[Methods and difficulties in using contraception prevention Pass by the youth in the Maine-et-Loire] / Modalités et difficultés d'utilisation du Pass prévention contraception par les jeunes en Maine-et-Loire.

INTRODUCTION: The assessment made by the regional council of the Pays de la Loire states a favorable review by the health professionals and Pass referents. What about the beneficiaries? The main objective is to assess the methods and difficulties in using contraception prevention Pass by the eligible youth aware of the device attending school in the Maine-et-Loire. METHOD: This is a quantitative, retrospective cohort and descriptive study carried out by individual and anonymous questionnaire. The inclusion criteria are students attending Maine-et-Loire schools who agreed to raise awareness about the Pass. RESULTS: 683 students were included. One out of two, girls mainly (P = 0.008), from the state schools and CFA-MFR (Apprentice Training Centers-Rural Family Houses), and from vocational education (P = 0.005) were aware and knew about Pass. 56% heard of it but only 41% of youth had received an explanation. 10% of the youth got hold of the Pass by themselves. 14% used it, mainly to receive contraceptives (condoms) without prescription. 61% of the girls and 44% of the boys felt they did not need it, with a significant difference between genders (P = 10­5). Twice as many girls (11%) as boys thought they could directly asked their general practitioner (GP) for contraceptives or a screening test (P = 0.005). One out of four thought it was easier to use the Pass than going to a CPEF (Family Planning Center), especially for the rural students (P = 0.02). DISCUSSION: One should review the collective information given to a population that seems less affected or in need of it. It would be useful to offer new communication mediums that match the youth behaviour, and one that is more explicit so as to help them visiting appropriate referenced medical units and to increase offering this device since this is free of charge for condoms, to encourage young people to have their GP or CEGGID prescribe screening tests and expand the Pass outreach to adults who are over 20.

[Quality of hospital emergency department discharge summaries to general practitioners]. / Qualité des courriers de sortie des consultants des urgences de l'hôpital aux médecins généralistes.

INTRODUCTION: Improvement of the quality of exchanges between primary care and hospital medicine is a major challenge for continuity of care in France. The objective of this study was to evaluate the quality of communication of information to general practitioners concerning the management of patients attending a university hospital emergency department. MATERIALS AND METHODS: This retrospective study was based on the medical charts of 602 patients consulting the Angers university hospital emergency department, using an evaluation grid of discharge summaries associated with a survey of general practitioners, by postal questionnaire, concerning the time to reception, the content and the mode of transmission of these discharge summaries. RESULTS: Strong points were patient identification, the visit date, the presence of complementary imaging investigation results and the presence of a conclusion. Weak points and aspects requiring improvement were identification of the emergency physician, indicated in only 48% of discharge summaries, notification of the previous treatment absent in 93% of cases, the treatment received in the emergency department and on discharge was absent or incomplete in 78% and 92% of discharge summaries, respectively, follow-up advice was provided in 36% of cases and the information given to the patient was indicated in 16% of discharge summaries. The time to reception of discharge summaries was < or = 48 hours in 8.5% of cases and < or = one week in 99% of cases. General practitioners were satisfied with the content (90%) and the form (84%) of emergency department discharge summaries; however, they would like to receive better structured and more concise discharge summaries, preferably sent by secure e-mail for 62% of them. CONCLUSION: Standardization of discharge summaries, adapted to the general practitioner's practice, given directly to the patient and sent by secure e-mail appear to be one of the main targets for improvement of the quality of management to be introduced in hospital emergency departments.

[Angers general practice residents' career projects in 2012]. / Intentions d'installation des internes angevins de médecine générale en 2012.

