Use of intravenous immunoglobulins in clinical practice: data from three French university hospitals.

Since several years, the use of intravenous immunoglobulins (IVIg) has increased. This growth has encouraged some countries to publish guidelines. In parallel, some countries have conducted audits to know how IVIg are used in clinical practice in the light of the available guidelines. The objective of this study was to assess IVIg use in three French university hospitals in 2006. All IVIg administrations were evaluated during 6 months (12 September 2005-12 March 2006) in French university hospitals of Marseille. Different data were recorded for each administration: patient characteristics, indication, formulation and quantity. During the study period, 2802 administrations of IVIg (corresponding to a total quantity of 76 780 g) have been recorded. Four hundred and thirty-five patients received at least one of these administrations. The five most reported indications were multifocal motor neuropathy (11.0% of total quantity), chronic inflammatory demyelinating polyradiculoneuropathy (10.2%), corticoresistant dermatomyositis (10.2%), immune thrombocytopaenia (9.9%) and primary immune deficiency (9.1%). According to available French recommendations, 70% of the IVIg use was for 'acknowledged indications', 9% for 'indications to be assessed' and 18% for 'unwarranted indications'. The 10 most reported indications were 'acknowledged indications' according to available recommendations of the French expert group. Nevertheless, the two most reported indications were not approved by the French Health Products Agency (AFSSAPS) at the time of the study and were approved since.

Pertinence of a pre-colonoscopy consultation for routine information delivery.

AIM OF THE STUDY: The purpose of this study was to determine whether patients have a better level of information about colonoscopy and are more satisfied with medical care when they attend a dedicated consultation with a gastroenterologist prior to the procedure. METHODS: We conducted a prospective study which compared "exposed" (E) and "non exposed" (NE) patients. In group E, information about colonoscopy was delivered by a gastroenterologist during a special consultation at least 24 hours before the procedure. In group NE, information was delivered in the usual manner. The patients' level of information was measured after colonoscopy and 3 months later. RESULTS: Thirteen patients were included in group E and 18 in group NE. The level of information was better in group E, 5.2 +/- 2.1 versus 3.3 +/- 2.1 (P<0.04), as was satisfaction with medical care, 24.9 +/- 4.6 versus 23.0 +/- 5.1 (P<0.03). The differences in information levels remained at 3 months. CONCLUSION: The information delivered during a dedicated precolonoscopy consultation increases assimilation of knowledge concerning the procedure and the patient's satisfaction with medical care.