[Burnout syndrome among third year medical students in Caen: Prevalence and associated factors]. / Syndrome de burn out chez les étudiants en pré-externat de la faculté de médecine de Caen : prévalence et facteurs associés.

BACKGROUND: Burnout syndrome is a reality in health professions. Many studies report a growing and alarming exhaustion among doctors and residents in France. However, medical studies deemed to be stressful, medical students could be also affected by this syndrome. Few studies are conducted in France at this stage of training, so we will focus our study on the sensitivity to burnout syndrome of students in pre-clerkship. METHODS: This is a descriptive cross-sectional study involving 312 students in their third year of medical school in Caen, France. These students answered a questionnaire about their lifestyle and their course, and two pre-established questionnaires, the MBI-test with the emotional exhaustion subscale (EE score) tracking burnout and the GHQ-28 evaluating psychiatric morbidity not psychotic. RESULTS: More than 4 in 10 (42.6%) students had a high EE score and a positive GHQ-28 score. More than one student in two (59.8%) had a moderate to high emotional exhaustion score. Likewise for the GHQ-28 score, 53.4% of students had a positive score. In addition, nearly one in three students (29.8%) felt threatened by burnout. Finally, various factors appeared to be related to burnout: female gender, wanting to stop studying, lack of support or changes in appetite. CONCLUSION: Burnout is a reality and many factors are associated with it. The study has allowed us to study its factors more closely to get a better understanding but many parameters remain uncertain and deserve more investigation. However, we must continue to act and implement care and support for students at risk. In the same way, it is necessary to sensitize and train students for a primary prevention against burnout from the first cycle of medical studies.

Rate of caesarean sections according to the Robson classification: Analysis in a French perinatal network - Interest and limitations of the French medico-administrative data (PMSI).

INTRODUCTION: The objective of our study was to determine, in accordance with WHO recommendations, the rates of Caesarean sections in a French perinatal network according to the Robson classification and determine the benefit of the medico-administrative data (PMSI) to collect this indicator. This study aimed to identify the main groups contributing to local variations in the rates of Caesarean sections. MATERIAL AND METHODS: A descriptive multicentric study was conducted in 13 maternity units of a French perinatal network. The rates of Caesarean sections and the contribution of each group of the Robson classification were calculated for all Caesarean sections performed in 2014. The agreement of the classification of Caesarean sections according to Robson using medico-administrative data and data collected in the patient records was measured by the Kappa index. We also analysed a 6 groups simplified Robson classification only using data from PMSI, which do not inform about parity and onset of labour. RESULTS: The rate of Caesarean sections was 19% (14.5-33.2) in 2014 (2924 out of 15413 deliveries). The most important contributors to the total rates were groups 1, 2 and 5, representing respectively 14.3%, 16.7% and 32.1% of the Caesarean sections. The rates were significantly different in level 1, 2b and 3 maternity units in groups 1 to 4, level 2a maternity units in group 5, and level 3 maternity units in groups 6 and 7. The agreement between the simplified Robson classification produced using the medical records and the medico-administrative data was excellent, with a Kappa index of 0.985 (0.980-0.990). CONCLUSION: To reduce the rates of Caesarean sections, audits should be conducted on groups 1, 2 and 5 and local protocols developed. Simply by collecting the parity data, the excellent metrological quality of the medico-administrative data would allow systematisation of the Robson classification for each hospital.

[Post-transfusion hepatitis C. From screening to compensation]. / Hépatites C post-transfusionnelles. Du dépistage à l'indemnisation.

In France, during the last decades preceding the 1990s, 100,000 to 400,000 blood recipients may have been infected by hepatitis C. Since 1990, thanks to advances in transfusion safety, the risk of hepatitis C contamination has become extremely low. Given the natural history of the disease, it can be a long time unnoticed. Thus, even today, a significant part of infected individuals do not know their serological status. Through several periods and several campaigns, we present the various means used for the detection of post-transfusion hepatitis C at the Caen University Hospital. These methods have been introduced as a result of legislation or through arrangements made by the institution. They were made possible through the action of haemovigilance system, monitoring adverse reactions related to blood products and of blood products traceability which helps to realise special researches in case of suspected transfused blood products. In addition to posttransfusion hepatitis C detection, we are discussing available victim ways to be indemnified for the injury suffered by contamination by hepatitis C.

