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Veinous thromboembolism (TEV) is an important cause of death in patients suffering from cancer. Indeed, many publications showed that professional practices recommendations for TEV care in these patients were not well respected. The professional evaluation of professional practices aimed to understand the physicians knowledge level regarding the recommendations for the management of thromboembolic events for patients suffering from cancer. On the one hand, focus was made on the prescription compliance regarding the anticoagulant therapy, its prescribed dose and its time limit, based on SRO-INCa recommendations. On the other hand, the aim of the evaluation was to assess hospital discharge letter compliance compared to HAS recommendations. Following the first trial results in 2017 an information leaflet for patients and a reminder leaflet for physicians were implemented. Furthermore, an hospital discharge letter model was created in order to harmonize this document for all physicians and to prevent them from leaving items out. The obtained results on professional practices between 2019 and 2021 showed a lack of knowledge about recommendations: 51% of compliance on prescriptions in 2020. The hospital discharge letter compliance was also perfectible. This can be explained by the fact that the time limit for the TEV treatment is missing in 59.5% of the discharge letters. The results obtained on the 3 last years are still insufficient and lead us to keep working on physicians training and awareness, enhancing the information spreading and thinking about new tools to help our medical teams. [ABSTRACT FROM AUTHOR]

Ensuring the safety of patient medication management is a public health priority. In hospitals, the medication circuit involves risks, especially in terms of storage. As part of an institutional project, the deployment of computerized medicine cabinets in our hospital's care units was initiated in 2015. By 2022, almost all care departments were equipped. Each drug picking is carried out by the registered nurse according to the patient's name, in accordance with the administration plan. In addition, local recommendations are to collect medication for a maximum of 24hours. In this context, our objective was to assess nursing professional practices in order to identify the steps requiring action plans. To meet this objective, we i) studied the compliance of computerized drug samplings with prescriptions on a given day throughout the establishment, ii) assessed picking practices with an observational audit, and iii) proposed questionnaires, including practical cases and satisfaction questions. Over 300 prescriptions were analyzed, including 2,511 drugs requiring at least one collect on the day of the assessment. The compliance rate for picking in relation to the drugs prescribed was 44.7%. According to the audit observation, the picking compliance rate was 74.5%. Non-compliances were mainly linked to the selection of the wrong patient at the computerized medicine cabinet and/or to a picking for longer than the recommended duration. Finally, the rate of correct answers to the proposed cases was 61.9%, and nurses were generally satisfied or very satisfied with the equipment., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

This work is inspired by an authentic clinical situation involving the notion of non-recourse to care via the 21st criterion of discrimination, i.e. economic vulnerability. A review of morbidity and mortality in general medicine was organized to understand the loss of medical opportunity that may result and to improve the quality and safety of care. [ABSTRACT FROM AUTHOR]

Context: To ensure compliance with the legal and normative framework, the professional orders, which supervise the practice of pharmacy have established a professional inspection process. In addition to this process, other external organizations also require an accreditation, authorization, certification or validation process for professional practices., Objective: The main objective is to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec., Results: In order to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec, our approach allowed us to identify more organizations in France (i.e., High Authority of Health, Regional Health Agencies, the National Order of Pharmacists, the Nuclear Safety Agency, the Biomedicine Agency and the National Agency for the Safety of Medicines and Health Products) than in Quebec (i.e., Accreditation Canada, Ordre des pharmaciens du Québec and Health Canada). The study highlights the legal framework and applicable standards, the surveyors, the evaluation methods and the particularities for the evaluation of the hospital, the pharmacy department and the members of the department., Conclusions: This study highlights the evaluation processes of pharmaceutical practice in hospitals. In France, as in Quebec, we recognize the importance of the drug circuit in the hospital, the development and operation of a pharmacy department and the practice of pharmacy. While there are more similarities for the assessment of the drug circuit in hospitals and pharmacy department, important differences are observed for the assessment of individuals. We believe that the publication of a comparative analysis can contribute to discussions and exchanges to benefit from the best practices of each country., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Self-administration consists in the administration of medications by the patient himself during his hospitalization. The order of October 10, 2022 (Arrêté du 10 octobre 2022 modifiant l'arrêté du 6 avril 2011) modified the April 6, 2011 regulation to allow and regulate self-administration practices in hospital units. This evolution opens new perspectives for patient autonomy. The objective of this study is, firstly, to evaluate the rate of medication errors from patients under self-administration and secondly, to evaluate the satisfaction of patients and caregivers., Material and Methods: Eligible patients were recruited from a locomotor and polyvalent rehabilitation unit. After verification of eligibility, explanation given to the patient about the hospital self-administration of medication procedure and signature of the compliance agreement, patients started self-administration. Medication errors were reported during seven days. Evaluations of patient and staff satisfaction were also carried out., Results: Of the 83 patients admitted to the care service, 32 were able to experiment self-administered medication procedure during their hospitalization. To assess the safety of this practice, 1235 drug intakes were analyzed. Ninety-four administration errors were noted: 98% of them concerned analgesic drugs. All of these errors were omissions and none of them were rated as serious. The 20 patients questioned were all satisfied with self-administration. The 14 carers interviewed were satisfied with this change in practice., Conclusion: The medication self-administration process set up in the rehabilitation unit did not lead to serious medication errors. Patients and caregivers reported being satisfied with this new hospital practice., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Résumé: La prise en charge précoce des arrêts cardio-respiratoires (ACR) est déterminante pour la survie des patients. Les sapeurs-pompiers (SP) interviennent souvent en premier. L'objectif principal de notre étude visait à la recherche de pistes d'amélioration de la qualité des soins prodigués par les SP de la Loire sur les ACR par la description de leur prise en charge grâce aux données des défibrillateurs semi-automatiques (DSA) et des CPRméter® utilisés lors des interventions. L'étude incluait 1185 ACR, dont 67 % d'hommes avec une moyenne d'âge de 68 ans ; 76,62 % des interventions étaient réalisées au domicile du patient. Un témoin était présent dans 90 % des cas et 46,05 % ont réalisé un massage cardiaque externe (MCE) seul ou associé à un bouche-à-bouche ou à la pose de défibrillateur automatique externe. L'évolution est immédiatement défavorable dans 81,10 % des cas. Le taux de survie à 1 mois est de 4,16 %. Early management of cardiopulmonary resuscitation (CPR) is critical to patient survival. Firefighters (FFs) often intervene first. The main objective of our study was to find ways to improve the quality of care provided by FFs for CPR by describing their management using data logging from automated external defibrillation (AEDs) and CPRmeter® used during interventions. The study included 1185 ACRs; 67% of which were male with an average age of 68 years and 76.62% were performed in the patient's home. A bystander was present in 90% of cases and 46.05% performed external cardiac massage (ECM) alone or in combination with mouth-to-mouth or external automatic defibrillator placement. The issue is immediately unfavorable in 81.10 % of cases. The 1-month survival rate in the Loire district is 4.16%. [ABSTRACT FROM AUTHOR]

