[Death certificate: recent changes and instructions for use]. / Certificat de décès : modifications récentes et mode d'emploi.

Death certificate : recent changes and instructions for use. Since January 1, 2018, doctors must write death certificates on new models. The year 2017 saw a number of changes regarding funeral legislation and death reporting, concerning, among other things, the practice of custodial care and the data to be completed, which will be analyzed by the Center for Epidemiology on Medical Causes to produce national mortality statistics. The death certificate may be prepared in electronic format or, failing that, in paper form available from regional health agencies.

Certificat de décès : modifications récentes et mode d'emploi. Depuis le 1er janvier 2018, les médecins doivent rédiger des certificats de décès sur de nouveaux modèles. L'année 2017 a vu apparaître plusieurs changements relatifs à la législation funéraire et à la déclaration des décès, concernant entre autres la pratique des soins de conservation ainsi que les données à renseigner qui seront analysées par le Centre d'épidémiologie sur les causes médicales de décès pour produire les statistiques nationales de mortalité. Le certificat de décès peut être établi sur support électronique ou, à défaut, sur support papier disponible auprès des agences régionales de santé.

Finding a balance between patients' rights, responsibilities and obligations.

Patients' rights have developed over recent decades in many countries, resulting in improved access to high quality medical care. The alliance between patients and physicians is a moral obligation, backed up by patient rights. Poor patient compliance with medical recommendations constitutes a public health issue, illustrating the difficulty of obliging patients to comply with treatment. The legal recognition of patients' responsibilities is defined in a few legislative and regulatory texts, but is primarily based on jurisprudence. Patients, who despite being fully aware and informed about the risks adopt a behaviour that is harmful to their health, tend to be considered as being irresponsible. This judicial approach raises a number of questions, as it fails to take into account the complexity of the human factors involved in a behaviour with either positive or negative health effects.

[Effectiveness of histopathologic examination in a series of 400 forensic autopsies]. / Intérêt de l'analyse anatomopathologique dans une série de 400 autopsies médicolégales.

OBJECTIVES: To assess the usefulness of histopathologic examination in forensic autopsies. MATERIAL AND METHODS: All consecutive pathological reports and slides from forensic autopsies performed in our department since 2006 have been reviewed. RESULTS: Four hundred forensic necropsies were reviewed. In only 150 cases (38%), pathologists had data about manner of death and gross autopsy findings. Major diagnoses, related to death, and unsuspected by forensic pathologists, were discovered in 83 cases (21%): in 48 cases (12%) gross examination of the heart, lungs and liver showed gross diagnoses missed by the forensic pathologists, and in only 35 cases (9%) microscopic examination revealed a major unsuspected diagnosis (in brain, heart, lungs, liver, kidney and pancreas specimens). In 213 cases (53%), histopathologic examination confirmed gross autopsy findings and allowed to date some wounds. In 104 cases (26%), microscopic examination was not contributory. CONCLUSION: Microscopic examination revealed major diagnoses in less than 10% of forensic autopsies. Its effectiveness is limited for homicides and suicides. Systematic microscopic examination of numerous organs is often useless and should be limited to cases with no anatomic causes of death. Our study emphasizes the need for a better communication between forensic pathologists and histopathologists, and for a better training of some forensic pathologists for gross examination.

[Identifying psychoactive substance use among new prison detainees]. / Repérage des détenus admis en maison d'arrêt ayant des consommations de substances psychoactives.

Consumption of psychoactive substances is widespread among prison detainees. This represents not only a public health problem but also a barrier to rehabilitation. Too few resources are devoted to this issue in France. We conducted a pilot study of psychoactive substance use among new prison entrants, in order to guide their therapeutic management. Tobacco, alcohol, cannabis, opiates and medicinal drugs were used daily by respectively 81%, 29%, 23%, 14% and l3% of study participants. Brief interventions targeted users of tobacco (92%), alcohol (25%), cannabis (65%), cocaine (67%) and opiates (56%)? These results encourage us to systematically identify substance use among new detainees in order to offer optimal support aimed and to facilitate their rehabilitation. Given the lack of specialized care, brief interventions may be an interesting option but they must be adapted to the specificities of this population.

[Possession of weapon and hunting license: the role of the physician]. / Détention d'armes et permis de chasser: rôle du médecin.