Direct costs associated with a hospital-acquired outbreak of rotaviral gastroenteritis infection in a long term care institution.

In January 2008, 63 patients were infected during an outbreak of rotaviral gastroenteritis in a long term care facility for elderly patients. The aim of this study was to evaluate the direct financial costs of this outbreak to the hospital. Data on costs were gathered from both medical records and the hospital finance department. The total hospital cost of the outbreak was euro17,959, or euro285.1 per case, comprising: euro4,948 for medical investigation and treatment costs, euro4,400 for isolation, euro1,879 for infection control staff, euro4,170 for other staff and euro2,562 for bed-day loss. The cost of this outbreak emphasises the importance of the early recognition of an outbreak and implementation of infection control measures.

[Hospital hygiene and medical students]. / L'hygiène hospitalière et les étudiants en médecine.

OBJECTIVE: Training in hospital hygiene is essential to prevent nosocomial infections and to promote health care quality. A survey was made on Caen medical students for hand hygiene habits, personal medical equipment, and white coat cleaning as well as on their opinion concerning hospital hygiene training quality. DESIGN: An anonymous questionnaire was submitted to medical students in third, fourth, and fifth year of medical studies. RESULTS: Hygiene was "always" or "often" a priority (94%) when students were working in clinical areas. Nevertheless, nearly half of them (46%) were not aware of the difference between simple hand washing and antiseptic hand washing. The white coat was too large for 50% of students. The white coat was cleaned on average every 3.5 weeks. Only 40% students cleaned their stethoscope regularly and 23% their reflex hammer. At last, 66.5% of students were dissatisfied by hospital hygiene training judged insufficient and unfit for their practice. CONCLUSION: the medical students' general knowledge of hospital hygiene must be improved. Further initial training should improve practices.

Clinical evaluation of a screen pneumotachograph as an in-line filter.

The American Thoracic Society/European Respiratory Society Task Force underlined that the use of in-line filters during respiratory function tests "is an area of controversy". The aim of the present study was to measure the contamination occurring during forced expiration downstream from a screen pneumotachograph (SP) with and without an in-line filter (Pall PF30S). A total of 40 healthy subjects performed eight consecutive maximal expiratory manoeuvres into four sterile apparatuses (A1: no filter, no SP; A2: filter-only; A3: SP-only; A4: filter and SP) in random order. A blood agar plate was fixed downstream from the apparatus. Colony-forming units (CFUs) were counted after 24 h incubation at 37 degrees C. Of the 40 plates obtained with each apparatus, 13 were sterile with A1 (range 0-679 CFUs), 25 with A2 (0-49 CFUs), 30 with A3 (0-35 CFUs) and 39 with A4 (one CFU in the only positive plate). A1 versus A2 and also A3 versus A4 gave different values for the CFU number, but A2 and A3 showed similar contamination levels. The authors conclude that: 1) the in-line filter does not perform better than a screen pneumotachograph; 2) it does not eliminate the need to decontaminate the pneumotachograph; and 3) equipment placed downstream from an in-line filter and a screen pneumotachograph is almost protected from contamination.

Use of censored data to monitor surgical-site infections.