Résumé: L'objectif de cet audit de pratique clinique était d'établir la légitimité d'un plan d'amélioration des stratégies de prise en charge diagnostique et thérapeutique du syndrome d'apnées-hypopnées obstructives du sommeil. Cette étude a été menée dans deux services de médecine aiguë gériatrique accueillant des patients âgés polypathologiques fragiles ou dépendants, en se basant sur les recommandations pour la pratique clinique émises par les sociétés savantes. Les résultats de l'évaluation des pratiques professionnelles mise en place démontrent l'intérêt d'assurer, auprès de l'ensemble des équipes gériatriques, une formation sur les troubles respiratoires du sommeil, afin de les sensibiliser à l'utilisation systématique des outils cliniques de leur dépistage et à la nécessité pour les médecins de rédiger des comptes rendus de polygraphie en appliquant les règles de scorage des événements respiratoires pathologiques. En tant qu'analyse prospective, un autre audit clinique ciblé sur la surveillance clinique nocturne des patients nouvellement hospitalisés et sur la lecture visuelle de tous les tracés de polygraphie permettant un calcul fiable de l'index d'apnées-hypopnées paraît essentiel, afin d'évaluer les bénéfices de cette proposition idéalisée dans les suites d'une formation médicale continue. [ABSTRACT FROM AUTHOR]

Background: Combined trisomy 21 screening in the first trimester is now the reference since 2007 HAS’s recommendations. Sonographists must get an identification number given by the local perinatality health network through a professional practice assessment procedure (PPA). The aim of this study was to evaluate screening practices in Basse Normandie, the brakes on getting an EPP, the self-evaluation habits acquired by practitioners who got an EPP, and the way patients are informed about screening modalities. Methods: Descriptive study was conducted from May to August 2016. A form was sent to sonographers practicing in Normandy, their number being evaluated at 78. Results: 47 forms were analyzed. 36 practitioners had an identification number, 35 of them adhered to the perinatal network of Basse Normandie and 29 routinely evaluated Herman’s score during nuchal translucency evaluation. 11 practitioners, 8 of whom did not join the network, did not perform combined screening, justifying this with a lack of screening practice and lack of time to get an EPP. Information on screening procedures was provided in 76.6% number of cases. Conclusion: Seven years after 2009 decree, full adherence to EPP programs is not achieved to get an optimal and consistent screening. Registration of practitioners to perinatal networks seems to favor the validation of EPP. This quality control approach encourages the practitioners to learn how to self-assess their subsequent exercise and, thereby, improve the quality of screening. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les inhibiteurs de la pompe à protons (IPP) sont largement prescrits pour des indications non reconnues, à forte dose, pour une durée prolongée, malgré des effets indésirables et des interactions médicamenteuses nombreux. En 2009, la HAS a publié des recommandations de bonne prescription mais ces dernières sont peu respectées. Dans ce contexte de surprescription et de surcoût pour la société, nous avons réalisé une évaluation des pratiques professionnelles sur le modèle de la roue de Deming. L’objectif de ce travail était d’optimiser la pertinence des prescriptions des IPP dans deux services de médecine interne et de gériatrie grâce à une évaluation des pratiques professionnelles. Toutes les prescriptions d’IPP étaient analysées qu’elles aient été initiées en externe ou durant l’hospitalisation. Patients et méthodes Le recueil des données était prospectif, sur deux périodes de 2 mois et incluait 163 (première phase) puis 139 patients (deuxième phase). Une grille d’évaluation des prescriptions d’IPP était remplie par les médecins concernant le principe actif, la posologie, la durée et l’indication de la prescription. La pertinence correspondait aux prescriptions d’IPP avec une indication et une durée conformes et aux prescriptions non recommandées arrêtées. À la suite de la première période de recueil des données, une information des internes et médecins sur la pertinence de leurs prescriptions au regard des recommandations actuelles et la distribution de plaquettes d’aide à la prescription étaient faites dans le but d’améliorer les pratiques avant la seconde période d’évaluation (deuxième phase). Résultats Lors de la première phase, seulement 25 % des prescriptions pré-hospitalières et 33 % des prescriptions hospitalières respectaient les recommandations de la HAS. La principale indication des IPP était la prévention d’ulcères gastroduodénaux dans un contexte de prise médicamenteuse estimée à risque. Une amélioration de la pertinence des prescriptions était observée après la sensibilisation des prescripteurs : pertinence de 26 % lors de la première phase à 60 % après rappel auprès des prescripteurs ( p < 0,012). Lors de la seconde phase, la part des prescriptions d’IPP initiées à l’hôpital diminuait de 33 à 17 % et l’arrêt de l’exposition non recommandée avec information des médecins correspondants augmentait de 6 à 33 % ( p < 0,001). Cependant, lors de la deuxième phase, 33 % des prescriptions initiées en hospitalisation étaient toujours non recommandées et 61 % des prescriptions débutées en externe non conformes étaient toujours poursuivis à la sortie, probablement par manque d’information suffisante pour arrêter la prescription d’IPP. Conclusion Notre étude souligne le non-respect fréquent des recommandations dans la prescription des IPP. De manière intéressante, une évaluation des pratiques professionnelles a permis une amélioration de la pertinence des prescriptions avec un arrêt plus fréquent des expositions chroniques non conformes et une baisse des prescriptions hors indications. Notre étude suggère qu’il est primordial de poursuivre la sensibilisation des internes et des médecins hospitaliers et de ville dans leur prescription d’IPP. Une information des patients sur les indications et la durée limitée de la prescription, les effets indésirables potentiellement graves d’une prise prolongée et le risque d’interactions médicamenteuses reste également nécessaire pour faciliter l’arrêt de l’exposition et limiter l’automédication. Introduction Proton pump inhibitors (PPI) are widely prescribed for unrecognized indications, at high a dose and for a long duration, in spite of side effects and numerous drug interactions. In 2009, the HAS (French Health Authority) published recommendations of good prescription but the latter are poorly respected. In this context of over prescription and additional cost for the society, we performed a professional practice evaluation of on the model of the Deming wheel. The objective of this work was to optimize the relevance of the prescriptions of the IPP in two services of internal medicine and geriatrics through an evaluation of the professional practices. All PPI prescriptions introduced in outpatient visits or during hospitalization were analyzed. Patients and methods Data collection was prospective, over two periods of 2 months and included 163 (first phase), then 139 patients (second phase). An assessment grid of PPI prescriptions was completed by physicians regarding the active substance, the dose, the duration and the indication of the prescription. The relevance of the prescription corresponded to PPI with a conformed indication and duration and to the prescriptions no recommended stopped. Following the first period of data collection, information was given to medical students and physicians on the relevance of their prescriptions with regard to the current recommendations and informative flyers were offered with the aim of improving the practices before the second period of evaluation (second phase). Results During the first phase, only 25% of the pre-hospital prescriptions and 33% of the hospital prescriptions respected the HAS recommendations. The main indication of the PPI was the prevention of peptic ulcers in a context of associated drug estimated at risk. An improvement of the global relevance of prescription was observed after awareness of the physicians: 26% relevance during the first phase and 60% in the second one ( P < 0.012). During the second phase, the part of PPI prescriptions introduced at hospital decreased from 33 to 17% and the discontinuation of the not corresponding prescriptions increased from 6 to 33%, with an additional information given to the general practitioner ( P < 0.001). However, during the second phase, 33% of the prescriptions introduced in hospitalization were always not corresponding and 61% of the not corresponding prescriptions begun in outpatient visits were always pursued on discharge, probably due to the lack of sufficient information to stop the prescription. Conclusion Our study underlines the frequent disrespect of the indications in the prescription of PPI. Interestingly, a professional practices evaluation improved the relevance of the prescriptions with a more frequent withdrawal of the not corresponding exposure and a decrease in global not corresponding prescriptions. Our study suggests that it is crucial to regularly inform physicians on the good prescription of PPI. Patient information focused on the indications and the limited duration of PPI prescription, potentially severe side effects of chronic exposure and on the risk of drug interactions also remains necessary in order to facilitate the stop of the exposure and restrict self-medication. [ABSTRACT FROM AUTHOR]