OBJECTIVE: Medical demography and the geographical distribution of general practitioners (GPs) in the Pays de la Loire Region constitute a challenge to equitable primary care access. The objective of this study was to describe the career projects of Angers general practice residents in 2012 and to assess their knowledge of installation aids and their impact on practice choices. METHOD: A questionnaire-based declarative study was conducted in April 2012. RESULTS: 204 out of 243 residents (84%) returned the questionnaire. Women represented 62% of responding residents. 56% of residents expressed their desire for predominantly outpatient general practice. A significant determinant in the choice of this type of practice was the voluntary choice of general practice during residency. Group practice was predominantly considered (86%), in semirural areas (60%). The administrative formalities to set up a general practice and the available aids were underestimated by 82% and 83% of residents, respectively. 91% of residents wanted to receive more information about administrative formalities and 82% considered that these aids could encourage their decision in favour of general practice. Anjou general practice residents appeared to be very attracted by outpatient general practice. CONCLUSION: This study shows that strategy of early contact with general practice in medical training should be continued. Information concerning the administrative formalities and aids available must be provided during medical training.

[Impact of the referral letter on triage decisions in adult patients admitted to the emergency department]. / Impact du contenu du courrier médical sur la qualité du triage initial des patients adultes admis aux urgences.

INTRODUCTION: We conducted a two-month prospective study (8,171 admissions) in the Angers university hospital emergency room to analyse the impact of the referral letter on the initial triage of patients admitted to the emergency room performed by the reception and triage nurse. METHODS: We analysed the level of priority of the CIMU triage scale (nurse's classification of emergency room patients), the presenting complaint, and the need for an urgent procedure before and after reading the referral letter and examined the nurse's comments for explanations concerning any triage changes. RESULTS: 1,516 patients arriving with a referral letter (18.5% of admissions) were included and interpretable data were available for 756 of these cases. After reading the referral letter, nurses modified the CIMU triage level for 34 (4.5%) patients, the presenting complaint for 50 (6.6%) patients and eliminated the need for an urgent procedure for 70 (9.3%) patients. No significant difference was observed concerning the choice of the CIMU triage level (p = 0.908). However, changes in triage level were significantly more frequently towards a more urgent category (p = 0.005). Analysis of the nurse's comments showed that these results can be explained by the signs of severity indicated in the referral letter. Certain histories and/or diagnostic hypotheses appeared to lead nurses to eliminate the need for an urgent procedure. CONCLUSION: In this study, the referring physician's letter had a limited impact on the choice of triage level defined by the nurse on admission to the emergency room except for patients in whom the referral letter mentioned signs of severity, not observed at reception, led the nurse to apply a more urgent triage level. It would be interesting to study the information contained in the referral letter, useful for triage of patients admitted to the emergency room, in order to improve the impact of the referral letter on the quality of triage.

[Childhood obesity and general medicine]. / Obésité infantile et médécine générale.

The results of a 2009-2010 survey of general practitioners in Maine-et-Loire show that their practices have improved over the last few years with regard to the prevention and treatment of childhood obesity. However, the recommendations of the French national health authority and the French national nutrition and health programme are not sufficiently applied and doctors face numerous difficulties, including a lack of parental involvement.

[The needs and expectations of HIV patients before starting a therapeutic patient education program]. / Besoins et attentes des patients vivant avec le VIH dans la perspective de la mise en place d'un programme d'éducation thérapeutique.

OBJECTIVES: The purpose of this study was to identify and quantify needs and expectations among HIV patients with a view to developing and implementing a therapeutic patient education program. MATERIALS AND METHODS: A qualitative study using semi-structured interviews was conducted to identify patient education needs. A quantitative study based on a personal questionnaire was subsequently conducted at the teaching hospitals of Nantes and Angers (France). RESULTS: The study was based on a sample of 351 patients (73% of the sample were men and 27% were women). The mean age of the participants was 45.7 years. 73% of the patients stated that they had spoken to a hospital practitioner, while just 29% claimed to have spoken to nurses. 83% stated that they were satisfied with the availability of nursing staff. 88% considered that practitioners explained their treatment decisions, while 80% stated that they had been asked for their opinion. Of the 301 patients treated, 97% felt that they were able to correctly take their medication, while 48% felt that they had no knowledge of HIV-related complications. 68% of the patients expressed concerns about infection risks, particularly young patients (p< 0.001). Concerning the side effects of treatment (lipodystrophy, pain, insomnia, physical changes), half of the patients felt that they had been adequately informed. In terms of emotional support, 79% of the patients stated that they had someone to talk to in the event of a problem. Half of the patients felt isolated and 19% felt discriminated against. Three quarters of the patients did not wish to discuss their financial difficulties, their work problems or the death of a close relative due to HIV infection. Finally, patients treated for more than ten years felt a stronger need to join an association (p = 0.001). CONCLUSION: The results suggest the need to improve patients' ability to express their needs, particularly those who are not members of an association. In addition to the implementation of a therapeutic education program, a social support program is also needed.

