[The practice of telemedicine by French internal medicine physicians in 2019]. / La pratique de la télémédecine par les médecins internistes français en 2019.

INTRODUCTION: Telemedicine has been developing in France since 2018. The objective of this survey was to assess the knowledge, attitudes, practices and training of internal physicians regarding telemedicine. MATERIAL AND METHODS: A national descriptive observational study carried out between July and October 2019, via an online self-questionnaire with members of the National Society of Internal Medicine and the Association of Young Internists, included a descriptive and comparative analysis by subgroups of age. RESULTS: Analysis of 309 responses from physicians qualified in internal medicine or practicing in an internal medicine service (61,8%) and residents in internal medicine (38%) showed that 34.6% had notions or a good knowledge of regulation of telemedicine. For 62,1%, 72.5% and 74.1% respectively, it could improve patient care, access to care and exchanges between internists and other doctors. The main obstacles to this practice were the absence of face-to-face with the patient (57.3%) and computer dysfunctions (55%). Only 23.3% practiced it, including 88.9% tele-expertise. Telemedicine was performed informally (telephone and email) in 70.8% of the cases. Doctors over the age of 50 were better acquainted with the regulations and more practiced official telemedicine. In total, 54% wanted to practice telemedicine and 72.8% wanted to train there. CONCLUSION: Attitudes towards telemedicine were positive, but few internists knew about it and practiced it formally, warranting appropriate training.

Nurses' role in supporting people who are HIV positive.

This is the second of two papers which report the results of a research study of the psychological and emotional needs of people with HIV disease and how nurses might best offer support. This paper discusses the nurse's role in offering psychological and emotional support to patients. Inductive analysis of in-depth interviews with in-patients and their nurses revealed four aspects of the nursing role that were highly valued: nurses being caring; acting therapeutically; assessing and monitoring patients' changing needs for emotional support; and acting as educators.

Psychological and emotional impact of an HIV diagnosis.

This is the first of two papers that reports the results of a research study into the psychological and emotional needs of people with HIV and how nurses might best offer support. This paper discusses the psychological impact of HIV diagnosis. Inductive analysis of indepth interviews with in-patients and their nurses generated five themes: reactions to critical events related to HIV infection; changes in body image and chronic ill health; fear and rejection; cognitive and minor dysfunction associated with HIV; and absent friends.

Enflurane for controlled hypotension.

Enflurane was substituted for halothane in an established technique of controlled hypotension, involving beta-blockade and sympathetic ganglion blockade, for 2 groups of patients. One group was undergoing major plastic surgery and/or major maxillo-facial surgery and these patients breathed spontaneously. The other group was undergoing major neurosurgery and received intermittent positive pressure ventilation (IPPV). All patients were carefully monitored during anaesthesia and for 24 hours postoperatively. Good operation conditions were produced and no ill effects of controlled hypotension were detected in any of the patients.

Enflurane analgesia.

An air-enflurane mixture was used for inhalation analgesia in conscious patients undergoing painful procedures such as burns dressings. A preliminary study indicated that enflurane possessed definite analgesic properties, but that the concentration of the air-enflurane mixture was critical if restlessness was to be avoided and cooperation retained. Further studies established that 1% enflurane in air provided good analgesia in the absence of anaesthesia. The analgesic effects were similar to those produced by 0.35% methoxyflurane in air, but were produced in a much shorter time (about 3 minutes compared with 9 to 10 minutes). Preoperative starvation was unnecessary and nausea and vomiting were absent. Details are given of the use of enflurane analgesia in 32 conscious burned patients who underwent 101 burns dressing procedures.