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Background: Interprofessional relationships between general practitioners (GPs) and dental surgeons with a doctorate in dental surgery are essential for the optimal management of the oral health of patients. The objectives of this study were to describe the factors associated with the referral of patients from GPs to dental surgeons in France, and to improve referral practices by establishing a standardized set of items to be included in a referral letter. Methods: A nationwide, observational, survey-based, cross-sectional study was conducted from 9 February 2023 to 6 April 2023. Two 13-item questionnaires were sent to GPs and dental surgeons. Data on practitioner characteristics, frequency, and perceived usefulness of medical correspondence between the two healthcare professionals were collected. Candidate items selected by expert medical opinion for a standardized referral letter template were appraised by the responding oral surgeons. Results: A group of 245 dental surgeons (mean age: 38.2 ± 11.1 years, 64.5% female) and 235 GPs (mean age: 36.8 ± 9.8 years, 71.9% female) participated in this study. Medical correspondence between GPs and dental surgeons was reported to be insufficient by most dental surgeons (91.4%). Dental surgeons agreed that GP correspondence could decrease the occurrence of adverse events linked with dental care (mean score: 7.36 ± 2.4, for a maximum of 10). Only 20% of GPs indicated that they had regular communication with dental surgeons. The physician characteristics under study were not statistically associated with initiating referrals. The items most frequently selected by dental surgeons for inclusion in a template referral letter were the presence of diabetes (99.6%), of immunosuppression (98.8%), and medication by anticoagulant or antiplatelet agents (98.3%). Conclusions: Despite known links between oral and general health, most healthcare professionals did not engage in correspondence or referrals with the other specialty. Standardized referral letters could include the list of items for which interest was confirmed by dental surgeons (including presence of diabetes, immunosuppressants and anticoagulants or antiplatelet agents). [ABSTRACT FROM AUTHOR]

Background: Delays in detection and treatment of breast cancer can lead to increased mortality. To date, participation in organized breast cancer screenings (OBCS) has been suboptimal worldwide. The objective of this study was to investigate the factors associated with deferral or non‐performance of mammography during the COVID‐19 pandemic for women who had previously participated in OBCS. Methods: A retrospective observational study was conducted on a cohort of 6282 women from the Aube Department of France, who were invited to an OBCS in 2020. Participants were divided into women who promptly underwent screening after receiving an invitation (between 22 and 25 months elapsed since the last mammogram), women who underwent late screening (≥26 months since the last mammogram), and those who were never screened. Data were collected from a self‐reported questionnaire. Comparative and multivariable analyses modeling the probability of each type of attendance were performed using these data. Results: In total, 2301 women (aged 50–74 years) returned a valid questionnaire. Compared to women who promptly underwent mammography, non‐ and late‐screening participants were younger, had less frequent gynecological follow‐up and a less frequent history of colorectal cancer screening. Women with higher education status and those residing in socially disadvantaged areas were more likely to attend late. Conclusion: The absence of regular gynecological follow‐up and the absence of colorectal cancer screening were significant factors associated with deferral of or non‐attendance at OBCS. [ABSTRACT FROM AUTHOR]

A new law was voted in France in 2016 to increase cooperation between public sector hospitals. Hospitals were encouraged to work under the leadership of local referral centers and to share their support functions (e.g., information systems) with newly created hospital groups, called "Regional Hospital Groups." The law made it compulsory for each public sector hospital to become affiliated with one of 136 newly created hospital groups. The policy's aim was to ensure that all patients were sent to the hospital best qualified to treat their unique condition, among the hospitals available at the regional level. Therefore, we aimed to assess whether this regionalization policy was associated with changes in observed patterns of patient mobility between hospitals. This nationwide observational study followed an interrupted time series design. For each stay occurring from 2014 to 2019, we ascertained whether or not the stay was followed by mobility toward another hospital within 90 days, and whether or not the receiving hospital was part of the same Regional Hospital Group as the sender hospital. The proportion of mobility directed toward the same regional hospital group increased from 22.9% in 2014 (95% CI 22.7–23.1) to 24.6% in 2019 (95% CI 24.4–24.8). However, the absence of discontinuity during the policy change year was consistent with the hypothesis of a preexisting trend toward regionalization. Therefore, the policy did not achieve major changes in patterns of mobility between hospitals. Other objectives of the reform, including long-term consequences on the healthcare offer, remain to be assessed. [ABSTRACT FROM AUTHOR]

