Insights of undergraduate health sciences students about a French interprofessional training initiative.

BACKGROUND: Incorporating interprofessional collaboration within healthcare is critical to delivery of patient-centered care. Interprofessional Education (IPE) programs are key to promoting such collaboration. The 'Public Health Service' (PHS) in France is a mandatory IPE initiative that embodies this collaborative spirit, bringing together students from varied health undergraduate training programs-nursing, physiotherapy, pharmacy, midwifery, and medicine- in a common training program focused on primary prevention. The aim of the study was to assess the experience and attitudes of students in the five health training programs regarding the interest of IPEs in the PHS. METHODS: A cross-sectional survey was administered to 823 students from the 2022-2023 cohort at a French university. The questionnaire was designed with 12 Likert-scale questions specifically created to evaluate the students' experiences, knowledge, and attitudes focused on IPE during the practical seminars, school interventions, and the overall PHS. Additionally, an open-ended question was utilized to gather qualitative data. Statistical analyses assessed satisfaction levels across undergraduate training programs, while thematic analysis was applied to the qualitative responses. RESULTS: Within the surveyed cohort, 344 students responded to the survey. The findings showed that students were satisfied with the interprofessional collaboration, both in practical teaching sessions (75% satisfaction) and in primary prevention projects conducted in schools (70% satisfaction), despite their having faced challenges with coordination. Pharmacy students, in particular, highlighted the need for adjustments in program scheduling. The qualitative feedback underscored the positive value of IPE, notwithstanding the organizational difficulties stemming from different academic timetables. CONCLUSION: The student feedback indicated a high level of satisfaction with the interprofessional work carried out in both the practical teaching and the primary prevention projects. To further enhance the educational impact and address the scheduling complexities, it is recommended that program refinements be made based on student feedback and pedagogical best practices.

Infectious disease hotlines to provide advice to general practitioners: a prospective study.

BACKGROUND: Telephone hotlines in infectious diseases (ID) are part of antimicrobial stewardship programs designed to provide support and expertise in ID and to control antibiotic resistance. The aim of the study was to characterize the activity of the ID hotlines and estimate their usefulness for general practitioners (GPs). METHODS: This was a multicenter prospective observational study in different French regions. ID teams involved in antimicrobial stewardship with a hotline for GPs were asked to record their advice from April 2019 to June 2022. In these regions, all GPs were informed of the ID hotline's operating procedures. The main outcome was usage rate of the hotlines by GPs. RESULTS: Ten volunteer ID teams collected 4138 requests for advice from 2171 GPs. The proportion of GPs using the hotline varied pronouncedly by region, from 54% in the Isere department, to less than 1% in departments with the lowest usage. These differences were associated with the number of physicians in ID teams and with the age of the hotline. These results highlighted the value of working time as a means of ensuring the permanence of expertise. The main reasons for calling were: a diagnostic question (44%); choice of antibiotic (31%). The ID specialist provided advice on antibiotic therapy (43%) or a proposal for specialized consultation or hospitalization (11%). CONCLUSIONS: ID hotlines could help to strengthen cooperation between primary care and hospital medicine. However, the deployment and perpetuation of this activity require reflection concerning its institutional and financial support.

Healthcare students' prevention training in a sanitary service: analysis of health education interventions in schools of the Grenoble academy.

BACKGROUND: The sanitary service is a mandatory prevention training programme for all French healthcare students. Students receive training and then have to design and carry out a prevention intervention with various populations. The aim of this study was to analyse the type of health education interventions carried out in schools by healthcare students from one university in order to describe the topics covered and the methods used. METHOD: The 2021-2022 sanitary service of University Grenoble Alpes involved students in maieutic, medicine, nursing, pharmacy and physiotherapy. The study focused on students who intervened in school contexts. The intervention reports written by the students were read doubly by independent evaluators. Information of interest was collected in a standardised form. RESULTS: Out of the 752 students involved in the prevention training program, 616 (82%) were assigned to 86 schools, mostly primary schools (58%), and wrote 123 reports on their interventions. Each school hosted a median of 6 students from 3 different fields of study. The interventions involved 6853 pupils aged between 3 and 18 years. The students delivered a median of 5 health prevention sessions to each pupil group and spent a median of 25 h (IQR: 19-32) working on the intervention. The themes most frequently addressed were screen use (48%), nutrition (36%), sleep (25%), harassment (20%) and personal hygiene (15%). All students used interactive teaching methods such as workshops, group games or debates that was addressed to pupils' psychosocial (mainly cognitive and social) competences. The themes and tools used differed according to the pupils' grade levels. CONCLUSION: This study showed the feasibility of conducting health education and prevention activities in schools by healthcare students from five professional fields who had received appropriate training. The students were involved and creative, and they were focused on developing pupils' psychosocial competences.

