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Sarcopenia in heart failure (HF) is associated with severe outcomes, increased mortality, and high healthcare cost burden. Systematic muscle screening in patients with chronic HF would improve quality and appropriateness of care. Here we tested handgrip strength (HGS) as a screening tool for sarcopenia in patients with chronic HF, using the EWGSOP 2010 and 2019 reference-standard definitions of sarcopenia.HF inpatients, aged 65 years old or above, were prospectively included between November 2014 and September 2018, and relevant sociodemographic, anthropometric and HF characterization data was collected. The accuracy of HGS as a screening test for sarcopenia was assessed by gender using area under the receiver operating characteristic (ROC) curves (AUC).The population consisted of 118 older patients (age: 78.9 yrs; BMI: 26.6 kg/mHGS can be used as a valid tool to screen for sarcopenia in older (≥65 yrs) patients with chronic HF.NCT03153774.

International audience; Background & aims: Sarcopenia is a multifactorial syndrome resulting in a decrease in both muscle mass and function. Little is known about the prevalence and prognostic impact of sarcopenia in patients with acutely decompensated chronic heart failure (ADHF). We aimed to evaluate the prevalence (main endpoint) and impact of sarcopenia on ADHF patients.Methods: 140 ADHF patients were enrolled between November 2014 and September 2018 in a multi-center prospective longitudinal study. A similar, independent multi-departmental cross-sectional study in 165 ADHF patients was used for external validation of prevalence data. All subjects were assessed on the European Working Group on Sarcopenia criteria.Results: Ninety-one patients (65%) had sarcopenia (vs. 53.6% in the external replication regional cohort). Patients with sarcopenia were older and more likely to have eGFR

International audience; Introduction: We aimed to identify the most relevant cost-effectiveness threshold of first-trimester Down syndrome (DS) maternal serum screening (T21T1) for the use of cell-free DNA (cfDNA) as a second-tier test in the French context. Method: A cost-effectiveness analysis was performed on 108 121 singleton pregnancies using a simulation model. The threshold of T21T1 screening was ranged from 1/51 to 1/1000 in steps of 1/50. The most relevant threshold was based on cost-effectiveness ratio (CER; costs = direct medical costs after T21T1 screening/ effectiveness = number of DS cases identified). Results: In the sample, 161 cases of DS were identified. At the threshold of ≥ 1/50, 47.2% of total DS cases were diagnosed. In the simulation model, for a threshold ≥ 1/250, 73.9% of total DS cases were diagnosed, for ≥ 1/500, 78.8% and for ≥ 1/1000, only two additional cases were diagnosed. The slope of the cost increase was slight from threshold ≥ 1/250 (978 634€), then steep up to 1/500 (1 966 576€) and increased exponentially to 1/1000 (3 980 216€). The CER was 38 560 for a threshold ≥ 1/500.Conclusion: The most cost-effective threshold for cfDNA as a second-tier test seems to be ≥ 1/500. For higher thresholds, costs increase dramatically for only a few additional cases of DS identified.; Introduction : Notre objectif était d’identifier la valeur seuil la plus cout-efficace des marqueurs sériques du 1er trimestre pour l’intégration du test ADN libre circulant en deuxième ligne dans le cadre du dépistage prénatal de la trisomie 21 en France.Matériel et méthodes : Une analyse cout-efficacité a été menée sur 108 121 grossesses uniques en utilisant un modèle de simulation. Les valeurs seuils testées des marqueurs sériques du 1er trimestre étaient comprises entre 1/51 et 1/1000 par pas de 1/50. La valeur seuil la plus coût-efficace a été déterminée par le calcul du ratio coût-efficacité (RCE, coûts= coûts directs médicaux après le dosage des marqueurs du 1er trimestre, efficacité=nombre de cas de trisomie 21 dépisté).Résultat : Dans notre échantillon, 161 cas de trisomie 21 ont été identifiés. Pour une valeur seuil ≥ 1/50, 47,2% des cas ont été diagnostiqués. Dans le modèle de simulation, pour un seuil ≥ 1/250, 73,9% des cas de trisomie 21 étaient identifiés, pour un seuil≥ 1/500, le pourcentage de détection s’élevait à 78,8% et pour un seuil ≥ 1/1000, 2 cas supplémentaires ont été identifiés. Le montant des coûts était stable pour un seuil ≥ 1/250 (978 634€), puis augmentait rapidement pour un seuil ≥ 1/500 (1 966 576€) et devenait exponentiel pour un seuil ≥ 1/1000 (3 980 216€). Le RCE pour le seuil ≥ 1/500 était de 38 560.Conclusion : La valeur seuil la plus coût-efficace pour l’implémentation du test ADN libre circulant en deuxième ligne semble être ≥ 1/500.

