Speculum self-insertion: an alternative method for gynaecological examination?

BACKGROUND: Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. AIM: This study investigates the women's views and healthcare providers' experiences of the self-insertion method. METHOD: A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. RESULTS: Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor-patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. CONCLUSION: The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique.

The use of a speculum is common in gynaecological consultations and most women are likely to encounter this tool during a medical examination. Several studies have already shown that this examination can cause pain and anxiety. Speculum self-insertion is not widely used and consists of allowing the woman to insert the speculum herself while being assisted by the practitioner. A study was conducted with 10 women and 13 healthcare providers to evaluate this technique and its impact on women's healthcare. This technique reduces the discomfort that can be felt during the examination. The woman will regain control of her body during the examination and this technique will reduce the hierarchical relationship felt by some women. A discussion about the gynaecological examination and women's healthcare is created during the consultation. Even if this technique does not seem to be suitable for all women, routinely offering self-insertion allows the healthcare provider to adapt to each woman and to her choice. The proposal of speculum self-insertion is an alternative technique that can improves women's feelings and their overall health.

Éducation précoce pour les enfants Sourds : les effets du dépistage à Saint-Étienne.

BACKGROUND: Launched in 2014, the national screening program for permanent neonatal deafness has reconfigured the care of Deaf children. By bringing forward the age of the start of care, it promotes language development and allows these children to be referred to dedicated services more quickly. OBJECTIVE: In this context of epidemiological reorganization and technological change (cochlear implantation in particular), the Family Support and Early Education Services of the Loire (Safep 42) propose a reflection of the type “evaluation of professional practices” around the mediations proposed in its service and the “educational garden” framework. METHOD: This mixed-method work combines composite data: activity reports, observations, interviews, experience capture, evaluation of professional practices. RESULTS: A decrease in the age of entry (linked to early detection) and an increase in the age of exit (due to the prevalence of children with associated disorders or complexity factors) led Safep 42 to adapt by creating new mediation, while maintaining the support provided for older children, particularly the educational garden. Safep is currently reaching its maximum capacity: in addition to this tension, there is a shortage of outpatient speech therapists and an increase in the number of deafness situations associated with multiple disabilities. The service has had to give up some of its tasks in order to be able to continue to provide proper care for the children in its care. DISCUSSION: The rehabilitation and family support program is accompanied by a longer period of care for the children and this data must be recorded by the funding authorities.

What interventions do firefighter nurses carry out? / Quelles interventions effectuent les Infirmiers Sapeurs-Pompiers ?

INTRODUCTION: With the rarefaction of home medical visits, prehospital emergencies are ensured by the Mobile Emergency and Resuscitation Structures (SMUR) and the Firemen accompanied by Firefighters Nurses (FfNs). PURPOSE OF RESEARCH: The main objective of this work is to describe the pathologies managed by the FfNs of the Loire district according to their International Classification of Primary Care version 2 and the Clinical Classification of Diseases of the initial SMUR during all interventions performed in 2019. The secondary objective will be to determine the associated Emergency Care Nursing Protocols (PISU). RESULTS: Among the 2969 interventions and 5036 PISU performed, trauma and polytrauma are the most common pathologies treated. Outside of trauma, the most frequent conditions are chest pain, carbon monoxide poisoning, and cardiopulmonary arrest (CPA). Analgesic protocols are the most used PISU and in second place comes the absence of PISU application, chest pain protocols, adult CPA and glucose administration. CONCLUSIONS: FfNs occupy an increasingly important place in the French rescue chain. Thanks to a wide range of interventions and a great autonomy of action, they make it possible to greatly limit the number of SMUR medical teams leaving the hospital, especially in situations that do not require a doctor immediately.

Introduction: Avec la raréfaction des visites médicales à domicile, les urgences préhospitalières sont assurées par les Structures Mobiles d'Urgence et de Réanimation (SMUR) et les Sapeurs-Pompiers accompagnés d'Infirmiers Sapeurs-Pompiers (ISP). Objectifs: L'objectif principal de ce travail est de décrire les pathologies prises en charge par les ISP de la Loire en fonction de la Classification internationale des soins primaires version 2 et de la Classification Clinique des Malades du SMUR initiales, lors de toutes les interventions effectuées en 2019. L'objectif secondaire sera de déterminer quels Protocoles Infirmiers de Soins d'Urgence (PISU) sont mobilisés. Résultats: Parmi les 2 969 interventions et 5 036 PISU réalisés, les traumatismes et polytraumatismes sont les pathologies les plus prises en charge. Hors traumatologie, les plus fréquentes sont les douleurs thoraciques, « les expositions aux fumées d'incendie ¼ et les arrêts cardio-respiratoires (ACR). Pour les PISU, les protocoles d'antalgies sont les plus utilisés et en seconde position vient l'absence d'application de PISU, les protocoles douleur thoracique, l'ACR de l'adulte et le resucrage. Conclusions: Les ISP occupent une place de plus en plus importante en France dans la chaîne des secours. Grâce à un domaine d'intervention large et une grande autonomie d'action, ils permettent de limiter grandement les sorties des équipes médicales du SMUR, notamment dans des situations qui ne nécessitent pas de médecin immédiatement.