Effects of a healthcare students' prevention intervention for school children on their own substance use: a before-after study.

BACKGROUND: Cognitive dissonance theory and research has suggested that engaging in prevention interventions for other students may be a means of reducing one's own problematic behaviors in order to reduce potential cognitive dissonance. This study assessed the effects of a new mandatory prevention intervention program for healthcare students in France. The aim was to measure the effects of engaging in a prevention program in schools on the usual increase in substance use in student populations. METHODS: Healthcare students were trained in a French university to develop psychosocial competences as a health promotion means (FEPS training) or more specifically to prevent substance use in teenagers (Unplugged program training). The students (n = 314) who accepted to take part in the study from both groups completed questionnaires before their interventions in schools, and at the end of the year, measuring their representations and behaviors regarding psychoactive substances. RESULTS: The results indicated a significant reduction in alcohol consumption in terms of quantity, but no significant reduction in tobacco and marijuana consumption. CONCLUSIONS: This study showed that, contrary to the usual increase in substance use in students as they advance in their year, the students who took part in this study showed reduced self-reported consumption of alcohol after they had performed the prevention intervention in schools regardless of the type of training they had received (general health promotion vs. specific substance use prevention program). Limitations and future perspectives are discussed.

Association between physical activity and health in healthcare professionals : Results from the nationwide AMADEUS survey.

OBJECTIVE: The objective of this study was to assess the prevalence of healthcare professionals engaging in insufficient levels of physical activity (PA) and to identify sociodemographic, professional and health characteristics associated with insufficient PA levels. METHODS: We conducted a nationwide online cross-sectional study targeting healthcare professionals in France from May 2021 to June 2021. Participant recruitment involved outreach through social networks, professional networks, and email invitations. PA levels were assessed using the International Physical Activity Questionnaire (IPAQ), with insufficient PA defined as weekly PA totaling less than 600 mets/week. RESULTS: The study included a total of 10,325 participants, of whom 3939 (38.1%, 95% confidence interval 37.1-39.0%) exhibited insufficient levels of PA. In the multivariable analysis, we identified factors associated with insufficient PA: ages between 35-44 (aOR=1.58, 95%CI [1.21-2.06], p=.001) and 45-54 years (aOR=1.40, 95%CI [1.07-1.83], p =.015), gender (female aOR=1.47, 95%CI [1.12-1.44], p<.001), and professions including health executive (aOR=1.27, 95%CI [1.32-1.64], p<.001), nurse assistant (aOR=1.25, 95%CI [1.07-1.47], p=.006), and physician (aOR=1.18, 95%CI [1.03-1.34], p=.015). Additionally, burnout (aOR=1.32, 95%CI [1.21-1.44], p<.001), tobacco use (aOR=1.33, 95%CI [1.20-1.58], p<.001), being overweight (aOR=1.39, 95%CI [1.28-1.52], p<.001), major depression (aOR=1.44, 95%CI [1.20-1.47], p<.001), and sleep disorders (aOR=1.14, 95%CI [1.05-1.25], p=.002) were associated with insufficient PA. Work night shifts was associated with sufficient PA. CONCLUSION: Our study has revealed a substantial prevalence of healthcare professionals with insufficient PA levels. This prevalence, coupled with various associated health-damaging behaviors and mental health issues, underscores the importance of acknowledging the barriers they encounter in adopting a physically active lifestyle.

Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit.

BACKGROUND: Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. RESULTS: Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). CONCLUSIONS: We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.

Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits.

BACKGROUND: The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. METHODS: This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. RESULTS: 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. CONCLUSIONS: Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. TRIAL REGISTRATION: French C.N.I.L. registration number 2108852. Registration date October 12, 2017.

Mitigating imperfect data validity in administrative data PSIs: a method for estimating true adverse event rates.