International audience; Background/objectives Sarcopenia is an age-related muscle disease associated with higher mortality, morbidity risk and health costs. An easy and convenient sarcopenia screening test would be hugely valuable for clinical critical care. The study aimed to assess handgrip strength (HGS) as a screening tool for sarcopenia in acute care-unit inpatients, using the EWGSOP 1 reference-standard definition. Subjects/methods Inpatients, aged 75 years old or above, of two acute care wards-a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), were included between September 2017 and June 2018 in a cross-sectional study. HGS, sarcopenia, nutritional status, functional status, number of medications and sociodemographic data were collected. The accuracy of HGS as a screening test for sarcopenia was assessed by gender using receiver operating characteristic (ROC) curves and area under the curve (AUC) in a population of older patients (n = 223; age: 85.8 yrs; BMI: 26.7 kg/m(2)). Results Screening was positive (patients confirmed with sarcopenia by the HGS test) with cut-off values of 18 kg for women and 25.5 kg for men, with ROC analysis giving a sensitivity of 92.9% in women and 78.6% in men. ROC curve analysis found also that HGS should be strictly higher than 15 kg in women and 18 kg in men to maximise AUC. Prevalence of sarcopenia according to the EWGSOP1 definition was 31.8% (95% CI: 22.1-41.6%) in the MCU and 27.8% (95% CI: 19.6-36.0%) in the GCU. Conclusions Acute care wards can use HGS as a valid, easy tool for early screening of sarcopenia.

Objective The metabolic syndrome (MetS) is responsible for an increased risk of type 2 diabetes, cardiovascular diseases and is associated with all-cause and cardiovascular mortality. Economic and social vulnerability is not an easy concept to grasp, but some studies investigate the association between MetS and socioeconomic and demographic factors, deprivation (more often correlations rather than causal one due to data). This work aims to assess the association between MetS and socio-economic gradient (SEG) in the literature by performing a meta-analysis. Design The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews were followed. Setting The raw list of studies extracted from PubMed as regard to the inclusion/exclusion criteria was imported in Word. Studies were filed with regard to our three definitions of SEG and their title. Participants Subgroup analysis were performed considering several definitions of Mets: NCEP-ATPIII and IDF2006. Results The overall multivariable-adjusted OR showed that the risk of MetS was significantly increased in association with SEG The results of the subgroup analysis showed an increased risk of MetS in association with SEG when IDF definition was considered. Conclusions Targeted interventions must be implemented in a specific way as prevention campaigns aimed at the general population are generally not adapted to this particular vulnerable population.

