[Maternal mortality and health care organization in France 2016-2018]. / Mortalité maternelle et organisation des soins en France 2016­2018.

Organization of care is one of the elements examined when assessing cases. Organization of care is a factor, which is considered in addition to the content of care when assessing mortality cases. The factors related to the organization of care concern the suitability of the place of care, the completion of a necessary transfer, the adequacy of human and material resources, and the communication between caregivers. For the 2016-2018 triennium these preventability factors are the subject of a dedicated chapter. Overall, one or more preventability factors linked to the organization of care were reported in 51 cases, i.e. 24% of all assessed cases. The field of communication was the most frequently reported (32/51), followed by inappropriate place of care (20/51), insufficient human resources (13/51), transfers not performed or performed late (11/51) and insufficient material resources (9/51). An overall analysis can be made along two dimensions: organization within the maternity unit, and coordination with other sectors or outpatient medicine. Areas for improvement within the maternity unit relate to the ability to deal with life-threatening emergencies, to organize the call for specialized and/or trained human reinforcements, to organize intensive monitoring of patients in the event of organ failure, and to facilitate good communication between caregivers. Regarding coordination with other units, it is proposed to improve collaboration between the maternity unit's emergency department and the general emergency department, and to improve the transfer of information required by all those involved, including primary care physicians, in the pre-, per- and postpartum period. Finally, the place of care for patients presenting with a psychiatric and somatic pathology is a situation that requires careful consultation.

Organization of French outpatient psychiatric clinics and delay to appointment.

OBJECTIVES: The goals of the study were to obtain a glimpse of the several types of organization of outpatient psychiatric clinics, as well as an overview of delays between a request for and the first appointment. We also look at geographical variability of appointment scheduling delays and assess the impact of the number of new applications on delays. METHODS: We analyzed information collected from a phone survey conducted with the 103 adult outpatient psychiatric clinics of the French region Hauts-de-France. This survey had a one-week inclusion period in November 2022 and focused on the organization and delays before obtaining an appointment. RESULTS: This study indicates that organizations seem to be homogeneous. Eighty-one outpatient psychiatric clinics (96.4%) receive with scheduled appointments. The initial evaluation by a nurse followed with a proposal for the organization of care seems to be the common practice. It also appears that primary psychiatric structures were capable of providing a response within a reasonable time frame in making a first appointment with a mental health professional. On the other hand, delays were much longer and heterogeneous for first appointments with psychiatrists and psychologists. CONCLUSIONS: The organizations of the outpatient psychiatric clinics of the French region Hauts-de-France seem homogeneous. The evaluation by a nurse followed with a care proposal is the common practice. Primary psychiatric structures are able to provide a response within a reasonable time, with half the centers proposing an appointment with a nurse within 10.0 days.

[Follow-up strategies for lung transplant recipients in France]. / Suivi partagé des patients transplantés pulmonaires.

BACKGROUND: Lung transplantation (LT) requires sustained care for a frequently polypathological condition. Follow-up is focused on three main issues: 1/stability of respiratory function; 2/comorbidity management; 3/preventive medicine. About 3000 LT patients in France are treated in 11 LT centers. Given the increased size of the LT recipient cohort, follow-up might be partially shared with peripheral centers. METHODS: This paper presents the suggestions of a working group of the SPLF (French-speaking respiratory medicine society) on possible modalities of shared follow-up. RESULTS: While the main LT center is tasked with centralizing follow-up, particularly the choice of optimal immunosuppression, an identified peripheral center (PC) may serve as an alternative to deal with acute events, comorbidities and routine assessment. Communication between the different centers should be free-flowing. Shared follow-up may be offered from the 3rd postoperative year to stable and consenting patients, whereas unstable and non-observant patients are poor candidates. CONCLUSION: These guidelines may serve as a reference for any pneumologist wishing to effectively contribute to follow-up, even and especially subsequent to lung transplant.

[Organization of the health system in the region to meet the needs of patients Covid long]. / Organisation du système de santé en région pour répondre aux besoins des patients Covid long.

