[Serious events: from statutory requirements to the implementation]. / Incidents graves : des exigences réglementaires à la mise en oeuvre.

From 2005, PACA area has formed think-tank group a priori risk in the transfusional chain. It has enabled to determine each step of the elementary process and evaluate the frequency, the seriousness and critical effect of the errors. Blood sample and conformity are the most critical points and depend on the vigilance identity. In September 2007, the southern blood bank of France has settled 12 nonconformities levels of blood samples. They send the listing of the nonconformities every month. This listing enables the executive staff to determine the errors and, therefore, to solve them. The regional notification of 2007 to 2008 confirms analysis of the think-tank team. Hence, we were able to list the most serious cases. Public and private hospitals have to notify the serious events and will be bound to evaluate professional practices. These acts will be taken into account by the regional-medical contract.

[French haemovigilance from 1994 to nowadays: Evolution and prospects]. / L'hémovigilance française de 1994 à nos jours : évolution et perspectives.

Born in France in 1993, haemovigilance aims at monitoring the blood transfusion chain from the donor to the recipient, receiving labile blood products. It differs from the other vigilances due to its organization and its completeness dealing with the collected information. Prior to the European directive, the French agency created a new gravity level: grade 0, aiming at reporting and analyzing the blood transfusion chain dysfunction. Thus, haemovigilance gradually integrates the management of the risks and is given new missions in hospitals and private hospitals. One of its first actions will be to achieve an a-priori analysis, preventing the risks throughout the blood transfusion chain. Such crosscutting missions will be used to manage the coordination of vigilance and in some cases identity monitoring. Haemovigilance may be a key player in identity monitoring because patients' immunology-hematological data base can make it possible to confirm or deny a patient's identity (misused identity or homonyms). Haemovigilance is going to meet other challenges such as the training of health professionals', the implementation of patients' blood management and the periodic revision of the blood transfusions bulletin. A new crosscutting medical profession appears in some countries: blood transfusion practitioner. It combines vigilance, risk management, support for the therapeutic blood transfusions, health professionals training and the evaluation of practices and results. A final mission would be for haemovigilance to be responsible for medicinal products derived from human blood to allow a better monitoring of plasma transfusions.

[Blood pressure in the child and the adolescent. Effect of age, sex, height, weight and heart rate]. / Les pressions artérielles de l'enfant et de l'adolescent. Influence du sexe, de l'âge, de la taille, du poids et de la fréquence cardiaque.

6,391 school children in the department of Seine-Saint-Denis were studied to determine the normal limits of blood pressure, its variations with age and sex, and its correlations with height, weight and heart rate. Blood pressure has a nearly perfect Gaussian distribution. Average blood pressures increase linearly with age according to sex. Boys have higher systolic blood pressures after the age of 14 and higher diastolic blood pressures after the age of 16. The estimated incidence of hypertension was 3,1% systolic hypertension and 2.2% diastolic hypertension. There was a very close relationship between systolic and diastolic blood pressure. Average systolic and diastolic blood pressures increased very significantly with height and weight, in both sex. Heart rate decreased with age. The average blood pressure was not related to heart rate. Blood pressure charts, related to age, sex, height and weight, allow follow-up of arterial blood pressure as children grow up and may lead to a better understanding of the mechanism of hypertension.

[Why is it necessary to review the December 15th 2003 circular relative to the transfusion act?]. / Pourquoi réviser la circulaire du 15 Décembre 2003, relative à l'acte transfusionnel?

Blood transfusion is currently a delegated medical act in patient care services. Following severe adverse events, hemovigilance now disposes of a dense regulation. Data collection and analysis in the national hemovigilance "e-FIT" database allow detection of errors or malfunctions in the transfusion act. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. In the circular relative to the transfusion act, many steps of the transfusion process, less explicit, can be interpreted differently by health care professionals and thus lead to errors or severe adverse events. Standardization of procedures for the transfusion act and its surveillance would increase their safety and avoid potential risks for the patient.

[Regional procedure of blood products transport by emergency medical services]. / Procédure régionale de transport des produits sanguins labiles par le samu.

Transfusions are exceptional while patients are rushed to hospital for sanitary reasons. The quality of care requires the collaboration with different partners (samu, blood bank centre, haemovigilance correspondents…). In response to dysfunctions that occurred during transports for sanitary reasons we have drawn up a regional procedure, which specifies how to get and use blood products. This procedure harmonizes our medical practice, states the role of the different participants (traceability of blood samples of immunohaematology tests, etc.), including a part dedicated to identity vigilance. The expected impacts of this procedure are: the decrease of dysfunctions and of destructions of red blood cells, the improvement of security while patients are transfused.

[Adverse unidentified transfusion reactions in five French regions: analysis, results, propositions]. / Les effets indésirables receveurs inconnus de cinq régions françaises: analyse, résultats, propositions.