In France, the physician can inform the prefect that a patient, detaining weapon and followed for a pathology (psychiatric notably), is dangerous. Then, it comes back to the prefect to appreciate the appropriate measurements to take, notably to order the delivery of weapon and ammunitions. In France, the doctor can be solicited to establish the necessary medical certficates during requests of approval or acquisition and having guns for hunting and sports shooting, or to obtain the licence of hunting. The acquisition and the possession of certain weapon cannot be granted if the applicant is a protected person over 18, was or is hospitalized, without his consent, owing to mental disturbances or, is in a physical or psychical state apparently incompatible with the possession of weapon. But it appears that the access to this information by the prefects is made difficult by the absence of files centralizing these data. Question settles to institute an automated national file of hospitalizations under pressure, which could be consulted prior to the deliverance or the approval of possession of weapon for hunting and as sports shooting. In our opinion, this should be made, in a strictly supervised manner, through a sworn doctor, systematically solicited as part of the licence of hunting and licence of shooting, to liberate the family practitioners of an expertise role.

Obesity surgery: French medico-legal aspects.

The demand for bariatric surgery is expected to increase. It is a procedure that carries a high surgical risk, and a risk of postoperative complications due to the pathologies associated with obesity. Obesity surgery is not classified as plastic surgery, but may subsequently lead to plastic surgery-type operations. Malpractices in the field of obesity surgery are most frequently at the pre-operative stage. In the absence of any fault, a patient may obtain indemnification by "national solidarity". Physicians and surgeons have an obligation to be able to prove that they informed their patients properly.

[Public health law in practice: violence and health in Picardy]. / De la loi de santé publique à l'expérimentation "Violence et santé" en Picardie.

Violence is too often considered an inevitable part of human existence. Physical, psychological and behavioural trauma has an impact not only on the health of the individual but also on the healthcare system. Largely perceived as a social problem, violence is also a public health issue. Promoted by the World Health Organisation and developed in France by Prof Henrion, the National Authority for Health and the mission led by Dr. Tursz, the public health dimension of "Violence and health" is now better defined. The Public Health law of 2004 provided for a national plan on "Violence and Health". After an initial action study, we developed a tool to coordinate public actions in this field. The group "For health, against violence in Picardy" was created to implement expert recommendations by building knowledge, promoting training and networking, and developing services to support and guide victims of violence.

["Violence and health": an autopsy of a public health plan]. / "Violence et santé", autopsie d'un plan de santé publique.

The law provides for an evaluation and a five-year review of the French Public Health Act. Among its five strategic plans, the law of August 9, 2004 provided for a "national plan to limit the health impact of violence, risk behavior and addictive behavior." Under the impetus of the World Health Organization's World Report on Violence and Health in 2000, a rich reflection was conducted in France on this issue establishing some key axes for implementation. Although we can link several actions related to this field within the framework of specific policies since 2004 (road violence, addictions, violence against women, etc.), we note that a plan on violence and health has not emerged. The lack of enforcement and application of this part of the law raises questions about the quality of the law as well as the in the role and place for the theme "violence and health" in an upcoming law.

[The gift of the body to science]. / Le don du corps à la science.

We detailed the practical methods of gift of the body and the functioning of the centers of gift of the body in France. The gift of the body is an ignored step, lacking a clear legal framework, which explains partly the disparities of operation noted within the various centers concerned. The doctors must be able to inform the patients and their families about the methods of the gift of the body.

[Compensation of victims of nosocomial or post-transfusion hepatitis C virus infection]. / Indemnisation des hépatites C d'origine nosocomiale ou transfusionnelle.

The purpose of this review is to inform physicians about the procedures for compensation of victims of nosocomial or post-transfusion hepatitis C virus infection. The different procedures are described in reference to the legislation and regulations. According to the law dated March 4, 2002 if Hepatitis C is contracted during care, in a private or public hospital, the hospital (and not the physician) is responsible for the damages resulting from the nosocomial infection, except if evidence of another cause is provided. For post-transfusion hepatitis C, the patient must show that a transfusion took place prior to the diagnosis of hepatitis C. The patient must also prove that there were no other sources of infection. The French Institute of Blood can sometimes not be held responsible by proving that none of the donors of the transfused blood were infected with the hepatitis C virus. This is a no fault system. Different examples of litigation show the important role of physicians, who must be aware of the main points of the procedures to better understand what is entailed by the medical certificates which the victim may request and also to provide him with any other steps to be taken to obtain compensation.

Adult Hirschsprung's disease diagnosed during forensic autopsy.

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.

[Knowledge of legal aspects of organ donation by live donors. Staff survey at a university hospital center]. / Connaissance des aspects législatifs du don d'organes chez une personne vivante. Enquête auprès du personnel d'un CHU.

