Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: A French regional multicenter study.

INTRODUCTION: We evaluate breast cancer (BC) pathway at a regional level including public, private and university institutions. We assessed the quality of multidisciplinary team meetings (MTM) and compliance with a panel of European high-quality indicators (EUSOMA QIs). METHODS: We conducted a retrospective multicenter (n = 20) study in the largest health care region in France. Between January and April 2015, we included all patients discussed at an MTM after a diagnosis of BC (n = 619). We analyzed quality of MTM by assessing the quorum, the reliability of data transcription and the exhaustivity of pre-therapeutic MTM. We then analyzed the compliance with a selected panel of 16 EUSOMA QIs. RESULTS: During MTM discussion, data were more than 95% consistent with medical records for 9/11 items. Pre-operative tumor histology (90.6%) and post-operative resection margins (84.3%) were the least concordant between medical records and MTM. Minimum standards as defined by EUSOMA were reached for 11/16 QIs, but not reached for pathology reports in non-invasive BC (78.2%), proportion of exclusive sentinel lymph node biopsies in patients with clinically negative axilla (85.2%), performing adjuvant chemotherapy (76.6%), and proportion of patients discussed in pre-therapeutic and post-operative MTM (63.5%). CONCLUSIONS: In this multicentric study evaluating the quality of BC care with a representative sample of institutions, compliance with EUSOMA indicators was satisfactory for all type of institutions. However, too few patients were discussed in pre-therapeutic MTM (especially in non-university hospitals 43.7% [39.4-48.1]) versus 88.7% for others [82.2-95.1]) and data transcription was likely responsible for up to 15% of discordance.

[Do adolescents of the Parisian suburbs take more drugs than others?]. / Existe-t-il une surconsommation de drogue parmi les jeunes de la région parisienne?

BACKGROUND: Because official statistics (e.g. mortality and morbidity data) report the high prevalence of drug abusers in the Parisian region, we hypothesized that drug use is higher in Parisian suburbs than in other regions of France. METHODS: Two epidemiological surveys were carried out in 1993: one among 12,391 adolescents in secondary schools aged 11 to 19, another among 2,821 youth, aged 16 to 24, in the scholar rehabilitation system. The level of drug use (alcohol, tobacco, cannabis and other illicit drugs) and associated behavior (violent behavior, school absenteeism, suicide attempt and road accidents) was compared between youth living in the Ile-de-France region (IDF) and youth living outside the region (NIDF). RESULTS: 1/Alcohol and tobacco consumption rates were lower in the IDF than in the NIDF; 2/There was no statistical difference between the illicit drug consumption rates in IDF and NIDF; 3/The association between alcohol, tobacco and cannabis was more frequent in IDF than in NIDF; 4/There was an association between drug use and the other behavioral problems among French youth, independent of the region. CONCLUSION: In 1993, there was no difference between Parisian region and the outside of the region, as far as drug consumption is concerned. One can expect, in the future, a more homogeneous pattern of mortality and morbidity statistics between regions.