Search

The quality of the relationship is important for the medical care of adolescents. The choice of the pronoun of address, "tu" or "vous", could be a determining factor in this relationship. A study of 220 adolescents showed that they preferred to be addressed as "tu". They waited for the doctor to offer it to them.

Introduction : L’impact sanitaire des vagues de froid et de chaleur est majeur. Neanmoins, l’impact respectif des temperatures extremes, hautes et basses, demeure controverse.Methode : Le nombre quotidien de (1) dossiers de regulation medicale (DRM) geres par le SAMU 93 – indicateur de la demande en soins primaires, (2) interventions des equipes SMUR – indicateur de severite des patients et (3) patients decedes ont ete releves. Les temperatures minimales et maximales quotidiennes ont ete relevees de 2010 a 2018.L’analyse a porte sur les 10 journees plus chaudes et les plus froides de chaque annee (2 × 70 journees), et sur les 30 journees les plus chaudes et les plus froides de la periode (2 × 30 journees).Resultats : Sur 2 702 jours, 1 513 070 DRM, 89 478 interventions SMUR et 7 350 deces ont ete analyses. Temperature mediane : 16,0[10,4-21,6]°C.Les journees les plus froides etaient associees a une augmentation significative des DRM (665[609-764] vs 538[474-619] ; p

Background The terrorist attacks in Paris and in Saint-Denis in November 2015 were unprecedented events involving various human and material resources. These events question the role of nurse students in prehospital teams. Purpose To investigate nursing students’ preference about whether they wished to participate in the prehospital care during a terrorist attack. Methods This cross-sectional study was conducted with student nurses, from two nursing schools in the Greater Paris area. They completed an anonymous survey assessing the desire to be called to help the mobile intensive care units (MICU) or another ward; whether their presence should be mandatory, and the feelings associated with their experience. The responses were collected with a visual analogue scale and could range from 1 (yes, very much) to 10 (no, not at all). A Chi-square test was performed for qualitative variables and a Mann–Whitney test for quantitative variables. Findings Among 225 students, 205 (91%) responded, 133 (65%) were women. When on duty, 169 (82%) would have preferred to accompany the MICU team, compared with 31 (15%) who would have preferred not to go. Overall, 146 students (71%) considered that this presence should be optional. Only gender was significantly associated with the choice to accompany the MICU team (W = 87% vs. M = 13%; p = .002). Students expressed a moderate feeling of frustration and fear. Discussion Students would prefer to assist the MICU team responding to the scene of a terrorist attack but feel this choice should be optional. A discussion in nursing schools and universities should be considered for the implementation of a “systematic” procedure to ensure the student's willingness to participate in such interventions.

Introduction Gender equity has become a major concern in many professional fields. The rate of women as authors has to be interpreted according to the rate of women in the related professions. In this perspective, studying nurses’ population should be of particular interest since, worldwide, nurses are mostly women. Then, our aim was to study gender disparity in nurses’ publications. Methods We selected the three main journals dedicated to nurse publications: International Journal of Nursing Studies, Journal of Nursing Scholarship, and European Journal of Cardiovascular Nursing. We included 20 recent consecutive papers from each journal. For each paper, the number of authors, their gender, and rank were recorded. Primary endpoint: overall rate of women as authors. Secondary endpoints: rate of women as first, last, second, and third authors. Results Sixty papers including 322 authors were analysed. Overall rate of women authors: 74%. Overall rate of women as first author: 82%. Overall rate of women as last author: 72%. Overall rate of women as second and third authors: respectively, 80% and 70%. Conclusion Almost three-quarters of the authors in these main scientific journals of nursing studies were female. This rate is lower than the gender rate in the nursing profession.

Introduction Worldwide, the COVID-19 epidemic has put health systems to the test. The excess mortality is partly due to the influx of patients requiring hospitalization and intensive care. We propose that the chronology of epidemic spread gives a window of time in which hospitals can act to prevent reaching capacity. Methods The out-of-hospital SAMU Emergency Medical System in an entry point into the French health care system. We recorded the number of patients managed, of patients transferred to emergency departments (ED), and of mobile intensive care units (MICUs) dispatched. Each criterion was compared to the mean of the same criterion over the previous 5 years. The alert threshold which indicated a public health crisis was defined as a 20% increase compared to the 5-year mean. Results The reference period, from January 2015 to December 2019, included 3 381 611 calls, and 1 137 856 patients. The study period, from 17 February to 28 March 2020, included 166 888 calls, and 56 708 patients. The daily numbers of patients managed crossed the threshold on February 25, and increased until the end of the study period. The daily number of patients transferred to ED crossed the threshold on March 16, and increased until the end of the period. The daily number of MICUs dispatched crossed the threshold on March 15, and increased until the end of the period. Conclusion The COVID-19 epidemic reached our department in three consecutive waves which overwhelmed the health care system. The first wave preceded by 30 days the massive arrival of critical patients. Health care systems must take advantage of this delay to prepare for the third wave.

