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With numerous clinical, technological or strategic innovations, radiation therapy is constantly evolving, contributing to major quality and safety issues, in a context where new regulatory standards are required. In this article, we will describe the conditions for implementing and applying the requirements for accreditation, periodic certification and peer audit in France., (Copyright © 2024 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

An essential link in the smooth running of the operation, the role of circulator is another facet of the operating room nurse's (ORN) activities. As the orchestra conductor of the operation, the circulating role gives the nurse the ability to coordinate the entire team, ensure continuity at every stage of patient care in the OR, and manage all risks that may arise during the operation., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

High-risk drugs, which are potentially a source of serious adverse reactions, are a major concern in healthcare establishments, particularly for geriatric patients, who often have multiple medications and co-morbid conditions. With a view to continuously improving the quality and safety of care, we have embarked on a proactive approach aimed at identifying, securing and improving the management of medicines at risk in geriatric wards., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background. Grab bars are used to support bathing tasks. Sometimes, temporary rim-mounted grab bars may be preferred over permanent wall-mounted grab bars. Purpose. We compared postural requirements, applied loads, and user perceptions between two configurations of rim-mounted grab bars, a vertical wall-mounted grab bar, and a no-grab bar condition. Method. Ten adults entered and exited a simulated bathing environment. Trunk flexion was evaluated via 3D kinematics, while load cells mounted to the grab bars facilitated the evaluation of applied loads. Participants rated each condition on perceived safety, comfort, effectiveness, and ease of use. Findings. Rim-mounted grab bars resulted in greater trunk flexion and greater applied loads and were less favorably perceived. Implications. The rim-mounted grab bars included in this study may induce challenging postural demands and loading scenarios, and occupational therapists should consider whether they meet the needs of their clients.

As part of their missions, firefighters are exposed to a multitude of risks that can impact their health. Sensitive to this health and safety issue, the departmental fire and rescue service of Seine-et-Marne has designed and deployed a doctrine of health and safety support in operation. The members of the sub-directorate of the departmental fire and rescue service are the main actors in this process. The implementation of health support for firefighters in response relies mainly on the firefighter nurse. Indeed, the latter is led to develop, beyond his nursing practice, skills related to the analysis of health risks and the deployment of preventive and curative actions on intervention., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Professor Marlene Freeman of Massachusset General Hospital's answer to the question "How should I prescribe valproic acid (for psychiatric disorders) to women of childbearing age?" is "Don't do it at all.", (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Reporting and learning are key components of quality and safety in radiotherapy. Each event must be reported to national authorities if considered significant according to national criteria. Lessons learnt from analysis of causal factors are primordial to decrease the risk of reoccurrence or the severity of further events. Thanks to national or international, mandatory or voluntary incidents reporting systems, and experience feedbacks, various sources of learning are available to improve risk management. This article aims to compare the regulations about mandatory declarations of significant events and describe national or international incident reporting and learning systems available., (Copyright © 2023 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Physical activity (PA) has its place in the continuum of care, the objective being to limit alterations associated with cancer and its treatments. This review of the literature collates the evidence and current data relating to PA carried out at different periods of treatment for lung cancer., State of the Art: PA is safe and feasible in patients with lung cancer throughout their oncologic treatment. The efficacy of multimodal programs is demonstrated regarding symptoms, exercise capacity, functional capacity, postoperative complications, length of hospital stay and quality of life. Nevertheless, this result remains to be confirmed with more robust upcoming trial, notably in the long term., Perspectives: Utilization of activity and energy expenditure sensors or PA questionnaires could help to increase the PA level of lung cancer patients during their continuum of care. For those not at ease with conventional training modalities, it may be judicious to offer intermittent high-intensity training or respiratory muscle strength training. Telerehabilitation could also be implemented. The targeting of populations at high risk should be investigated., Conclusion: Teams caring for patients with lung cancer during or after their oncologic treatment should develop innovative strategies designed to overcome difficulties of access or adherence to exercise programs, so that the PA be an integral part of the care of these patients. Physical therapists play an important role in supporting these patients during their assessment or treatment., (Copyright © 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Radiation therapy (RT) is a key component of the management of elderly breast cancer patients. However, level I evidence in elderly patients is limited. Patient selection should include comorbidities and geriatric assessment. Advances in radiation planning and delivery are improving target coverage, reducing toxicity, and expanding treatment eligibility. Some alternative techniques, such as treatment in the lateral or prone position, may reduce the risk of toxicity. Shorter cycles of hypofractionated whole breast RT are safe and effective. In some cases, partial breast irradiation may be an option., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

