Despite financial penalties, French physicians' knowledge of regulatory practice guidelines is poor.

OBJECTIVE: To evaluate the level of awareness and knowledge of regulatory practice guidelines (references medicales opposables [RMOs] or regulatory medical references) implemented to control ambulatory care costs among French family physicians. DESIGN: Observational study. Participants were asked to identify RMO topics among a list of actual and fictitious RMO topics and the RMOs themselves among a list of actual and fictitious RMOs. SETTING: General practice in France. SUBJECTS: Three hundred twenty-one family physicians. MAIN OUTCOME MEASURE: Average score of 100 (95% confidence interval [CI]) on the awareness of RMO topics and knowledge of the RMOs. RESULTS: The average overall score was 55.8 of 100 (95% CI, 53.3-58.3) for the awareness of the RMO topics and 50.5 (95% CI, 48.3-52.7) for knowledge of the RMOs themselves-53.2 (95% CI, 51.1-55.3) for diagnostic RMOs and 47.8 (95% CI, 45.6-50.0) for therapeutic RMOs. Chance would have yielded an expected mean score of 50. A statistically significant difference was noted between the average score for actual (62.2) and fictitious (43.2) RMOs, P<.001. None of the respondents correctly identified all 24 correct answers. CONCLUSION: Despite implementation of RMO policy, the awareness and knowledge of RMOs among French family physicians seem weak. The number of RMOs and the difficulties in controlling physicians probably explain these results. Thus, it is doubtful that the RMO policy will have a long-term effect on physicians' behavior.

Patients with sexually transmitted disease: a well-defined HIV risk group in general practice?

Since patients with sexually transmitted disease (STD) form the most apparent risk group for HIV infection in general practice, differences in sexual behaviour in patients with and without STD were studied. Patients fulfilling at least one of four clinical criteria for suspicion of STD were offered four microbiological tests and a serological HIV test and were asked to complete a questionnaire concerning possible HIV exposure. Control patients were selected from a sample of ordinary consulting patients in general practice, without clinical suspicion of STD. The answers to the questionnaires given by six male and 52 female patients with a positive microbiological test for STD were compared with answers given by control patients matched for sex, age, education and geographical region. Females with STD had multiple male partners more often than controls. STD patients were more uncertain whether they had had sex with a HIV-positive person, and they reported more previous gonorrhea than the control patients. The proportion of patients who reported practicing oral sex was the same in both groups, while data for anal sex were insufficient. There were no significant differences in the use of condoms with a new partner, although there was a higher proportion of never-users of condoms among the STD patients. Identifying STD patients on clinical grounds is difficult in general practice. Clinical criteria have limited sensitivity because of asymptomatic infections, and the specificity is low. Patients with microbiologically confirmed STD should receive HIV-related attention, but attention to STD patients alone is not enough. Many people without STD have sexual behaviour which may exposure them to the HIV virus. The only means to a selective approach is increased attention to an appropriate sexual medical history.

[The decision to hospitalize. Apropos of a survey of 539 hospitalizations requested by general practitioners]. / La décision d'hospitaliser. A propos d'une enquête sur 539 hospitalisations demandées par des généralistes.

Reasons for hospitalization. A study about 539 hospitalizations decided by general practitioners. In this paper hospitalization is studied from the point of view of the general practitioner (GP) who is the most frequent supplier of in-patients. Five GP's practising in the southern suburbs of Paris have analysed their decision to hospitalize a total of 539 patients over one year. Owing to the number of hospital units available in that area and to the variety of diseases treated, it is understandable that these patients were referred to not less than 62 different units. Nevertheless, two-thirds of the patients were referred to 3 units: the Regional Hospital Centre (CHR) and 2 private hospitals. The majority of surgical patients were referred to the private sector, the choice of the unit in such cases being determined by the surgeon's skills as experienced or heard of by the GP. The CHR attracts GP's by its departments of internal medicine and specialties. The notoriety of a department as a whole or that of particular physicians working in the department explains the GP's choice. The degree of uncertainty surrounding the diagnosis, which varies with the nature of the disease requiring hospitalization, divides the departments into two categories: over one-half of the patients with a known diagnosis were referred to surgical departments, whereas 41 percent of those with unknown or uncertain diagnoses were sent to the internal medicine department.

[New interpretation of the symmetry of Cereus pedunculatus (Actiniaria) during embryonic development]. / Nouvelle interprétation dans la symétrisation de l'Actinie Cereus pedunculatus au cours du développement embryonnaire

A spatial reconstitution is used to determine with precision the relative position of pharynx and mesenteries during the embryonic development of Cereus pedunculatus. Three successive stages are described for embryonic symmetrisation.