Under the impetus of the Regional Health Agencies, the organization of the health system was redeployed throughout the health crisis linked to Covid-19. Mostly supported by coordination support mechanisms, post-Covid coordination units were activated in 2021 in each region, at the departmental level, to meet the needs of professionals and users. This article reports on the deployment of the Covid long devices in the Occitanie region.

[Promoting the quality of sleep of hospitalized elderly people]. / Favoriser la qualité de sommeil des personnes âgées hospitalisées.

The geriatric care teams are particularly invested in preserving the sleep of elderly patients as much as possible. Some specific cares implemented by the night teams can contribute to this. In a geriatric service at the Grenoble University Hospital (38), care manager, nurses and nurse's aides organize theirs actions in order to preserve patients' rest.

[Telemedicine from experimentation (ETAPES) to COVIDOM a new era ?] / La télémédecine, d'ETAPES à COVIDOM vers une nouvelle ère ?

Telemedicine has been recognized since 2010 as a constitutive element of care, however, it was not until 2016 that the first national experiments were able to be launched with the aim of validating a framework allowing a possible rapid passage in the common right. These experiments, which are due to end in December 2021, have succeeded in involving more than 100,000 patients, mainly suffering from cardiac pathologies. The arrival of COVID-19 has made it possible to measure the usefulness of practices at a distance both from teleconsultation and telemonitoring, with the appearance of organizational and technical innovations that must now be maintained and developed in order to integrate the telemedicine of tomorrow into our actual medicine.

[Recommendations and management in Home Blood Transfusion: Levers, brakes and prospects]. / Recommandations et prise en charge transfusionnelle en HAD : leviers, freins et perspectives.

In our roles as regional coordinator for haemovigilance and transfusion safety (RCHTS - CRHST), Correspondant for haemovigilance in a medical and surgical obstetrics/hospital home care centre (MSO/HHCC-MCO/HAD) and a doctor responsible for haemovigilance in HHC, we shared our interdisciplinary viewpoints and compared our practices in an attempt to gain a better understanding of the factors that hinder and facilitate the development of blood transfusion in HHC. Despite the revaluation of tariffs for blood transfusion in HHC (effective since March 2018), and the widespread circulation of recommendations for good practice in the transfusion of packed red blood cells in HHC (April 2018), this sector is still struggling to develop. On completing our analysis, we were able to demonstrate that while our institutional and regional work continues to be essential, the power to move things forward now lies in the hands of a national authority. In our opinion, using this power would give strong, national recognition of the vital role which HHC played at a nationwide level throughout the recent health crisis.

[Development of a psychiatric care facility into a Covid unit]. / Aménagement d'une structure de soins psychiatriques en unité Covid-19.

Covid-19 did not spare the psychiatric care services. At the Sainte-Anne Hospital, as in the medicine-surgery-obstetrics departments, several care units had to be transformed and organised in order to accommodate positive patients who did not need to be admitted to intensive care. Feedback on the transformation of a care structure of the "Clinique des maladies mentales et de l'encéphale" for more than two months.

[Reception of patients with chronic renal failure, COVID-19]. / Accueil des patients insuffisants rénaux chroniques et Covid-19.

The renal disease center of the university hospital of Caen Normandy (14) is dedicated to the ambulatory care of patients with chronic renal disease, including those treated by dialysis or transplanted. These are fragile patients and, for many of them, coming to the center is inevitable for their care. Faced with the COVID-19 pandemic, the care teams have shown a great capacity to adapt, even to be creative, in order to welcome and care for them in optimal safety conditions.

[COVID-19 and patients with cancer: Experiment of a French comprehensive cancer center]. / Première vague COVID-19 : expérience d'un centre de lutte contre le cancer.