To mitigate excessive rises in core temperature (>1 °C) in non-heat acclimatized workers, the American Conference of Governmental Industrial Hygienists (ACGIH) provides heat stress limits (Action Limit Values; ALV), defined by the wet-bulb globe temperature (WBGT) and a worker's metabolic rate. However, since these limits are based on data from men, their suitability for women remains unclear. We therefore assessed core temperature and heart rate in men ( n  = 19; body surface area-to-mass ratio: 250 (SD 17) cm 2 /kg) and women ( n  = 15; body surface area-to-mass ratio: 268 (SD 24) cm 2 /kg) aged 18-45 years during 180 min of walking at a moderate metabolic rate (200 W/m 2 ) in WBGTs below (16 and 24 °C) and above (28 and 32 °C) ACGIH ALV. Sex did not significantly influence (i) rises in core temperature, irrespective of WBGT, (ii) the proportion of participants with rises in core temperature >1 °C in environments below ACGIH limits, and (iii) work duration before rises in core temperature exceeded 1 °C or volitional termination in environments above ACGIH limits. Although further studies are needed, these findings indicate that for the purpose of mitigating rises in core temperature exceeding recommended limits (>1 °C), ACGIH guidelines have comparable effectiveness in non-heat acclimatized men and women during moderate-intensity work. Novelty : Sex did not appreciably influence thermal strain nor the proportion of participants with core temperatures exceeding recommended limits. Sex did not significantly influence tolerance to uncompensable heat stress. Despite originating from data obtained in only men, current occupational heat stress guidance offered comparable effectiveness in men and women.

Wide awake local anesthetic no tourniquet (WALANT) is gaining popularity amongst hand surgeons. Digital adrenaline use has been shown to be safe in multiple studies and the misconception forbidding it is receding. Phentolamine has been shown to safely reverse the effects of adrenaline should the feared complication of digital ischemia occur. A survey was circulated to 40 specialist practitioners who regularly perform hand procedures at a major tertiary plastic and hand surgery unit. Knowledge and understanding of WALANT, onset and duration of adrenaline effects and reversal was assessed. Whilst the majority of respondents (80%) recognized digital adrenaline use as safe, only 65% were aware of the delay until adrenaline takes full effect. Similarly, only 25% of respondents were aware of the duration of effect of adrenaline. Half of respondents were aware that phentolamine is the established reversal agent for adrenaline with only 20% knowing the correct dose. Given the lack of clinician knowledge surrounding adrenaline and its reversal, we feel that to safely undertake WALANT surgery at our Unit a WALANT protocol must be implemented. Drawing on the successes in the airline industry, a variety of safety frameworks have been established to deliver targeted education for prevention and eventual management of predictable risks. We plan to develop a checklist style protocol targeting the knowledge gaps raised in the survey. This will educate and equip all practitioners working with adrenaline with the knowledge to safely manage complications should they occur. LEVEL OF EVIDENCE: Level 5 (UK Oxford Centre for Evidence based Medicine (CEBM) Levels of Evidence)., (Crown Copyright © 2022. Published by Elsevier Masson SAS. All rights reserved.)

Night work takes on different aspects for nurses, from a regulatory, individual, physiological, collective and organizational point of view. It is important to be able to rely on the resources that make night work bearable by taking these different elements into account. Exploration of the personal, groupal and organizational variability observed in a university hospital and propositions to facilitate the management of night work while preserving the interest of the tasks and physiological rhythms., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The geriatric care teams are particularly invested in preserving the sleep of elderly patients as much as possible. Some specific cares implemented by the night teams can contribute to this. In a geriatric service at the Grenoble University Hospital (38), care manager, nurses and nurse's aides organize theirs actions in order to preserve patients' rest., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

During uncompensable occupational heat stress, heat-mitigation controls are required to prevent core temperature exceeding recommended limits (≥38 °C). However, the initial stay time before employing controls remained unknown. We estimated these times for moderate-intensity work at 26, 28, 30, and 32 °C wet-bulb globe temperatures (WBGT) in 50 young (18-30 years) and older (50-70 years), non-heat acclimatized men. Initial stay time was 111 min at 26 °C WBGT and declined exponentially to 44 min at 32 °C WBGT. Novelty: We provide estimates of the moderate-intensity work duration before heat-mitigation is required in wet-bulb globe temperatures between 26-32 °C for young and older, non-heat acclimatized men.