[Seasonal and pandemic A (H1N1) 2009 influenza vaccination coverage among health-care workers in a French university hospital]. / Couverture vaccinale antigrippale saisonnière et pandémique (H1N1) 2009: étude auprès du personnel du chu d'Angers.

The aim of this study was to highlight the perceived risk, behavioural changes and acceptance of the seasonal and pandemic (H1N1) 2009 influenza vaccine by healthcare workers in a French teaching hospital. We surveyed healthcare workers from the Angers French teaching hospital (CHU) using a cross-sectional intercept design during phase 5A of the French National Plan for the Prevention and Control of the 2009 "Pandemic Influenza". Professionals were asked to take the survey in their workplace from November 2009 to February 2010. The primary endpoint was immunization coverage among healthcare workers who had contact with at-risk patients. Among the 532 workers responding, 22.3% were vaccinated against seasonal influenza and 36.5% against H1N1 influenza. The immunization coverage rate was significantly higher among physicians. For seasonal influenza, the 2 most-cited reasons for vaccination were "to protect the patient" and "to avoid getting sick"; arguments against vaccination were "I never get the flu" or "getting vaccinated is inconvenient and takes too long". For the pandemic A (H1N1) 2009 flu, the arguments for vaccination were "to protect the patient" and "to protect the family"; arguments against vaccination were linked to vaccine safety. Vaccination coverage against seasonal influenza was lower than that reported in the literature, possibly because of the time required between vaccination for pandemic (H1N1) 2009 influenza and seasonal influenza and the priority often given to vaccination against H1N1. This study emphasizes the lack of perception of pandemic (H1N1) 2009 influenza severity and lack of understanding about the process of developing the seasonal and H1N1 influenza vaccines. Concerns about safety, the possibility of side effects and the vaccine development process need to be addressed. An information campaign stressing the necessity for healthcare workers to be vaccinated must be strengthened.

Acceptance of seasonal and pandemic a (H1N1) 2009 influenza vaccination by healthcare workers in a french teaching hospital.

INTRODUCTION: The aim of this study was to highlight the perceived risks, behavioural changes and the rate of acceptance of seasonal and pandemic (H1N1) 2009 influenza vaccines by healthcare workers (HCWs) in a French Teaching Hospital. METHODS: We sampled HCWs from the Angers French Teaching Hospital (France) using a cross-sectional intercept design during phase 5A of the 2009 French National Plan for the Prevention and Control of 'Pandemic Influenza'. From November 2009 to February 2010, HCWs were approached in the workplace to undertake the survey. The primary endpoint assessed immunization coverage among HCWs who had contact with at-risk-patients. RESULTS: Of the 532 HCWs who answered the questionnaire, 119 (22.4%) had received a seasonal vaccine and 194 (36.5%) the H1N1 pandemic vaccine. Coverage rate was significantly higher among physicians (45% for the seasonal vaccine, 61% for the H1N1 vaccine). The main reasons given for acceptance of the seasonal vaccine were "protection of the patient" and "self-protection", whereas the main arguments against were "low risk of being infected" and "doubts about vaccine safety". For the H1N1 vaccine, reasons for vaccination were to "protect the patient" and "protect the family". The main arguments against were "fear of side effects" and "doubts about vaccine safety". CONCLUSION: This study emphasizes the lack of perception by HCWs of the importance of being immunized against seasonal and pandemic A (H1N1) 2009 Influenza. In the future, particular efforts are needed, during vaccination campaigns, to provide more information to HCWs regarding development process and safety of such vaccines.

Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial.

STUDY DESIGN: Randomized parallel group comparative trial with a 1-year follow-up period. OBJECTIVE: To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. SUMMARY OF BACKGROUND DATA: Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. METHODS: A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). RESULTS: In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. CONCLUSION: Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs.

Comparison of the automated oscillometric method with the gold standard Doppler ultrasound method to access the ankle-brachial pressure index.

OBJECTIVE: Despite its screening interest, the ankle-brachial pressure index (ABPI) remains uncommon in general practice, because it needs training and specific devices as Doppler. Easier methods such as the use of automated oscillometric devices may facilitate the peripheral arterial diseases (PADs) screening. We wanted to assess the reliability of the automated oscillometric measurement of the ABPI, compared with the gold standard Doppler ultrasound measurement. PATIENTS AND METHOD: In 287 patients aged 65 years or older without diagnosed PAD, we performed ABPI measurements with oscillometric and Doppler devices. Reproducibility was assessed by the intraclass correlation coefficient of agreement (R) and the Bland and Altman method. RESULTS: The intermethod reliability was bad (R = .346, 95% CI = (0.268-0.420)), with a large confidence interval of the individual differences between the 2 methods: 95% CI = (-0.183-0.346). CONCLUSION: Automatic oscillometric devices cannot be recommended as reliable methods for ABPI measurement.

[Personnel at risk for occupational blood exposure in a university hospital in West Algeria]. / Le personnel a risque d'accidents d'exposition au sang dans un CHU de l'Ouest Algérien.

The accidental occupational exposure of health care workers to blood or other body fluids after skin injury or mucous contact, constitutes a risk for the transmission of the hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency viruses (HIV). This paper presents the results of a survey carried out over two years (January 2005 - December 2006) on reported occupational blood exposures (OBE). The study aimed to determine incidence, workers and professional categories at risk, and circumstances of OBE occurrence in order to identify avoidable cases and to orient prevention measures. Personal and professional data, immunization status, circumstances of OBE incidents, preventive measures, workers' behaviour post-exposure, and serology surveillance were collected. 108 exposures were reported by 70 women and 38 men. In total, 44 accidents were reported in 2005, and 64 in 2006. Needle stick injuries represented 81% of cases. Source patient serology was unknown in most of the cases, negative in 9% of cases and positive in 10% of cases. 62% of exposed health workers received immediate serology, follow up and screening as of the first day of exposure, 12% after 3 months and 36% after 6 months. No seroconversion case was noted. Cleaning staff and hygiene workers are at high risk of blood contamination as well as nurses, and more than one-third of injuries occurred because of mismanagement of healthcare waste produced in the hospital environment, where needles were not disposed of appropriately in a hard container. Thus, 41.66% of injuries could be avoided if objects were thrown away correctly in specific containers. It is urgent to raise awareness of health care personnel and strengthen adherence to standard precautions as well as to provide suitable containers for the collection and disposal of needles and sharp objects.

[Mobile screening unit for HIV and STI among seasonal workers in the ski resorts of Savoy, France: interest and perspectives]. / Dispositif mobile de dépistage des infections sexuellement transmissibles chez les travailleurs saisonniers en Savoie: intérêt et perspectives.

Seasonal workers in 11 Savoy ski resorts were screened for HIV and sexually transmitted infections by a special mobile unit set up by the Chambery hospital. The service is free and anonymous. In order to evaluate this initiative, information was collected via a survey conducted of the 539 people who used the services of the mobile unit between February 1st and April 1st 2007 through the use of a questionnaire. In addition, sixty-three interviews were conducted with local, regional and national partners. Ninety-two percent of the clients were seasonal workers and their main request (95%) was for HIV and STI testing. None tested positive for HIV, and only three had an STI. This unit is the main entry point into the health system for this population. The results of the evaluation report support the recommendation for the mobile unit to be positioned as an important social focal point for seasonal workers, providing the prevention for high-risk behaviors, closely linked to the structures of "seasonal workers homes" and employing seasonal workers peer educators.

