[Identifying the barriers to pulmonary rehabilitation for patients with COPD]. / Identification des freins à la réhabilitation respiratoire chez le patient BPCO. Étude qualitative par focus group et entretiens individuels auprès des patients, des médecins généralistes, des médecins du sport, des pneumologues et des professionnels de santé paramédicaux.

INTRODUCTION: Although pulmonary rehabilitation is a core treatment for chronic obstructive pulmonary disease (COPD) approved by the French National Authority for Health, there is no doubt that it is insufficiently used in France. Pulmonary rehabilitation consists of exercise training and patient education delivered in a multidisciplinary programme of care to reverse the downward spiral of deconditioning caused by the illness as well as improving patients' ability to self-manage. The aim of this study was to identify the obstacles that prevent the delivery of pulmonary rehabilitation, so as to understand its lack of use. METHOD: A qualitative study was undertaken with semi-structured interviews in focus groups and individually, involving the different actors within COPD care pathways, including doctors, other healthcare professionals, and patients. RESULTS: Three group interviews and nine individual interviews were analysed. From these, 13 issues appeared: the disease itself, the perception of the disease, the multidisciplinary work, the relationship between caregivers and the patient, motivation, smoking, the comorbidities, fear, geography, economy, the social, the temporality and the establishment of a pulmonary rehabilitation programme. CONCLUSION: This work illustrates the many barriers that will be interesting to explore, in order to increase the use of pulmonary rehabilitation for patients with COPD.

[Survivorship care plan (SCP) : The viewpoints of women with breast cancer and their general practitioners]. / Programme personnalisé d'après cancer (PPAC) : vision des patientes atteintes de cancer du sein et de leur médecin traitant.

BACKGROUND: The French National Cancer Institute recommends the use of survivorship care plans (SCP) for all cancer survivors. Developing useful SCP's requires understanding of what survivors and their providers need and how SCP's can be implemented in practice. We conducted a study to assess the delivery of SCP comprehensive binders for breast cancer women (BCW) and their general practitioners (GP) in a Cancer center from January 2019. METHODS: SCP binders, containing a full range of information on topics related to post-cancer care to survivor-specific information and referrals, were given to BCW during a post-treatment dedicated consultation. Then a letter, containing the treatment summary and 5-year follow-up schedule, was sent to their GPs. Comprehensive binder delivery assessment was carried out using item checkbox, and anonymous open-answered, self-reported questionnaires were sent by email to BCW and their GPs. RESULTS: The questionnaire response rates were 81.3% for BCW (n = 109/134) and 48.6% for their GPs (n = 52/107). Most BCW (85%) reported that SCP binders provided useful and comprehensive information. However, some of them (18%) felt abandoned and anonymous during the post-treatment follow-up. Most GPs found SCP letters from our anti-cancer center physicians to be useful for their patients, 38% of them had used this information to assure transition of care with other care providers. In addition, GPs were unanimous to express their feeling that this SCP could improve the long-term surveillance of BCW. There was a high concordance between BCW survivors' and PCP' answers, especially regarding SCPs as a communication bridge between GPs and BCW survivors. Response results concerning use of the binders: to talk about them: 59% for BCW vs. 51% for GPs, and to show them: 35% for BCW vs. 31% for GPs. CONCLUSION: The opinions of BCW survivors' and PCP' opinions about the use of SCP's by our Cancer Center seems to be favourable. It is essential to implement and develop SCP's as a key tool in long-term surveillance and support for cancer patient survivors and they are a useful instrument for care providers in communication and transition.

Videos for embryology teaching, power and weakness of an innovative tool.

BACKGROUND AND AIM: Difficulties are encountered in embryology learning such as imagining embryo modifications in three-dimensions and time. We provided an experimentation to evaluate if short videos during magisterial lecture could increase the quality and the efficiency of embryology teaching. METHODS: The study was conducted amongst students in first year of medical studies in France. It is an intense and highly competitive year at the end of which students can engage in medical or paramedical specialties depending on their rank. In a first step, pre-implantation embryo development and microscopic videos of in vitro Fertilization were presented during a course of medical ethics. Three months later, students gave their opinion on this presentation in a satisfaction survey using a Likert scale. In a second step (the two following years), similar videos were integrated in the regular embryology lectures and the results of the subsequent embryology test were analyzed. RESULTS: In the first step, students declared that movies could increase their interest in embryology and significantly help to the comprehension and memorization of embryologic processes. In the second step, we found that students answered better to the video-related questions of the test even if globally in the first year, results were weaker compared to previous years. DISCUSSION: The effects of movies in pedagogy are discussed, especially the accelerated rhythm imposed by this medium. Adverse consequences could be balanced by traditional drawing. CONCLUSIONS: The association of complementary pedagogic methods like movies and drawing could allow an optimization of embryo teaching.

Dronabinol use in France between 2004 and 2017.