Résumé Introduction La prescription aux adolescents d’antipsychotiques, est responsable d’effets secondaires importants. Elle impose un bilan pré-thérapeutique ainsi qu’une surveillance régulière et oblige à penser l’articulation entre les soignants. Objectif Évaluer par un audit les pratiques professionnelles concernant les prescriptions d’antipsychotiques à l’adolescence durant une hospitalisation (information délivrée, bilan pré-thérapeutique et suivi, articulation avec les médecins en aval). Patients et méthode Ont été considérés tous les patients hospitalisés dans le département de psychiatrie de l’IMM entre le 1/01 et 31/12/2014. La méthode retenue était l’audit de dossiers selon trois axes : la traçabilité de l’information délivrée au patient concernant les traitements antipsychotiques, le bilan pré-thérapeutique (suivi clinique et biologique), les effets secondaires et la transmission de ces informations aux partenaires de soins en aval de l’hospitalisation. Résultats La trace de l’information délivrée au patient et à sa famille est absente dans la majorité des dossiers. Si la traçabilité du bilan et du suivi était bonne, celle de la survenue d’effets indésirables était davantage lacunaire. La transmission des éléments du suivi à mettre en œuvre aux médecins en aval est apparue variable d’une unité à l’autre. Conclusion Les outils de suivi ont été perfectionnés et d’autres ont été créés. Une formation à la prescription d’antipsychotiques a été mise en place. Cette évaluation des pratiques professionnelles a permis la mobilisation des équipes soignantes tant dans leur dynamique interne que sur le sens de leurs pratiques, cela au bénéfice de la sécurité des patients. Introduction The prescription of antipsychotics for teenagers is responsible for important side effects. It imposes a pre-therapeutic assessment and a regular supervision. This suggests that the relations among the different medical staff have to be assessed. Objective To estimate by an audit the professional practices concerning the prescriptions of antipsychotics to the adolescent during a hospitalization (delivered information, pre-therapeutic assessment and follow-up, joint with the medical doctors operating downstream). Patients and method All the patients hospitalized in the department of psychiatry of the IMM between 1/01 and in 31/12/2014 have been considered. The selected method was the audit of files, per three axis: the traceability of the information given to the patient about the antipsychotic treatments, the pre-therapeutic assessment (followed clinical and biological), the side effects and the transmission of this information to the care partners who acted prior to the hospitalization. Results There is no record of information, delivered to the patient and to its family, in the majority of files. If the assessment traceability and the follow-up were evaluated as being good, that of side effects was more incomplete. The transmission of the elements of the follow-up that need to be implementedtransmitted to the downstream medical doctors seemed to vary from one unity to another. Conclusion Follow-up tools were perfected and others created. A training in the prescription of antipsychotics has been organized. This evaluation of the professional practices allowed the mobilization of the medical teams, both in their internal dynamics and for the sense of their practices, all of it for the benefit and the safety of patients. [ABSTRACT FROM AUTHOR]

Le partogramme est un outil incontournable dans la pratique quotidienne en salle de naissance. C'est le reflet écrit de la qualité de la prise en charge materno-fétale pendant l'accouchement et le post-partum immédiat. Le but de notre travail est d'évaluer la conformité de la tenue du partogramme au sein de notre maternité et de proposer des axes d'amélioration de la qualité de sa tenue. il s'agit d'une étude rétrospective par audit clinique, effectuée sur 400 dossiers des patientes ayant accouché dans la maternité universitaire de Kairouan du 1er Janvier au 31 décembre 2014. Le référentiel utilisé est celui de la Haute Autorité de Santé (2006) comportant 29 critères divisés en 3 domaines (PARTOten, PARTOobs, PARTOeve). le Taux de Conformité Globale (TCG) de la tenue du partogramme dans notre audit était de 55,9%. Pour le domaine I à La tenue du partogramme à (PARTOten), le TCG était de 88,9%. Pour le domaine II à la traçabilité du déroulement du travail à (PARTOobs), le TCG était de 51,4%. Pour le domaine III à la traçabilité des actes, des évènements et des traitements au cours du travail à (PARTOeve), le TCG était de 27,4%. Notre étude a permis de dégager plusieurs points à améliorer. Le but ultime de l'Audit Clinique est l'amélioration des pratiques professionnelles, de ce fait nous allons mettre en place un plan d'action (formation, sensibilisation...) qui sera suivi par une réévaluation afin de vérifier la pérennité des actions correctives.