OBJECTIVE: Law no. 2004-800 dated August 6, 2004, establishes new legal measures to facilitate live organ donation, in view of the shortage of organs for transplantation. We sought to assess the knowledge of this statute among hospital personnel. METHOD: We sent an e-mail questionnaire to 1015 persons working at Amiens university hospital center. It contained eleven closed questions (yes/no/don't know) about permissible live organ and tissue donation and two questions requesting personal opinions about live donation. We compared responses according to profession and department. RESULTS: Questionnaires were returned by 245 respondents. The questions for which more than 70% provided correct answers concerned the fundamental principles of bioethics (consent revocable at any time, donations by adults, donations between spouses, bone marrow donations by minors). Fewer than half the respondents knew the correct answers about the new legal measures adopted in the statute (extension of the circle of potential donors, possible exceptions for donations by minors and incompetent adults). Knowledge of the law concerning assisted reproduction techniques was much poorer: fewer than 30% knew that sperm or oocyte donation requires spousal consent. Three quarters of the respondents have discussed their wishes with their family; 65% would provide a live kidney donation, although some only for a family member. In all 31% have organ donor cards. DISCUSSION: Donations by live donors raise psychological as well as ethical and legal issues. This survey increased the awareness of hospital staff, provided them with information about the relevant law and, we hope, stimulated their thinking about the topic of live donations.

[Regional conciliation and compensation commissions: how they work]. / Fonctionnement pratique des commissions régionales de conciliation et d'indemnisation.

The Law of 4 March, 2002, established regional commissions of conciliation and indemnification (CRCI) to enable the swift and amicable resolution of demands for damages due to medical care (including prevention and diagnosis) by private practitioners, private clinics, and public hospitals. The commission may decide that: (1) the physician or healthcare facility is liable (generally, indemnification by the insurance company), or (2) that indemnification is due in the name of 'national solidarity' (indemnification by a national organism called ONIAM), or (3) no damages are due. There are two important restrictions: For the CRCI to have jurisdiction to determine indemnification, it is imperative that at least one of the severity criteria be met. The 4 severity criteria are: (1) a permanent disability greater than 24%, (2) temporary disability for at least 6 months during a one-year period, or (3) permanent inability to perform the previous occupation, or (4) rarely, especially severe problems (for example, economic) in living conditions that result from the medical care. The procedure applies only to care provided since 5 September 2001. From the request for indemnification by 'ONIAM or the insurer, the process must last no longer than one year.

Compensation of asbestos victims in France.

The alarming development of pathologies linked to asbestos led to the creation in France of two funds to indemnify the victims of asbestos-related illnesses: the FCAATA (Fund for asbestos workers who take early retirement), which compensates for their reduced life expectancy, and the FIVA (Indemnification fund for asbestos victims) which ensures full compensation for harm suffered by asbestos victims.

Arthrodesis of the first metatarsophalangeal joint using convex and concave drills. A report on 50 cases.

The authors report their results after arthrodesis of the first metatarsophalangeal joint (MP) performed in 50 cases including 18 rheumatoid feet, 18 major hallux valgus deformities and 14 recurrent deformities. Preparation of the bone ends for arthrodesis was achieved using convex and concave drills and fixation was done with an axial screw. The patients were evaluated after an average of 12 months, using Kitaoka's score. Eighty per cent were very satisfied, 16% were satisfied and 4% were dissatisfied. Ninety six percent reported no pain over the MP joint of the hallux, and none complained of metatarsalgia. Return to activities was normal in 80% of cases. Radiographs showed non-union in six cases; they did not show interphalangeal osteoarthritis in any instance.

The examination of genetic characteristics since the adoption of the French law on bioethics.

The French bioethics law of July 1994 was due to be revised five years after its enactment. It was not until 6 August 2004, that the revised law was finally adopted. The examination of the genetic characteristics of a person may only be undertaken for medical purposes or for the purposes of scientific research. Consent must therefore be obtained in writing, after fully informing the patient, and may be withdrawn at any time, in either form (orally or in writing). French law nevertheless authorises carrying out such an examination where there is no consent, solely for medical purposes and in the interest of the patient. The issue has arisen of the detection of a serious genetic anomaly during an examination of genetic characteristics. In this respect, certain anomalies may lead to the patient's relatives being tested, in order to suggest suitable treatment. A procedure for informing families has been implemented by the French Biomedicine Agency (details of which will be specified in a decree).

[Physician assessment of aptitude for driving in the European Union]. / Évaluation médicale de l'aptitude à la conduite automobile au sein de l'Union européenne.