The emergence of the Coronavirus Disease 2019 (COVID-19) has caused profound upset in health systems around the world. As cancer patients seem to be at greater risk, the organization of oncological care had to be adapted. We first report the progress of the "first wave" of COVID-19 at the Institut Curie, a French comprehensive cancer center, by describing the measures implemented to limit the risk of transmission of COVID-19 while ensuring as much as possible the continuation of anticancer treatments. Then, we present the results of a prospective institutional database in which the characteristics and outcome of our patients with cancer and suffering from COVID-19 were collected. From March 13 to April 25, 2020, 141 patients followed at Institut Curie for cancer developed COVID-19, of which 26 (18%) died from it. The minimum incidence of COVID-19 in Institut Curie is estimated at 1.4% over this period. No risk factors for developing a severe form of COVID-19 related to cancer have been identified. Cancer patients do not appear to be at greater risk of developing COVID-19, nor of having a more severe form than the general population. With the current increase of COVID-19 cases, it seems essential to share the experience already acquired to minimize the impact of this crisis on the long-term outcome of patients followed for cancer.

[Ensuring continuity of cancer treatment despite the COVID-19 epidemic]. / Assurer la continuité des traitements anticancéreux malgré l'épidémie de Covid-19.

A real organisational challenge for the teams working alongside people being treated for cancer, the continuity of treatment and care has mobilised all those involved in care since the beginning of the COVID-19 epidemic. To ensure the safety of these patients, who are more vulnerable due to their illness, and to ensure that they do not lose any chances against their cancer, the care providers of the Lyon Regional Cancer Centre have innovated and adapted their practices, both in the city and in the hospital.

[Temporality in nursing research: a metronome for the benefit of quality?] / La temporalité en recherche infirmière, un métronome au profit de la qualité ?

Time is a key element of the nursing research process, notably because it is lacking in daily life and is subject to strict regulations. Engage in a nursing research project thereby forces the researcher to review the time available, to rethink nursing practice. It can therefore prove to be a useful tool in the organisation of are and the improvement of practices.

[Responsiveness and sustainability of psychiatric care in France during COVID-19 epidemic]. / Réactivité et pérennité des soins psychiatriques en France à l'épreuve du COVID-19.

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.

[Childhood cancer in part of France: Key issues and organization of care in Corsica island]. / État des lieux des maladies onco-hématologiques pédiatriques en Corse et organisation des soins.

INTRODUCTION: In France, the management of pediatric cancers is carried out in reference hospitals that can delegate care to local health centres (LHC), forming "care networks". There is no LHC in Corsica, forcing children and their families to leave the island for all care in the reference centre. The aim of this study was to describe the situation in Corsica and to consider this organisation. METHODS: This is a descriptive preliminary study based on databases from the National Childhood Cancer Registry, "RHeOP" network and a patient questionnaire. We included over a period of 10 years all children with onco-hematological disease who resided in Corsica. RESULTS: The incidence of pediatric cancers since 2005 ranged from 5 to 12 new cases per year. The hospital centre of Timone (Marseille) was the reference centre for 73% of patients, followed by Nice University Hospital for 14%. Almost all the parents interviewed (90%) were in favour of creating an LHC and all of them highlighted many difficulties that, according to them, could be improved by the presence of a LHC in Corsica (organisation of travel, delay and distance from home…). However, there currently appears to be a lack of training for medical and paramedical staff to provide quality second-line care. CONCLUSION: The rates of pediatric onco-hematological diseases in Corsica may warrant the creation of an LHC on the island. Additional cost studies on the feasibility of an LHC in Corsica are needed to optimise the care and quality of life of these children and their families.

[Proton therapy in France in 2019]. / État des lieux de la protonthérapie en France en 2019.

