[The limits of patient education in short-term hospitalization: the case of cardiovascular patients]. / Éducation thérapeutique en court séjour : quelles limites ? Cas de patients cardiovasculaires.

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.

Prevalence of iron deficiency and health-related quality of life among female students.

OBJECTIVE: To investigate prevalence of iron deficiency and examine the relationship between iron status and Health-related Quality of Life among female students. DESIGN: Cross-sectional study. SUBJECTS AND SETTING: Data were collected from 543 female students, aged 17 to 38 years, attending University or secondary schools in Clermont-Ferrand (France) and its metropolitan area. Three groups were defined, according to the rate of serum ferritin: iron deficient (serum ferritin < 15 microg/L), iron depletion borderline (serum ferritin 15-20 microg/L), and iron replete (serum ferritin > 20 microg/L). Those 3 groups of menstruating female students were compared in terms of health-related quality of life using univariate analysis. MEASURES OF OUTCOME: Health-related Quality of Life based on SF-36 questionnaire, and iron status measured by serum ferritin. RESULTS: The prevalence of iron deficiency was 19.3%, the prevalence of borderline iron status was 11.4%. Regarding the SF-36 questionnaire, the only significant difference between iron deficient and iron replete female students concerned the dimension reflecting 'general health', which was significantly lower in iron deficient group (p = 0.015). CONCLUSION: Iron deficiency seems to impair the perceived general health in female students. Further research should be conducted on this little known subject.

[Medical guidelines and medical practices: The example of lipid lowering therapy]. / Suivi des recommandations de pratique clinique: l'exemple des hypolipémiants.

INTRODUCTION: The SPOT epidemiologic survey assessed the results of long-term cholesterol-lowering therapy in France and the reasons why patients do or do not meet their therapeutic objectives. OBJECTIVE: To assess the guidelines on which doctors base their practices for cholesterol-lowering therapy and make suggestions to improve the match between recommendations and practices. METHODS: LDL cholesterol was measured in 2479 French outpatients in 2003 and classified according to whether it met therapeutic objectives of 3 different scales: the official French (AFSSAPS) recommendations issued in 2000, the physician's opinion of the ideal level for the patient, and the physician's goal level for the patient. Agreement between these 3 criteria was analyzed. RESULTS: French doctors used guidelines stricter than the official recommendations to assess the achievement of lipid-lowering objectives. DISCUSSION: Physicians rely more on American than French guidelines. They also considered the patient's history and clinical condition in setting individual goals.

[Measurement of the prevention policy in the hospital]. / Mesure de l'effet de la prévention à l'hôpital.

INTRODUCTION: Prevention policy is a legal obligation for French hospitals. As such, preventive clinical practices should therefore be assessed. OBJECTIVE: Assess the results of the hospital prevention policy. METHOD: A cross-sectional, stratified epidemiological survey, took place in 10 hospital wards of the university hospital of Clermont-Ferrand. The patients included had to be aged over 60 and leaving the hospital. The criteria for prevention assessment were surveillance of blood pressure and glycaemia, screening of viral serologies for people having had blood transfusion or major surgery, surveillance of weight, check of tetanus vaccination, check of influenza vaccination for people aged 65 and over, detection of prostatic disorders for men aged 70 and over, and detection of dementia in people aged 60 and over. RESULTS: 315 patients were examined during the 33 weeks study. The probable malnutrition rate was twice the obesity rate (10.7 vs 5.9%) but detection of obesity was better in the hospital. Tetanus vaccination rate decreased with age and was lower than influenza vaccination rate (59.5 vs 73.0%). Detection of prostatic disorders was only biological. DISCUSSION: The hospital prevention policy could be improved in terms of data collection and transmission of information to the GP's. We dispose of a tool for the measure of secondary prevention, independent of the treatment context, in the hospital. Measurements reveal wide gaps between norms and reality and would help to increase awareness among the health care providers.