Objective: Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis. Methods: We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics), and psychopathological data (psychiatric comorbidities, dissociation, and alexithymia) through psychiatric interviews and standardized scales. Clusters were identified by the Partitioning Around Medoids method. The similarity of patients was computed using Gower distance. The clusters were compared using analysis of variance, chi‐squared, or Fisher exact tests. Results: Three patient clusters were identified in this exploratory, hypothesis‐generating study and named on the basis of their most prominent characteristics: A "No/Single Trauma" group (31.4%), with more male patients, intellectual disabilities, and nonhyperkinetic seizures, and a low level of psychopathology;A "Cumulative Lifetime Traumas" group (42.6%), with clear female predominance, hyperkinetic seizures, relatively common comorbid epilepsy, and a high level of psychopathology; andA "Childhood Traumas" group (26%), commonly with comorbid epilepsy, history of childhood sexual abuse (75%), and posttraumatic stress disorder, but also with a high level of anxiety and dissociation. Significance: Although our cluster analysis was undertaken without any a priori hypothesis, the nature of the trauma history emerged as the most important differentiator between three common FDS disorder subtypes. This subdifferentiation of FDS disorders may facilitate the development of more specific therapeutic programs for each patient profile. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians' perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management. Methods: This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis. Results: Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14–115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07–38.51) were both significantly associated with an overall satisfaction with the management of the crisis. Conclusion: This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information. [ABSTRACT FROM AUTHOR]

Background: In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The objective of this study was to analyze the impact of opening new on-demand care services based on variations in patient flow at a large hospital emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube region in eastern France, that focused on ED attendance at Troyes Hospital. A hierarchical clustering based on co-occurrence of diagnoses was applied which divided the population into different multimorbidity profiles. Temporal trends of the resultant clusters were also studied empirically and using regression models. A multivariate logistic regression model was constructed to adjust the periodic effect for appropriate confounders and therefore confirm its presence. Results: In total, 120,722 visits to the ED were recorded over a 24-month period (2018–2019) and 16 clusters were identified, accounting for 94.76% of all visits. There was a decrease of 56.77 visits per week in seven specific clusters and an increase of use of unscheduled health care services by 328.12 visits per week. Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the ED, these findings may help inform public health policy experts on the implementation of unscheduled care services to ease pressure on hospital EDs. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES. Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the DSM-5 criteria of traumatic events and PTSD to define TES and PS-PTSD. We assessed all traumatic life events unrelated to epilepsy, general and specific psychiatric comorbidities, and quality of life. Results: Nearly half (n = 48) of the 107 participants reported at least one TES (44.85%). Among these, one-third (n = 16) developed PS-PTSD. The TES group was more likely to experience traumatic events unrelated to epilepsy (p < 0.001), to have generalized anxiety disorder (p = 0.019), and to have specific psychiatric comorbidities [e.g., interictal dysphoric disorder (p = 0.024) or anticipatory anxiety of seizures (p = 0.005)]. They reported a severe impact of epilepsy on their life (p = 0.01). The determining factors of TES according to the multifactorial model were the experience of trauma (p = 0.008), a history of at least one psychiatric disorder (p = 0.03), and a strong tendency toward dissociation (p = 0.03). Significance: Epileptic seizures may be a traumatic experience in some patients who suffer from pharmacoresistant epilepsy and may be the source of the development of PS-PTSD. Previous trauma unrelated to epilepsy and psychiatric history are determining factors of TES. These clinical entities should be explored systematically. [ABSTRACT FROM AUTHOR]