OBJECTIVE: To take into account the proportion of patients lost to follow-up when calculating surgical-site infection (SSI) rates. DESIGN: A multicenter SSI monitoring network in Basse-Normandie, France, using the definitions for SSI of the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. PATIENTS: Between January 1, 1998, and December 31, 1999, 3,705 patients were operated on in 25 units of 10 institutions. RESULTS: Of the patients, 41.2% (range, 5.1% to 95.5%) were seen 30 days or more after their operation. The global SSI attack rate was 2.19% (95% confidence interval, 1.72% to 2.66%). With the use of the Kaplan-Meier method, the incidence rate was 3.11% (95% confidence interval, 3.06% to 3.16%). The difference between the attack rate and the Kaplan-Meier incidence rate for each unit varied according to the percentage of patients seen on or after day 30 postoperatively and the number of SSIs diagnosed in patients seen on or after day 30. CONCLUSIONS: Practice guidelines are needed for the international monitoring for postdischarge SSIs and the calculation of SSI rates. The proportion of patients seen 30 days after their operation is a major quality criterion for SSI monitoring and should be routinely given in monitoring reports, oral communications, and publications to compare results obtained by different teams

Randomized multi-centre trial of the effects of a catheter coated with hydrogel and silver salts on the incidence of hospital-acquired urinary tract infections.

Catheters coated with hydrogel and silver salts have been proposed to prevent hospital-acquired urinary tract infections (UTI). We carried out a randomized, prospective, double-blind multi-centre trial to compare those catheters with classical urinary tract catheters. We included in the study 199 patients requiring urethral catheterization for more than three days: 109 in group 1 (classical catheter) and 90 in group 2 (catheter coated with hydrogel and silver salts). Urine from the patients was tested for 10 days after the insertion of the catheter (reactive dipsticks each day and diagnostic urinalysis every two days). The UTI associated with catheterization was defined on the basis of bacterial and cytological criteria (>10(5)cfu bacteria per mL and >10 leucocytes per mm(3)). Twenty-two UTIs were recorded: 13 in group 1 and nine in group 2. The cumulative incidence of UTI associated with catheterization was 11.1% overall, 11.9% for group 1 and 10% for group 2; the odds ratio was 0.82 (95% confidence interval: 0.30 to 2. 20); the cumulative incidence for UTI, calculated by the Kaplan-Meier method was 36.3 overall, 35.2 in group 1 and 36.0 in group 2; the overall incidence density was 19 per thousand days of catheterization, 21 in group 1 and 18 in group 2. The differences between the two groups were not significant. Overall, we feel that there is not enough evidence to conclude that catheters coated with silver salts and hydrogel give greater protection than classical catheters and to recommend widespread use.

[Nosocomial risk]. / Le risque nosocomial.

The risks of hospital-acquired infection were, for many years, not seriously considered. However, current conditions increase risk, and the intense media and legal interest have led to the issue becoming a major medical concern. Hospital-acquired infections can be considered from four angles: the clinical dimension is the most obvious. It involves hospitalized patients, and to an increasing degree, hospital staff; the economic impact although difficult to assess, is a largely underestimated drain on hospital budgets; the legal problems have been recently highlighted by developments in jurisprudence; finally, there are ethical considerations associated with the behaviour sometimes found among health care workers, as a consequence of workplace risks. In this article we try to define and assess the significance of the major factors. We discuss the validity of various epidemiological and economic tools, and thus highlight the role of hospital-acquired infections in the working of hospitals.

Influence of rural environment on diagnosis, treatment, and prognosis of colorectal cancer.

STUDY OBJECTIVE: Several studies have shown that residential location (urban or rural) influences the incidence of colorectal cancer. The aim was to investigate the influence of rural environment on colorectal cancer history and survival in a well defined population. DESIGN: Patients with colorectal cancer diagnosed in the department of Calvados (France) were classified by place of residence (urban/rural) and information on clinical symptoms, tumour extension, treatment, and survival was collected. SETTING: The study was population based, in the department of Calvados in France. PATIENTS: During 1978-1984, 1445 colorectal cancers were collected by the Digestive Tract Cancer Registry of Calvados, 1047 with an urban place of residence (544 males and 503 females) and 284 with a rural place of residence (134 males and 150 females). MEASUREMENTS AND MAIN RESULTS: In both sexes, rural patients with colorectal cancers were treated less frequently in a specialised health care centre (40.0%) than patients from an urban population (53.4%). The difference was mainly but not entirely explained by distance from the specialised health care centre. In females in the rural population, cancers were diagnosed more frequently at the stage of severe clinical symptoms (22.1%) and metastases (18.8%) than they were in the urban population (15.5% and 12.3%). In addition among females a rural environment appeared to confer a worse prognosis (relative risk = 1.3). CONCLUSIONS: Our findings suggest an inequality between rural and urban populations, especially for women. The loneliness of rural women leads to a delay in diagnosis and worse survival. In health education campaigns on colorectal cancer, efforts must be made to provide medical information to rural women in order to reduce the delay in diagnosis and improve survival.