Objective: In France, C-sections are classified through a color code according to their degree of urgency. A red-classified C-section is triggered when life of mother or fetus is immediately threatened These cases happen very rarely and represent less than 1% of total deliveries. Many French maternity hospitals are above this rate. This risky procedure should remain an exception. The main purpose of this study is to develop a new tool enabling to determine the relevance of red C-sections in order to improve obstetrical practices., Methods: Eleven national obstetrical experts were submitted with relevant-estimated indications of red C-sections. A two-round Delphi methodology was then used to reach a consensus on a new table of relevance., Results: Five different groups of indications were proposed to the panel of experts. After two rounds, four groups achieved a consensus by being qualified "very relevant" or "relevant" by more than 80% of the 11 experts., Conclusion: The aim of this new consensual table of relevance is to improve quality of care. It allows to evaluate the relevance of red C-sections and determine when red C-sections are non-relevant but it particularly helps teams to identify ways of improvements. Finally, this tool enables a reproductible analysis that can be further intra- or inter-hospitals developed towards harmonization of practices., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé La découverte d’un souffle systolique cardiaque est fréquente en unité. Souvent bénin chez l’adulte jeune asymptomatique, le souffle peut révéler une valvulopathie qui pourrait s’aggraver lors des activités physiques ou une cardiopathie exposant à un risque de mort subite. Cette étude a pour but d’évaluer l’efficience diagnostique du médecin d’unité devant la découverte d’un souffle systolique chez un jeune patient asymptomatique. Matériels et méthode Ce travail prospectif d’un an a impliqué les trois centres médicaux des armées de Bretagne et les cardiologues de l’hôpital d’instruction des armées de Brest. La population étudiée regroupait des militaires de moins de 40 ans asymptomatiques sans cardiopathie sous-jacente connue. Le médecin d’unité a recueilli les caractéristiques du souffle et de l’ECG de manière anonyme en proposant un diagnostic : souffle innocent ou organique. Secondairement, le cardiologue a procédé de même puis a réalisé une échocardiographie délivrant le diagnostic final. Résultats Cinquante-huit patients ont été adressés, 5 ne respectant pas les critères d’inclusion. Sur les 53 patients inclus, le médecin d’unité a retrouvé 46 souffles innocents et 7 souffles organiques. Le cardiologue a retrouvé 51 souffles innocents et 2 souffles organiques. L’échocardiographie n’a retenu qu’un souffle organique dépisté par le cardiologue mais considéré comme innocent en unité (lié à une bicuspidie aortique). Discussion La majorité des souffles diagnostiqués innocents en unité (45/46) ont été confirmés. Parmi les 7 souffles considérés organiques, les arguments séméiologiques relevés (intensité supérieure à 3, persistance à l’orthostatisme, irradiation diffuse) procèdent des critères habituellement cités dans la littérature et témoignent de bons réflexes auscultatoires. Les auteurs proposent une conduite pratique devant la découverte d’un souffle systolique chez un patient jeune asymptomatique. Conclusion Le médecin d’unité semble maîtriser la séméiologie du souffle organique. Ce constat plaide en faveur de la promotion d’un examen clinique holistique afin de ne pas systématiser le recours à l’échocardiographie tant en termes d’économie de santé qu’en termes de valorisation de l’expertise médicale. The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients. Materials and methods During one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis. Results Fifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner. Discussion Most of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients. Conclusion Military general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise. [ABSTRACT FROM AUTHOR]