Recent therapeutic innovations are significantly changing the management of young children with severe haemophilia. A team from the University Hospital of Nice (06) introduced emicizumab, the first subcutaneous non-replacement therapy. Integrated into the multi-professional management of children and their families, this innovative therapeutic option has shown encouraging initial results. Experience sharing., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Chronic illnesses, such as diabetes, have an impact on the body, but also on the psyche, disturbing the body image of the child or adolescent. This must be integrated into their"growing up process". To this end, health care professionals specialising in these populations provide the most appropriate support during these periods of doubt and uncertainty., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Safe nursing staffing and patient safety are closely related. A systematic review of the literature was carried out, comparing the number of falls in elderly inpatients in medical-surgical wards with these staffing levels. A review of scientific articles, selected through a keyword search of several electronic databases, showed a direct, although not significant, association between improved nurse staffing and a decrease in the number of falls in elderly inpatients., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Plant features represent a modality of outdoor architecture that can be integrated into a project to take into account the particularities of patients and residents, and in particular those with cognitive disorders and risks of running away. The concept of a "plant-based security system" is an innovative and transposable prevention approach that reconciles the constitutional right to freedom of movement and security. A living concept illustrated by the Seilleraye EHPAD in Carquefou., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: The aim of the vigilance system in Switzerland is the evaluation and classification of reported suspected adverse reactions of immunological veterinary medicines (IVMP), including suspected lack of expected efficacy. The Institute of Virology and Immunology (IVI) is the competent authority for marketing authorizations of immunological veterinary medicinal products in Switzerland and responsible for the vaccinovigilance system. In 2020, 130 adverse reaction reports were received (5% less compared to 2019). The reports mainly concerned dogs (41%) and cats (25%) followed by cattle (18%) and horses (7%). Many of the reports in dogs involved the application of combined vaccines against canine distemper, hepatitis, parvovirosis and parainfluenza in combination with canine leptospira components, in cats against cat flu and feline panleukopenia in combination with feline leukaemia virus infection. Causality assessments were done according to the international ABON system. In 27% of the reported cases, the causality assessments between the vaccination and the reaction described were evaluated as being probable (ABON A), in 44% as possible (ABON B).

Objectives: To analyse the most frequent DRP over time and pharmacists' interventions made among older patients aged over 75 years old. DRP between older patients and younger patients aged 18 to 74 years and between older patients treated in geriatric wards or not were also compared., Methods: A cross-sectional observational study conducted on DRP detected by pharmacists at the university hospital centre of Lyon and prospectively recorded in the Act-IP© database from January 2008 to December 2015., Results: A total of 56,223 DRP were investigated - 19,056 in older patients and 37,167 in younger patients. A supratherapeutic dosage was mainly reported (22.4% in older patients vs. 19.0% in younger patient) and pharmacists made interventions mostly to adjust dosage (27.3% vs. 24.2%). Physicians' acceptance was significantly lower in older patients (57.1% vs. 64.3%). DRP associated to a drug included a supratherapeutic use of acetaminophen (5.2% vs. 3.8%) and hypnotics (4.0% vs. 1.4%), medication in cardiology used without indication (1.4% vs. 0.2%) and underuse of vitamin D (1.2% vs. 0.1%). Supratherapeutic dosages were more significantly detected with a lower overall physicians' acceptance in older patients treated in general wards., Conclusions: This study highlights the specificity of DRP among older patients and encourages health care professionals to remain especially alert regarding older patients treated in general wards. These findings can contribute to define or adjust training needs and quality indicators to improve the daily practices of health care professionals., (Copyright © 2021 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Domestic violence has numerous consequences on the victims' health. Supporting these victims means firstly being able to recognise the warning signs. Tools exist to facilitate the role of health professionals on the front line to screen for domestic violence and identify with the victims the gravity of their situation. Depending on the risks involved, it is sometimes important to let them make their own enlightened choices to help them regain confidence and independence., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The protection of a healthcare facility means maintaining a permanent approach of alertness for everyone working there. The hospital security plan involves internal and external players (police and emergency services), and requires the regular sharing of information and training., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

