[Determination of full blood count normal reference values for adults in France]. / Étude des valeurs normales de l'hémogramme chez l'adulte: un besoin pour une meilleure interprétation et pour l'accréditation du laboratoire.

The full blood count (FBC) is the most prescribed laboratory test in France. Due to the lack of data, there is a great variability in reference values of the FBC, between medical laboratories. The aim of this work was to provide normal reference values for FBC in adults. These normal values were defined in a population of 33 258 healthy adults, 19 612 men and 13 646 women. These values were determined after excluding subjects having conditions in order to modify, either directly or indirectly, FBC parameters. For each parameter, we provide results for values of standard parameters, by sex and age, from 16 to 69 years. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. These normal values are proposed to be used in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they can be applied to the entire metropolitan France.

Full blood count normal reference values for adults in France.

AIMS: To determine full blood count (FBC) normal reference values for adults. METHODS: FBC normal values for healthy adults were defined, after establishing preanalytical conditions, in a population of 33 258 subjects, 19 612 men and 13 646 women. The values were established after excluding from this population all people having conditions liable to modify, directly or indirectly, FBC parameters. RESULTS: Results for values of standard parameters are provided in detail for each parameter, by sex and by age group from 16 to 69 years of age. In addition, we present FBC values from a population of 339 subjects aged over 69 years with no comorbidities. CONCLUSIONS: These normal values are proposed for use in everyday practice. They make it possible to distinguish, without ambiguity, a normal situation from a pathological situation. Moreover, they might be used over all mainland France.

[Heterogeneity in the handling of vitamin-K-antagonists and of INR: the example of Quercy-Rouergue]. / Hétérogénéité du maniement des antivitamines K et de l'INR : l'exemple du Quercy-Rouergue.

Using a questionnaire, we have evaluated how VKA and INR are handled by medical doctors in Quercy-Rouergue. This evaluation is part of an international post-analytical quality assessment survey in laboratory medicine supervised by Noklus (http://www.noklus.no/). The original questionnaire designed by Noklus has been adapted to our local practices in replacing warfarin by fluindione. The « Centre de référence et d'éducation aux antithrombotiques d'Ile de France ¼ (Creatif) also participated. Of 282 medical doctors who were sent the questionnaire 109 filled it in, 62% of them being general practitioners. For a target INR at 2.5, the thresholds used to change the dose of VKA range between 1.3 and 2.3 for low values, and between 2.8 and 4 for high values. The bleeding or ischemic risks of being under VKA, versus of not being under VKA, are largely overestimated. INR measurements also tend to be too frequent in stable, and even more so in overdosed, patients. In case of INR at 4.8 only 59% of the participants implement the recommendation of la Haute autorité de santé (HAS) and le Groupe d'étude sur l'hémostase et la thrombose (GEHT) which consists of skipping one dose of VKA, and the attitudes also diverge regarding the importance of the VKA dose reduction, and the number of days under reduced dose before the next INR measurement, the attitude of the Creatif being barely predominant among the participants, and slightly different from that recommended by the HAS and the GEHT. In conclusion, despite the limitations of our methods (the analysis of a questionnaire being less close to the truth than an analysis of actual practices), our evaluation points to the heterogeneity in the knowledge about, and in handling, VKA and INR regarding more particularly management of overdosing, and the estimation of bleeding or ischemic risks, despite the availability of supposedly clear and simple practice guidelines.

Critical Appraisal of Microbiology Guidelines Endorsed by two Professional Organisations: Société Française De Microbiologie (SFM) and American Society of Microbiology (ASM).

Medical practice guidelines (GLs) being tools that are mainly designed to evaluate medical professionals, it sounds logical, and fair, that professionals should in turn evaluate GLs. Microbiology being a medical discipline, we used the AGREE instrument, i.e. an established evaluation tool for GLs, in order to evaluate the quality of two major microbiology guidelines, i.e. the SFM GLs and the ASM GLs). Both guidelines remain sub-optimal in their levels of quality, and obtain scores that are not very different from the average scores obtained by many other guidelines in various medical disciplines. We therefore believe that both guidelines need to be modified before they can be recommended without provisos. A higher degree of multi-disciplinary work, including a more formal implication of methodologists, as well as of infectious disease clinicians, and of economists, might perhaps enable future editions of these guidelines to reach higher levels of quality.

[Evaluation of the AFSSAPS clinical practice guidelines on prevention and treatment of thrombo-embolic disease in medicine (2009), in comparison with those of the American College of Chest Physicians (ACCP 2008) with the help of the AGREE tool]. / Évaluation du référentiel de l'Afssaps sur la prévention et le traitement de la maladie thromboembolique veineuse en médecine (2009) par comparaison à celui de l'American College of Chest Physicians (ACCP 2008) à l'aide de la grille AGREE.

We have evaluated the methodological quality of the AFSSAPS French clinical practice guidelines on prevention and treatment of thrombo-embolic disease in medicine, published in 2009. We have evaluated in parallel the similar recommendations from north-America on the subject (ACCP 2008). Our evaluation tool was the AGREE instrument which is consensual at an international level, in particular at the WHO (World Health Organisation) and at the European Union. The methodological quality of the AFSSAPS guidelines is sub-optimal, significantly lower than that of the ACCP guidelines. Compared with the ACCP guidelines, the weakest points of the AFSSAPS guidelines are about rigor of development (AGREE domain 3), applicability (AGREE domain 5) and editorial independence (AGREE domain 6). The main common shortcoming in quality of both guidelines is about lack of stakeholder involvement (AGREE domain 2). A more important implication of methodologists might explain why the ACCP guidelines reach a higher level of quality than those of the AFSSAPS guidelines. We do not make judgments about the content of the recommendations of the AFSSAPS or of the ACCP.

[Evaluation of the methodological quality of the Rémic (microbiology guidelines - bacteriology and mycology) of the Société française de microbiologie]. / Évaluation de la qualité méthodologique du Rémic (référentiel en microbiologie médicale - bactériologie et mycologie) de la Société française de microbiologie, 3(e) édition (2007).

We have evaluated the methodological quality of the Rémic (microbiology guidelines - bacteriology and mycology) of the Société française de microbiologie (edition2007), using to AGREE criteria, which are consensual at an international level, in particular at the the World Health Organisation (WHO) and at the European Union. The methodological quality of the Rémic appears to be sub-optimal. These shortcomings in quality are mainly observed in AGREE domain n° 5 (applicability), in AGREE item n° 5 (patients' opinions were not considered), and in AGREE item n° 23 (conflicts of interest were not declared). The users of the Rémic must be aware of these few methodological shortcomings in order for them to be careful before they put its recommendation in practice. In conclusion, we advise the editors of the Rémic to insert at least a methodological chapter in their next edition.