[Exploring the prospects for general practitioners over 55 years old from three counties of western France]. / Perspectives d'activité pour les médecins généralistes de plus de 55 ans dans l'ouest de la France.

OBJECTIVE: Medical demography and the practice of medicine will be influenced by the personal plans of GPs and their decisions to stop practicing in the coming years. This study aims to understand the events that could potentially worsen the medical demography in terms of shortages of GPs for primary care in the short term. METHOD: 455 GPs (all aged over 55 years) practicing in three districts of western France were selected to participate in this prospective study. 258 valid and complete questionnaires (56%) were received. With the use of a special programme, SPSS version 1.5, an overall comprehensive analysis and one by geographical sub-regional groups were performed. RESULTS: When queried about their plans or wishes for their practice between the present time and their age of 65, of the responding physicians, 27% wanted to continue working under the same conditions, 10% were undecided, and 63% wanted to stop or adjust their professional activity before age 65. The main reasons and factors motivating these plans were their current time constraints, the workload related to administrative tasks and the continuity of care; moreover, GPs noted the demands and expectations of patients, professional burnout and difficulties in obtaining a healthy work-life balance as factors contributing to these plans. DISCUSSION: Physicians who wanted to stop practicing (30%) were the least satisfied with their work and seem to have anticipated this plan of action given that they reduced their number of hours in the office and on-call. Those who wish to adapt their work time (33%) are for the most part satisfied even if they work more, but 70% want to reduce their work hours. CONCLUSION: The impact of these projects is a potentially heavy one, especially since two of the counties concerned have a low medical density and high rate of practicing physicians. Government measures currently proposed do not seem to respond to the evolution of private practice expected by GPs over 55 years.

[Medical activities of GPs outside of their medical practice]. / Activités médicales hors cabinet des médecins généralistes.

It is not unusual for many doctors to perform other activities outside of their regular practice, herewith referred to as Activities Outside Medical Office (AMHC). The aim of our work was to identify physicians who practiced AMHC, record and describe these AMHC, as well as understand GPs' motivations to pursue them. The study population was composed of general practitioners in private practice in the department, and physicians in a particular exercise mode (MEP) were excluded. The survey covered 661 GPs in a region of western France; 329 responses (53%) were collected. More male doctors than female doctors reported having at least one AMHC (58% of men versus 33% of women). These activities range from practicing medicine in other establishments, to teaching at a medical school, to providing expert consultations and are mostly underpinned by supplementary training. When these AMHC are seen as more prevalent among older doctors, they sometimes constitute the beginning of a career conversion or change of profession for older professionals who no longer wish to have a full time medical practice. These different kinds of AMHC are diverse, both in terms of the level of investment they require and in terms of their various levels of remuneration. The existence and practice of AMHC seem to serve as a response to the difficulties posed to the practice of general medicine while simultaneously being limited by it. The practice of these activities could be disrupted by changes in medical demography.

[Early suspension of private practice: the current trends for general practitioners in three counties in western France]. / Cessations anticipées d'activité des médecins généralistes libéraux dans les trois départements de l'ouest de la France. Quelle réalité?

The purpose of this study is to conduct a census of general practitioners in order to better understand their early withdrawal from primary care practice and to assess the impact of such withdrawal on current medical demography. The study covers the withdrawals from January 2000 to December 2005 in three western French counties. Data were collected through the district councils of the practitioners'guild, followed by a questionnaire filled in by 75 doctors. The participation rate was 60%. The study reveals that only 29% of these withdrawals are due to retirement. More than one in two doctors left to pursue another paid employment, and more than 25% chose to relocate their practice in a different area of the county. Two thirds of them were practicing in rural or semi-rural locations. Less than half, 47%, were replaced by a successor. General practitioners surveyed did not stop all professional medical care provision and service activities. Their careers are complex, and they are mobile professionals. The main reasons for suspending their activities in a given location were essentially related to the difficulties they had in dealing with their work loads and in maintaining a healthy work-life balance. They have noted that they will leave a range of possibilities open, either looking for private practice or not, exploring the possibility of primary care or not; the basis of their decision is whether a new position will correspond to their desire of mobility and meet their needs for more free.