[Phenylketonuria: new questions for another generation]. / Phénylcétonurie: de nouvelles questions pour une autre génération.

Young women with phenylketonuria are at risk of bearing children with mental retardation. It results from the effects of the mother's elevated blood phenylalanine on the developing fetus. These effects may be prevented if a low phenylalanine diet is maintained prior to and throughout pregnancy.

[Resistance of hospital flora to imipenem. Experience in two intensive care units]. / Résistances à l'imipénème de la flore hospitalière. Expérience de 2 services de réanimation.

Imipenem is a beta-lactam antibiotic active against most Gram-negative bacilli. Between July 1, 1987 and September 30, 1989 (9 semesters), the activity of imipenem against 6 micro-organisms was tested in two intensive care units attached to the university hospital of Caen (Normandy). During the same period, the consumption of imipenem was evaluated from the number of vials drawn by each of these two units from the central pharmacy. Imipenem was found to be 100 percent effective against 5 of the 6 micro-organisms tested, but transient falls in sensitivity and an increase in imipenem consumption were observed when Pseudomonas aeruginosa was the pathogen. The most probable cause of these transient decreases of imipenem activity against Ps. aeruginosa was the existence of a resistant strain which showed a protein abnormality in its outer membrane by temporary selection pressure.

Septicemia caused by contaminated parenteral nutrition pouches: the refrigerator as an unusual cause.

Eleven patients in a hospital presented with septicemia caused by Enterobacter cloacae. The origin was the contamination of parenteral nutrition admixture from a resting place in the refrigerator of the parenteral mixture preparation room.

Comparison of vaginal examination findings in two antenatal clinics.

Findings of routine vaginal examinations during pregnancy were compared in two teaching hospitals located in the same area of Paris. We selected 2943 women who had had at least one antenatal visit between 29 and 31 weeks of gestation. Large differences in the frequency of maturation signs were observed between the two hospitals for mid-position, soft consistency and expanded lower uterine segment, although the higher frequency of each sign was not found in the same hospital. No difference was observed for dilatation of the internal os. A better reliability in assessing dilatation than other signs of maturation may explain our results and the role of dilatation in the prediction of preterm delivery.

Changing trends in preterm childbirth.

Progress in perinatal care has been accompanied recently by increasing numbers of induced premature deliveries because of fetal distress. This is confirmed by study of 26,796 consecutive births in the Caen Hospital Group between 1980 and 1987. Study of the fate of these children shows that this attitude has not led to any excess mortality when the share of the IPD before 32 weeks are regularly growing. This would imply that the prematurity rate is no longer a sufficiently accurate epidemiological index for the evaluation of prenatal care policies.

Female urinary incontinence: comparative value of history and urodynamic investigations.

In order to identify the role of urodynamic investigation in relation to urinary symptoms, the authors assessed the diagnostic value of history and of urodynamic investigation in female urinary incontinence. 154 patients presenting with urinary incontinence were investigated prospectively, by standardised history and investigation of bladder stability and investigation of bladder stability and of cervico-urethral closure function. Clinical and urodynamic diagnostic conclusions were compared. Urodynamic results were highly discordant in the presence of clinical 'erethism', whilst agreement was more marked in the case of stress incontinence. Urodynamic investigation may be indicated after failure of medical treatment in the case of 'dysfunction'. By contrast, it is essential in stress incontinence in order to identify the mechanism or detect subclinical 'dysfunction'.