It is difficult on a daily basis to reconcile security and freedom, particularly the freedom to come and go of residents in accommodation facilities for dependent elderly people, and more specifically in the protected sector. With the COVID-19 epidemic, everyone experienced the effects of the lack of freedom. This echoed what residents may experience on a daily basis in institutions, where their freedom is often abused. If the effects of confinement are beginning to be studied in the general population, what about the repercussions on residents already weakened by the disease? How did they experience it? The deprivation of freedom acts on our emotions, on our psyche, in different ways. We will certainly have to learn from this period, notably on the importance of feeling free even in an institution., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the safety and efficacy of Cyberknife® (CK) for the treatment of primary or recurring thymic tumours., Materials and Methods: We retrospectively reviewed 12 patients (16 tumour lesions) with primary or recurring thymic tumours who were treated with CK between March 2008 and October 2017. Their data was stored in prospectively collected database. Kaplan-Meier method was used to calculate survival curves., Results: Five patients (41.7%), who had inoperable disease or refused surgery, were treated with CK initially, and 7 patients (58.3%) were treated with CK when they had recurrence diseases. The disease sites treated with CK were primary tumour site (5), regional lymph nodes (4), tumour bed (3), chest wall (2), pleura (1), and bone (1). The median target volume was 43.8 cm 3 (range, 13.1-302.5cm 3 ) for the 16 tumour lesions. The median follow-up time was 69.3 months (range, 9.7-124.8 months). The median survival time was 48.2 months, and the 5-year and 10-year OS rates were 68.2% and 45.5%, respectively. A high response rate for the tumour lesions irradiated with CK was obtained. Only one patient (8%) experienced in-field recurrence, and the 5-year local recurrence free survival was 90.9%. A case indicated that CK may induce the abscopal effect, which provides the potential to combine CK and immunotherapy. No severe radiation related toxicities were observed, and no treatment related death occurred., Conclusion: CK treatment resulted in good outcomes, particularly local control, with minimal side effects, in highly selected patients with primary and recurring thymic tumours. More studies with larger sample are needed., (Copyright © 2020. Published by Elsevier Masson SAS.)

The use of physical, as well as chemical, restraints is subject to a medical prescription. It is a medical decision, most often fortunately made as a team. Responsibilities are involved when it is implemented. It is necessary to know them, as well as it is essential to know the alternatives. A study of the caring perception of restraint of hospitalized patients with neurocognitive disorders and excessive ambulation has been carried out. Thus, an ethical approach would make it possible to adopt a fairer approach taking into account the notions of individual and collective freedom, safety and risk., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

A real organisational challenge for the teams working alongside people being treated for cancer, the continuity of treatment and care has mobilised all those involved in care since the beginning of the COVID-19 epidemic. To ensure the safety of these patients, who are more vulnerable due to their illness, and to ensure that they do not lose any chances against their cancer, the care providers of the Lyon Regional Cancer Centre have innovated and adapted their practices, both in the city and in the hospital., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: The registration of adverse events after the use of immunological veterinary medicinal products (IVMP) is the aim of the vigilance reporting system in Switzerland. Adverse events comprise suspected adverse reactions and lack of expected efficacy. Since the Institute of virology and immunology (IVI) is the competent authority for the regulation of immunological VMP in Switzerland, the reporting system is administrated by the IVI. In 2019, 137 reports concerning authorized immunological VMP were received (15% less compared to 2018). While most of the reports were submitted by the marketing authorization holders (56%), practicing veterinary surgeons contributed to the reporting system, too (40%). This corresponds to an increase of 22% of reported adverse events by the practicing veterinary surgeons compared to the previous year. Private persons (4%) submitted five reports. In comparison to 2018, in 2019 79% of the adverse events were reported by marketing authorization holders and 18% by veterinarians. Dogs (55%) and cats (20%) were mainly affected. Further reports were related to cattle (13%) and horses (5%). Recently, the numbers of reports concerning dogs (+12%) and cats (+4%) have considerably increased. Most of the reports were based on the application of vaccines against canine distemper, hepatitis, parvovirosis and parainfluenza in combination with leptospirosis in dogs as well as cat flu and feline panleukopenia in cats. In 34% of the submitted cases, the causality assessment between the vaccination and the reaction described was evaluated as probable.