Résumé Les voies veineuses centrales (VVC) sont essentielles pour l’administration de la nutrition parentérale. Le risque de complications est dépendant de la qualité des soins apportés à la VVC qui influence de ce fait la qualité de vie des patients et le coût des soins. Beaucoup de complications des VVC, infectieuses ou non, peuvent être prévenues par l’existence de protocoles de soins appropriés et standardisés. L’information sur les soins des VVC et les éventuelles complications est essentielle pour le dépistage et le traitement précoce de ces complications ; elle doit faire l’objet de protocoles partagés entre les patients et les soignants. Cet article décrit une évaluation des pratiques professionnelles sous la forme d’un audit clinique destiné à améliorer la qualité de soins des patients en nutrition parentérale porteurs de VVC. Central venous access devices (CVAD) are essential for the administration of parenteral nutrition. The quality of the care of CVAD influences the risk of complications and so the quality of life of the patients and the costs of care. Numerous infectious or non-infectious complications of CVAD can be prevented by appropriate, standardized protocols of care. Information about the care of CVAD and complications is essential for the early recognition and treatment of complications and should be shared between patients and caregivers. This article describes an audit for CAVD care that can be used to improve quality of care in a professional practice evaluation program. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’évolution de la glomérulonéphrite extramembraneuse idiopathique (GEMi) est variable ; le traitement est débattu. Notre travail avait pour objectif principal d’évaluer les résultats d’une stratégie standardisée de prise en charge proposée en 2006 en Lorraine par le réseau Néphrolor. L’objectif secondaire était d’évaluer les pratiques professionnelles. Patients et méthodes Cette étude comparait l’évolution des GEMi incidentes entre 2002 et 2005 (Avant), puis entre 2007 et 2010 (Après) : dates de point respectives au 31/12/2006 et au 31/12/2011. Chez les patients néphrotiques sans insuffisance rénale, l’appréciation du risque dévolution vers l’insuffisance rénale chronique terminale reposait sur le débit urinaire de β2-microglobuline (uβ2 m, seuil à 0,5 μg/min). Les patients à haut risque devaient recevoir un traitement immunosuppresseur. Résultats Soixante-quatorze GEMi étaient diagnostiquées par biopsie rénale, dont 50 néphrotiques (22 Avant et 28 Après) parmi lesquels 20 avaient une fonction rénale normale. Chez ces néphrotiques, il n’y avait pas de différence significative concernant la probabilité et le délai moyen de survenue d’une rémission entre les deux groupes ( p = 0,26). Le dosage de uβ2 m était réalisé dans 35 % des cas. Cinquante pour cent étaient traités par IS en accord avec la stratégie. Conclusion Malgré des écarts entre la stratégie et les pratiques, pouvant expliquer les résultats non significatifs, nous avons observé des changements dans la réflexion et l’attitude thérapeutique du clinicien. La stratégie tend à standardiser et améliorer les pratiques concernant la GEMi en Lorraine, ce qui semble améliorer les résultats en matière de rémission. Nous incitons donc à généraliser l’application de cette stratégie et à poursuivre le suivi de cette cohorte. Introduction The evolution of idiopathic membranous membranous (MNi) is variable, treatment is discussed. Our work's main objective was to evaluate the results of a standardized management strategy proposed in 2006 in Lorraine (Nephrolor health network). The secondary objective was to evaluate the professional practices. Patients et methods This study compared the evolution of incident MNi between 2002 and 2005 (Before) and between 2007 and 2010 (After), the respective dates point to 31/12/2011 and 31/12/2006. In nephrotics patients without renal failure, the risk assessment of end stage renal disease based on urinary β2-microglobulin (uβ2 m, threshold to 0,5 μg/min). Patients at high risk should receive immunosuppressive therapy (IS). Results Seventy-four biopsy-proven MNi were diagnosed with 50 nephrotic (22 Before and 28 After) of which 20 had normal renal function. In these nephrotic, there was no significant difference in the probability and the average time of remission between the two groups ( P = 0.26). Dosage of uβ2 m was performed in 35% of cases. Fifty percent were treated with IS respecting strategy. Conclusion Despite differences between the strategy and practices, which may explain these non-significant results, we observed changes in thinking and therapeutic attitude of the clinician. The implementation of this strategy tends to standardize and improve practices about MNi in Lorraine, which seems to improve results in remission. We encourage to generalize the application of this strategy and to continue this cohort follow. [ABSTRACT FROM AUTHOR]

Résumé Objectif Recenser à partir du registre RéAC, les arrêts cardiaques extrahospitaliers survenus sur l’agglomération caennaise afin d’étudier l’épidémiologie et d’analyser nos pratiques professionnelles. Type d’étude Étude observationnelle et prospective, monocentrique. Patients et méthodes De mars 2012 à mars 2013, nous avons recensé 151 patients. Les paramètres démographiques, les délais, les thérapeutiques et le devenir des patients ont été analysés à partir des données saisies dans le registre RéAC. Selon le type de variable étudiée, l’analyse statistique a utilisé le test de Mann et Whitney ou du Chi 2 . Résultats Après exclusion de 22 patients (absence de réanimation spécialisée et transport à « cœur arrêté »), 129 arrêts cardiaques ont été analysés : 107 (83 %) d’origine médicale et 22 (17 %) d’origine traumatique. Un témoin direct était présent pour 94 (73 %) d’entre eux. Les gestes élémentaires de survie étaient débutés pour 59 (46 %) des patients et un conseil téléphonique était délivré par le médecin régulateur pour 47 (36 %) d’entre eux. Après une réanimation cardiopulmonaire spécialisée, 74 (57 %) patients sont décédés sur place. Sur les 55 patients arrivés vivants à l’hôpital, 39 (71 %) sont décédés en réanimation et 16 (29 %) sont sortis vivants de l’hôpital, dont 14 (88 %) avec un pronostic neurologique favorable. Conclusion Le registre national RéAC nous a permis d’analyser les données épidémiologiques concernant les arrêts cardiaques dans notre centre. Ce registre nous a également permis de mettre en évidence des axes de prises en charge perfectibles dont il faudra tenir compte pour améliorer nos pratiques professionnelles. Objective Identify from the RéAC registry, out-of-hospital sudden cardiac arrest in Caen and it's suburbs, to study epidemiology and assess our medical practices. Study design Observational, prospective and monocentric study. Patients and methods From March 2012 to March 2013, we identified 151 patients. Demographic parameters, delays until treatment, drugs given and patient outcomes were analyzed from the RéAC data registry. Depending on the variable studied, the statistical analysis used Mann-Whitney or the Chi 2 tests. Results Twenty-two patients were excluded (no resuscitation attempt and patients who were transported to hospital with chest compressions only, in the absence of spontaneous circulation). One hundred and twenty-nine sudden cardiac arrests were analyzed: 107 (83%) with medical origin and 22 (17%) with traumatic origin. Direct witnesses were present for 94 (73%) of them. Basic life support actions were begun for 59 (46%) patients and a telephone advice was issued by the medical response team for 47 (36%) of them. After an advanced life support, 74 (57%) patients died on the spot. Of the 55 patients reaching the hospital alive, 39 (71%) died in the intensive care unit and 16 (29%) were discharged alive from hospital, of whom 14 (88%) with a favorable neurological outcome. Conclusion RéAC national registry has allowed us to analyze epidemiological data on out-of-hospital sudden cardiac arrests in our center. This register has also allowed us to highlight areas for improvement. They should be taken into account to improve our medical practices. [ABSTRACT FROM AUTHOR]

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Copyright of Les Cahiers de l'Année Gérontologique is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In Western French Guiana, 70% of pregnant women have anemia. Périnat Guyane network coordinated a practice review using a clinical pathway in order to improve prevention, screening, and care for anemia during pregnancy. Before implementation of actions, 54 medical records were audited. After implementation, 82% of practitioners reported to have changed their professional practice. [ABSTRACT FROM AUTHOR]