Resume Objectif La polyarthrite rhumatoide (PR) est le plus frequent des rhumatismes inflammatoires systemiques avec des manifestations extra-articulaires a l’origine de comorbidites. Ces comorbidites sont plus frequentes, plus graves et moins prises en charge que dans la population generale. L’objectif principal de ce travail etait d’analyser la pertinence economique d’une consultation infirmiere dediee a la prise en charge des actes de prevention des patients atteints de PR. Methode L’essai clinique controle randomise multicentrique COMEDRA qui s’est deroule de mars 2011 a juin 2012, mesurait l’efficacite d’une consultation infirmiere dediee a la prise en charge des comorbidites des patients atteints de PR a travers 11 procedures de prevention. L’analyse economique etait une analyse de type cout–avantage en recherche d’equivalence entre le cout de la consultation infirmiere dediee et le cout des actes de prevention. La consultation infirmiere etait jugee efficace si son cout etait egal ou moindre aux couts des actes de prevention supplementaires realises qu’elle avait engendres. Les couts ont ete calcules sur la base des tarifs conventionnes de l’Assurance Maladie. Compte tenu de l’heterogeneite des couts des actes de prevention et de la variation de leur frequence de realisation, la part contributive de chaque acte de prevention a l’efficacite du programme a ete calculee. Resultats L’intervention de l’infirmiere a contribue a la realisation de 747 actes de prevention supplementaires soit un cout de 30 805,8 euros. En se basant sur l’hypothese de rentabilite, l’intervention d’une infirmiere dediee a la prevention des comorbidites chez les patients atteints de polyarthrite rhumatoide est acceptable. Conclusions Une consultation de prise en charge des comorbidites de la polyarthrite rhumatoide telle que preconisee dans les recommandations, realisee par une infirmiere, est pertinente du point de vue medical et economique en perspective hospitaliere.

Background/objectives Sarcopenia is an age-related muscle disease associated with higher mortality, morbidity risk and health costs. An easy and convenient sarcopenia screening test would be hugely valuable for clinical critical care. The study aimed to assess handgrip strength (HGS) as a screening tool for sarcopenia in acute care-unit inpatients, using the EWGSOP 1 reference-standard definition. Subjects/methods Inpatients, aged 75 years old or above, of two acute care wards-a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), were included between September 2017 and June 2018 in a cross-sectional study. HGS, sarcopenia, nutritional status, functional status, number of medications and sociodemographic data were collected. The accuracy of HGS as a screening test for sarcopenia was assessed by gender using receiver operating characteristic (ROC) curves and area under the curve (AUC) in a population of older patients (n = 223; age: 85.8 yrs; BMI: 26.7 kg/m²). Results Screening was positive (patients confirmed with sarcopenia by the HGS test) with cut-off values of 18 kg for women and 25.5 kg for men, with ROC analysis giving a sensitivity of 92.9% in women and 78.6% in men. ROC curve analysis found also that HGS should be strictly higher than 15 kg in women and 18 kg in men to maximise AUC. Prevalence of sarcopenia according to the EWGSOP1 definition was 31.8% (95% CI: 22.1-41.6%) in the MCU and 27.8% (95% CI: 19.6-36.0%) in the GCU. Conclusions Acute care wards can use HGS as a valid, easy tool for early screening of sarcopenia.

International audience

Background: Deprivation is associated with inequalities in health care and higher morbidity and mortality. To assess the reliability of a new individual deprivation score, the EPICES score and to analyse the association between the Townsend index, the Carstairs index and the EPICES score and causes of death in one French administrative region. Methods: Eligible patients were 16 years old or more who had come for consultation in Health Examination Centres of the French administrative region of Nord-Pas-de-Calais. An ecological study was performed between 2002 and 2007 in the 392 districts of this administrative region. The EPICES score was compared with the Townsend and the Carstairs indices. These three measurements of deprivation were compared with social characteristics, indicators of morbidity, health-care use and mortality and specific causes of death. The Pearson correlation coefficients were calculated to assess the reliability of the EPICES score. The association between deprivation and mortality was assessed by comparison of the standardized mortality ratio (SMR) between the most and least deprived districts. Results: The EPICES score was strongly correlated with the Townsend and Carstairs indices and with the health indicators measured. SMR increased with deprivation and the higher the deprivation the higher the SMR for all-cause mortality, premature and avoidable deaths and for most specific causes of death. Conclusion: The individual deprivation EPICES score is reliable. Deprivation was related to excess death rate, which clearly indicates that deprivation is a determinant factor that should be considered systematically by health policy makers and health-care providers.