OBJECTIVES: To investigate prescription practices for dronabinol, a pure extract of delta-9-tetrahydrocannabinol, prescribed for refractory chronic pain in France since 2004. DESIGN: A descriptive study based on answers to a questionnaire sent to dronabinol prescribers throughout metropolitan France between June and July 2017. MAIN OUTCOMES MEASURES: We assessed the type of prescribers including place of work (hospital, clinic or private practice) and their specialty. We also collected information about the patient profiles, diseases or symptoms initiating dronabinol prescription, its efficacy and side effects. RESULTS: We received completed questionnaires from 26 prescribers in 17 different areas throughout 12 regions. This represented a total of 191 patients of the 377 indexed since 1st January 2006: the sex ratio was 1:1, with an average age of 51 years for men and of 45 for women. The reason for dronabinol prescription was: multiple sclerosis (49.7%); central neuropathic pain from other causes (36.6%); peripheral neuropathic pain (8%); Parkinson's disease (2.9%); and other causes (around 1%). The duration of dronabinol treatment ranged from 1 month to 6 years and the dose from 2.5mg to 30mg per day (in one or several intakes). 59% of the patients declared experiencing a 30 to 50% reduction in pain. CONCLUSION: This first investigation into dronabinol in France underlines the need to further investigate prescription practices and efficacy so as to define conditions of good use and the place of dronabinol in pain management.

[Early satisfaction with care among outpatients with substance dependence]. / Satisfaction précoce vis-à-vis des soins ambulatoires chez des patients dépendants aux substances psychoactives.

BACKGROUND: Patient satisfaction with health care is an important indicator of health care quality. The main objective was to identify factors associated with early outpatient satisfaction with care 45 days after study inclusion for alcohol and opioid dependence. The secondary objective was to study the reproducibility of the satisfaction during the care. METHODS: A longitudinal study was conducted. Satisfaction was assessed during the early care process 15 and 45 days after study inclusion using the quality of care satisfaction questionnaire in outpatient consultation EQS-C. Multiple linear regression was performed to identify the variables associated with satisfaction level. The reproducibility of the questionnaire between the two measurements (15 and 45 days after inclusion) was tested by intraclass correlation coefficient. RESULTS: A total of 189 outpatients were included, and 90 patients completed the satisfaction questionnaire both at 15 and 45 days after inclusion. The level of early satisfaction with care was high. If patients without a history of previous care for substance dependence were at first more satisfied at 45 days (ß=6.8; P=0.05) than those who had received care previously, only the total score of the satisfaction with care at 15 days is associated with satisfaction with care at 45 days when taken into account in the model (ß=0,7; P<0.0001). The results indicated good total satisfaction reproducibility with an intraclass correlation coefficient ICC=0.68. CONCLUSION: We recommend an early measure of satisfaction with care among outpatients with substance dependence.

[AFSSAPS 2005 recommendations have not modified the way parents take care of children's fever]. / Les recommandations Afssaps de 2005 n'ont pas modifié la prise en charge parentale de la fièvre de l'enfant.

INTRODUCTION: Fever in children is frequent. Often mild, initial care is the parents' responsibility: medicinal treatments and medical consultations. Unfortunately, the efficiency of parental care is poor. Therefore, in 2005 the AFSSAPS updated its recommendations. One and 6 years after publication of the guidelines, this study rates their impact by describing and comparing parents' knowledge and behavior when faced with fever in their children. MATERIAL AND METHODS: This survey was conducted in families whose children were attending preschool in and near Metz (France) in 2006 and 2012. The same questionnaire was given to assess the knowledge, care, and symptoms of serious fever. The results were processed based on the number of children in the family and the family's socioeconomic category. RESULTS: In 2006, 1038 questionnaires were distributed and 1273 in 2012. The fever threshold was not better known in 2012. Bathing and uncovering children remained the predominant physical methods used. Treatment was based on the use of ibuprofen and alternating treatments. However, the conditions of administering medication were well known to parents. The causes and motives for consultation were not better understood in 2012 however. The main source of information was physicians. DISCUSSION: The message disseminated since 2005 has not been efficient. Its complexity has not eradicated old beliefs and inappropriate parental practices. A campaign based on a brief, simple message has to be organized, providing better chances of being assimilated by the public. Medical practices should be standardized.

[The flexibility of family medicine]. / La flexibilité en médecine générale.

We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.

[Impact of the A influenza pandemic on anti-seasonal influenza vaccination of French general practitioners: A cohort follow-up 2007-2010]. / Impact de la pandémie de grippe A sur la vaccination des médecins généralistes français contre la grippe saisonnière : suivi d'une cohorte entre 2007 et 2010.

BACKGROUND: Our objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners. METHODS: A survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been. RESULTS: Responses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination. CONCLUSION: This first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.

[Lights on connections between humanitarian medicine and general medicine]. / Réflexions sur certains aspects de la médecine générale à partir de constats sur l'humanitaire.

Humanitarian Medicine's practical experiences show the potential violence of the medicine's power over bodies everywhere. The inequality between assistance and people receiving benefits is comparable to the asymmetrical relationship between doctor and patient. Efforts have to be done in order to comprehend other possibilities of life's organization. The understanding of double subjectivities in the therapeutic relationship is a requirement for success, in any situation--as usual. Furthermore, the adverse effects of assistance remind us the primary principle not to harm. These admissions of failure urge to develop assessment reasoning, including all factors of influence on health (resources, policy...), and an approach which aims people to become self-sufficient.