Immunotherapy by immune check-points inhibitors (ICIs) recently improved many solid tumors survival data. ICIs target and inhibit down-regulation signals between T cells and tumor cells involved in carcinogenesis, in order to enhance anti-tumor immunity. With few years' hindsight of ICIs utilization in daily practice, we learned about their safety profile. By releasing the brakes of the host immune-system, ICIs exposure leads to on-target off-tumor immune related adverse events (IRAEs). Compared to standard chemotherapiy regimens, IRAEs remain rare, but sometimes serious and compromising treatment continuation, mostly despite objective tumor response. Several immunotherapy molecules are currently developed, with various mechanisms of action but always targeting the immune anti-tumor response. New drugs imply new safety profiles, especially since a lot of ongoing clinical trials are assessing combination of multiples drugs. Consequently, a good knowledge and management of these new toxicities will be essential to choose the new therapeutic schedules in many tumor types. Indeed, despite the actual poor prognosis of concerned tumor types, the progressive outcomes improvement implies long-term exposure to treatments. Safety and quality of life under treatment will become key endpoints for therapeutic decision., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership. Indeed, the writing of the White Book of Cancer gave voice to sick people and stressed the need for new devices, such as the Caregiving Time. Patients can no longer be considered as objects of care but as people whose dignity and autonomy must be imperatively respected. The acquisition of knowledge allows a bilateral exchange, prerequisite of a dynamic collaboration. Patients can be partners in their own care, partners in training and research (expert patient), but also partners in health institutions and policies. It is this notion of partnership and involvement of the person in their path of care in radiation oncology that we will analyse here. It will be about defining it, by developing the concept of autonomy, and bringing out its complexity and ambivalence through two examples from our clinical practice: the shared decision-making process for patients with localized prostate cancer and the patient's involvement in the success of his radiotherapy., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