Une « équipe relais formation autisme ¼ : bricoler vers l'inclusion.

OBJECTIVE: The need to train parents and professionals in autism spectrum disorders is repeatedly affirmed by public health actors, parents’ associations, specialised professionals, etc. The challenges in the children’s sector concern improved screening, a smoother care pathway and better inclusion. In 2016, the Loire Autisme Evaluation Unit set up a Training Relay Team (ERF) to support the training of childcare professionals. The ERF was set up in a context of economic insecurity, but was committed to this experiment, convinced of the validity of its action. Despite several thousand professionals trained in the department, the credits would not be renewed and the activity ceased at the end of 2019. The objective of this work is to report on how the training sessions were constructed, experienced, and linked to practices. METHOD: Through the capitalization of trainers’ experience, this study collects and analyses activity reports and interviews with professionals who have received training. RESULTS: The results describe the beneficiaries, the contents of the training courses, the dynamics created by the meetings between trainers and beneficiaries and the projects carried out. CONCLUSION: Several difficulties are noted, both on the side of the ERF for which the model of co-construction of training sessions is sometimes questioned by trained professionals who remain under the illusion of a a possible ‘turn-key’ method. The construction of new cooperation and partnerships is the achievement valued by all the protagonists.

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.

Does the distance between the patient's home and the laboratory influence laboratory monitoring of diabetes? / La distance entre domicile du patient et laboratoire influence-t-elle le suivi biologique du diabète ?

Objective: Laboratory tests play an important role in general practice. Access to a clinical laboratory is essential and can potentially influence whether or not these tests are performed. This study assessed the impact of the distance between the patient's home and the clinical pathology laboratory on laboratory monitoring of diabetes. Methods: This was a retrospective observational study conducted over a period of 3 years on a cohort of diabetic patients from 11 clinical pathology laboratories in the Saint-Etienne region. The primary endpoint was at least three HbA1c, one serum creatinine, one lipid profile and one microalbuminuria over a 12-month period. Statistical analysis was based on the following variables: distance between the patient's home and the clinical pathology laboratory, patient's age, their health insurance, type of urban area and the site of blood sampling. Results: Among the 12,773 subjects included, 1,889 (14.8%) complied with the monitoring procedure. The successful monitoring rate decreased by 38% when the distance from the laboratory was more than 5 km (OR 1.38 [1.18 to 1.61]). Monitoring compliance increased with age (OR 0.71 [0.61 to 0.83] for subjects 55-65 years old and 0.61 [0.53 to 0.71] for subjects over 65 years old). However, patients in rural areas and in urban areas with less than 10,000 inhabitants presented better compliance with monitoring than patients living in towns with more than 200,000 inhabitants. Conclusions: Compliance with laboratory monitoring decreased as the distance between the patient's home and the clinical pathology laboratory increased. These results raise the question of the possible role of home sampling and the availability of other relevant tests required for general practice.

[Who treats somatic diseases and their associated disorders in young autistic patients?] / Qui traite les pathologies somatiques et les troubles associés des enfants autistes ?

This study highlights the conditions that limit access to primary care: the severity of autistic disorders, the implicit sidestepping of tasks by physicians, exhaustion of families who fail to coordinate the various types of care and tense relationships between professionals..

[Rethinking the Prescription's Comprehension: an Example of Care Centers for Deaf People]. / Repenser la compréhension de l'ordonnance : l'exemple des soins aux Sourds.

