Improving patient self-reporting of antihypertensive adverse drug events in primary care: a stepped wedge cluster randomised trial.

BACKGROUND: About 25% of patients experience adverse drug events (ADE) in primary care, but few events are reported by the patients themselves. One solution to improve the detection and management of ADEs in primary care is for patients to report them to their general practitioner. The study aimed to assess the effect of a booklet designed to improve communication and interaction between patients treated with anti-hypertensive drugs and general practitioners on the reporting of ADEs. METHODS: A cluster randomized controlled cross-sectional stepped wedge open trial (five periods of 3 months) was conducted. A cluster was a group of general practitioners working in ambulatory offices in France. Adults consulting their general practitioner to initiate, modify, or renew an antihypertensive prescription were included. A booklet including information on cardiovascular risks, antihypertensive treatments, and ADE report forms was delivered by the general practitioner to the patient in the intervention group. The primary outcome was the reporting of at least one ADE by the patient to his general practitioner during the three-month period after enrolment. Two clusters were randomised by sequence for a total of 8 to receive the intervention. An intention-to-treat analysis was conducted. A logistic mixed model with random intercept was used. RESULTS: Sixty general practitioners included 1095 patients (median: 14 per general practitioner; range: 1-103). More patients reported at least one ADE to their general practitioner in the intervention condition compared to the control condition (aOR = 3.5, IC95 [1.2-10.1], p = 0.02). The modification and initiation of an antihypertensive treatment were also significantly associated with the reporting of ADEs (aOR = 4.4, CI95 [1.9-10.0], p <  0.001 and aOR = 11.0, CI95 [4.6-26.4], p <  0.001, respectively). The booklet delivery also improved patient satisfaction on general practitioner communication and high blood pressure management. CONCLUSION: A booklet can improve patient self-reporting of ADEs to their general practitioners. Future research should assess whether it can improve general practitioner management of ADEs and patient's health status. TRIAL REGISTRATION: Trial registry identifier NCT01610817 (2012/05/30).

[Social representations of vaccination among patients and general practitioners: a study based on hierarchized evocation]. / Représentations sociales de la vaccination chez les patients et les médecins généralistes : une étude basée sur l'évocation hiérarchisée.

In France, there is a discrepancy between perceptions and practices related to vaccination, the causes of which are poorly understood. The purpose of this study was to examine and compare patients' and physicians' social representations of vaccination. A qualitative study based on hierarchized evocation was conducted on a sample of 30 patients and 30 general practitioners. The participants were asked to write down seven words or word groups (word associations) induced by the concept of "vaccination" and to rank them in order of importance. The associations were grouped by theme and sub-theme. Their frequency, connotations and importance were compared between the two groups. The results show that, overall, the physicians had a positive view of vaccination, while the patients had a more neutral view (polarity index: + 0.38 vs + 0.07, p < 0.01). Among both patients and general practitioners, vaccination tends to be perceived as a form of medical care mainly targeting children and aimed at prevention, and its effectiveness is considered to be implicit. However, the patients appeared to be more concerned about the potential side effects of certain vaccinations, while the GPs emphasized the harmlessness of vaccination. The participating GPs also tended to take a collective view of vaccination, while some patients criticized the lack of targeted vaccinations. Better communication on these key aspects of representations may help to increase confidence in vaccination and to close the gap between perception and practice.

Effects of dietary protein level during rearing period and age at overfeeding on magret and foie gras quality in male mule ducks.

The aim of this trial was to study the effects of dietary protein content during the rearing period on the performance of mule ducks, according to age at overfeeding (O). Ducks (n = 612) were divided into four groups differing in the protein content in the diet offered during the starting period (S, 0-20 days; Sl vs. Sh : 150 vs. 175 g/kg crude protein (CP)) and growing-finishing period (GF; 21-67 or 81 days, depending on age at O; GFl vs. GFh : 133 vs. 152 g/kg CP). The relative weight of pectoral muscle was lower when ducks were fed a low protein diet during S (-5%, P < 0.01) or GF period (-6%, P < 0.001) at 68 days and higher in ducks of the Sl GFh group (+6%; P < 0.05) at 82 days. Both foie gras and magret weights fell when ducks were fed Sl or GFl (P < 0.05 and < 0.01). Mortality during the O period was higher in ducks fed the Sl diet and overfed at late age (7.4% vs. 0%; P < 0.01). In conclusion, a reduction in the dietary protein supply should be recommended only during the GF period for ducks overfed at a late age.

[Cost of dialysis in France]. / Coût de la prise en charge de la dialyse en France.

The provision of care for patients with end-stage chronic renal failure is an important medical and economic challenge for the Health Insurance. Previous studies have shown a lower cost for home dialysis. More recently, studies have confirmed identical short-term survival rates between haemodialysis and peritoneal dialysis. Notwithstanding, home dialysis techniques utilization remains weak in France. This work aims at: determining the average annual cost of dialysis, per patient and per technique of dialysis, and assessing the global annual cost of dialysis in France, from the Health Insurance perspective. Methodologically, this article provides a static estimation of the cost of dialysis. Costs related to co-morbidities of end-stage chronic renal failure have not been considered. Standard patient care schemes have been outlined by a multidisciplinary expert committee, for each dialysis technique, and have been valorised using publicly available data and tariffs recorded in 2005. Our result show that home dialysis techniques are the less costly, with an average annual cost per patient of 49.9, 49.7 and 50.0 k euro respectively for home haemodialysis, automated peritoneal dialysis, and continuous ambulatory peritoneal dialysis. Autodialysis, autonomous in-center haemodialysis and in-center haemodialysis respectively cost 59.5, 62.3 and 81.5 k euro per patient and per annum. The total 2005 cost of dialysis for the Health Insurance is estimated at 2.1 billion euro. Therefore, the development of alternative techniques to in-center haemodialysis, such as home dialysis or autonomous in-center haemodialysis, autodialysis being already well developed, could generate savings for the Health Insurance. From the patient's perspective, it could also allow the enlightened choice of the best customized technique, less guided by local offer than by medical or social criteria, as well as by the patient's own opinion.