Introduction: Anti-glomerular basement membrane (GBM) antibodies are pathogenic antibodies first detected in renal-limited anti-GBM disease and in Goodpasture disease, the latter characterized by rapidly progressive crescentic glomerulonephritis combined with intra-alveolar hemorrhage. Studies have suggested that anti-GBM antibody positivity may be of interest in lupus nephritis (LN). Moreover, severe anti-GBM vasculitis cases in patients with systemic lupus erythematosus (SLE) have been described in the literature, but few studies have assessed the incidence of anti-GBM antibodies in SLE patients. Objective: The main study objective was to determine if positive anti-GBM antibodies were present in the serum of SLE patients with or without proliferative renal damage and compared to a healthy control group. Methodology: This retrospective study was performed on SLE patients' sera from a Franco-German European biobank, developed between 2011 and 2014, from 17 hospital centers in the Haut-Rhin region. Patients were selected according to their renal involvement, and matched by age and gender. The serum from healthy voluntary blood donors was also tested. Anti-GBM were screened by fluorescence enzyme immunoassay (FEIA), and then by indirect immunofluorescence (IIF) in case of low reactivity detection (titer >6 U/ml). Results: The cohort was composed of 100 SLE patients with proliferative LN (27% with class III, 67% with class IV, and 6% with class V), compared to 100 SLE patients without LN and 100 controls. Patients were mostly Caucasian and met the ACR 1997 criteria and/or the SLICC 2012 criteria. Among the 300 tested sera, no significant levels of anti-GBM antibodies were detected (>10 U/ml) by the automated technique, three sera were found "ambivalent" (>7 U/ml): one in the SLE with LN group and two in the SLE without LN group. Subsequent IIF assays did not detect anti-GBM antibodies. Conclusion: Anti-GBM antibodies were not detected in the serum of Caucasian patients with SLE, even in case of renal involvement, a situation favoring the antigenic exposure of glomerular basement membranes. Our results reaffirm the central role of anti-GBM antibodies as a specific diagnostic biomarker for Goodpasture vasculitis and therefore confirm that anti-GBM antibody must not be carried out in patients with SLE (with or without LN) in the absence of disease-suggestive symptoms. [ABSTRACT FROM AUTHOR]

Objectives We aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators. Design Adjusted before-after analysis. Setting A large hospital in the Champagne-Ardenne region, France. Participants Patients admitted to the ED between 13 January 2015 and 13 January 2017. Intervention Implementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016). Primary and secondary outcome measures Proportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions. Results The ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before-after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before- after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%. Conclusions The implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery is used to treat severe obesity. We aimed to investigate the incidence of clinically significant bone mineral density (BMD) loss at 6 and 12 months after bariatric surgery. Methods: Observational study performed in a specialized center for the treatment of obesity at the University Hospital of Reims, France. Surface BMD was measured by dual x-ray absorptiometry (DEXA). A reduction of > 0.03 g/cm2 was considered clinically significant. Results: A total of 110 patients were included. A clinically significant reduction in BMD was observed in 62.1% of patients at 6 months, and in 71.6% at 12 months after surgery. No case of osteoporosis was observed. There were four cases of osteopenia and one fracture post-surgery. BMD loss was related by univariate analysis to the reduction in body mass index (BMI) (p < 0.01), weight loss (p < 0.01), fat mass (p < 0.01), and lean mass (p < 0.01). Multivariable analysis found a significant association between the reduction in BMD and the excess weight loss percentage (odds ratio 1.11, 95% confidence interval (1.05–1.18), p < 0.001). Conclusion: There was a clinically significant reduction in BMD at 6 months after surgery in over 60% of patients undergoing bariatric surgery. BMD loss is persistent over time and predominantly situated at the femoral level, and strongly associated with weight loss. Systematic vitamin and calcium supplementation, as well as follow-up by DEXA scan seems appropriate. Systematic DEXA scan pre- and post-surgery, and annually thereafter until weight has stabilized seems appropriate. [ABSTRACT FROM AUTHOR]

The article offers information about the telemedicine in nursing homes during the Covid-19 outbreak. It discusses the implementing non-pharmaceutical interventions to slow the spread of disease. It mentions the presence of comorbid conditions worsens prognosis and leads to increased mortality, along with information on the role of remote consultations in protecting healthcare workers from unnecessary exposure to disease.

Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches. [ABSTRACT FROM AUTHOR]

Background: The palliative care unit is an emotionally challenging place where patients and their families may feel at loss. Art can allow the expression of complex feelings. We aimed to examine how cancer patients hospitalized in the palliative care unit experienced a musical intervention. Methods: We conducted a qualitative study based on semi-structured interviews. The study took place in a palliative care unit from 18 January 2017 to 17 May 2017. Two artists performed in the palliative care unit once a week from 9:30 am to 5:30 pm. The data from patient interviews were analysed based on an inductive approach to the verbatim accounts. Results: The accounts we gathered led us to weigh the positive emotions engendered by this musical intervention against the potential difficulties encountered. The artists opened a parenthesis in the care process and brought joy and well-being to the palliative care unit. Patients also encountered difficulties during the intervention: reference to an altered general state, to loss of autonomy; a sense of the effort required, of fatigue; an adaptation period; reference to the end of life, to death; a difficulty in choosing songs. Conclusions: Although music appeared to benefit the patients, it sometimes reminded them of their altered state. The difficulties experienced by patients during the experience were also related to physical exhaustion. Additional studies are needed to determine the benefits of music for patients and their families in the palliative care unit. [ABSTRACT FROM AUTHOR]