Objectives Rheumatoid arthritis (RA) cause major functional, psychological, social and occupational repercussions for patients and has important economic consequences for society. The principal objective of this work was to determine the economic pertinence of a staff nurse specialised in preventive management for these patients. Methods The COMEDRA multicentre randomised controlled clinical trial, conducted from March 2011 to June 2012, showed the effectiveness of a nurse-led programme dedicated to the management of comorbidities trough the promotion of 11 preventive procedures. A cost-benefit analysis, from a societal perspective and based on direct medical cost, was conducted to assess the equivalence of the cost of the nurse-led programme and the cost of the additional preventive procedures performed, engendered by the programme. The programme was considered effective if its cost was less than or equal to the costs of the additional preventive procedures. The costs were calculated from the approved health insurance charges. From the total costs induced, a contributive share was measured, corresponding to the ratio of the total costs of each type of procedure to the overall total cost. Results The cost of the intervention was assessed at € 16,804.2. This intervention contributed to the performance of 747 additional preventive procedures, at a cost of € 30,184.8. This intervention with these patients is financially balanced when at least 37 patients follow the recommendations for every preventive procedure. Conclusions From the hospital's perspective and from both a medical and economic point of view, a nurse-led programme to manage the comorbidities of RA is useful.

Deprivation, a process that prevents people to assume their social responsibilities, is a main cause of inequalities in health. Metabolic syndrome has a growing prevalence in France.To assess the association between deprivation and the metabolic syndrome and to identify the most relevant waist circumference cut-off point.A cross-sectional multicentre study was carried out of data extracted from health examination centres of two French areas in 2008. The harmonized definition of the metabolic syndrome contained five criteria with two thresholds for waist circumference. Deprivation was calculated by the Evaluation of Deprivation and Inequalities in Health Examination Centres score (EPICES). Eligible patients were at least 16 years old. The methodology of time to event analysis was used on patients having two criteria to identify the most relevant waist circumference threshold, taking waist circumference as event and computing it as a continuous variable. The median corresponded to the waist circumference threshold for which half of the patients switched from two to three criteria and so metabolic syndrome.Of the 32374 persons included in the study, 39.4% were socially deprived. The prevalence of the metabolic syndrome varied from 16.3% to 22.2% in the overall sample depending on the published waist circumference thresholds chosen. Deprivation was an independent factor associated with the metabolic syndrome. The cut-off point for waist circumference was between 95 and 99 cm for men and 88 and 97 cm for women.Deprivation is associated with a higher prevalence of the metabolic syndrome. The most relevant threshold for waist circumference could be 94 cm for men and 88 cm for women.

L’objectif de ce travail etait d’identifier les limites d’une prise en charge informative et educative des facteurs de risques chez des patients cardiovasculaires en hospitalisation court sejour. Notre etude s’est basee sur une recherche qualitative basee sur une annee d’enquetes : 18 situations d’observations des pratiques professionnelles et 18 entretiens avec 5 professionnels et 13 patients. Les resultats ont montre l’existence d’une discordance de temps, de preoccupations et d’attentes entre patients et professionnels, qui limitent l’efficacite de la prise en charge proposee. En conclusion, l’hospitalisation court-sejour est vecue par les patients comme un temps de « survie » apres un episode aigu (Accident Vasculaire Cerebral ou Infarctus). Elle est inappropriee pour la mobilisation des capacites cognitives et emotives des patients dans le cadre d’un programme d’education therapeutique.