Among over 100 proton therapy centres worldwide in operation or under construction, French proton therapy is coming to full maturity with the recent opening of the Nice (1991, upgrade in 2016) and Caen (2018) facilities next to the Orsay (1991, upgrade in 2010) centre. Proton therapy is a national priority for children and young adults in all three centres. The patient-related activity of the three French centres is coordinated via the Protonshare portal to optimise referral by type of indication and available expertise in coordination with the French society of radiation oncology SFRO and French radiotherapy centres. The centres are recognised by the French Health Care excellence initiative, promoted by the ministry of Foreign Affairs. The three centres collaborate structurally in terms of clinical research and are engaged at the international level in the participation to European databases and research initiatives. Concerted actions are now also promoted in preclinical research via the Radiotransnet network. Ongoing French developments in proton therapy are well presented in international hadron therapy meetings, including European Proton Therapy Network and Particle Therapy Cooperative Oncology Group. Proton therapy teaching in France is offered at several levels and is open to colleagues from all radiation oncology centres, so that they are fully informed, involved and trained to facility recognition of possible indications and thereby to contribute to appropriate patient referral. This close collaboration between all actors in French radiation oncology facilitates the work to demonstrate the required level of medical and scientific evidence for current and emerging indications for particle therapy. Based on that, the future might entail a possible creation of more proton therapy facilities in France.

[The perception of liaison psychiatry by the medico-chirurgical services]. / La perception de la psychiatrie de liaison par les services médico-chirurgicaux, Fès, Maroc.

INTRODUCTION: Research addressing the perception of liaison psychiatry by caregivers is still limited in Morocco. Collaboration between practitioners in liaison psychiatry is necessary, and the perception of physicians influences their implications in liaison psychiatry. OBJECTIVES: To evaluate the perception of this activity among the various medical and surgical units, determine the involvement, level of collaboration and expectations of practitioners, as well as the difficulties and constraints encountered. METHODOLOGY: A survey was carried out among medical personnel at the Hassan II University Hospital Centre in Fez in 2016, through a self-questionnaire determining the perception and position of carers with regard to liaison psychiatry. The data are collected using an anonymous self-administered questionnaire, consisting of 27 items. We included in this study a targeted population: interns, residents and professors. RESULTS: The total population of caregivers participating in this survey was 615 physicians, including 111 professors, 436 residents, and 68 interns. The participation rate was 80.32%. The average age was 30.25 years, with 47.6% (236) women and 52.4% (258) men. The percentage of doctors who obtained their doctorates in medicine in Morocco was 89.3% (85.9% at the Faculty of Medicine in Fez) and 92.3% had received a unique internship in the psychiatry department during their university studies, while 98.7% never received any continuing training in the field of psychiatry. Half of responding physicians reported difficulties in managing psychiatric disorders diagnostically, and 59.5% (292) reported difficulties in treating patients with psychiatric disorders, while 90% (444) reported that they are unable to provide therapeutic follow-up. Only 35.6% of the doctors surveyed were informed about the establishment of liaison psychiatry, but only 10% of these doctors were informed about the procedure for requesting a psychiatric opinion. Faced with a psychiatric disorder, 98% of doctors managed the situation by seeking psychiatric advice, 87.1% considered this request urgent. The reasons for not soliciting q psychiatrist were divided between difficulties in identifying a psychiatric disorder (51%) and difficulties in requesting an opinion (49%). CONCLUSION: Our study showed several difficulties perceived by practitioners, whether in the diagnosis, treatment or follow-up of patients with psychiatric manifestations. Collaboration between different practitioners is an indispensable element of patient management. Improving knowledge through awareness-raising and the organization of scientific days bringing together the different specialties will help to improve doctors' perceptions.

[Assessing the contribution of the advanced practice nurse]. / Évaluer la contribution de l'infirmier en pratique avancée.

An assessment of the impact of advanced practice will be presented to the French parliament in 2021. Advanced practice nurses must make use of this opportunity. Indeed, this assessment is likely to come with major challenges in terms of the reorganisation of the healthcare provision following the implementation of this new function. The definition of adapted indicators is essential.

[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. / Ressources humaines pour les activités non programmées en gynécologie-obstétrique. Propositions élaborées par le CNGOF, le CARO, le CNSF, la FFRSP, la SFAR, la SFMP et la SFN.

OBJECTIVE: To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS: Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS: Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION: These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.