BACKGROUND The terrorist attacks in Paris and Saint Denis on November 13, 2015 were an unprecedented traumatic event in France. It was an especially distressing ordeal for the healthcare personnel involved in the care of the victims. The aim of this study was to estimate the effect of direct participation in the rescue on posttraumatic stress disorder (PTSD) symptoms among these workers. METHODS Less than a month later, 613 healthcare providers (professionals and paraprofessionals) from three hospitals in the Paris suburbs were asked to complete an anonymous questionnaire. A multivariable Poisson model estimated the effect of participating onsite in the rescue (exposure variable) on the number of PTSD symptoms measured by the Trauma Screening Questionnaire (TSQ; outcome variable), adjusted for covariates. RESULTS Two hundred thirty-three providers completed the assessment (38% response rate), 130 participated directly in the rescue (56%). Participation was associated with a higher number of symptoms of PTSD (RR = 1.34, P = .002) than for nonparticipants. Female gender (RR = 1.39, P

To evaluate the prevalence of advance directives and their impact on the management of out-of-hospital cardiac arrest (OHCA) victims.We analyzed data extracted from the French national registry of adult OHCA patients (RéAC). The data concerned the emergency medical services (EMS) of a Paris suburb over the period 01/01/2013 to 30/11/2015. The primary endpoint was the prevalence of advance directives. Secondary endpoints were the characteristics of the population, of cardiac arrest, and of basic life support as well as outcomes in patients with or without advance directives.Advance directives were available for 148/1985 (7.5%) of OHCA patients. Advanced life support was given to 35 patients with directives and 941 patients without (24% vs. 51%, p0.0001) with no significant difference in the characteristics of the support provided. Spontaneous recovery of cardiac activity was observed in 5 patients with directives and in 217 patients without (14% vs. 23%, p=0.3). Among patients with advance directives, only one was admitted to hospital. He/she died within 24h of admission.Advance directives were accessed by EMS for 7.5% OHCA patients. Despite their availability, advanced life support was provided to 24% of patients.

The health impact of cold and hot waves is major. Nevertheless, the respective impact of extreme high and low temperatures remains controversial.The daily number of (1)#160;patients managed by SAMU#160;93 dispatching centre#8211; primary care requirement indicator, (2)#160;Mobile Intensive Care Unit (MICU) interventions#8211; patient severity indicator and (3)#160;number of deaths have been recorded. Daily minimum and maximum temperatures were recorded from 2010 to 2018. The analysis covered the 10#160;warmest and coldest days of each year (2#160;#215;#160;70#160;days), and the 30#160;warmest and coldest days of the total period (2#160;#215;#160;30 days).Over 2,702#160;days, 1,513,070#160;patients, 89,478#160;MICU interventions and 7,350#160;deaths were analysed. Median temperature: 16.0[10.4-21.6]#176;C.The coldest days were associated with a significant increase in patients managed (665[609-764] vs 538[474-619]; P#160;lt;#160;0.001), MICU interventions (35[32-39] vs 33 [28-38]; P#160;=#160;0.006) and deaths (3[2-5] vs 2[1-4]; P#160;=#160;0.0008) considering the 10#160;days of extreme temperatures in each year and a significant increase in patients managed 615[580-698] vs 542[475-627]; P#160;lt;#160;0.001) considering the 30-day extreme of the period.The hottest days were associated with a significant decrease in patients managed (484[443-549] vs 538[474-619]; Plt;#160;0.001), MICU interventions (31[25-37] vs 33[28-38]; P#160;=#160;0.006) and deaths (2[1-3] vs 2[1-4]; P#160;=#160;0.0008) considering the 10 extreme days of each year and a significant decrease in patients managed (536[479-576] vs 542[475-627]; Plt;#160;0.001) considering the 30 extreme days of the period.Primary care requirement, number of severe patients and mortality increased significantly with extreme low of temperature.