Background Prevention has become a legal obligation for French GPs, since a law was passed in March 2002. Aim Measurement and analysis of preventive procedures performed by French GPs. Design of study Observational survey. Setting GP surgeries in Puy-de-Dome, France. Method Doctors completed a questionnaire about their socioprofessional characteristics, and a researcher completed another questionnaire about preventive procedures performed on the last 15 patients seen by each GP. Twenty preventive services were evaluated and, for each service, medical records, targets, and objectives were defined according to the national preventive care guidelines. The gap between guidelines and practice was explained by doctor characteristics. Statistical analyses were performed using χ 2 and logistic regression. Results Representative samples of 179 doctors and 2453 medical records were randomised. Four preventive services were performed in more than 75% of cases, and the gap was explained by the salaried job the doctors had. Ten preventive services were performed in 25% to 75% of cases and the gap was explained by the medical software used. The six remaining services were performed in less than 25% of cases and no explanatory variable was identified. Conclusion Sixteen preventive procedures were insufficiently performed. The more a preventive service is performed the more the gap will be explained by GPs9 socioprofessional characteristics. The gap for a preventive procedure performed in 25% to 75% of cases was mainly explained by management of the medical records. A nationwide policy to improve prevention performance in general practice seems to be essential.

Background: Since 2008, French health institutions providing medical, surgical and obstetrical care are assessed on the basis of a set of quality indicators. The French National Authority for Health developed a survey design in which 80 records are randomly selected from each institution. The main aim was to assess the effects of internal heterogeneity of a hospital that comprises several units. The survey method is based on the hypothesis of intra-institution homogeneity, which overlooks the fact that in wide hospitals homogeneity is related to departments and thus leads to overall intra-hospital heterogeneity. Methods: Simulated databases were created to modelise the heterogeneity of our hospital and computed to assess the reliance of indicator measurement. We used real data from a large teaching hospital having internal heterogeneity related to each department. Results: Variance under heterogeneity was greater than under homogeneity (3- to 18-fold) leading to an increased size of the confidence interval (CI) (at 95%) from 9 (given Haute Autorite de Sante sources) to 22 (for greatest internal heterogeneity). Conclusions: The variations in a quality indicator can be explained by intra-institution heterogeneity and are not related to changes in the quality policy of the hospitals and may lead to errors in terms of pay for performance.

Purpose of the research The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. Methods and sample A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m 2 . The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. Key results The main results showed a higher rate of resumption of occupational activities in the intervention group ( p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study ( p = 0.0014), and on their ability to perform family activities ( p = 0.033). The stay in a thermal centre was cost-effective at 12 months. Conclusions Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

Purpose of the research The French setting, including laws and guidelines, advocates greater involvement of informal caregivers in the care of cancer patients to protect the caregivers from depression, distress, and a decrease in their quality of life. This study aimed to assess the efficacy of a caregiver educational programme by measuring two outcomes: patients' and caregivers' quality of life and caregivers' burden. Methods and sample A multicentre randomised controlled trial was performed in six oncology wards in French hospitals. Eligible patients had a cancer, a main caregiver, allowed their caregivers' involvement, and received an inclusion agreement by a doctor/psychologist dyad. The experimental group participated in an educational programme performed by nurses to improve their skills in meal support, nursing care, welfare care, or symptom management. The SF36 and the Zarit burden scales were used to measure quality of life and caregivers' burden at the beginning and at the end of the study. Key results 67 patients were randomised and 33 were included in the experimental group. Evolution scores, which measured the difference between baseline and final scores, showed an improvement in patients' and caregivers' quality of life and an alleviated burden for experimental group caregivers. Conclusions An educational programme for caregivers encourages the involvement of patients, informal caregivers and health-care providers in a triangular relationship which enhances the quality of life of patients and caregivers alike and decreases caregivers' burden. Care organisation should therefore be rethought as a triangular relationship between patients, caregivers and health-care providers, with nurses as the mainstay.

The purpose of this study was to examine the limitations of therapeutic education for patients with cardiovascular risk factors during short hospital stays. The paper presents the results of a qualitative study conducted over the course of a year involving 18 case studies of professional practices and 18 interviews with 5 health professionals and 13 patients. The results show that professionals and patients have conflicting views about the time spent in hospital, as well as conflicting concerns and expectations, thus limiting the effectiveness of educational care. The findings suggest that after acute myocardial infarction or a stroke, patients tend to view themselves as survivors during their experience of short-term hospitalization in a care unit. As a result, short-term hospitalization may not be conducive to the mobilization of patients' cognitive and emotional capacities in a therapeutic education program.