A child's sleep is constantly changing. Many parents find themselves helpless when faced with children who have difficulty sleeping. Concrete tools can be implemented to help them. The role of caregivers is to accompany these families and to direct them with appropriate advice., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The home is a unique place of practice for caregivers, with specific constraints linked, notably, to the environment. In addition to the well-known risks (infections, moving/lifting patients), the caregiver faces isolation and sometimes difficult emotional, social and environmental situations. The prevention of these situations requires continuing training and improved communication as well as appropriate tools and safety measures., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The ageing of the population leads health professionals to question the tolerance and the effectiveness of the different biotherapies used in autoimmune diseases. Due to the exponential increase of biotherapies and their indications, several studies have been carried out to evaluate their impact on elderly patients suffering from autoimmune disease. However, these studies are still too few to take into account all the different specificities of elderly patients and their comorbidities; prescribers are therefore hesitant with their introduction after 75 years or even 65. More than the age of patients, it is necessary to evaluate the comorbidities before introducing this kind of treatments. Every biotherapy has different indications and contraindications, which must be known to adapt each treatment to each patient. This focus aims to remind of the adaptations and contraindications of the different biological disease-modifying anti-rheumatic drugs for geriatric population, and improve their uses since the treatments for these patients are sometimes not enough. Here we resume the methods allowing supervisors to identify errors of clinical reasoning in medical students and interns and we explain remediation techniques adapted to the types of error identified. Access to short illustrative videos of a MOOC (Massive Open On line Course) devoted to the supervision of clinical reasoning constitutes practical help for supervisors who are not expert in the complexity of medical pedagogy at the bedside., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Background: International guidelines recommend that preoperative coronary angiography is performed on patients at risk of coronary disease who have infective endocarditis requiring surgical treatment. However, the risks of contrast-induced nephropathy or vegetation embolization in case of aortic endocarditis should be considered., Aims: To assess the safety, therapeutic implications and prognostic impact of coronary angiography in patients requiring surgical treatment for active infective endocarditis., Methods: This retrospective monocentric study was conducted in patients referred to a tertiary care centre for active endocarditis management with a theoretical indication for surgery between January 2013 and February 2017., Results: One hundred and ninety-three patients were included; 73.1% were men, the mean age was 61.9±16.3 years and the median EuroSCORE II was 5.8%. One hundred and nineteen patients (61.7%) had aortic endocarditis, which was associated with aortic vegetation in 74 cases (38.3%). Invasive coronary angiography was performed in 142 patients (73.6%) - 130 (91.6%) by radial approach - and 14 patients were evaluated by coronary multislice computed tomography (one patient had exploration with both techniques). Acute renal failure after coronary angiography was observed in 15 patients (10.6%), two patients (1.4%) presented a stroke within 24h after coronary angiography, but none had aortic endocarditis. Among the 178 patients (92.2%) who underwent surgery, 35 (19.7%) had significant coronary lesion(s) and 25 (14.0%) underwent an associated coronary artery bypass graft., Conclusions: Preoperative coronary angiography in patients affected by infective endocarditis provides relevant information in a significant proportion of patients and can be performed safely., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the acceptability and safety of thermal ablation (TA) for the treatment of precancerous cervical lesions in women in Honduras., Methods: Human papillomavirus (HPV) and visual inspection with acetic acid (VIA) screen-positive eligible women received TA. After treatment, women rated the level of pain experienced during treatment using the Wong-Baker FACES® pain-rating scale from 0 to 10. Short-term safety outcomes that could require medical attention were assessed one month after treatment., Results: A total of 319 women received TA treatment. The average pain rating was 2.5 (95% CI: 2.3-2.8), and 85% rated their pain levels as less than 6. No significant differences in low (below 6) or high (6 and above) pain were found by age or number of biopsies performed, but there was a significant difference by the number of TA applications (P < 0.01). When asked if they would recommend this treatment, all women said they would. At the one-month follow-up visit, the most common reported discomforts were bleeding (10%) and cramping (8.4%); 11 women reported severe lower abdominal pain, and none required medical attention., Conclusions: TA is safe and acceptable to patients as a treatment option for precancerous cervical lesions in low-resource settings., (© 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)

Virtual reality is an innovative solution in simulation when it is used to reinforce caregivers' skills. A health facility has set up a continuing professional development programme using this technique. It has enabled caregivers to reinforce their skills in the area of blood transfusion safety., (Copyright © 2019. Published by Elsevier Masson SAS.)

The immunotherapies known as "inhibitors of checkpoint" (ICP) are monoclonal antibodies used since 2010 and have dramatically modified the management of the advanced or metastatic melanomas. By reactivating the anti-tumoral immune response, these antibodies can activate the immune system in all the tissues with a risk to induce immune related adverse events (IrAE). Thus, the adverse effect's profile of ICP is considered as very different from that usually associated with conventional chemotherapies. The objectives of our retrospective monocentric study were the evaluation of the real life's safety and efficiency of the ipilimumab and the pembrolizumab in patients with an advanced melanoma. Seventy-two patients treated by ipilimumab and\or pembrolizumab between August 1st, 2008 and December 31st, 2016 were investigated. The main IrAE occurring involved the gastro- intestinal, skin, and the endocrine systems. The average onset time of IrAE was 39, 104 and 68 days, respectively and their respective duration was of 67, 50 and 111 days. There were 13 events of grade III and IV along with one death. The overall survival was 5 months for the patients treated in monotherapy with ipilimumab, and 14 months for those treated by pembrolizumab. Our real life's study tends to confirm the current safety profile of ICP treatment. Moreover and according to our analyses, the drug sequence seems to have a global survival impact., (Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The registration of adverse events after the use of immunological veterinary medicinal products (VMP) is the aim of the vaccinovigilance reporting system in Switzerland. Adverse events comprise suspected adverse reactions and lack of expected efficacy. Since the Institute of virology and immunology (IVI) is the competent authority for the regulation of immunological VMP in Switzerland, the reporting system is administrated by the IVI. In 2018, 162 reports concerning authorized immunological VMP were received. While most of the reports were submitted by the marketing authorization holders (79%), practicing veterinary surgeons contributed to the reporting system, too (18%). Five reports were submitted by private persons (3%). Dogs were mainly affected (43%) with several terrier breeds and chihuahuas being the most frequently reported dog breeds. Further reports were related to cats (16%), cattle (14%) and horses (14%). Recently, the numbers of reports concerning cats (+26) and horses (+23) have considerably increased after there had been clearly less reports concerning these species (11 and 5, respectively) in the previous year. Most of the reports were based on the application of combined vaccines against canine distemper, hepatitis, parvovirosis and parainfluenza with or without leptospirosis in dogs as well as cat flu and feline panleukopenia in cats. In 29.6% of the submitted cases, the causality assessment between the vaccination and the reaction described was evaluated probable.