["Standard precautions" practices among nurses in a university hospital in Western Algeria]. / Respect des "précautions standards" par le personnel infirmier d'un centre hospitalo-universitaire de l'ouest algérien.

Health care workers are exposed daily to blood borne injury and infection with a high risk of hepatitis B or C and human immunodeficiency virus (HIV) transmission. In the 1980s, the US Centers for Disease Control and Prevention (CDC) developed a set of protocols and guidelines known as standard precautions (SP) to prevent accidental transmission of pathogens. The SP should be followed for each intervention or delivery of care in order to protect health care workers from risks associated with contact with blood and other biological liquids. A survey was conducted in a Western Algerian university hospital to assess nurses' adherence to SP practices. A questionnaire was administered to 450 nurses in the hospital workplace setting. A field survey was also conducted in order to take into account the means and support available to the nurses in these hospital departments, namely to determine availability of hand washing and drying facilities. A total of 133 nurses, 81 women and 52 men, participated in the survey. Personal and professional data, hand-washing frequency, glove wearing practices were collected as data. A large majority (95%) of nurses reported washing their hands after removing their gloves, and 69% of them reported washing their hands between two patients. Male nurses wear gloves more often than females (respectively 77% and 53%). Sharp instruments were correctly disposed of in a puncture-resistant container more of the time. Recapping needles has been reported by two-thirds of survey respondents. Lack of liquid soap and alcohol-based washing solution were noted as major deficiencies as well as the lack of means to properly dry hands in many health care wards. Lack of SP adherence is primarily due to the lack of awareness and knowledge as well as insufficient supply of equipment and materials for good hand hygiene maintenance. This study highlights the urgent need to implement a programme to improve SP adherence among nurses and to increase the supply of hand washing and drying materials. Greater adherence to SP practices will also reduce the risk of occupational exposure to blood borne injury and infection.

[Screening for sensory defects in infants: the application of recommendations by GPs in the Maine-et-Loire region]. / Dépistage des troubles visuels et auditifs chez l'enfant. Application des recommandations chez les médecins généralistes du Maine-et-Loire.

Early detection of sight problems and hearing difficulties in babies facilitates better management of treatment by doctors who take care of them. This role is mainly played by general practitioners who conduct obligatory post-natal examinations at 9 and 24 months. A survey was carried out via questionnaire sent to all of the general practitioners from a French department in order to discover more about their daily clinical practice regarding the detection of sensory defects. Twenty nine per cent (n = 321) of them answered the survey. We observe that the clinical examination is not systematic, and that it is mainly carried out when babies are 4, 9 and 24 months old or upon the parents' request. Although clinical symptoms are for the most part well-known by general practitioners, signs of risk factors which might be present are not thoroughly examined. The clinical examination remains general with a broad overview by checking of the main visual reflexes, but with only a superficial examination of the strabismus and amblyopia. The hearing examination is mainly carried out with the use of voice or hand clapping, although two thirds of them have tools for gauging at their disposal. The minimum age required for treating eye trouble and hearing difficulties is not well known by practitioners and the ignorance of that fact can delay the implementation of a good care plan. The new health and medical record system should enable practitioners to more accurately detect sensory disorders in babies. Better dissemination of information and treatment option recommendations is needed.

Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France.