CONTEXTE : l’augmentation de l’espérance de vie est associée à une augmentation de la prévalence des maladies chroniques et implique un risque accru de polymédication. Définie par la prise de cinq médicaments ou plus par jour, elle est un des principaux facteurs de risque de morbi-mortalité chez le sujet âgé. La déprescription apparaît donc comme un enjeu de santé publique.OBJECTIF : évaluer les croyances et les attitudes des patients âgés de 65 ans ou plus et vivants en milieu rural vis-à-vis de la déprescription.MÉTHODES : étude transversale monocentrique d’amélioration des pratiques professionnelles et d’amélioration de la pertinence des soins basée sur la passation de l’auto-questionnaire validé APaD (Attitudes des Personnes âgées vis-à-vis de la déprescription). Il comporte 22 questions mesurant 4 dimensions (fardeau, pertinence, préoccupations concernant l’arrêt et implication) et 2 questions d’ordre global sur une échelle de type Likert. Un score par dimension est calculé. Des analyses descriptives et multivariées des scores obtenus et des réponses à chacun des items ont été effectuées pour identifier les déterminants sociodémographiques.RÉSULTATS : au total, 200 patients âgés en moyenne de 76,6 ans (écart type 6,5) dont 55 % de femmes ont été inclus. Parmi cet échantillon, 89,5 % sont prêts à arrêter un ou plusieurs de leurs médicaments habituels si leur médecin leur explique que cela est possible, 32,5 % trouvent qu’ils prennent un grand nombre de médicaments et 26 % pensent parfois prendre trop de médicaments. Il n’a pas été retrouvé d’association significative entre les facteurs sociodémographiques étudiés et la disposition des patients à la déprescription. Un score faible pour le facteur « préoccupations concernant l’arrêt » est associé à une meilleure acceptation de la déprescription.CONCLUSION : une grande majorité des patients est disposée à la déprescription. Il existe donc un réel intérêt à la mettre en œuvre en pratique courante en s’appuyant sur les nouveaux modes d’organisation de soins aux niveaux local et territorial.

