implementation of an automated drug dispensing system resulted in a 53% reduction in MAEs. All error types were reduced in the UDDS period compared with the WSS period ( P < 0.001). Wrong dose and wrong drug errors were reduced by 79.1% (2.4% versus 0.5%, P = 0.005) and 93.7% (1.9% versus 0.01%, P = 0.009), respectively. Conclusion An automated UDDS combining a unit dose dispensing robot and AMDCs could reduce discrepancies between ordered and administered drugs, thus improving medication safety among the elderly. [ABSTRACT FROM AUTHOR]

Rationale In nephrology, the NEOERICA project assessed the feasibility of the diagnosis scheme based on a general practice database. This approach opened a new area where routinely collected data could be used for purposes other than patient management, such as epidemiological analysis and professional practice evaluation. In Lyon, the TIRCEL network is made up of a coordination team and an online database. In 2008, a total of 468 professionals participated and 983 patients were in the database corresponding to 4114 consultations and 9250 biological assessments. Objective To investigate the impact of a quality control process on the data from operational databases. Methods We set up a quality control process and we described the impact of this process on data. We also specifically investigated the role of measurement scales in error frequency and we studied the impact of data quality on variables which could be used for professional practice evaluation. Results Quality control allowed us to detect as inconsistent data 7.5% of tested data. This rate is linked to the parameters and varied from less than 1% (weight, diastolic blood pressure and urinary sodium) to more than 30% (serum iron and ferritin). Quality control led mainly to the validation of the identified data for 80.4%, a direct correction was realized for 12.9%, 5.6% by the lab and only 1.2% were set to missing. Average proteinuria was modified with the quality control process (2.09 g per 24 hours vs. 0.82 g per 24 hours); however, the median remained stable (0.21 g per 24 hours). Conclusion Specialty databases such as TIRCEL could not be used for epidemiological research or for the extraction of indicators for professional practice evaluation without strict quality control or the set-up of data-entering limits and alarms. [ABSTRACT FROM AUTHOR]

Introduction The objectives of reference centres for rare diseases are multiple and mainly concern disease management and coordination between specialties, but they also have to improve knowledge through epidemiological studies and biomedical research. A first database was created by the hereditary haemorrhagic telangiectasia network to achieve these objectives, but facing a lack of data entered in the first database, we established a new database, named CIROCO (Clinical Investigation for the Rendu-Osler Cohort). This new database was constructed after the first database assessment. Methods We listed all difficulties encountered in the first database. We focused on three themes: database technical characteristics, database design (the number and characteristics of variables and the overall structure) and data entry. Based on this expertise, we defined the characteristics that should lead to an optimization of the database. We then compared the performance of these databases in terms of available data. Results The first database had 1273 fields spread out on 14 forms. A total of 838 patients was entered from 2001 to 2005 and among the 1273 fields, 205 (16%) had no data at all. The new database gathered 362 fields from the first database and 173 new fields. These fields were rearranged into 443 variables. A total of 1410 patients directly seen by the clinicians were entered. For patients seen by clinicians each variable used for defining the disease was available for at least 93% of patients. Conclusion Items to be included in a specific database should be carefully selected in order to achieve good results and an epidemiological utility. [ABSTRACT FROM AUTHOR]

Many women are prescribed oestrogen-containing contraceptives for whom oestrogen-containing methods may be less suitable. Two surveys examining contraceptive prescription practices among doctors ( n = 419) and attitudes towards contraception among women ( n = 1623) in France, Germany, Spain, Italy and Russia were evaluated. Progestin-only pills and hormone-free intrauterine devices were the most commonly prescribed contraceptives for women with medical conditions for which oestrogen-containing methods are not preferred (40% and 20%, respectively), those suffering from oestrogen-related side effects (32% and 21%) and those with concerns about the safety of oestrogen-containing methods (28% and 24%). Combined oral contraceptives (COC) were prescribed to ≥10% in these two groups. One-quarter of contraceptive users had asked to be switched from one COC to another because of oestrogen-related side effects; a similar proportion had been switched by their doctor for this reason. Half of the women surveyed did not want or had concerns about foreign/additional oestrogen, and about 80% said that they would consider switching to a different hormonal contraceptive to minimize oestrogen exposure. Although most doctors were aware of the World Health Organization medical eligibility criteria for contraceptive use, they still prescribed COCs or other oestrogen-containing contraceptives to women with medical conditions for which oestrogen-containing options are not favoured, suggesting a need for additional education. By complying with guidelines and heeding women's concerns, doctors can individualize their contraceptive recommendation to improve safety, acceptance and compliance and, ultimately, reduce the risk of an unintended pregnancy. [ABSTRACT FROM AUTHOR]

Rationale and objectives Analgesia is a recommended practice for pain treatment in prehospital emergency medicine, but all experts note suboptimal pain relief or oligoanalgesia. The increase in the Care Workload (CW) and the Medical Treatment Duration (MTD) linked to analgesia are two explanatory factors, and they are representative of the unavailability of a prehospital team. The unavailability of a team is an opportunity cost which is probably the most important cost within the framework of prehospital emergency. The aim of this study was to analyse the influence of analgesia use on the availability of prehospital emergency teams. Methods This study was a prospective, multicentre cohort study conducted in 10 French Mobile Emergency and Resuscitation Services (MERS) between September 2001 and June 2003. A case–control study was performed including 568 case patients who received analgesia matched with controls based on diagnosis and severity. The pairs were compared for MTD and CW. Results No significant difference between cases and controls was found concerning MTD ( P = 0.134). Conversely, a difference was found for CW ( P < 10−4), with a mean value of 53.7 Project Recherche Nursing (PRN) points for the cases and 45.8 PRN points for the controls. Conclusions This study shows that analgesia generates an additional CW without increasing the MTD, and does not hinder the MERS teams' availability. This economic result should improve adherence to these clinical practice guidelines. Thus, analgesia appears to be a factor of productivity in the current context of economic pressures in terms of the funding of the healthcare system. [ABSTRACT FROM AUTHOR]

Objectives This study was designed to analyse factors potentially influencing children's return visits to physicians for symptoms of acute otitis media (AOM) within 14 days after being diagnosed with nasopharyngitis (NP), and the impact of recent antibiotic use. Design A controlled population-based pharmaco-epidemiological trial in 3- to 6-year-old children conducted from January to May 2000. Setting Three different geographical regions in France. Participants Among 2507 eligible children, 2456 could be analysed and 505 children had 634 office-based physician visits (OBPV) for NP symptoms. Interventions The statistical associations between antibiotics prescribed for NP and an OBPV for AOM within 14 days in a population-based study were analysed along with risk factors of AOM. Main outcomes measure Clinical events and antibiotic use. Results During the 2 weeks following physician-diagnosed NP, antibiotic use, especially a beta-lactam, significantly decreased the risk of OBPV for AOM in children (odds ratio = 0.2; 95% confidence interval = 0.09–0.7; P = 0.002). Conclusion Antibiotics prescribed to children for NP seem to protect during the following 2 weeks against the risk of OBPV for AOM. It remains to be determined whether a subgroup at high risk of developing AOM after a viral infection exists and what might be the best strategy to adopt for NP in a national programme of optimal antibiotic use. [ABSTRACT FROM AUTHOR]