Introduction: Waiting rooms in general practitioners' (GP) surgeries are a potentially useful site for spreading educational messages about health behaviors. We aimed to evaluate the impact of posters displayed in GPs' waiting rooms on the number of donors attending the blood donation drives in the Aube Department of France. The secondary objective was to identify self-reported factors that incited people to give blood among donors who did and donors who did not see the posters., Methods: Observational, multicenter, prospective study, from 1 June to 31 December 2021. Six blood donation centers in the Aube Department were selected. All GPs located within a 15 km radius around each center were invited to participate by hanging posters advertising blood drives in their waiting rooms. The number of blood donations per hour was measured before and during the campaign. Factors prompting people to give blood were evaluated by questionnaires completed by persons attending the blood drives., Results: 33 GPs participated. The number of donations per hour was lower in the year in which the posters were displayed (2021) compared to the previous year (12 vs. 15). A total of 1,469 questionnaires were completed by blood donors: 729 reported having seen the posters, and 740 reported not having seen the posters. Those who claimed to have seen the posters were more likely than those who claimed not to have seen the posters to respond that in parallel, they had been prompted to give blood via online publicity (7.5 vs. 3.9%, adjusted Odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.12-2.82, p = 0.02). They also more often reported that they had been prompted to donate by television advertisements (8.0 vs. 4.2%, aOR 1.74, 95%CI 1.10-2.76, p = 0.02). Overall, 68% of all respondents indicated that posters in the GP's waiting room would incite them to give blood more often., Conclusion: The number of blood donations per hour was lower during the year in which posters were displayed. Questionnaire data from donors suggests that promoting blood donation via posters in GPs' waiting rooms could have a positive effect: 68% of donors claimed that posters would incite them to give blood., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Renaux, Bouazzi, Sanchez, Hottois, Martin, Chrusciel and Sanchez.)

Aim: The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes., Methods: Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident., Results: In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention., Conclusion: This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.

Elastic compressions are standard treatment for leg ulcers of venous etiology. The effect of compressions on ulcers of mixed (arterial or venous) etiology, however, has rarely been studied. The objective of this study was to evaluate the variation in transcutaneous oxygen pressure (TcPO2) in patients with ulcers of mixed arterial or venous etiology treated with 1 month of compression. This prospective cohort study was conducted at a university hospital in France. Patient eligibility was for those attending a consultation of a work-up of a leg ulcer of mixed arterial-venous etiology lasting at least 4 to 6 weeks. Compressions were prescribed according to the hemodynamic status and were evaluated by the ankle-brachial index and toe-brachial index using a decision-making algorithm based on French national guidelines. Quality of life was assessed using the Short-Form 36-Item (SF-36) questionnaire. In total, 32 patients were included between September 30, 2018 and May 31, 2019. A difference was observed between TcPO2 before compression (49.3 ± 13.01 mm Hg) and after 1 month (51.2 ± 15.05 mm Hg), average change 1.9 ± 2.04 mm Hg ( p  = 0.025). The average ulcer size prior to compression was 49 ± 102 cm 2 versus 37 ± 94 cm 2 after 1 month of effective compression, corresponding to a reduction of 12 ± 8 cm 2 ( p  < 0.001). There was a reduction in the bodily pain dimension of the SF-36. Compressions adapted to the hemodynamic status led to an increase in TcPO2, a reduction in wound size, and an improvement to bodily pain in patients with leg ulcers of mixed arterial-venous etiology., Competing Interests: Conflict of Interest The authors declare that they do not have conflicts of interest regarding this study., (International College of Angiology. This article is published by Thieme.)

Objectives: Previous studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care., Methods: We performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life., Results: Among the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001)., Conclusion: More studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care., Ethics Approval: The study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l'Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)