Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians.

The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.

COVID-19 psychological impact in general practitioners: A longitudinal study.

INTRODUCTION: COVID-19 may have negatively impacted the mental health of front-line healthcare workers, including general practitioners (GPs). This study sought to assess the psychological impact (stress, burnout and self-efficacy) of the COVID-19 outbreak in French GPs. METHODS: We carried out a postal-based survey of all GPs who worked in the French region of Normandy (departments of Calvados, Manche and Orne) from the exhaustive database of the Union Régionale des Médecins libéraux (URML Normandie) as of 15th April 2020 (one month after the first French COVID-19 sanitary lockdown). The second survey was conducted four months later. Four validated self-report questionnaires were used at both inclusion and follow-up: Perceived Stress scale (PSS), Impact of Event Scale-revised (IES-R), Maslach Burnout Inventory (MBI) and General Self-Efficacy scale (GSE). Demographic data were also collected. RESULTS: The sample consists of 351 GPs. At the follow-up, 182 answered the questionnaires (response rate: 51.8%). The mean scores of MBI significantly increased during follow-up [Emotional exhaustion (EE) and Personal accomplishment, P<0.01]. Higher burnout symptoms were found at the 4-month follow-up in 64 (35.7%) and 86 (48.0%) participants (43 and 70 participant at baseline), according respectively to EE and depersonalisation scores (P=0.01 and 0.09, respectively). CONCLUSION: This is the first longitudinal study that has shown the psychological impact of COVID-19 in French GPs. Based on validated a self-report questionnaire, burnout symptoms increased during follow-up. It is necessary to continue monitoring psychological difficulties of healthcare workers especially during consecutive waves of COVID-19 outbreak.

Healthcare pathways and practitioners' knowledge about ADHD in children.

INTRODUCTION: Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD. METHODS: A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder. RESULTS: Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD. CONCLUSIONS: This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.

[Collaborative work between coordinating physicians, geriatric EMGE physicians and emergency physicians]. / Un travail collaboratif entre médecins coordonnateurs, médecins gériatres des EMGE et médecins urgentistes.

The medical summary section (VSM) was formalized in 2011 with its content defined in 2013. In residential facilities for dependent elderly people (Ehpad), the VSM is almost non-existent and is requested by the majority of doctors who have to take medical care of a resident, often in an emergency situation. Following the health crisis and under the aegis of the regional and national associations of coordinating physicians, a working group was set up in 2021 to create a unique VSM that meets the needs of the field. This document was created and tested with very favorable feedback from users. This VSM is currently being deployed in the Ehpad of the Île-de-France region.

[The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. / Rôle des gériatres libéraux dans le système de santé (2/2) : analyse qualitative compréhensive par entretiens semi-dirigés.

Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.

[Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. / Rôle des gériatres libéraux dans le système de santé (1/2) : analyse quantitative descriptive par questionnaire.

Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.

Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol.

CONTEXT: Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. OBJECTIVES: The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. MATERIALS AND METHODS: The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. STUDY POPULATION: Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses' aides, auxiliary nurses and midwives will be included. COLLECTED DATA: Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). ETHICS: This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). EXPECTED RESULTS: Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

[Outpatient psychiatric activity in the elderly]. / Activité ambulatoire en psychiatrie de la personne âgée.

Outpatient psychiatry and its health action for the elderly has taken a certain boom in the 2010s. The health policies wanted undoubtedly to mitigate the will to close hospital beds, and to limit hospitalizations in a good way. Ambulatory teams and governments have often provided the means in terms of personnel and logistics to meet the demands in urban and rural areas. Probably, in the image of the clinical history, this ambulatory effort is necessary and positive for the patient, even if these actions will not be able to replace the hospital care in complex cases.

[Prevention of genetic diseases : the return of the family practitioner ?] / Prévention des maladies génétiques. Le retour du médecin de famille ?

BACKGROUND: Information to kin is one of the major ethical problems of the new genetics. In France, the revised bioethics law in 2011 created the possibility for patients to authorize professionals, under certain conditions, to directly contact their relatives at risk. Beyond this, other actors, such as GPs, could however play a role in this process. METHODS: Our article is based on an ethnographic-type sociological study by observations and semi-structured interviews with patients (n=59) and genetic professionals (n=16) that took place from 2014 to 2016 in three genetic hospital wards in France and Canada. It focuses particularly on genetic predispositions to breast and ovarian cancers as well as genetic hemochromatosis. RESULTS: Because of its position as a primary care specialist, the general practitioner can play a decisive role in the process of informing relatives about genetic disorders. Upstream of the genetic test, the generalist, thanks to his knowledge of the family context of his patients, can play a referral role towards a specialized consultation. Downstream, it can also ensure a more effective follow-up of the information procedures undertaken by its patients thanks to the medical follow-up that it carries out. CONCLUSION: The data collected during our study highlight the unprecedented place that could be that of the general practitioner in the field of prevention in genetics. At the articulation between primary care and highly specialized care, it is the figure of the "family" doctor who seems to be called here to be renewed by genetics.