CONTEXT: Since the realization of the difficulties for Deaf people to access care, specific assisting services in french sign language (FSL) and adapted prevention campaigns have developed in France. Illiteracy, a significant problem among Deaf people, makes the comprehension of prescription uncertain. AIM: Exploring and describing the adaptations implemented by professional signers to avoid confusion related to prescription's directions. METHOD: This qualitative study in participant observation listed the different sources of confusion and the adaptations applied on prescriptions on a daily basis by eight practitioners and three intermediators who worked in six care cent ers for Deaf people. Interviews with deaf patients aimed to ascertain the encountered difficulties. These adaptations were presented, for a three-way correlation, during a national meeting attended by professional workers in care centers for Deaf people. They were subjected to a review by all attendees in order to generate a more consensual report. RESULTS: The sources of the identified misunderstandings turned out to be connected with time representation, the use of unknown words or words with double meaning, and the issuing of several documents. To reduce the risk of error, professional signers would use charts, calendars, drawings, replace durations by dates. Some of them requested that the patient would rephrase the understood information. Pros and cons, as well as the pat ient's profile were detailed for each adaptation. CONCLUSION: Even if no method can suppress all risks of confusion, this work leads us to a reflection on alterity through the risk of medicinal errors, on prescription in general, may it be directed to a patient with no particular vulnerability or to a handicapped or illiterate one.

[A dedicated ambulatory system for the primary healthcare of the deaf people]. / Un dispositif ambulatoire pour la santé des Sourds en soins primaires.

BACKGROUND: A law of 11 February 2005 recognises French Sign Language (LSF) as a language in its own right and requires the implementation of practices that facilitate access to health care of deaf patients. OBJECTIVE: This study describes an ambulatory system devoted to primary care for the deaf people. METHOD: Case study: quantitative and prospective analysis of consultation data between 2009/01/01 and 2012/12/01, qualitative analysis of the ambulatory system, of an appointments selection and of some community-based health practices. RESULTS: From an active list of 116 patients, 885 consultations were held. The number of annual consultations doubled between 2009 and 2012; the average number of consultations per patient amounts to 3,5/year. The system, stemming from private practice, consists of a general practitioner trained in LSF progressively helped by his partners from the group practice. It compensates for the lack of hospital units in the area. The clinical situations described help in the understanding of the project's significance. CONCLUSION: The benefits of the system are obvious but should not become a reason to ignore the necessity of the creation of a hospital unit that provides health care for the deaf people, including the possibility of a mobile unit taking into account multiple disabilities and isolated people.

[The impact of a general practitioner training program on the colorectal cancer screening participation rate]. / Impact d'une formation pour les médecins généralistes sur la participation au dépistage du cancer colorectal.

AIM: Colorectal cancer mortality in France in 2011 was 13.8/100,000 men and 8.2/100,000 women. As participation in mass screening remains insufficient, training was proposed to general practitioners in the Drôme-Ardèche departments. The objective of this study was to assess the impact of this training after one year. METHODS: This study compared a group of trained volunteers with the other general practitioners in the two departments. The participation rate was measured in patients aged 50 to 74 years examined during the year following the training programme. The participation rate was then assessed on the total population of patients aged 50 to 74 seen by each practitioner, and the practitioner's degree of conviction (tests performed / test kits delivered) and the clarity of instructions (interpretable tests / tests performed) were assessed. RESULTS: Thirty-five general practitioners attended the training programme in Spring 2011. The number of tests performed in this group of trained GPs was 0.29 per target patient examined (vs 0.17 among the 604 practitioners who did not attend the training programme) with a significant difference (p < 0.0001). The number of tests performed on the total patient population aged 50 to 74 was 0.24 per patient (vs 0.14) with p < 0.001. The conviction index was 0.85 (vs 0.90) with p < 0.0008 and the clarity of instructions index was 0.94 (vs 0.93) (p not significant). CONCLUSION: The training programme had a limited impact on participation in colorectal cancer screening, but trained practitioners nevertheless distributed more test kits and more tests were performed.

Prevalence of cardiovascular risk factors in a population of French firefighters.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.

Sleep quality and sleep disturbances among volunteer and professional French firefighters: FIRESLEEP study.

BACKGROUND: Although insufficient sleep among firefighters reduces work efficiency and increases the risk of injury, little is known about the sleep quality of French firefighters in the Loire department. The aim of the FIRESLEEP study was to evaluate sleep quality and sleep disturbances among professional and voluntary French firefighters. METHODS: A cross-sectional observational study was conducted between November 2018 and May 2019. Firefighters were invited to complete a questionnaire on a secure platform including clinical questions and validated questionnaires (Pittsburgh Sleep Quality Index [PSQI], Epworth sleepiness scale [ESS], Insomnia Severity Index [ISI] and the STOP-Bang score) during their periodic medical examination. RESULTS: 193 firefighters were included in this study, of which 29% were of professional status and 71% were volunteer firefighters. Among them, 26.9% had poor sleep quality, 27.7% showed excessive daytime sleepiness (EDS), 18.8% reported moderate-to-severe symptoms of insomnia, and 1.6% had moderate-to-high risk of obstructive sleep apnea. Subgroup analysis revealed that professional firefighters had poorer sleep quality and higher sleep disturbances than volunteer firefighters. The independent risk factors associated with poor sleep quality were known sleep disorder, treated anxiety/depression, night calls, and insomnia symptoms. Moreover, the independent risk factors associated with EDS were short sleep duration, taking a nap, and insomnia symptoms; while older age was a protective factor for EDS. CONCLUSIONS: Poor sleep quality and sleep disturbances are highly frequent in French firefighters and underdiagnosed. Prevention through education and systematic screening could limit the impact of sleep disturbances on firefighters' global health.