BACKGROUND: Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors. PATIENTS AND METHODS: This study included all patients treated at Angers University Hospital between January 1995 and December 2005 for leptospirosis - both probable (cases combining epidemiologically suggestive features with compatible clinical, laboratory, and radiographic findings, with no other diagnosis envisioned) and confirmed (by finding microorganism on direct examination or culture of blood, urine or CSF, or by seroconversion or by a significant increase in the antibody titer between two samples). Severe leptospirosis was defined by hospitalization in the critical care department or need for renal dialysis. The statistical analysis used SPSS software version 12. RESULTS: Of 97 records reviewed, we retained 62 cases that met the criteria above, including 35 confirmed cases, 27 probable and 15 severe. The sex ratio was nine men for every woman. The patients' mean age was 45+/-18 years [12-77]. The principal clinical signs observed were: fever (n=59) with shivering (n=42), diffuse myalgia (n=41), headaches (n=38), jaundice (n=24), conjunctival suffusion (n=10), rash (n=11), herpes eruption (n=7), renal damage (n=33) that was sometimes severe (>500 micromol/L) (n=7), meningitis (n=12), meningoencephalitis (n=2), myocarditis or pericarditis (n=6), and atypical radiographic lung disease (n=16), sometimes with ARDS (n=6). Blood tests showed thrombocytopenia (platelets<140 G/L) in 65.5% of patients (n=40). Logistic regression modeling showed that two criteria remained independently predictive of development toward severe leptospirosis: clinical jaundice (p=0.005) and cardiac damage seen either clinically or on ECG (p<0.02). These factors can be identified easily at the first clinical examination and during evolution, and should help to reduce mortality by allowing earlier management of patients with suspected leptospirosis.

[Fifty years old and more patients' attitudes towards and experiences of generic substitution of prescription medicines]. / Connaissance et perceptions des médicaments génériques après 50 ans.

OBJECTIVE: Assess 50 years old and over patients' attitudes towards and experiences of generic substitution of prescription medicines. A special focus on information on patient attitude to generic drugs provided by their general practitioners (GPs). METHODS: Prospective study of patients in 15 general practices and in 2 retirements home was surveyed using a self-questionnaire. RESULTS: Four hundred and forty patients were included. Four twenty eleven per cent of the patients stated that they knew of the difference between brand-name drugs and generics but only 57% knew it exactly in fact. Seventy seven per cent had received generics by their GPs; 45% reported to have received information from their physician. The study found that patients who report to have received information from their physician about generic substitution were more likely to have switch. Patient in retirement home more frequently refused substitution. Elderly patients (75 and more) were wrong with generics definition compared with others patients, and observed more adverse effects after switching (20% versus 9%--p=0.027); patients made more mistake using generics than brand-name drugs (15.5% versus 7%--p<0.005); two thirds of the patients (72%) were satisfied with switching, and 57% reported to want more information and 85% of them that it comes from their GPs. CONCLUSION: Most of the patients are satisfied with generics. GPs are in an ideal position to inform their patients adequately about the equivalence of brand-name and generic drugs. Patient education is the best way to use generics in the future. More efforts must be devoted to provide adequate information to patients and GPs.

[Evaluation of care delivered to stroke patients in a French hospital.]. / Evaluation de la prise en charge des patients atteints d'accident vasculaire cérébral (AVC) dans un centre hospitalier.

The aim of this study was to evaluate the quality of care provided in a university hospital to stroke patients with the use of an evaluation of practice carried out by comparing results to the recommendations of the High Authority of Health (HAS). The study period covered two years (2005 and 2006). The study was retrospective based on patients' medical records (n=154), and it compared local medical practices to national guidelines. Significant gaps with the recommended practices were noted, in particular in the prescription of additional examinations and their delay in being carried out. There were also noticeable deficiencies in therapeutic care. Furthermore, there was a certain element of heterogeneity of care in the acute phase of stroke attack within the same hospital service. Establishment of a multidisciplinary medical team including at least two neurologists who are aware of and motivated by evaluation would be an opportunity for this hospital to improve services. In addition, the referral of stroke patients to a specialized service and the implementation of a standardized template card to collect clinical criteria are also proposed.