[Evaluation of 114 abnormal Pap smear follow-up in ambulatory care.] / Évaluation du suivi de 114 femmes ayant présenté un frottis cervico-utérin pathologique en ambulatoire.

AIM: In France, cervical cancer screening has led to a decrease in mortality, though it could be optimized by improving the management of abnormal cytology. The aim was to evaluate the follow-up of women with abnormal Pap smear prescribed by an ambulatory health professional, compared to the ANAES guidelines of 2002. METHOD: Quantitative monocentric and retrospective study of 120 women with abnormal Pap smear performed before October 2014 in the French department of the Loire. RESULTS: 114 abnormal Pap smear follow-ups of women between the ages of 18 and 75 have been analyzed. Cytological abnormalities were spread among 90 ASC-US (79%), 16 LSIL (14%), 6 HSIL (5,3%) and 2 ASC-H (1,7%). Compared to the ANAES guidelines, 52% of follow-ups were incomplete, 24% were comprehensive with too long of a delay, and 24% were guidelines compliant. Women under 29 were more likely to have an incomplete follow-up: OR 0,306 [0,116-0,805]. CONCLUSION: In our sample, the analysis of the follow-ups of women with abnormal Pap smear has reflected over screening and lack of conformity, eventually allowing the screened lesion to progress towards cancer. A national screening program could help to improve the quality of a follow-up for these women.

Vaccination errors in general practice: creation of a preventive checklist based on a multimodal analysis of declared errors.

BACKGROUND: Vaccination is a common act in general practice in which, as in all procedures in medicine, errors may occur. To our best knowledge, in this area, few tools exist to prevent them. OBJECTIVE: To create a checklist that could be used in general practice in order to avoid the main errors. METHODS: From April to July 2013, we systematically searched for vaccination errors using three sources: a review of literature, individual interviews with 25 health care workers and supervised peer review groups meeting at the Medicine school of Saint-Etienne (France). The errors most frequently retrieved were used to create the checklist that was regularly submitted to interviewed caregivers to improve its construction and content; its stabilization has been conceived as an evidence of finalization. RESULTS: The checklist's draw-up included three parts allowing verification at each stage of the vaccination process: before, during and after the vaccine administration. Before the vaccination, items to be checked were mainly does my patient need and may he/she receive this vaccine in accordance with the national French vaccination guidelines? During the preparation and the administration of vaccination, items to be checked were are the patient and the practitioner comfortable? Is all the material needed correctly prepared? Is the appropriate route defined? Ultimately, after the vaccination, most items to be checked concerned traceability. This checklist seemed useful and usable by the panel of practitioners questioned. CONCLUSION: This vaccination checklist may be useful to prevent errors. Its efficacy and feasibility in clinical practice will require further testing.

[Perception of adverse reactions of chemotherapy and hormone therapy by women treated for breast cancer]. / Perception des effets indésirables de la chimiothérapie et de l'hormonothérapie par les femmes prises en charge pour un cancer du sein.

INTRODUCTION: In Europe, breast cancer is the most common cancer among women. His treatment (TTT) can have a significant impact on daily life. AIMS: Explore the experienced short-term side effects (SE) of chemotherapy and hormonal therapy by women themselves, the information delivered and the place of the general practitioner (GP). METHOD: Qualitative study by individual interview, conducted from January to May 2015, with 14 women followed for no metastatic breast cancer after chemotherapy and possible initiation of hormone therapy, at the Cancer Institute of the Loire (France). RESULTS: The SE of chemotherapy, except vomiting, have appeared very trying (fatigue, pains oral and cutaneous involvement), punctuated and accentuated by the cures. They were resounding on daily life, requiring family or professional assistance. Falling dander, considered stigmatizing, violated the person and femininity. The women have estimated to be well informed. They had appreciated the initial response of the pivot nurse. The least expected SE of hormone therapy, hot flashes and articular pains might limit activities. To counteract these side effects, mostly accepted to prevent recidivism, a remedy for complementary therapies was frequent. The GP was solicited for some SE, sometimes for complementary medicine (CM). CONCLUSION: Over the cures, women suggested support meetings, a more sustainable action of the pivot nurse, a better attention to their complaints and a more personalized information. The development of TTT less EI provider was desired. The effect of CM on SE should be explored.

[Experiences of main caregivers helping patients suffering from lung cancer and position assigned to general practitioners]. / Vécu des aidants principaux de patients traités pour cancer broncho-pulmonaire et place attribuée au médecin généraliste.

INTRODUCTION: Cancer turns into a chronic disease. Its impact on patient's daily life may require the assistance of caregiver. AIMS: To explore the experiences of main caregivers (MCs) helping patients suffering from lung cancer (LC), and to explore the role and the position assigned to general practitioners (GPs). METHOD: Qualitative study using semi-directive interviews with 13 PCs, recruited in Roanne's hospital and the Cancer Institute Lucien-Neuwirth (Rhône-Alpes), conducted from February to May 2014. RESULTS: MCs' life was affected on a social, family, and professional level. Despite a need of listening and support, they remained behind, by devotion. GPs' were care managers, and were found out empathic, compassionate and reassuring. Present at the cancer announcement and viewed as an actor at the end of life, their functions were variable, following MCs during the treatment phase. During this phase, some of them perceived that lack of time, expertise and/or information seemed to be an obstacle to their solicitations. CONCLUSION: GPs' regular care could improve MCs' quality of life. Telemedicine could facilitate communication between GPs and hospital staff asked by the MCs.

[Death certification and general practitioners: opinion about propositions of improvement. Qualitative survey conducted among 14 general practitioners in the Loire]. / Certification de décès et médecins généralistes: opinions sur les propositions d'amélioration. Enquête qualitative réalisée auprès de 14 médecins généralistes de la Loire.

Death certificates are one of the sources of national mortality statistics and allow for an evaluation of public health. General practitioners regularly certify deaths but studies revealed that they had difficulties in doing it. Propositions were made to improve death certification. The objective of our study was to know family physicians opinion about death certification and about those propositions. A qualitative survey was conducted through the analysis of 14 general practitioners' interviews. Our study confirmed that family physicians had difficulties completing death certificates. It also revealed that some propositions were rejected: to go rapidly to the deceased (with a few exceptions), whole and systematic body examination, call of regular doctor, notification of violent or suspect deaths according to official texts. The reasons were practical, technical, ethical and personal, or related to an obviously natural death (especially for elderly people). Majority of general practitioners rejected electronic death certification because they found it unpractical. Other propositions were approved: a reminder, written on the death certificate, of all situations that need to be referred to a coroner, intervention of forensic pathologists for some complex cases. In our study, family physicians seem to refuse to investigate patients' death. Therefore, better collaboration between forensic pathologists and general practitioners is of prime importance: it could be organized through easier access to specialists when necessary or through an informative booklet, as suggested by some doctors in our study. The validity of these propositions needs to be confirmed.