QUESTION: Are there ways to mitigate the challenges associated with imperfect data validity in Patient Safety Indicator (PSI) report cards? FINDINGS: Applying a methodological framework on simulated PSI report card data, we compare the adjusted PSI rates of three hospitals with variable quality of data and coding. This framework combines (i) a measure of PSI rates using existing algorithms; (ii) a medical record review on a small random sample of charts to produce a measure of hospital-specific data validity and (iii) a simple Bayesian calculation to derive estimated true PSI rates. For example, the estimated true PSI rate, for a theoretical hospital with a moderately good quality of coding, could be three times as high as the measured rate (for example, 1.4% rather than 0.5%). For a theoretical hospital with relatively poor quality of coding, the difference could be 50-fold (for example, 5.0% rather than 0.1%). MEANING: Combining a medical chart review on a limited number of medical charts at the hospital level creates an approach to producing health system report cards with estimates of true hospital-level adverse event rates.

Bilan du service sanitaire 2018-2019 de l'Université Grenoble Alpes, inter-filière médecine, pharmacie, maïeutique, kinésithérapie.

OBJECTIVE: "Health service", a French national service-learning program for health profession students, was launched in 2018. It aimed at developing knowledge and skills in health promotion and prevention. The purpose of this study was to assess the local implementation of this program, among medical, pharmacy, midwifery and physical therapy students at the Grenoble Alps University. METHODS: Relevant data were extracted from the placement reports, the directors' feedback forms and an on-line questionnaire for students. We described the teams, the actions, the targeted publics, the students' satisfaction and directors' satisfaction. RESULTS: 400 students participated in this service-learning program (207 medical students, 93 pharmacy students, 39 midwifery students and 61 physical therapy students). 92 teams took actions in 91 institutions, including 90 secondary schools. 96.0% of the students were in interprofessional teams. Of 7,926 people reached, 7,872 (99.3%) were secondary school pupils. The main issues addressed were the substance-use prevention program based on life skills development, Unplugged (55 schools) and screen time and cyberstalking (17 schools). CONCLUSIONS: This program achieved interprofessional education and practice, with health-student-delivered activities. Interdisciplinarity was a core strength of the "Health service". Areas for improvement were the communication and the reimbursement of transportation expenses.

[Evaluation of an interprofessional service-learning program among health profession students: the experience of Grenoble Alps University] / Bilan du service sanitaire 2018-2019 de l'Université Grenoble Alpes, inter-filière médecine, pharmacie, maïeutique, kinésithérapie.

OBJECTIVE: “Health service”, a French national service-learning program for health profession students, was launched in 2018. It aimed at developing knowledge and skills in health promotion and prevention. The purpose of this study was to assess the local implementation of this program, among medical, pharmacy, midwifery and physical therapy students at the Grenoble Alps University. METHODS: Relevant data were extracted from the placement reports, the directors’ feedback forms and an on-line questionnaire for students. We described the teams, the actions, the targeted publics, the students’ satisfaction and directors’ satisfaction. RESULTS: 400 students participated in this service-learning program (207 medical students, 93 pharmacy students, 39 midwifery students and 61 physical therapy students). 92 teams took actions in 91 institutions, including 90 secondary schools. 96.0% of the students were in interprofessional teams. Of 7,926 people reached, 7,872 (99.3%) were secondary school pupils. The main issues addressed were the substance-use prevention program based on life skills development, Unplugged (55 schools) and screen time and cyberstalking (17 schools). CONCLUSIONS: This program achieved interprofessional education and practice, with health-student-delivered activities. Interdisciplinarity was a core strength of the “Health service”. Areas for improvement were the communication and the reimbursement of transportation expenses.

[Evaluation of an interprofessional service-learning program among health profession students: the experience of Grenoble Alps University]. / Bilan du service sanitaire 2018-2019 de l'Université Grenoble Alpes, inter-filière médecine, pharmacie, maïeutique, kinésithérapie.