Résumé: La sécurité transfusionnelle concerne toutes les étapes depuis la prescription des examens immuno-hématologiques jusqu’à la réalisation de l’acte transfusionnel. Dans sa décision du 5 novembre 2006 relative aux bonnes pratiques transfusionnelles, l’Afssaps recommande de transfuser les patients pendant les heures ouvrables de l’établissement et de limiter les transfusions la nuit aux seules urgences vitales. Une enquête rétrospective menée au sein de notre établissement a permis d’évaluer la proportion des transfusions réalisées en horaires de garde. L’objectif de cette évaluation des pratiques professionnelles est d’analyser les raisons conduisant à réaliser des transfusions à des horaires tardifs et d’en évaluer la pertinence. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer les pratiques professionnelles des médecins anesthésistes-réanimateurs (AR) concernant la prise en charge périopératoire des patients coronariens en chirurgie non cardiaque et apprécier l’écart par rapport aux recommandations en vigueur. Méthodes: Un auto-questionnaire a été envoyé de juin à septembre 2011, auprès de 5000 AR, représentatifs des AR exerçant en France métropolitaine. Les différents items concernaient : la démographie, l’évaluation préopératoire du risque cardiovasculaire, le recours à un avis cardiologique spécialisé et la modalité, la prise en charge per- et postopératoire de ce type de patient, et enfin leur connaissance des recommandations en vigueur. Résultats: Dans les neuf régions prospectées, 1255 AR ont répondu, soit un taux de réponse de 25 %. Parmi les répondeurs, 73 % étaient des hommes et 38 % travaillaient dans le public ; 70 % travaillaient dans un bloc opératoire commun avec une activité polyvalente. Concernant l’évaluation préopératoire, 85 % des AR adressaient les patients à haut risque à un cardiologue. Dans 16 % des cas seulement, le score de Lee figurait dans le dossier d’anesthésie et avait été utilisé pour évaluer le risque cardiaque en périopératoire. Seulement 61 % des AR prenaient en compte les six facteurs de ce score nécessaires à la bonne évaluation du risque cardiaque. En revanche, 91 % des AR évaluent systématiquement la capacité à l’effort par l’interrogatoire. L’examen préopératoire le plus fréquemment réalisé (49 % des AR répondants) était un ECG chez les patients âgés. Dans 96 % des cas, les bêtabloquants pris habituellement par les patients étaient prescrits lors de la prémédication. Dans 62 % des cas, les AR arrêtaient systématiquement le clopidogrel avant l’intervention chez les patients à risque. En cas d’arrêt, 38 % utilisaient un relais, dont 29 % par héparine de bas poids moléculaire. Sept pour cent des AR envisageaient une revascularisation chez les patients ayant une coronaropathie connue et stable sous traitement. L’étude POISE était connue par 40 % des AR et 18 % estimaient qu’elle avait modifié leur pratique. Vingt et un pour cent des AR réalisaient en préopératoire des réunions pluridisciplinaires pour les patients à risque. Vingt-cinq pour cent des AR disposaient d’algorithmes de prise en charge des patients à risque cardiaque élevé. Soixante-trois pour cent des AR monitoraient le segment ST en peropératoire. En postopératoire, seuls 11 % des AR demandaient systématiquement chez les patients à risque coronarien : un ECG, un dosage de troponine, une surveillance postopératoire, un suivi cardiologique à distance. En cas d’élévation modérée de la troponine, 70 % des AR réalisaient a minima un ECG et/ou une échographie. Conclusion: Cette enquête met en évidence des écarts entre les recommandations concernant la prise en charge périopératoire du patient coronarien en chirurgie non cardiaque en vigueur et la pratique quotidienne des médecins anesthésistes, justifiant des mises à jour régulières de celles-ci. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: L’hémorragie massive reste une cause importante de mortalité dans les pays développés, particulièrement en obstétrique, chez le polytraumatisé et dans les chirurgies majeures. Le facteur VII activé recombinant (rFVIIa) (Novoseven®) a été développé pour le traitement substitutif des hémophiles, mais était actuellement utilisé dans d’autres indications de saignement aigu. L’objectif de cette étude était d’évaluer le respect des critères d’utilisation hors AMM du rFVIIa selon les groupes définis par l’Afssaps, dans les hôpitaux de l’assistance publique à Paris (AP–HP) en 2010. Patients et méthodes: Nous avons rétrospectivement contacté les services d’anesthésie-réanimation des centres ayant une activité en obstétrique, d’accueil de polytraumatisés, de chirurgie cardiaque, hépatique et pédiatrique pour récupérer tous les dossiers d’utilisation hors AMM du rFVIIa en 2010. La qualité de l’indication et de son utilisation a été analysée sur la base des recommandations françaises ou européennes ou selon la littérature existante dans les domaines considérés. Trois catégories de prescriptions ont été établies : conforme, acceptable et non conforme. Résultats: Sur les 59 patients ayant reçu du rFVIIa hors AMM en 2010, 49 prescriptions ont pu être analysées. L’indication et le moment d’administration étaient conformes dans 100 % des prescriptions pour le polytraumatisme et 83 % des prescriptions pour les hémorragies du postpartum. Les critères biologiques étaient remplis dans deux tiers des prescriptions. La prescription a été jugée conforme ou acceptable dans 82 % des cas, toutes indications confondues. Conclusion: Dans la grande majorité des cas, les prescriptions de rFVIIa, utilisé hors AMM à l’AP–HP en 2010, respectaient les recommandations en vigueur. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Il s’agit d’une évaluation des pratiques professionnelles (EPP) sur l’antibiothérapie dans un service de médecine interne. Matériels et méthodes: Un recueil prospectif sur six mois des prescriptions antibiotiques et leur comparaison avec les recommandations locales et nationales (molécule, dose journalière, modalité d’administration, durée) ont été réalisés. Résultats: Deux cent vingt-sept antibiothérapies ont été recueillies. Par rapport aux recommandations locales, on retrouvait 56 % de schémas totalement respectés (STR) (infections bronchopulmonaires [IBP] : 38 %, urinaires : 88 % et cutanées : 73 %), 33 % de schémas partiellement respectés (SPR) et 11 % de schémas différents (SD). En prenant comme référentiel les recommandations nationales relatives aux IBP, les résultats étaient : STR : 81 % (dont IBP : 80 %), SPR : 16 %, et SD : 3 %. Conclusion: Ce retour sur les prescriptions a permis de mettre en place des actions pérennes d’amélioration des pratiques. Cette démarche anticipe les EPP qui seront nécessaires pour l’accréditation des établissements et souligne l’intérêt de la prise en compte de plusieurs sources de recommandations pour l’interprétation des résultats. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer l’adéquation de nos pratiques avec les recommandations (17e conférence de consensus, SPILF 2008) et identifier les facteurs associés aux délais des principaux temps de prise en charge. Méthodes: Étude rétrospective observationnelle (2009–2011) portant sur les méningites bactériennes aiguës (MBA) de l’adulte. Les données ont été recueillies par questionnaire standardisé à partir des dossiers médicaux et infirmiers. Résultats: Sur 31 MBA admises aux urgences, 29 (93,5 %) y ont reçu ceftriaxone ou céfotaxime. Les indications de corticothérapie et d’imagerie étaient conformes dans 71,0 % et 83,9 % des cas. Les délais médians (IQR) ont été : admission/ponction lombaire (PL), 2h43 (1h09–5h57) ; admission/antibiothérapie, 3h21 (1h34–5h11). La mention de suspicion de méningite dans le courrier d’admission était associée à une PL plus précoce (p =0,01), et une tendance à l’instauration plus rapide de l’antibiothérapie (p =0,05). Conclusions: La mention de suspicion de MBA dans le courrier d’admission est associée à une meilleure prise en charge aux urgences. [ABSTRACT FROM AUTHOR]

