Survey on the Mental Health of Dispensing Pharmacists in the Auvergne-Rhône-Alpes Region (France).

BACKGROUND: The COVID-19 pandemic intensely involved pharmacists in France, with new responsibilities on a large scale, introducing to dispensary practice the performance of vaccination and nasopharyngeal swabs. This study aimed to assess the prevalence of burnout, anxiety, and depression in pharmacists after the COVID-19 health crisis and to identify factors associated with psychological distress. METHODS: A cross-sectional observational study involved 1700 pharmacies in an entire French region. Sociodemographic, geographical, and medical information (burnout tested with the MBI and anxiety/depression measured on the HAD scale) were collected via an online anonymous self-administered questionnaire. The characteristics of the pharmacy and the practice of antigen testing and vaccination were requested. Quantitative and qualitative variables associated with psychological distress were investigated with a factor analysis. RESULTS: In total, 360 responses were collected (20.5%). Of the responses, 41.9% showed definite anxiety symptoms and 18.3% showed proven depressive symptoms. Three clusters were described according to the intensity of burnout experience, depersonalization, and loss of personal accomplishment. The analysis identified that one cluster was at high risk of burnout (high burnout and depersonalization scores). Of these stressed, exhausted pharmacists, 69.3% showed definite anxiety, 37.9% showed proven depression, and in smaller pharmacies. The carrying out of antigenic testing and anti-COVID vaccination, as well as the geographical location of the pharmacy, were not discriminating factors in these three groups. CONCLUSION: Mental health care and suicide prevention should be provided to at-risk pharmacists. It seems essential to publicize the range of resources available to support pharmacists.

[Chemical risks in the medical biology laboratory]. / Les risques chimiques au laboratoire de biologie médicale.

Although biological/infectious risks are the most important in a medical biology laboratory, chemical risks should not be underestimated. Chemical products are used for analyses, and for disinfecting premises and equipment. Their toxicity imposes strict legislation, which is available to medical biologists in the French Labor Code, European legislation and Inrs (National Institute for Research and Safety) documentation. These sources are necessary because chemical risks are not taken into account by COFRAC (Comité français d'accréditation). The educational aim of this article is threefold: to identify the hazards and risks associated with the use of chemical products; to explain what to do in the event of an accident; and, finally, to provide information on prevention and protection.

The financialization of medical laboratories in France: what are the risks for the profession and public health? / La financiarisation des laboratoires de biologie médicale en France : quels sont les risques pour la profession et la santé publique ?

Medical laboratories in France have always adapted to technical and medical progress, as well as to the regulations imposed by the supervisory authorities. However, over the last ten years, this evolution has been so important that biologists are witnessing a revolution in their mode of practice. The supervisory authorities wanted to increase and harmonize the quality of laboratory results. But the new legislation, sometimes misused, as well as the fear and the cost of accreditation, are at the origin of the excessive acceleration of the financialization of medical biology laboratories. We will see how the hegemony of financial groups can be detrimental to the quality of service provided to patients and to the independence of the medical biologist.

Les laboratoires de biologie médicale en France se sont toujours adaptés aux progrès techniques et médicaux, ainsi qu'à la réglementation imposée par des autorités de tutelle. Mais, depuis une dizaine d'années, cette évolution est si importante que les biologistes assistent à une révolution de leur mode d'exercice. Les autorités de tutelle ont souhaité accroître et harmoniser la qualité des résultats des laboratoires. Mais la nouvelle législation, parfois détournée, ainsi que la peur et le coût de l'accréditation, sont à l'origine de l'accélération démesurée de la financiarisation des laboratoires de biologie médicale. Nous verrons comment l'hégémonie des groupements financiers peut nuire à la qualité du service rendu aux patients et à l'indépendance du biologiste médical.

Medical biology in France: evolution and issues / Rapport des Académies nationales de médecine et de pharmacie. La biologie médicale en France : évolutions et enjeux

Medical biology is an essential part of patient care, both for the diagnosis and monitoring of diseases and for certain therapeutic advances. However, in recent years, it has been confronted with fundamental questions concerning its future. This report is the follow-up to the one published in 2018 by the National Academies of Medicine and Pharmacy and unfortunately only confirms a strong deterioration at all levels. The public authorities do not assume their role of regulator, thus allowing the excessive financialization of Medical Biology to grow considerably and lead to disproportionate groupings of Medical Biology Laboratories (MBL), destructive and sources of health risks. The result is that the Medical Biology Laboratories in towns, which are already known to be poorly distributed, are gradually becoming simple sampling sites, with patients finding themselves alone, often anxious, with their results sent to them by Internet without interpretation. Moreover, although progress in the field of Medical Biology is incredible and should constitute a major pole of attraction for young people, the disaffection of the discipline is total and worrying. Finally, innovation, in the context of current technological progress: connected devices, artificial intelligence and big data, represents a major challenge for the future. Here again, little or nothing is being done, even though the challenges are immense. After these alarming observations, the report will end with a series of recommendations aimed at optimizing the entry of MBL into a new era.