OBJECTIVE: “Health service”, a French national service-learning program for health profession students, was launched in 2018. It aimed at developing knowledge and skills in health promotion and prevention. The purpose of this study was to assess the local implementation of this program, among medical, pharmacy, midwifery and physical therapy students at the Grenoble Alps University. METHODS: Relevant data were extracted from the placement reports, the directors’ feedback forms and an on-line questionnaire for students. We described the teams, the actions, the targeted publics, the students’ satisfaction and directors’ satisfaction. RESULTS: 400 students participated in this service-learning program (207 medical students, 93 pharmacy students, 39 midwifery students and 61 physical therapy students). 92 teams took actions in 91 institutions, including 90 secondary schools. 96.0% of the students were in interprofessional teams. Of 7,926 people reached, 7,872 (99.3%) were secondary school pupils. The main issues addressed were the substance-use prevention program based on life skills development, Unplugged (55 schools) and screen time and cyberstalking (17 schools). CONCLUSIONS: This program achieved interprofessional education and practice, with health-student-delivered activities. Interdisciplinarity was a core strength of the “Health service”. Areas for improvement were the communication and the reimbursement of transportation expenses.

Prospective diagnostic performance of semiconductor SPECT myocardial perfusion imaging: wall thickening analysis reduces the need for an additional prone acquisition.

PURPOSE: To determine whether the assessment of regional wall thickening (WT) in addition to myocardial perfusion from stress supine acquisitions could compensate for the lack of prone acquisition and the corresponding decrease in the diagnostic performance of SPECT myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease (CAD). METHODS: The study group comprised 41 patients (123 vessels) with known or suspected CAD prospectively recruited for systematic prone and supine 201Tl stress SPECT MPI. The diagnostic performance of SPECT MPI was determined for various image sets including nongated supine images (supine NG), nongated combined prone and supine images (prone and supine NG) and gated supine images, allowing WT evaluation from NG images in addition to perfusion (supine NG + WT) using invasive coronary angiography and fractional flow reserve as the gold standards. RESULTS: The rate of false positives was significantly higher among the supine NG images (20.8%) than among either the prone and supine NG or the supine NG + WT images (3.3% and 2.7%, respectively, P < 0.05 vs. supine NG). Consequently, specificity was higher for the prone and supine NG images than for the supine NG images (96.1% vs. 76.1%, P < 0.01) and was highest for the supine NG + WT images (96.8%, P not significant vs. prone and supine NG), without significant differences in sensitivity (80.0%, 86.6% and 73.3%, respectively, P not significant for all comparisons). CONCLUSION: The diagnostic performance of supine stress SPECT MPI is improved when WT assessment of ischaemic segments is used as an additional diagnostic criterion to values not significantly different from those with combined prone and supine acquisitions.

Evaluation of ceftriaxone prescriptions in the emergency department of a university hospital: an urgent need for improvement and alternative therapy.

To evaluate the relevance of ceftriaxone prescriptions in an emergency department of a university hospital and suggest whenever possible an antibiotic alternative with a lower ecological impact. All ceftriaxone prescriptions in the first complete week of each month during the year 2016, in the emergency department of the Grenoble university hospital, have been analyzed by an IDS referent in antibiotic prescriptions. Ceftriaxone prescription was considered appropriate if justified (an antibiotic must be used), relevant (ceftriaxone is a good choice), and adapted (in terms of dose, route, and period of administration), regardless of a potential antibiotic association, consistent with international recommendations. We considered patient outcome regarding the quality of initial prescription. Additionally, alternatives were suggested for relevant prescriptions. We included 327 patients, of which ceftriaxone prescriptions were not appropriate in 37.6% of cases: 13.5% were not justified, 12.8% not relevant, and 11.3% not adapted. The main factors associated with unjustified prescriptions were urinary, dermatological, and less frequent infection sites (p < 0.001). The main factors associated with irrelevant prescriptions were patients carrying multi-resistant bacteria (p = 0.002) or already following an antibiotic prescription at emergency department admission (p = 0.024). Antibiotic prescriptions were poorly adapted in patients with a creatinine rate over 150 µmol/L (p < 0.001) and septic shocks (p = 0.032). No difference was found concerning the hospital length of stay comparing appropriate initial prescriptions to inappropriate ones. However, alternatives with lower ecological impact were suggested in 55.2% of relevant prescriptions. In emergency departments, it is crucial to preserve ceftriaxone, selecting better indications and considering alternatives.

Damage Control Surgery for Non-traumatic Abdominal Emergencies.

