Management of orbital floor fractures in France: Results of a national online survey.

INTRODUCTION: Orbital floor fractures (OFF) are common facial trauma injuries, and there are no official guidelines for their medical and surgical management. The aim of this study was to provide an overview of the management of OFF in France. MATERIALS AND METHODS: An online questionnaire was sent to 144 surgeons at the 88 French centers involved in the management of OFF (2019 data from the National Health Insurance Body). The questions related to the preoperative clinical and radiographic examinations, the criteria for surgical indication, the materials used, and the elements of the postoperative period. RESULTS: Ultimately, 42 questionnaires were analyzed (32 from oral and maxillofacial surgeons (OMFS), 8 from ophthalmologists, and 2 from ENT or plastic surgeons). For 69% of the surgeons, a systematic ophthalmological examination was carried out, 3-7 days after the trauma, and based on a Lancaster test or visual acuity (97.6% and 83.3% of the responders, respectively). The most important criteria for the therapeutic decision were diplopia or oculomotor disorder that persisted for more than 7 days (76.2%), clinical enophthalmos (54.8%), a large fracture (52.4%), and ptosis of the orbital content on CT scan (38.1%). The mean surgical delay was 7-15 days for 54.8% of the responders. Resorbing sheets were the preferred materials to repair small fractures, while larger fractures required alloplastic implants (titanium mesh). CONCLUSION: This survey confirms the diversity of practices in France regarding the management of OFF. Further studies are needed before guidelines can be developed.

[MEOPA use practices in a university hospital: Which conformity?] / Pratiques d'utilisation du MEOPA dans un CHU : quelle conformité ?

INTRODUCTION: MEOPA (equimolar mixture of oxygen and nitrous oxide) is used for its analgesic and anxiolytic properties in order to obtain conscious sedation of the patient when performing painful care. It is subject to an enhanced pharmacovigilance and addictovigilance monitoring. In this context, it is important to dispose of hospital utilization data. This work aims to assess the compliance of the use of nitrous oxide regarding the recommendations of the summary of product characteristics, in a French university hospital (Nantes) and consider possible improvements. MATERIALS AND METHODS: Transversal descriptive study, conducted in 2014 with all health professionals using MEOPA. RESULTS: Two thousand thirty-four health professionals answered the questionnaire ; durations of administrations are in conformity and the premises are generally appropriate but almost 60% of professionals have the feeling of inhaling the drug. The systematization of the prescription (always or almost always prescribed for 67% of professionals) and traceability of use (always or almost always in the patient's file for 71% of professionals) are potential source of improvement, particularly since 18% of professional health reported "abuse demands" from patients. CONCLUSION: The formation and information of health professionals are major issues of good use of nitrous oxide.

[Disclosing harmful adverse event: Assessment of medical practices from clinical vignettes]. / Annonce d'un événement indésirable grave associé aux soins au patient : évaluation des pratiques médicales à partir de vignettes cliniques.

The French National Authority for Health has made serious adverse event disclosure one of its priority areas of work. The objective of the study was to explore clinicians' perceived practices of disclosing such events. Between June and July 2012, a structured questionnaire was emailed to all clinicians and residents working at the Nantes Teaching Hospital. The questionnaire consisted of 3 parts first, clinical vignettes-with medical and surgical cases exploring five areas of practices (initial disclosure, disclosure of details, disclosure of the cause, apologies, and patient information about preventive actions); second, questions about the reasons for disclosure or non-disclosure; third, an evaluation of the training needs. The overall response rate was 18.8% (n=322/1709). Clinicians did not realize initial disclosure in 13.4%, disclosure of details in 24.5%, disclosure of the cause in 44.1%. Of the respondants, 4% of them would not apologize and 11.2% of them would not discuss detailed plans for preventing recurrences. Results were significantly different between medical and surgical specialities concerning disclosure of details and the cause of adverse events: surgeons were significantly less inclined than physicians to volunteer any details unless asked by the patient (72.9% vs 16.1%; P<0.001); to disclose the cause of the events (54.2% vs 42.3%, P<0.001); and to apologize or to offer an expression of regret (16.7% vs 1.8%; P<0.001). The main reason that led respondents to disclose as well as not disclose was to maintain trust in their relationship with the patient. Younger clinicians expressed more difficulties with adverse event disclosure and had more important training needs. Based on these results, an improvement program for the disclosure of serious adverse events is currently being implemented in the hospital, consisting of training sessions, documentation and support for the clinicians.

Relationship between inpatient satisfaction and nurse absenteeism: an exploratory study using WHO-PATH performance indicators in France.