[General practitioners' views on cognitive disorders diagnosis: a qualitative study]. / Représentations des médecins généralistes à propos du diagnostic des troubles cognitifs.

Diagnosis of cognitive disorders is at medical and ethical stake. The aim of an qualitative study based on interviews was to explore the views of general practitioners on this diagnosis. General practitioners are ambivalent about the relevance and temporality of the diagnosis of cognitive disorders, which could be resolved by a shared decision making at each stage of the diagnostic approach.

[The geriatric hotline improves practice, survey of general practitioners in the Saint-Etienne area]. / La hot line gériatrique, enquête auprès des médecins généralistes du bassin stéphanois.

Faced with an aging French population, the demand for unscheduled care is growing. In order to avoid referring elderly patients to emergency departments, which are unsuitable for them, the Regional Health Agencies have created telephone hot lines dedicated to geriatrics. They are exclusively accessible to general practitioners in order to obtain advice or a place in a geriatric hospital. General practitioners are rarely asked about the value of this tool in their practice.

[A pragmatic approach to iatrogenic risk in the emergency room]. / Approche pragmatique du risque iatrogène aux urgences.

The links between the emergency department (ED) and drug-related harm are close. In practice, it is necessary to ask systematically if an iatrogenic accident is possible and to evaluate a new prescription carefully so as not to create iatrogenia during the visit to the emergency department. Any situation in which a nurse takes charge of an emergency room must be subject to precautions. Simple measures should be put in place during any hospitalisation of an elderly person.

[Preventing suicide in general practice]. / Prévenir le suicide en médecine générale.

With one of the highest rates in Europe, suicide is a major public health problem in France. General practitioners are the backbone of the health system. They play a major role in suicide prevention. Mental health accounts for a large proportion of primary care practitioners' patients, the majority of which are for depressive and anxiety disorders. However, patients prefer to go to their general practitioner when they first encounter psychological difficulties. They are more likely to consult a mental health professional based on the advice of their general practitioner, hence the importance of linking primary and more specialised care.

Pigmented Remedies: The Pharmacy of Colour in Early Modern Europe.

This article will examine pigments recently identified in an unpublished conservation survey at the Wellcome Collection that included two 17th-century medical manuscripts. These pigments, which were drawn from plant and mineral products, served a dual purpose based on their medicinal and pigmented properties. An exploration of how these pigments were used (and why) by a range of practitioners - including apothecaries, physicians, "kitchen physicians," and artisans - reveals the importance of colour throughout early modern Europe. The persistence of traditional medical theories is revealed by examining evidence across an extensive period covering the 16th to the 18th century. Receipt books, medical treatises, and health guides are contrasted with artisanal texts reflecting the blurring of boundaries between the worlds of medicine and art. Modern analysis by conservators of colour used in medieval and early modern texts is crucial to the preservation of pigments but also provides a deeper understanding of what and how pigmented products were used in the period and, ultimately, informs our current understandings of early modern life and medicine.

[Physical activity upon prescription]. / L'activité physique adaptée sur prescription.

The concept of adapted physical activity (APA) was born in the 1980s in French universities, and more particularly in the Sciences and techniques of physical and athletic activities degree. Today, it is an integral part of the caregivers' therapeutic arsenal. However, if everything seems to be done to ensure that the practice of APA is prescribed to as many people as possible, for doctors, this new therapeutic opportunity to improve the health of their patients is not so easy to put in place in the field.

[Doctor-patient relationship: teenagers prefer "tu" to "vous"]. / Les adolescents préfèrent être tutoyés par leur médecin.

The quality of the relationship is important for the medical care of adolescents. The choice of the pronoun of address, "tu" or "vous", could be a determining factor in this relationship. A study of 220 adolescents showed that they preferred to be addressed as "tu". They waited for the doctor to offer it to them.

Publishing and Paternalism in the Grenfell Mission: Wilfred Grenfell's Accounts of a Boy Patient and Doctor-Patient Relations in Northern Newfoundland and Labrador, 1900-14.

In 1906 Dr. Wilfred Grenfell, founder and head of the Grenfell medical mission of northern Newfoundland and southeastern Labrador, published a short article in Putnam's Monthly about a nine-year-old boy named Clem Richards, who had shot himself in the knee while hunting seabirds. The boy's identity was disclosed in full, with Grenfell including his name and image as well as a detailed description of his living conditions. The "story" of the boy's injury and recovery became a favourite of Grenfell's, and it was modified and republished in a number of magazines and books between 1906 and 1923. This article explores the appeal that Richards' accident held for Grenfell and argues that his dramatic mid-winter rescue of the boy helped Grenfell promote his mission and construct a public image of himself that would appeal to American readers and donors. By comparing published accounts with Richards' medical case record, however, we also see how much Grenfell distorted the incident to heighten its drama and reader appeal. The article also considers how the mission's dominance over northern Newfoundland and southeastern Labrador enabled Grenfell to use Richards' name and image for mission publicity with no consideration of patient consent.