BACKGROUND: Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS: Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7.25), coagulopathy (INR ≥ 1.7) and massive (>5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II). RESULTS: DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ≥ 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ≥3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis. CONCLUSIONS: DCS can be lifesaving in critically ill patients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.

Hospital survey on patient safety culture (HSOPS): variability of scoring strategies.

OBJECTIVE: To assess the variability of safety culture dimension scores and their associated rankings depending on three different scoring strategies using the Hospital Survey On Patient Safety Culture (HSOPS). DESIGN: Cross-sectional study using a self-administered questionnaire. SETTING: The study was conducted in an 1836-bed acute-care French university hospital with an annual volume of 135 999 stays, between April 2013 and November 2014. PARTICIPANTS: All caregivers and technical-administrative staff with at least 6 months of employment, spending at least half of their working time in the hospital, were asked to participate. INTERVENTION: None. MAIN OUTCOME MEASURE: The variability of the HSOPS results using three different scoring methods: the percentage of positive responses recommended by the Agency for Healthcare Research and Quality, the averaged individual means and the averaged individual sums. RESULTS: The response rate was 78.6% (n = 3978). The percentage of positive responses resulted in lower scores compared to averaged individual means and averaged individual sums in the six least developed dimensions, and gave more widely spread scores and greater 95CIs in the six most developed dimensions. Department rankings also varied greatly depending on the scoring methods. CONCLUSION: The values of the HSOPS scores and their corresponding rankings greatly depended on the computation method. This finding shows how important it is to agree on the use of the same scoring strategies, before broadly comparing results within and across organizations.

Serum potassium concentration predicts brain hypoxia on CT after avalanche-induced cardiac arrest.

BACKGROUND: Brain anoxia after complete avalanche burial and cardiac arrest (CA) may occur despite adequate on-site triage. PURPOSE: To investigate clinical and biological parameters associated with brain hypoxia in a cohort of avalanche victims with whole body computed tomographic (CT) scan. METHODS: Retrospective study of patients with CA and whole body CT scan following complete avalanche burial admitted in a level-I trauma center. MAIN FINDINGS: Out of 19 buried patients with whole body CT scan, eight patients had refractory CA and 11 patients had pre-hospital return of spontaneous circulation. Six patients survived at hospital discharge and only two had good neurologic outcome. Twelve patients had signs of brain hypoxia on initial CT scan, defined as brain edema, loss of gray/white matter differentiation and/or hypodensity of basal ganglia. No clinical pre-hospital parameter was associated with brain anoxia. Serum potassium concentration at admission was higher in patients with brain anoxia as compared to patients with normal CT scan: 5.5 (4.1-7.2) mmol/L versus 3.3 (3.0-4.2) mmol/L, respectively (P<.01). A threshold of 4.35 mmol/L serum potassium had 100% specificity to predict brain anoxia on brain CT scan. CONCLUSIONS: Serum potassium concentration had good predictive value for brain anoxia after complete avalanche burial. This finding further supports the use of serum potassium concentration for extracorporeal life support insertion at hospital admission in this context.

Experience Feedback Committee: a management tool to improve patient safety in mental health.

BACKGROUND: A management tool, called the Experience Feedback Committee, has been applied for patient safety and successfully used in medical departments. The purpose of this study was to analyse the functioning of an Experience Feedback Committee in a psychiatric department and to explore its contribution to the particular issues of patient safety in mental health. METHODS: We conducted a descriptive study based on all the written documents produced by the Experience Feedback Committee between March 2010 and January 2013. The study was conducted in Grenoble University Hospital in France. We analysed all reported incidents, reports of meetings and event analysis reports. Adverse events were classified according to the Conceptual Framework for the International Classification for Patient Safety. RESULTS: A total of 30 meetings were attended by 22 professionals including seven physicians and 12 paramedical practitioners. We identified 475 incidents reported to the Experience Feedback Committee. Most of them (92 %) had no medical consequence for the patient. Eleven incidents were investigated with an analysis method inspired by civil aviation security systems. Twenty-one corrective actions were set up, including eight responses to the specific problems of a mental health unit, such as training to respond to situations of violence or management of suicide attempts. CONCLUSIONS: The Experience Feedback Committee makes it possible to involve mental healthcare professionals directly in safety management. This tool seems appropriate to manage specific patient safety issues in mental health.