Optimizing Strategies for Chlamydia trachomatis and Neisseria gonorrhoeae Screening in Men Who Have Sex With Men: A Modeling Study.

BACKGROUND: International guidelines recommend the systematic screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections in all men who have sex with men (MSM) who have engaged in unprotected sex. However, the optimal screening strategy remains unclear. We developed a modeling approach to optimize NG/CT screening strategy in MSM. METHODS: A compartmental model of NG/CT screening and infection was implemented. NG/CT anal, pharyngeal, and urine (APU) samples from MSM attending the sexually transmitted infections clinic were used to estimate the screening rate, prevalence, and incidence in a base case scenario. Different screening strategies (scenarios; S) were then evaluated: APU samples every 12 months (S1); APU samples every 3 months (S2); APU samples every 6 months (S3); anal and pharyngeal (AP) samples every 6 months (S4); and AP samples every 3 months (S5). RESULTS: We analyzed 2973 triplet APU samples from 1255 patients. We observed 485 NG and 379 CT diagnoses. NG/CT prevalence and incidence estimates were 12.0/11.1% and 40/29 per 100 person-years, respectively, in the base case scenario. As compared to S2, the reference strategy, the proportions of missed NG/CT diagnoses were 42.0/41.2% with S1, 21.8/22.5% with S3, 25.6/28.3% with S4, and 6.3/10.5% with S5, respectively. As compared to S2, S1 reduced the cost of the analysis by 74%, S3 by 50%, S4 by 66%, and S5 by 33%. The numbers needed to screen for catching up the missed NG/CT diagnoses were 49/67 with S1, 62/82 with S3, 71/87 with S4, and 143/118 with S5. CONCLUSIONS: S5 appears to be the best strategy, missing only 6.3/10.5% of NG/CT diagnoses, for a cost reduction of 33%.

Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France.

INTRODUCTION: In France, over 20% of hospitalizations of elderly people are a result of adverse drug events, of which 50% are considered preventable. Tools have been developed to detect inappropriate prescriptions. The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria are innovative and adapted to French prescriptions. This is one of the first French prospective studies to evaluate the impact of acute geriatric care on prescriptions at discharge in elderly patients using the STOPP/START criteria. METHOD: The evaluation of prescriptions according to STOPP/START was carried out on admission and at discharge of patients in acute geriatric units at three hospitals in the Nord-Pas de Calais region, France. A total of 202 elderly hospitalized patients were included during the 4.5 months of the study (1.5 months per center). RESULTS: The mean number of drugs was seven on admission and at discharge. Over half of the prescriptions at admission contained at least one potentially inappropriate medication or one potential prescription omission. The prescriptions at discharge contained significantly fewer potentially inappropriate medications than prescriptions on admission (P < 0.001). In contrast, there was no difference between prescriptions at discharge in terms of potential prescription omissions. CONCLUSION: Acute geriatric hospitalization in France improves prescriptions in terms of potentially inappropriate medication, but has no impact on potential prescription omissions. Further studies must be carried out to see if STOPP/START could be used as a tool in French prescription.

The continued care of pregnant women receiving opiate substitution treatment by midwives.

BACKGROUND: The care of pregnant women receiving opiate substitution treatment (OST) is generally provided by a variety of health care professionals. Midwives working in prenatal consultations take part in this continued care and may meet with their patients several times throughout the pregnancy, which can have a tremendous impact on monitoring. The purpose of the study was to determine whether midwives are used to accompanying women taking OST and to determine their level of knowledge and investment in this area. METHODS: One hundred fifty-nine midwives working in prenatal consultations in Lille, Roubaix, and Tourcoing received a questionnaire with 21 questions. RESULTS: One hundred ten surveys were collected and analyzed. The majority (103) of the midwives were attending pregnant women taking OST. They were familiar with the effects of heroin on pregnancy but were not familiar with the management of OST. CONCLUSIONS: The training of these professionals is important in risk reduction, and they should know the management of OST. All of the midwives requested specific training.

Pharmacists' role in the continued care of patients under opiate substitution treatment.

CONTEXT: In France, over 170 000 persons benefit from opiate substitution treatment. The treatment delivery is most often assured by community pharmacies spread out throughout the territory. The aim of this study is to better know the continued care of individuals treated by methadone or high-dose buprenorphine in community pharmacies in Lille (North of France). METHOD: This was a cross-sectional descriptive study with hand-delivered questionnaires. All pharmacies (n=65) in Lille were included. RESULTS: Fifty-eight of pharmacies (89%) responded to the survey and 55 of them (95%) followed patients treated by opiate substitution treatment. Addiction was considered as an illness by 53 of pharmacists (91%). Confidential discussions could only be conducted at one of every two treatment delivery work station. CONCLUSION: Pharmacists are active in the continued care of individuals treated by opiate substitution treatment. They have a privileged relationship with the general practitioner. A rearrangement of pharmacies' premises could foster the development of therapeutic patient education within the pharmacy.