Road safety is for several years a major public health issue, given the number of casualties and annual deaths caused by road accidents in France or Europe. European directives of 2006 and 2009 were aimed harmonized community practices for the conduct, including medically. We studied the laws in force in each of the 28 countries of the European Union to make an inventory of the organization on this subject. The results showed that 25 countries introduce, at least once, including 21 medical check regularly. Age is the main factor that motivates control. The frequency of examinations increases with the age of the driver. In other countries, a sworn statement of the absence of pathology is enough. Although a medical examination is mostly carried out systematically, it the content is extremely variable, ranging from a simple vision test to a full review with psycho test. Management of professional secrecy is approached differently in different countries, although predominantly an exemption exists in the event of discovery of the inability of a patient. We note that there is a great diversity in the medical screening modalities unsuited to driving. These systems will be harmonized to comply with the wishes of European directives.

[Violence undergone by the general practitioners: Under-reporting of the attacks or of the infringements to their properties]. / Violences subies par les médecins généralistes exerçant en libéral : sous-déclaration des agressions ou des atteintes aux biens.

INTRODUCTION: The main objective of this study was to estimate prevalence on the liberal general practitioners. The secondary objectives are to identify the possible brakes with the declaration in the monitoring observatory for security of the doctors as well as to determine if the feminization of the profession was associated with the situations violence. METHODS: A questionnaire in 5 parts was submitted by telephone to 146 drawn lots liberal general practitioners. It approached the undergone physical and verbal attacks, the infringements on the properties arisen during their career, and the proven feeling of insecurity. RESULTS: The rate of participation was 63% (93/146). In all 171 incidents were reported among which 96 physical and verbal attacks (56%), and 75 infringements on the properties (44%) without difference according to the sex. The main motive for the attacks was the refusal of prescription (44%). Practically, no concerned doctor made declaration for the monitoring observatory for the security of the doctors, for lack of interest for 5 of them or the ignorance of its existence for 10 on 32 practitioners having undergone an aggression after the creation of the monitoring observatory. CONCLUSION: We observed an under-reporting of the attacks or of the infringements on the properties by the doctors victims. Our study did not highlight difference between men and women.

[Forensic aspect of acute drunkenness]. / Aspects médico-légaux de l'ivresse éthylique aiguë.

Alcohol consumption in itself is not forbidden in France. Two situations are reprehended by the law: public drunkenness - where only the behavior is sanctioned and not the alcohol level - and driving with a level of alcohol superior to 0.5g per liter. The management of a severe state of drunkenness - even though frequent - is on the one hand poorly managed and on the other hands badly mastered by doctors. The management of drunken patients lies essentially in a strong monitoring of the possible complications. The inherent question of the returning-back-home for a drunken patient should be approached according to the state of consciousness rather than the alcohol rate in the blood. No matter what the rate is, the authorization to release a patient depends on the preservation of his judgmental capacities. If those are altered, the doctor can then decide to keep - even against his will - the patient temporarily and until he has recovered his discernment. Patients still keep their right to refuse any medical treatment. Indeed, the law does not provide any answer concerning the particular issue of the refusal of medical care by the patient, especially in case of a severe alcoholic intoxicated state that let the patient incapable to express his will and to understand the range of the given information. There is no legal measure that can able a doctor to firmly forbid a drunk patient to be released and to take the wheel. Doctors have to try to dissuade them by proposing other alternatives but they cannot physically oppose themselves to the patient decision. However, proofs that the doctor tried his best to convince the patient not to drive while under the influence of alcohol can be demanded. Doctors have the duty to inform patients on every risk that alcohol can bring while driving but do not have any measure of pressure.

[Role of the medical officer for the assessment of driving ability. Practical aspects, liability and confidentiality]. / Rôle du médecin agréé pour l'évaluation de l'aptitude à la conduite. Aspects pratiques, responsabilité et secret médical.

Every candidate for a driving license or any driver who meets a health problem must, on its own initiative, to submit to a medical examination. The list of approved doctors is available in the prefectures. There is a list of medical conditions that are incompatible with the licensing or involve restrictions on the use of the license. The treating physician is not authorized to carry out the assessment of medical fitness to drive for his own patients. This is the prefect who decides after consulting a licensed physician or medical committee composed of licensed doctors. If it deems medically necessary, the medical consultant outside medical commission may request the person to be summoned before the primary medical committee whose jurisdiction is then substituted for his. Possible advice is: fitness, temporary fitness, fitness subject to the license restrictions on use, or the inability of the candidate or driver to drive vehicles of the requested class. We emphasize the absence of shared secret between the attending physician and the medical officer or the Medical Committee.