Context: In France, a major reform of Forensic Medicine was set up in 2010. One of its objectives was to harmonize and improve practices, both in the areas of thanatology and victimology. This approach is part of the public policies implemented since the 2000s in favor of better carefor victims of infractions. The main change brought by this reform was the structuration of the forensic medical activity by entrusting it to dedicated public structures (Medico Legal Institutes and Forensic Units). This reform was assessed in december 2013 by an inter-ministerial commission. The interdepartmental report submitted in january 2014 showed that the results were insufficient, particularly in the field of victimology. In 2016, Dr. Malou Guerant conducted a qualitative study to highlight the determinant of patient’s satisfaction who be seen by a doctor in the forensic department of the university hospital of Clermont-Ferrand. The determinants identified were: a short time delay between the aggression or accident and the consultation, the quality of the welcome in the department, the doctor’s ability to listen and make them feel confident, his ability to answer questions and his expert quality. The question of psychological care and the way it can be initiated after the medical consultation were also relevant. The results of this study allowed her to propose a version of satisfaction questionnaire dedicated to patients consulting in victimology. It comprises 41 items and is built based on a previously validated questionnaire, the QSH (Hospitalized patient Satisfaction Questionnaire), used by the University Hospital of Clermont-Ferrand. The validation of this questionnaire would make it the first one assessed in this area. It could become a central tool in the evaluation of practices and feed future reflection on a reassessment of the care system in victimology. Objectives: Validation of the metrological properties of the Questionnaire of Satisfaction about Victimology Consultations. Method: The validation of such a questionnaire requires it be completed by test patients in order to evaluate its acceptability, the validity of its internal structure, its validity against external criteria and its reproducibility. This questionnaire was tested via two filling methods: computerized and paper. We needed to include 230 patients in each arm to validate both modalities. The choice of filling mode was left to the patient. They received the questionnaire at least 15 days after their consultation. Reproducibility was studied by submitting 85 patientsfrom each arm to a test-retest. Results: Since its beginning, our study has allowed the inclusion of 129 patients in the computerized arm and 58 patients in the paper arm. We collected respectively 39 and 17 answers. This study has not yet generated enough data to test its primary endpoint, but its continuation in the coming months will help to reach the number of subjects needed. Once this questionnaire is validated, its implementation in the routine service will be discussed. Conclusion: The measurement of patient satisfaction is an essential element of a quality management policy. Providing a tool for this measurement in victimology is an essential step in the implementation of a practice evaluation process that can subsequently pave the way for their improvement and harmonization., Contexte : En France, une réforme d’envergure de la Médecine Légale a été mise en place en 2010. Celle-ci avait entre autres objectifs l’harmonisation et l’amélioration des pratiques, tant en médecine légale du mort que du vivant. Cette démarche s’inscrit dans le cadre des politiques publiques menées depuis les années 2000 en faveur d’une meilleure prise en charge des victimes d’infraction. La principale mesure de cette réforme a été la structuration de l’activité en la confiant à des structures publiques dédiées (IML et UMJ). Cette réforme a été évaluéeen décembre 2013. Le rapport interministériel remis en janvier 2014 montre que ses résultats sont insuffisants, en particulier dans le cadrede la victimologie. En 2016, le Dr Malou Guerant a réalisé au sein du service de médecine légale du CHU de Clermont-Ferrand une étude qualitative afin d’identifierles déterminants de la satisfaction des patients reçus en consultation de victimologie. Les déterminants identifiés étaient : un délai court entre les faits et la consultation, la qualité de l’accueil dans le service, la capacité d’écoute du médecin, sa capacité à mettre en confiance, à répondre aux questions et sa qualité d’expert. Enfin la question de la prise en charge psychologique et son articulation avec la consultation médicale ressortait également. Les résultats de cette étude ont permis de proposer un modèle de questionnaire de satisfaction dédié aux patients pris en charge en victimologie comprenant 41 items construit sur la base d’un questionnaire antérieurement validé, le QSH (Questionnaire de Satisfaction du patient Hospitalisé) utilisé par la CHU de Clermont-Ferrand. S’il est validé, cet outil serait le premier questionnaire de satisfaction mis en place dans ce domaine et pourrait devenir un outil central dans l’évaluation des pratiques et une éventuelle réflexion à venir sur une réévaluation du fonctionnement de la prise en charge en Victimologie. Objectifs : Validation des propriétés métrologiques du Questionnaire de Satisfaction des Consultations de Victimologie. Méthode : La validation d’un tel questionnaire nécessite qu’il soit rempli par des patients test afin d’évaluer son acceptabilité, la validité de sa structure interne, sa validité contre critère externe et sa reproductibilité. Ce questionnaire est testé via deux modalités de remplissage : questionnaire informatisé et questionnaire papier. Il est nécessaire d’inclure 230 patients dans chaque branche pour valider ces deux modalités.Le choix de la modalité de remplissage est laissé au patient. Celui-ci reçoit le questionnaire au moins 15 jours après sa consultation. La reproductibilité sera étudiée en soumettant 85 patients de chaque branche à un test-retest. Résultats : Depuis sa mise en place, notre étude a permis l’inclusion de 129 patients dans la branche informatique et 58 patients dans la branche du questionnaire papier. Nous avons recueilli respectivement 39 et 17 réponses. Cette étude n’a pas encore permis de réunir suffisamment de données pour pouvoir tester son critère de jugement principal mais sa poursuite dans les mois à venir permettra d’atteindre le nombre de sujets nécessaires. Une fois ce questionnaire validé, sa mise en application dans le service en routine sera discutée. Conclusion : La mesure de la satisfaction des patients est un élément incontournable d’une politique de qualité de la prise en charge. Se munir d’un outil permettant cette mesure en victimologie est une étape indispensable dans la mise en place d’une démarche d’évaluation des pratiques qui peut par la suite ouvrir la voie à leur amélioration et leur harmonisation.