Search

The French public health medical residency was created in 1984 to train medical public health specialists. Knowledge was lacking on the career of the trained practitioners, with the sole study dating from 1995. In this study, the French national association of medical public health residents aimed to describe the training and career of all medical public health specialists since the inception of the residency.An online survey took place during the first semester of 2012 to collect information on all medical public health specialists graduated from the French public health medical residency. Descriptive analysis of the collected information was performed.Replies from 563 graduated medical public health residents were collected from all over the country and years since the inception of the training. Ninety-eight percent of the informants were in activity. They mostly worked in public healthcare facilities (56%) and public administration (16%). Their main areas of practice were: epidemiology, clinical research, biostatistics (37%); health management information system (19%); health policy (14%). Eighty-eight percent of the respondents held a master degree, 29% a PhD. Practical training during the medical residency was deemed as very useful or needed by 73% of the informants, theoretical training by 43%. Sixty-eight percent of informants were very or fully satisfied by their carrier, 29% rather satisfied.This is the first study to achieve coverage of more than 45% of all medical public health specialists graduated since the inception of the public health medical residency. Full employment, wide-range activities, evolving carriers can explain the high satisfaction rates. The public health medical residency being the main access point to the public health medical specialty, the impact of the initial training on the career should lead to rethink the design of the public health medical residency to fulfil the needs in the public health sector.

Observation of schistocytes on the peripheral blood following haematopoietic stem cell transplantation (SCT) is a common finding. As their presence is not specific to the onset of SCT-related thrombotic microangiopathy, we evaluated the interest of schistocyte measurement twice a week during the entire follow-up of 195 patients undergoing SCT, particularly focussing on the 125 allogeneic SCT.Schistocytes were strickly defined as triangular-, crescent- or helmet-shaped red blood cells according to consensus standards and were checked blindly under the microscope and with computer image analysis.Mean schistocyte percentage was 0.7% (±0.5%, reference value ≤0.5). High schistocyte percentage was observed after allografts (0.79%) when compared to autologous SCT (0.47, P0.001). All but one patients undergoing allogenic SCT had schistocytes ≥0.6%. Conversely, significant schistocytosis was observed in 20% of the autologous SCT. Initial diagnosis [chronic myelocytic leukaemia, acute lymphoblastic leukaemia (ALL)], high-risk status, unrelated transplant and conditioning regimen including total body irradiation influenced higher schistocyte percentage (≈0.9%). Significant rise in the schistocyte percentage was observed during acute/chronic graft-versus-host disease, veno-occlusive disease (VOD), cholestatic hepatitis, haemorrhagic cystitis (HC) and pulmonary complications. Multivariate analysis showed a significant association between thrombotic microangiopathy (TM), renal impairment and delayed thrombopaenia after day 50, and schistocyte1.2%. SCT-TM grade ≥2 occurred in nine patients. A marked rise in schistocyte4.5% was observed, which was not reached during the other SCT-related complications. Children with ALL, undergoing unrelated allogeneic SCT, with early acute graft-versus-host disease refractory to steroids were prone to present SCT-TM, associated with VOD, interstitial pneumopathy and HC, resulting in a high mortality rate (six of seven patients). Our data confirmed that schistocytosis was common after SCT. Mild percentages were likely concomitant with extensive endothelial damage but higher percentage should have prompted to a close monitoring with SCT-TM investigation.In our experience, systematic schistocyte count after HSCT proved to be useful: the occurrence of an increased percentage was a surrogate marker for complications even if unspecific for TM.

Our objective was to improve the organization and management of care facilities for children suffering from cancer or leukaemia and to be aligned with the legislation in force in France.Our report is on the successive steps for the implementation of a quality assurance system, methods used, motivations, cost, difficulties encountered as well as the advantages obtained. In the Regional Centre for Paediatric Oncology (CRCP) at the CHU in Clermont-Ferrand, we launched a quality programme based on ISO9001/2000 standards. The implementation of the quality assurance system was conducted as a research project and an established medical project with the support of the Management Team. The mission was divided into several "processes", an approach consisting of considering the clinical service in terms of flow and successions of transformations (reception, care, support, accompaniment, etc.) which produce added-value (services and products adapted to the needs of the "customers": children, families, correspondents).We singled out ten physical processes or "job specializations" such as "diagnosis", "care" or "project for the child". The cartography which is the systematic representation of the processes and the interactions between them made it possible to draw up a global vision of the CRCP "care" activity.The ISO9001/2000 standard is a tool designed to help organization and management. The benefit obtained in implementing it in a clinic was perceived in organisational terms and lead to a true team spirit, a standardization of the professional practices and the enhancement of the role of each person. The advantages appear at three levels: the child and his/her family, the medical and paramedical teams, and the administrative supervisory bodies.