International audience; INTRODUCTION:Obesity and overweight strongly contribute to increasing cardiovascular morbidity and mortality, and are becoming a worldwide health issue. The prevalence of obesity has increased dramatically in Latin America. Child obesity is a major issue. Fast food is strongly suspected of contributing to this epidemic of obesity, although there is a lack of evidence.METHODS:We studied the correlation between the number of McDonald restaurants and overweight and obesity prevalence by region stratified by gender and age. Data on prevalences were obtained within national studies conducted by the Brazilian Ministry of Health. Three age sub-groups were analyzed: 5 to 9-year-olds, 10 to 19-year-olds and over 19-year-olds.RESULTS:There was a very strong positive correlation between overweight rates and the number of McDonald restaurants for both males and females between 5 and 9 years old (R2 respectively = 0.92 and 0.84) and a strong positive correlation for females between 10 and 19 years old (R2 = 0.68). There was a very strong positive correlation between obesity rates and the number of McDonald restaurants for males between 5 and 9 years old (R2 = 0.95). This positive correlation was strong for both males and females between 10 and 19 years old (R2 respectively = 0.77 and 0.63). Other correlations were not significant.CONCLUSION:A strong correlation between the prevalence of overweight and obesity and the number of McDonald restaurants was found for Brazilian children and was most important within the group of youngest children. These results should be taken into consideration by education and prevention campaigns.

Purpose Restraint is often used when administering procedures to children. However, no metrologically scale to measure the restraint intensity had yet been validated. This study validated the metrological criteria of a scale measuring the restraint intensity, Procedural Restraint Intensity in Children (PRIC), used during procedures in children. Design and methods The PRIC scale performance was measured by a group of 7 health professionals working in a children's hospital, by watching 20 videos of health care procedures. This group included 2 physicians, 1 pediatric resident, and 4 nurses. The intra-class correlation coefficients were calculated to evaluate the inter-rater and test-retest reliability and the construct validity with the correlation between PRIC scale and a numerical rating scale. Results One hundred and forty measurements were made. Inter-rater and test-retest correlation coefficients were 0.98 and 0.98, respectively. The 2 scales were positively correlated with a Spearman coefficient of 0.93. Conclusions This study validated the Procedural Restraint Intensity in Children (PRIC) scale in metrological terms with some limitation. However, there is not gold standard scale to precisely validate the reliability of this tool and this study has been conducted in "experimental" conditions. Nevertheless, this is the first scale measuring the intensity of physical restraint with a metrological validation. The next step will be to validate it in real clinical situations.

Background: The phenomenon of forceful physical restraint in pediatric care is an ethical issue because it confronts professionals with the dilemma of using force for the child’s best interest. This is a paradox. The perspective of healthcare professional working in pediatric wards needs further in-depth investigations. Purpose: To explore the perspectives and behaviors of healthcare professionals toward forceful physical restraint in pediatric care. Methods: This qualitative ethnographic study used focus groups with purposeful sampling. Thirty volunteer healthcare professionals (nurses, hospital aids, physiotherapists, and health educators) were recruited in five pediatric facilities in four hospitals around Paris, France, from March to June 2013. The data were processed using NVIVO software (QSR International Ltd. 1999–2013). The data analysis followed a qualitative methodological process. Ethical Considerations: The research was conducted in compliance with the Declaration of Helsinki. Written informed consent was collected systematically from participants. Findings: This study provides elements to help understand why restraint remains common despite its contradiction with the duty to protect the child and the child’s rights. All participants considered the use of forceful physical restraint to be a frequent difficulty in pediatrics. Greater interest in the child’s health was systematically used to justify the use of force, with little consideration for contradictory or ethical aspects. Raising the issue of forceful restraint always triggered discomfort, unease and an outpour of emotions among healthcare professionals. The findings have highlighted a form of hierarchy of duties that give priority to the execution of the technical procedure and legitimize the use of restraint. Professionals seemed to temporarily suspend their ability to empathize in order to apply restraint to carry out a technical procedure. This observation has allowed us to suggest the concept of “transient empathic blindness.” Conclusion: Using physical restraint during pediatric care was considered a common problem by participants. This practice must be questioned, and professionals must have access to training to find alternatives to strong restraint. Conceptualizing this phenomenon with the concept of “transient empathic blindness” could help professionals understand what happens in their minds when using forceful restraint.