Abstract: In 2003, we sought to determine what were the needs of patients prescribed with long-term glucocorticoid therapy in our internal medicine department. Following this inventory, we decided to homogenize the medical practices regarding glucocorticoid prescriptions in our institution. We also set up a therapeutic educational program focused on these prescriptions. This program is based both on individual and collective sessions. Its aims are to improve patients’ autonomy regarding the glucocorticoid therapy and to improve the quality of care. This program has widely favored discussions within the medical team and has contributed to enrich experience and expertise of each of its member. We believe it has improved both the satisfaction of the patients and the medical staff. [Copyright &y& Elsevier]

Au moyen d’une enquête de satisfaction sur les interventions pharmaceutiques ciblant l’ensemble des prescripteurs, il a été réalisé, au centre hospitalier spécialisé de Sevrey (Saône-et-Loire), une évaluation de la pratique de la pharmacie clinique. Tous les prescripteurs paraissent intéressés par la pharmacie clinique. D’après eux, le pharmacien a certes un rôle d’information sur le bon usage du médicament et sur la détection d’interactions médicamenteuses, mais n’intervient pas dans le choix thérapeutique. Ces conclusions ont conduit à l’élaboration d’un plan d’actions d’améliorations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess, a year after the deployment of the check-list in the centre hospitalier Lyon Sud (CHLS – HCL), the perception of medical and nursing staff regarding the advantages of the check-list and its level of integration within the overall organization of the operating room. Type of study: Descriptive study, questionnaires and audits. Materials and methods: Distribution of individual questionnaires to the entire operating room staff, and observational audits in the operating room, to objectively assess the quality of implementation of the check-list (level II of the HAS – French National Autority of Health). Results: The medical and nursing staff participated equally in using the check-list. This was derived from the individual questionnaires and reinforced by the observational audit; they also revealed an uneven implementation of the three phases, with phase 3 almost never performed. In two-third of the cases, the time-out requirements did not comply with HAS instructions. Nurses and physicians perceived the check-list differently. Even though they agreed that the check-list should be a team effort and is useful, nurses noted a lack of investment and leadership from doctors, in addition to communication problems, which led to a feeling of disrespect towards them when they play the role of the check-list coordinator. Conclusion: The questionnaire and the audit of practice showed strong adherence to the concept in that the surgical check-list was considered useful by all staff. However, it was also considered to be an added formality and its full implementation was rare in practice. There was a problem of distribution and acceptance of roles with nurses often observing that they were the only ones strictly following the check-list due to a lack of medical investment. [Copyright &y& Elsevier]

Abstract: Objectives: To reduce the episiotomy rates, according to the Clinical Practice Guidelines, of 2005, from the French College of Obstetricians and Gynaecologists. Patients and methods: A cross sectional study was conducted, in the university hospital maternities (Maternity 1 and 2) with a retrospective record from medical files. Patients who had delivered in those maternities, by vaginal route, after 22 weeks amenorrhea were eligible. The global rate of episiotomy was analysed from 2006 to 2008. A descriptive clinical study was performed with a retrospective analysis (from July to December 2005 on 100 medical files and from July to December 2007 on 85 files). Besides, a study of episiotomy rate was conducted from 2006 to 2008. Improvement actions were developed between the two phases of assessment of the audit: sharing and comparing the results to standardized episiotomy rates, and elaborating an informatized regional perinatality file with episiotomy related items and national recommendations. Results: Episiotomy rate decreased during the study, from 22.35% in 2005 to 19.34% in 2008, in the Ward 1 (p <0.0001) and from 33.62% in 2005 to 17.93% en 2008 (p <0.0001) in the Ward 2. An improvement was observed between the two periods of audits, for each item of the chart but without statistical signification. Discussion and conclusion: Theses procedures have led to a positive impact on practices thanks to the work group and because of the politics of the perinatal network in favour of an episiotomy reduction. We hope these results could be improved in the future. [Copyright &y& Elsevier]

Abstract: Objectives: Leonetti Law of 2005 concerns procedures for questioning about the appropriateness of initiating or maintaining life-sustaining treatments. Decision of withdrawing and withholding treatment has long been practiced by neonatologists, adult and pediatricians intensivists. In this regard, the recommendations of societies encourage medical teams to assess their practices to improve them. Our evaluation is based on the document of the Ethics Committee of SRLF edited in 2010. Type of study: We achieved a retrospective evaluation of professional practices of the transcription of our decisions of withdrawing and withholding treatment. Patients and methods: This study included all children (95 patients) who have had a questioning about life-sustaining treatment of ICU between March 2008 and August 2011 in the pediatric intensive care unit of Children''s Hospital of Lyon. Our evaluation is based on the document of the Ethics Committee of French Society of intensive care (SRLF) edited in 2010. We collected epidemiological data on children concerned by questioning about the appropriateness of initiating or maintaining LST and an evaluation of the transcription of our procedures for LST in our folders. Evaluation included 40 cases: 20 folders randomly selected prior an information meeting (January 2011) which were compared with 20 cases occurred consecutively after this information. This meeting was intended to remind recommendations of good practice and principal points of the law. The main assessment measure was the improvement of the practices respecting criteria of the document of the Ethics Committee of SRLF modified for pediatric care. Main results: Epidemiological data on procedures are comparable to literature data. Concerning the evaluation of our practices before/after a briefing and highlighted a tendency to the improvement without statistically significance. The transcription of reflection and the arguments of decision of withdrawing and withholding treatment and evaluation of pain was the points who need improvement. Finally, despite the positive developments in the therapeutic use of analgesics and sedatives, pain continues to be undervalued. Conclusion: The evaluation of professional practices is recommended to improve the procedures of questioning about life-sustaining treatments have become an area of expertise in intensive care. [Copyright &y& Elsevier]