Primary physicians' attitudes toward their patients receiving a proposal to participate in a vaccine trial.

A trustworthy relationship between primary physicians (PPs) and their patients is crucial for vaccine acceptance. Little is known about attitudes of PPs toward participation of their patients in a preventive vaccine trial (PVT) proposed by investigation sites.A cross-sectional study was conducted in Auvergne-Rhône-Alpes region (France) including an anonymous questionnaire for general practitioners (GPs) and other specialists as well as face-to-face interviews. A scenario of a patient, with chronic medical conditions, invited to participate in a PVT and reporting this situation to his/her PP was drawn up. PPs' attitudes were assessed in quantitative approach by a 5-point Likert scale and in qualitative approach by semi-directed individual interviews.Among the 521 respondents to the questionnaire, 429 (82.3%) were GPs and 92 (17.7%) were other specialists. Only 7.5% (39/521) of respondents regularly practice clinical research. Confronted with the scenario, 312 respondents (59.8%) declared they would give their opinion spontaneously. Before giving their opinion, PPs would like more information about the trial (91.4%, n = 476). Whatever their attitude, 488 (93.7%) would be influenced by available safety data. Face-to-face interviews confirmed that PPs lack of knowledge about clinical research, and would like to obtain information from investigators, particularly about safety.PPs seem to be concerned by the decision of their patients to participate or not in a PVT but would like more information about the trial and clinical research before giving their opinion. Getting PPs to be more involved in the enrollment of patients in PVT may improve recruitment.

Volunteer and Career French Firefighters With High Cardiovascular Risk: Epidemiology and Exercise Tests.

OBJECTIVE: We aim to identify cardiovascular risk factors in firefighters of Loire (French district) with a high cardiovascular risk and report results of a screening program using exercise tests. METHODS: A retrospective descriptive study was performed in a cohort of 158 career and 400 volunteer firefighters with a high cardiovascular risk who had undergone an exercise test. RESULTS: Five hundred fifty-eight exercise tests and cardiovascular profiles were analyzed. Prevalence was 18% for high blood pressure, 19% for dyslipidemia, and 48% for overweight. Exercise tests were positive in 91 cases (16.3%): sensitivity, 53%; specificity, 74%. Risk of onset of a predictive event was higher in the high-risk group: odds ratio, 3.2 (95% confidence interval 2.0 to 5.1). There were more events on exercise test in volunteer firefighters. CONCLUSION: Prevalence of cardiovascular risk factors in the cohort of firefighters was acceptable in comparison to French general population and other firefighters' cohort. Physical training of volunteer firefighters needs reinforcing.

Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

PURPOSE: Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic. METHODS: A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France. RESULTS: During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96). CONCLUSION: Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes.

A survey of French general practitioners on the epidemiology of wounds in family practice.

BACKGROUND: To measure the frequency and nature of wounds in patients treated in general practice and to describe the patients' tetanus vaccination status and the sources providing information about this status. METHODS: A descriptive, prospective, week-long, national electronic survey was conducted among general practitioners within the Sentinelles network. RESULTS: The participation rate was 12.6% (95% confidence interval [CI], 10.6%-14.6%; 130 general practitioners): 197 patients with wounds were reported, and 175 of them were described. Wound frequency was 1.4 (95% CI, 1.2-1.6) per 100 consultations. These wounds had an acute character in 76 (95% CI, 69.7-82.3) of cases, were mostly of traumatic origin (54.8% of cases; 95% CI, 47.5%-62.1%), were more than 24 hours old (67.1%; 95% CI, 59.1%-75.1%), and were clean, without bone and/or muscle decay (94%; 95% CI, 90.5%-97.5%). Vaccination status was known for 71 (95% CI, 64-78) patients. According to the 2013 immunization schedule, 21% (95% CI, 13.9%-28.1%) of the patients had not updated their vaccinations, mostly among the patients older than 75 years. CONCLUSION: This survey describes in detail the wounds treated in general practice in France and the associated patients' immunization status. It also shows how difficult it is for general practitioners to assess the risk of contracting tetanus and the disease's development. It highlights as well the fact that the ideal solution to assess tetanus risk is an up-to-date immunization schedule.