Evaluation of an interactive program for preventing adverse drug events in primary care: study protocol of the InPAct cluster randomised stepped wedge trial.

BACKGROUND: Adverse drug events could often be prevented. One of their main causes is that patients rarely know how to detect them. Another cause is inadequate communication between patients and physicians. If patients were to be effectively trained in detecting and reporting adverse drug events, this should help to prevent their occurrence and subsequent complications. Our purpose is to present the protocol of the InPAct trial, which aims to evaluate an interactive program that encourages patients to report adverse drug events in primary care. METHODS/DESIGN: We will conduct a cluster randomised controlled stepped wedge trial, with eight clusters of 10 general practitioners each. The physicians will suggest to all of their antihypertensive-treated patients that they take part in this study. The InPAct program will be implemented in the clusters in random order along five successive three-month periods. Two new clusters will be trained in implementing the program at each step. The program features: an interactive patient booklet including informative paragraphs, several care plans and adverse drug event report forms; and standardised training of physicians in how to present the booklet to the patient. The primary outcome will be the reporting of adverse drug events by patients to their physician within three months. We assume that the number of patients reporting at least one adverse drug event will increase from 3% before program implementation to 7.5% afterward (coefficient of variation = 0.5, α = 0.05, ß = 0.2), which means that 1,200 patients must be included. The effect of the intervention on the main outcome will be quantified and tested using a mixed logistic model to integrate cluster and time effects. DISCUSSION: Our choice of a stepped wedge design is particularly appropriate for evaluating the implementation of a patient safety program within the constraints of general practice. We describe the InPAct intervention, which is an original program that is intended to improve communication between patients and physicians. Indeed, none of the previously published intervention studies has combined a patient education program and a patient reporting system for adverse drug events with the aim of improving patient safety in primary care. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov NCT01610817.

[Which treatments for infantile colics?]. / Quels traitements pour les coliques du nourrisson?

BACKGROUND: Infantile colics or excessive crying represent a source of stress for parents and a frequent reason for encounter in primary care. OBJECTIVE: To assess the effectiveness of treatments of this syndrome from a systematic review. INFORMATION SOURCES: Medline, Cochrane and Embase databases. SELECTION OF STUDIES: We used the following inclusion criteria: therapeutic assessment of infant colics or excessive crying, randomized controlled trials or meta-analyses, published in English or French language. Thirty-one randomized controlled trials and one meta-analysis have been included. RESULTS: Allopathic drugs have not proved effectiveness (simethicone, lactase) and some of them can cause potentially serious adverse reactions (dicyclomine). Protein hydrolysate or soy formulas seem to be effective, but soy milk can induce allergies. Sucrose solutions provide some benefit in studies with low level of evidence. Effectiveness is likely for a probiotics (Lactobacillus reuteri) and for herbal mixtures containing fennel extracts. Evidence is lacking for manual (osteopathy, acupuncture) and behavioural therapies (decreased stimulations, reassurance of parents). LIMITATIONS: The definition of infantile colics and the methods used for crying measurement changed across trials. The included trials were of variable quality, especially with no double-blind procedure in 17 trials. CONCLUSION: The most validated treatments for infantile colics are the substitution of cows' milk by a hydrolysed formula, the use of L. reuteri and of fennel extracts.

New generation photon-counting cameras: algol and CPNG.

Algol and Comptage de Photons Nouvelle Génération (CPNG) are new generation photon counting cameras developed for high angular resolution in the visible by means of optical aperture synthesis and speckle interferometry and for photon noise limited fast imaging of biological targets. They are intensified CCDs. They have been built to benefit from improvements in photonic commercial components, sensitivity, and personal computer workstations processing power. We present how we achieve optimal performances (sensitivity and spatiotemporal resolution) by the combination of proper optical and electronics design, and real-time elaborated data processing. The number of pixels is 532 x 516 and 1024(2) read at a frame rate of 262 and 100 Hz for CPNG and Algol, respectively. The dark current is very low: 5.5 x 10(-4) e(-) .pixel(-1). s(-1). The saturation flux is approximately 7 photon events /pixel/s. Quantum efficiencies reach up to 36% and 26% in the visible with the GaAsP photocathodes and in the red with the GaAs ones, respectively, thanks to the sensitivity of the photocathodes and to the photon centroiding algorithm; they are likely the highest values reported for intensified CCDs.

Compact high-resolution spaceborne echelle grating spectrometer with acousto-optical tunable filter based order sorting for the infrared domain from 2.2 to 4.3 microm.

A new compact spaceborne high-resolution spectrometer developed for the European Space Agency's Venus Express spacecraft is described. It operates in the IR wavelength range of 2.2 to 4.3 microm and measures absorption spectra of minor constituents in the Venusian atmosphere. It uses a novel echelle grating with a groove density of 4 lines/mm in a Littrow configuration in combination with an IR acousto-optic tunable filter for order sorting and an actively cooled HgCdTe focal plane array of 256 by 320 pixels. It is designed to obtain an instrument line profile of 0.2 cm(-1). First results on optical and spectral properties are reported.