Safety of Pharmacotherapy in Emergencies Abstract. Emergency pharmacotherapy is one of the most commonly used medical procedures. At the same time, pharmacotherapy in an emergency is always a potentially dangerous action. Medication errors are even among the most frequently registered errors in medicine. Due to the special circumstances in emergency medicine, special precautions are required to ensure the safety of drug therapy. In addition to the important background information, this article presents procedures that are recognized and applicable in daily routine to increase safety in pharmacotherapy.

Metformin, together with lifestyle intervention, is considered first-line treatment for glycemic management in people with type 2 diabetes. Despite this widespread use, one of the areas of longstanding debate has been whether metformin can be used safely in those with chronic kidney disease (CKD). The concern is the possibility of an increased risk for lactic acidosis resulting from metformin accumulation in those with renal impairment. Options in this patient population are limited, and many believe this risk has been overstated, so several organizations around the world have made recommendations to allow for the cautious use of metformin in patients with CKD. Lalau and colleagues have added new evidence with the publication of 3 complementary studies of the use of metformin in people with CKD stages 3A, 3B or 4-a dose-finding study, a chronic metformin treatment study and a pharmacokinetic study. The authors tested adjusted dosage regimens based on level of CKD. The study demonstrates that although there is a relationship between eGFR and metformin levels, there is not a relationship between metformin levels and plasma lactate. In addition, as long as the metformin dosage was adjusted to the level of CKD, pharmacokinetics remained stable. Based on this new evidence, together with past epidemiologic data and systematic reviews, metformin appears to be a safe option for patients with CKD, assuming that the dosage is adjusted individually. Stopping the drug during acute illness is also imperative to ensure its safe use., (Copyright © 2018 Diabetes Canada. Published by Elsevier Inc. All rights reserved.)

This study examines the safety of time restricted feeding (TRF; 8-h feeding window/16-h fasting window daily) in obese adults. Twenty-three subjects participated in an 8-h TRF intervention for 12 weeks. Self-reported adverse events, body image perception, complete blood count, and disordered eating patterns did not change from baseline to week 12. These findings suggest that consuming food within an 8-h window can safely facilitate weight loss in subjects with obesity.