La biologie médicale est un maillon essentiel de la prise en charge des patients, tant pour le diagnostic et le suivi des maladies que pour certaines avancées thérapeutiques. Elle est toutefois, depuis quelques années, confrontée à des questions fondamentales concernant son avenir. Le présent rapport s'inscrit dans le prolongement de celui publié en 2018 par les Académies nationales de médecine et de pharmacie et ne fait malheureusement que conforter une forte dégradation à tous les niveaux. Les pouvoirs publics n'assument pas leur rôle de régulateur, permettant ainsi que la financiarisation à outrance de la biologie médicale s'amplifie considérablement et conduise à des regroupements démesurés des laboratoires de biologie médicale (LBM), destructeurs et sources de risques sanitaires. Le résultat est que les LBM de ville, dont on connaît déjà la mauvaise répartition territoriale, deviennent progressivement de simples sites de prélèvements, les patients se retrouvant alors seuls, souvent angoissés, avec leurs résultats transmis par Internet sans interprétation. Par ailleurs, bien que les progrès dans le domaine de la biologie médicale soient incroyables et devraient constituer un pôle d'attractivité majeur pour les jeunes, la désaffection de la discipline est totale et inquiétante. Enfin, l'innovation, dans le cadre des progrès technologiques actuels : dispositifs connectés, intelligence artificielle et mégadonnées (big data), représente un enjeu majeur pour l'avenir. Là encore rien n'est fait, ou presque, alors que les chantiers sont immenses. Après ces constatations alarmantes, le rapport se terminera par une série de recommandations visant à optimiser l'entrée des LBM dans une nouvelle ère.

[The missions of Biologie Sans Frontières (BSF)]. / Les missions de Biologie Sans Frontières (BSF).

« Biologie sans Frontières ¼ (BSF) is a non-governmental organisation whose mission is to develop medical biology where it is most needed, particularly in French-speaking Africa. In Guinea Conakry, with Fondation Mérieux and the Guinean Ministry of Health, BSF is in charge of training "trainers/teachers" of technicians. This training will take place at the National Health School of Kindia, a school that has been completely rehabilitated and re-equipped thanks to the support of Fondation Mérieux. This project is supported by the French Development Agency. BSF has an in-depth knowledge of the local needs in medical biology training. After an audit carried out by two BSF members, the findings were alarming: these trainers had no experience in medical biology and their theoretical knowledge was still of low level. Three training courses were then provided by BSF, the first in biochemistry, sero-immunology and immuno-hematology, the second in cyto-hematology and the last one in bacteriology-parasitology. The basic techniques have been acquired, the "student trainers" have shown great assiduity, but the level remains fragile and will require new training, which is essential to help these future teachers to provide structured, functional and above all useful practical work adapted to local practices and needs.

The Contribution of the Humanities and Social Sciences to Pharmacy Education: Literature Review and Perspectives.

BACKGROUND: Healthcare systems worldwide adapt to patients' needs and expectations, following social evolutions. Pharmaceutical practice has shifted towards activities such as therapeutic education. Such new missions require to prioritize human and social sciences, which now play a predominant role in training. OBJECTIVE: This work consists of assessing the contribution of human and social sciences to the field of pharmacy, with a twofold focus on practice and training. METHOD: A literature review was carried out according to the PRISMA guidelines focusing on the last 10 years. Selected full texts were read and analyzed to elicit the contribution of human and social sciences to pharmacy. RESULTS: Overall 36 articles were included. Three specific topics were identified during an inductive process of full text analysis: public health policy, patient care, and interprofessional collaboration. CONCLUSIONS: Although human and social sciences are essential to the evolution of the pharmacist profession, their impact on health care costs remains difficult to evaluate. Moreover, teaching human and social sciences can prove difficult to standardize. Such approaches must be supported and organized by governments and universities with a view of upscaling practices.

[Ethics and confidentiality of a patient in a medical biology laboratory]. / L'éthique et la confidentialité du patient au laboratoire de biologie médicale.

Confidentiality is based on principles of deontology and ethics, which are included in French regulations and supported by the professional orders. It contributes to the respect and dignity of the patient. If this consideration of the human person is old, it has been updated to build the framework imposed by the accreditation of medical biology laboratories. Confidentiality is thus reflected in a charter of ethics, a model of which we propose here. It reflects the commitments of healthcare professionals in the processing of biological samples from patients. Confidentiality is thus applied, in a practical way, at each phase of the laboratory's activity. In the pre-analytical phase, it organizes the reception of the patient and the taking of samples, taking into account the particular case of minors. In the analytical phase, confidentiality imposes limited access to the technical premises and the organization of the flow of personnel from outside the laboratory. Finally, in the post-analytical phase, the reporting of results is regulated, depending on the type of analyses performed and the person to whom the results are to be reported (patient or prescriber). The particular case of spermiology illustrates all these points. Finally, during these phases of sample processing, document management is also a matter of confidentiality and data protection. Confidentiality is essential to the functioning of a health care structure, but it is restrictive in its day-to-day implementation. Nevertheless, it must be combined with an awareness of all staff to address the ethical issue of human dignity.

[Medical biology in the face of the evolution of health care needs]. / Rapport des Académies nationales de médecine et de pharmacie sur la biologie médicale La biologie médicale face aux défis de l'évolution des besoins de santé.

Since the publication of the ordinance of January 13th 2010, ratified by the law of May 30th 2013, medical biology in France has undergone a massive restructuration with the emergence of groups of several hundred laboratories. This evolution, which leads to a considerable reduction in the number of structures, causes numerous problems related to increased industrialization and financialization, difficulties of accreditation and disappearance of the proximity link between the biologist and the prescriber or the patient. It also leads to a clear disaffection of students, especially medical students, for this specialty whose medical character has been clearly affirmed by the law. This report takes stock of the current situation of medical biology and makes recommendations to strengthen the role of the medical biologist in the health system and patients' care.