Abstract: Objective: Observational study relating to the inscriptions with universitary diplomas (DU) in relation with anesthesiology and intensive care during the year 2010–2011. We had in mind to know the profile and the motivations of the students concerned. Method: A questionnaire was put on line and the registered students with the various diplomas were contacted by e-mail. Different items investigated concerned: demography, type of exercise of the students, heading of diplomas, scientific level of the students, their motivations at the time of the inscription and finally practical organization. Results: We collected 265 questionnaires, that is to say 42 % of answers. The demographic distribution of the registered voters was the followed: 71% of MD, 28% of residents. These doctors exerted for the majority with the public hospital (87%). The inscriptions concerned intensive care diplomas in 90% of the cases. The total scientific level of the students was high, since 46% of them had a diploma other than their medicine thesis. The students were registered for the majority of them “to widen their field of competence” (65%) or “in complement of their initial training” (46%). The other reasons were: “to make up a deficit of their initial training (26%)”, “as continuous medical training” (16%) and finally “for the university validation of an asset” (10%). The rate of total satisfaction of the diplomas was very high (96%). Financial aid was assumed by the institution for 46% of students. Residents were less financially helped than senior practitioners. The overall costs of the DU/DIU, including the registration fee, transport and lodging, were important (>500 euros in 61% of the cases). Conclusion: DUs related to our specialty are much appreciated. They interest a majority of senior doctors, but also a considerable number of residents, which poses the problem of the place of these additional trainings within the framework of initial training. The principal motivations of the registered voters are to supplement their initial training or to widen their field of competence, much more than to make up a deficit of this initial training. Lastly, the total financial expenses associated with these diplomas remain important and appear inversely proportional to the incomes of the registered students. [Copyright &y& Elsevier]

Abstract: In France, continuing medical education (CME) and professional practice evaluation (PPE) became mandatory by law in July 2009 for all health professionnals. Recently published decrees led to the creation of national specialty councils to implement this organizational device. For radiation oncology, this council includes the French Society for Radiation Oncology (SFRO), the National Radiation Oncology Syndicate (SNRO) and the Association for Continuing Medical Education in Radiation Oncology (AFCOR). The Radiation Oncology National Council will propose a set of programs including CME and PPE, professional thesaurus, labels for CME actions consistent with national requirements, and will organize expertise for public instances. AFCOR remains the primary for CME, but each practitioner can freely choose an organisation for CME, provided that it is certified by the independent scientific commission. The National Order for physicians is the control authority. Radiation oncology has already a strong tradition of independent CME that will continue through this major reform. [Copyright &y& Elsevier]

Abstract: Objective: To estimate the morbidity and mortality conferences (MMC) impact in intensive care unit (ICU) setting on quality of care and patients’ safety. Data sources: A review of English and French articles in Medline database (1990–2011) related to MMC in the ICU. Keywords used: “morbidity (and) mortality conference(s)”, “intensive care unit”, “intensive/critical care medicine”. Additional studies identified by hand search in French national guidelines about MMCs and in the Annales Françaises d’Anesthésie Réanimation and Réanimation journals index. Identification and preliminary analysis performed using title and abstract, for every study related to MMC in the ICU. Study selection: Only original studies about MMC in the ICU setting that reported an assessment were included. Papers reporting guidelines and methods for MMC implementation were excluded. Data extraction: Extraction used predefined data fields, including study design, MMC characteristics, assessment methods and results. Data synthesis: Studies about MMC in the ICU are recent and scarce. Results comparison and synthesis are impaired by discrepancies in study designs. Although the effectiveness of MMC is not evidence-based, data are consistent for their positive impact on quality of care and patient safety in the ICU. Conclusion: Further studies are required to assess the impact of MMC in the ICU. Based on this literature review, a 4-level evaluation scheme can be suggested: 1) evaluation of MMC implementation in care units and facilities; 2) evaluation of MMC organization; 3) evaluation of MMC on quality of care; 4) evaluation of MMC impact on patients’ mortality and morbidity. [Copyright &y& Elsevier]

Abstract: Introduction: Fluid therapy is one of the major elements of severe sepsis and septic shock management. A systematic initial fluid bolus is recommended before evaluation of left ventricular filling pressure by the use of indicators of fluid responsiveness, preferentially dynamic ones. A massive fluid therapy could be damaging for the patient. Dynamic indicators of fluid responsiveness are not often relevant in the emergency department. This study was aimed to evaluate the use of indicators of fluid responsiveness by emergency practitioners during septic shock management. Study design: Cross sectional survey using anonymous self-questionnaire. Methods: We included all practitioners working in public emergency department of Languedoc-Roussillon (France). Primary-end point was the use of one indicator of fluid responsiveness at least. Uni- and multivariate analysis was conducted to find associated factors. Results: Of 232 practitioners included, we collected 149 questionnaires (response rate=64%). Hundred and eight practitioners (72% [64–79%]) used at least one indicator of fluid responsiveness. Fifty-six practitioners (38% [30–46%]) used echocardiography, 54 practitioners (36% [29–44%]) used blood lactate concentration, 45 practitioners (30% [23–38%]) used passive leg raising. The use of indicators of fluid responsiveness is associated with easy access to echography device (odd ratio=2.94 [1.16–7.62], P =0.03). Conclusion: Emergency practitioners use preferentially less invasive and less time-consuming indicators of fluid responsiveness. [Copyright &y& Elsevier]