OBJECTIVE: Adverse transfusion effects with "unidentified diagnosis" are yearly notified on the French national database "e-FIT" in various numbers and with high interregional discrepancies. The aim of this work was to analyse them in order do reach a better understanding of these notifications. RESULTS: On a total of 2499 "Fiches d'Effets Indésirables Receveurs" (FEIR) registered in 2006 in five French regions, 416 with "unidentified diagnosis" were analysed. Fifty-seven percent of them were kept classified in "unidentified diagnosis". Forty-three per cent of FEIR were reclassified, some in already proposed diagnostic categories (100 EIR), some in new proposed diagnostic categories (80 EIR) as: pathological context of the patient, pains linked to transfusion, hypotension. CONCLUSION: The study confirms the necessity to re-examine the French notification system. It underlines the insufficiency of clinical and biological investigations, which could allow to reach accurate diagnosis. It gives prominence the necessity of taking into account the patient's pathology and targets at least two diagnoses of transfusion adverse effects which are not yet proposed on the FEIR model. This work brings an overture about evolution of the French haemovigilance database which will involve further developments.

[Patient safety and root cause analysis]. / Sécurité des patients et analyse des causes racines.

Safety in the field of transfusion medicine has greatly improved in France. The risk of viral transmission has decreased by a factor greater than 1500 within the last 20 years. In comparison, the risk related to ABO error has decreased only by half. The reporting of critical incidents, which occur at any step of the transfusion procedure is now mandatory in France and is subject to an in-depth analysis, using methods close to that used in aviation safety. The goal of these analyses is to better understand human factors in order to implement more adequate prevention measures.

[Essential hypertension in the child and the adolescent. Epidemiological study in schools (author's transl)]. / L'hypertension artérielle essentielle de l'enfant et de l'adolescent. Etude épidémiologique en milieu scolaire.

Amongst a group of 819 children and adolescents aged between 10 and 18 years and attending a public school, the distribution of blood pressure was determined in relation to age, sex, height-weight ratio and family history. Mean blood pressure values increased with age both sexes for both systolic and diastolic levels. Children outside the norms, blood pressure 2SD, should be considered to be hypertensive and be followed up. The prevalence of systolic hypertension was 3.95 per cent amongst the boys and 3,83 per cent amongst girls. That for diastolic hypertension was 7.33 per cent for boys and 6.97 per cent for girls. Obesity appeared to be the major factor associated with hypertension since half of the hypertensive individuals were overweight. Individual prevention is thus possible. The existence of a family history of hypertension and of obesity more particularly in obese hypertensive children should lead to steps aimed at the familial prevention of hypertension.

[Obesity, hypertension and their relationship in children and adolescents. An epidemiological study in schools (author's transl)]. / Obésité-hypertension artérielle. Leurs relations chez l'enfant et l'adolescent. Une étude épidémiologique en milieu scolaire.

In a school population of 532 boys between 10 and 18 years and 287 girls between 10 and 15 years, were drawn up the normal weight height ratios and blood pressures. The frequency of obesity was 6% in both sexes. Girls were more obese than boys. The disease started before the age of 5--6 years. They are frequently familial. A narrow correlation exists between the weight height ratios and blood pressure. The obese patients had in 8 cases a high systolic blood pressure and in 4 cases a high diastolic blood pressure. Half the hypertensive patients were over weight. A strong link between obesity and high blood pressure was also found in the family history. These facts should lead us to treat obesity in children by slimming diets or at least prevent the disease by an appropriate diet. Half the cases of high blood pressure in children and adolescents improved on losing weight.

[Essential hypertension in the child and adolescent. A preliminary study at an interval of more than one year (author's transl)]. / Hypertension artérielle essentielle de l'enfant et de l'adolescent.

One to two years after an initial study establishing normal values for blood pressure in a population of 819 children and adolescents, the outcome in 74 individuals, 39 of whom were considered to be hypertensive and the influence of the observer and methods on the collection of cases of hypertension are evaluated. 58% of the hypertensive individuals remained hypertensive. Overweight appeared to be the essential factor in determining the persistence of hypertension. 74 % of the overweight hypertensive subjects remained hypertensive as against a figure of 42 % of subjects with a normal weight prevent arterial hypertension could be considered by preventing excess weight. The influence of the observer is slight if methods and equipment are identical. Failure to follow the reference methodology increases the number of cases of hypertension artificially. In order to avoid this risk, the practitioner should refer to normographic scales, use the same method and apparatus and repeat measurements yearly or twice a year in order to eliminate observer error.

[Blood pressures in children and adolescents. An epidemiological study on 6 391 school children in a French circumscription (author's tranls)]. / Les pressions artérielles de l'enfant et de l'adolescent. Une étude épidémiologique en milieu scolaire en Seine Saint-Denis, sur 6 391 sujets.

Distribution characteristics of blood pressure (BP) by age and sex were studied in a school population of 6 391 children aged 6-18 years. BP distributions were according to a Gaussian curve tending towards the higher values. Mean BP increased with age according to linear curve. Systolic BP (SBP) was higher in boys from 14 and diastolic BP (DBP) after 16. An over all prevalence of 3,1 % systolic and 2,2 % diastolic hypertension (BP greater than or equal to 2 DS) was detected. Subjects with hypertension must be annually examined ; only those with BP greater than or equal to 3 DS must be completely investigated for etiological purpose. SBP and DBP were strongly connected. Scales give opportunity to BP follow-up during growth and promise a better understanding of early hypertension.