BACKGROUND: Indicators describing results of care are widely explored in term of patient satisfaction (PS). Among factors explaining PS, human resources indicators have been studied in terms of burnout or job satisfaction among healthcare professionals. No research work has set out to explore the effect of absenteeism on PS scores. The objective of this study was to explore interaction between rate of absenteeism among nurses and PS results. METHODS: France has taken part in a project named PATH (Performance Assessment Tool for Hospitals) of the World Health Organization, aiming to develop a tool for the assessment of hospital performance. In the first semester 2008, 25 volunteering short-stay hospitals (teaching, general and private) provide complete data on nurse short-absenteeism (periods of up to 7 consecutive days of sick leave) and on PS (a cross-sectional postal survey using a standardized validated French-language scale EQS-H exploring "quality of medical information" (MI) and "relationships with staff and daily routine" (RS)). A multi-level model was used to take into account of the hierarchical nature of the data. RESULTS: Two thousand and sixty-five patients responded to the satisfaction questionnaire (participation rate: 40.9%). The mean age of respondents was 58 yrs (± 19), 41% were men. The mean duration of hospitalisation was 7.5 days (± 11.1). The mean absenteeism rate for nurses was 0.24% (± 0.14).All the PS scores were significantly and negatively correlated with rate of short-absenteeism among nurses (MI score: ρ = -0.55, p < 0.01), RS score ρ = -0.47, p = 0.02). The mixed model found a significant relationship between rate of absenteeism among nurses and PS scores (MI: p = 0.027; RS: p = 0.017). CONCLUSION: Results obtained in this study show that short-term absenteeism among nurses seems to be significantly and negatively correlated with PS. Our findings are an invitation to deepen our understanding of the impact of human resources on PS and to develop more specific projects.

[Assessment of inappropriate prescribing in the elderly subject during acute care hospitalisation]. / Évaluation du risque iatrogénique médicamenteux des patients âgés hospitalisés en court séjour.

OBJECTIVE: Inappropriate prescribing in elderly is considered as common (40% of subjects from community from the 3CStudy in France had a inappropriate prescription, using Beer's criteria), and can lead to severe issues. Few studies have assessed inappropriate prescribing for elderly inpatients in acute care, with multiple tools. Our study was designed to assess outcome prescriptions concordance of elderly inpatients, for potentially inappropriate medication use. METHODS: A retrospective study based on a random sample of 170 inpatients in 2009 was performed at Nantes University Hospital. We used standardized tools, especially general prescriptions rules of the "Collège professionnel des gériatres français", Beers's criteria, the Anticholinergic Risk Scale, concordance for renal function, and search for medication with tight therapeutic edge. RESULTS: Mean age of inpatients was 85.2 ±â€Š4.1 years. Median numbers of prescribing drugs was eight. General prescriptions rules were followed up to 90% of inpatients: no forbidden drug-drug interaction was found. However, more than two psychotropic medications were prescribed for 3.9% of inpatients. At least one drug listed in Beers's criteria were found for 41 (27.0%) inpatients: amiodarone (18 inpatients) and long-term benzodiazepines (seven inpatients). A medication from the anticholinergic risk scale was found for 28 subjects (18.6%): however, for only seven of them, the score was higher than 3. Concordance for renal function was required for 126 inpatients (82.9%) for at least one prescription, 9 (7.1%) patients have a medication overdose according to their renal impairment. Medications with tight therapeutic edge were prescribed for 52 subjects (34.2%): mostly oral anticoagulants (27 subjects). In 15 cases, the dose was underneath the recommended level. CONCLUSION: Some potentially inappropriate medication uses were revealed by our study. It is essential to spread out results for clinicians, for a better knowledge of these risks.

Validation of a tool assessing appropriateness of hospital days in rehabilitation centres.

OBJECTIVE: To develop and validate a list of objective criteria to assess the appropriateness of hospital days for patients admitted to rehabilitation centres and sub-acute care units. DESIGN: Sixteen appropriateness criteria were defined by a multidisciplinary panel of 33 experts using a formalized consensus method. A single ticked criterion classifies the hospital day as appropriate. Reliability was studied by measuring concordance between two independent and simultaneous ratings using the instrument. External validity was tested by comparing conclusions derived from the instrument with the individual judgements of one, two or three experts on the same random sample of hospital days. PARTICIPANTS: The assessment on these criteria was performed on a randomized sample of 406 hospital days from 17 French wards. MAIN OUTCOME MEASURES: Inter-rater reliability and external validity were evaluated using the kappa statistic and prevalence-adjusted and bias-adjusted kappa (PABAK). RESULTS: The inter-rater reliability test showed a kappa-value of 0.71 [95% confidence interval (95% CI) 0.63-0.78] and a PABAK of 0.77 (95% CI 0.70-0.83). There was a good agreement between the conclusions reached using the instrument and the individual judgements of experts with a kappa coefficient of 0.42 (95% CI 0.35-0.50) and a PABAK of 0.60 (95% CI 0.52-0.67). CONCLUSIONS: The instrument is reliable and valid for assessing appropriateness of hospital days in rehabilitation centres and sub-acute care units. The next step in this study is the development of a tool for the analysis of causes of inappropriateness.