[Dialogue between general practitioner and patient regarding tobacco and alcohol consumption, from the patient's standpoint]. / Dialogue entre médecin généraliste et patient : les consommations de tabac et d'alcool en question, du point de vue du patient.

BACKGROUND: General practitioners (GP) are key players in screening and counselling for smokers and alcohol drinkers exceeding French guidelines for low-risk consumption thresholds. Tackling the subject from the patients' perspective, the authors aim at estimating the proportion of the population having discussed their smoking and alcohol consumption with their GPs, and to pinpoint the factors associated with their having done so. METHODS: The data (n=6346) are derived from nationwide representative phone survey in mainland France conducted by the French public health monitoring center Baromètre de Santé publique France. RESULTS: Among the persons aged 18-75 having consulted a GP over the last 12 months (82.5%), 36.7% stated that smoking had been discussed in consultation while 16.8% had talked about alcohol use. For both substances, being a man, a smoker, an excessive alcohol user and having a chronic illness were not only independently associated with being questioned by one's doctor, but also with more frequent patient initiative. About 87% considered it normal to be asked by their GP about their alcohol intake, this proportion being higher among men and people with high incomes. CONCLUSION: Even though a large portion of the population would deem it normal to discuss smoking and alcohol intake in consultation with a GP, the subjects are rarely broached. Our results underline the need to bolster efforts at systematic screening for substance use by GPs.

[The role of the general practitioner in management of psychiatric disorders]. / Le rôle du médecin généraliste dans la prise en charge des pathologies psychiatriques.

AIM: Psychiatric disorders represent a huge burden of disease worldwide. Significant gaps in their diagnosis and treatment remain. In Morocco, an observed shortage of psychiatrists would logically call for their collaboration with family physicians. Our objectives were to analyse perceptions of general practitioners' capacity to manage psychiatric disorders, to study the difficulties encountered in their management of these pathologies, and to assess their degree of collaboration with existing mental health structures. METHODS: A cross-sectional nationwide survey of family physicians practicing in urban and rural areas in the private and public sectors in the Kingdom of Morocco was organised. Carried out over a period of 10 months (April 2016 to January 2017), the study was based on an anonymised self-administered questionnaire comprising 23 items. Were excluded from the sample: physicians who had tested the questionnaire prior to its distribution, medical students, family physicians employed in administrative services, resident doctors in university hospitals, and questionnaires with incomplete answers. RESULTS: All in all, five hundred and four questionnaires were distributed, with a participation rate of 79.8%, while 57.9% of the respondents were men. Their seniority as doctors ranged from 1 year to 60 years with average duration of 19.5±11 years. An overwhelming majority of the doctors had obtained their doctorates in Morocco, while 8.4% had been trained abroad. The majority of the doctors surveyed worked in private practice in urban areas (53.1%), and most of them (81.9%) agreed that the management of psychiatric disorders is a public health priority. The participating physicians stated that they received an average of five patients per day suffering from mental disorders, representing 17.3% of their medical consultations. According to their perceptions, the most frequent psychiatric pathologies were depression, somatoform disorders and sleep disturbances, which were cited by 92.9%, 78.8% and 78.5% of them respectively. Regarding the diagnosis of psychiatric pathologies, 60.2% of the doctors considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia, autism and dementia, while the pathologies reported as the most difficult to treat were addictive behaviours, schizophrenia, bipolar disorder, autism and dementia. Physicians felt a need for training, primarily pertaining to anxiety disorders, schizophrenia and bipolar disorders (49.5%, 35% and 33.7%, respectively). Nearly a quarter of the respondents (22.4%) mentioned a need for training in management of all psychiatric illnesses. Regarding the reasons for their referral of patients to mental health care structures, 65.4% of the physicians justified their doing so by a need for hospitalisation, while in 43.7% of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by the respondents were firstly a lack of adapted means of care (77.5%), followed by their insufficient training in mental healthcare (52.4%) and absence of collaboration with mental health professionals (52.4%). CONCLUSION: For the majority of the physicians surveyed, psychiatry represented a public health priority, and their prioritising provides a probable explanation for their positive perception of their role in the management of mental disorders. However, we went on to observe that a number of difficulties constituted obstacles to their role in management of mental disorders and induced them to refer their patients to psychiatrists. Our analysis highlighted the impact of continuing education on physicians' attitudes and the interest of collaboration between practitioners. Efforts in university teaching and continuous education should be encouraged in view of enabling family physicians to more effectively cope with the demands of daily practice and meet the expectations of the overall population.

[COVID pandemic in accommodation facilities for dependent elderly]. / Pandémie de Covid dans les Ehpad.

During the coronavirus outbreak, accommodation facilities for dependent elderly (Ehpad) had to adapt quickly to an unknown and dangerous situation for residents, putting all the resources of these places to the test. Caregivers faced clinical and organizational emergencies with the coordinating doctors and nurse, going through different individual and collective phases. The directors, who are legally responsible for Ehpad, had to make room for the "we", anticipate, apprehend and evaluate the crisis but also deal with paradoxical recommendations.