Summary Introduction One potential COVID-19 treatment, hydroxychloroquine has been the focus of much debate since its first publication by a French research team. To an unusual degree, this debate has extended outside of the medical community into the public sphere. Objective To know if this interest, which conceals the reality of scientific debate, occurred worldwide. Methods Methodological use of the Google-Trends was standardized. We researched the web queries for “hydroxychloroquine” and “chloroquine” and “amoxicillin” and “acetaminophen” as reference. Analysis was detailed by country. The relationship between these queries and the COVID-19 epidemic was supported by analysis of the main “related queries”. Google-Trends provided results on a relative value basis, on a scale from 0 to 100, with a value of 100 indicating the most researched criterion over the study period. Results Web queries for “amoxicillin” never exceeded the value of 1. Searches for “acetaminophen” peaked on March 13 with a value of 13. “Hydroxychloroquine” was the most frequently researched term. It reached its peak value of 99 on April 7. Queries for “chloroquine” peaked (value 100) on March 24. Searches for “hydroxychloroquine” came essentially from Asia and the United States, with France in 22nd position (value of 21). Searches for “chloroquine” came essentially from Africa, with France in 8th position (value of 55). The five main related searches were in both cases associated with the COVID-19 epidemic. Conclusion Interest in chloroquine is not specific to France. Results of ongoing studies have been and will be scrutinized attentively in all corners of the globe.

International audience; Burnout is common in emergency physicians. This syndrome may negatively affect patient care and alter work productivity. We seek to assess whether burnout of emergency physicians impacts waiting times in the emergency department. Prospective study in an academic ED. All patients who visited the main ED for a 4-month period in 2016 were included. Target waiting times are assigned by triage nurse to patients on arrival depending on their severity. The primary endpoint was an exceeded target waiting time for ED patients. All emergency physicians were surveyed by a psychologist to assess their level of burnout using the Maslach Burnout Inventory. We defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day (8:30 to the 8:30 the next day). A logistic regression model was performed to assess whether burnout level of the day was independently associated with prolonged waiting times, along with previously reported predictors. Target waiting time was exceeded in 7524 patients (59%). Twenty-six emergency physicians were surveyed. Median burnout score was 35 [Interquartile (24–49)]. A burnout level of the day higher than 35 was independently associated with an exceeded target waiting time (adjusted odds ratio 1.54, 95% confidence interval 1.39–1.70), together with previously reported predictors (i.e., day of the week, time of the day, trauma, age and daily census). Burnout of emergency physicians was independently associated with a prolonged waiting time for patients visiting the ED.

Background The themes of qualitative assessments that characterize the experience of family members offered the choice of observing cardiopulmonary resuscitation (CPR) of a loved one have not been formally identified. Methods and Findings In the context of a multicenter randomized clinical trial offering family members the choice of observing CPR of a patient with sudden cardiac arrest, a qualitative analysis, with a sequential explanatory design, was conducted. The aim of the study was to understand family members’ experience during CPR. All participants were interviewed by phone at home three months after cardiac arrest. Saturation was reached after analysis of 30 interviews of a randomly selected sample of 75 family members included in the trial. Four themes were identified: 1- choosing to be actively involved in the resuscitation; 2- communication between the relative and the emergency care team; 3- perception of the reality of the death, promoting acceptance of the loss; 4- experience and reactions of the relatives who did or did not witness the CPR, describing their feelings. Twelve sub-themes further defining these four themes were identified. Transferability of our findings should take into account the country-specific medical system. Conclusions Family presence can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death and of having participated in this important moment. Our results showed the central role of communication between the family and the emergency care team in facilitating the acceptance of the reality of death.

Background Medical practice in the media is usually far from reality. Thus, the viewer may be led astray. The world-famous fictional Dr House has to face a difficult diagnosis every week. His practice does not seem to reflect reality. The aim of this study was to assess the diagnosis strategy involved in this television program. Methods An observer has previewed the 2011 season. The episode running time, the patient's age and sex, the list of all investigations and interventions, the final diagnosis, and the patient's outcome were collected. Number and proportion of French viewers for each episode were recorded. Results We analyzed 18 episodes. The median running time was 42.5 (42.1-43.2) minutes. Main patient characters were 12 men (66%) and 6 women (33%); the average age was 31 (22-38) years. There were 225 investigations or interventions reported, averaging 14 (9-15) per episode, representing one examination every 3.1 (2.9-4.8) minutes. The most frequently prescribed investigations were magnetic resonance imaging (MRI; 13; 72%), blood sample (11; 61%), and biopsy (10; 56%). The most frequent interventions were surgery, anti-infectious treatments, and steroid treatments (9 each; 50%). Two patients (11%) died. The median number of spectators was 8.4 (8.1-8.7) million, corresponding to 33% (33%-34%) of the French national audience. Conclusion The population and the examination strategies used by Dr House were unrealistic. Because of this distortion, patients may not understand, nor accept the delay, the investigation choices, the intervention costs, risks, nor failures of a daily medical practice. Physicians should be aware of this "information bias."

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 8 septembre 2016

La Presse Medicale - In Press.Proof corrected by the author Available online since dimanche 21 aout 2016