The inmate is a special patient. Indeed, his status requires a specific organization. The Versailles hospital centre (78) is the reference centre for the Yvelines prison and the women's prison. The majority of interventions for detained patients are performed on an outpatient basis., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The exercise test is still a key examination in cardiology, used for the diagnosis of myocardial ischemia, as well as for the clinical evaluation of other heart diseases. The cardiopulmonary exercise test can further define functional capacity and prognosis for any given cardiac pathology. These new guidelines focus on methods, interpretation and indications for an exercise test or cardiopulmonary exercise test, as summarized below. The safety rules associated with the exercise test must be strictly observed. Interpretation of exercise tests and cardiopulmonary exercise tests must be multivariable. Functional capacity is a strong predictor of all-cause mortality and cardiovascular events. Chest pain, ST-segment changes and an abnormal ST/heart rate index constitute the first findings in favor of myocardial ischemia, mostly related to significant coronary artery disease. Chronotropic incompetence, abnormal heart rate recovery, QRS changes (such as enlargement or axial deviations) and the use of scores (based on the presence of various risk factors) must also be considered in exercise test interpretation for a coronary artery disease diagnosis. Arrhythmias or conduction disorders arising during the exercise test must be considered in the assessment of prognosis, in addition to a decrease or low increase in blood pressure during the exercise phase. When performing a cardiopulmonary exercise test, peak oxygen uptake and the volume of expired gas/carbon dioxide output slope are the two main variables used to evaluate prognosis., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Transfusion has become extremely safe but can still be associated with adverse reactions. Some adverse reactions can be mitigated by applying measures to donor selection, the process of separating blood components as well as hospital-based procedures consisting in matching the donor and the recipient; special attention is given to optimizing the best fit between the component and the beneficiary, which is not only an immuno-hematological challenge (fresh versus old blood, testing for certain viruses such as CMV, parvovirus B19, etc.). Considerable progress has also been achieved to strengthen the overall quality and safety of the whole transfusion chain. Guidelines and recommendations have resulted in substantial progress, and the recent revisiting of patients as part of a more holistic approach has enabled blood management programs to be created. Such programs, when wisely applied in a context of optimal blood use, reinforce patient safety; they enhance hospital recognition of transfusion and hemovigilance specialists as useful players acting in the interests of patients in full compliance with hospital budgets. This review considers the step-by-step processes that reinforce transfusion safety and identifies hurdles that cannot yet be properly addressed; it proposes steps for further progress, in light of personalized medicine., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The practice of restraint in geriatric care leads caregivers to examine their own practice. It is a matter of respecting the elderly patient while assuring their safety and being true to one's professional values. Reflecting on the issue collectively as a team is a potential strategy for providing the best possible response. This article analyses some examples at Grenoble-Alpes University hospital., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Certification Process of a Hospital at Home Facility: The certification visit by the French National Health Authority requires a high level of commitment and collaboration on the part of the teams of the healthcare facility concerned. Professionals from a hospital at home unit having obtained its Level A certification describe the process and explain how the approach helped to give meaning to collective action when caring for patients in their home., (Copyright © 2018. Published by Elsevier Masson SAS.)

PROGRAMME FOR THE CONTINUOUS IMPROVEMENT OF TEAM WORK TO IMPROVE THE SAFETY OF PATIENT CARE.: The analysis of the causes of care-related adverse events shows that in order to improve safety, human and organisational factors must be taken into account, and action taken to target team work. Based on this observation, the French National Health Authority designed and tested with volunteer teams the Programme for the Continuous Improvement of Team Work, between 2013 and 2016. This programme provides professionals with a series of tools and methods to improve they way they work in a team. Eventually, the implementation of the programme will be a requirement for the certification of healthcare facilities., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The National Policy of Care Quality and Safety Indicators: Care quality and safety indicators, piloted by the national health authority, are tools forming part of a global programme of improvement of quality and safety of care. The national scheme for measuring the quality and safety of care provides, for all healthcare facilities, dashboards for managing care quality and safety. Currently focused on the public and private hospital sector, it needs to evolve to widen its scope to include community care and the medical-social sector., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Since the late sixties, platelet concentrates are transfused to patients presenting with severe thrombocytopenia, platelet function defects, injuries, or undergoing surgery, to prevent the risk of bleeding or to treat actual hemorrhage. Current practices differ according to the country or even in different hospitals and teams. Although crucial advances have been made during the last decades, questions and debates still arise about the right doses to transfuse, the use of prophylactic or therapeutic strategies, the nature and quality of PC, the storage conditions, the monitoring of transfusion efficacy and the microbiological and immunological safety of platelet transfusion. Finally, new challenges are emerging with potential new platelet products, including cold stored or in vitro produced platelets. The most debated of these points are reviewed., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit / risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices., (Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Safety in health care is permanently influenced by national and local policies. Since twenty years, number of methodologies and tools inspired from industry, have been implemented to reduce adverse events. Those tools managed to reduce adverse event impact but errors still occur on hospitals and they are difficult to contain. Given the low evolution of the results regarding patient care safety, it seemed important to question other dimensions such as leadership in safety even if the meaning of the word "leadership" is still unknown in almost all hospital organizations. This research analyses the bibliography to identify useful leadership for patient care safety. In order to improve safety results in healthcare, the perception of patient care safety and leadership were studied by using a specifically amended safety culture survey amended. Results prove that the level of leadership employed influences the caregiver's safety perception. Furthermore, the most effective leadership is not the one currently used in hospitals, but rather a leadership with liberated characteristics. Finally, proposals are made to change the leadership characteristics used with the view to improve safety perception of caregiver's., (Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)